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OBJECTIVES: There is a high prevalence of anaemia in individuals living in rural India, which may be modified by a number of environmental factors. The association between access to water, toileting facilities and healthcare services with the prevalence of anaemia was explored to determine potentially modifiable community-level risk factors. STUDY DESIGN: This was a cross-sectional survey. METHODS: Data were collected from adolescent females (aged 13-17 years) living in 34 villages in rural areas of the Maharashtra state of India on measures of sanitation facilities and access to health care along with haemoglobin measurements. Linear and logistic regression analyses were conducted to investigate associations between environmental (community) factors and adolescent haemoglobin levels and anaemia, respectively. RESULTS: Data were available from 1010 individuals, which represented a response rate of over 97% of those who were approached for the study. The prevalence of anaemia was very high (87%) when measured using haemoglobin levels. Access to a piped water supply was associated with 0.59 g/dL of increase in haemoglobin levels (95% confidence interval: 0.10-1.09). Associations between access to communal toilets, travel time to the hospital, health centres or nurses and haemoglobin levels or anaemia were not statistically significant. CONCLUSIONS: Anaemia prevalence was very high in our study population. Simple improvements such as provision of regular piped water is associated with an increase in haemoglobin levels in rural Indian females. These are consistent with the hypothesis that chronic exposure to higher levels of microbes in the living environment contributes to the risk of anaemia.

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OBJECTIVE: This study tested the hypothesis that systemic inflammation is inversely associated with haemoglobin levels in adolescent girls in India. METHODS: The study population consisted of adolescent girls aged between 10 and 19 years living in a remote rural region in Maharashtra State, India. Data were collected on anthropometric measures, and a venous blood sample was taken and tested for complete blood count and C-reactive protein (CRP). RESULTS: Of 679 individuals who were invited to the research site to participate, data were available from 401 participants giving a response rate of 59%. Median blood CRP was 1.26 mg/l (Range 0.00 to 26.33), and 167 (41.6%) participants had CRP level < 1.0 mg/l. The mean haemoglobin was 12.24 g/dl (standard deviation [SD] 1.51), and the mean total white blood cells (WBC) count was 9.02 × 103 /µl (SD 2.00). With each g/dl increase in blood haemoglobin, the risk of having an elevated CRP of ≥ 1 mg/l increased with an odds ratio of 1.16 (95% CI 1.01 to 1.33, P = 0.03). Total WBC count was also positively associated with blood haemoglobin, increasing by 0.24 × 103 /µl (95% CI 0.11 to 0.37, P < 0.001) per g/dl increase in haemoglobin. Both analyses were adjusted for age. CONCLUSIONS: In this population, blood haemoglobin levels were positively associated with two measures of systemic inflammation, contrary to the primary hypothesis being tested. Other unmeasured environmental exposures may modify haemoglobin levels in this population. Understanding this observation may help design better public health interventions to improve the well-being of adolescent girls in India.

OBJECTIF: Cette étude a testé l'hypothèse selon laquelle l'inflammation systémique est inversement associée aux taux d'hémoglobine chez les adolescentes en Inde. MÉTHODES: La population étudiée était composée d'adolescentes âgées de 10 à 19 ans vivant dans une région rurale éloignée de l'Etat du Maharashtra, en Inde. Les données ont été collectées sur des mesures anthropométriques et un échantillon de sang veineux a été prélevé et testé pour la formule globulaire complète et la protéine C-réactive (CRP). RÉSULTATS: Sur 679 personnes qui ont été invitées au site de recherche à participer, des données étaient disponibles pour 401 participantes, soit un taux de réponse de 59%. La CRP sanguine médiane était de 1,26 mg/L (intervalle de 0,00 à 26,33) et 167 participantes (41,6%) avaient un taux de CRP <1,0 mg/L. L'hémoglobine moyenne était de 12,24 g/dL (écart-type [ET] 1,51), et le nombre moyen total de globules blancs (GB) était de 9,02 x103 /µL (ET 2,00). Avec chaque augmentation par g/dL de l'hémoglobine sanguine, le risque d'avoir une CRP élevée ≥1 mg/L augmentait avec un rapport de cotes de 1,16 (IC95%: 1,01 à 1,33, p = 0,03). La numération totale des GB était également positivement associée à l'hémoglobine sanguine, augmentant de 0,24 x103 /µL (IC95%: 0,11 à 0,37, p <0,001) par g/dL d'augmentation de l'hémoglobine. Les deux analyses ont été ajustées en fonction de l'âge. CONCLUSIONS: Dans cette population, les taux d'hémoglobine sanguine étaient positivement associés à deux mesures de l'inflammation systémique, contrairement à l'hypothèse principale testée. D'autres expositions environnementales non mesurées peuvent modifier les taux d'hémoglobine dans cette population. Comprendre cette observation peut aider à concevoir de meilleures interventions de santé publique pour améliorer le bien-être des adolescentes en Inde.

