Hysterectomy, removal of the uterus, is a commonly performed surgery for gynaecological morbidities. Emerging evidence indicates that hysterectomy performed before age 45 (early hysterectomy), is associated with considerable risks to women's health. While most evidence on hysterectomy is from high-income settings, national surveys from India report high prevalence of early hysterectomy in specific regions, as well as higher prevalence amongst women in rural areas and with less education. The median age at hysterectomy in India is close to ten years before the onset of natural menopause. India has recently introduced national guidelines to address early hysterectomy, but large evidence gaps on the causes and consequences remain - which in turn limits the potential effectiveness of interventions at the clinical, health system and community level. Methods: SAHELI is a Team Science study that will examine: (i) individual, social and health system determinants of early hysterectomy; (ii) women's treatment pathways to hysterectomy and for gynaecological morbidity in general; and (iii) the consequences of undergoing hysterectomy on women's physical, mental, economic and social well-being across the life course. This mixed-methods study includes population surveys amongst women in ages 25-49 in three high-prevalence states; qualitative health systems research to trace treatment journeys with women, health care providers and other stakeholders; evidence syntheses; and knowledge translation activities to ensure findings inform co-produced strategies and interventions. The study is grounded in a feminist epidemiology approach, aiming to examine individual and structural causes of vulnerability and prioritising the views of women, particularly in knowledge translation. Conclusions: SAHELI, implemented by an all-women, multi-disciplinary team, is the first study in India to examine the causes and consequences of hysterectomy in a life course approach. We aim to influence interventions, policy and future research on women's health, particularly access to quality gynaecological care and comprehensive health services through the life course.

This bibliometric study examines the scholarly landscape of migration and women's health, analyzing 1314 Scopus-indexed articles from 462 journals published between 2000 and 2023. Findings indicate a consistent increase in research output, reflecting growing global interest in this interdisciplinary field. Geographically, high-income countries (HICs), including the United States, Canada, the United Kingdom, and Australia, dominate contributions, while low- and middle-income countries (LMICs) remain underrepresented despite hosting significant migrant populations. International collaborations play a crucial role, with key institutions such as the University of California and the London School of Hygiene and Tropical Medicine shaping research efforts. The keyword co-occurrence analysis highlights migration, gender dynamics, mental health, and reproductive health as dominant themes. Persistent gaps in mental and reproductive healthcare access for migrant women emphasize the need for trauma-informed care (TIC), mobile bilingual healthcare services, and inclusive health policies. Disparities in research funding further exacerbate global health inequities, underscoring the necessity of equitable redistribution of resources, including redirecting at least 10 % of HIC research grants to LMIC-led studies. The COVID-19 pandemic magnified pre-existing vulnerabilities, stressing the importance of multilateral collaborations and sustainable policy interventions to enhance migrant healthcare access. This study provides valuable insights into research trends, collaboration networks, and thematic focus areas, offering a foundation for future interdisciplinary research and evidence-based policymaking aimed at promoting health equity for migrant women globally.

Diabetic retinopathy, nephropathy, and neuropathy are significant microvascular complications of diabetes mellitus, contributing to substantial morbidity and mortality worldwide. This comprehensive review examines the clinical relationship between these complications, focusing on shared pathophysiological mechanisms, bidirectional relationships, and implications for patient management. The review highlights the importance of understanding the interconnected nature of diabetic complications and adopting a holistic approach to diabetes care. Insights gleaned from this review underscore the necessity for early detection, timely intervention, and integrated care models involving collaboration among healthcare professionals. Furthermore, the review emphasizes the need for continued research to elucidate underlying mechanisms, identify novel therapeutic targets, and assess the efficacy of integrated care strategies in improving patient outcomes. By fostering interdisciplinary collaboration and knowledge exchange, future research endeavors hold the potential to advance our understanding and management of diabetic complications, ultimately enhancing patient care and quality of life.

