Months In India Research Articles

Regional patterns in minimum diet diversity failure and associated factors among children aged 6-23 months in India.

Background About 35% of the global child deaths and 11% of the total disease burden are due to inadequate nutrition. While in India, 1 in 3 children are underweight and stunted, and 1 in 5 children are wasted. Methods Using multivariate and descriptive statistical analysis, we examined the prevalence, determinants of minimum diet diversity failure (MDDF) and trends of MDDF across different regions of India among children aged 6-23 months. Dietary pattern in 8 food groups was also examined using the National Family and Health Survey (NFHS) data from 2005-06 to 2019-21. Results Overall, MDDF in India has decreased from 87.4% (2005-06) to 77.1% (2019-21). The central region (84.6%) reported the highest prevalence of MDDF in 2019-21. Children of illiterate and rural residing mothers with no mass media exposure, children of the first birth order and children not exposed to counselling and health check-ups at Anganwadi/Integrated Child Development Services (ICDS) centres, children with low birth weight and anaemic, and who belonged to a large family had greater likelihood for MDDF. Conclusion To tackle the high prevalence of MDDF, a holistic action is needed from the government, i.e. improved public distribution system (PDS), intensified Integrated Child Development Scheme (ICDS) programme, use of social media, and nutrition counselling through local self-governance.

Trends and predictors of severe and moderate anaemia among children aged 6–59 months in India: an analysis of three rounds of National Family Health Survey (NFHS) data

BackgroundChildhood anaemia remains a significant public health problem in India, as it adversely affects child development and overall health outcomes. This study aimed to analyse the prevalence of severe and moderate anaemia among children aged 6–59 months and identify consistent predictors of this condition over the past 15 years.MethodsData from the three most recent rounds of the NFHS were used for this analysis. The final weighted sample included 40,331 children from the NFHS-3 (2005–2006), 200,093 from the NFHS-4 (2015–2016), and 178,909 from the NFHS-5 (2019–2021). Descriptive and bivariate analyses were conducted, followed by binary logistic regression to identify factors associated with severe and moderate anaemia in children aged 6–59 months. All statistical analyses were performed using Stata version 14.ResultsOver the past 15 years, the prevalence of severe and moderate anaemia among children in India has shown a slight decline. However, the influence of various predictors has changed over time. Young children (aged 6–23 months), those from Scheduled Caste (SC) and Scheduled Tribe (ST) communities, and children born to mothers with high parity and low educational attainment remain particularly vulnerable to anaemia. Additionally, short-term illness significantly increases the risk of anaemia. Furthermore, women’s autonomy, indicated by higher education and lower fertility rates, along with maternal nutrition education, have emerged as key factors in reducing anaemia burden in the future. Notably, children whose mothers had no education were 1.4 times more likely to suffer from severe or moderate anaemia. Similarly, children born to mothers with four to five children (OR 1.1, p < 0.05) and those with six or more children (OR 1.2, p < 0.05) had an elevated risk of anaemia.ConclusionThe findings highlight three key areas for programmatic focus to accelerate anaemia reduction in India: [1] targeting young children (aged 6–23 months); [2] ensuring the inclusion of SC and ST communities in all relevant interventions; and [3] promoting women’s autonomy. These strategies are essential for reducing the burden of anaemia across the country.

Retinoblastoma - A comprehensive review, update and recent advances.

