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A well-structured digital database is essential for any national priority project as it can provide real-time data analysis and facilitate quick decision making. In recent times, particularly after the COVID-19 pandemic, invasive fungal infections (IFIs) have emerged as a significant public health challenge in India, affecting vulnerable population, including immunocompromised individuals. The lack of comprehensive and well-structured data on IFIs has hindered efforts to understand their true burden and optimize patient care. To address this critical knowledge gap, the ICMR has undertaken a Pan-India pioneer initiative to develop a network of Advanced Mycology Diagnostic research centres in different geographical zones of the country (ICMR-MycoNet). Under the aegis of this project, a clinical registry on IFIs in the ICUs is initiated. This process paper presents a detailed account of the steps involved in the establishment of a web-based data entering and monitoring platform to capture data electronically, ensuring robust and secure data collection and management. This system not only allows participating ICMR-MycoNet centres to enter patient information directly into the database using standardized Case Report Form (CRF) but also includes data validation checks to ensure the accuracy and completeness of entered data. It is complemented by a real-time, web-based, and adaptable data visualization platform. This registry aims to provide crucial epidemiological insights, promote evidence-based hospital infection control programs, and ultimately improve patient outcomes in the face of this formidable healthcare challenge. [ABSTRACT FROM AUTHOR]

Considering the prevailing situations, the mathematical modeling and dynamics of novel coronavirus (2019-nCoV) particularly in India are studied in this paper. The goal of this work is to create an effective SEIRS model to study about the epidemic. Four different SEIRS models are considered and solved in this paper using an efficient homotopy perturbation method. A clear picture of disease spreading can be obtained from the solutions derived using this method. We parametrized the model by considering the number of infection cases from 1 April 2020 to 30 June 2020. Finally, numerical analysis and graphical representations are provided to interpret the spread of virus. [ABSTRACT FROM AUTHOR]

In this paper, the existing Susceptible-Infected-Recovered-Deceased (SIRD) compartmental epidemiologic process model is modified for forecasting the coronavirus effect in India. The data from India was studied for weekly fatalities, weekly infected, weekly recovered, new cases, infected and recovered individuals, Reproductive Number R0, recovery rate, death rate, and coefficient of transmission from 30 January 2020 to 31 July 2021. SARS Coronavirus 2 (SARS-CoV-2) is the Covid strain that causes Covid sickness (COVID-19), a respiratory ailment that triggered the outbreak of COVID-19 at the beginning of December 2019. We aim to provide a hybrid SIRD model for predicting the COVID-19 outbreak. In the proposed method, to improve the exploration ability of the Grey Wolf Optimizer (GWO) or to avoid stagnation in the swarm, a modified Grey Wolf Optimization Algorithm is used to optimize the initial value of Infected individuals. The modified SIRD model is further applied to get the predicted values. The data is examined on weekly basis to prevent noise. Depending on the fact, that the precise mode of transmission is highly dependent on how and when different precautions such as isolation, confinement, and other preventative measures were implemented, we put together our projections concerning satisfactory speculations based on genuine realities. The experimental results show the various trends observed in the pandemic in terms of number of peaks, increasing trend, decreasing trend, and continuous trend for infected individuals, weekly change in number of cases, weekly deaths, weekly infected, and weekly recoeverd cases of Covid-19. The proposed modified SIRD model could be a valuable tool for assessing the impact of government measures on COVID-19 outbreak. [ABSTRACT FROM AUTHOR]

Background: Carbapenem-resistant Enterobacteriaceae, especially Klebsiella pneumonia, have become a severe global problem with a significant threat to public health, but few studies have investigated the risk factors and epidemiology of carbapenem-resistant K. pneumonia (CRKP) infections in India. Methods: We performed a retrospective observational study of 224 participants with K. pneumoniae who were admitted to the medical intensive care unit (ICU) of Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India, between January 1 and December 30, 2020. Antibiotic susceptibility testing was done by automated broth microdilution VITEK® 2 (BioMerieux, Inc., Hazelwood, USA). The Clinical and Laboratory Standards Institute document M100-S22 (January 2020) was used to interpret antimicrobial susceptibility testing. Data were obtained from paper medical records. Results: Two hundred and twenty-four subjects with culture-positive for K. pneumonia were retrieved during the study period, out of which 108 had CRKP. The risk factors for univariate analysis were Acute Physiology and Chronic Health Evaluation II, ICU length of stay (LOS), invasive mechanical ventilator days, central venous catheter days, and arterial line days. The multivariate analysis showed invasive mechanical ventilation and ICU LOS were independent risk factors for CRKP infection. Mortality in the CRKP group was 48 (44%) compared to 27 (23%) in the carbapenem-sensitive K. pneumonia (CSKP) group, which was statistically significant (P < 0.01). Conclusion: Infection due to CRKP in the ICU was associated with 1.9 times higher mortality as compared to CSKP. Invasive mechanical ventilation and ICU LOS were found to be independent risk factors for CRKP infection. [ABSTRACT FROM AUTHOR]

Background and Aim: Burden of hepatitis C in India is not known. We therefore conducted a systematic review of the available data on anti‐hepatitis C virus (HCV) seroprevalence in the Indian population. Methods: We searched several publication databases for English language papers that reported data on anti‐HCV seroprevalence from India and also identified other unpublished sources of such data. Data on groups likely to represent seroprevalence in general population and in selected high‐risk groups were extracted and subjected to meta‐analysis. Results: Of the 3995 published papers and 94 additional data sources identified, 327 were selected; these provided 414 anti‐HCV seroprevalence data points. Pooled anti‐HCV seroprevalence rates in community‐based studies, blood donors, and pregnant women were 0.85% (95% confidence interval: 0.00–3.98%), 0.44% (0.40–0.49), and 0.88% (0.21–1.90), respectively. Among groups considered at high risk of HCV, pooled anti‐HCV seroprevalence rates were as follows: people living with HIV (40 studies from 17 states: 3.51% [2.43–4.76]), persons on maintenance hemodialysis (37, 13; 19.23% [13.52–25.65]), people who inject drugs (46, 14; 44.71% [37.50–52.03]), multi‐transfused persons (38, 12; 24.06% [20.00–28.36]), persons with sexually transmitted diseases (7, 5; 4.10% [0.98–9.04]), and those with high‐risk sex behavior (6, 5; 4.06% [1.79–7.10]). Conclusions: Community‐based data on HCV seroprevalence in India were limited. Large amount of data on blood donors and pregnant women were identified, with pooled anti‐HCV seroprevalence rates of 0.44% and 0.88%, respectively. Among high‐risk groups, anti‐HCV prevalence was higher among people living with HIV, those with sexually transmitted diseases, high‐risk sex behavior or injection drug use, and those receiving hemodialysis or frequent transfusions. [ABSTRACT FROM AUTHOR]

Research in mental health is a complex phenomenon that requires the use of more than one technique. It is extremely crucial to study and understand people's perceptions, beliefs, healing practices and coping strategies related to mental health. Stipulating only one between the medical/biomedical and medical anthropology perspectives may not be adequate to understand the dynamics of mental health research. The number of variables and components associated with the respondents and their social environments give diverse results. Research on mental health is very crucial and different from other kinds of health-related researches. Thus, while conducting mental health research, it is important that the researchers be careful in choosing and applying appropriate methodology. It is a very critical field of research, requiring Interdisciplinary research methodological approaches. An eclectic strategy is required to give an innate understanding of the phenomenon of mental health. Studies should follow both anthropological and epidemiological notions to understand human behaviour, for better management and planning of the mental health services. The proposed paper discusses 'cultural epidemiology' as a methodology and explores its contribution to the contemporary mental health research. [ABSTRACT FROM AUTHOR]

