Open Access Original

Article DOI: 10.7759/cureus.

Assessment of Reproductive Health Knowledge

among College Students in Northwestern India: A
Cross-Sectional Study
Shilpa Dutta 1, Akash More 1 , Sanket Mahajan 1, Neha Nawale 2, Namrata Choudhary 1, Deepti Shrivastava 3

1. Clinical Embryology, Datta Meghe Institute of Higher Education and Research, Wardha, IND 2. Clinical Embryology,
Datta Meghe Institute Of Higher Education And Research, Wardha, IND 3. Department of Obstetrics and Gynaecology,
Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND

Corresponding author: Akash More, aakashmore87@gmail.com

Abstract
Background
Reproductive health knowledge is a critical aspect of overall well-being, particularly among college students
who represent a demographic transitioning into adulthood. In Northwestern India, where cultural nuances
and societal perceptions play a significant role, understanding the factors influencing reproductive health
knowledge becomes imperative. This cross-sectional study explores the interplay between demographic
factors and awareness of reproductive health and infertility treatment among college students in
northwestern India.

Methods
A diverse sample of 564 college students in Northwestern India participated in the study, providing
information on key demographic variables, including age, gender, marital status, degree, field of study, and
college year. Statistical analysis, including the calculation of p-values, was employed to determine the
significance of associations between these demographic factors and the participants' knowledge of
reproductive health. Descriptive statistics, including percentages and numbers, were calculated to present a
comprehensive overview of the data. To evaluate the significance of associations, chi-square tests were
conducted for categorical variables such as age, gender, marital status, degree, field of study, and college
year. The p-values were computed to determine the statistical significance of observed relationships, with a
significance level set at 0.05.

Results
The study uncovered notable findings with implications for targeted interventions. Among age groups,
participants aged 23-25 exhibited the highest knowledge percentage at 43.22% (51/564), and this association
was statistically significant (p = 0.042). Gender disparities were evident, with females showing higher
awareness (46.52% (127/564)) compared to males, and this difference was statistically significant (p = 0.001).
Marital status revealed significant differences (p = 0.0012), particularly in single individuals who
demonstrated a knowledge percentage of 46.52% (127/564). Significant variations were observed based on
the degree held, with doctorate holders having the highest awareness at 49.15% (58/564) (p = 0.01). Field of
study significantly influenced knowledge (p = 0.0001), particularly in medical and engineering disciplines.
College year also exhibited significance (p = 0.003), with the first-year students demonstrating a knowledge
percentage of 42.20% (73/564).

Conclusion
These findings underscore the importance of tailored educational interventions and targeted awareness
campaigns. Recognizing the influence of demographic factors on reproductive health knowledge is crucial
for developing effective strategies that address the specific needs of college students in Northwestern India,
promoting a more informed approach to reproductive health and infertility treatment.

Categories: Epidemiology/Public Health, Medical Education, Obstetrics/Gynecology

Keywords: taboo, health, students, reproduction, knowledge, infertility

Introduction
World Health Organization (WHO) defines infertility as the inability to conceive after at least 12 months of
regular sexual activity without contraception [1]. Infertility constitutes a significant global health challenge,
affecting approximately 12-15% of couples worldwide [2]. Worldwide, overall fertility rates are declining
steeply, possibly influenced by prolonged time to conceive among both men and women for their first child
[3]. Current literature suggests that approximately 86% of the young population resides in developing
countries, with a total of around 1.7 million young cohorts globally [4]. India hosts about 65% of this young

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population, according to the latest report of 2020 [5]. Therefore, acquiring proper reproductive health
knowledge is imperative to avoid unforeseen fertility issues. The factors contributing to infertility and
unfavourable pregnancy outcomes are multifaceted and arise from intricate interactions among genetic,
environmental, and lifestyle factors prevalent in the general population [6]. It has been reported that more
than one-third of India's younger population suffers from sexually transmitted diseases such as Acquired
Immune Deficiency Syndrome (AIDS), indicating a lack of active awareness about reproductive health and
safety measures among the younger cohort [7].

It has been observed that knowledge about fertility heavily influences decisions concerning reproductive
health [3]. In 2017, the International Glossary of Infertility and Fertility Care defined fertility awareness as
the understanding of reproduction and fertility, encompassing various individual risk factors such as
advanced age, sexual health considerations, sexually transmitted infections, and lifestyle factors like
smoking and obesity. Furthermore, it entails the recognition of non-personal risk elements, including
environmental and workplace factors. This understanding extends to awareness of the social and cultural
influences on family planning decisions, as well as the societal and cultural dynamics impacting the desire
for family formation [3].