The aim was to establish a specific and definite connection between non-syndromic orofacial cleft patients and associated congenital heart disease (CHD). Following PRISMA guidelines, selective databases were searched for data collection. Studies showing a definite association of CHD with orofacial cleft were included, and studies non-specific of the association of orofacial cleft with CHD were excluded. Data extraction criteria were study design, frequency of CHD in overall non-syndromic orofacial cleft and in specific cleft type, and most prevalent congenital cardiac anomaly. DerSimonian Laird random effects model was used to estimate the pooled proportion of CHD, along with corresponding 95% confidence intervals (CIs) for each measure. Publication bias was assessed using Fail-Safe N analysis and the Rosenthel approach. Of a total of 182 articles searched, only 30 studies were assessed. The overall pooled estimate of the proportion of CHD in total cleft lips/palates was 16% (95% CI: 13-19). The odds of developing CHD in cleft palates was 4.08 times more as compared to cleft lips with 95% CIs of 3.86-4.33, and 1.65 more as compared to cleft lips and palates both with 95% CI of 1.52-1.68. We affirm the upsurging prevalence of CHD in non-syndromic cleft children and vehemently propose that it is of utmost importance to inculcate it in practice and policy-making to screen all non-syndromic orofacial cleft children for congenital cardiac anomaly. This study was registered on PROSPERO (ID no. CRD42023391597) on February 24, 2023.

Tobacco use in India contributes to over 1.35 million deaths annually, posing a major public health challenge. Tobacco industry interference (TII) is a significant barrier to effective tobacco control, especially in low- and middle-income countries (LMICs), such as India. This interference undermines public health efforts by manipulating policy implementation and enforcement. The adoption of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) Article 5.3 in India has made progress, with 23 states implementing the guidelines. However, enforcement gaps and persistent tobacco industry (TI) tactics continue to weaken tobacco control measures. Nefarious strategies, such as lobbying and misinformation, further complicate the effective execution of these policies. To effectively reduce tobacco use in India, stronger and enforceable policies are needed at both national and state levels. Strengthened legal frameworks, increased public awareness, and robust monitoring systems are critical to protect public health policies from TII. These steps are essential to safeguard public health and enhance the impact of tobacco control initiatives.

Background: Drug use is a major public health issue in India. Significant changes in the approach toward drug use have happened in the last few decades. Despite this, no systematic attempt has been made to document the same in the scientific literature. This narrative review attempts to discuss the major drug laws, policies, and national programs of the Government of India (GoI). Methods: A thorough search was conducted to look for policies, programs, acts, and notifications related to substance use/drug use on various websites of different ministries of the GoI. Acts, programs, and policies addressing substance use were identified. Results: Various drug laws, programs, and acts from the GoI provide a multipronged approach to curbing the procurement of drug use along with its prevention and cure. The Ministry of Social Justice and Empowerment (MoSJE) is the nodal ministry for drug demand reduction. The enactment of the Narcotic Drugs and Psychotropic Substances (NDPS) Act 1985 and Policy 2012 and the implementation of India's Drug De-Addiction Program (DDAP) are important landmarks in this journey. Conclusion: The GoI initiatives for reducing the mental health burden in this country in general and substance use disorders (SUDs), in particular, are immense. The acts/statutes/laws/notifications are all interlinked. Stakeholders in mental health, public health, and policy-making need to upgrade themselves with the relevant statutes to curb the menace of drug use.

Overview Comprehensive community-based approaches to treat wasting do not yet exist at scale in India. Under POSHAN Abhiyaan, the Indian government has demonstrated its commitment to the large-scale implementation of treatment services for severely wasted children. With SAM prevalence ranging from 2.2% to 11.9%, which are unusually high rates when compared with other countries, implementing the CMAM model is essential to meet the need and is feasible given India’s highly developed health and nutrition infrastructures at the community-level into which services can be integrated. CMAM guidelines have been in development since 2017, although they are not yet published. Meanwhile, states are moving ahead with the CMAM agenda. The complex policy environment and the limited evidence base for CMAM in India has led to the development of multiple treatment protocols which vary as to their adherence to the global protocols. Therefore, a better understanding of these revised models, which have a limited evidence base for effectiveness, is essential. UNICEF seeks to hire an agency to undertake a comprehensive external evaluation of CMAM services provided through government systems in India. The specific objective will be to evaluate the relevance and appropriateness, effectiveness, coverage, efficiency and sustainability in two states (Gujarat and Madhya Pradesh), considering programme outcomes over the last one-year period. In addition, the evaluation will focus on assessing cross-cutting issues, such as coordination and management, equity (specifically gender and caste), and information and data management on programme performance. Gujarat and Madhya Pradesh have been chosen as they have adopted different treatment protocols, one which uses a therapeutic food that meets WHO standards and the second which uses a therapeutic food that does not meet WHO standards. Report Details Year Published 2024 Type Project/Programme Joint No Partner/s N/A Consultant name Paul Binns, Hugh Lort-Phillips, Federico Ercolano, Patrizia Pajak, Alexandra Rutishauser-Perera Agency Focal Point Atishay Mathur Focal Point Email amathur@unicef.org Managed by Independent Evaluation Office No Geographic Scope Country Country/ies India