Background: Road traffic accidents (RTAs) have emerged as a major public health concern due to the growing number of motorized vehicles all over the world. In India, the burden of road traffic accidents is increasing and from 1991 to 2011, the number of fatal deaths has more than doubled. Madurai district is among road accident-prone regions of the state of Tamil Nadu. Objective: This paper aims to examine and understand trends and patterns of RTAs in rural areas of Madurai District between 2014-2018. Methods: The researchers collected RTAs data from Madurai District Crime Records Bureau. we have considered time-series data from 2014 to 2018 and the number and percentage of deaths by the distribution of relevant factors such as timing, gender, road type, and vehicles to understand holistic patterns of RTAs. Results: Totally 9950 road accidents were reported by Madurai District Crime Records Bureau between 2014 and 2018 and on an average over 1990 accidents have occurred every year. Nearly 40 per cent fatal accidents occurred between 15-21 h. Men were the victims in 87 per cent of deaths and men died 6.8 times higher than females during 2014-2018. Over 57 per cent of fatalities have occurred in National Highways. The proportion of two-wheelers contributed to road deaths is 28 per cent and two-wheelers caused maximum road deaths than other vehicles. Conclusion: The study shows a decreasing trend in road accidents and fatalities in Madurai district. However, a significant number of men dying in road accidents highlights the difficulties of their families. [ABSTRACT FROM AUTHOR]

Introduction: Deliberate corrosive substance attacks (DCSA) have traditionally been associated with low- and middle-income countries (LMIC). However, the incidence of DCSA in certain geographical locations of the UK has increased in recent years. These attacks have a relatively low mortality rate but cause extensive life-changing injuries and the management from point of wounding to definitive care is challenging for all involved. Methods: A systematic review was used to identify literature about DCSA and establish how much evidence about these attacks has been published over the last decade. Victim and perpetrator characteristics, substances used, injury patterns, mortality, pre-hospital and hospital-based management and complications associated with management were areas of interest. The review included any medical literature (case reports, letters, reviews) published within the last 10 years that described DCSA against human victims. Non-English language articles were excluded. Results: Eighteen articles containing 762 victims of DCSA were included; seven victims had incomplete data. Articles were mostly from LMIC (Bangladesh, Columbia, Cambodia, India, Iran, Sri Lanka and Pakistan) but there were five articles were from the UK (three 'Letters to Editors', one survivor letter and one retrospective review of 21 victims). UK victim and perpetrator characteristics varied from those in LMIC. Seven papers described pre-hospital management and nine described hospital/surgical management. Conclusions: The evidence base surrounding DCSA is limited especially in the UK setting. More research into the epidemiology and management of DCSA in the UK is warranted. [ABSTRACT FROM AUTHOR]

Of the 70 million persons with epilepsy (PWE) worldwide, nearly 12 million PWE are expected to reside in India; which contributes to nearly one-sixth of the global burden. This paper (first of the two part series) provides an in-depth understanding of the epidemiological aspects of epilepsy in India for developing effective public health prevention and control programs. The overall prevalence (3.0-11.9 per 1,000 population) and incidence (0.2-0.6 per 1,000 population per year) data from recent studies in India on general population are comparable to the rates of high-income countries (HICs) despite marked variations in population characteristics and study methodologies. There is a differential distribution of epilepsy among various sociodemographic and economic groups with higher rates reported for the male gender, rural population, and low socioeconomic status. A changing pattern in the age-specific occurrence of epilepsy with preponderance towards the older age group is noticed due to sociodemographic and epidemiological transition. Neuroinfections, neurocysticercosis (NCC), and neurotrauma along with birth injuries have emerged as major risk factors for secondary epilepsy. Despite its varied etiology (unknown and known), majority of the epilepsy are manageable in nature. This paper emphasizes the need for focused and targeted programs based on a life-course perspective and calls for a stronger public health approach based on equity for prevention, control, and management of epilepsy in India. [ABSTRACT FROM AUTHOR]

Cervical cancer is on the declining trend in India according to the population-based registries; yet it continues to be a major public health problem for women in India. Multifactorial causation, potential for prevention, and the sheer threat it poses make cervical cancer an important disease for in-depth studies, as has been attempted by this paper. This paper attempts to review the available knowledge regarding the epidemiology and pattern of cervical cancer; types of HPV (human papilloma virus) prevalent among cervical cancer patients and among women in general, high-risk groups such as commercial sex workers, and HIV (human immunodeficiency virus)-positive women; and the role of the national program on cancer in control efforts. The peak age of incidence of cervical cancer is 55-59 years, and a considerable proportion of women report in the late stages of disease. Specific types of oncogenic HPV-16, 18 have been identified in patients with cervical cancer. Other epidemiological risk factors are early age at marriage, multiple sexual partners, multiple pregnancies, poor genital hygiene, malnutrition, use of oral contraceptives, and lack of awareness. A multipronged approach is necessary which can target areas of high prevalence identified by registries with a combination of behavior change communication exercises and routine early screening with VIA. Sensitizing the people of the area, including menfolk, is necessary to increase uptake levels. Vaccination against types 16 and 18 can also be undertaken after taking into confidence all stakeholders, including the parents of adolescent girls. Preventing and treating cervical cancer and reducing the burden are possible by targeting resources to the areas with high prevalence. [ABSTRACT FROM AUTHOR]

Introduction: Role of vaginal sex in heterosexual transmission of HIV has been investigated but that of heterosexual anal sex (HAS) is not fully understood. This paper examines practice of HAS among Female Sex Workers (FSWs) and its correlates in India where the HIV epidemic is being primarily driven by core groups like FSWs. Methods: Data for this paper are drawn from Round I survey of 9667 FSWs in the Integrated Biological and Behavioral Assessment (IBBA) from 23 districts of 4 high HIV prevalent states of India. Bivariate and multivariate analysis identified factors associated with HAS. Results: Ever having anal sex was reported by 11.9% FSWs (95% CI: 11.3%–12.6%). Typology (AOR 2.20, 95% CI 1.64–2.95) and literacy (AOR 1.28, 95% CI 1.10–1.49) were positively associated with practice of HAS. Longer duration in sex trade (AOR 1.69, 95% CI 1.44–1.99), entertaining larger number of clients the previous week (AOR 1.78, 95% CI 1.47–2.15), alcohol consumption (AOR 1.21, 95% CI 1.03–1.42) and inability to negotiate condom use (AOR 1.53, 95% CI 1.28–1.83) were also correlated with HAS. Self-risk perception for HIV (AOR 1.46, 95% CI 1.25–1.71) did not impede HAS. Although symptoms of sexually transmitted infections (STIs) in the last 12 months were associated with anal sex (AOR 1.39, 95% CI 1.13–1.72) there was no significant association between laboratory confirmed HIV and other STIs with HAS. Conclusion: Practice of HAS by FSWs might significantly contribute to HIV transmission in India. This study also shows that despite self-risk perception for HIV, even literate FSWs with longer duration in sex work report HAS. General messages on condom use may not influence safe HAS. FSWs need to be targeted with specific messages on HIV transmission during anal sex. Women controlled prevention methods, such as rectal microbicides and vaginal microbicides are needed. [ABSTRACT FROM AUTHOR]

Background: Even though cholera has existed for centuries and many parts of the country have sporadic, endemic and epidemic cholera, it is still an under-recognized health problem in India. A Cholera Expert Group in the country was established to gather evidence and to prepare a road map for control of cholera in India. This paper identifies cholera burden hotspots and factors associated with an increased risk of the disease. Methodology/Principle findings: We acquired district level data on cholera case reports of 2010–2015 from the Integrated Disease Surveillance Program. Socioeconomic characteristics and coverage of water and sanitation was obtained from the 2011 census. Spatial analysis was performed to identify cholera hotspots, and a zero-inflated Poisson regression was employed to identify the factors associated with cholera and predicted case count in the district. 27,615 cholera cases were reported during the 6-year period. Twenty-four of 36 states of India reported cholera during these years, and 13 states were classified as endemic. Of 641 districts, 78 districts in 15 states were identified as “hotspots” based on the reported cases. On the other hand, 111 districts in nine states were identified as “hotspots” from model-based predicted number of cases. The risk for cholera in a district was negatively associated with the coverage of literate persons, households using treated water source and owning mobile telephone, and positively associated with the coverage of poor sanitation and drainage conditions and urbanization level in the district. Conclusions/Significance: The study reaffirms that cholera continues to occur throughout a large part of India and identifies the burden hotspots and risk factors. Policymakers may use the findings of the article to develop a roadmap for prevention and control of cholera in India. [ABSTRACT FROM AUTHOR]