A subset of individuals may engage in novel behaviors such as substance abuse, unprotected sexual activity,
and involvement with multiple sexual partners due to hormonal changes, depression, and peer influence [8].
There is a scarcity of research, primarily conducted abroad, concerning the knowledge base of university
students regarding infertility. Despite their aspirations for parenthood, these students exhibit a heightened
risk of infertility due to intensive efforts to achieve academic and career objectives [9,10]. Gavin et al.
observed that fostering positive youth development programs plays a crucial role in advancing the sexual
and reproductive health of adolescents and young individuals [11].

Studies have reported that university students tend to express a desire to have children as they approach a
stage of declining reproductive capacity. Nevertheless, they exhibit a deficit in understanding age-related
decreases in fertility, along with relevant risk factors and infertility issues [8,12,13]. Hence, this article
focuses on assessing the reproductive health knowledge among college students in northwestern India and
their awareness of infertility treatment. The results of this study will help evaluate further plans needed for
the targeted population to improve fertility outcomes accordingly.

Materials And Methods

Study Design
The study design for the article was cross sectional. It included 600 elected participants through a snowball
sampling technique. A Google form was distributed among the participants with a preset of questionnaires
having 16 multiple-choice questions. Individuals were conveniently selected and were further encouraged to
circulate the questionnaire survey among other participants who met the criteria of the study. Initial
participants were elected through known connections, communities and pre-existing networks. Further,
participants were elected through known contacts of the initial group of selected participants, which
fostered a snowball sampling method. After thorough data cleaning, 564 eligible participants’ answers from
the questionnaire were selected to be evaluated for the study. The anonymity of the respondents was
maintained throughout to ensure the participant's privacy, and hence, the offered responses were candid
and truthful.

Data Analysis
Descriptive statistics was utilised for the quantification of the answers obtained through Google Forms. Chi-
square (χ2) test were used for the calculation of the statistical value. A P-value less than 0.05 was considered
to be statistically significant for the analysis of the data collected. SPSS software 26.0 for Windows Student
Version was used for the evaluation of the study.

Ethical Considerations
Prior to the conduction of the online questionnaire survey, Informed consent was diligently obtained from
all participants. This study has been ethically approved by the Institutional Review Board of Datta Meghe
Institute of Higher Education and Research in its meeting held on 2nd September,2023 having reference
number DMIHER(DU)/IEC/2023/1321.

Results
As shown in Table 1, the demographic data reveals a diverse distribution of participants across various age
groups, genders, and marital statuses. In terms of age, the majority of respondents fall within the 23-25 age
bracket, comprising 45.04% (254/564) of the sample, followed by those aged 20-22 (24.11% (136/564)) and
17-19 (8.69% (49/564)). The gender distribution shows a relatively balanced representation, with 48.05%
(271/564) identified as male and 51.95% (293/564) as female. Regarding marital status, the participants are
spread across single (40.78% (230/564)), married (34.93% (197/564)), and separated (24.29% (137/564))
categories. This demographic snapshot provides valuable insights into the composition of the surveyed

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 population, allowing for a more nuanced understanding of the factors under consideration in the study.

Demographic Data Number (N) %

Age (years)

17-19 49 8.69 (49/564)

20-22 136 24.11 (136/564)

23-25 254 45.04 (254/564)

25-27 74 13.12 (74/564)

27-29 32 5.67 (32/564)

30+ 19 3.36 (19/564)

Gender

Male 271 48.05 (271/564)

Female 293 51.95 (293/564)

Marital Status

Single 230 40.78 (230/564)

Married 197 34.93 (197/564)

Separated 137 24.29 (137/564)

TABLE 1: Demographic data of the participants.

The data has been represented as N=Total number of participants who selected the aforementioned option among all the choices available.

% has been calculated by = N/Total number of participants elected for the study(564).