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OBJECTIVES: The objective of this study is to conduct a systematic review to summarise currently implemented interventions, investigating their effectiveness in reducing alcohol use and sexual risk taking behaviour in teenagers and young adults. STUDY DESIGN: This is a systematic review. METHODS: Studies published in English language with both alcohol and sexual risky behaviour reduction interventions were searched using five electronic database platforms. All review tasks such as study screening, selection, data extraction, quality rating and synthesis were performed in accordance with systematic review guidelines. RESULTS: The review included 18 studies. Fifteen studies were randomised control trials (RCTs), whereas three were interventional studies having pre-intervention and postintervention analysis. Overall study duration ranged from 6 months to 24 months. The retention rate decreased with an increase in study duration and ranged from 60% to 80% for majority of studies, whereas some studies particularly planned for a shorter period had a higher retention rate (≥90%). The study site showed a range of patterns (in schools/college = 5, at family level/home environment = 3, web based = 2, sexual health clinics = 2, mental health clinics = 1, community level = 1 and juvenile detention facility = 4). The study quality assessment showed that most studies were of medium to high quality. Evidence from this systematic review suggests that after interventions, young people are less likely to engage in risky sexual behaviour and choose harmful alcohol drinking. The major factors influencing individuals during adolescence and early adulthood include local cultural norms, acceptability of casual sex and binge drinking trends in the teenage and young communities. It was also observed that study setting and target population determine the type of intervention required and impacts on outcomes. CONCLUSIONS: This review suggests that interventions to reduce risky sexual behaviour and alcohol consumption work in teenagers and young adults. However, selection of appropriate intervention type/design, delivery methods and follow-up plans are key elements to ensure both uptake and success of such intervention projects.

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The co-existence of different types of medical systems (medical pluralism) is a typical feature of India's healthcare system. For conditions such as influenza-like illness (ILI), where non-specific disease signs/symptoms exist, clinical reasoning in the context of medical pluralism becomes crucial. Recognising this need, we undertook a qualitative study, which explored factors underpinning clinical decisions on diagnosis and management of ILI. The study involved semi-structured interviews including clinical vignettes with 20 healthcare practitioners (working within allopathy, homeopathy and Ayurveda) working in the private healthcare sector in Solapur city, India. An inquiry was conducted into criteria influencing the diagnosis, treatment, referral to specialist care and role of treatment guidelines for ILI. Thematic analysis was used to identify aspects relating to ILI diagnosis, treatment and referral. The diagnosis of influenza was based largely on clinical symptoms suggestive of influenza in the absence of other diagnoses. Referral for laboratory tests was only initiated if illness did not resolve, generally after 2-3 consultations. Antibiotics were often prescribed for persistent illness, with antivirals rarely considered. Some differences between practitioners from different medical systems were observed in relation to treatment and referral in case of persistent illness. A combination of analytical and intuitive clinical reasoning was used by the participants and clinical decisions were based on both social and clinical factors. Clinical decision-making was rarely a linear process and respondents felt that broad guidelines on influenza that allowed doctors to account for the sociocultural context within which they practised medicine would be helpful.

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OBJECTIVE: The aim of this prospective study was to estimate the prevalence and risk factors for maternal anaemia and low birth weight (LBW) in pregnant women living in Maharashtra state, India. STUDY DESIGN: This is a prospective study. METHODS: Women between 3 and 5 months of pregnancy were recruited from 34 villages based in Maharashtra state. Baseline data collection, anthropometric measurements and blood investigations were performed. Participants were followed-up to record birth weight. RESULTS: In total, 303 women were eligible, and 287 (95%) provided data. 77% were anaemic, defined as haemoglobin less than 11.0 g/dl at the time of recruitment, with a mean corpuscular volume of 80.5 fl/cell (standard deviation: 7.22, range: 53.4-93.8). The increased risk of anaemia was seen in women with consanguineous marriages (odds ratio [OR]: 2.41, 95% confidence interval [CI]: 1.16-5.01, P = 0.01) after adjustment for potential confounding factors. Postdelivery data from full-term singleton live births demonstrated a 7% prevalence of LBW. Consanguineous marriage was a major risk factor for LBW (OR: 4.10, 95% CI: 1.25-13.41, P = 0.02). The presence of maternal anaemia during 3-5 months of pregnancy was associated with lower risk of LBW (unadjusted OR: 0.34, 95% CI: 0.13-0.92, P = 0.03). CONCLUSION: About 30% of our study participants were in a consanguineous marriage, which was identified as a potentially avoidable risk factor for both anaemia and LBW.

