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ABSTRACT Ovarian steroid cell tumors are rare, representing less than 0.1% of all ovarian neoplasms. Among the myriad causes of hirsutism, ovarian tumors account for 1% of the reported cases. We present the case of a 49-year-old parous postmenopausal woman who sought medical attention for hirsutism for 2 years. This case illustrates the unusual and interesting connection between rare ovarian pathology and the clinical manifestation of hirsutism in a postmenopausal patient. Her ultrasonography and MRI showed a right adnexal mass of solid-cystic consistency with thin septations. Her laboratory workup revealed high levels of total testosterone of 256 ng/ml (8.4-48.1ng/ml) and free testosterone of 7.36 pg/ml (0.2-4.1 pg/ml), while DHEAS - 234 µg/dl (35.4-256 µg/dl) and CA125 - 15.8U/L (0.0-35 U/L) were in the normal range. She underwent exploratory laparotomy with a total abdominal hysterectomy and oophorectomy. Histopathological examination and immunohistochemistry conclusively established the presence of a steroid cell tumor, specifically classified as "Not Otherwise Specified"(NOS), in the right ovary.
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Background & objectives: Assessing healthcare seeking behaviour (HSB), healthcare utilization and related out-of-pocket expenditures of Particularly Vulnerable Tribal Groups (PVTGs) of India through a prism of the health system may help to achieve equitable health outcomes. Therefore, this comprehensive study was envisaged to examine these issues among PVTGs of Odisha, India. However, there exists no validated questionnaire to measure these variables among PVTGs. Therefore, a study questionnaire was developed for this purpose and validated. Methods: Questionnaire was constructed in four phases: questionnaire development, validity assessment, pilot testing and reliability assessment. Nine domain experts face validated questionnaire in two rounds, followed by a single round of quantitative content validity. Next, the questionnaire was pretested in three rounds using cognitive interviews and pilot-tested among 335 and 100 eligible individuals for the two sections healthcare seeking behaviour (HSB-Q) and maternal and child healthcare service utilization (MCHSU-Q). Internal consistency reliability was assessed for de novo HSB-Q. Results: On two rounds of expert-driven face validity, 55 items were eliminated from 200 items. Questionnaire showed moderate to high content validity (item-level content validity index range: 0.78 to 1, scale-level content validity index/universal agreement: 0.73; scale-level content validity index/average: 0.96 and multirater kappa statistics range: 0.6 to 1). During the pre-test, items were altered until saturation was achieved. Pilot testing helped to refine interview modalities. The Cronbach alpha and McDonald’s omega assessing internal consistency of HSB-Q were 0.8 and 0.85, respectively. Interpretation & conclusions: The questionnaire was found to be valid and reliable to explore healthcare seeking behaviour, maternal and child healthcare utilization and related out-of-pocket expenditure incurred by PVTGs of Odisha, India.
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Background & objectives: Traditional beliefs on child healthcare at time lead to potentially harmful practices like branding. However, there is a gap in people’s perceptions, attitudes and beliefs about branding practice. Therefore, the present study was undertaken to document the cultural motivation, ability and opportunity for branding practice in a tribal district of Odisha, India. Methods: Initially, such practices were observed in the tribal community for three months. Then, 18 in-depth interviews were conducted - ten among women having under-five children, and eight among traditional healers. Six focus group discussions were conducted with community health workers as well. The responses were digitally recorded, transcribed and translated and were further used for thematic framework analysis. Results: The primary determinants of branding practice were cultural beliefs compounded with low-health literacy, proximity to conventional care and influence of family and friends. The key driver for branding practices was traditional cultural beliefs on child healthcare decisions and health-seeking behaviours. Opportunities in the health system – availability and quality of health services – frequently drive them to seek healthcare from the system structure and routine health communication improves their ability to make better healthcare decisions. Interpretation & conclusions: Culture significantly affects the conceptualisation of illness and care-seeking pathways in a society. The indigenous community used to consult local traditional healers for their health concerns. While the government has made efforts to increase community health literacy through various platforms and multiple stakeholders’ engagements, the doorstep availability of modern care and health promotion interventions remains critical for meeting the health needs of the indigenous community.
