Introduction We investigated the burden of surgical conditions, level of unmet needs and reasons for non‐utilization of surgical services in a slum of Ahmedabad, India. Methods A community‐based cross‐sectional study was carried out from August to December 2019. Inclusion criteria was age > 14 years; any type of injury/condition that requires surgery; subject has had surgery in last 1 year, and death information of family members. Data were stored and coded in Microsoft excel and exported to IBM SPSS statistics version 25 software for data analysis. Frequencies and proportions (categorical variable) are used to summarize utilization of surgical services and understanding surgical need. The Surgeons Overseas Assessment of Surgical was used to identify surgical met and unmet needs translated into local language. Open Data Kit software was used to install questionnaire in the “Tablet” to collect information and stress‐free workflow in field. Results Out of 10,330 population in 2066 households, 7914 were more than 14 years of age. 3.46% (n = 274) people needed surgery; 116 did not avail surgery and were categorized in “unmet need.” Fifty percent of individuals with surgical needs had abdominal‐ or extremities‐related problems followed by eyes surgery need (14%); back, chest and breast surgical need was 13.5%. Seventeen percent of participants with surgical needs had wounds related to injury or accident while 63% had wounds that were not related to injury. Almost all participants had gone to a physician to seek healthcare, however 42% did not avail surgical care needed for a variety of reasons. Forty‐six percent of participants needing surgical care underwent major surgical procedure, while 11% had minor procedures. Financial reasons (34.5%) and lack of trust (35.3%) were major reasons for not availing surgical care. Conclusions and Relevance Ahmedabad is a relatively high income metropolitan city, has universally free health care and multiple healthcare facilities. Despite this, we have shown that there is significant unmet need for surgical procedures in the low‐income population. A unique finding was that most patients sought a consultation but approximately 50% did not avail of the free surgical procedures under the universally free health care system in this city. We propose creation of community healthcare workers focused on surgical conditions.

Background Little research has explored the influence of social context on health of Indian adolescents. We conceptualized community-level women’s education (proxy for value placed on women’s wellbeing) as exerting contextual influence on adolescent hemoglobin level and body mass index (BMI). Methods We derived our sample of more than 62,000 adolescent aged 15 through 17 years from the Indian National Family Health Survey 2015–16. The sample consisted of a total of 62648 adolescents (54232 girls and 8416 boys) for the hemoglobin, and 62846 adolescents (54383 girls and 8463 boys) for the BMI analysis. We fitted multilevel random intercepts linear regression models to test the association of village- and urban-ward-level-women’s education with hemoglobin level and BMI of adolescents, accounting for their own and their mother’s education; as well as relevant covariates. Findings Our fully adjusted model estimated that if the 52% of communities with less than 20 percent of women having a tenth-grade education in our sample were to achieve 100 percent tenth-grade completion in women, hemoglobin would be 0·2 g/dl higher (p<0·001) and BMI would be 0·62 kg/m2 higher on average among all adolescents in such communities. Unexplained variance estimates at the contextual level remained statistically significant, indicating the importance of context on adolescent undernutrition. Interpretations Adolescents are deeply embedded in their context, influenced by contextual factors affecting health. Promoting adolescent health therefore implies altering social norms related to adolescent health and health behaviors; along with structural changes creating a health-promoting environment. Integrating our empirical findings with theoretically plausible pathways connecting community-level women’s education with adolescent undernutrition, we suggest that enhancing community-level women’s education beyond high school is necessary to facilitate these processes. Implications Addressing contextual determinants of adolescent undernutrition might be the missing link in India’s adolescent anemia and undernutrition prevention efforts, which are currently focused heavily on individual-level biomedical determinants of the problem.

