Asian Institute of Public Health

Endocrine-disrupting chemicals (EDCs) and environmental pollutants are ubiquitous and increasingly linked to the aetiology of cancer. This review synthesises existing evidence on the carcinogenic potential of EDCs, including bisphenols, phthalates, pesticides, heavy metals and persistent organic pollutants, with a focus on genetic and epigenetic pathways. The molecular mechanisms by which these chemicals induce carcinogenesis, including DNA damage, chromosomal aberrations, dysregulation of oncogenes and tumour suppressor genes and alterations in DNA repair was critically accessed. Epidemiological research emphasises epigenetic changes, including aberrant DNA methylation, histone modifications and deregulated non-coding RNA expression, which mediate long-term and potentially transgenerational effects of exposure. The interplay among endocrine signalling, oxidative stress, inflammation and epigenetic reprogramming is discussed in relation to hormone-dependent and hormone-independent cancers. Epidemiological, in vivo and in vitro experimental evidence, together with high-throughput omics data, were integrated to strengthen mechanistic plausibility. This review identified important research gaps, including low-dose and mixture effects, timing of exposure and population-wide vulnerability and provides future directions for risk assessment and regulatory policy. Greater insight into the genetic and epigenetic effects of EDCs is needed to advance cancer prevention and inform evidence-based community health interventions.

Dengue fever, transmitted by Aedes aegypti mosquitoes, presents a wide clinical spectrum ranging from mild febrile illness to severe manifestations such as dengue hemorrhagic fever. It poses a substantial global health concern, with India significantly contributing to its burden. Factors such as rapid urbanization, population density, and favorable climatic conditions facilitate its spread, particularly in states like Odisha. This study aimed to estimate the financial burden imposed by dengue on households in Bhubaneswar, Odisha, and to explore the coping strategies adopted by these households to address the financial burden of dengue. A case-based cross-sectional study was conducted between May and July 2022 in Bhubaneswar, part of Khordha District. A total of 200 laboratory-confirmed dengue patients were enrolled. Quantitative data on sociodemographic details, health facility choices, and expenditure specifics were collected using structured questionnaires. In-depth interviews were conducted with a subset of patients and caregivers to understand the broader socioeconomic impact. Data analysis involved descriptive statistics, bivariate analysis, and linear regression. Majority of patients were urban residents, predominantly males aged 21-40 years. Private healthcare incurred significantly higher costs than government facilities (INR 21,859 versus INR 1225). The average out-of-pocket expenditure (OOPE) was INR 5567, disproportionately affecting females, older age groups, higher-income individuals, and married participants. Most households (93%) utilized savings, while only 3% relied on health insurance as a coping strategy. Dengue fever inflicts a considerable financial and emotional toll on households in Odisha. The findings underscore the urgent need to strengthen public health infrastructure, increase awareness of financial protection schemes, regulate private healthcare costs, and integrate psychosocial support into dengue management strategies.

ABSTRACTBackground:Malnutrition among women in the reproductive age group is a significant risk factor for low birth weight and infant mortality rates. Recent statistics show that undernutrition and overnutrition are double the burden in many developing countries.Aim:To assess the nutritional status and identify risk factors of malnutrition among rural women in the reproductive age group, Wayanad District, Kerala.Material and Methods:A cross-sectional study was conducted with women aged 18 years to 49 years. A house-to-house survey was done in five villages, covering 56 participants from each village.Results:About 50.7% of women were 25-40 years old. A significant proportion of 60% was overweight or obese, with a mean body mass index (BMI) of 26.34. Around 43.93% had moderate and 20.36% had high health risk waist − hip ratio (WHR). The mean waist circumference was 81.52. Employment (AOR 2.84, 95% CI 1.10 to 15.19, P = 0.046), fatty food intake (daily or weekly) AOR 4.88, 95% CI 9.43 to 17.29 (P < 0.001), sweet juices or soft drinks intake daily: AOR 2.23, 95% CI 3.44 to 13.96 (P = 0.11), physical activity (mild work) AOR 7.74, 95% CI 8.92 to 87.45 (P < 0.001), and television watching hours (daily) AOR 5.22, 95% CI 4.27 to 48.68 (P < 0.001) were found to be statistically significant with the BMI and WHR.Conclusion:The number of overweight and obese individuals with moderate to high-risk WHR was substantially higher in this study. An unbalanced, unhealthy diet, along with physical inactivity, contributes to the increase in the number of overweight individuals and central obesity.

BackgroundA package of Maternal, Newborn and Child Health (MNCH) services are administered sequentially to mother–child dyads as Continuum of Care (CoC), but often each intervention is reviewed in silo in low-middle-income countries like India. Therefore, we aimed to examine the coverage of the entire package by computing composite CoC score of Indian mother–child dyads. We also aimed to estimate the effect of Indian states on CoC after adjusting for variations in socio-economic determinants; and then rank the Indian states based on their adjusted effects.MethodsWomen (15–49 years) with most recently-born child (in last 5 years) aged 12–23 months (n = 40,687) from National Family Health Survey-5 (2019–21) of India were analysed. Nineteen CoC interventions (Y/N) were added (equally-weighted) to construct a composite CoC score. Multi-level models were used to study the state effect on CoC score after adjusting for individual-level wealth, education, caste, urban/rural residence and fertility. Indian states were ranked by their CoC performance using adjusted state residuals from the model.ResultsOnly 3% dyads received all the 19 interventions, however, 50% received 14/19. Sterile delivery kit usage (94.4%), newborn weighing (92.4%) and skilled birth attendance (89.4%) were services with higher coverage, whereas early initiation of breastfeeding (43.7%) and appropriate iron-folate consumption (56.8%) had low coverage. The state factor explained 23% CoC score. Odisha, a comparatively less-developed state, was ranked first and also other less-developed states like Madhya Pradesh and Chhattisgarh outperformed richer counterparts. But many traditionally weaker Northern and North-Eastern states continued to lag behind.ConclusionOdisha and a few other less-developed Indian states demonstrated that good CoC coverage can be achieved even with restricted resources, perhaps through strengthening of public health system. Other states should emulate and help India as a nation achieve full CoC coverage of all its mother–child dyads and attain MNCH-related sustainable development goals.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-23697-x.