The participant background data, as shown in Table 2, provides a comprehensive overview of the educational
and academic profile of the surveyed individuals. Among the degrees held by respondents, the majority
possess a Bachelor's degree (29.61% (167/564)), followed closely by those with a Master's degree (24.11%
(136/564)), and Doctorate holders (21.45% (121/564)). Diploma holders constitute 14.36% (81/564), and
there is a notable presence of individuals with other qualifications (10.46% (59/564)). When considering
college years, the distribution is fairly even, with the highest representation in the first year (28.72%
(162/564)) and descending proportions in subsequent years. The field of study diversity is evident, with
Commerce (18.44% (104/564)), Arts (12.41% (70/564)), and Law (14.01% (79/564)) being the most prevalent
disciplines. This comprehensive breakdown of participant backgrounds illuminates the varied educational
journeys and fields of expertise within the surveyed group, providing valuable context for interpreting
responses and drawing insights in the research study.

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 Participant Background Number (N) %

Degree

Diploma 81 14.36 (81/564)

Bachelors 167 29.61 (167/564)

Masters 136 24.11 (136/564)

Doctorate 121 21.45 (121/564)

Others 59 10.46 (59/564)

College Year

First 162 28.72 (162/564)

Second 97 17.19 (97/564)

Third 136 24.11 (136/564)

Fourth 91 16.13 (91/564)

Fifth 78 13.83 (78/564)

Field of Study

Medical 48 8.51 (48/564)

Engineering 49 8.69 (49/564)

Arts 70 12.41 (70/564)

Commerce 104 18.44 (104/564)

Science 40 7.09 (40/564)

Law 79 14.01 (79/564)

Humanities 86 15.25 (86/564)

Management 68 12.05 (68/564)

Others 20 3.55 (20/564)

TABLE 2: Background of the participants

The data has been represented as N=Total number of participants who selected the aforementioned option among all the choices available.

% has been calculated by = N/Total number of participants elected for the study(564).

The data on reproductive health awareness, as shown in Table 3, sheds light on participants' attitudes,
knowledge, and confidence regarding this critical aspect of well-being. A significant portion of respondents
actively seeks information about their reproductive health, with 52.66% (297/564) indicating that they do so
sometimes, and 18.62% (105/564) doing it very often. In contrast, 28.72% (162/564) of participants never
seek such information. The distribution of previous knowledge about reproductive health and infertility
treatment is varied, with 48.40% (273/564) being unsure, 30.67% (173/564) having no previous knowledge,
and 20.92% (118/564) affirming their awareness. Confidence levels in the accuracy of reproductive health
information vary as well, with 40.60% (229/564) expressing a lack of confidence and 22.16% (125/564)
feeling somewhat confident. The most common sources for seeking information are friends (48.76%
(275/564)) and the internet (24.11% (136/564)), showcasing the role of social networks and online platforms
in disseminating reproductive health knowledge. This comprehensive data provides insights into the
participants' engagement with and trust in reproductive health information, highlighting areas for targeted
awareness campaigns and education.

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 Reproductive Health Awareness Number (N) %

Do you seek information regarding your reproductive health

Very often 105 18.62 (105/564)

Sometimes 297 52.66 (297/564)

Never 162 28.72 (162/564)

Do you have previous knowledge about reproductive health and infertility treatment?

Yes 118 20.92 (118/564)

No 173 30.67 (173/564)

Not sure 273 48.40 (273/564)

How confident are you in the accuracy of the reproductive health information you come across?

Very confident 94 16.67 (94/564)

Somewhat confident 125 22.16 (125/564)

Neutral 116 20.57 (116/564)

Not confident 229 40.60 (229/564)

Where do you usually seek information about reproductive health and fertility?

Friends 275 48.76 (275/564)

Family 71 12.59 (71/564)

Internet 136 24.11 (136/564)

Healthcare professionals 24 4.25 (24/564)

Others 58 10.28 (58/564)

TABLE 3: Reproductive health awareness among the participants

The data has been represented as N=Total number of participants who selected the aforementioned option among all the choices available.

% has been calculated by = N/Total number of participants elected for the study(564).

The social outlook data, as shown in Table 4, provides valuable insights into the perceptions and attitudes of
participants towards reproductive health in the broader societal context. A substantial majority, comprising
50.35% (284/564), strongly agree that there is societal pressure associated with the ability to reproduce, and
an additional 28.72% (162/564) agree with this sentiment. Conversely, only a small percentage, 7.97%
(45/564), disagrees with this notion, emphasizing the prevalence of societal expectations regarding fertility.
A significant portion, 62.94% (355/564), believes that there is a stigma attached to discussing or seeking help
for infertility, while 14.54% (82/564) are unsure. Assessing their own knowledge about factors influencing
infertility and methods to conceive, participants express a range of confidence levels, with 21.63% (122/564)
rating their knowledge as very good and 15.43% (87/564) as very poor. This data underscores the importance
of understanding societal perceptions and stigma surrounding reproductive health, advocating for more
open conversations, and addressing knowledge gaps to foster a supportive and informed community.