Retinoblastoma is the most common pediatric ocular malignancy. It is triggered by a biallelic mutation in the RB1 gene or MYCN oncogene amplification. Retinoblastomas can be unilateral (60%-70%) or bilateral (30%-40%); bilateral tumors are always heritable and present at an earlier age as compared to unilateral ones (18-24 months vs. 36 months in India). High prevalence rates, delayed presentation, and inaccessibility to healthcare lead to worse outcomes in developing countries. The past few decades have seen a paradigm change in the treatment of retinoblastomas, shifting from enucleation and external beam radiotherapy to less aggressive modalities for eye salvage. Multimodality treatment is now the standard of care and includes intraarterial or intravenous chemotherapy along with focal consolidation therapies such as transpupillary thermotherapy, cryotherapy, and laser photocoagulation. Intravitreal and intracameral chemotherapy can help in controlling intraocular seeds. Advanced extraocular or metastatic tumors still have a poor prognosis. Genetic testing, counseling, and screening of at-risk family members must be incorporated as essential parts of management. A better understanding of the genetics and molecular basis of retinoblastoma has opened up the path for potential targeted therapy in the future. Novel recent advances such as liquid biopsy, prenatal diagnosis, prognostic biomarkers, tylectomy, and chemoplaque point to promising future directions.

Associated factors of child wasting among children aged 0 – 23 months in India: Analysis of the National Family Health Survey-5

The enduringly high prevalence of child wasting (weight-for-height-2SD) in India is a significant cause for concern. The objective of this study is to identify areas with high incidence of wasting among children aged 0 &amp;ndash; 23 months and to uncover the factors influencing wasting among young children in India. The analysis utilized individual and district-level data from the National Family Health Survey-5 in 2019 &amp;ndash; 2021. The wasting prevalence exceeding 30% was found in 81 districts, with 501 districts surpassing 15%. Our analysis indicated that children from the poorest households (adjusted odds ratio [AOR] = 1.60, 95% confidence interval [CI] = 1.43 &amp;ndash; 1.79), those lacking access to improved sanitation facilities (AOR = 1.18, 95% CI = 1.11 &amp;ndash; 1.25), belonging to other backward class families (AOR =1.12, 95% CI = 1.04 &amp;ndash; 1.20), and born to mothers with body mass index (BMI) &lt;18.5 (AOR = 1.30, 95% CI = 1.23 &amp;ndash; 1.37) faced higher odds of wasting. In addition, low birth weight (&lt;2500 g) increased the odds of wasting by 27% (AOR = 1.27, 95% CI = 1.20 &amp;ndash; 1.36). The study further found that a minimum acceptable diet and female gender had protective effects on wasting among children aged 6 &amp;ndash; 23 months. These findings underscore the need for a comprehensive programmatic response to addressing wasting in young children. Urgent policies and programmatic actions are warranted, with a specific focus on strengthening the care of low birth weight and premature babies, as well as promoting optimal child feeding practices. There is a call for intensified nutrition services as an integral component of routine health services for mothers. Early identification and management of wasting and counseling during pre-conception and pregnancy should be prioritized.

Prevalence and predictors of minimum acceptable diet (MAD) feeding among tribal children aged 6–23 months in India

ABSTRACT Minimum acceptable diet (MAD) that combines minimum dietary diversity (MDD) and minimum meal frequency (MMF) is one of the eight core indicators for assessing infant and young child feeding (IYCF) practices for children aged 6–23 months. With low MAD, young children and infants are more susceptible to undernutrition. The study assesses the prevalence and predictors of MAD among tribal children aged 6–23 months in India. Descriptive, bivariate, and multivariate analyzes were performed on data from 6326 tribal children of the National Family Health Survey (2019–21). Stata was used for the analyzes, with a 5% significance level. Only 12% of tribal children were fed with a MAD, while 24% had MDD and 34% MMF. Children aged 18–23 months had a three times higher chance of MAD than their 6–8 months counterparts. Children receiving Integrated Child Development Services (ICDS), children of mothers with ten or more years of schooling, children whose mothers were exposed to mass media, and whose mothers had 4+ antenatal care visits in their last pregnancy had a higher likelihood of MAD. The study concludes that MAD among tribal children aged 6–23 months is unsatisfactory and varies significantly by socio-demographic characteristics, suggesting targeted intervention.

Prevalence and determinants of anemia due to micronutrient deficiencies among children aged 12-59 months in India-Evidence from Comprehensive National Nutrition Survey, 2016-18.

