Theophilus Lakiang

Early adolescence is the period of the emergence of most mental disorders contributing significantly to the mental health burden globally, including India. The major challenges in India are early identification of mental health problems, treatment gap, lack of professionals, and interventions that address the same. Our review aimed to assess the effectiveness of mental health interventions among adolescents in India. We systematically searched PubMed, PsycINFO, and Cochrane databases and used cross-referencing to review the interventions published from 2010 to 2020. Eleven interventions were included in this review; nine were school-based, one community, and one digital. Most of the school-based programs used a life skills curriculum. Additionally, coping skills and resilience curricula showed improvement in depressive symptoms, cognitive abilities, academic stress, problem-solving, and overall mental well-being. The multi-component whole-school intervention was quite promising and helped in improving the overall school climate and various other mental health outcomes. Hence, school-based programs should be implemented as an entry point for screening mental health problems. However, there is a need for a more comprehensive mental health program in the country for adolescents. Additionally, there is a need to address the gap by conducting more interventions for early and out-of-school adolescents.

Maternal undernutrition can lead to protein-energy malnutrition, micronutrient deficiencies, or anemia during pregnancy or after birth. It remains a major problem, despite evidence-based maternal-nutrition interventions happening on ground. We conducted a scoping review to understand different strategies and delivery mechanisms to improve maternal nutrition, as well as how interventions have improved coverage and uptake of services. An electronic search was conducted in PubMed and Google Scholar for published studies reporting on the effectiveness of maternal-nutrition interventions in terms of access or coverage, health outcomes, compliance, and barriers to intervention utilization. The search was limited to studies published within ten years before the initial search date, 8 November 2019; later, it was updated to 17 February 2021. Of 31 studies identified following screening and data extraction, 22 studies were included for narrative synthesis. Twelve studies were reported from India and eleven from Bangladesh, three from Nepal, two from both Pakistan and Thailand (Myanmar), and one from Indonesia. Nutrition education and counselling, home visits, directly observed supplement intake, community mobilization, food, and conditional cash transfer by community health workers were found to be effective. There is a need to incorporate diverse strategies, including various health education approaches, supplementation, as well as strengthening of community participation and the response of the health system in order to achieve impactful maternal nutrition programs.

Background: Children born to high-risk pregnancies are more likely to experience adverse health outcomes later in life. As estimated, 15% of all pregnancies are at risk of various life-threatening conditions leading to adverse maternal and foetal outcomes. Millennium Development Goal resulted in the global reduction of maternal death from 390,000 to 275000 in 1990–2015). Similarly, to keep this momentum, the current United Nations Sustainable Development Goal (SDG: 3.1) aims at reducing the global maternal mortality ratio to less than 70 per 100,000 live births by 2030, and this can be achieved by addressing high-risk pregnancy contributing to significant mortality and morbidity. In India, gestational diabetes, gestational hypertension, and gestational hypothyroidism were identified as factors contributing to the high-risk pregnancy. This review summarises the commonly used approach for screening, diagnosis, and management of these conditions in the Asian population. It draws a comparison with the current protocols and guidelines in the Indian setting.Methods: Electronic search in PubMed and Google Scholar, reference snowballing, and review of current guidelines and protocols were done between January 2010 to October 2019. Published studies reporting Screening, diagnosis, and management of these conditions were included. Articles selected were then screened, appraised for quality, extract relevant data, and synthesised.Results: Screening, diagnosis, and management of these three conditions vary and no single universally accepted criteria for diagnosis and management exist to date. In India, national guidelines available have not been evaluated for feasibility of implementation at the community level. There are no national guidelines for PIH diagnosis and management despite the increasing burden and contribution to maternal and perinatal morbidity and mortality. Criteria for diagnosis and management of gestational diabetes, gestational hypertension, and gestational hypothyroidism varies but overall early screening for predicting risk, as reported from majority of the articles, were effective in minimizing maternal and foetal outcome.Conclusion: Existing National guidelines for Screening, Diagnosis, and Management of Gestational Diabetes Mellitus (2018) and Gestational Hypothyroidism (2014) need to be contextualized and modified based on the need of the local population for effective treatment. Findings from this review show that early screening for predicting risk to be an effective preventive strategy. However, reports related to a definitive diagnosis and medical management were heterogeneous.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the efficacy and safety of pertussis vaccination in pregnancy for preventing whooping cough in early infancy.

Introduction India accounts for more neonatal deaths than any other country. There is a lack of consolidated evidence from India regarding the determining factors of pneumonia in neonates. This systematic review is aimed to consolidate and appraise the evidence on risk factors and determinants of pneumonia among neonates in India. Methods and analysis This protocol is part of a project consisting of three reviews (two systematic reviews and one scoping review) and a qualitative study on neonatal pneumonia in India. English language observational studies which report risk factors and determinants of neonatal pneumonia in India will be eligible for inclusion. Electronic searching of nine databases, and hand searching will be done. Two authors will independently conduct screening (title, abstract and full-text stages), extract data and assess risk of bias. A meta-analysis is planned to be performed with random-effects model. A narrative synthesis will be used to summarise the characteristics and findings of the review, if a meta-analysis cannot be performed. If there are more than 10 studies, publication bias will be assessed. Sensitivity and subgroup analysis will performed based on data availability. The quality of our review will be assessed by using ‘Assessing the Methodological quality of Systematic Reviews’ and ‘Grades of Recommendation, Assessment, Development and Evaluation’. Ethics and dissemination The protocol of the entire project has been approved by the host institution’s ethics body (Institutional Ethics Committee, Manipal University, Manipal, India), and the ‘Health Ministry Screening Committee’ under the Ministry of Health and Family Welfare, Government of India. The study findings will be disseminated among relevant stakeholders using knowledge dissemination workshops, policy briefs, publications, etc. PROSPERO registration number CRD42016044019.

