From Campus to Crisis: Psychological Effect of the COVID-19 Pandemic on Indian Management Students.

BACKGROUND: The COVID-19 pandemic has adversely affected students pursuing higher education, but limited studies highlight student's psychological experiences, especially from Western India. OBJECTIVE: The present study aimed to understand psychological experiences, coping behaviors, and the perceived role of tele-counseling services among final-year students of Masters of Business Administration from leading business schools (B-schools) in Western India. DESIGN: A qualitative research design was adopted for the study. A semi-structured interview guide was utilized to conduct in-depth interviews with 35 students. Students were reached via personal networks and social media, and data was gathered after the second wave of the COVID-19 pandemic. A thematic analysis technique was employed to analyze the data. RESULTS: The findings showed that management students had upsetting psychological experiences. Key stressors that emerged in the study were job concerns, lifestyle changes, concerns about their own and parents' health and safety, uncertainty about the future, and social isolation. They expressed the need for mental health help; however, they were reluctant to utilize tele-counseling services. The authors present an integrated psychological well-being model for promoting positive mental health among students in higher education institutions. CONCLUSION: The study explains the psychological toll on management students. Enhancing mental health literacy through awareness sessions and other innovative means would be critical to addressing myths around mental health and mental healthcare-seeking behavior in higher education institutions. An integrated approach to promoting positive mental health and well-being is needed.

Effectiveness of the QuitSure Smartphone App for Smoking Cessation: Findings of a Prospective Single Arm Trial.

BACKGROUND: Digital therapies, especially smartphone apps for active and continuous smoking cessation support, are strongly emerging as an alternative smoking cessation therapy. In the Indian context, there is a growing interest in the use of app-based smoking cessation programs; however, there is limited evidence regarding their effectiveness in achieving long-term continuous abstinence. OBJECTIVE: This study aimed to evaluate the long-term abstinence effect (up to 30-d abstinence postprogram completion) of a smartphone app, QuitSure, for smoking cessation in active smokers from India. METHODS: In this prospective single-arm study, participants who signed up for the QuitSure app were enrolled in this study. The primary end point was the prolonged abstinence (PA) rate from weeks 1 to 4 (day 7 to day 30). Furthermore, data for withdrawal symptoms, relapse reasons, and reasons for not continuing the program were also assessed. RESULTS: The quit rate was calculated considering only the participants who followed up and completed the survey sent to them (per protocol) at day 7 and at day 30, respectively. The PA rate at day 7 was found to be 64.5% (111/172; 95% CI 56% to 72%), and the PA rate at day 30 was found to be 55.8% (72/129; 95% CI 45% to 65%). Within the 7-day abstinence period, 60.4% (67/111) of the participants did not have any withdrawal symptoms. The most common mild withdrawal symptoms were mild sleep disturbance (21/111, 18.9%), mild digestive changes (19/111, 17.1%), and coughing (17/111, 15.3%). Severe withdrawal symptoms were rare, with only 5.4% (6/111) experiencing them. For those achieving 30-day postprogram abstinence, 85% (61/72) had no mild withdrawal symptoms, and 99% (71/72) had no severe withdrawal symptoms. Among successful quitters at day 7, a total of 72.1% (80/111) reported minimal to no cravings, which increased to 88% (63/72) at day 30. Furthermore, 78% (56/72) of those with PA at day 30 reported no change in weight or reduced weight. Among participants experiencing relapse, 48% (28/58) cited intense cravings, 28% (16/58) mentioned facing a tragedy, and 26% (15/58) reported relapsing due to alcohol consumption. The PA rates as a result of the QuitSure program were found to be better than those reported in the results of other smoking-cessation app programs' studies. CONCLUSIONS: The QuitSure app yields high PA rates and ameliorates symptoms associated with smoking cessation. In order to obtain conclusive evidence regarding the effectiveness and efficacy of the QuitSure program, future research should include appropriate control measures. Nevertheless, the QuitSure program can serve as a valuable adjunct to a conventional smoking cessation treatment program to aid sustained abstinence.

Accelerating Actions Against Malnutrition: A Call for Strengthening the Capacity of Health and Nutrition Program Staff in Devbhumi Dwarka, Gujarat.