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 Social Outlook Number (N) %

Do you believe it is not perceived well by society if someone is not able to reproduce?

Strongly agree 284 50.35 (284/564)

Agree 162 28.72 (162/564)

Neither agree or disagree 70 12.41 (70/564)

Disagree 45 7.97 (45/564)

Strongly disagree 3 0.53 (3/564)

In your opinion, is there a stigma associated with discussing or seeking help for infertility?

Yes 355 62.94 (355/564)

No 127 22.52 (127/564)

Not sure 82 14.54 (82/564)

How would you rate your knowledge about the factors influencing infertility and methods to conceive?

Very Poor 87 15.43 (87/564)

Poor 104 18.44 (104/564)

Neutral 180 31.92 (180/564)

Good 71 12.59 (71/564)

Very Good 122 21.63 (122/564)

TABLE 4: Social outlook of the participants

The data has been represented as N=Total number of participants who selected the aforementioned option among all the choices available.

% has been calculated by = N/Total number of participants elected for the study(564).

The data on infertility awareness, as shown in Table 5, reflects a spectrum of knowledge and perceptions
among participants. A significant portion, comprising 24.82% (140/564), is aware of factors contributing to
infertility, while 31.56% (178/564) are not and 43.62% (246/564) are unsure. Interestingly, when asked to
enumerate factors contributing to infertility, participants demonstrated varied levels of awareness. Notable
factors such as age, lifestyle choices, and medical conditions were well-recognized, with 94.15% (531/564)
identifying sexually transmitted infections (STIs) like Acquired Immune Deficiency Syndrome (AIDS) and
90.78% (512/564) associating smoking, excessive alcohol consumption, and drug use with infertility.
However, unconventional factors like weather, tight underwear, and laptop use also garnered responses.
About 66.49% (375/564) of participants believe that infertility can be treated, while 18.08% (102/564) think
otherwise, and 15.43% (87/564) are unsure. This diversity in responses underscores the need for targeted
education to enhance public awareness about infertility causes and treatments, fostering informed
perspectives on this significant reproductive health issue.

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 Infertility Awareness Number (N) %

Are you aware of factors that can contribute to infertility.

Yes 140 24.82 (140/564)

No 178 31.56 (178/564)

Maybe 246 43.62 (246/564)

Can you enlist all factors that can contribute to infertility by selecting from below options

Age 487 86.35 (487/564)

Smoking, excessive alcohol consumption, drug use 512 90.78 (512/564)

Weight gain/loss 375 66.49 (375/564)

Stress 278 49.29 (278/564)

Sexually transmitted infections (STIs) like AIDS 531 94.15 (531/564)

Poor diet 364 64.54 (364/564)

Weather 201 35.64 (201/564)

Medical Conditions: Conditions like diabetes, thyroid disorders, etc 215 38.12 (215/564)

Hormonal Imbalance 97 17.20 (97/564)

Genetic Factors 82 14.54 (82/564)

Reproductive organ Issues 112 19.86 (112/564)

Medications 107 18.97 (107/564)

Previous Surgeries 71 12.59 (71/564)

Tight Underwear 136 24.11 (136/564)

Laptop Use 46 8.16 (46/564)

Cycling 30 5.32 (30/564)

Cell Phone Radiation 89 15.78 (89/564)

Birth Control Pill Use 53 9.39 (53/564)

Masturbation 78 13.83 (78/564)

Breastfeeding 15 2.66 (15/564)

All of above 249 44.15 (249/564)

Not sure of options given 278 49.29 (278/564)

Do you think infertility can be treated?

Yes 375 66.49 (375/564)

No 102 18.08 (102/564)

Not sure 87 15.43 (87/564)

TABLE 5: Infertility awareness among the participants

The data has been represented as N=Total number of participants who selected the aforementioned option among all the choices available.

% has been calculated by = N/Total number of participants elected for the study(564).

