Bangladesh struggles with undernutrition in women and young children. Nutrition‐sensitive agriculture programmes can help address rural undernutrition. However, questions remain on the costs of ...multisectoral programmes. This study estimates the economic costs of the Targeting and Re‐aligning Agriculture to Improve Nutrition (TRAIN) programme, which integrated nutrition behaviour change and agricultural extension with a credit platform to support women's income generation. We used the Strengthening Economic Evaluation for Multisectoral Strategies for Nutrition (SEEMS‐Nutrition) approach. The approach aligns costs with a multisectoral nutrition typology, identifying inputs and costs along programme impact pathways. We measure and allocate costs for activities and inputs, combining expenditures and micro‐costing. Quantitative and qualitative data were collected retrospectively from implementers and beneficiaries. Expenditure data and economic costs were combined to calculate incremental economic costs. The intervention was designed around a randomised control trial. Incremental costs are presented by treatment arm. The total incremental cost was $795,040.34 for a 3.5‐year period. The annual incremental costs per household were US$65.37 (Arm 2), USD$114.15 (Arm 3) and $157.11 (Arm 4). Total costs were led by nutrition counselling (37%), agriculture extension (12%), supervision (12%), training (12%), monitoring and evaluation (9%) and community events (5%). Total input costs were led by personnel (68%), travel (12%) and supplies (7%). This study presents the total incremental costs of an agriculture‐nutrition intervention implemented through a microcredit platform. Costs per household compare favourably with similar interventions. Our results illustrate the value of a standardised costing approach for comparison with other multisectoral nutrition interventions.
Key messages
Nutrition‐sensitive agriculture programmes can improve rural undernutrition but lack information on costs.
We use a standardised approach to estimate the total incremental costs of an integrated nutrition intervention in Bangladesh to improve maternal and child undernutrition.
Costs per household compare favourably with similar interventions.
This study provides evidence on the costs of integration to support the design and implementation of multisectoral nutrition programmes.
Our results illustrate the value of standardising costing to facilitate comparisons with other multisectoral nutrition interventions.
Abstract
Gynecological cancers are among the most common cancers in women and hence an important public health issue. Due to the lack of cancer awareness, variable pathology, and dearth of proper ...screening facilities in developing countries such as India, most women report at advanced stages, adversely affecting the prognosis and clinical outcomes. Ovarian cancer has emerged as one of the most common malignancies affecting women in India and has shown an increase in the incidence rates over the years. Although cervical cancer is on a declining trend, it remains the second most common cancer in women after breast cancer. Many researchers in India have published important data in the field of gynecologic oncology, covering all domains such as basic sciences, preventive oncology, pathology, radiological imaging, and clinical outcomes. This work has given us an insight into the in-depth understanding of these cancers as well as the demographics and survival rates in the Indian population. This aim of this review is to discuss the important studies done in India for all gynecological cancers.
In the United States, 1 out of every 3 people lives in a mental health professional shortage area. Shortage areas tend to be rural, have higher levels of poverty, and have poor mental health ...outcomes. Previous work has demonstrated that these poor outcomes may arise from interactions between a lack of resources and lack of recognition of mental illness by medical professionals.
We aimed to understand the differences in how people in shortage and nonshortage areas search for information about mental health on the web.
We analyzed search engine log data related to health from 2017-2021 and examined the differences in mental health search behavior between shortage and nonshortage areas. We analyzed several axes of difference, including shortage versus nonshortage comparisons, urban versus rural comparisons, and temporal comparisons.
We found specific differences in search behavior between shortage and nonshortage areas. In shortage areas, broader and more general mental health symptom categories, namely anxiety (mean 2.03%, SD 0.44%), depression (mean 1.15%, SD 0.27%), fatigue (mean 1.21%, SD 0.28%), and headache (mean 1.03%, SD 0.23%), were searched significantly more often (Q<.0003). In contrast, specific symptom categories and mental health disorders such as binge eating (mean 0.02%, SD 0.02%), psychosis (mean 0.37%, SD 0.06%), and attention-deficit/hyperactivity disorder (mean 0.77%, SD 0.10%) were searched significantly more often (Q<.0009) in nonshortage areas. Although suicide rates are consistently known to be higher in shortage and rural areas, we see that the rates of suicide-related searching are lower in shortage areas (mean 0.05%, SD 0.04%) than in nonshortage areas (mean 0.10%, SD 0.03%; Q<.0003), more so when a shortage area is rural (mean 0.024%, SD 0.029%; Q<2 × 10
).
