Background The health of children and adolescents can be promoted through schools as they spend most of their time in school. The Health Promoting Schools (HPS) framework provides a set of policies to be followed in schools for improving the health status of school-going children and adolescents. The current study was done to assess this framework among schools in rural Puducherry. Methods Key informant interviews were done with the teachers under the six World Health Organisation (WHO) HPS framework domains to develop an observation checklist for the assessment of schools in the study area. After the survey, in-depth interviews were conducted as an approach to explore the existing health promotion activities, facilitating or hindering factors in the implementation of health promotion framework and suggestions for improving the same. Results A quantitative survey on nine schools showed that almost all the schools were lacking in domains such as health promotion policy, behaviour counselling and mental and social support. Physical education, facilities and policies for nutrition and community collaboration exist in only some of the schools. Qualitative interviews also showed similar findings and most of the teachers suggested to include training for general health emergencies and behaviour counselling. Conclusion The current study showed that most of the schools were lacking in almost all the domains under the HPS framework. Hence, stakeholders at all levels should be made aware of this framework and develop a strategy for uniform implementation of it in all the schools in the region.

Background The World Health Organisation has reported that mental disorders are one of the leading causes of disability worldwide. Social phobia is one such mental disorder that can have significant impact on the livelihood of adults if not detected at an early stage. There have been very few studies done on social phobia among adolescents in South India. Hence, this study was done to determine the prevalence of social phobia and factors associated with it among the school-going adolescents in rural Puducherry. Methodology A community-based cross-sectional study was conducted among 1018 school going adolescents from December 2017 to January 2018 in rural Puducherry. Information on socio-demographic characteristics was collected by a pre-tested semi-structured questionnaire and social phobia was assessed using the validated Social Phobia Inventory (SPIN) questionnaire. Results Among 1018 participants, 738 (72.5%) belonged to early adolescence (10–13 years); 520 (51.1%) were boys; 557 (54.7%) were studying in a middle class; 931 (91.5%) were Hindus; 978 (96.1%) had siblings. The prevalence of social phobia among adolescents was found to be 22.9% (95% CI: 20.4–25.5%). The prevalence of mild social phobia was 18% [95% confidence interval (CI): 15.7–20.4%], moderate social phobia was 4% (95% CI: 2.9–5.4%), severe social phobia was 0.7% (95% CI: 0.3–1.3%) and very severe social phobia was 0.2% (95% CI: 0.03–0.64%). Higher age, female gender, lack of counselling services and specialist visits at school were found to be determinants of social phobia. Conclusion The current study showed that one in every five adolescents was at risk of developing social phobia. Health education for students, teachers and family members needs to be given to make them aware of the importance of social phobia.

Background: Trend in morbidity and mortality due to noncommunicable diseases (NCDs) is rising because of poor control status. Medication nonadherence is one of the most common and modifiable causes of inadequate control status. Objectives: To examine the barriers in drug adherence among NCD patients in rural Puducherry. Methods: This qualitative study includes in-depth and key informant interview conducted among 6 NCD patients and 4 health-care providers. Interviews were audio-recorded, and transcript was prepared in verbatim format. Thematic content analysis was done to derive the categories and themes. Results: Major barriers for nonadherence to medications found were stress, substance abuse, forgetfulness, lack of family support, and high case load of health facilities. Corrective measures suggested to address the barriers were to provide health education to patients and family members, awareness campaigns in community, and health education sessions at the clinic. Conclusion: Psychological factors such as stress, social isolation, and negligence are major barriers for drug adherence. Health education session at community and health system is needed to improve the adherence.

In India, out-of-pocket (OOP) expenditure on health care services has been showing an increasing trend. The cost and willingness to pay determines the use of facility-based maternal health services. Hence, the current study was done to find the costs and determinants of OOP payments on childbirth care in India. We analyzed the most recent National Family Health Survey-4 data (NFHS-4) gathered from the Demographic Health Survey (DHS) program. Stratification and clustering in the sample design were accounted for by using the "svyset" command. Out of 43 507 women, 26 916 (61.9%) had incurred OOP expenditure during their most recent institutional delivery. The average OOP expenditure for delivery care was INR 5985 ($93.3) with median cost being INR 1000 ($15.6). About 80% of women who had OOP expenditure reported that they handled the financial situation by utilizing the money in their bank/savings account. Determinants of OOP expenses were the age of mother, education, religion, state of residence, number of antenatal visits place of delivery, and mode of delivery (P < .05). Out-of-pocket expenditure for accessing care is one of the key determinants of service utilization which, if not

Background Understanding the factors associated with private sector preference for vaccination will help in understanding the barriers in seeking public facility and also the steps to improve public–private partnership (PPP) model. Methods We analysed the recent National Family Health Survey-4 data (NFHS-4; 2015–16) gathered from Demographic Health Survey programme. Stratification and clustering in the sample design was accounted using svyset command. Results Weighted proportion of children receiving private vaccination was 10.0% (95% CI: 9.7–10.3). Children belonging to highest wealth quantile (adjusted Prevalence ratio; aPR-1.58), male child (aPR-1.07) urban area (aPR-1.11), not receiving anganwadi/Integrated Childhood Development Services (aPR-1.71) and receiving antenatal care in private sector was significantly associated with higher proportion of private vaccination. Conclusion Current study showed that 1 in 10 <5 years child in India received vaccination from private health facility. Preference for private health facility was found to be influenced by higher socio-economic strata, urban area residence and seeking private health facility for antenatal and delivery services.