The present study aimed to estimate the prevalence of anemia, and anemia with micronutrient deficiencies (iron/ vitamin B12/ folic acid) and their determinants among children aged 12-59 months in India. Comprehensive National Nutritional Survey (2016-2018) is Asia's largest nutrition survey conducted among 0-19 years aged children in India. We used generalised linear model (modified Poisson) with adjusted prevalence ratio (aPR) to assess the socio-economic and biochemical factors associated with anemia and anemia with micronutrient deficiencies amongst children aged 12 to 59 months. Out of the total of 11,237 children included in the study, 40.5% (95%CI:38·6-42·6) were anemic, 30.0% (95%CI:27·8-32·4) had anemia with micronutrient deficiencies and 60.9% (95%CI:58·2-63·5) had micronutrient deficiencies with or without anemia. Younger age (aPR(95%CI) for one year old: 1.9(1.5-2.4), two year old: 1.8(1.5-2.2), three year old: 1.4(1.2-1.7) compared to four year old children) and lower educational status of the mother (mothers without formal schooling aPR(95%CI):1.4(1.1-1.8); 1-9 standards: 1.4(1.2-1.7)) vs mother educated with high school and above, consumption of less than 100 iron-folic acid tablets during pregnancy (aPR(95%CI):1.3(1.0-1.7) vs consumption of ≥ 180 tablets, any self-reported illness among children within two weeks preceding the interview (aPR(95%CI):1.2(1.1-1.4) vs no-illnesses, iron deficiency (aPR(95%CI):2.2(2.0-2.6)) and zinc deficiency (aPR(95%CI):1.3(1.1-1.4)) were associated with anemia in children. Among anemic, the children from scheduled tribe (aPR(95%CI):1.4(1.1-1.8)) vs other caste categories, and those following unsafe child faeces disposal practices (aPR(95%CI):1.2(1.0-1.4)) vs those who follow safe faeces disposal practices had higher chance of having micronutrient deficiency. One third of children aged 12-59 months had anemia with micronutrient deficiency (iron/ folic acid/ vitamin B12). More than half of children had micronutrient deficiencies irrespective of anemia. Micronutrient deficiencies, antenatal IFA intake, safe hygiene practices need to be strengthened to leave no stone unturned in control of anemia among under-five children in India.

Food texture experiences across nine age groups in Indian infants from urban areas.

The introduction of complementary food plays a fundamental role in dietary behaviours later in life. Little is known about the influences of age on food texture acceptance in young Indian children. Thus, the objective of this cross-sectional study was to describe the relationship between age and food texture experiences in young children aged 4-36 months in India from urban areas using a parental-reported survey. This study relies on a face-to-face parent survey, which was conducted comprising 306 children categorised into 9 age groups. Questions focussed on food texture experience considering 16 textures were analysed. Textures such as dissolvable, sticky, and soupy/liquidy were already accepted by more than half of 4-5-month-old infants. In India, soupy/liquidy is a more common base texture than pureed. Indeed, pureed was found to be introduced to a majority of infants only from 8 to 9 months onwards. Food textures such as rubbery, slippery, and foods with skin were more likely rejected by the youngest children. With increasing age, the refusal probability of food textures decreased. Our survey showed food texture experiences in Indian children aged from 4 to 36 months. It provides useful insights for parents and healthcare professionals by contributing to the understanding of texture acceptance during the transition to complementary foods.

Determinants of the First Birth Interval Among Women in India.

