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AbstractEconomic progress in India over the past three decades has not been accompanied by a commensurate improvement in the nutritional status of children, and a disproportionate burden of undernutrition is still focused on socioeconomically disadvantaged populations in the poorest regions. This study examined the nutritional status of children under 3 years of age using data from the fourth round of Indian National Family Health Survey conducted in 2015–2016. Child undernutrition was assessed in a sample of 126,431 under-3 children using the anthropometric indices of stunting, underweight and wasting ('anthropometric failure') across 640 districts, 5489 primary sampling units and 35 states/UTs of India. Descriptive statistics were used to examine the regional pattern of childhood undernutrition. Multilevel logistic regression models were fitted to examine the adjusted effect of social group (tribal vs non-tribal) and economic, demographic and contextual factors on the risks of stunting, underweight and wasting accounting for the hierarchical nature of the data. Interaction effects were estimated to model the joint effects of socioeconomic position (household wealth, maternal education, urban/rural residence and geographical region) and social group (tribal vs non-tribal) with the likelihood of anthropometric failure among children. The burden of childhood undernutrition was found to vary starkly across social, economic, demographic and contextual factors. Interaction effects demonstrated that tribal children from economically poorer households, with less-educated mothers, residing in rural areas and living in the Central region of India had elevated odds of anthropometric deprivation than other tribal children. The one-size-fits-all approach to tackling undernutrition in tribal children may not be efficient and could be counterproductive.

BACKGROUND: In India,due to manpower constraints, patients' family members are often actively involved in healthcare activities of their near and dear ones. They have significant contact with the patient at all the 5 moments for hand hygiene (HH) as listed by WHO. At our tertiary care hospital in north India, we have been monitoring HH compliance (HHC) for nearly a decade. In this study, we analyzed the impact of decade long awareness campaigns to improve HH compliance in our patients' attendants. METHODS: Trained infection control nurses directly observed the compliance to hand hygiene at each of the five moments for patients' attendants over different areas of the hospital over a period of 5 years (January 2014–December 2018). Compliance was calculated as percentage of events over total opportunities and compared. RESULTS: 7290 opportunities were observed with an overall compliance of 46.3%. The overall HHC in patient attendants has increased from 35.5% in 2014 to 48.2% in 2018 (P < 0.0001). Compliance at WHO moment 1, 2, 3, 4 and 5 was 51.2%, 47.8%, 67.8%, 48.9% and 24.4% respectively. Among family members, mothers of newborn babies had a much higher HHC (77%) than others (44.7%) (P < 0.0001). Also, the compliance was higher in medical vs. surgical wards and pediatric wards vs. adult wards (P < 0.0001 in both). CONCLUSION: This is the first study about family members' HHC in a hospital setting in a low and middle-income country. Once trained, family members exhibit fairly good hand hygiene compliance while involved in healthcare activities of their patients. Mothers of newborn babies exhibit exemplary hand hygiene compliance while caring for their babies in our hospital. It is worthwhile empowering and educating patient attendants about the importance and process of hand hygiene as it is likely to result in immense benefit for patients. [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.

AbstractIncreasing body of health planning and policy research focused upon unravelling the fundamental drivers of population health and nutrition inequities, such as wealth status, educational status, caste/ethnicity, gender, place of residence, and geographical context, that often interact to produce health inequalities. However, very few studies have employed intersectional framework to explicitly demonstrate how intersecting dimensions of privilege, power, and resources form the burden of anthropometric failures of children among low-and-middle income countries including India. Data on 2,15,554 sampled children below 5 years of age from the National Family Health Survey 2015-2016 were analysed. This study employed intersectional approach to examine caste group inequalities in the anthropometric failure (i.e. moderate stunting, severe stunting, moderate underweight, severe underweight, moderate wasting, severe wasting) among children in India. Descriptive statistics and multinomial logistic regression models were fitted to investigate the heterogeneities in the burden of anthropometric failure across demographic, socioeconomic and contextual factors. Interaction effects were estimated to model the joint effects of socioeconomic position (household wealth, maternal education, urban/rural residence and geographical region) and caste groups with the likelihood of anthropometric failure among children.More than half of under-5 children suffered from anthropometric failure in India. Net of the demographic and socioeconomic characteristics, children from the disadvantageous caste groups whose mother were illiterate, belonged to economically poor households, resided in the rural areas, and coming from the central and eastern regions experienced disproportionately higher risk of anthropometric failure than their counterparts in India. Concerted policy processes must recognize the existing heterogeneities between and within population groups to improve the precision targeting of the beneficiary and enhance the efficiency of the nutritional program among under-5 children, particularly for the historically marginalized caste groups in India.

