Background: Equitable access to health care is an important issue and cannot be ignored during any pandemic. Although affordability is the most common barrier to healthcare, in a coronavirus disease (COVID)-19 pandemic lockdown people may not get necessary healthcare due to non-availability of transport, cancellation of appointments, and fear of getting infected by a coronavirus (severe acute respiratory syndrome coronavirus 2) in the hospitals besides disruption of the healthcare services. Due to this millions of people could lose access to essential healthcare services. Objectives: The study was conducted with the objective to assess the level of unmet healthcare needs and to identify major barriers to healthcare during the COVID-19 pandemic. Materials and Methods: This was an online survey conducted at the household level during the COVID-19 pandemic on a self-designed questionnaire which was based on European Union Statistics on Income and Living Conditions,

BackgroundWithin Kashmir, which is one of the topographically distinct areas in the Himalayan belt of India, a total of 2,236 cumulative deaths occurred by the end of the second wave. We aimed to conduct this population-based study in the age group of 7 years and above to estimate the seropositivity and its attributes in Kashmir valley.MethodsWe conducted a community-based household-level cross-sectional study, with a multistage, population-stratified, probability-proportionate-to-size, cluster sampling method to select 400 participants from each of the 10 districts of Kashmir. We also selected a quota of healthcare workers, police personnel, and antenatal women from each of the districts. Households were selected from each cluster and all family members with age 7 years or more were invited to participate. Information was collected through a standardized questionnaire and entered into Epicollect 5 software. Trained healthcare personnel were assigned for collecting venous blood samples from each of the participants which were transferred and processed for immunological testing. Testing was done for the presence of SARS-CoV-2-specific anti-spike IgM, IgG antibodies, and anti-nucleocapsid IgG antibodies. Weighted seropositivity was estimated along with the adjustment done for the sensitivity and specificity of the test used.FindingsThe data were collected from a total of 4,229 participants from the general population within the 10 districts of Kashmir. Our results showed that 84.84% (95% CI 84.51–85.18%) of the participants were seropositive in the weighted imputed data among the general population. In multiple logistic regression, the variables significantly affecting the seroprevalence were the age group 45–59 years (odds ratio of 0.73; 95% CI 0.67–0.78), self-reported history of comorbidity (odds ratio of 1.47; 95% CI 1.33–1.61), and positive vaccination history (odds ratio of 0.85; 95% CI 0.79–0.90) for anti-nucleocapsid IgG antibodies. The entire assessed variables showed a significant role during multiple logistic regression analysis for affecting IgM anti-spike antibodies with an odds ratio of 1.45 (95% CI 1.32–1.57) for age more than 60 years, 1.21 (95% CI 1.15–1.27) for the female gender, 0.87 (95% CI 0.82–0.92) for urban residents, 0.86 (95% CI 0.76–0.92) for self-reported comorbidity, and an odds ratio of 1.16 (95% CI 1.08–1.24) for a positive history of vaccination. The estimated infection fatality ratio was 0.033% (95% CI: 0.034–0.032%) between 22 May and 31 July 2021 against the seropositivity for IgM antibodies.InterpretationDuring the second wave of the SARS-CoV-2 pandemic, 84.84% (95% CI 84.51–85.18%) of participants from this population-based cross-sectional sample were seropositive against SARS-CoV-2. Despite a comparatively lower number of cases reported and lower vaccination coverage in the region, our study found such high seropositivity across all age groups, which indicates the higher number of subclinical and less severe unnoticed caseload in the community.