Background The Integrated Child Development Services (ICDS), a flagship program of the Government of India, is addressing the malnutrition, health, and development needs of young children, pregnant and lactating women, and adolescent girls for more than four decades. Although the program has been implemented for the past four decades, it could not bring the expected outcomes in terms of reducing malnutrition. The program's limited success can be attributed, among others, to insufficient skills of the program staff and inadequate convergence with the existing nutrition programs implemented through the health department. For the success of any program, advanced knowledge, improved skills, motivation, and the right attitude of the program staff are essential and can be instilled through the need-based training of the staff. The present study aimed at identifying gaps in existing training for health and ICDS program staff in the district and developing a capacity-building strategy to strengthen the implementation of the nutrition program in the district, including "Project Tushti," which aimed at combating malnutrition in Devbhumi Dwarka district of the Gujarat state. Methods The training needs assessment (TNA) was conducted using a descriptive cross-sectional study design. TNA is a method to determine program gaps and training required to fill in programmatic gaps. Appropriate use of TNA can promote designing effective training and nurture program staff productivity, thereby ensuring efficient use of resources for achieving desired program outcomes within the prescribed timeline. Considering the coronavirus disease 2019 (COVID-19)-led lockdown, convenient sampling was used to reach out to potential study participants. A total of 150 program staff from both health departments (particularly medical officers, taluka health officer, National Adolescent Health Program - Rashtriya Bal Swasthya Karyakram (RBSK) medical officer, community health officer from health and wellness center, female health workers, and Accredited Social Health Activists (ASHAs)) and ICDS team (chief district program officer, supervisor, Anganwadi workers, and helpers at Anganwadi center) were interviewed telephonically using a semi-structured interview guide. Interviews were conducted between May 10 and 16, 2020. Results Results reveal that about 49% of the health team and ICDS staff had not received nutrition-specific training in the last year. In terms of coverage, the training coverage was partial, and training content on nutrition was limited. Training contents were divided based on supervisory and implementing cadre feedback. Participants expressed the need for in-depth nutritional refresher training, including topics such as community-based management of acute malnutrition, identification of malnutrition, use of ICDS common application software, and soft skills such as communication skills and supportive supervision. Although 62% of participants preferred the face-to-face medium of training, they agreed with the online mode of training. Conclusion Findings indicate an urgent need for training, particularly in the district's nutrition domain for the staff involved in the implementation, and soft skills for supervisory level staff. Innovative training approaches using the digital platform can be explored for training delivery. The paper discusses innovative capacity-building strategies to address training needs effectively.

Comprehensive league table of cost-utility ratios: A systematic review of cost-effectiveness evidence for health policy decisions in India.

Background and objectives: Although a relatively recent concept for developing countries, the developed world has been using League Tables as a policy guiding tool for a comprehensive assessment of health expenditures; country-specific "League tables" can be a very useful tool for national healthcare planning and budgeting. Presented herewith is a comprehensive league table of cost per Quality Adjusted Life Years (QALY) or Disability Adjusted Life Years (DALY) ratios derived from Health Technology Assessment (HTA) or economic evaluation studies reported from India through a systematic review. Methods: Economic evaluations and HTAs published from January 2003 to October 2019 were searched from various databases. We only included the studies reporting common outcomes (QALY/DALY) and methodology to increase the generalizability of league table findings. To opt for a uniform criterion, a reference case approach developed by Health Technology Assessment in India (HTAIn) was used for the reporting of the incremental cost-effectiveness ratio. However, as, most of the articles expressed the outcome as DALY, both (QALY and DALY) were used as outcome indicators for this review. Results: After the initial screening of 9,823 articles, 79 articles meeting the inclusion criteria were selected for the League table preparation. The spectrum of intervention was dominated by innovations for infectious diseases (33%), closely followed by maternal and child health (29%), and non-communicable diseases (20%). The remaining 18% of the interventions were on other groups of health issues, such as injuries, snake bites, and epilepsy. Most of the interventions (70%) reported DALY as an outcome indicator, and the rest (30%) reported QALY. Outcome and cost were discounted at the rate of 3 by 73% of the studies, at 5 by 4% of the studies, whereas 23% of the studies did not discount it. Budget impact and sensitivity analysis were reported by 18 and 73% of the studies, respectively. Interpretation and conclusions: The present review offers a reasonably coherent league table that reflects ICER values of a range of health conditions in India. It presents an update for decision-makers for making decisions about resource allocation.

