Prevalence of Selected Cardiovascular Risk Factors and Their Associated Factors among People Living with HIV/AIDS in India

Background

Low- and middle-income countries face the dual problem of infectious and non-infectious diseases. Persons living with HIV/AIDS (PLHIV) are also at risk of cardiovascular diseases. Hence, we did this study to determine the prevalence of cardiovascular risk factors (CVRF) among PLHIV and to find the factors associated with it.

Methods

We carried out a cross-sectional analytical study among all adults aged ≥18 years registered at a facility-integrated anti-retroviral therapy center in Puducherry, India, from September 2016 to February 2018. After obtaining informed consent, we interviewed the participants to assess physical activity, alcohol, and tobacco use. We measured weight, height, abdominal circumference, and blood pressure, with biochemical investigations such as blood glucose and lipid profile.

Results

Of the total 316 adults PLHIV studied, the most common cardiovascular risk factor found was dyslipidemia (82.7%), followed by inadequate physical activity (74.4%). Other behavioral risk factors studied, such as current tobacco use and current alcohol use, showed a prevalence of 12.8% and 5.4%, respectively, among male participants. The prevalence of hypertension among adult PLHIV studied was 15.8%, and diabetes was 12.3%. In the multivariate analysis, diabetes, and hypertension were significantly associated with age and literacy. Obesity was found to be associated with diabetes and abdominal obesity with dyslipidemia.

Conclusion

Dyslipidemia was the most common cardiovascular risk factor, followed by inadequate physical inactivity among PLHIV. Regular screening with blood glucose, blood pressure, and lipid profile, and timely cross-referrals can help in the early detection of CVRF among PLHIV and hence improve their quality of life through appropriate treatment.

Effect of daily zinc supplementation for 12 weeks on serum thyroid auto-antibody levels in children and adolescents with autoimmune thyroiditis - a randomized controlled trial

OBJECTIVES

To assess the effect of daily zinc supplementation for 12 weeks on thyroid auto-antibodies - thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb), and oxidative stress in children with autoimmune thyroid disease (AITD) compared to standard therapy.

METHODS

This open-labeled, parallel, randomized controlled trial was done in a tertiary care teaching institute in south India. Children aged 3-18 years with AITD were randomized to receive 25 mg elemental zinc daily for 12 weeks or standard therapy alone. The change in thyroid function tests (thyroid stimulating hormone, free T3, free T4), thyroid auto-antibody (TPOAb, TgAb) titers, oxidative stress markers (glutathione peroxidase, malondialdehyde, superoxide dismutase, and total antioxidant capacity) were compared.

RESULTS

Forty children, 20 in each arm, were recruited in the study. We observed a female-to-male ratio of 7:1. Median duration of disease was 2 (0.25, 4.25) years. A total of 37 (92.5 %) children were hypothyroid, two hyperthyroid, and one euthyroid at enrolment. A total of 13 children (32.5 %) had associated co-morbidities, most commonly type 1 diabetes mellitus and systemic lupus erythematosus, three (7.5 %) each. We did not find any significant change in thyroid function tests, thyroid auto-antibody titers, and oxidative stress markers. However, the requirement of levothyroxine dose was significantly increased in the control arm, compared to the zinc group (p=0.03). Only four (20 %) children had minor adverse effects like nausea, metallic taste, and body ache.

CONCLUSIONS

Zinc supplementation did not have any effect on thyroid auto-antibodies and oxidative stress. Zinc-supplemented children did not require escalation in levothyroxine dose.

Situation Analysis of Early Implementation of Programmatic Management of Tuberculosis Preventive Treatment among Household Contacts of Pulmonary TB Patients in Delhi, India

Tuberculosis Preventive Treatment (TPT) is a powerful tool for preventing the TB infection from developing into active TB disease, and has recently been expanded to all household contacts of TB cases in India. This study employs a mixed-methods approach to conduct a situational analysis of the initial phase of TPT implementation among household contacts of pulmonary TB patients in three districts of Delhi, India. It was completed using a checklist based assessments, care cascade data, and qualitative analysis. Our observations indicated that organizational structure and planning were established, but implementation of TPT was suboptimal with issues in drug availability and procurement, budget, human resources, and training. Awareness and motivation, and shorter regimen, telephonic assessment, and collaboration with NGOs emerged as enablers. Apprehension about taking TPT, erratic drug supply, long duration of treatment, side effects, overburden, large population, INH resistance, data entry issues, and private provider reluctance emerged as barriers. The study revealed potential solutions for optimizing TPT implementation. It is evident that, while progress has been made in TPT implementation, there is room for improvement and refinement across various domains.

Anti-SARS-CoV-2 antibody kinetics up to 6 months of follow-up: Result from a nation-wide population-based, age stratified sero-epidemiological prospective cohort study in India

Repeated serological testing tells about the change in the overall infection in a community. This study aimed to evaluate changes in antibody prevalence and kinetics in a closed cohort over six months in different sub-populations in India. The study included 10,000 participants from rural and urban areas in five states and measured SARS-CoV-2 antibodies in serum in three follow-up rounds. The overall seroprevalence increased from 73.9% in round one to 90.7% in round two and 92.9% in round three. Among seropositive rural participants in round one, 98.2% remained positive in round two, and this percentage remained stable in urban and tribal areas in round three. The results showed high antibody prevalence that increased over time and was not different based on area, age group, or sex. Vaccinated individuals had higher antibody prevalence, and nearly all participants had antibody positivity for up to six months.