The first-birth interval after a marriage indicates the reproduction behavior of women and influences the population's birth rates and size. The present study assesses predictors of the interval between marriage and first childbirth in India. The study employed the Cox proportional hazard model and Kaplan Meier Survival plot based on the data collected from 79,787 ever-married women in the 15-49 age group from the National Family Health Survey 2019-2021. The median age of marriage to the first birth interval was 23 months in India. The older marriage cohort had longer birth intervals than the younger. The hazard ratios (HR) showed that the risk of first birth after marriage was much higher among women with higher education (HR= 2.05, 95% confidence interval (CI) = 1.98-2.11) than women without education. Women in urban areas (HR=1.22, 95% CI = 1.20-1.25) had a higher risk of first birth after marriage earlier than women from rural areas. Women from North-east (HR=1.14, 95% CI=1.10-1.18) and South (HR=1.15, 95% CI=1.12-1.19) had a higher risk of having their first birth earlier after marriage than women in the North region. The women who married within 18-24 years of age had a 69 percent higher likelihood of first birth interval than those women who were married below the age of 18. The risk of first birth after marriage increased as women delayed marriage up to age 25 years and more (HR=3.18, 95% CI=3.02-3.35) than others. The timing of first birth was associated with the age at the first marital union, women's educational attainment, place of residence, region, economic status, exposure to mass media, contraception use, and history of pregnancy termination.

Mathematical Model for COVID-19 pandemic with implementation of intervention strategies and Cost-Effectiveness Analysis

In this study, a novel mathematical model for the dissemination dynamics of COVID-19 is developed. The main objective is to analyze the effectiveness of pharmaceutical interventions in lowering the COVID-19 contagions. We first demonstrate the positivity and boundedness of the solutions of the model and then compute the fundamental reproduction number. The stability analysis of contagion-free equilibrium is performed. The model is fitted to the COVID-19 reported data for a period of twelve months in India and estimate three parameters. The sensitivity analysis is conducted to identify the significant factors which impact the COVID-19 disease prevalence. We then define an optimum control problem using pharmaceutical interventions vaccination and treatment as the control functions to minimize the dissemination of COVID-19 contagions and disease-related mortality. Cost-effectiveness analysis is employed to determine the most effective and least costly strategy. The results are determined that the combination of vaccination and treatment is the most effective and least costly strategy in mitigating the spread of COVID-19 contagions. Furthermore, the impact of different levels of vaccine efficacy on contagion trajectories is examined, and it is shown that COVID-19 contagions and disease related fatalities would decrease as vaccination efficacy increases. The outcomes would assist administrators in developing efficient strategies to reduce the scope of the COVID-19 pandemic.

The Indian REgistry on Current Patient PrOfiles and TReatment TrenDs in Hypertension (RECORD): Final Outcomes of the Real-world Observational Study.

Objectives: The Indian Registry on Current Patient Profiles and Treatment Trends in Hypertension (Record) evaluated the current trends and outcomes related to hypertension (HTN) management at 3, 6, 12, and 24 months in India. This study highlights and evaluates the outcomes and trends noted at 24 months. Materials and methods: The detailed study methodology is provided in the earlier publication (interim analysis at 12 months). Aspects such as changes in the quality of life (QOL), percentage of patients reaching target blood pressure (BP), treatment pattern among patients with comorbid conditions, and difference in treatment patterns between public and private healthcare settings, at 24 months, were evaluated in the current study. Results: The study population included 2,000 patients (55.7% males) with a mean age of 54.45 years. Telmisartan (43.7%) and amlodipine + telmisartan (16.4%) were the most prescribed monotherapy and combination therapy among patients with newly diagnosed HTN. A significant decrease in both systolic BP (SBP) and diastolic BP (DBP) was noted in the overall patient population at 24 months (p < 0.001). The mean change in SBP and DBP was slightly higher at 24 months compared to 12 months. This was more evident among patients on combination therapy. A significant improvement in QOL was noted at 24 months. Conclusion: Treatment strategies in HTN management are changing and are associated with effective HTN control and improvements in QOL. However, there is a further need for improved awareness regarding the optimal usage of combination therapy for better management of uncontrolled HTN. How to cite this article: Rajadhyaksha GC, Reddy H, Singh AK, et al. The Indian REgistry on Current Patient PrOfiles and TReatment TrenDs in Hypertension (RECORD): Final Outcomes of the Real-World Observational Study. J Assoc Physicians India 2023;71(11):43-49.