Objective: India has seen a rapid rise in COVID-19 cases. Examine spatiotemporal variation of COVID-19 burden Tracker across Indian states and union territories using SMAART RAPID Tracker. Method: We used SMAART RAPID Tracker to visually display COVID-19 spread in space and time across various states and UTs of India. Data gathered from publicly available government information sources. Data analysis on COVID-19 conducted from March 1 2020 to October 1 2020. Variables recorded include COVID-19 cases and fatality, 7-day average change, recovery rate, labs and tests. Spatial and temporal trends of COVID-19 spread across Indian states and UTs is presented. Result: The total number of COVID-19 cases were 63, 12,584 and total fatality was 86,821 (October 1 2020). More than 85,000 new cases of COVID-19 were reported. There were 1,867 total COVID-19 labs throughout India. More than half of them were Government labs. The total number of COVID-19 tests was 76,717,728 and total recovered COVID-19 cases was 5,273,201. Results show an overall decline in the 7-day average change of new COVID-19 cases and new COVID-19 fatality. States such as Maharashtra, Chandigarh, Puducherry, Goa, Karnataka and Andhra Pradesh continue to have high COVID-19 infectivity rate. Discussion: Findings highlight need for both national guidelines combined with state specific recommendations to help manage the spread of COVD-19. Conclusion: The heterogeneity represented in India in terms of its geography and various population groups highlight the need of state specific approach to monitor and combat the ongoing pandemic. This would further facilitate the tailored approach for each state to mitigate and contain the spread of the disease.

34 p. ; In the Potyvirus genus, the P1 protein is the first N-terminal product processed from the viral polyprotein, followed by HCPro. In silencing suppression patch assays we found that Potato virus Y (PVY) HCPro expressed from a P1-HCPro sequence increased the accumulation of a reporter gene, whereas protein expressed from an HCPro sequence did not, even with P1 supplied in trans. This enhancing effect of P1 had been noticed in other potyviruses, but remained unexplained. We analyzed the accumulation of PVY HCPro in infiltrated tissue and found it higher when expressed from P1-HCPro than from HCPro sequences. Co-expression of heterologous suppressors increased the steady-state level of mRNA expressed from the HCPro sequence, but not that of protein. This suggested that in the absence of P1 upstream, either HCPro acquired a conformation that affected negatively its activity or stability, or that its translation was reduced. To test these options, we purified HCPro expressed in the presence or absence of upstream P1, and found no differences in purification patterns and final soluble states. By contrast, alteration of the Kozak context in the HCPro mRNA sequence to favor translation increased partially both suppressor accumulation and activity. Furthermore, it was as active as protein expressed from P1-HCPro sequences. Thus, a direct role for P1 on HCPro suppressor activity or stability by influencing its conformation during translation can be excluded. However, P1 could still have an indirect effect favoring HCPro accumulation. Our data highlight the relevance of cis-acting translational elements in the heterologous expression of HCPro. ; This work was supported by grant AGL2008-03482 from the Spanish Ministry of Innovation and Science and by a joint grant between the Spanish Ministry of Economy and Competitivity (AC1/2009-0855) to T. Canto and the Department of Science and Technology of the Government of India (DST/INT/SPAIN/P-9/2009) to S. Praveen. N. Sahana was funded by a grant from the Indian Agricultural Research Institute, New Delhi ; Peer reviewed

BACKGROUND: The Government of Madhya Pradesh employed Indoor Residual Spraying (IRS) with alpha-cypermethrin synthetic pyrethroids in sub-centres with Annual Parasite Incidence (API) from 2 to 4.99. In sub-centres with API more than 5, Long-Lasting Insecticidal Nets (LLINs) were distributed. At the request of the State Government, the Malaria Elimination Demonstration Project (MEDP) staff observed and provided support to both IRS and LLINs campaigns. In the year 2017, the study team monitored only the IRS campaigns, however, in the year 2018, the supportive supervision was provided to the IRS campaign teams along with post-distribution monitoring of the LLINs. METHODS: The study was carried out during IRS spraying using a pre-tested, closed-ended monitoring checklist which consisted of two parts- observations of spraying team and observation of sprayed houses. For LLINs, a sample of the households that received the bed nets was taken for the study. For IRS, the spraying teams were monitored for quality and technique for a total of 159 times in 2017 and 183 times in the year 2018, respectively. For post spraying observations, a total of 1261 and 1791 households were observed in the years 2017 and 2018, respectively. The use of LLINs was observed in 5 % of the households in 2018 and 2020, which is about 2,000 houses in each survey where each house received about 2.5 LLINs per household. The results of surveys were compared to assess impact of supportive supervision and monitoring. RESULTS: Significant improvement was noted after supportive supervision in year 2018 in various aspects of spraying. Preparedness of spraying, such as advance information to villagers, presence of equipment and records improved by up to 70 %. The methodology of spraying preparation improved from 50 to 90 %, spraying technique improved from 54 to 80 %, and proper use equipment during spraying improved from 51 to 92 %. After eight months post distribution of the LLINs in 2019, improvement was seen in regular usage of LLINs by 28 %. It was ...