Factors Associated with Perinatal Mortality in Adult Pregnant Women with Hypertensive Disorders: A Case-Control Study

Background

Hypertension complicates 5-10% of pregnancies and is a common cause of perinatal death. The perinatal mortality is estimated to be 3 to 5 times higher in hypertensive women compared to those without hypertension.

Methods

A hypertensive mother either with a stillbirth or if baby died within 7 days of life was included as a case. Once a case was recognized, the next two consecutive hypertensive mothers who delivered a live baby, who survived up to 7 days of life, were taken as controls. Fetuses with congenital malformations incompatible with life and multiple pregnancies were excluded from the study. One hundred and twelve women in cases and 224 women in controls were studied.

Results

Among 112 cases of perinatal death, 70% had died in utero before labor. Among the 33 fetuses alive, 50% were born still after labor and 50% died within 7 days of birth. We found that early onset hypertension (< 34 weeks) (p-< 0.001 (Chi2-23.819)), gestational age at termination of 28-32 weeks (OR 2.76), value of serum creatinine > 1.1 mg/dl (OR 10.1), abruption (OR 6.2) and birth weight < 1.5 kg was significantly associated with perinatal mortality (p-0.007, OR 5.7). Abnormal Doppler findings was a predictor of perinatal deaths.

Conclusion

Severely growth retarded fetuses in association with early onset severe preeclampsia are likely to die in utero and need vigilant monitoring antenatally. Abnormal umbilical artery Dopplers predict perinatal mortality. Caesarean section at the gestational age of ≥ 32 weeks and an estimated fetal weight of ≥ 1.2 kg in our hospital resulted in favorable outcome.

Prevalence of hypertension and determinants of treatment-seeking behaviour among adolescents and young adults in India: an analysis of NFHS-4

BACKGROUND

Previous evidences have reported that almost three-fourth of young hypertensives are not seeking care for their condition leading to severe complications. This study was conducted to assess the determinants of treatment-seeking behaviour among the young hypertensives in India.

METHODS

The National Family Health Survey-4 data were analysed. Sampling weights and clustering was accounted using svyset command. Screening, awareness, prevalence and control status were reported with 95% confidence interval (CI). Poisson regression was done to identify the determinants of treatment-seeking behaviour.

RESULTS

In total, 13.8% of younger adults had hypertension, 51.1% were aware of their status and 19.5% sought treatment. Participants in 15-19 years (adjusted Prevalence Ratio (aPR) = 0.70) and 20-29 years (aPR = 0.63), male gender (aPR = 0.84), Muslim religion (aPR = 1.14), urban region (aPR = 0.87), secondary (aPR = 0.88) and higher education (aPR = 0.86), residing in Northern (aPR = 0.79), Central (aPR = 0.76), Southern region (aPR = 0.65), preferring home treatment, medical shop or any other care (aPR = 0.63) were significant determinants of treatment-seeking behaviour.

CONCLUSION

More than 1 in 10 younger adults in India have hypertension and only half of them were aware of their status and one-fifth sought treatment. Adolescents, males, Hindus, urban population, higher education and residing in Northern, Central and Southern region had poor treatment-seeking behaviour.

Down referral and assessing comprehensive diabetes care in primary care settings: An operational research from India

BACKGROUND AND AIMS

In this study, we aimed to refer eligible (patients with stable blood sugar and without any history of cardiovascular events or proliferative retinopathy) and willing persons with diabetes (PwDs) to primary healthcare centers (PHCs) from tertiary care and to compare the care indicators.

METHODS

This before-after interventional study was conducted among PwDs aged ≥18 years at a tertiary care hospital in South India. Care indicators (regularity to the clinic, waiting time, and blood sugar control status) were assessed before down referral and after three months of follow-ups at PHCs.

RESULTS

Of 204 PwDs referred to PHCs. Among them, 88% (n = 180) registered at PHCs for care and 46% (n = 94, 95% CI 39.1-53.2%) were lost to follow-ups at PHCs. The main reason for loss to follow-ups was the unavailability of medicines at PHCs(n = 41, 44%). Among those who were on regular follow-ups at PHCs, there was no significant difference in fasting blood glucose (FBG) control status compared to tertiary (52%-64.6%, p = 0.083). However, there was a significant improvement in the regularity of clinic visits (75% vs. 100%, p < 0.001), consultation waiting time (90 vs. 60 min, p = 0.028), and waiting time at pharmacy queues (120 vs. 30 min, p < 0.001) between tertiary care and PHCs. However, among those registered at PHCs, only 40.6% (n = 73, 95% CI 33.3-48.1) were willing to continue care at PHCs for their diabetes management.

CONCLUSION

Primary care was better than tertiary care in terms of PwD's regularity of clinic visits and waiting time for care.

Hypertension in men - An emerging public health challenge for India: Evidence from national family health survey-4

Background

Men in the 25-54 year age group form the major workforce in developing countries like India. The rising trend of hypertension in this age group is a growing matter of concern.

Objectives

This study analyzed secondary data analysis from the National Family Health Survey-4.

Methods

Men in the 25-54 age group (n = 76,410) from 640 districts of the country were included in the study. State and district-wise trends in hypertension in men along with selected individual lifestyle characteristics were displayed using a geographic information system.

