IntroductionThe Healthy Life Trajectories Initiative is an international consortium comprising four harmonised but independently powered trials to evaluate whether an integrated intervention starting preconceptionally will reduce non-communicable disease risk in their children. This paper describes the protocol of the India study.Methods and analysisThe study set in rural Mysore will recruit ~6000 married women over the age of 18 years. The village-based cluster randomised design has three arms (preconception, pregnancy and control; 35 villages per arm). The longitudinal multifaceted intervention package will be delivered by community health workers and comprise: (1) measures to optimise nutrition; (2) a group parenting programme integrated with cognitive–behavioral therapy; (3) a lifestyle behaviour change intervention to support women to achieve a diverse diet, exclusive breast feeding for the first 6 months, timely introduction of diverse and nutritious infant weaning foods, and adopt appropriate hygiene measures; and (4) the reduction of environmental pollution focusing on indoor air pollution and toxin avoidance.The primary outcome is adiposity in children at age 5 years, measured by fat mass index. We will report on a host of intermediate and process outcomes. We will collect a range of biospecimens including blood, urine, stool and saliva from the mothers, as well as umbilical cord blood, placenta and specimens from the offspring.An intention-to-treat analysis will be adopted to assess the effect of interventions on outcomes. We will also undertake process and economic evaluations to determine scalability and public health translation.Ethics and disseminationThe study has been approved by the institutional ethics committee of the lead institute. Findings will be published in peer-reviewed journals. We will interact with policy makers at local, national and international agencies to enable translation. We will also share the findings with the participants and local community through community meetings, newsletters and local radio.Trial registration numberISRCTN20161479, CTRI/2020/12/030134; Pre-results.

Rise of groundwater-sourced irrigation in India towed along grave concerns over water resources conservation. In this narrative, we offer the authorities (groundwater and irrigation systems’ managers) a Groundwater Depletion Awareness Index (GDAI) – a collective expression of farmers’ cognitive awareness, integrating four key aspects of irrigated agriculture: (i) groundwater depletion; (ii) water-efficient crops; (iii) irrigation innovations for water conservation; and (iv) uptake of recent irrigation policies at grassroots. We employed a mixed method approach, a cross-sectional survey (10 villages, 100 farmers in Sonepat, Haryana) combined with multivariate statistics (principal component analysis and multivariate regression). Results indicated that although there is certain level of awareness about groundwater depletion, only about 8% of the interviewees adopted water-efficient practices, such as micro-irrigation (MI) and poly house farming (PH). About 42% of interviewees heard of government’s MI policy (Per Drop More Crop; launched in 2015), while only 7% were aware of its benefits. None was aware of the advantages of PH. At the grassroots, farmers appeared more aware of potential challenges of MI and PH than their opportunities. None was aware of the Haryana state government’s recent Jal Hi Jeevan Hai policy (Water is Life; 2019) that urges farmers to diversify and switch to water-efficient crops. Overall, the GDAI revealed multidimensional cognitive barriers to increase uptake of water-efficient farming. It owes to profound disconnect between policy-making and awareness generation at grassroots. We outline means to bridge the gap about how to (i) promote PH-based farming; (ii) restructure financial packages for MI; and (iii) motivate farmers by hands-on demonstration of economic returns of PH and MI.

Air pollution has emerged as a serious health emergency both locally and globally. The same air pollutants that cause illnesses and premature deaths also trap heat and cause global warming, interfere with rainfall and accelerate icecap and glacier melting, affect vegetation and ecosystems, and also have trans-boundary effects. This complex set of effects poses a serious challenge for public policy. While policy action itself has to gather momentum to meet the clean air targets across cities and regions to protect public health, policy action will also have to respond more holistically to a range of scientific evidence that has now established more a complex link between air pollution and several other environmental and climate impacts. But this is also an opportunity to adopt policy indicators that can be mainstreamed across sectors to align a full range of interventions for effective mitigation and achieve multiple co-benefits related to health and climate security and sustainable development goals. Keywords: Government, intervention, challenges, nutrition, maternal, mortality, resources