Non-iron Deficiency Anemia in Rural Indian Women: A Cross-Sectional Study.

Introduction Anemia is an important public health concern, affecting almost 25% of the global population. In India, these statistics are even more worrisome with more than half of the children, non-pregnant and pregnant women being affected by the disease. Though the major cause of anemia is iron deficiency, other causes cannot be neglected considering the magnitude of the problem. The present study was designed to estimate the prevalence of non-iron deficiency anemia (NIDA) in Devbhoomi Dwarka District of Gujarat. Methods For this cross-sectional study, total of 258 mothers (antenatal and postnatal) were enrolled from 27 primary health centers. Apart from demographic details and obstetric history, hemoglobin and ferritin levels were measured from the participant's blood after obtaining consent. Clinical information such as the history of recent illness and fever were also noted through questionnaires. Prevalence was anemia was calculated using a standard threshold of blood hemoglobin and NIDM was defined using ferritin levels. Results As per hemoglobin levels, anemia was present in 65.9% of the mothers, which was relatively higher in antenatal women (90%) as compared to postnatal women (57%). Ferritin levels showed that out of this total anemic mothers, 61.8% (105/258) have normal ferritin levels indicating the presence of non-iron deficiency. Trimester-wise analysis of anemia in AN showed that NIDM prevalence increases with increasing trimester in contrast to IDA where a considerable reduction was found with iron supplementation. Conclusion The study indicated that two out of every three women were anemic and only one out of four were anemic with depleted iron storage. These findings have important policy implications as in India the anemia control programs address only iron deficiency anemia and not NIDA. The development of a framework for diagnosis and appropriate treatment can be recommended for integration into national guidelines.

Food Consumption Pattern and Dietary Diversity Among Pregnant and Lactating Women, Children, and Adolescent Girls in Devbhumi Dwarka District, Gujarat: A Cross-Sectional Study.

Background Food consumption patterns and dietary diversity are vital sources for the nutrition status of pregnant women (PW) and lactating women (LW), children, and adolescent girls. Undernutrition, food consumption pattern, and poor dietary diversity are interlinked; however, not much is known in the context of rural Gujarat. This study aims to assess the regional pattern of food consumption and dietary diversity among pregnant and lactating women, children, and adolescent girls from Devbhumi Dwarka District in the state of Gujarat. Methods A cross-sectional study was conducted in four blocks of Devbhumi Dwarka District of Gujarat. A cluster sampling method was used for a better representation. A total of 632 pregnant women, 562 lactating mothers, 855 children aged 7-24 months, and 1,252 adolescent girls were assessed for food consumption patterns. Results Consumption of cereals (98%) was found to be highest among pregnant women, whereas consumption of pulses and fruits, which are rich in proteins and vitamins, was inadequate. Overall, the consumption of fruits was inadequate among adolescent girls (56.5%). Moreover, inadequate consumption of green leafy vegetables (36.4%) was noted among children. The dietary diversity score (DDS) for the study population ranges between 4.5 and 4.8, indicating medium diversity in food. Conclusion Cereal consumption is higher, which indicates a major part of the energy consumed by vulnerable groups. In contrast, low consumption of pulses, fruits, milk, and green leafy vegetables suggests the possibility of one or more micronutrient deficiencies. There is a need for innovative intervention to change food habits and promote locally available nutrient-rich food and awareness of the importance of various food groups to improve food patterns and the health of vulnerable groups.

Sociocultural Determinants of Nutritional Status Among Children Under Five Years of Age: An Ethnographic Study From Gujarat.