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Background & objectives: Contrary to overall declining trend in smokeless tobacco (SLT) use in India, an increase is observed in north-east (NE) India. This study examined the predictors of daily SLT use by gender and assessed the demographic and socio-economic characteristics that contribute to gender differences in SLT use in NE India. Methods: Data collected from 15,259 and 13,574 adults in the two rounds of Global Tobacco Adult Survey 1 and 2 for NE India during 2009-2010 and 2016-2017 were analyzed. Relative change, multivariable binary logistic regression and Blinder-Oaxaca decomposition analysis were used for analysis. Results: The findings suggest that among women in NE India, the daily SLT use significantly increased by 58 per cent between 2009-2010 to 2016-2017. Women residing in Nagaland, Manipur, Mizoram and Tripura were 3.5 and 2.5 times, respectively more likely to be daily SLT users compared to those in Assam. While age, education and wealth were the significant predictors of SLT use in both women and men, increased odds of SLT use were observed with women’s type of occupation and the State of residence. The majority of the gender differences in daily SLT use was explained by differences in work status (44%), age (26%), education (14%) and wealth status (9%) between men and women. Interpretation & conclusions: Increasing prevalence of SLT use amongst women in the NE States necessitates integration of gender-specific messages on harmful effects of SLT in the ongoing tobacco control programmes and development of culturally appropriate community-based interventions for cessation of SLT use.
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India is home to the largest population of indigenous tribes in the world. Despite initiative of the National Rural Health Mission, now National Health Mission (NHM) and various tribal development programmes since India’s Independence, disparity in healthcare for Scheduled Tribes (STs) prevails. The constitution of Village Health Sanitation and Nutrition Committees (VHSNCs) in 2007 by the NHM is a step towards decentralized planning and community engagement to improve health, nutrition and sanitation services. VHSNCs are now present in almost all States of the country. However, several reports including the 12th Common Review Mission report have highlighted that these committees are not uniformly following guidelines and lack clarity about their mandates, with no clear visibility of their functioning in tribal areas. Therefore, this review was conducted to assess the participation of the VHSNCs in tribal dominated States in order to know in detail about their functioning and gaps if any that require intervention. Several deviations from the existing guidelines of NHM were identified and we concluded that in order to sustain and perform well, VHSNCs not only require, mobilization and strict monitoring but also motivation and willingness of its members to bring in a radical change at the grassroot level. With continuous supervision and support from both the Government and various non- governmental organizations, handholding, strategic deployment of workforce, community participation and sustained financial support, VHSNCs would be able to facilitate delivery of better healthcare to the indigenous population
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Background & objectives: Sickle cell disease (SCD) constitutes frequently inherited haemoglobin disorders and poses a significant health burden in India. Hydroxyurea (HU), the most commonly used drug, has shown promising results in the clinical management of SCD. The present systematic review was undertaken to assess the efficacy and toxicity of HU in Indian sickle cell patients. Methods: A systematic review of studies on HU therapy was conducted to identify the application of HU and its outcome(s) across India. PubMed, Scopus and Cochrane Library was used as data sources for various studies on the efficacy and toxicity of HU therapy for treatment for SCD in India published between January 2001 and October 2021. Two authors independently extracted the data on study design, patient characteristics and therapeutic outcomes of HU in order to determine the study quality of the present review. Results: Overall, 14 studies were included for a systematic analysis. Of these 11 were prospective, two cross-sectional and one double-blind randomized controlled trial. Low-dose HU (10 mg/kg/day) was found to reduce the rates of vaso-occlusive crisis and hospitalization as well as decreased the requirement of blood transfusion in SCD patients. The foetal haemoglobin (HbF) level was recorded in 13 (80%) studies all of whom reported an elevation in the HbF levels, with a mean increase in per cent HbF from 15.8 to 21.4 per cent across studies. The common adverse events were reversible, mild-to-moderate cytopenia and anaemia. Interpretation & conclusions: The findings of the present review suggest that there is still insufficient information presently to determine the long-term or major adverse effects on organ damage, fertility as well as pregnancy on the use of HU therapy for SCD. Long-term multi-centric studies are thus required to address these problems.