Introduction India accounted for more neonatal deaths (estimated at 696 000) than any other country, as of 2015. Of these , most neonatal deaths due to infections can be attributed to pneumonia which accounts for 16% of all neonatal mortalities (2010). Despite simple, inexpensive case management strategies being available, pneumonia continues to cause significant mortality and morbidity among neonates. Understanding the perceptions and experiences of stakeholders of neonatal care can help find solutions to barriers to care and design tailored strategies for controlling neonatal pneumonia. Methods and analysis A pan-India qualitative study will be conducted. Participants include healthcare providers, programme officers, academicians, representatives of non-governmental organisations/bilateral agencies and policy makers. They will be recruited purposively from rural and urban, public and private, and facility and community healthcare settings across six Indian regions. Within each region, a minimum of one state will be selected. Districts will be based on neonatal mortality indicators, and will be subject to feasibility at the time of conducting the study. We plan to conduct in-depth interviews (IDI) and focus group discussions focusing on (a) burden, (b) risk factors, (c) case management, (d) treatment guidelines, (e) barriers to case management, (f) recommendations. The number of interviews will depend on the information saturation. Interviews will be audio-recorded with prior written consent and transcribed verbatim. Principles of thematic analysis will be applied for qualitative data analysis using R package for Qualitative Data Analysis (RQDA). Ethics and dissemination The protocol has been approved by the Health Ministry Screening Committee, Government of India and the Institutional Ethics Committee at the host institution. Confidentiality and privacy of the participants will be maintained. The findings of the study will be shared with all stakeholders of this research including the participants. Knowledge dissemination workshops will be conducted to ultimately transfer the evidence tailored to the stakeholders' need.

Introduction India contributes to the highest neonatal deaths globally. Case management is said to be the cornerstone of pneumonia control. Much of the published evidence focuses on children aged 1 to 59 months. This scoping review, thus, aims to identify the treatment options for and barriers to case management of neonatal pneumonia in India. Methods and analysis This protocol is part of a series of three reviews on neonatal pneumonia in India. Studies addressing treatment of or barriers to case management of neonatal pneumonia in Indian context, published in English in peer-reviewed and indexed journals will be eligible for inclusion. Electronic search will be conducted on nine databases. Hand searching and snowballing will be done for published and grey literature. Selection of studies will be done in title, abstract and full-text stages. A narrative summary will be performed to summarise the details of evidence. Ethics and dissemination As this is a review involving analysis of secondary data which is available in the public domain and does not involve human participants, ethical approval was not required. The findings of the study will be shared with all stakeholders of this research. Knowledge dissemination workshops will be conducted with relevant stakeholders to ultimately transfer the evidence tailored to the stakeholder (eg, policy briefs, publications, information booklets and so on). PROSPERO 2016 CRD42016045449

Introduction India contributes to the highest number of neonatal deaths globally. It also has the greatest number of pneumonia-related neonatal deaths in the developing world. We aim to systematically review the evidence for the factors associated with mortality due to neonatal pneumonia in the Indian context, to address the lack of consolidated evidence on this important issue. Methods and analysis This protocol is part of a series of three reviews on neonatal pneumonia in India. Observational studies reporting on outcome of neonatal pneumonia in the Indian context, and published in English in peer-reviewed and indexed journals will be eligible for inclusion. Outcomes of this review will be the factors determining mortality due to neonatal pneumonia. A total of nine databases will be searched. Electronic and hand searching of published and grey literature will be performed. Selection of studies will be done in title, abstract and full text screening stages. Risk of bias, independently assessed by two authors, will be evaluated. Meta-analysis will be performed and heterogeneity assessed. Pooled effect estimates will be stated with 95% confidence intervals. Narrative synthesis will be done where meta-analysis cannot be performed. Publication bias will be evaluated and sensitivity analysis performed according to study quality. Quality of this review will be evaluated using AMSTAR (Assessing the Methodological quality of Systematic Reviews) and GRADE (Grades of Recommendation, Assessment, Development & Evaluation). A summary of findings table will be reported using GRADEPro. Ethics and dissemination Since this is a review involving analysis of secondary data which is available in the public domain, and does not involve human participants, ethical approval was not required. The findings of the study will be shared with all stakeholders of this research. Knowledge dissemination workshops will be conducted with relevant stakeholders to transfer the evidence, tailored to the stakeholder (eg, policy briefs, publications, information booklets, etc).

Introduction: Fifty-three percent of Indian under-5 deaths occur during the neonatal age group. Recognizing that there is a lack of illustrated district-level data on neonatal mortality in India, we mapped this to visually highlight districts where neonatal health issues require the most attention. Methods: District-level estimates of 596 Indian districts were used to generate maps and to illustrate neonatal mortality rates (NMRs), absolute numbers of neonatal deaths; the best and worst performing districts (positive and negative deviants) in each Indian state; the neonatal female/male death ratio; and district lag in NMR reductions. Results: The NMR ranged from 4.3 (Kannur, Kerala) to 65.1 (Datia, Madhya Pradesh), with the mean NMR being 29.8. Almost two-thirds of the districts (n = 380, 63.7%) had NMRs between 20 and 40. The top third of neonatal deaths could be accounted for by just 71 districts of a total of 596. Conclusion: There is an urgent need for up-to-date data on district-level neonatal mortality in India.