Results

The prevalence of hypertension among men in the age group of 25-54 was found to be 35.6% for the entire country. In urban India, the prevalence of hypertension was 38.4% (uncorrected - 40.2%) compared with 33.8% (uncorrected - 34.9%) in rural India. Among the 27,973 hypertensives, 6984 (25%) were the known hypertensives prior to the survey. Out of these only 2403 (34.4%) were taking medicines. The prevalence of tobacco use in any form among the men in this age group was 45.7% (uncorrected - 49%).

Conclusion

In conclusion, the study highlights the burden of hypertension in men in the prime age group along with the alarming burden of tobacco consumption and recommends public health and policy interventions targeting both hypertension and tobacco control. It requires urgent attention and specialized strategies in tiding over this epidemic brewing in the workforce of the country.

Active Case Finding for Tuberculosis among Health Care Workers in a Teaching Hospital, Puducherry, India

Background

Health care workers (HCWs) are at risk of acquiring tuberculosis (TB) infection and disease due to occupational exposure. But there are no national guidelines on routine screening for TB (active case finding (ACF)) among HCWs and understand its implementation and feasibility.

Methods

This study was conducted among HCWs in a teaching hospital in India. We used symptom screening to identify those with presumptive TB and were further evaluated for diagnosis of TB.

Results

A total of 1,001 HCWs were screened over a period of 18 months. In our study, 51 (5.1%) HCWs were found to have presumptive TB and on further evaluation, 5 (0.5%) of these patients were diagnosed with active TB. The number needed to screen (NNS) for one active TB among the HCWs was 200. Alcohol use was significantly associated with both presumptive TB (P = 0.037) and active TB (P = 0.035) among HCWs, and exposure to active TB patients (P = 0.014) in the family and workplace and increased frequency of exposures (P = <0.001) were associated with presumptive TB.

Conclusion

ACF for TB among HCWs had a good yield in our study. ACF utilizing routine national TB program guidelines is feasible to be implemented among HCWs to aid in the early diagnosis and treatment of TB in this high-risk group.

The Burden of Peripheral Neuropathy in Nondiabetic Chronic Kidney Disease and the Role of Ghrelin Isoforms in its Development

Introduction

Peripheral neuropathy is one of the most common complications in chronic kidney disease (CKD). The neuroprotective role of ghrelin is being explored recently. Here we aim to determine the burden of neuropathy in nondiabetic CKD and to find the association of peripheral nerve function with plasma ghrelin levels in these patients.

Methods

This was a cross-sectional study conducted in nondiabetic CKD patients on conservative management to determine the magnitude of neuropathy. The association of ghrelin isoforms with nerve functions was assessed between three groups, namely CKD with neuropathy, CKD without neuropathy, and healthy volunteers, with 20 participants in each group.

Results

The proportion of neuropathy in nondiabetic CKD was 78% (n = 78), of which 51% (n = 40) were asymptomatic. Des acyl ghrelin (DAG) and total ghrelin (TG) levels were 1545.5 ± 487.4 and 1567.4 ± 485.3 pg/mL, respectively, in CKD patients with neuropathy and were found to be elevated compared to those without neuropathy, who had 1000.4 ± 264.2 and 1019.7 ± 264.3 pg/mL of DAG and TG, respectively (P < 0.001). Assessment of correlation between nerve conduction parameters and DAG levels showed positive correlation between DAG levels and common peroneal latency (r = 0.69; P < 0.01), median sensory latency (r = 0.45; P < 0.05), and sural latency (r = 0.51; P < 0.05). We found negative correlation between median velocity (r =-0.56; P < 0.05), common peroneal velocity (r = -0.64; P < 0.01), median sensory velocity (r =-0.49; P < 0.05), and sural velocity (r = -0.54; P < 0.05). There was no statistically significant difference in acyl ghrelin levels among the groups.

Conclusion

The prevalence of peripheral neuropathy in CKD is significantly higher with almost half of them being asymptomatic. Impaired renal clearance in CKD leads to the accumulation of DAG, which subsequently inhibits the neuroprotective functions of AG leading to neuropathy in CKD.

Pattern of Antimicrobial Susceptibility and Antimicrobial Treatment of Neonates Admitted with Suspected Sepsis in a Teaching Hospital in Ghana, 2021

Neonatal sepsis is a life-threatening emergency, and empirical antimicrobial prescription is common. In this cross-sectional study of neonates admitted with suspected sepsis in a teaching hospital in Ghana from January-December 2021, we described antimicrobial prescription patterns, compliance with national standard treatment guidelines (STG), blood culture testing, antimicrobial resistance patterns and treatment outcomes. Of the 549 neonates admitted with suspected sepsis, 283 (52%) were males. Overall, 529 (96%) received empirical antimicrobials. Most neonates (n = 407, 76.9%) were treated empirically with cefuroxime + gentamicin, while cefotaxime was started as a modified treatment in the majority of neonates (46/68, 67.6%). Only one prescription complied with national STGs. Samples of 257 (47%) neonates underwent blood culture testing, of which 70 (27%) were positive. Isolates were predominantly Gram-positive bacteria, with coagulase-negative Staphylococcus and Staphylococcus aureus accounting for 79% of the isolates. Isolates showed high resistance to most penicillins, while resistance to aminoglycosides and quinolones was relatively low. The majority of neonates (n = 497, 90.5%) were discharged after successfully completing treatment, while 50 (9%) neonates died during treatment. Strengthening of antimicrobial stewardship programmes, periodic review of STGs and increased uptake of culture and sensitivity testing are needed to improve management of sepsis.