The present paper attempts to explore the socio-demographic profile of patients with rhinosporidiosis in an endemic area. A cross-sectional study was carried out in a tertiary-care hospital in Purulia district, India, including consecutive patients with histologically-proved rhinosporidiosis. Their socio-demographic profiles were obtained through a pre-designed proforma with given epidemiologic parameters. Data was statistically analyzed with inputs from literature review. Of the 39 patients included, 87 % were fresh/new cases. The age-group of 10-20 years was mostly involved, with multiple peaks around 50. About 82 % were from rural background, commonly involved in cattle farming and agriculture, with a universal habit of pond-bathing. There was a male preponderance; however women were being increasingly affected. Nasal cavity was the predominant site involved; nasal obstruction and epistaxis were the primary complaints. About 13 % had recurrent lesions that were statistically related to higher age-group (≥15 years) and occupation (agriculture, labor). Rhinosporidiosis is predominantly the disease of young rural adults engaged in field activities and habituated to pond-bathing. A bimodal age distribution was noticed. The present article provides an update on the socio-demographic perspectives of rhinosporidiosis in an endemic zone. It also summarizes the factors that would identify the vulnerable population and help formulate preventive measures. [ABSTRACT FROM AUTHOR]

Context: A number of local dialects and languages exist in India, which leads to a single disease being addressed by a number of names which may overlap with other disease names also. This creates misunderstanding and is a hindrance to effective patient–doctor communication. Aims: The paper aims to find out how effectively the name of the respiratory disease is communicated to the patient. The terminology used by patients to describe their disease was also noted at limited level. Settings and Design: The study was conducted in the form of parallel cross-sectional surveys, among pulmonologists and patients. Methods: Among the members of the Indian Chest Society and those attending the National Conference on Pulmonary Diseases (NAPCON-2015), 1028 pulmonologists participated in the online survey which was the first part of the study. The term used to address the common respiratory disease was inquired in the survey. To find the response of patients, a questionnaire was given to the patients attending four respiratory disease clinics of a city. They were inquired about the name of respiratory disease they were suffering from. Results: Pneumonia was the disease which was communicated with exact terminology by 898 (87.4%) doctors to their patients. In contrast, idiopathic pulmonary fibrosis was communicated with precise terminology by only 171 (16.6%) doctors. Pulmonary tuberculosis was exactly told by 708 (69%), asthma by 731 (71.1%), and chronic obstructive pulmonary disease by 593 (57.7%) doctors. However, only 17.6% of the 1122 patients participating in the survey had a knowledge of the name of disease they were suffering from. Conclusions: The exact terminology of the common respiratory diseases is not effectively used by many doctors and most of the patients. The study identifies an important gap in patient–doctor communication, and therefore, highlights the need of effective patient education. [ABSTRACT FROM AUTHOR]

This paper describes the interrelationship among men's self-reports of symptoms, unsafe sexual behavior, and biologically tested sexually transmitted infections (STIs). Data are drawn from the baseline survey of six-year (2001-2007) research and intervention project on men's sexual health and HIV/STI risk reduction conducted in three urban poor communities in Mumbai, India. The survey collected a wide range of demographic, attitudinal, knowledge, and behavioral data. In addition, men were tested for common STIs by selecting a systematic random sub-sample of 816 men (assuming 20% non-response). Data in this paper are based on 641 men who had completed the survey interview and for whom the testing of blood and urine samples was conducted. Results suggest that the self-reported STI-like symptoms and unsafe sexual behavior taken together as a predictor of confirmed STIs improve the sensitivity to a significantly greater degree (χ 2=2.83, p<0.05) as compared to the sensitivity of self-reported STI-like symptoms or unsafe sexual behavior alone as a predictor of confirmed STIs. In addition, the consistency of self-report was found to vary among socio-demographic and behaviorally defined sub-groups. These results provide preliminary support for the importance of population-based surveys, which collect all the three types of data such as reported behavior, symptoms and laboratory confirmed STIs for a full understanding of sexual risk and STIs and for identification of sub-groups within communities that vary in their ability to identify STI symptoms. [ABSTRACT FROM AUTHOR]

India has over a century old tradition of development and production of vaccines. The Government rightly adopted self-sufficiency in vaccine production and self-reliance in vaccine technology as its policy objectives in 1986. However, in the absence of a full-fledged vaccine policy, there have been concerns related to demand and supply, manufacture vs. import, role of public and private sectors, choice of vaccines, new and combination vaccines, universal vs. selective vaccination, routine immunization vs. special drives, cost-benefit aspects, regulatory issues, logistics etc. The need for a comprehensive and evidence based vaccine policy that enables informed decisions on all these aspects from the public health point of view brought together doctors, scientists, policy analysts, lawyers and civil society representatives to formulate this policy paper for the consideration of the Government. This paper evolved out of the first ever ICMR-NISTADS national brainstorming workshop on vaccine policy held during 4-5 June, 2009 in New Delhi, and subsequent discussions over email for several weeks, before being adopted unanimously in the present form. [ABSTRACT FROM AUTHOR]

Aim: To present the epidemiology of brucellosis and to assess and suggest public health intervention strategies to control brucellosis in rural India. Methods: The paper is based on a review of various serological and other studies and evidence on brucellosis in India. Results: Brucellosis is present in all livestock systems. Although the true incidence for human brucellosis is not available, various state specific studies and extrapolated incidence (321 cases annually) have shown that it is a serious disease present in the population. The studies also show that there is a conducive condition and environment for wide-spread human infection on account of unhygienic conditions and poverty in rural areas which need public health attention and intervention. Conclusion: The paper suggests that brucellosis needs to be included in public health education and public awareness programmes, particularly in the rural areas of India. It also suggests promoting safe livestock practices, active co-operation between health and veterinary services and a paradigm shift from the current 'biomedical model' to a 'sociocultural model' for the elimination of brucellosis in India. [ABSTRACT FROM AUTHOR]

This paper examines technical practices, such as epidemiological modeling, used to produce HIVprevalence estimates within India's national policy establishment. These technical practices are a useful site within which to investigate the shifting politics between India's national government and international agencies such as the World Bank and UNAIDS. The paper argues that international actors, and the technical practices they purvey, carry a 'foreknowledge' about the epidemic. This foreknowledge provides a pre-existing template of an AIDS epidemic; it helps the government imagine what an AIDS epidemic looks like, anticipate patterns of risk, and plan public health interventions. However, pre-packaged foreknowledge leaves relatively little room for surprises, and sits alongside a selective silencing of local experiences and public health history. [ABSTRACT FROM AUTHOR]

Due to the availability of a huge amount of epidemiological and public health data that require analysis and interpretation by using appropriate mathematical tools to support the existing method to control the mosquito and mosquito-borne diseases in a more effective way, data-mining tools are used to make sense from the chaos. Using data-mining tools, one can develop predictive models, patterns, association rules, and clusters of diseases, which can help the decision-makers in controlling the diseases. This paper mainly focuses on the applications of data-mining tools that have been used for the first time to prioritize the malaria endemic regions in Manipur state by using Self Organizing Maps (SOM). The SOM results (in two-dimensional images called Kohonen maps) clearly show the visual classification of malaria endemic zones into high, medium and low in the different districts of Manipur, and will be discussed in the paper. [ABSTRACT FROM AUTHOR]