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Background & objectives: Globally, mental disorders are rising with increasing urbanization. India has the world’s second-largest tribal population and it is critical to appreciate the mental health problems in this population. However, the extent of mental health issues among tribal populations is unknown. Against this background, we systematically reviewed community-based studies on mental health issues among tribal populations in India. Methods: Online databases PubMed, Embase, ProQuest databases and Google Scholar were searched and articles published between January 1990 and May 2021 including primary community-based quantitative observational studies focused exclusively on tribal population were retrieved. PRISMA guidelines were followed and this review was registered on PROSPERO (CRD42020178099). Results: A total of 935 articles were identified, of which 63 were selected for full-text review, and finally, 11 studies were included. Seven studies examined alcohol use disorder with a pooled prevalence of 40 per cent. Two studies reported on suicidal attempts. A few studies mentioned anxiety, depression and other mental health conditions. Interpretation & conclusions: This systematic review established that a few community-based primary studies were conducted on mental health issues among tribal populations over the last three decades. Among these, fewer studies focused exclusively on tribal communities. The studies differed in their study design and the tools used. The findings of these investigations highlighted a limited range of mental health issues, primarily alcoholism, anxiety, depression and suicide.
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Abstract Introduction The classification of odontogenic tumors has been revised from time to time in order to provide unified terminology. This reclassification had considerable impact on their prevalence and frequency distribution. Objectives This study was aimed to emphasize impact of changing classification systems on prevalence and relative frequency of odontogenic tumors. The secondary objective was to analyze demographics of various histological types of odontogenic tumors in comparison to published literature. Review of Indian studies (1992-2020) elaborating frequency of odontogenic tumors is summarized in the end. Methods This was a hospital-based retrospective study wherein case files of odontogenic tumors diagnosed from 1990 to 2019 period were retrieved. The classification system used originally at the time of diagnosis was retained and prevalence of odontogenic tumors in three different periods (1990-2004, 2005-2016 and 2017-2019) was compared. Further, prevalence, frequency distribution and demographics of all these tumors (1990-2019) were analyzed using latest World Health Organization 2017 classification. Results A total of 345 odontogenic tumors was diagnosed as per World Health Organization 2017 system of classification from 1990 to 2019. 96.81% tumors were benign and 3.81% constituted malignant odontogenic tumors. However, there was marked increase in prevalence of odontogenic tumors in 2005-2016 (6.2%) period as compared to 1990-2004 (3.87%) and 2017-2019 (3.47%). Ameloblastoma remained the most common tumor in three different periods, whereas keratocystic odontogenic tumor became second commonest tumor in 2005-2016 as compared to odontoma in 1990-2004 and adenomatoid odontogenic tumor in 2017-2019. Conclusions The continuous evolving systems of classification may partly be responsible for inconsistency in odontogenic tumors, with inclusion of keratocystic odontogenic tumor,and has marked impact on prevalence and frequency distribution of odontogenic tumors. The geographical variations in demographics of odontogenic tumors might reflect genetic and environment influence; however it requires elucidation by further studies.
Resumo Introdução A classificação dos tumores odontogênicos é revisada de tempos em tempos para fornecer uma terminologia unificada. Essas revisões tiveram um impacto considerável na prevalência e distribuição da frequência desses tumores. Objetivo Enfatizar o impacto da mudança dos sistemas de classificação na prevalência e frequência relativa dos tumores odontogênicos. O objetivo secundário foi analisar os dados demográficos de vários tipos histológicos de tumores odontogênicos em comparação com a literatura publicada. A revisão dos estudos indianos (1992-2020) sobre a frequência dos tumores odontogênicos é resumida no fim. Método Este foi um estudo retrospectivo com base em registro hospitalar de casos de tumores odontogênicos diagnosticados de 1990‐2019 que foram revisados. O sistema de classificação usado originalmente no momento do diagnóstico foi mantido e a prevalência de tumores odontogênicos em três períodos (1990-2004, 2005-2016 e 2017-2019) foi comparada. Além disso, a prevalência, a distribuição da frequência e os dados demográficos de todos esses tumores (1990-2019) foram analisados com a classificação mais recente da OMS de 2017. Resultados Foram diagnosticados 345 tumores odontogênicos de acordo com o sistema de classificação da OMS (2017) de 1990-2019. A ocorrência de tumores odontogênicos benignos e malignos foi de 96,81% e 3,81%, respectivamente. Contudo, houve um aumento acentuado na prevalência de tumores odontogênicos de 2005‐2016 (6,2%), comparado aos períodos de 1990‐2004 (3,87%) e 2017‐2019 (3,47%). O ameloblastoma permaneceu como o tumor mais comum em três períodos, enquanto o tumor odontogênico ceratocístico passou a ser o segundo tumor mais comum em 2005‐2016, comparado ao odontoma em 1990‐2004 e ao tumor odontogênico adenomatoide em 2017‐2019. Conclusões Os sistemas de classificação em evolução contínua podem, em parte, atribuir uma inconsistência à classificação dos tumores odontogênicos com a inclusão do tumor odontogênico ceratocístico e causar um impacto marcante na prevalência e distribuição da frequência dos tumores odontogênicos. As variações geográficas na demografia dos tumores odontogênicos podem refletir influências genéticas e ambientais, mas requerem elucidação por estudos futuros.