BACKGROUND: Malaria Elimination Demonstration Project (MEDP) was started as a Public-Private-Partnership between the Indian Council of Medical Research through National Institute of Research in Tribal Health, Govt. of Madhya Pradesh and Foundation of Disease Elimination and Control of India, which is a Corporate Social Responsibility (CSR) initiative of the Sun Pharmaceutical Industries Limited. The project's goal was to demonstrate that malaria can be eliminated from a high malaria endemic district along with prevention of re-establishment of malaria and to develop a model for malaria elimination using the lessons learned and knowledge acquired from the demonstration project. METHODS: The project employed tested protocols of robust surveillance, case management, vector control, and capacity building through continuous evaluation and training. The model was developed using the learnings from the operational plan, surveillance and case management, monitoring and feedback, entomological investigations and vector control, IEC and capacity building, supply chain management, mobile application (SOCH), and independent reviews of MEDP. RESULTS: The MEDP has been operational since April 2017 with field operations from August 2017, and has observed: (1) reduction in indigenous cases of malaria by about 91 %; (2) need for training and capacity building of field staff for diagnosis and treatment of malaria; (3) need for improvement insecticide spraying and for distribution and usage of bed-nets; (4) need for robust surveillance system that captures and documents information on febrile cases, RDT positive individuals, and treatments provided; (5) need for effective supervision of field staff based on advance tour plan; (6) accountability and controls from the highest level to field workers; and (7) need for context-specific IEC. CONCLUSIONS: Malaria elimination is a high-priority public health goal of the Indian Government with a committed deadline of 2030. In order to achieve this goal, built-in systems of accountability, ...

BACKGROUND: The catechol-O-methyltransferase (COMT) enzyme plays a crucial role in dopamine degradation, and the COMT Val158Met polymorphism (rs4680) is associated with significant differences in enzymatic activity and consequently dopamine concentrations in the prefrontal cortex. Multiple studies have analyzed the COMT Val158Met variant in relation to antipsychotic response. Here, we conducted a meta-analysis examining the relationship between COMT Val158Met and antipsychotic response. METHODS: Searches using PubMed, Web of Science, and PsycInfo databases (03/01/2015) yielded 23 studies investigating COMT Val158Met variation and antipsychotic response in schizophrenia and schizo-affective disorder. Responders/nonresponders were defined using each study's original criteria. If no binary response definition was used, authors were asked to define response according to at least 30% Positive and Negative Syndrome Scale score reduction (or equivalent in other scales). Analysis was conducted under a fixed-effects model. RESULTS: Ten studies met inclusion criteria for the meta-analysis. Five additional antipsychotic-treated samples were analyzed for Val158Met and response and included in the meta-analysis (ntotal=1416). Met/Met individuals were significantly more likely to respond than Val-carriers (P=.039, ORMet/Met=1.37, 95% CI: 1.02-1.85). Met/Met patients also experienced significantly greater improvement in positive symptoms relative to Val-carriers (P=.030, SMD=0.24, 95% CI: 0.024-0.46). Posthoc analyses on patients treated with atypical antipsychotics (n=1207) showed that Met/Met patients were significantly more likely to respond relative to Val-carriers (P=.0098, ORMet/Met=1.54, 95% CI: 1.11-2.14), while no difference was observed for typical-antipsychotic-treated patients (n=155) (P=.65). CONCLUSIONS: Our findings suggest that the COMT Val158Met polymorphism is associated with response to antipsychotics in schizophrenia and schizo-affective disorder patients. This effect may be more pronounced for atypical antipsychotics. ; C.C.Z. is supported by the Brain and Behavior Research Foundation, American Foundation for Suicide Prevention and Eli Lilly. D.F. is supported by the Vanier Canada Graduate Scholarship. D.J.M. has been or is supported by the Canadian Institute of Health Research (CIHR) Operating Grant: "Genetics of antipsychotic-induced metabolic syndrome," Michael Smith New Investigator Salary Prize for Research in Schizophrenia, NARSAD Independent Investigator Award by the Brain & Behavior Research Foundation, and Early Researcher Award from Ministry of Research and Innovation of Ontario. E.H. is supported by the Canada Graduate Scholarship. H.Y.M. has grant support from Sumitomo Dainippon, Sunovion, Boehringer Ingelheim, Eli Lilly, Janssen, Reviva, Alkermes, Auspex, and FORUM. J.A.L. has received research funding from Alkermes, Biomarin, EnVivo/Forum, Genentech, and Novartis. J.L.K. is supported the CIHR grant "Strategies for gene discovery in schizophrenia: subphenotypes, deep sequencing and interaction." J.R.B. is supported by NIH grant MH083888. A.K.T. is supported by a NARSAD Young Investigator Award. J.S. is supported by a Pfizer independent grant. P.M. receives salary from Clinica Universidad de Navarra and has received research grants from the Ministry of Education (Spain), the Government of Navarra (Spain), the Spanish Foundation of Psychiatry and Mental Health, and Astrazeneca. S.G. is supported by the Ningbo Medical Technology Project Fund (No. 2004050), the Natural Science Foundation of Ningbo (No. 2009A610186, No. 2013A610249), and the Zhejiang Provincial Medical and Health Project Fund (No. 2015127713). S.G.P. has received research support from Otsuka, Lundbeck, FORUM, and Alkermes.