COTPA implementation status: An observational study in South Indian city

Background & objectives

The World Health Organization (WHO) document released on the World No Tobacco Day, 2020, mentions that tobacco kills over 22,000 people worldwide every day either from its use or second-hand smoke exposure, which is one person every 4 sec. In 2003, the Cigarettes and Other Tobacco Products Act (COTPA) was enacted by the Indian government to control/regulate use of tobacco and tobacco products. Despite various amendments to this law, there has not been any appreciable decrease in tobacco use. The objective of this study was to assess the compliance level with sections 4-10 of COTPA in urban Puducherry in South India.

Methods

Random sample survey of 13 wards was carried out in selected parts of the city of Puducherry. The estimated sample size was minimum 160 public places and point of sales (PoS) each. A pre-tested checklist was used to obtain information on compliance with COTPA. Statistical and spatial analysis was performed using STATA v12.0 and QGIS v2.14.21, respectively.

Results

Eight per cent of public places, 0 per cent of PoS, 1.7 per cent of educational institutions and 48 per cent of tobacco packages were found compliant with COTPA specifications. The compliance in public places varied from 0 (bus stops) to 55 per cent (religious places).

Interpretation & conclusions

The overall compliance with COTPA was found to be very low in urban Puducherry. In order to ensure proper implementation of the laws, effective enforcement with periodic monitoring of various sections of COTPA are needed.

Prevalence and associated factors for awareness of hypertension in India: Findings from national survey-4

Background

Despite the fact that hypertension is increasing, merely 50% are aware of the disease. Being aware of hypertension is important to control it.

Aim

The study's objective was to estimate the level of hypertension awareness in India and explore its associated sociodemographic factors.

Materials and Methods

The data collected in National Family Health Survey 4 (2015-2016) among men aged 15-54 years and women aged 15-49 years were analyzed. Taking awareness of hypertension as an outcome variable, descriptive analysis, and multivariable logistic regression model were performed, by gender.

Results

Of 1,41,215 hypertensive individuals analyzed, 34.7% of men and 53.6% of women were aware of being hypertensive. The control among those aware was 67.1% in men and 74.6% in women. The awareness varied among states ranging from 29.6% in Chhattisgarh to 75.6% in Tamil Nadu. The multivariable logistic regression model explained the awareness of hypertension in males increased with age (odds ratios [OR]: 0.226 for 95% confidence interval [CI]: 0.139-0.366 for 25-29 years of age increased to 0.599 for 95% CI: 0.48-0.74 for 40-44 years of age), education (OR of 0.66 for 95% CI: 0.51-0.85 for primary increased to 0.69 for 95% CI: 0.54-0.89 for secondary school level), and wealth status (OR of 0.407 for 95% CI: 0.309-0.535 for poor wealth quintile increased to 1.030 for 95% CI: 0.863-1.230 for the richest wealth quintile). For women, the awareness increased with age (OR of 0.306 for 95% CI: 0.119- 0.791 for the age of 20-24 years increased to 0.736 for 95% CI: 0.570-0.951 for the age of 45-49 years) and wealth status (OR of 0.28 for 95% CI: 0.18-0.44 for poor wealth quintile increased to 1.262 for 95% CI: 0.859-1.855 for the richest wealth quintile).

Conclusion

Improving access to hypertension screening and awareness especially among men, with lower wealth and younger age is needed.

COVID-19 vaccine hesitancy among health care worker-parents (HCWP) in Puducherry, India and its implications on their children: A cross sectional descriptive study

Background

Vaccine hesitancy affects immunization programs worldwide and can impact vaccine coverage and fight against Coronavirus disease 2019 (COVID-19) too.

Objectives

Primary objectives: To find out the magnitude of COVID-19 vaccine hesitancy among the Health Care Worker Parents (HCWPs), the reasons for vaccine hesitancy, and their perceptions regarding COVID-19 vaccination of their children. Secondary objective: To analyze the clinic-socio-demographic correlates of COVID-19 vaccine hesitancy among HCWPs.

Methods

This was a cross sectional descriptive study. Health care workers who are parents were invited to participate in the study. Details about COVID vaccination status, COVID-19 illness of HCWPS and family members and its outcomes , reasons for not getting vaccinated, willingness to vaccinate their children, reasons for not willing to vaccinate their children, their responses to vaccine hesitancy survey (VHS) questionnaire and Modified Oxford COVID-19 vaccine hesitancy scale (MOVHS) were collected and analyzed using descriptive statistics.

Results

A total of 269 HCWPs participated in the study. Of the HCWPs, 97% had completed their COVID-19 vaccination schedule. Majority stated that they would vaccinate their children when it is available. Although majority of the responses were positive or towards agreement, there were some striking variations in the responses among some sections of HCWPs. Positive responses to the questionnaire were associated with higher self-vaccination and a decision to vaccinate their children.

Conclusion

Vaccine hesitancy was less common among HCWPs in our study. A section of the HCWPs might be disproportionately more hesitant than others. Majority were in favor of vaccinating their children.