Background: As Bangladesh, India and Nepal progress towards visceral leishmaniasis (VL) elimination, it is important to understand the role of asymptomatic Leishmania infection (ALI), VL treatment relapse and post kala-azar dermal leishmaniasis (PKDL) in transmission. Methodology/ Principal Finding: We reviewed evidence systematically on ALI, relapse and PKDL. We searched multiple databases to include studies on burden, risk factors, biomarkers, natural history, and infectiveness of ALI, PKDL and relapse. After screening 292 papers, 98 were included covering the years 1942 through 2016. ALI, PKDL and relapse studies lacked a reference standard and appropriate biomarker. The prevalence of ALI was 4–17-fold that of VL. The risk of ALI was higher in VL case contacts. Most infections remained asymptomatic or resolved spontaneously. The proportion of ALI that progressed to VL disease within a year was 1.5–23%, and was higher amongst those with high antibody titres. The natural history of PKDL showed variability; 3.8–28.6% had no past history of VL treatment. The infectiveness of PKDL was 32–53%. The risk of VL relapse was higher with HIV co-infection. Modelling studies predicted a range of scenarios. One model predicted VL elimination was unlikely in the long term with early diagnosis. Another model estimated that ALI contributed to 82% of the overall transmission, VL to 10% and PKDL to 8%. Another model predicted that VL cases were the main driver for transmission. Different models predicted VL elimination if the sandfly density was reduced by 67% by killing the sandfly or by 79% by reducing their breeding sites, or with 4–6y of optimal IRS or 10y of sub-optimal IRS and only in low endemic setting. Conclusion/ Significance: There is a need for xenodiagnostic and longitudinal studies to understand the potential of ALI and PKDL as reservoirs of infection. [ABSTRACT FROM AUTHOR]

Background. There are striking global inequities in our knowledge of the incidence, aetiology, and outcome of psychotic disorders. For example, only around 10% of research on incidence of psychotic disorders originates in low- and middleincome countries. We established INTREPID I to develop, implement, and evaluate, in sites in India (Chengalpet), Nigeria (Ibadan), and Trinidad (Tunapuna-Piarco), methods for identifying and recruiting untreated cases of psychosis, as a basis for investigating incidence and, subsequently, risk factors, phenomenology, and outcome. In this paper, we compare case characteristics and incidence rates across the sites. Method. In each site, to identify untreated cases of psychoses in defined catchment areas, we established case detection systems comprising mental health services, traditional and spiritual healers, and key informants. Results. Rates of all untreated psychoses were 45.9 (per 1 00 000 person-years) in Chengalpet, 31.2 in Ibadan, and 36.9 in Tunapuna-Piarco. Duration of psychosis prior to detection was substantially longer in Chengalpet (median 232 weeks) than in Ibadan (median 13 weeks) and Tunapuna-Piarco (median 38 weeks). When analyses were restricted to cases with a short duration (i.e. onset within preceding 2 years) only, rates were 15.5 in Chengalpet, 29.1 in Ibadan, and 26.5 in Tunapuna-Piarco. Further, there was evidence of age and sex differences across sites, with an older average age of onset in Chengalpet and higher rates among women in Ibadan. Conclusion. Our findings suggest there may be differences in rates of psychoses and in the clinical and demographic profiles of cases across economically and socially distinct settings. [ABSTRACT FROM AUTHOR]

Considering the high burden of injuries, the Health Authority - Abu Dhabi developed a draft electronic and paper-based injury and poisoning notification system (IPNS) to generate better data on the nature and severity of injuries. The pilot testing and evaluation of IPNS was conducted with the specific objectives to (1) identify the characteristics of injury cases, (2) explore potential risk factors, (3) illustrate the nature and type of data, and (4) the working mechanism of data collection. Data were collected from selected hospitals on patient demographics, injury information and clinical assessment. Descriptive, bivariate and multivariate analyses were conducted. Of 4226 injury cases, nearly three-fourths were male, majority were non-UAE nationals, and the mean age was 21.9. Multivariate findings suggested that compared to UAE nationals, non-UAE nationals were 27% more likely to experience fatal, severe or moderate injuries (p= 0.01). Individuals with health insurance were 31% less likely to suffer a fatal, severe or moderate injury compared to those having no health insurance (p< 0.001). This is the first systematically standardised collection of injury data across three facilities in Abu Dhabi, and provides initial information on characteristics and injury risk factors that will help identify the need for evidence-based intervention for injury prevention and control. [ABSTRACT FROM PUBLISHER]

Background:The occurrence of juvenile nasopharyngeal angiofibroma is reportedly higher in India than in some other parts of the world, and our centre has seen a four-fold increase in its occurrence across seven decades.Methods:This paper reports a retrospective archival analysis of 701 juvenile nasopharyngeal angiofibroma cases from 1958 to 2013, and considers probable environmental factors in an Indian context that may affect its biology and the global distribution, as reported in the literature.Results:A continuously progressive increase in occurrence was evident, but the rapid rise observed in the current decade was alarming. The world map of juvenile nasopharyngeal angiofibroma incidence does not reflect true global distribution given the paucity of reporting. Our centre has dealt with approximately 400 cases in the last 24 years.Conclusion:With the alarming increase in juvenile nasopharyngeal angiofibroma incidence, there is a need for a registry to define its epidemiology. The world literature needs to reflect the status of juvenile nasopharyngeal angiofibroma incidence in the third world as well. Environmental factors known for hormone disruptive actions may influence its occurrence. Such aspects need to be considered to plan specific prevention policies. [ABSTRACT FROM PUBLISHER]

Sexually transmitted diseases (STD) consist of different group of endemic diseases of varying clinical presentation, characterized epidemiologically as sexually transmitted infections. Sexually transmitted diseases in individuals have far reaching health, social and economic consequences. Sexually transmitted infections are very important because of their potential complication and interaction with HIV/AIDS. Recognition of HIV/STI cases has tremendous contribution for targeted intervention in the hospital. By evaluating the HIV/STI cases it will be a signal to know the affected groups and major determinants. In this Paper, the study was conducted to evaluate the clinical, epidemiological and laboratory characteristics of the sexually transmitted diseases (STD) found in the government general Hospital, Nizamabad in the year 2013. [ABSTRACT FROM AUTHOR]

Background: A deficient data is among the biggest obstacle facing planners and policy makers. Health data collection in the developing world is often hampered by the high costs and inefficiencies of traditional large-scale paper-based surveys. mHealth using Epi-Info is most appropriate tool to create, share, deploy health surveys and for strengthening of health systems. The program runs on free and open software, is easy to use, and can be downloaded to handheld devices to be used by workers in the field. Objectives: To find out the usefulness and limitations of data collection for mHealth by use of Epi Info™ software. Material and Methods: The devices used Epi Info 7.1.5 (Android version), which has been modeled as a database with variables of the traditional form. A cross sectional survey among adolescents regarding their health needs was carried out in a sample of 200 adolescents (purposive sampling) of rural hilly (Jaunpur block of Tehri Garhwal district) and plain (Doiwala block of Dehradun district) areas of Uttarakhand by the use of Android tablets with Epi Info™. Results: It was found that adolescent questionnaire tool developed in Epi Info™ android tablet application is a powerful tool for data collection having numerable practical advantages like: Interview Time Tracking (ITT) that gives the reality check in field studies along with cases Geographical presentation by GIS mapping. In addition to this complete filling of data in field so no left over or guessing for data entry operator, paperless, bio-friendly. Despite of Tablet cost, it is cost effective as tablet can be repeatedly used for other surveys. Conclusions: Epi Info™ is a developing open access software for primary data collection and analyzing data from the field, with advantageous benefits of epidemiological surveys. [ABSTRACT FROM AUTHOR]