Malaria represents a major vector borne global health problem. The greatest challenge in the malarial treatment is due to the increasing resistance of parasite to antimalarial drugs. The rise of drug-resistant malaria parasites is undermining the effectiveness of more potential drugs. Consequently, there is an urgent requirement for novel antimalarial compounds to manage this disease. Therefore, the current investigation is designed to analyze the antimalarial properties of Artemisia nilagirica against chloroquine (CQ) resistant K1 strain and chloroquine-sensitive 3D7 strain through different solvent extracts of various plant parts (root, stem, leaf and flower). Among the multiple extracts tested, the methanolic flower extract exhibited the highest antiplasmodial activity against CQ resistant K1 strain (IC50= 5.76 ?g/mL) and CQ-sensitive 3D7 strain (IC50= 6.24 ?g/mL) respectively. The lowest values of antimalarial activity were reported in aqueous extract of root against CQ resistant K1 strain (IC50= 68.83 ?g/mL) and CQ sensitive 3D7 strain (IC50= 70.02 ?g/mL). However, moderate activity was reported in chloroform, n-hexane, petroleum ether and ethanol extracts. The GC-MS investigation of methanol extracts of flower confirmed the availability of specific bioactive compounds like bicyclo (2.2.1) heptane-2-one 1,7,7-trimethyl, bicyclo (3.1.1) heptanes 2,4,6-trimethyl, 1,6- cyclodecadiene 1- methyl-5- methylene-8-(1-methyl ethyl) and 3,3- iminosprolamine, 3- methyl-3,5 (cyanoethyl) tetrahydro-4-thiopyranone which are responsible for antiplasmodial activity. The present study’s findings confirm the potential antimicrobial activity of flower methanolic extracts of A. nilagirica against CQ resistant and sensitive strains of P. falciparum.

Introduction: Biopsy is the gold standard for Oral Potentially Malignant Disorders (OPMD) diagnosis. Chemiluminescence provide promising complementary alternative diagnostic adjunct for its simple non invasive collection and technique and to screen large population. Aim: To summarise and compare the existing evidence on diagnostic accuracy of chemiluminescence in detecting oral potentially malignant disorders. Materials and Methods: The systematic review and metaanalysis protocol was registered at the international prospective register of systematic reviews (PROSPERO- CRD42022306061) and performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Diagnostic Test Accuracy (PRISMA- DTA) checklist. PubMed, Google Scholar, EBSCOhost were searched from 2000 to 2021 to identify the screening potential of chemiluminescence for oral potentially malignant disorders. True positive, false positive, true negative, false negative, sensitivity, specificity values were extracted or calculated if not present for each study. Quality of selected studies was evaluated based on Quality Assessment for Diagnostic Accuracy Studies -2 (QUADAS-2) tool. Meta-analysis was performed in Meta-Disc 1.4 software and Review Manager 5.3 using a bivariate model parameter for the sensitivity and specificity and summary points, Summary Receiver Operating Curve (SROC), confidence region, and prediction region were calculated. Results: Twenty-four studies were included for qualitative synthesis and out of that fourteen were included for metaanalysis. Sufficient data for meta-analysis was available only for leukoplakia, oral lichen planus and oral submucous fibrosis. Sensitivity and specificity were calculated with Area Under Curve (AUC). For leukoplakia, chemiluminescence had sensitivity and specificity of 75% and 98% with 0.74 Area Under curve. For Oral lichen planus it was 78% and 60% with 0.70 AUC. For oral submucous fibrosis it was 89% and 76% with 0.69 AUC. Conclusion: Chemiluminescence overall had good sensitivity and specificity values along with good AUC. This strongly supports the fact that it can be used an alternative diagnostic adjunct to biopsy for various oral potentially malignant disorders.

India and sub-Saharan Africa contributes about 85% of the global malaria burden, and India is committed to eliminating malaria by 2030. Two novel initiatives-the Malaria Elimination Demonstration Project (MEDP) in Madhya Pradesh and Durgama Anchalare Malaria Nirakaran (DAMaN) in Odisha-were initiated independently to demonstrate that indigenous malaria can be eliminated in a short period of time. These initiatives focused on rural, tribal areas where there is a high malaria burden and complex epidemiology. The case management and vector control strategies used in these programmes were based on the national guidelines, with context-specific changes and introduction of accountability at management, operational, technical and financial levels. The MEDP achieved a 91% reduction in malaria cases and recorded zero transmission for 6 consecutive and a total of 9 mo. The DAMaN project brought about an 88% reduction in malaria cases. Malaria elimination will require robust surveillance and case management, monitoring of vector control interventions, community-centric information education communication and behaviour change communication initiatives and management controls, as well as regular internal and external reviews.