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Background: The World Health Organization (WHO) factsheet revealed that 15 million babies are born too early every year and almost 1 million children die each year due to complications of preterm birth. The objective of this study was to determine whether cervicovaginal β-hCG level can be used as predictor of preterm delivery in asymptomatic high-risk pregnant women at 24-34 weeks gestation age.Methods: This was prospective observational study. Total 134 asymptomatic pregnant women were taken for study who had at least one risk factor for preterm delivery at 24-34 weeks gestation age. Cervicovaginal secretion was collected and β-hCG level was measured by chemiluminescent immunoassay.Results: Out of 134 cases, 42.5% had preterm delivery and 57.5% had term delivery. Mean cervicovaginal β-hCG level (mIU/ml) in preterm delivery group was 39.38±19.66 and term delivery group was 21.86±11.18. Cervicovaginal β-hCG level was significantly higher in preterm group compare to term group demonstrating significant association of raised β-hCG with preterm group (p value <0.001). ROC curve analysis was done to find out best cut off value of cervicovaginal β-hCG for prediction of preterm delivery and optimal cut off value was 36.45 mIU/ml. The optimal cut off value for cervicovaginal β-hCG (36.45 mIU/ml) gave sensitivity 71.9%, specificity 81.8%, positive predictive value 74.5%, negative predictive value 79.7% and diagnostic accuracy of 77.6% for prediction of preterm delivery.Conclusions: Cervicovaginal β-hCG can be used as sensitive and specific biomarker of prediction of preterm delivery in asymptomatic high-risk women.
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Introduction: Myasthenia gravis is a chronic autoimmuneneuromuscular disease characterised by varying degree ofmuscle weakness. Undiagnosed myasthenia gravis owing tovery unusual presentation in perioperative period leading tosignificant complications.Case report: A case report of undiagnosed myasthenia gravispatient presented for direct laryngoscopy and biopsy, withcomplaint of dysphagia and jaw pain.Conclusion: Myasthenia gravis is an autoimmune diseaseand may be detected accidentally. And care should be paidto possible complications because of neuromuscular blockingagents.
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Introduction: Spontaneous haemoperitoneum is rare duringpregnancy but a life threatening complication. It is consideredidiopathic as the source of bleeding is not known.Case report: Presenting here a case of 20 years primigravidapatient who was taken up for caesarean section because ofpersistent foetal tachycardia. Patient had no significant pastor family history, had normal hemogram and coagulationprofile with all other normal investigations. Unexpectedlyintra-operatively hemoperitoneum was observed for which noidentifiable cause could be established.Conclusion: Though it is a rare entity but it can be lifethreatening. Shock and foetal distress have a much moregradual onset when the amount of bleeding is less severe.
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Role of music has been identified since ancient times for alleviating anxiety. Music has been known for its potential to produce a sense of wellbeing and peace. Anaesthesia and surgery are major stress factors for any person. Preoperative anxiety is a usual phenomenon in patients posted for various surgical interventions as well as those admitted to intensive care units (ICU). Literature shows ample evidence regarding neurohormonal disturbances related to stressful situations like preoperative, intraoperative and post-operative periods. Music has been shown to attenuate release of various biochemical molecules leading to relaxing and sedative effects on the brain. Not only patients under regional anaesthesia who are awake have a positive impact, even patients under general anaesthesia have also been shown to benefit from listening to music intraoperatively. Music is a hazard free intervention which can be added to various drug combinations used by anaesthesiologists.