Case Report: Tropical sprue, diagnostic challenges of an old but unrecognized disease

Tropical sprue (TS) is a post-infective disease of the small bowel characterized by a malabsorption syndrome affecting tropics inhabitants and visitors. Diagnosis of TS remain challenging since it can be confused with common diarrheal diseases, especially in non-endemic areas. We report a Tunisian case of latent TS. A 58-year-old male with a history of chronic watery diarrhea, was admitted to the intensive care unit for confusion which was related to dehydration[J1] . Despite the neurological improvement after hydro-electrolytic resuscitation and acid-base disorders correction, the patient continued to have three to five loose stools daily. A nutritional assessment showed a malabsorption syndrome: iron, Vitamin B12 and folate deficiencies; normochromic normocytic anemia and hypoalbuminemia. Gastrointestinal endoscopy showed duodenal villous atrophy and biopsy confirmed subtotal villous atrophy with increased intraepithelial lymphocytosis and a thickened hyalinized [J2] sub-epithelial basal lamina. Celiac disease was evoked, however the patient did not improve on a gluten-free diet and the celiac serology was negative. On re-interviewing, we discovered that the patient had spent two months in India three years prior. Given the travel history, clinico-biological and histological data TS was highly considered and a good response to a five-month antibiotic course combined to nutritional supplementation supported this diagnosis. Clinico-biological, endoscopic and histological findings were overlapping between TS and other malabsorption diseases, explaining diagnosis difficulties. TS should be systematically discussed in tropics visitors presenting with chronic diarrhea. Improvement after micronutrient and vitamin deficiencies replacement combined to a prolonged antibiotic course supports the diagnosis of TS. [J

Influence of socio-demographic and environmental factors on child mortality in India

Background: According to National Family Health Survey (NFHS) report (round 5), under five child mortality rate is 42 per 1000 live births which is far behind the sustainable development goal and National Health Policy, 2017. This research work aims to investigate the socio-demographic and environmental risk factors associated with child mortality between age 0-59 months in India. Methods: To analyse the objective of this study secondary data of NFHS round 5 are used. NFHS is a large scale, multi-rounds survey conducted by ministry of Health and Family Welfare (MoHFW) with the collaboration of International Institute for Population Sciences (IIPS), Mumbai. Cox regression model is used for the statistical analysis and the data analysis work is carried out using R software. Results: The research found that mortality rate is higher among mother’s age less than 20 years and mother’s having no education. In rural areas mortality rate is high compared to urban residence. Birth order of child more than 6 has 2.0966 times higher risk to die and the male child is more likely die than the female. Children born to family having richest wealth index (HR=0.6550, CI: 0.5856-0.7327) has the least mortality rate. Use of polluting cooking fuel and unimproved sanitation facility increase death risk on under-five mortality 1.1334 times and 1.0905 times respectively. Conclusions: The study found a strong influence of socio-demographic and environmental factors on child mortality under the age of five.

AI-driven real-time patient identification for randomized controlled trials.