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Exposure to air pollution produced by cooking is common in developing countries, and represents a potentially avoidable cause of lung disease. Cross-sectional data were collected by the World Health Organization's Study on Global AGEing and Adult Health conducted in India between 2007 and 2010. Exposure to biomass cooking was also associated with a decrease in forced expiratory volume in 1 s (FEV1) (-70 ml, 95%CI -111 to -30) and FEV1/FVC (forced vital capacity) ratio (-0.025, 95%CI -0.035 to -0.015) compared to those who were not exposed. These associations were predominantly observed in males (P < 0.05 for interaction analyses). Intervention studies using non-biomass fuels in India are required to ascertain potential respiratory health benefits.

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OBJECTIVE: Iron-deficiency anaemia (IDA) is the most common nutritional disorder observed in adolescent girls in India. Our aim was to investigate the prevalence and risk factors associated with IDA in rural Maharashtra, India, to address current evidence gaps. STUDY DESIGN: Cross-sectional survey. METHODS: The study recruited 13- to 17-year-old adolescent girls living in 34 villages of Osmanabad district. Data were collected on individual health, dietary, sociodemographic factors, and anthropometric measurements were taken. Haemoglobin (Hb) levels were measured using Sahli's haemometer. Logistic and linear regressions were used to identify risk factors associated with IDA and Hb levels, respectively. RESULTS: Among 1010 adolescent girls (response rate 97.5%), the mean Hb was 10.1 g/dl (standard deviation = 1.3), and 87% had anaemia (Hb < 12 g/dl). The prevalence of mild (11.0-11.9 g/dl), moderate (8.0-10.9 g/dl) and severe (Hb ≤ 7.9 g/dl) anaemia was 17%, 65% and 5%, respectively. Anaemia likelihood increased significantly with age (odds ratio (OR): 1.41 per year, 95% confidence interval (CI): 1.17-1.70). Factors associated with decreased anaemia risk were mid-upper arm circumference (MUAC) ≥22 cm (OR: 0.51, 95% CI: 0.31-0.82), ≥3 days/week consumption of fruit (OR: 0.35, 95% CI: 0.23-0.54) or rice (OR: 0.39, 95% CI: 0.17-0.91), and incomplete schooling (OR: 0.47, 95% CI: 0.24-0.91). In the final model lower age, MUAC and fruit consumption were significantly associated with Hb level. CONCLUSION: Anaemia prevalence was extremely high among adolescent girls in rural areas of Maharashtra. Whilst we identified risk factors that could be used for targeting interventions, there is urgent need of comprehensive preventative interventions for the whole adolescent girl population.

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Medical Nutrition Education (MNE) has been identified as an area with potential public health impact. Despite countries having distinctive education systems, barriers and facilitators to effective MNE are consistent across borders, demanding a common platform to initiate global programmes. A shared approach to supporting greater MNE is ideal to support countries to work together. In an effort to initiate this process, the Need for Nutrition Education/Innovation Programme group, in association with their strategic partners, hosted the inaugural International Summit on Medical Nutrition Education and Research on August 8, 2015 in Cambridge, UK. Speakers from the UK, the USA, Canada, Australia, New Zealand, Italy, and India provided insights into their respective countries including their education systems, inherent challenges, and potential solutions across two main themes: (1) Medical Nutrition Education, focused on best practice examples in competencies and assessment; and (2) Medical Nutrition Research, discussing how to translate nutrition research into education opportunities. The Summit identified shared needs across regions, showcased examples of transferrable strategies and identified opportunities for collaboration in nutrition education for healthcare (including medical) professionals. These proceedings highlight the key messages presented at the Summit and showcase opportunities for working together towards a common goal of improvement in MNE to improve public health at large.

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