The presented data, as shown in Table 6, illustrates the distribution of participants' responses based on their
knowledge of reproductive health and infertility treatment, segmented by various factors. The p-values
associated with each factor indicate the statistical significance of the observed differences, with p-value less

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 than 0.05 is considered as statistically significant. In terms of age, respondents aged 23-25 exhibited the
highest awareness, with a p-value of 0.042. Gender significantly influenced knowledge, as males displayed
higher awareness compared to females (p=0.001). Marital status also played a significant role, with single
individuals having greater knowledge than their married or separated counterparts (p=0.0012). Educational
background showed a noteworthy impact, with participants holding doctorate degrees being the most
informed group (p=0.01). Field of study emerged as a crucial factor, with medical and engineering students
exhibiting higher awareness compared to other disciplines (p=0.0001). Additionally, college year
demonstrated a statistically significant effect on knowledge, with fifth-year students being the most
informed (p=0.003). These findings underscore the importance of considering demographic variables in
understanding and addressing awareness levels regarding reproductive health and infertility treatment.

Do you have previous knowledge about reproductive health and infertility treatment?

Factors Yes Not Sure No P-Value

Number (N) % Number (N) % Number (N) %

Age (years)

17-19 6 5.08 (6/564) 17 6.23 (17/564) 26 15.03 (26/564)

20-22 21 17.79 (21/564) 64 23.44 (64/564) 51 29.48 (51/564)

23-25 51 43.22 (51/564) 136 49.82 (136/564) 67 38.73 (67/564) 0.042

25-27 21 17.79 (21/564) 35 12.82 (35/564) 18 10.40 (18/564)

27-29 8 6.78 (8/564) 15 5.49 (15/564) 9 5.20 (9/564)

30+ 11 9.32 (11/564) 6 2.19 (6/564) 2 1.16 (2/564)

Gender

Male 71 60.17 (71/564) 146 53.48 (146/564) 54 31.21 (54/564) 0.001

Female 47 39.83 (47/564) 127 46.52 (127/564) 119 68.79 (119/564)

Marital Status

Single 21 17.79 (21/564) 127 46.52 (127/564) 82 47.40 (82/564)

0.0012
Married 52 44.06 (52/564) 78 28.57 (78/564) 67 38.73 (67/564)

Separated 45 38.14 (45/564) 68 24.91 (68/564) 24 13.87 (24/564)

Degree

Diploma 11 9.32 (11/564) 48 17.58 (48/564) 22 12.72 (22/564)

Bachelors 17 14.40 (17/564) 86 31.50 (86/564) 64 36.99 (64/564)

0.01
Masters 24 20.34 (24/564) 67 24.54 (67/564) 45 26.01 (45/564)

Doctorate 58 49.15 (58/564) 44 16.12 (44/564) 19 10.98 (19/564)

Others 8 6.78 (8/564) 28 10.26 (28/564) 23 13.29 (23/564)

Field of Study

Medical 36 30.50847 10 3.66 (10/564) 2 1.16 (2/564)

Engineering 12 10.16949 28 10.26 (28/564) 9 5.20 (9/564)

Arts 11 9.322034 35 12.82 (35/564) 24 13.87 (24/564)

Commerce 8 6.779661 57 20.88 (57/564) 39 22.54 (39/564)

0.0001
Science 19 16.10169 13 4.76 (13/564) 8 4.62 (8/564)

Law 17 14.40678 46 16.85 (46/564) 16 9.25 (16/564)

Humanities 5 4.237288 36 13.19 (36/564) 45 26.01 (45/564)

Management 3 2.542373 40 14.65 (40/564) 25 14.45 (25/564)

Others 7 5.932203 8 2.93 (8/564) 5 2.89 (5/564)

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 College Year

First 22 18.64407 67 24.54 (67/564) 73 42.20 (73/564)

Second 15 12.71186 53 19.41 (53/564) 29 16.76 (29/564)

0.003
Third 17 14.40678 82 30.03 (82/564) 37 21.39 (37/564)

Fourth 28 23.72881 42 15.38 (42/564) 21 12.14 (21/564)

Fifth 36 30.50847 29 10.62 (29/564) 13 7.52 (13/564)

TABLE 6: Factors associated with participants' knowledge about reproductive health and
infertility treatment
The data has been represented as N=Total number of participants who selected the aforementioned option among all the choices available.

% has been calculated by = N/Total number of participants elected for the study(564).

A P-value<0.05 is considered as statistically significant in the study.