Compliance with Medication amongst Persons with Diabetes Mellitus during the COVID-19 Pandemic, Kerala, India: A Cross Sectional Study

Compliance with medication in persons with diabetes mellitus (DM) has been a challenge during the COVID-19 pandemic, leading to poor glycemic control and higher risk of complications. In the state of Kerala, India, 20−25% of adults have DM. Our cross-sectional study aimed to assess medication compliance and factors associated with poor compliance in DM persons attending selected primary care government facilities in Kerala during the COVID-19 pandemic. Persons registered with DM for >6 months were consecutively interviewed between August and September 2021. Poor compliance was defined as answering “No” to one or more of three questions related to access and intake of medication two weeks prior to and the day before the interview. Factors independently associated with poor compliance were assessed using adjusted prevalence ratios (aPr) and 95% confidence intervals. Of the 560 DM persons included, 209 (37%) exhibited poor compliance. Factors associated with poor compliance were age 19−45 years (aPr 1.4, 1.1−1.9); inability to be blood glucose tested during the COVID-19 pandemic (aPr 3.6, 2.9−4.3); not having COVID-19 (aPr 1.4, 1.0−1.9); and being double vaccinated against COVID-19 (aPr 1.4, 1.1−2.0). Focused attention must be paid to these groups to improve medication compliance and prevent DM complications and severe COVID-19-related disease.

Epidemiology and Response to the COVID-19 Pandemic in Kerala, India, 2020-2021: A Cross-Sectional Study

Kerala, a southern state in India, experienced a slightly different COVID-19 pandemic than the rest of India. Using data from daily COVID-19 bulletins and two other Kerala health information systems, this study reported on epidemiological characteristics and response measures of the COVID-19 pandemic between January 2020 and December 2021. After the first six months, Kerala experienced three distinct phases, with COVID-19 cases peaking in October 2020, May 2021, and August 2021. This contrasts with India, which experienced two main peaks in September 2020 and May 2021. The demographic profile of cases aligned with the national profile except for a slight increase of COVID-19 in persons aged ≥60 years. Monthly COVID-19 deaths increased dramatically from May 2021 onwards in line with case numbers but also reflecting changes in definitions of COVID-19 deaths. Case fatality for the two years was significantly higher in males than females, increased with increasing age groups, and varied between districts (p < 0.001). Trends in bed occupancy in field hospitals, hospitals for severe disease, intensive care units, and mechanical ventilation mirrored the different phases of the pandemic. The monitoring system in Kerala allowed certain aspects of the pandemic to be mapped, but it would benefit from further strengthening.

COVID-19 Amongst Travelers at Points of Entry in Nepal: Screening, Testing, Diagnosis and Isolation Practices

WHO recommends surveillance for COVID-19 among travelers at Points of Entry (POE) to countries. At 13 selected POE at the Nepal-India border, between March 2021 and July 2021, we describe the screening, testing, diagnosis and isolation practices of COVID-19 amongst travelers. Those who stayed in India or elsewhere for > one day and those who did not have a negative RT-PCR result within the last 72 h of travel were tested for COVID-19 with rapid antigen diagnostic tests. Daily surveillance reports maintained at POE were used for analysis. Of 337,338 travelers screened, 69,886 (21%) were tested and 3907 (6%) were diagnosed with COVID-19. The proportions tested averaged 15% during April-May when screened numbers were high and increased to 35% in July when screened numbers had decreased. The proportions diagnosed positive peaked at 10% in April-May, but decreased to below 1% in June and July. Testing coverage varied from 0−99% in the different POE. Most COVID-19 cases were Nepalese, male, <60 years of age, migrant workers and presented with fever. Of COVID-19 cases, 32% had home-based isolation, 64% underwent community-based isolation and the remainder either went to hospital or returned to India. In conclusion, about one fifth of travelers overall were tested, with coverage varying considerably over time and among different POE. Strengthening surveillance processes at POE is needed.

Comparison of respiratory distress syndrome amongst preterm twins (28-34 Weeks) born within and after two weeks of completion of single antenatal corticosteroid course: A bidirectional cohort study

BACKGROUND

The literature on neonatal outcomes in preterm twins delivered before 34 weeks but within and after 14 days of a single initial steroid course is limited.

MATERIAL AND METHODS

This bidirectional (226 prospective and 42 retrospectives) cohort study was performed at a tertiary care teaching hospital in South India. We compared the respiratory distress syndrome and neonatal death amongst preterm twins from 28 to 34 weeks born < 14 days (Group A, n=268) and after 14 days (Group B, n=268) of completion of a single course of antenatal steroids. We used multivariable regression analysis (log-binomial model) to adjust for confounding variables. We generated a propensity-matched score with probit regression to analyse outcomes (respiratory distress and neonatal deaths).

RESULTS

The two groups had significant differences in the distribution of birthweight, gestation period and mode of delivery. On adjusted analysis, the period of gestation below 33 weeks and weight below 1.5 kg had the maximum influence on respiratory and other morbidities, and weight less than 1 kg on neonatal death. [adjusted relative risk (ARR) 26.06, (95%CI=2.37-285.5), p=0.008]. On propensity scoring after matching all these variables, we found an [ARR of 2.0 (95% CI: 1.03-3.88), P=0.017] for neonatal death after 14 days of steroid injection. The ARR for respiratory distress syndrome was 1.13 in those born after 14 days of steroids, though it did not reach statistical significance.