Background The magnitude of child malnutrition, including severe child malnutrition, is high in India, and Gujarat has a higher prevalence of child malnutrition. Prior studies have employed anthropometric measures to identify the prevalence and associated factors of children's undernutrition. The present study explored community-level determinants of malnutrition among malnourished and well-nourished children in Devbhumi Dwarka district of Gujarat State, India. Methods A qualitative research employing focused ethnographic methodologies was used. In-depth observations of 60 families in a home food environment were carried out. Each child was observed at their respective homes for three consecutive days. Data were analyzed using thematic analysis techniques. Results The study revealed that lack of knowledge on malnutrition, inadequate feeding practices, poor socioeconomic status, insufficient hygiene and sanitation practices, lack of food variety, use of health facilities, and birth complications were the major community-based determinants of malnutrition. Conclusion The study identified community-level determinants of malnutrition among children under five years in the Devbhumi Dwarka district. To tackle the immediate and underlying causes of malnutrition, interventions are urgently needed to create community awareness about malnutrition as a disease and optimal infant and young child feeding (IYCF) practices using behavior change communication strategies.

Nutritional Status of Children Under Two Years of Age in the Devbhumi Dwarka District, Gujarat: A Descriptive Cross-Sectional Study.

Improvements in the analysis of child nutrition status can be helpful in increasing the understanding of the magnitude and critical causes of undernutrition. The present study aimed to assess the nutritional status and related factors in children under two years of age in the Devbhumi Dwarka District of Gujarat, India. A descriptive cross-sectional study was conducted for which the sample size was calculated using Open Epi and considering a 20% non-response rate. The sample size for the study was 1200, but the achieved sample size was 1301. Statistical analysis was performed to identify significant determinants of under-nutrition separately for stunting, wasting, and underweight. The prevalence of wasting, underweight, and stunting was 14%, 17%, and 32%, respectively. Prevalence of low birth weight was recorded as 14% in the district. The overall prevalence of overweight was 20% and 6% as per weight for height and weight for age criteria, respectively. The proportion of children with exclusive breastfeeding was observed to be decreasing with increasing age from birth to six months. About 70% of children were exclusively breastfed at the age of six months. Chi-square analyses revealed that parity and spacing are significant determinants of under-nutrition in children under two years in the Devbhumi Dwarka District. A multipronged and convergence approach is needed to combat the menace of child malnutrition.

Malnutrition in Devbhumi Dwarka: A Situation Analysis.

Background Malnutrition among children, adolescent girls and women is a serious public health issue in India. Malnutrition among adolescent girls is likely to carry on this vicious cycle by giving birth to low birthweight babies. Moreover, low birthweight babies who survive are likely to suffer growth retardation and illness throughout their childhood, adolescence and adulthood. Present situation analysis highlights not only the overall nutrition picture of Devbhumi Dwarka but also narrates the uptake of current nutrition and healthcare services in the Devbhumi Dwarka district. Methods A descriptive cross-sectional study was conducted with 3,738 study population (1,301 children, 1,185 pregnant and lactating women and 1,252 adolescent girls) across four blocks of the Devbhumi Dwarka district of Gujarat. Anthropometric assessments were carried out and the WHO Asia Pacific classification was used for the assessment of malnutrition. Results The prevalence of wasting, underweight and stunting was 14%, 17% and 32%, respectively, in children under two years of age. The prevalence of anaemia among pregnant women (Hb <11 g/dL) was 72.92%; 91.36% of lactating women were anaemic (Hb <12 g/dL). The prevalence of underweight (<-2 SD) among adolescent girls was 19.6%. Block-wise variation in prevalence was observed. Overall, utilization of integrated child development services and health services by these target groups remained sub-optimal. Conclusion The study has revealed the suboptimal nutritional status of children, pregnant and lactating women and adolescent girls of Devbhumi Dwarka, which signifies the need for urgent attention. Several areas of priority have been identified and discussed to improve the overall nutrition status in the district.

Mental health consequences of COVID-19 pandemic among college students and coping approaches adapted by higher education institutions: A scoping review.