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Low temperature is one of the major environmental constraints which reduce plant development and crop productivity. Plants are able to adapt to low-temperature stress through activation of reactive oxygen scavenging systems. Salicylic acid (SA) is one component of a complex signaling pathway modulate the plant responses to environmental stresses including low temperature stress. In this study, we evaluated the effectiveness of salicylic acid (SA) pretreatment on antioxidant system in Egyptian clover under low temperature stress. Antioxidants play important role in enhancing low temperature tolerance in plants. Berseem (var. BL-42 and BL-10) seeds were germinated for three days at 25°C after hydro-priming or SA priming (25, 50, 75, 100 and 125 µg/mL) for 4 hours. After germination of three days, one set of Petri plates was exposed to low temperature (LT) stress (5°C) for five days and other set was retained at 25°C. Physiological and biochemical parameters were observed in root and shoot samples after seven days of germination. Higher vigor index was obtained at 50 and 75 µg/mL of SA pretreatment. Low temperature treatment upregulates antioxidant enzyme (CAT, APX, GR, GPX and SOD) activities but LT+SA treatment further enhanced the antioxidant potential of clover seedlings. SA pretreatment @ 50 to 100 µg/mL concentrations resulted in upregulation of non-enzymatic antioxidants at both 25°C and 5°C. Total protein, proline and total phenol were differentially affected by different SA treatments under LT stress. SA alleviated the adverse effect of LT stress by decreasing lipid peroxidation and H2O2 content in berseem seedlings. Results have shown that SA pretreatment ameliorated LT stress in clover by upregulating antioxidants and biochemical metabolites.
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Background: Parturient undergoing repeat caesarean section (CS) under spinal anaesthesia usually experience anxiety due to unpleasant operative environment. Music therapy has been found to have positive psychological impact to relieve anxiety, improve patient satisfaction and provide stable haemodyanamics.Methods: Sixty patients without any co morbidity having history of previous CS, scheduled for another caesarean under spinal anaesthesia were included in the study. Patients were divided into two groups of 30 each. Group(M) patients were subjected to hearing music of their choice with the help of headphones after administration of spinal anaesthesia till the end of surgery. Group(N) patients were not made to listen to any music but headphones were applied. Haemodyanamic parameters including mean arterial pressure (MAP) and heart rate (HR), visual analogue score for anxiety (VASA) after administering spinal block and at the end of surgery, patient satisfaction score (PSS) and comparison of anxiety with previous CS were observed and recorded.Results: Both MAP and HR in Group M started falling after 10 minutes of spinal anaesthesia as compared to Group N and difference was significant (P <0.005), VASA 2 (2.2±1.8) in Group M was significantly lower than VASA 1 (5.4±1.7). PSS was also in favour of music group (Group M) and difference was highly significant as compared to group N (p=0.018). Patient’s anxiety as compared to anxiety with previous CS was lesser in Group M as compared to Group N(p=0.009).Conclusions: Music is a non-invasive tool to relieve anxiety during intraoperative period along with higher patient satisfaction and stable haemodyanamics.
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Background: Endometriosis is a benign gynaecological condition that causes significant morbidity to women of reproductive age group. It uncommonly affects the gastrointestinal tract and acute bowel obstruction is a rare manifestation.Methods: A retrospective observational study was conducted on eight patients.Results: In three patients (37.5%), small intestinal involvement was seen, and colon was involved in five patients (62.5%). One (12.5%) patient presented with complete bowel obstruction while in others partial obstruction of the intestine was seen.Conclusions: Intestinal endometriosis is a diagnostic challenge and should be considered in young menstruating women with gastrointestinal symptoms. Intestinal endometriosis is the most common extra-pelvic site and it is found in 12% of women with endometriosis. The true incidence of endometriosis causing bowel obstruction is unknown. Pre or intraoperative sigmoidoscopy may prove helpful in ruling out malignancy. The gold standard for diagnosis is laparoscopy and biopsy, which allows a full assessment of the pelvis as well as surgical resection if required. The management of endometriosis is an integrated approach of both medical and surgical therapy. Bowel resection is usually undertaken if there are features of obstruction or bleeding, and if there is suspicion of malignancy.
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In clinical practice, various obstetrical indications lead to the need to perform caesarean section deliveries in order to ensure maternal safety and favourable neonatal out comes. World Health Organization (WHO), in accordance with scientific evidence has stated that maximum safe limit of caesarean sections in any region throughout the globe is 10-15%. However, many countries including India have shown much higher rates during researches. Socio cultural factors like auspicious dates and time of deliveries also have a hidden role to play in these rising caesarean trends, in which the babies are delivered at the desired day and time for bright future as predicted by astrologers. This practice may be full of hazards and complications for mother, baby, as well as the medical and paramedical personnel. In addition, the resource crunch created in society by unnecessary surgeries may also hamper treatment of deserving patients.