This study demonstrates differences in how people from geographically marginalized groups search on the web for mental health. One main implication of this work is the influence that search engine ranking algorithms and interface design might have on the kinds of resources that individuals use when in distress. Our results support the idea that search engine algorithm designers should be conscientious of the role that structural factors play in expressions of distress and they should attempt to design search engine algorithms and interfaces to close gaps in care.
This article presents an ethnographic study of the adoption and use of Facebook among urban Indian youth from socioeconomically disadvantaged communities. Mobile-centric use of the Internet is widely ...prevalent here as general packet radio service (GPRS)-enabled mobile phones and data plans have become increasingly affordable. Less privileged youth are the lead adopters of these new technologies, and typically the first generation of Internet users, in their communities. My research uncovers their leisure-driven engagement with new media, seen through the lens of Facebook use, and the development-friendly outcomes that result from it. By examining the direct and indirect affordances of Facebook perceived by these youth, this article highlights how they swiftly negotiate social boundaries and technological hurdles, transitioning into legitimate members of a global community.
Investments in social assistance programmes (SAPs) have accelerated alongside interest in using SAPs to improve health and nutrition outcomes. However, evidence of how design features within and ...across programme types influence the effectiveness of SAPs for improving diet and nutrition outcomes among women and children is limited. To address this, we reviewed evaluations of cash, in‐kind and voucher programmes conducted between 2010 and 2020 among women and children, and examined associations between design features (targeting, including household and individual transfers, fortified foods and behaviour change communication) and positive impacts on diet (diet diversity, micronutrient intake) and nutrition (anthropometric indicators, haemoglobin, anaemia) outcomes. Our review has several key findings. First, SAPs improve dietary diversity and intake of micronutrient‐rich foods among women and children, as well as improve several nutrition outcomes. Second, SAPs were more likely to impact diet and nutrition outcomes among women compared with children (23/45 51% vs. 52/144 36% of outcomes measured). Third, in‐kind (all but one of which included fortified foods) compared with cash transfer programmes were more likely to significantly increase women's body mass index and children's weight‐for‐height/length Z‐score, and both women's and children's haemoglobin and anaemia. However, there is limited evidence on the effectiveness of SAPs for improving micronutrient status and preventing increased prevalence of overweight and obesity for all populations and for improving diet and nutrition outcomes among men, adolescents and the elderly. Further research in these areas is urgently needed to optimize impact of SAPs on diet and nutrition outcomes as countries increase investments in SAPs.
Key Points/Highlights
Social assistance programmes (SAPs) can be used to improve diets of women and children.
Effectiveness of SAPs may differ by programme type and outcome assessed. For example, in‐kind transfers (with fortified foods) compared with cash transfer programmes were more likely to significantly increase children's weight‐for‐length/height Z‐score (WLZ/WHZ), and women's and children's haemoglobin concentration (Hb) and decrease anaemia prevalence.
If programmes aim to reduce stunting and anaemia or increase WLZ/WHZ, mid‐upper arm circumference or Hb, they should consider targeting women and/or young children, including both household and individual transfers, fortified foods/supplement and/or behaviour change communication.
Evidence of the effectiveness of SAPs for improving micronutrient status and preventing an increase in overweight and obesity is scarce as is evidence for the effectiveness of SAPs for improving diet and nutrition outcomes among men, adolescents and the elderly in low‐ and middle‐income countries.
To better understand which programme design features are most important for achieving impacts, randomized evaluation designs and consistency in programme and evaluation design across several programmes in different contexts are needed.
Background: Severe acute respiratory virus syndrome coronavirus 2 (SARS-CoV-2) was responsible for coronavirus disease (COVID-19) pandemic. As patients recovered from COVID-19 infection, hair loss ...was increasingly observed as a distressing symptom.