Severe acute respiratory syndrome coronavirus - SARS CoV 2 (COVID 19) has posed a dire threat, not only to physical health but also to mental health, impacting our overall lifestyles. In addition to these threats, there have been unique challenges for different subsets of the population. Likewise, college students including research scholars are facing a variety of challenges in response to the COVID-19 outbreak. The scoping review maps existing literature on the mental health of college students in the times of COVID-19, approaches adopted by universities and academic institutions to help students cope with challenges posed by COVID-19 and draws lessons learnt and potential opportunities for integrating mental health promotion as part of routine services, particularly in low-and-middle-income countries context such as India. Four electronic databases (PubMed, PsycINFO, Scopus and Google Scholar) were searched following Arksey and O'Malley's scoping review process. Out of the total 1038 screened records, thirty-six studies were included in the review. Data characteristics such as the type of document, intervention and outcome were extracted. Data were synthesized using thematic content analysis. The fact that the COVID-19 pandemic has impacted the mental health of students, accentuates the urgent need to understand these concerns to inform the action and public mental health interventions that can better support college students to cope with the crisis.

Workplace Mental Health Interventions in India: A Rapid Systematic Scoping Review.

The mental health initiatives at the workplace are growing in numbers over the past few years. Public and private sectors continue to explore avenues to navigate and adapt initiatives to promote employee's mental wellbeing. However, such initiatives in the Indian context are not thoroughly studied. We attempted to review existing literature on workplace mental health interventions in the Indian context. The scoping review was conducted following the standard process as recommended by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews. We searched in the databases such as PubMed, Google Scholar and Scopus. Scientific literature including gray literature of the past decade was searched to synthesize evidence on types of mental health interventions and their unique features. Of the 1,311 records, 30 records that met the inclusion criteria were included for the final review. The review highlights evidence on stress and mental health problems faced by the working population and various strategies adopted by organizations to address mental health problems. However, very few interventions were accompanied by comprehensive needs assessment, impact evaluation and workplace policy initiatives. Most interventions were curative-provisioning counseling services, limiting the scope of mental health promotion activities. Addressing mental health wellbeing comprehensively and aligning an organization's policies are crucial. Research on employee mental health, its risk factors, and cost-effectiveness analysis of workplace mental health interventions in the Indian context need to be prioritized.

Social strain, distress, and gender dysphoria among transgender women and Hijra in Vadodara, India.

Background: There is immense diversity among transgender people in India with respect to ethnicity, sub-culture, and gender expression. Aim: This study examines psychological distress, gender dysphoria, transgender congruence, and social strain among transgender women, and explores their reflections on self and community using a mixed-method approach. Method: Gender dysphoria, psychological distress, and transgender congruence were assessed with standardized scales while the participants' reflections were captured using semi-structured interviews. A total of 20 transgender women and Hijras were included in the study using convenience sampling. Data was analyzed using quantitative and qualitative techniques. Results: A positive correlation was found between psychological distress and social strain, but no correlation was found between psychological distress and gender dysphoria. Half of the participants fell into the range of gender dysphoria, five of them underwent gender affirming surgery, while two could not undergo the surgery and the rest did not express any discomfort with their gender. While all participants experienced psychological distress due to psycho-socio-cultural stressors, Hijra reported additional stressors related to the Hijra tradition. Discussion: Findings reveal that the psychological distress experienced by transgender women and Hijra had a significant, positive relationship with social strain rather than gender dysphoria. Participants reported various psycho-socio-cultural factors causing psychological distress, which impacted their lives more negatively than gender identity conflicts. These findings support the recent advances by the World Health Organization in ICD-11 to extract transgender conditions from the Mental and Behavioral Disorders category. Limitations of the study are elucidated by authors and the need for a culturally relevant and nonbinary gender dysphoria scale, and implications are discussed.

Addressing determinants of malnutrition: A protocol of project Tushti.