CONCLUSION

On propensity scoring, the steroid-delivery interval more than 14 days was associated with a significantly increased risk (ARR of 2) of neonatal death.

Alcohol use among adult men and its impact on personal and family life: findings of a community-based cross-sectional survey and focus groups discussions from a low alcohol taxed region, Puducherry, India

BACKGROUND

There is limited published literature on the impact of alcohol use among alcohol dependents and their family members.

OBJECTIVES

To find the factors associated with alcohol use and explore the impact of alcohol use on alcohol dependents and their family members.

METHODS

A cross-sectional analytical study was conducted among 316 men aged above 18 years, and four focus group discussions (FGDs) were conducted among alcohol dependents and their family members. A validated semi-structured questionnaire was used.

RESULTS

The mean (SD) age of the study participants was 45.2 (15.1) years, and 276 of them (87.3%) were educated. The prevalence of alcohol use was found to be 38% [95% confidence interval (CI) = 32.8-43.4]. Older age [adjusted prevalence (APR) = 2.23 (95% CI = 1.17-4.27)], no formal education [APR = 1.20 (95% CI = 1.20-1.20)], rural residence [APR = 1.05 (95% CI = 1.05-1.05)], self-reported comorbidities [APR = 1.21 (95% CI = 1.21-1.21)], tobacco use [APR = 2.42 (95% CI = 1.98-2.97)] and individuals having a family history of alcohol use [APR = 2.42 (95% CI = 1.73-3.37)] were the factors associated with alcohol use. The family members of alcohol users suffer mainly mental, emotional and physical abuse. Abusive language used by the alcoholic father and family break-ups have an influence on children and in their schooling.

CONCLUSIONS

Prevalence of alcohol use in a low alcohol taxed region in India was high. The family members of alcohol users mainly suffer mental, emotional and physical abuse.

Food allergy in children with asthma and its correlation with level of asthma control

Background

There is paucity of regional data regarding food allergy among children with asthma.

Objectives

To estimate the proportion of children with asthma who have food‐related respiratory symptoms and to correlate it with (a) skin prick test (SPT) results and (b) level of asthma control.

Methodology

This cross‐sectional study involved children with asthma, aged ≥6 years attending the childhood asthma clinic in a tertiary care hospital, in the southern part of India from July 2017 to July 2019. Basic demography and clinical details were recorded. In subjects with a history of food allergy, skin prick test (SPT) was done using AllergoSPT according to guidelines recommended by British Society of Allergy and Clinical Immunology (BSACI). Asthma control was assessed using asthma control test (ACT) and childhood ACT questionnaires.

Results

Of the total 305 children included, the most commonly reported allergen was banana (45%, n = 137). The predominant symptom reported was wheezing (54%). SPT was positive in 76 children (24.9%). Level of asthma control (P value < .01), family history of atopy (P value < .01), and age at introduction of complementary foods (P value < .01) were significantly associated with food allergy.

Conclusion

Presumed food allergy is seen in one‐fourth of children with asthma and significantly affects symptom control in them.

Lung Function Impairment In Patients Treated For Pulmonary Tuberculosis and Associated Factors in Puducherry, South India

Context

After completion of treatment, a proportion of pulmonary tuberculosis (TB) (PTB) patients experience lung function impairment (LFI) which can influence their quality of life.

Aim

This study was aimed to determine the prevalence of LFI in patients treated for PTB and the associated factors.

Settings and Design

A cross-sectional study was conducted among patients treated for PTB in eight primary health centers in Puducherry.

Subjects and Methods

The study was carried out among 118 patients. Those aged 18 and above whose PTB treatment outcomes were declared as cured or completed between 2018 and 2019 were included. Demographic data, respiratory symptoms before TB diagnosis, comorbidities, and chest radiography findings before TB treatment were collected. All participants underwent spirometric tests before and after dilatation with salbutamol nebulization.

Statistical Analysis

Multivariable analysis identified smear-negative TB and indoor exposure to biomass for cooking as significant independent risk factors for LFI.

Results

Of 118 participants interviewed, 70.3% were male and the median age of the participants was 47.7 years. The prevalence of LFI was 62.7% (95% confidence interval: 53.3-71.4).

Conclusion

LFI was frequent in patients treated previously for TB. Creating awareness about the possible LFI among these patients along with the awareness for seeking health care for this condition is the need of the hour.

Estimation of seroprevalence of melioidosis among adult high risk groups in Southeastern India by indirect Hemagglutination assay

Burkholderia pseudomallei is an environmental saprophyte known to cause melioidosis, a disease endemic in northern Australia and Southeast Asia. With the increasing number of melioidosis cases, there is a lack of data on seroprevalence rates and extent of exposure in high risk population of melioidosis from different endemic regions in India. The present cross sectional study was undertaken to estimate the seroprevalence of melioidosis in high risk populations in and around Puducherry, a coastal town in Southeastern India. Blood samples were collected from 275 diabetic individuals attending a tertiary care centre in Southern India and 275 farmers residing under the rural field practice area of our hospital. The antibody levels were estimated using an Indirect Hemagglutination Assay. The overall seropositivity was found to be 19.8% with a titer ≥1:20. Farmers were 2.8 times more likely to be seropositive than non-farmers. Rates of seroprevalence among diabetic subjects were less compared to the non-diabetic individuals. The seropositivity rates in non-diabetic farmers were higher (56/203, 27.6%) compared to diabetic farmers (34/164, 20.7%). The lowest seropositivity was seen among diabetic non-farmers at 10.4%. Multivariable logistic regression analysis revealed domicile (adjusted odds ratio-aOR: 2.32, 95% Confidence interval-CI: 1.05, 5.13) and contact with animals (aOR: 1.89, 95% CI:1.04, 3.44) as significant predictors of seropositivity. None of the other socio-demographic factors including gender and age were significantly associated with seropositivity. This study demonstrates widespread exposure to B. pseudomallei among adults residing in and around Puducherry, including those engaged in non-farming occupations.