Report Details Year Published 2024 Type Project/Programme Joint No Partner/s N/A SDG/s SDG12 - Responsible Consumption and ProductionSDG15 - Life on Land Geographic Scope Country Country/ies India

Report Details Year Published 2024 Type Project/Programme Joint No Partner/s N/A SDG/s SDG12 - Responsible Consumption and ProductionSDG15 - Life on Land Geographic Scope Country Country/ies India

Cervical cancer is a significant public health concern globally, with low and middle-income countries bearing the highest burden, specifically the South Asian region. Therefore, the current scoping review aimed to highlight the factors influencing the implementation of human papillomavirus (HPV) vaccination in South Asia. Adopting the 'Arksey and O'Malley and Levac et al.' methodology, multiple electronic databases were searched to identify relevant records. The results were narratively synthesised and discussed, adopting the Consolidated Framework for Implementation Research (CFIR) model. We identified 527 records, which were assessed for eligibility based on title, abstract, and full text by three reviewers, followed by data extraction of 29 studies included for analysis in the review. Implementing HPV vaccination programs in South Asia faces various challenges, such as economic, health system, financial, health literacy, and sociocultural factors that hinder their successful implementation. To successfully implement the vaccine, a tailored risk communication strategy is necessary for these countries. Knowledge gained from the experience of South Asian nations in implementing the HPV vaccine can assist in policymaking in similar healthcare for advancing the implementation of HPV vaccination.

General practitioners (GPs) are critical in providing primary palliative care in the community. Apprehensions about managing a dying person at home, difficulties in goals of care discussion, limited resources and lack of palliative care education often hinder end-of-life care provision in the community. This review focused on the end-of-life care training programs accessed by GPs and sought to understand if the training programs' content and mode of delivery aligned with their preferred needs. MEDLINE, EMBASE, CINAHL, and PsycINFO were searched to identify articles published in English between 01 January 1990 and 30 September 2022. Additionally, searches were conducted using SCOPUS, the Web of Science, and the Cochrane database using free texts. The reviewers screened the titles, abstracts, and full text to identify eligible studies and extracted textual data to analyse and generate themes. Out of 5532 citations initially accessed, 17 studies were included in the review. Six themes were generated: knowledge translation, skill development, a change in attitude, self-efficacy, satisfaction, and patient outcomes. The GPs' end-of-life care knowledge, skills, attitude, self-efficacy, and patient outcomes were better when their training had a combination of small-group interactive workshops, trigger case-based reflective learning, mentor-facilitated experiential learning, web-based modules, and peer learning. The synthesis of review findings supports blended learning as a training approach for general the practitioners' end-of-life care education as it facilitates learning and patient outcomes.