Background: Improved nutrition situation analysis can increase the understanding of the likely magnitude and main causes of the nutrient gap among children less than 2 years of age. The present study was aimed at assessing nutritional status and factors related to it in children less than 2 years of age in the Devbhumi Dwarka District of Gujarat, India. Methods: A descriptive cross-sectional study was conducted. The sample size for a population-based survey was calculated using Open Epi and considering 20% non-response rate. Sample size for the study was 1,200 but sample size achieved was 1,301. Chi-square analyses were performed to identify significant determinants of under-nutrition separately for stunting, wasting, and underweight. Results: The prevalence of wasting, underweight, and stunting was 14, 17, and 32%, respectively. Prevalence of low birth weight was recorded as 14% in the district. The overall prevalence of overweight was 20% and 6% as per weight for height and weight for age criteria, respectively. The proportion of children with exclusive breastfeeding observed to be decreasing with increasing age from birth to 6 months; 70% of children were exclusively breastfeed at the age of 6 months compared to 84% at their births. Chi-square analyses revealed that parity and spacing as significant determinants of under-nutrition in children less than 2 years in the district. Conclusion: In Devbhumi Dwarka, burden of malnutrition was recorded. Maternal literacy, parity, and spacing emerged as significant determinants of under-nutrition in children less than 2 years in the district. Multipronged and convergence approach is needed to combat menace of child malnutrition.

Impact of COVID-19 on Transgender Women and Hijra: Insights from Gujarat, India.

Protecting vulnerable populations from the COVID-19 pandemic is a strategic imperative, especially when considering the potential vulnerability it has on a wide range of marginalized communities. Transgender women and hijra individuals who struggle to cope financially, mentally, or physically are vulnerable groups that require attention during the COVD-19 pandemic. Using a qualitative descriptive research design, 12 transgender women and hijra persons participated in semi-structured telephone interviews during India's lockdown phases (1.0 and 2.0) of the COVID-19 pandemic. A snowball sampling technique was used to recruit study participants. Authors identified five themes: knowledge and practice; psychological domain; health conditions; individual and community experiences; and support. Findings offer broad insights into bolstering health concerns and access to healthcare services from public health and human rights perspective. An access to adequate healthcare services is a fundamental human right. The COVID-19 pandemic response without a human rights framework will have a major impact on the progress of the Sustainable Development Goals. Future studies of this population will illuminate unique considerations for healthcare workers while providing care to this neglected group.

Cost-Effectiveness of mHealth Intervention (TeCHO+) for Improving Maternal and Child Health Indicators in Gujarat, India.

Background: Gujarat has implemented an mHealth program, technology for community health operations-plus (TeCHO+) in 2019. TeCHO+ is a mobile and web-based application that essentially enables data entry by the frontline workers providing service at the time and place of service delivery to improve the coverage and data quality. It also facilitates early identification of morbid condition and timely treatment. This study assessed the cost-effectiveness of TeCHO+ program in Gujarat. Materials and Methods: The study compared key program outcome indicators before and after the launch of TeCHO+ program. As the program was launched across the State, eMamta, the previous version of mother and child tracking system was used for comparison. A decision tree was parameterized to estimate change in disability-adjusted life year (DALY) and cost as a result of implementing TeCHO+ from a health system perspective. Results: TeCHO+ incurred a cost of Rs. 2,624 per beneficiary against Rs. 1,075 per beneficiary under the previous eMamta program. TeCHO+ has resulted in significant DALY averted through early identification of high-risk cases both among pregnant women and children. Overall, cost-effectiveness analysis indicated that TeCHO+ incurred an incremental cost of Rs. 1802.84 per DALY averted, which is 1.19% of the GDP per capita of India (year 2020). Conclusion: This study concludes that TeCHO+ is cost-effective for mother and child care and can be considered for replicating.

Cost-Effectiveness of Portable Electrocardiogram for Screening Cardiovascular Diseases at a Primary Health Center in Ahmedabad District, India.