Serological prevalence of SARS-CoV-2 antibody among children and young age group (between 2 and 17 years) in India: An interim result from a large multicentric population-based seroepidemiological study

Background:

Estimating seroepidemiolgical prevalence of SARS-CoV-2 antibody is an essential public health strategy. There is insufficient evidence of prevalence among those belonging to young age population in India.

Objective:

To compare the SARS-CoV-2 seropositivity rate between children and adults in selected sites from India.

Materials and Methods:

This was a multicentric population-based seroepidemiological study conducted in selected urban and rural areas of five sites selected from four states (Delhi, Odisha, Uttar Pradesh, Tripura) of India. Participants aged ≥1 year were included from different clusters of each area. Total serum antibody against SARS-CoV-2 virus was assessed qualitatively by using a standard enzyme-linked immunosorbent assay (ELISA) kit.

Results:

Data collection period was from 15 March 2021 to 10 June 2021. Total available data was of 4509 participants, of whom 700 were <18 years of age and 3809 were ≥18 years of age. The site-wise number of available data among those aged 2–17 years was 92, 189, 165, 146 and 108 for the sites of Delhi urban, Delhi rural, Bhubaneswar rural, Gorakhpur rural and Agartala rural area, respectively. The seroprevalence was 55.7% in the <18 years age group and 63.5% in the ≥18 years age group. The prevalence among female children was 58% and among male children was 53%.

Conclusion:

SARS-CoV-2 seropositivity rate among children was high and comparable to that of the adult population. Hence, it is unlikely that any future third wave by prevailing SARS-CoV-2 variant would disproportionately infect children 2 years or older.

Prevalence and Risk Factors for Resistant Hypertension: Cross-Sectional Study From a Tertiary Care Referral Hospital in South India

Background Around 10% patients with hypertension have resistant hypertension (RH). Older age, Black race, obesity, diabetes mellitus (DM) and chronic kidney disease (CKD) are the common risk factors for RH. The present study was done to find out the prevalence and factors associated with RH. Methods This cross-sectional study was done between December 2018 and February 2020. Adult patients registered with the hypertension clinic and on care for more than three months were included in the study. History was noted and blood pressure (BP) was measured using standard precautions. The patients were divided into two groups - resistant and non-resistant hypertension. Chi-square test was done to check the significance of the differences between the two groups. Binary logistic regression was done for the risk factors with a p-value < 0.2 in the Chi-square test. Results A total of 275 patients were included. The mean age was 56 ± 10 years and 61% were females. The mean duration of hypertension was 7 ± 5 years; 77% of patients were overweight or obese. A family history of hypertension was present in 30% and 18% had diabetes mellitus. History suggestive of secondary hypertension was present in 13%. BP was controlled (<130/80 mm of hg) in 145 (53%), uncontrolled in 130 (47%) and resistant hypertension was seen in 31 [(11%) 95% CI 8-16%] patients. Duration of hypertension, obesity, and elevated fasting blood sugar were significantly associated with RH.  Conclusions RH was found in 11% of hypertensive patients. Longer duration of hypertension, obesity, and higher fasting blood glucose were associated with RH.

Predisposition of Blood group Non-secretors to Urinary tract infection with Escherichia coli Anti-microbial Resistance and Acute Kidney Injury

Urinary tract infection (UTI) causes significant renal damage and disease severity is compounded by antimicrobial resistance (AMR) and other comorbidities in the patient. Blood group antigens secreted in body fluids (secretor status) are known to play a role in bacterial adhesion and we studied its influence on AMR in UTI. A total of 2758 patients with UTI were studied with urine culture, qualitative and semiquantitative urine microscopy, serum creatinine and secretor status in saliva samples by adsorption-inhibition method. Of these, AMR from 300 patients with E. coli infection were assessed as per CLSI 2019 guidelines and extended-spectrum beta-lactamase (ESBL) genes (bla TEM, bla CTX-M, bla SHV) and NDM1 genes were studied using TaqMan probes in Real-time polymerase chain reaction. Patients with UTI were followed up for two weeks. Female patients had higher predilection (57%) for E. coli infection while patients with diabetes or non-secretors had none. In our study, ESBL producers were seen in 62% of the E. coli isolates and fosfomycin had 100% susceptibility. Non-secretors were significantly associated with acute kidney injury (AKI), AMR and ESBL genes. Multidrug-resistance (MDR) was noted in 127/160 (79.4%) ESBL and 17/18 (94%) NDM1 gene encoding strains. Quantitative urine microscopy scoring predicted AKI both at presentation and at end of follow up. ESBL producers were common in our study population and non-secretors had a significant association with AMR genes. Urine microscopy scoring system may be a useful tool to predict AKI in patients with UTI.