An amendment to this paper has been published and can be accessed via a link at the top of the paper. [ABSTRACT FROM AUTHOR]

Background: Worse health outcomes including higher morbidity and mortality are most often observed among the poorest fractions of a population. In this paper we present and validate national, regional and state-level distributions of national wealth index scores, for urban and rural populations, derived from household asset data collected in six survey rounds in India between 1992–3 and 2007–8. These new indices and their sub-national distributions allow for comparative analyses of a standardized measure of wealth across time and at various levels of population aggregation in India. Methods: Indices were derived through principal components analysis (PCA) performed using standardized variables from a correlation matrix to minimize differences in variance. Valid and simple indices were constructed with the minimum number of assets needed to produce scores with enough variability to allow definition of unique decile cut-off points in each urban and rural area of all states. Results: For all indices, the first PCA components explained between 36% and 43% of the variance in household assets. Using sub-national distributions of national wealth index scores, mean height-for-age z-scores increased from the poorest to the richest wealth quintiles for all surveys, and stunting prevalence was higher among the poorest and lower among the wealthiest. Urban and rural decile cut-off values for India, for the six regions and for the 24 major states revealed large variability in wealth by geographical area and level, and rural wealth score gaps exceeded those observed in urban areas. Conclusions: The large variability in sub-national distributions of national wealth index scores indicates the importance of accounting for such variation when constructing wealth indices and deriving score distribution cut-off points. Such an approach allows for proper within-sample economic classification, resulting in scores that are valid indicators of wealth and correlate well with health outcomes, and enables wealth-related analyses at whichever geographical area and level may be most informative for policy-making processes. [ABSTRACT FROM AUTHOR]

Since the beginning of the HIV/AIDS epidemic in India, pregnant women attending antenatal clinics (ANC) have been considered as a low HIV risk population. Yet, a substantial proportion of new HIV infections are occurring among stable heterosexual couples. This paper sought to investigate the proportion and profile of women who, within the low-risk population, are potentially at higher risk of HIV infection. HIV risk perception of pregnant women enrolled within the ANRS 12127 Prenahtest trial was described and associated socio-behavioral characteristics, husband's characteristics, and HIV-related characteristics were analyzed using univariate and multivariate logistic regression models. Among 484 women enrolled, baseline data were collected for 479 women and 460 women with completed data were considered for the present analysis (96%). Eighty-nine (19.4%) women perceived themselves at risk of HIV. Women with educational level <11years (Adjusted Odds Ratio, AOR = 2.4 [CI = 1.28–4.53]), who stayed in joint families (AOR = 1.89 [CI = 1.12–3.12]), who had experienced insult or hurt from the partner (AOR = 1.91 [CI = 1.11–3.27]) and whose partner were alcoholic (AOR = 2.19 [CI = 1.31–3.66]) were significantly more likely to perceive themselves at risk of HIV. Women who had heard about sexually transmitted infections were also more likely to report HIV risk perception (AOR = 3.36 [CI = 1.83–6.18]). Substantial proportion of women (one out of five) perceived themselves at risk of HIV and most of these have reported some form of vulnerability in their couple relationship such as intimate partner violence, alcoholic partner, lack of communication, and spaces for communication with partner. Though awareness and knowledge is the first step for prevention, considering the vulnerabilities associated with HIV risk perception, HIV prevention interventions in India should target overall sources of vulnerability to HIV. Targeted risk reduction for women in ANC should be considered for primary HIV prevention among couples. [ABSTRACT FROM AUTHOR]

Oral cancer is one of the leading causes of human morbidity and mortality especially in developing countries like India. Tobacco consumption in smokeless and smoking form along with alcohol is considered as the primary risk factors. Tobacco is a major health challenge with various tobacco products available for use which are known to have deleterious effects on the oral mucosa. The oral lesions caused by tobacco are inclusive of those that are less likely to progress to cancer; lesions with increased tendency to develop into cancer and cancerous lesions. Prevention and control of tobacco induced oral mucosal lesions is the prime requisite currently and mainly involves measures undertaken at primary, secondary and tertiary levels. Primary prevention plays a pivotal role in tobacco induced lesions and steps can be taken at policy level, community as well as individual level. This review paper focuses on the epidemiological data of tobacco induced oral mucosal lesions in India available in the literature with an overview on various strategies for their prevention and control. [ABSTRACT FROM AUTHOR]

HIV epidemic in India is predominantly concentrated in subgroups of population, such as female sex workers (FSWs) and their clients, whose behavior exposes them to a higher risk of acquiring HIV infection. This paper aims to present the changing patterns of socio-demographic characteristics, behaviors, reported sexually transmitted infections (STIs), and associated factors among FSWs over 11 years. Multistage cluster sampling with probability-proportional-to-size (PPS) method was used in the surveys. A sample of 400 FSWs was studied every year. The mean age and literacy at the baseline level increased significantly over the years. House-based sex increased by 40% from 43.3% in 1997 to 83% in 2008 (p<0.001). Condom use at last sex with one-time clients; consistent condom use (CCU) with one-time and regular clients indicated increasing trends. FSWs reported low levels of condom use at last sex (14.5% in 1997 to 5% in 2008;p<0.001) and CCU (12.6% in 2004 to 3.6% in 2008;p<0.01) with regular partners. FSWs who used condom with one-time clients at last sex reported significantly less STI symptoms. A two-third reduction in genital ulcers was found from 13.1% in 1997 to 4.5% in 2008 (p<0.001). Nonliterate and hotel-based sex workers were 1.6 (1.0–2.5; 95% CI) and 2.2(1.3–3.7; 95% CI) times more likely to have reported STI symptoms. The percentage of FSWs who underwent HIV testing increased (p<0.001); similarly, a 20% increase was found in FSWs who availed counseling services from 65.2% in 1997 to 85.4% in 2008 (p<0.001). Poor, illiterate, and marginalized were more likely to get involved in risky behaviors which suggest the need for structural interventions as part of HIV prevention strategy. [ABSTRACT FROM AUTHOR]

Among infectious diseases, Infectious coryza is one of the major problems affecting commercial poultry industry in the developing country like India. It is an upper respiratory tract disease of chickens caused by Haemophilus paragallinarum. The economic impact of the disease is mainly due to increased number of culls and significant reduction (10 to 40 %) in egg production, especially on multi-age farms (Blackall et al., 1997). The research work on infectious coryza so far in India is so scanty that does not provides necessary impact analysis of the disease on the commercial poultry rearers in the country. This paper presents an overview of the occurrence of the disease in India and other countries. The paper compares the economic losses to the poultry owners due to the disease in developed and developing countries. [ABSTRACT FROM AUTHOR]

: In this paper from Basu and colleagues, a simulation of tobacco control and pharmacological interventions to prevent cardiovascular disease mortality in India predicted that Smokefree laws and increased tobacco taxation are likely to be the most effective measures to avert future cardiovascular deaths in India. Please see later in the article for the Editors' Summary [ABSTRACT FROM AUTHOR]

Background: India, with a population of more than 1.21 billion, has the highest maternal mortality in the world (estimated to be 56000 in 2010); and adolescent (aged 15–19) mortality shares 9% of total maternal deaths. Addressing the maternity care needs of adolescents may have considerable ramifications for achieving the Millennium Development Goal (MDG)–5. This paper assesses the socioeconomic differentials in accessing full antenatal care and professional attendance at delivery by adolescent mothers (aged 15–19) in India during 1990–2006. Methods and Findings: Data from three rounds of the National Family Health Survey of India conducted during 1992–93, 1998–99, and 2005–06 were analyzed. The Cochran-Armitage and Chi-squared test for linear and non-linear time trends were applied, respectively, to understand the trend in the proportion of adolescent mothers utilizing select maternity care services during 1990–2006. Using pooled multivariate logistic regression models, the probability of select maternal healthcare utilization among women by key socioeconomic characteristics was appraised. After adjusting for potential socio-demographic and economic characteristics, the likelihood of adolescents accessing full antenatal care increased by only 4% from 1990 to 2006. However, the probability of adolescent women availing themselves of professional attendance at delivery increased by 79% during the same period. The study also highlights the desolate disparities in maternity care services among adolescents across the most and the least favoured groups. Conclusion: Maternal care interventions in India need focused programs for rural, uneducated, poor adolescent women so that they can avail themselves of measures to delay child bearing, and for better antenatal consultation and delivery care in case of pregnancy. This study strongly advocates the promotion of a comprehensive ‘adolescent scheme’ along the lines of ‘Continuum of Maternal, Newborn and Child health Care’ to address the unmet need of reproductive and maternal healthcare services among adolescent women in India. [ABSTRACT FROM AUTHOR]