Report Details Year Published 2023 Type Project/Programme Joint No Partner/s N/A SDG/s SDG12 - Responsible Consumption and ProductionSDG15 - Life on Land Geographic Scope Country Country/ies India

Overview The implementation of Swabhimaan programme started in the year 2017 and is expected to be completed by the end of 2021. The programme has a built-in impact evaluation component, which measures its impact on the well-being of women and girls. This will be achieved through the ongoing endline survey that is being implemented. The endline survey alone, however, will not be able to establish the reasons for the impact findings, specifically the achievement or non-achievement of outcomes or any unintended/unexpected changes in outcome. It will not be able to assess whether the programme was implemented as planned, if all intended beneficiaries were reached, how activities translated to outputs and outcomes and what challenges were encountered. This is important not just to understand the results of the programme, but also to inform decisions around scale-up of the programme. For these reasons, a more comprehensive ‘programme’ evaluation needs to be undertaken, that encompasses the endline survey as one component. These Terms of Reference (ToR) are for hiring an experienced individual consultant evaluator to undertake the programme evaluation of the Swabhimaan programme in the states of Bihar, Chhattisgarh and Odisha. The programme evaluation will use two approaches: a) use existing evidence collected through programme monitoring reports, the biannual tele-monitoring monitoring and impact evaluation components of the programme (baseline, midline and endline), as well as the findings from the value for money analysis and the fidelity assessment; b) collect additional qualitative data, to plug any evidence/information gaps. The consultant will be responsible for conducting his/her own analysis of the qualitative data and programme reports, and where appropriate, analysing and/or spot checking the accuracy of the quantitative analyses conducted by IIPS. It is essential that the evaluation augments or adds to the existing data and Report Details Year Published 2023 Type Project/Programme Joint No Partner/s N/A Agency Focal Point Atishay Mathur Focal Point Email amathur@unicef.org Managed by Independent Evaluation Office No Geographic Scope Country Country/ies India

Report Details Year Published 2023 Type Project/Programme Joint No Partner/s N/A SDG/s SDG13 - Climate Action Geographic Scope Country Country/ies India

Report Details Year Published 2023 Type Project/Programme Joint No Partner/s N/A SDG/s SDG13 - Climate Action Geographic Scope Country Country/ies India

Overview With the GAVI programme gradually drawing to a close, this UNICEF SBCC evaluation is intended to provide critical programmatic insights into what has worked, what has not worked and key learnings from the sample states included in the evaluation. Similarly, the findings of the evaluation are expected to support strengthening of SBCC cell functioning, and ongoing program initiatives aimed directly at maximizing utilization of public services. Based on the findings of the evaluation, UNICEF aims to advise the MoHFW and other public administrative bodies on the effectiveness and sustainability of institutionalizing SBCC Cells. Report Details Year Published 2023 Type Project/Programme Joint No Partner/s N/A Agency Focal Point Atishay Mathur Focal Point Email amathur@unicef.org Managed by Independent Evaluation Office No Geographic Scope Country Country/ies India

Overview Career guidance portals, launched under UNICEF’s career guidance programme in partnership with state governments and technical partner (Aasman Foundation) in 2019, is a comprehensive initiative aimed at bridging the knowledge gap among adolescents (students in classes 9-12) in India and enable them to make informed decisions about their future. The programme was initially launched in three states in 2019 and is currently being implemented in 17 states1 across the country. The career guidance portal intends to notify the students about the available career pathways, institutions catering to their interests, entrance exams and scholarships, providing students with educational opportunities and career possibilities. The overarching purpose of the evaluation was to generate learnings on implementation modalities – what worked and how; as well as what gaps emerged, if any – in the interventions rolled out since 2019 with support of UNICEF. The evaluation findings and recommendations will help inform UNICEF’s education programme and help develop an effective career guidance programme and strategies for the new country programme (2023-2027). Report Details Year Published 2023 Type Project/Programme Joint No Partner/s N/A Agency Focal Point Pramila Manoharan Focal Point Email pmanoharan@unicef.org Managed by Independent Evaluation Office No Geographic Scope Country Country/ies India

Report Details Year Published 2023 Type Strategic/ Thematic Joint No Partner/s N/A SDG/s SDG1 - No PovertySDG11 - Sustainable Cities and CommunitiesSDG17 - Partnerships for the Goals Geographic Scope Country Country/ies India

Report Details Year Published 2023 Type Project/Programme Joint No Partner/s N/A SDG/s SDG1 - No Poverty Geographic Scope Country Country/ies India

Report Details Year Published 2023 Type Project/Programme Joint No Partner/s N/A SDG/s SDG11 - Sustainable Cities and Communities Geographic Scope Country Country/ies India