Background: District Health Authority in Ahmedabad, Gujarat has introduced Project Lifeline, 12-lead portable ECG devices across all primary health centers (PHC) in the district to screen cardiac abnormalities among high-risk and symptomatic adults for providing primary management and proper timely referral. The prime purpose of the study was to assess the cost-effectiveness of portable ECG for the screening of cardiovascular diseases (CVD) among high-risk and symptomatic adults at the PHC in Ahmedabad, Gujarat. Methods: Cost-effective analysis was conducted using a societal perspective. An incremental costing approach was adapted, and cost-effectiveness analysis was done using a decision-analytic model. We surveyed 73 patients who screened positive for cardiac abnormality, documented the type of ECG abnormalities, and diagnosed CVD. The program cost was obtained from the implementers. Transition probabilities were derived from primary data supported by expert opinion for the intervention arm, while a systematic search of the literature was undertaken to derive transition probabilities for the control arm. Results: The ECG screening at PHC saves 2.90 life years at an incremental cost of 89.97 USD (6657.47 INR), yielding a cost-effectiveness ratio of 31.07 USD (2,299.06 INR) per life-year saved, which is below the willingness to pay threshold. The budget impact analysis was also performed. Results are sensitive to the relative risk reduction associated with the non-participation and the cost of initial screening. Conclusion: Cost-effectiveness analysis clearly shows that the facility to screen cardiac abnormality at the PHC level is highly recommended for high-risk adults and symptomatic cases.

Cross-Sectional Analysis of Nutritional Status, Knowledge and Uptake of Nutritional Services Among Adolescent Girls in Western India.

PURPOSE: Malnutrition status of adolescent girls remains a major public health problem in India. The present study assessed nutritional status, associated factors contributing to malnutrition and their access to health-care services in Dev Bhumi Dwarka district of Gujarat situated in western part of India. MATERIALS AND METHODS: The study was carried out using descriptive cross-sectional design. A total of 1252 adolescent girls from all four blocks of Dev Bhumi Dwarka district were interviewed by field investigators. The data were collected on socio-demographic characteristics, physical activities, diet, and anthropometry. The WHO classification for body mass index (BMI) was used to assess underweight, overweight, and obesity among adolescent girls. Chi-square analyses were performed to identify significant determinants of under-nutrition. RESULTS: Mean age of the study population was 13.82±2.31. Of the total, around 34% of the adolescent girls were out-of-school. The prevalence of underweight (<-2SD) was 19.6%, 8.9% were overweight, and 2.6% were obese. The mean BMI was 19.77±2.42 kg/m2, and height was 149.15 (2.23m2). In terms of knowledge, almost 79.6% were unaware of iron-deficiency anaemia, about 70% were not aware of haemoglobin test, and 44% did not know the benefit of using sanitary napkins. In addition, uptake of nutritional and health services was limited. The study found a statistically significant association of age (p = 0.00), the number of family members (p = 0.016), knowledge (p = 0.05), and use of toilet (0.041) with low-BMI. CONCLUSION: Existing nutritional interventions need to focus on nutrition, health and hygiene education. It also reinforces a need for implementation research to understand barriers in uptake of health and nutrition services.

'You want to deal with power while riding on power': global perspectives on power in participatory health research and co-production approaches.

INTRODUCTION: Power relations permeate research partnerships and compromise the ability of participatory research approaches to bring about transformational and sustainable change. This study aimed to explore how participatory health researchers engaged in co-production research perceive and experience 'power', and how it is discussed and addressed within the context of research partnerships. METHODS: Five online workshops were carried out with participatory health researchers working in different global contexts. Transcripts of the workshops were analysed thematically against the 'Social Ecology of Power' framework and mapped at the micro (individual), meso (interpersonal) or macro (structural) level. RESULTS: A total of 59 participants, with participatory experience in 24 different countries, attended the workshops. At the micro level, key findings included the rarity of explicit discussions on the meaning and impact of power, the use of reflexivity for examining assumptions and power differentials, and the perceived importance of strengthening co-researcher capacity to shift power. At the meso level, participants emphasised the need to manage co-researcher expectations, create spaces for trusted dialogue, and consider the potential risks faced by empowered community partners. Participants were divided over whether gatekeeper engagement aided the research process or acted to exclude marginalised groups from participating. At the macro level, colonial and 'traditional' research legacies were acknowledged to have generated and maintained power inequities within research partnerships. CONCLUSIONS: The 'Social Ecology of Power' framework is a useful tool for engaging with power inequities that cut across the social ecology, highlighting how they can operate at the micro, meso and macro level. This study reiterates that power is pervasive, and that while many researchers are intentional about engaging with power, actions and available tools must be used more systematically to identify and address power imbalances in participatory research partnerships, in order to contribute to improved equity and social justice outcomes.