Context: Though the cardiovascular diseases are the leading cause of mortality in India, little is known about the human and economic loss attributed to the disease. The aim of this paper is to account the age and sex pattern of mortality, hospitalisation and the cost of hospitalisation for cardiovascular diseases in India. Data and Methods: Data for the present study has been drawn from multiple sources; 52nd and 60th rounds of the National Sample Survey, Special Survey of Death, 2001–03 and the Sample Registration System 2004–2010. Under the changing demographics and constant assumptions of mortality, hospitalisation and cost of hospitalisation, we have estimated the deaths, hospitalisation and cost of hospitalisation for cardiovascular diseases in India during 2004 to 2021. Descriptive analyses and multivariate techniques were used to understand the socio-economic differentials in cost of hospitalisation for cardiovascular diseases in India. Findings: In India, the cardiovascular diseases accounted for an estimated 1.4 million deaths in 2004 and it is likely to be 2.1 million in 2021. An estimated 6.7 million people were hospitalised for cardiovascular diseases in 2004, and projected to be 10.9 million by 2021. Unlike mortality, majority of the hospitalisation due to cardiovascular diseases will be in the prime working age group (25–59). The estimated cost of hospitalisation for cardiovascular diseases was 94/− billion rupees in 2004 and expected to be 152/− billion rupees by 2021, at 2004 prices. The cost of hospitalisation for cardiovascular diseases was significantly high in private health centres, high fertility states and among high socio-economic groups. Conclusion: The cardiovascular mortality and hospitalisation will be largely concentrated in the prime working age group and the cost of hospitalisation is expected to increase substantially in coming years. This calls for mobilising resources, increasing access to health insurance and devising strategies for the prevention, control and treatment of cardiovascular diseases in India. [ABSTRACT FROM AUTHOR]

Background This paper examines the association between degree of confidence in collective efficacy and self-efficacy for condom use and empowerment among heterogeneous female sex workers (FSWs) in two metropolitan Indian cities with high HIV prevalence. Methods The study utilises data from the Behavioural Tracking Survey, a cross-sectional behavioural study with 2106 FSWs recruited from 411 intervention sites in Mumbai and Thane. The key independent measures used determine the degree of confidence in collective efficacy (belief in the power to achieve goals and address problems together) and outcome measures included: self-efficacy for condom use with occasional clients and condom use with regular partners, self-confidence in handling a crisis situation and public speaking ability. Univariate and multivariate statistical methods were used to examine the study objectives. Results Of the analytical sample of 2106 FSWs, 532 (25.3%) reported high degree of collective efficacy for achieving certain goals and 1534 (72.8%) reported collective efficacy for addressing specific problems. FSWs reporting a higher collective efficacy as compared with those reporting lower collective efficacy were as follows: more likely to negotiate condom use with occasional clients (60.3% vs 19.7%; adjusted OR (AOR) =6.3, 95% CI 4.8 to 8.4) as well as regular partners (62.8% vs 20.2%; AOR =6.4, 95% CI 4.9 to 8.4); confident in facing troublesome stakeholders (73.5% vs 38.8%; AOR =4.3, 95% CI 3.3 to 5.6), confident in supporting fellow FSWs in a crisis (76.1% vs 49.6%; AOR =2.9, 95% CI 2.2 to 3.7), received help from other FSWs when a client or partner was violent (73.9% vs 46.3%; AOR =3.5, 95% CI 2.7 to 4.5) and had stood up to the police or madams/brokers to help fellow FSWs in the past 1 year (5.8% vs 3.3%; AOR =2.7, 95% CI 1.5 to 4.9). Conclusion The results suggest that the strategy of collectivisation in HIV prevention programme has much broader benefits than merely the promotion of safer sex practices. Future HIV prevention interventions in India and elsewhere may include collectivisation as the core strategy within HIV prevention programmes. [ABSTRACT FROM AUTHOR]

Background Community mobilisation interventions for HIV prevention among female sex workers (FSWs) aim to organise FSWs for collective action and challenge the structures of power that underlie HIV risk. Assessing intervention impact is challenging because the importance of direct individual exposure to intervention components may decrease over time as change occurs at social-normative, policy and other structural levels. In this paper, the authors examine changes over time in consistent condom use among FSWs in Rajahmundry, Andhra Pradesh, the location of a long-standing community mobilisation intervention. Methods The authors analyse cross-sectional data collected among FSWs at three time points (n=2276) using respondent-driven sampling. Multiple logistic regression was used to assess the association of programme exposure with consistent condom use and whether this association varied over time. Results The proportion of FSWs having no exposure or only receptive exposure to the intervention decreased over time, while active utilisation increased from 19.4% in 2006 to 48.5% in 2009-2010. Consistent condom use with clients also increased from 56.3% in 2006 to 75.3% in 2009-2010. Multivariate analysis showed that age, age at start of sex work, venue, living conditions and programme exposure were significantly associated with condom use. The positive association between programme exposure and consistent condom use did not vary significantly over time. Conclusions Findings indicate improvements in HIV risk reduction behaviour among FSWs and suggest that the intervention has substantial reach in the FSW population. The intervention's strategies may be contributing to population-level HIV risk reduction among FSWs. [ABSTRACT FROM AUTHOR]

Using population-based and family structural data from a high HIV-prevalence district of Southern India, this paper considers four suggested social scenarios used to explain the positive correlation between HIV prevalence and previously married status among Indian women: (1) infection from and then bereavement of an infected husband; (2) abandonment after husbands learn of their wives' HIV status; (3) economic instability after becoming previously married, leading women to seek financial support through male partners; and (4) the social status of being previously married exposing women to sexual harassment and predation. By also considering seroprevalence of two other common sexually transmitted infections (STIs), herpes and syphilis, in a combined variable with HIV, we limit the likelihood of the first two scenarios accounting for the greater part of this correlation. Through a nuanced analysis of household residences patterns (family structure), standard of living, and education, we also limit the probability that scenario three explains a greater portion of the correlation. Scenario four emerges as the most likely explanation for this correlation, recognizing that other scenarios are also possible. Further, the interdisciplinary literature on the social position of previously married women in India strongly supports the suggestion that, as a population, previously married women are sexually vulnerable in India. Previously married status as an STI risk factor requires further biosocial research and warrants concentrated public health attention. [ABSTRACT FROM AUTHOR]

The figure showing how the model of Kermack and McKendrick fits the data from the 1906 plague epidemic in Bombay is the most reproduced figure in books discussing mathematical epidemiology. In this paper we show that the assumption of constant parameters in the model leads to quite unrealistic numerical values for these parameters. Moreover the reports published at the time show that plague epidemics in Bombay occurred in fact with a remarkable seasonal pattern every year since 1897 and at least until 1911. So the 1906 epidemic is clearly not a good example of epidemic stopping because the number of susceptible humans has decreased under a threshold, as suggested by Kermack and McKendrick, but an example of epidemic driven by seasonality. We present a seasonal model for the plague in Bombay and compute the type reproduction numbers associated with rats and fleas, thereby extending to periodic models the notion introduced by Roberts and Heesterbeek. [ABSTRACT FROM AUTHOR]