Background: The term pregnancy induced hypertension (PIH) suggests a disorder of blood pressure that arises because of the pregnancy. PIH is defined as new onset hypertension with or without significant proteinuria emerging after 20 weeks of gestation, during labour, or in first 48 hours post-partum. It is classified as gestational hypertension (without proteinuria), preeclampsia (with proteinuria), and eclampsia (associated with convulsions). Incidence of PIH varies from country to country and has been reported to occur as low as 0.51% to as high as 38.4%. The objectives of the study were to estimate the incidence of PIH in block Hazratbal, Srinagar and to see the extent of progression of gestational hypertension into preeclampsia and eclampsia.Methods: A community based longitudinal study was conducted in block Hazratbal (district Srinagar) for a period of 18 months. All the pregnant females attending the antenatal clinic at the sub-centers and PHCs were included in the study and assessed for eligibility (less than 20 weeks and normotensive), till the desired number of 385 eligible pregnant females was reached. The pregnant women enrolled in the study were examined again around 30 weeks, 37 weeks and once in postnatal period.Results: The incidence of PIH was 20%. Majority of them (14.5%) had Gestational Hypertension and about one-fourth (5.5%) progressed to pre-eclampsia, while no one developed eclampsia.Conclusions: PIH is common among Kashmiri females, 20 out of 100 pregnant females develop PIH. PIH is a major cause of perinatal mortality, preterm delivery, IUGR, and maternal morbidity and mortality.

Background: Pregnancy is a normal physiological state which a woman experiences at some point of her life. During pregnancy a woman may develop complications which pose a risk to both maternal and fetal health. Caesarean section is a surgical procedure in which incision is made through a mother’s abdomen and uterus to deliver one or more babies. The aim and objective of the study was to describe feto-maternal outcome among the study population in block Hazratbal, Srinagar.Methods: A community based longitudinal study was conducted in block Hazratbal (District Srinagar) for a period of 18 months. All the pregnant females attending the antenatal clinic at the subcenters and PHCs were included in the study and assessed for eligibility. The pregnant women enrolled in the study were examined again around 30 weeks, 37 weeks and once in postnatal period. Results: Only 2.6% were home deliveries. More than two-thirds (71.7%) of the study subjects delivered by LSCS and less than 2% of the study subjects delivered twins. Out of 391 children born 2 were born dead and 55.2% were of male gender. The mean gestational age at delivery was 38.56 weeks and the mean birth weight of neonates was 2.731 kg with only 4.9% LBW neonates. Conclusions: The percentage of institutional deliveries was good (97.4%) and the proportion of twins and male babies were within expected limits. The prevalence of LBW babies was only 4.9 against the national average of 28%. But the 71.7% caesarean section rate is too high and needs immediate attention by policy makers. Moreover both healthcare professional as well as general population need to be educated about the disadvantages of unnecessary caesarian sections.

Background: Elderly population aged 60 years and above in the world will reach 1.2 billion by the year 2025, the majority of whom will be in developing countries. Major health problems which are faced in this age group are hypertension, CAD, atherosclerosis, strokes, DM, obesity, cancers, cataracts, osteoarthritis, osteoporosis, chronic obstructive airway disease, benign hyperplasia of prostate, Alzheimer's disease, Parkinson's disease, senile Dementia and depression.Objective: To estimate the prevalence of depression among geriatric population in block Hazratbal, district Srinagar. Methodology:The 496 elderly subjects were interviewed in their local/Urdu language and they were examined by using a pre-tested, pre-structured study questionnaire. The questionnaire was divided into two parts. The first part comprised of the socio-demographic information which covered a diverse set of parameters such as age, sex, marital status, education, socio-economic status, Non-communicable diseases, living conditions, economic dependency and the dependency for the activities of daily living, impact of turmoil caused due to conflict in the state. In second part Geriatric Depression Scale (GDS 30-item) was used to measure depression in geriatric population in the selected sample population. Results:In the present study, it was found that 31.5% of elderly were suffering from depression. 27.2% of elderly had Mild depression, whereas only 4.2% had severe depression as males (31.5%) p<0.001. Both the categories of depression were found to be more in elderly females. Prevalence of severe depression in elderly females (7.1%). Conclusion:Overall prevalence of depression was fairly high among the elderly subjects in this part of the world. Depression was more common in females as compared to males. Advanced age, illiteracy, occupations, marital status, socio-economic class, family pattern, economic dependence, dependence for activities of daily living, children dependency, expected care givers, relationship with spouse are the strong predictors on the prevalence of depression in the elderly.