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Background: Priming is one of those techniques in which a small dose of non-depolarizing muscle relaxants is administeredfollowed by a large intubating dose. Cisatracurium is the newly introduced drug with Hoffman elimination. The problem with itsuse is delayed onset of action. The present study was conducted to compare the onset of cisatracurium for tracheal intubationwith and without priming dose of rocuronium.Materials and Methods: A total of 60 American Society of Anesthesiologist physical Status Ι and ΙΙ patients undergoing surgeryunder general anesthesia were included in the study. Patients were divided into two groups of 30 each. Patients in Group Rreceived priming dose of rocuronium 0.06 mg/kg before intubating dose of cisatracurium (0.14 mg/kg). Group C patients didnot get any priming, only normal saline was given before intubating dose of cisatracurium (0.15 mg/kg).Results: Time gap between administration of the cisatracurium and complete loss of T1 was recorded as intubation time.The intubation time was significantly less in Group R, i.e., 130 ± 11.02 s as compared to Group C, i.e., 230.33 ± 12.82 s. Theintubating conditions were similar in both the groups. The hemodynamic changes were statistically insignificant. The time to25% recovery of the T1 response is defined as the clinically effective duration of neuromuscular block. The rate of recovery isdescribed by the recovery index, which is defined as the time from 25% to 75% T1 recovery.Conclusion: Priming with rocuronium decreased the onset time without increasing the clinical duration of action or recovery index.
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A variety of syndromes/disorders (genetic/acquired) are encountered in our day-to-day life. Among them, ectodermal dysplasia is a rare syndrome which is transmitted as x-linked recessive/dominant disorder and is known to majorly affect males as compared to females. Clinically, it is observed that there is presence of partial or complete anodontia with conical teeth along with maxillary retrusion, prominent supraorbital ridges or frontal bossing, fine and blond, scanty hair (resembling lanuogo), deformed or absent nails, facial physiognomy (fairy-like face) and reduced sweating. Early diagnosis remains the key for the management of ectodermal dysplasia. Since patient suffers from unpleasant appearance (due to partial or complete anodontia); hence, dental management includes replacement of teeth by either fixed/removable partial or complete dentures /implant- supported dentures. We present a case of ectodermal dysplasia with features of oligodontia, severely deficient alveolar processes and maxillary retrusion which was managed with tooth-supported complete overdentures.
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Guillian-Barre syndrome (GBS) is an acquired autoimmune polyradiculopathy. Areflexia and progressive flaccid weakness are essential for its diagnosis. Here we report a case of 25 year old female presenting with acute onset flaccid quadriparesis. The diagnosis of GBS was made on history and clinical findings supported by cerebro-spinal fluid (CSF) analysis and nerve conduction studies (NCS). The hallmark of this case was the presence of hyperreflexia in all four limbs without involvement of higher functions, sensory, autonomic and bulbar dysfunction. To diagnose this rare entity, a high index of suspicion is needed.
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Background: Anganwadi workers (AWW) are India’s primary tool against the menace of child malnourishment, infant mortality, and lack of child education, community health. The anganwadi workers should have basic knowledge of treatment of minor ailment. So with this aim this study was planned to assess the existing knowledge regarding minor ailments of children among anganwadi workers problems and in curbing preventable diseases. Methods: The present study was conducted in the Department of Community Medicine SGRDIMSAR, Amritsar. By adopting stratified random sampling technique, 5 AWW were selected per each training session. A pre- designed and pre-tested questionnaire prepared was used to collect information from AWW. Pre-test and post-test assessment to determine the knowledge of minor ailments among AWW was done. The data collected was statistically analysed using SPSS 20.0 version. Results: The study revealed that out of 135 AWW, 40% were in the age group of 25-45 years. Only 8.9% AWW were aware that a neonate should be referred in case he suffers from any of these conditions i.e. hypothermia, jaundice, fever. Awareness about newborn care practices was observed to increase with increase in education level. There was statistically significant improvement in the knowledge regarding minor ailments in post-test scores of AWWs. Conclusions: Anganwadi workers are India’s primary tool against the scourges of child malnourishment, infant mortality and curbing preventive diseases such as most minor ailments.