e13565 Background: In India, clinical trial recruitment is a challenging process, often relying on the time- and labor-intensive process of investigators reviewing handwritten charts to identify potential candidates. We developed an AI-driven, real-time solution to address this issue and demonstrated its feasibility by identifying patients that would have been candidates for a 2017-2018 study of metastatic breast cancer (mBC) patients who failed prior chemotherapy. The original trial recruited 46 patients across 16 sites over 7 months in India. Methods: The study protocol was reviewed and applied to six years (2017-2022) of retrospective electronic medical records (EMR) data from a cancer hospital in India’s National Capital Region. Trial inclusion and exclusion criteria were translated to data elements which were extracted from both structured (e.g., lab) and unstructured (e.g., clinical notes) EMR data. For the unstructured data specifically, natural language processing algorithms were developed and implemented over the span of three weeks to extract the specific data elements. The veracity of the extracted data was confirmed via manual review by an oncologist. To assess the sensitivity of the results to the study criteria and provide a range of the potential candidate population size, the criteria were applied in two ways – as a strict application (e.g., ECOG must be reported and must be &lt; = 2) and as a relaxed application (e.g., ECOG may be unreported or, if reported, must be &lt; = 2). Results: Among the initial cohort of 112,239 females between 18 and 65 years of age, 3,203 (3%) were identified as having mBC and failure of prior chemotherapy or relapse. 537 patients remained after applying all inclusion criteria (ECOG status &lt; = 2, LVEF &gt; = 50%, no prior radiotherapy, prior chemo completed 4+ weeks prior, adequate bone marrow, renal, and hepatic function). Exclusion criteria (prior taxane exposure, 2+ prior chemotherapies, cardiac conditions, CNS lesions, motor/sensory neurotoxicities, HBV/HCV/HIV infection) were then applied, resulting in 37 patients that would be potential candidates for the trial, per the strict application of criteria. The relaxed version of the analysis yielded a candidate pool that was five times larger than the strict application, which was largely driven by cases where information was unavailable in the EMR. Conclusions: We demonstrated that the use of an AI-driven platform to apply clinical trial criteria to Indian real-world data can provide an efficient solution to identifying candidate trial patients. Once the criteria are defined and algorithms are developed, patient identification can happen in real time and reduce patient recruitment timelines by months. Future applications will include other cancer types and expand the breadth of data elements extracted to enable the rapid assessment of additional inclusion and exclusion criteria.

Vaccination inequities among children 12–23 months in India: An analysis of inter-state differences

BackgroundPrevious research has shown that socioeconomic and demographic risk factors in children are additive and lead to increasingly negative impacts on vaccination coverage. The goal of this study is to examine if different combinations of four risk factors (infant sex, birth order, maternal education level, and family wealth status) vary by state among children 12–23 months in India and to determine the impact of ≥ 1 risk factor on differences in state vaccination rates. MethodsUsing data from the National Family Health Survey (NFHS) conducted in India between 2005 and 2006 (NFHS-3) and 2015–2016 (NFHS-4), full vaccination of children 12–23 months was examined. Full vaccination was defined as receipt of one dose of bacillus Calmette–Guérin (BCG), three doses of diphtheria-pertussis-tetanus vaccine (DPT) vaccine, three doses of oral polio vaccine (OPV), and one dose of measles-containing vaccine (MCV). Associations between full vaccination and the four risk factors were assessed using logistic regression. Data were analyzed by the state of residence. ResultsA total of 60.9% of children 12–23 months were fully vaccinated, in NFHS-4, ranging from 33.9% in Arunachal Pradesh to 91.3% in Punjab. In NFHS-4, the odds of full vaccination across all states were 15% lower among infants with 2 risk factors versus 0 or 1 risk factors (OR: 0.85, 95% CI: 0.80–0.91), and 28% lower among infants with 3 or 4 risk factors versus 0 or 1 risk factor (OR: 0.72, 95% CI: 0.67–0.78). Overall, the absolute difference in the full vaccination coverage in those with > 2 vs < 2 risk factors decreased from −13% in NFHS-3 to −5.6% in NFHS-4, with substantial variation across states. ConclusionsDisparities in full vaccination exist among children 12–23 months experiencing > 1 risk factor. Indian states that are more populous or located in the north were more likely to have greater disparities.

Inequality in time to first antenatal care visits and its predictors among pregnant women in India: an evidence from national family health survey