Background: India launched a national conditional cash transfer program, Janani Suraksha Yojana (JSY), aimed at reducing maternal mortality by promoting institutional delivery in 2005. It provides a cash incentive to women who give birth in public health facilities. This paper studies the extent of program uptake, reasons for participation/ non participation, factors associated with non uptake of the program, and the role played by a program volunteer, accredited social health activist (ASHA), among mothers in Ujjain district in Madhya Pradesh, India. Methods: A cross-sectional study was conducted from January to May 2011 among women giving birth in 30 villages in Ujjain district. A semi-structured questionnaire was administered to 418 women who delivered in 2009. Socio-demographic and pregnancy related characteristics, role of the ASHA during delivery, receipt of the incentive, and reasons for place of delivery were collected. Multinomial regression analysis was used to identify predictors for the outcome variables; program delivery, private facility delivery, or a home delivery. Results: The majority of deliveries (318/418; 76%) took place within the JSY program; 81% of all mothers below poverty line delivered in the program. Ninety percent of the women had prior knowledge of the program. Most program mothers reported receiving the cash incentive within two weeks of delivery. The ASHA's influence on the mother's decision on where to deliver appeared limited. Women who were uneducated, multiparious or lacked prior knowledge of the JSY program were significantly more likely to deliver at home. Conclusion: In this study, a large proportion of women delivered under the program. Most mothers reporting timely receipt of the cash transfer. Nevertheless, there is still a subset of mothers delivering at home, who do not or cannot access emergency obstetric care under the program and remain at risk of maternal death. [ABSTRACT FROM AUTHOR]

Unlabelled: Background: During 2001-2007, the National Institute of Epidemiology (NIE), Chennai, Tamil Nadu, India admitted 80 trainees in its two-year Field Epidemiology Training Programme (FETP). We evaluated the first seven years of the programme to identify strengths and weaknesses.Methods: We identified core components of the programme and broke them down into input, process, output and outcome. We developed critical indicators to reflect the logic model. We reviewed documents including fieldwork reports, abstracts listed in proceedings and papers published in Medline-indexed journals. We conducted an anonymous online survey of the graduates to collect information on self-perceived competencies, learning activities, field assignments, supervision, curriculum, relevance to career goals, strengths and weaknesses.Results: Of the 80 students recruited during 2001-2007, 69 (86%) acquired seven core competencies (epidemiology, surveillance, outbreaks, research, human subjects protection, communication and management) and graduated through completion of at least six field assignments. The faculty-to-student ratio ranged between 0.4 and 0.12 (expected: 0.25). The curriculum was continuously adapted with all resources available on-line. Fieldwork led to the production of 158 scientific communications presented at international meetings and to 29 manuscripts accepted in indexed, peer-reviewed journals. The online survey showed that while most graduates acquired competencies, unmet needs persisted in laboratory sciences, data analysis tools and faculty-to-student ratio.Conclusions: NIE adapted the international FETP model to India. However, further efforts are required to scale up the programme and to develop career tracks for field epidemiologists in the country. [ABSTRACT FROM AUTHOR]

In India, poor feeding practices in early childhood contribute to the burden of malnutrition as well as infant and child mortality. This paper aims to use the newly developed World Health Organization (WHO) infant feeding indicators to determine the prevalence of complementary feeding indicators among children of 6-23 months of age and to identify the determinants of inappropriate complementary feeding practices in India. The study data on 15 028 last-born children aged 6-23 months was obtained from the National Family Health Survey 2005-2006. Inappropriate complementary feeding indicators were examined against a set of child, parental, household, health service and community level characteristics. The prevalence of timely introduction of complementary feeding among infants aged 6-8 months was 55%. Among children aged 6-23 months, minimum dietary diversity rate was 15.2%, minimum meal frequency 41.5% and minimum acceptable diet 9.2%. Children in northern and western geographical regions of India had higher odds for inappropriate complementary feeding indicators than in other geographical regions. Richest households were less likely to delay introduction of complementary foods than other households. Other determinants of not meeting minimum dietary diversity and minimum acceptable diet were: no maternal education, lower maternal Body Mass Index (BMI) (<18.5 kg/m2), lower wealth index, less frequent (<7) antenatal clinic visits, lack of post-natal visits and poor exposure to media. A very low proportion of children aged 6-23 months in India received adequate complementary foods as measured by the WHO indicators. [ABSTRACT FROM AUTHOR]

Improving infant and young child feeding practices will help South Asian countries achieve the Millennium Development Goal of reducing child mortality. This paper aims to compare key indicators of complementary feeding and their determinants in children aged 6-23 months across five South Asian countries - Bangladesh, India, Nepal, Pakistan and Sri Lanka. The latest Demographic and Health Survey and National Family Health Survey India data were used. The analyses were confined to last-born children aged 6-23 months - 1728 in Bangladesh, 15 028 in India, 1428 in Nepal, 2106 in Sri Lanka and 443 infants aged 6-8 months in Pakistan. Introduction of solid, semi-solid or soft foods, minimum dietary diversity, minimum meal frequency and minimum acceptable diet, and their significant determinants were compared across the countries. Minimum dietary diversity among children aged 6-23 months ranged from 15% in India to 71% in Sri Lanka, with Nepal (34%) and Bangladesh (42%) in between. Minimum acceptable diet among breastfed children was 9% in India, 32% in Nepal, 40% in Bangladesh and 68% in Sri Lanka. The most consistent determinants of inappropriate complementary feeding practices across all countries were the lack of maternal education and lower household wealth. Limited exposure to media, inadequate antenatal care and lack of post-natal contacts by health workers were among predictors of inappropriate feeding. Overall, complementary feeding practices among children aged 6-23 months need improvement in all South Asian countries. More intensive interventions are necessary targeting the groups with sup-optimal practices, while programmes that cover entire populations are being continued. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Broor et al. (2011) Emergence of 2009A/H1N1 cases in a tertiary care hospital in New Delhi, India. Influenza and Other Respiratory Viruses 5(6), e552-e557. Objective To determine virologic and epidemiologic characteristics of pandemic (H1N1) 2009 at All India Institute of Medical Sciences (AIIMS) a tertiary care hospital in New Delhi, India. Methods Nasal and throat swabs from patients with febrile acute respiratory illness (FARI) from August to December 2009 ( n = 1401) were tested for 2009A/H1N1 and seasonal influenza A viruses by real-time RT-PCR. Results Of 1401 samples tested, 475 (33·9%) were positive for influenza A, of these majority (412; 87%) were 2009A/H1N1, whereas the remaining 63 (13%) were seasonal influenza A (49 were A/H3 and 14 were A/H1). While co-circulation of 2009A/H1N1 and A/H3 was observed in August-September, subsequent months had exclusive pandemic influenza activity (October-December 2009). Pandemic 2009A/H1N1 emergence did not follow typical seasonal influenza seasonality in New Delhi, which normally peaks in July-August, but instead showed bimodal peaks in weeks 39 and 48 in 2009. The percent of specimens testing positive for 2009A/H1N1 influenza virus was found to be highest in >5- to 18-year age group (41·2%; OR = 2·3; CI = 1·6-3·2; P = 0·00). Conclusions Taken together, our data provide high prevalence of pandemic 2009A/H1N1 in urban New Delhi with bimodal peaks in weeks 39 and 48 and highest risk group being the children of school-going age (aged >5-18). [ABSTRACT FROM AUTHOR]