Methods: This was a prospective cross-sectional study of patients with post COVID-19 hair loss between July to December 2021 at a tertiary care centre. Detailed history, clinical examination, trichoscopy and biochemical tests were performed and recorded. COVID-19 disease severity was assessed based on duration of COVID-19 infection and place of management.
Results: The study included 120 patients with mean age being 39.6 years. Majority of the patients were females, treated at home and had COVID-19 infection for >2 weeks. Mean visual analog scale (VAS) score for stress was 5.25. Vitamin D deficiency was present in 56.7% and low ferritin in 30% of cases. Mean time of onset of hair loss post COVID-19 was 49 days. Patients mainly presented with diffuse hair loss. Trichodynia was present in 15.8% of cases. The degree of hair loss was severe in 55.8% of the subjects. Positive hair pull test was seen in 65% of patients. Most common trichoscopic features included single hair follicles’ (81.7%) and vellus hair >10% (60%).
Conclusions: The mean time of onset of hair loss post COVID-19 infection was less than 2 months. Majority patients had diffuse pattern and severe degree of hair loss. Trichoscopy can aid in unmasking co-existing patterned hair loss in patients presenting clinically with diffuse hair loss.
Azulene is a non‐alternant non‐benzenoid aromatic system, and in turn, it possesses unusual photophysical properties. Azulene‐based conjugated systems have received increasing interest in recent ...years as optoelectronic materials. Despite the routes available for the preparation of substituted azulene derivatives, there remain few methods that allow regioselective substitution on the seven‐membered ring of azulenes due to the subtle reactivity difference among the various positions. This report explores the reactivity of substituted tropolones as the azulene precursors and also provides a new method to create 5‐substituted azulenes. The reaction of cyanoacetate enolate with unsubstituted 2‐methoxytropone affords azulene through the attack of the nucleophile on the C‐2 center (normal pathway). We have observed that 3‐substituted 2‐methoxytropones undergo steric‐guided nucleophilic addition at the C‐7 center (abnormal pathway) to afford 5‐substituted azulene derivatives. Based on this observation and DFT calculation, a new synthetic strategy is devised for the regioselective synthesis of 5‐substituted multifunctional azulenes, which cannot be accessed by any other method.
Unexpected outcome: Abnormal nucleophilic attack on the 3‐substituted 2‐methoxytropones, rather than the expected normal nucleophilic attack, leads to a new steric strategy for the synthesis of 5‐substituted multifunctional azulenes (see scheme).
IntroductionIndia is home to over 6 million women’s groups, including self-help groups. There has been no evidence synthesis on whether and how such groups improve women’s and children’s ...health.MethodsWe did a mixed-methods systematic review of quantitative and qualitative studies on women’s groups in India to examine effects on women and children’s health and to identify enablers and barriers to achieving outcomes. We searched 10 databases and included studies published in English from 2000 to 2019 measuring health knowledge, behaviours or outcomes. Our study population included adult women and children under 5 years. We appraised studies using standard risk of bias assessments. We compared intervention effects by level of community participation, scope of capability strengthening (individual, group or community), type of women’s group and social and behaviour change techniques employed. We synthesised quantitative and qualitative studies to identify barriers and enablers related to context, intervention design and implementation, and outcome characteristics.FindingsWe screened 21 380 studies and included 99: 19 randomised controlled trial reports, 25 quasi-experimental study reports and 55 non-experimental studies (27 quantitative and 28 qualitative). Experimental studies provided moderate-quality evidence that health interventions with women’s groups can improve perinatal practices, neonatal survival, immunisation rates and women’s and children’s dietary diversity, and help control vector-borne diseases. Evidence of positive effects was strongest for community mobilisation interventions that built communities’ capabilities and went beyond sharing information. Key enablers were inclusion of vulnerable community members, outcomes that could be reasonably expected to change through community interventions and intensity proportionate to ambition. Barriers included limited time or focus on health, outcomes not relevant to group members and health system constraints.ConclusionInterventions with women’s groups can improve women’s and children’s health in India. The most effective interventions go beyond using groups to disseminate health information and seek to build communities’ capabilities.Trial registration numberThe review was registered with PROSPERO: CRD42019130633.
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