For countries with high maternal mortality and morbidity, on-time initiation of antenatal care (ANC) is indispensable. Therefore this paper aims for studying the median survival time (MST) of first ANC among pregnant women as well as understanding the contextual factors that influence a mother’s decision to access ANC services in India. The study used cross-sectional survey data obtained from the NFHS-4 conducted in 2015–2016. The MST of the timing of the first ANC visit was estimated using the Kaplan-Meir estimate. A multivariate Cox-proportional hazard regression model was used to identify the factors related to the timing of the first ANC visit with a 95% confidence interval (CI). Overall at least one ANC checkup was assessed by 60.15% of women and the median survival time for the first ANC checkup was found to be 4 months. Early initiation of ANC in pregnant women increased by 37% (AHR: 1.37, CI:1.34–1.39) for primary education, and 88% (AHR:1.88, CI:1.86–1.90) for secondary education compared to women having no formal education. Results of the current study revealed that the median survival time of the first ANC visit was 4 months in India which is delayed compared to recommendations of WHO. Therefore boosting the access and utilization of antenatal care coverage among pregnant women can ensure the best health outcomes for their pregnancy.

An Equity Analysis of Zero-Dose Children in India Using the National Family Health Survey Data: Status, Challenges, and Next Steps.

Background While immunization programs across the world have made considerable progress, children and communities continue to be beyond the reach of healthcare services. Globally, they are now referred to as zero-dose (ZD) children (those who have not received a single dose of diphtheria, pertussis, and tetanus-containing vaccine). Pre-COVID-19 pandemic analyses suggest that nearly 50% of vaccine-preventable deaths occur among ZD children. Two-thirds of these children live in extremely poor households suffering from multiple deprivations including lack of access to reproductive health services, water, and sanitation. Hence, ZD childrenhave now been prioritized as a key cohort for identification and integration with the health systems as we build back from the pandemic. Methodology Extracting data from the last two National Family Health Survey (NFHS) rounds (NFHS 4, 2015-2016 and NFHS 5, 2019-2021), this study aims to ascertain the status of ZD children aged 12-23 months in India, the challenges, and the necessary action agenda going forward. Data were analyzed for equity determinants such as gender, place of residence, religion, birth order, caste, and mother's schooling. Key determinants included the change in ZD prevalence at the national, state, and district levels; variations across equity parameters and states with maximum improvements; and disparity across these indicators. A correlation analysis was also conducted to understand the nature of the association between ZD prevalence and critical maternal and child health indicators. Results The overall ZD prevalence between the two rounds was reduced by 4.1% (10.5-6.4%). A total of 26 states in the country reported a ZD prevalence of <10% in NFHS 5 compared to 18 in NFHS 4. In total, 324 districts reported a ZD prevalence of <5%, and 145 districts reported a prevalence of >10%. The equity parameters reflected a slow-footed reduction among ZD for girl children, across urban geographies, firstborn children, mothers with 12 or more years of schooling, and children in families with the highest wealth quintiles. A negative correlation accentuated between the two NFHS rounds was established between first-trimester registration, four or more antenatal visits, institutional deliveries, and ZD prevalence. Conclusions The findings point toward sustained improvement across key equity parameters, however, challenges do exist. Moreover, the impact of the pandemic on immunization programs across the globe and in India is bound to halt and reverse the progress and potentiate further inequities. It is thus imperative that continued and augmented efforts are continued to identify, integrate, and immunize ZD children, families, and communities.

Effects of Dietary Diversity on Growth Outcomes of Children Aged 6 to 23 Months in India: Evidence from National Family and Health Survey.

Low dietary diversity significantly interplays with children's growth failure. However, evidence of its crucial role in children's health remains inconclusive in developing countries such as India. This study attempts to find the association between dietary diversity and growth outcomes among children aged between 6 and 23 months in India using the fourth round of the National Family Health Survey (NFHS), 2015-2016. A total of 67,278 mother-child pairs of children between the ages of 6-23 months and mothers aged 15-49 years were included in this study. Pearson's chi-square significance test and multivariable logistic regression were used to determine the association between dietary diversity and child growth outcomes (stunted, wasted, and underweight). The study found that the prevalence of stunting and severe stunting among children aged between 6 and 23 months were 35.9% and 16.2%; 23.8% and 8.5% represented wasting, and severe wasting; and more than 32%, 10% were underweight and severely underweight respectively. This present study found that having an inadequate minimum dietary diversity (&lt;4 food groups) significantly increases the risk of being stunted (adjusted odds ratio (AOR) = 1.29; 95% confidence interval (CI); 1.21-1.38), wasted (AOR = 1.29; 95% CI; 1.21-1.38), and underweight (AOR = 1.47; 95% CI; 1.39-1.56). Further, it was noted that children who did not intake dairy products, eggs, and other fruits and vegetables were more likely to be stunted, wasted, and underweight and more likely to be severely stunted, wasted, and underweight. Therefore, additional nutrition-specific interventions are urgently needed to strengthen and enhance existing feeding interventions aimed at improving infant and young child feeding (IYCF) practices, including complementary feeding practices among children aged between 6 and 23 months in India. The Government should focus such interventions more on states or regions where the prevalence of adequate minimum dietary diversity (MDD) and malnutrition is high.