This paper explores the ways in which women's sterilisation decisions are influenced by the combination of a preference for male children and a desire for smaller family size among young married women in two urban slums in Bengaluru, India. While both son preference and an emphasis on sterilisation are well-known demographic characteristics of most South Asian countries, relatively little research has been conducted that links the two. We take advantage of a longitudinal survey of 416 unsterilised married women aged 16-25 to explore how having sons and the number of children influence a woman's sterilisation decision. Discrete-time event history techniques are used to estimate two models: the first examines the effect of having sons and number of children separately, and the second examines them in combination in the form of an interaction. The results suggest sterilisation is motivated by son preference mainly at lower parities (three or fewer children) and by concerns about family size at higher parities. Understanding how sterilisation and other reproductive behaviours are influenced by the interaction of family size and sex preferences will help policy-makers and programmers to meet the needs of women while continuing to address discriminatory behaviour against females. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal (MS) pain is responsible for poor quality of life and decreased productivity. Objective information about the burden of musculoskeletal disorders among the general community in India is scanty, and the few reports that exist are based on a small sample size. Materials and Methods: This paper examines the issue of MS pain and its associated risk factors in a cross-sectional study of 2086 subjects from National Capital Region (NCR). Results: Overall prevalence of MS pain was found to be 25.9%. Pain was found to be more frequent among females (31.3%) as compared with males (20.9%). Significant association of pain in joints/limbs/knee/lower legs with obesity (OR = 2.1, P < 0.001) and high body fat (OR = 2.2, P < 0.001) was established. More than 50% of the subjects complained of backache. Conclusions: Our findings confirm that MS pain is a significant burden of disease among the residents of NCR. Women and subjects doing heavy work load, like agriculture and dairy farming, constitute the chief demographic groups. It is high time that a policy is framed to reduce this load of sickness. [ABSTRACT FROM AUTHOR]

Early identification and management of treatment failure on highly active antiretroviral therapy (HAART) is crucial in maintaining a sustained response to therapy in HIV infection. However, HIV viral load (VL) and resistance testing, and second-line HAART regimens, are unaffordable to many patients in India, leaving them with limited treatment options. Predictors and reasons for antiretroviral switching, therefore, are likely to differ in settings of varying resources. A one-year, observational study of patients receiving antiretroviral therapy was conducted in a private, non-profit hospital in Bangalore. This paper examines the predictors and consequences of antiretroviral treatment switching in this setting and explores reasons for switching in a subset of patients. Data on demographics, drug regimens, adherence, and physical and psychosocial outcomes were collected quarterly. Tests of VL and CD4 cell counts were performed every six months. One-third of the patients switched therapy during the study period. Baseline predictors of switching included lower CD4 cell counts and more physical symptoms. Contrary to studies in other settings, a high VL did not predict treatment switching, and only a minority of those experiencing drug failure were switched to second-line regimens. Both groups (switchers and non-switchers) improved significantly over time with respect to CD4 counts and psychological well-being, and showed a reduction in physical and depressive symptoms. Any differences between the groups were no longer significant at the end of the study, once we controlled for baseline levels. Clinical, policy, and research implications of these findings are discussed within the context of resource-limited settings. [ABSTRACT FROM AUTHOR]

Continuous ambulatory peritoneal dialysis (CAPD) is a major form of therapy for chronic end stage renal disease patients, which may lead to CAPD-associated peritonitis. The spectrum of organisms associated with CAPD peritonitis varies geographically. Not much data is available regarding this from southern India. The aim of this study was to characterize the spectrum of organisms associated with CAPD peritonitis in this region and observe the utility of automated blood culture systems to culture peritoneal dialysate. Ninety episodes of peritonitis were cultured over a span of 3 years using an automated blood culture system. The yield of culture positivity was 50%. The most predominant organism was found to be coagulase-negative Staphylococcus spp. (21.1%) followed by Enterobacteriaceae (12.2%). Other organisms isolated were non-fermenting Gram-negative bacilli (4.4%), Pseudomonas aeruginosa (3.3%), α-haemolytic Streptococci (3.3%), Candida spp. (2.2%), Staphylococcus aureus (1.1%), β-haemolytic Streptococci (1.1%) and Micrococci (1.1%). A high degree of resistance to third generation cephalosporins (66.7%) was noted amongst the Gram-negative bacilli. Also, all the Gram-negative bacilli isolated from patients who had prior empirical antibiotic therapy of ceftazidime before arrival at the centre, were resistant to third generation cephalosporins. A varied spectrum of organisms isolated from peritoneal dialysate compared to the global scenario was observed. Also, a high degree of third generation cephalosporin resistance was noted amongst the Gram-negative bacilli. Thus, it is suggested that the empirical therapy should be dependent on the local epidemiology. This paper describes the pattern and organisms involved in continuous ambulatory peritoneal dialysis peritonitis in southern India. The authors also use an automated blood culture bottle technique for culturing peritoneal dialysis fluid but describe a high culture negative rate. [ABSTRACT FROM AUTHOR]

Background: Diarrhea is an important problem among the under-five children in India. Objective: The paper examines long-term impacts of recurrent floods on diarrhea among under-five children in Uttar Pradesh, India. Design: A two stage stratified cluster survey was conducted in flood affected (exposed) and non-flood affected areas (unexposed). Results: The long-term impact of the floods was not clearly marked in the overall prevalence of diarrhea with the exposed group having prevalence of 55.1% as against 56.2% in the unexposed group of children under five. Economic condition of the household is associated with the prevalence of diarrhea in both exposed and unexposed strata. Anemia was found to be a significant risk factor for diarrhea among children in both the flood exposed and non-flood exposed populations. The recurrent floods did not have any significant effect on the prevalence of diarrhea in relation to gender, religion, caste, and household size. Conclusions: The study indicates that the long-term impacts of floods are very differently manifested than the immediate impacts. [ABSTRACT FROM AUTHOR]

Objective Visceral Leishmaniasis (VL) is highly prevalent in Bihar, India. India and its neighbours aim at eliminating VL, but several knowledge gaps in the epidemiology of VL may hamper that effort. The prevalence of asymptomatic infections with Leishmania donovani and their role in transmission dynamics are not well understood. We report data from a sero-survey in Bihar. Methods Demographic and immunological surveys were carried out in July and November 2006, respectively in 16 highly VL endemic foci in Muzaffarpur district in Bihar. Household and individual information was gathered and capillary blood samples were collected on filter papers. Direct agglutination test (DAT) was used to determine infected individuals (cut-off titre 1:1600). DAT results were tabulated against individual and household variables. A multivariate generalized estimating equation (GEE) model was used to study the prevalence of serologically positive individuals taking into account the clustering at household and cluster levels. Results Of study subjects 18% were DAT positive, and this proportion increased with age. Women had a significantly lower prevalence than men >14 years old. Owning domestic animals (cows, buffaloes or goats) was associated with a higher risk of being DAT positive [OR 1.16 (95% CI 1.01–1.32)], but socio-economic status was not. Conclusions Prevalence of leishmanial antibodies was high in these communities, but variable. Demographic factors (i.e. marriage) may explain the lower DAT positivity in women >14 years of age. Within these homogeneously poor communities, socio-economic status was not linked to L. donovani infection risk at the individual level, but ownership of domestic animals was. [ABSTRACT FROM AUTHOR]

Background: Early surveys showed people of India and its neighbors to be highly susceptible to periodontitis. This was based on the early surveys which estimated a higher prevalence. Aim: This paper reviews the prevalence of periodontitis in India and Bangladesh and attempts to find out why the populations of the Indian subcontinent were considered more susceptible to periodontitis. Settings and design: Review of periodontitis prevalence studies on the Indian and Bangladeshi population. Methods and material: After identifying articles from Pub Med, DAOJ and hand searching, the epidemiology of periodontitis is reviewed. Results and conclusion: This review identifies that very few studies have been done on representative population. Yet it can be certainly concluded that there is a high prevalence of periodontitis in the adults and the economically weak population which can be reduced by adopting preventive public health strategies. Conclusions: Standardized population based studies in a representative population with a robust design to identify the true prevalence of periodontitis is needed. [ABSTRACT FROM AUTHOR]