Background There is a theory-praxis gap related to health literacy interventions focused on non-communicable diseases (NCD) among young people. We designed a NCD curriculum and investigated its’ effect on health literacy in non-medical, non-nursing college students in India. We deliberately selected non-medical and non-nursing college students as we hypothesized they would have minimal baseline knowledge of NCDs. Methods We initially carried out a pilot study in 85 students in a four-day long workshop (12 teaching hours) using empirically developed health literacy instrument. We administered the curriculum to 120 randomly selected students in 4 colleges, while 50 students were controls. The curriculum was given over 4 days for a total of 32 hours. Each lecture comprised of didactic lecture followed by discussion and skills testing of measuring BP and blood sugar. Health literacy was measured using a specifically designed tool at baseline and endline. Difference in health literacy scores between the two time-points was analyzed using the t-test. Multiple linear and Poisson regression models were used for covariates. Results Study groups were comparable at baseline. The intervention group showed 20.6% higher health literacy score at endline versus control group (p<0.001). Participants scoring 40% or above on the health literacy measure in both groups were comparable at baseline. However, the proportion of participants scoring 40% or above was higher in the intervention group versus control group at endline (p<0.001). Conclusions We provide empirical data to support incorporation of NCDs as a credit course in college curricula in low and middle income countries. This is the first study in the Indian context that addressed NCD-related health literacy in a randomized trial.

We conceptualized Surgical Accredited and Trained Healthcare Initiative (SATHI) as a community-based worker through which patients who are unaware or undecided of surgical conditions would be linked to service providers. These personnel will help patients to attain the benefits of health schemes and will offer counseling through trust-building and elimination of fear of surgical procedures to reduce the surgical unmet needs. Our baseline study identified five common surgical problems among the study population: extremity injuries/wounds; kidney stones; cataracts; abdominal pain, including external hernias, and menstrual disorders. Based on these findings, we designed a modular, skills-focused curriculum and recruited six full-time staff who have undergone didactic and practical training. Upon finding any suspected health condition, SATHI staff are trained to encourage the patient and their family to seek medical advice. They are also equipped with the basic information about the surgical management of these conditions and will offer preoperative and post-operative surgical care and psychosocial support. This publication describes the process of development of training material, methods and process. Each SATHI worker has been assigned 1000 households (~5000 population). Based on our estimates, he/she will have to cater to 64 cases of unmet surgical needs if the unmet need is 40%. This means a SATHI worker would have approximately five to six cases of unmet surgical needs per month. We are planning to analyze the survey findings, document the process of implementation, and based on learnings from the pilot project, modify the training material and protocol.

BackgroundThere is a theory-praxis gap related to health literacy interventions focused on non-communicable diseases (NCDs) among young people. We designed an NCD curriculum and investigated its' effect on health literacy in non-medical, non-nursing college students in India. We deliberately selected non-medical and nonnursing college students (age 17 to 22 years) as we hypothesized, they would have a minimum baseline knowledge of NCDs. MethodsWe initially carried out a pilot study on 85 students in a four-day-long workshop (32 teaching hours) using empirically developed health literacy instrument. We administered the curriculum to 120 randomly selected students in four colleges, while 50 students were assigned to the comparison group. The curriculum was given over four days for a total of 32 hours. Approval was sought to give four credits for completion of the course. Each lecture comprised didactics, followed by discussion, and skills testing of measuring blood pressure and blood sugar. Health literacy was measured using a specifically designed tool at baseline and endline. The difference in health literacy scores between the two time-points (timepoint 1: before delivering the curriculum, time-point 2: at the end of four days of training) was analyzed using the t-test. Multiple linear and Poisson regression models were used to account for covariates. ResultsThe average difference between the intervention and the control group in baseline scores was 0.05% points (unpaired t-test statistics: -1.36, degrees of freedom 103.15, p>0.05). The same at endline was 20.59% points (unpaired t-test statistics: -11.31, degrees of freedom 138.14, p<0.001). The endline to baseline difference in health literacy scores was 18.54% points higher in the intervention group versus the control group (unpaired t-test statistics: -10.88, degrees of freedom 161.32, p<0.001). The difference-in-difference scores remained significant after accounting for college setting and baseline score (Multivariable linear regression model, β: 19.62% points, p<0.001). None of the socio-economic characteristics were significantly associated with the difference in the difference scores, independent of the intervention effect. The proportion of participants scoring 40% or above on the health literacy measure at endline was significantly higher in the intervention versus the control group (p<0.001). ConclusionsWe provide empirical data to support the incorporation of NCDs as a credit course in college curricula in low-and middle-income countries. Our findings showed that a theory-driven skills-focused curriculum may be a tool for enhancing NCD health literacy in Indian youth from diverse academic and socio-economic backgrounds.