Change in Socioeconomic Inequality in Minimum Dietary Diversity among Children Aged 6–23 Months in India: Evidence from National Family Health Survey

Change in Socioeconomic Inequality in Minimum Dietary Diversity among Children Aged 6–23 Months in India: Evidence from National Family Health Survey

Factors associated with suboptimal complementary feeding practices among mothers of infants and young children in India.

To examine the current complementary feeding practices among infants and young children aged 6 to 23 months in India, and factors influencing these practices at child, parental, household and community levels. Data on 74,095 last-born children aged 6 to 23 months used in this study were obtained from the 2015 India Demographic and Health Survey (IDHS). Complementary feeding indicators (timely introduction of complementary foods to infants aged 6 to 8 months old, minimum meal frequency, minimum dietary diversity, and minimum acceptable diets) were estimated, and their associated factors were identified using descriptive and multivariate (logistic regression) analyses. The prevalence of the timely introduction of complementary foods to infants aged 6 to 8 months was 45.1%. The proportion of children between ages 6 to 23 months who received the minimum meal frequency, minimum dietary diversity and minimum acceptable diets were 36%, 21% and 9.1%, respectively. Findings from the multivariate analyses revealed that mothers of infants delivered at home, mothers who had no antenatal check-up, mothers who are Hindus, mothers living in rural areas or those from the Western/Northern geographical regions of India were at higher risk of suboptimal complementary feeding practices.

Post Covid-19 Acute Invasive Fungal Rhinosinusitis (AIFR): A Study of Histopathological Findings After FESS in Radiologically Diagnosed AIFR.

COVID-19 pandemic has led to a concerning surge of post-COVID-19 AIFR. Mucormycosis (BLACK fungus) is a rare but severe and life-threatening fungal infection occurred by mucormycetes, a family of moulds. More than 49,000 cases of AIFR were reported in three months in India. It primarily affects diabetics and spreads from the nasal cavity and paranasal sinuses (PNS). It also involves eye, palate, or brain. It is diagnosed clinically followed by radiological and pathological findings. We aimed to compare and analyse the pre-operative imaging with postoperative histopathological findings. The study was conducted in ENT department of tertiary care hospital, Rajkot. 200 patients were randomly selected who were presented to ENT OPD with clinically suspected Post COVID-19 AIFR. All patients underwent detailed ENT examination and radiological modality like MRI PNS, Brain, and Orbit. After proper pre-op evaluation, all patients underwent Functional Endoscopic Sinus Surgery (FESS). MRI findings were confirmed with that of histopathological findings done on KOH mount. All the patients were showing AIFR on MRI findings whereas 49% of patients had mucormycosis on Histopathology. Various other fungal infections like aspergillosis (7%), candidiasis (1.5%) were also found on HPE. 9% of patients showed combined infection with mucor and aspergillus species. Rest of the patients showed non-fungal rhinosinusitis. Inflow of the epidemic, plenty of patients were shown invasive fungal sinusitis in MRI patterns whereas many of them were HPE negative. Thus this study was done to know the efficacy of radiological features with pathological diagnosis. We have considered both procedures standard in our study.