Discussion
The findings from this study of the cross-sectional data set aimed at assessing reproductive health
awareness among Northern India college students are profound. It has been observed by researchers that
due to insufficient knowledge about reproductive health, college students tend to make less use of existing
reproductive healthcare facilities available [14]. Thus, this leads to an increasing trend of reproductive
health problems among the reproductive age cohorts. Studies from Kenya, China, Kerala, Turkey, and other
countries have reportedly evaluated and pointed out the fact that there is a substantial lack of reproductive
health knowledge among different sociodemographic profiles, and the percentage of the population that
contributes majorly belongs to the college students [4, 15-18].

Gender-wise distribution of reproductive knowledge appears to be balanced; however, upon a closer analysis
of the respondents’ data, it is observed that males had a slight upper hand as compared to females in
reproductive health knowledge. This finding can be attributed to the fact that males have comparatively
easier access to available information about reproductive health awareness or social expectations. Studies
from India are scarce, and from the limited research literature available, it has been reported that females
tend to generally have poor knowledge of sexual health, leading to several fertility-related issues [19, 20].
Upon analysing the answers from an educational background perspective, it has been observed that
individuals holding degrees in medical, engineering, and higher educational qualifications, such as
doctorates, tend to have better reproductive knowledge as compared to other qualifications. Both developed,
and developing countries have a trend of high-risk sexual behaviours predominantly among the younger age
cohorts, thereby increasing incidents of unwanted pregnancies due to a lack of safer intercourse knowledge
[21]. Hence, it is a matter of utmost importance to spread awareness about reproductive health among
college students to curb the incidence of unwanted pregnancies. Parents hold the primary role as the initial
educators of the young population regarding these topics, influencing the development of adolescents'
attitudes and behaviours surrounding sexuality significantly [21]. However, many studies have reported that
young adults tend to seek reproductive health knowledge from social sites, friends, and unreliable sources,
while parents and siblings are the least seemed knowledge sources [22]. These generally lead to incorrect
sharing of information among the reproductive groups, thereby increasing stances of high-risk sexual
behaviours, leading to STIs and infertility.

Although the majority of college students have shown intention in many literatures to postpone
childbearing, their understanding of age-related fertility decline was found to be limited, and they tended to
overestimate the success rates of fertility treatments [23]. Previous studies from the United States, Sweden,
have highlighted that individuals having college degrees tend to have their first child above the age of 30
years, which is much higher than those having lesser qualifications [24, 25]. However, such studies in India
are limited due to which this study tried to bridge the gap in knowledge. Our study was in line with other
researches around the world that the younger age cohort particularly lacks awareness of reproductive health
and participates in unsafe intercourse, which majorly contributes to STIs in India. Thus, it is of utmost
importance to build a robust awareness plan to increase the knowledge of fertility health and stances related
to infertility to gain control over the increasing rate of infertility rise in India and improve the overall
reproductive health of the major population group of India.

Conclusions
Our study sheds light on the intricate relationship between demographic factors and reproductive health

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knowledge among college students in Northwestern India. The findings underscore the significance of age,
gender, marital status, educational background, field of study, and college year in influencing awareness of
reproductive health and infertility treatment. Noteworthy patterns emerged, such as higher awareness
among individuals aged 23-25, females, singles, doctorate holders, and students in specific fields like
medical and engineering disciplines. These insights emphasise the need for targeted educational
interventions and awareness campaigns tailored to the diverse characteristics of college students.
Recognising the influence of demographic factors on reproductive health knowledge is imperative for
developing effective strategies that empower this population to make informed decisions about their
reproductive well-being. Addressing these demographic-specific needs has the potential to enhance overall
awareness and contribute to a more proactive and informed approach to reproductive health and infertility
treatment among college students in Northwestern India.

Additional Information
Disclosures
Human subjects: Consent was obtained or waived by all participants in this study. Datta Meghe Institute of
Higher Education and Research issued approval DMIHER(DU)/IEC/2023/1321. The Institutional Ethics
Committee in its meeting held on 2nd September. 2023 has approved the following research proposed to be
carried out Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital, Datta Meghe
Institute of Higher Education & Research (DU), Sawangi (Meghe), Wardha. This approval has been granted
on the assumption that the proposed research work will be carried out in accordance with the ethical
guidelines prescribed by Central Ethics Committee on Human Research (C.E.C.H.R.). Animal subjects: All
authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In
compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services
info: All authors have declared that no financial support was received from any organization for the
submitted work. Financial relationships: All authors have declared that they have no financial
relationships at present or within the previous three years with any organizations that might have an
interest in the submitted work. Other relationships: All authors have declared that there are no other
relationships or activities that could appear to have influenced the submitted work.

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