Walking a Tightrope: Dosage Modifications and Treatment Outcomes of All-Trans-Retinoic Acid, Arsenic Trioxide, and Daunorubicin for High-Risk Acute Promyelocytic Leukemia

PURPOSE

The use of all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) in the treatment of low- and intermediate-risk acute promyelocytic leukemia (APL) is the standard of care. We report the combined use of ATRA, ATO, and daunorubicin (DNR) in patients newly diagnosed with high-risk APL. The primary focus was to describe the drug dosage modifications made in the real-world scenario.

METHODS

In this descriptive study, we included 16 out of 28 patients with high-risk APL from two tertiary care centers in South India (Vijayawada and Trichy) between January 2015 and December 2018. A unique approach of initiating ATRA at a dose of 25 mg/m² on day 1 and escalation to 45 mg/m² after cytoreduction with DNR and hydroxyurea was followed in all patients to avert differentiation syndrome, in the setting of hyperleukocytosis at presentation.

RESULTS

All patients who survived the first 3 days of admission achieved complete remission after a median duration of 29 days. There were no deaths during induction or consolidation, and the regimen was well tolerated; two patients developed grade 3/4 peripheral neuropathy requiring treatment modification. After a median follow-up duration of 1.9 years, there were no hematologic or molecular relapses.

CONCLUSION

The study sheds light on the modifications made to recommended dosages of ATRA, ATO, and DNR to optimize outcomes in high-risk APL and reaffirms the importance of ATO use in the front-line setting to achieve durable responses with minimal toxicity.

Effect of mobile voice calls on treatment initiation among patients diagnosed with tuberculosis in a tertiary care hospital of Puducherry: A randomized controlled trial

Objective

In India, about one third of tuberculosis (TB) patients diagnosed at tertiary hospitals are missed during a referral to peripheral health institutes for treatment. To address this, we assessed whether mobile voice call reminders to TB patients after diagnosis at a tertiary hospital decrease the proportion of "pretreatment loss to follow-up" (PTLFU), compared with the conventional paper-based referral.

Design

A two-group parallel-arm randomized controlled trial was conducted.

Setting

The study was conducted in a tertiary care hospital at Puducherry, South India.

Participants

All newly diagnosed TB patients, both pulmonary and extrapulmonary, who were referred for treatment from the selected tertiary care hospital and possessed a mobile phone were eligible to participate. The participants were enrolled between March 2015 and June 2016 and were randomized to study groups using the block randomization with allocation concealment.

Intervention

The participants in the intervention arm received standardized mobile voice calls reminding them to register for anti-TB treatment on the second and seventh day after referral in addition to the conventional paper-based referral received by the control group.

Primary outcomes

Patients not started on anti-TB treatment within 14 days of referral were considered as PTLFU. The outcome of PTLFU was ascertained through phone calls made on the 14^th day after referral. The intention-to-treat analysis was used, and the proportion of PTLFU in the study groups and the risk difference with 95% confidence interval (CI) were calculated.

Results

Of the 393 patients assessed for eligibility, 310 were randomized to the intervention (n = 155) and control (n = 155) arms. In the intervention arm, 14 (9%) out of 155 were PTLFU compared with 28 (18%) of the 155 patients in the control arm. The absolute risk difference was 9% (95% CI [1.5, 16.6], P = 0.01).

Conclusion

Mobile voice call reminder to patients is a feasible intervention and can reduce PTLFU among referred TB patients.

Neurodevelopmental Outcome of Preterm Newborns with Abnormal Umbilical Artery Doppler - A Prospective Cohort Study

OBJECTIVE

To assess the neurodevelopmental outcome of preterm neonates with absent/reversed end diastolic flow (A/REDF) in umbilical artery Doppler at 1 year of corrected age.

METHODS

A cohort of 70 preterm newborns with fetal growth restriction (FGR), defined as estimated fetal weight (EFW) <10th centile, confirmed by birthweight <10th centile, along with A/REDF in the umbilical artery Doppler was followed up till 1 year of corrected age (CA). An equal number of gestation and gender matched preterm newborns with birthweight >10th centile [appropriate for gestational age (AGA)] and normal antenatal ultrasound were taken as controls. Primary outcome was a composite of death or major neurodevelopmental disability (NDD) at 1 year of corrected age. Matched analysis was performed.

RESULTS

A total of 140 newborns were enrolled, of which, 20 expired and 8 were lost to follow-up. The primary outcome (death/major NDD) occurred in 26.8% of the FGR (A/REDF) newborns as compared to 9.3% of their AGA counterparts (RR-2.83, p = 0.02, 95% CI:1.11-7.18). Mean motor quotient in Development Assessment Scale for Indian Infants (DASII) at 1 year of corrected age was significantly lower in FGR (A/REDF) infants (91 ± 13.6 vs. 96.3 ± 7.1, p < 0.05). Multiple other co-morbidities were also significantly more among these newborns.

CONCLUSIONS

Preterm newborns with FGR and A/REDF are at significantly increased risk of death/major NDD at 1 year of corrected age.

Decentralizing diabetes care from tertiary to primary care: how many persons with diabetes can be down-referred to primary care settings?

BACKGROUND

In a cohort of persons with diabetes (PWDs) seeking care at a tertiary care center, we aimed to determine the proportion of PWDs eligible and willing for down referral to primary health centers (PHCs).

METHODS

We conducted a cross-sectional analytical study among PWDs on treatment for at least 1 year. PWDs with stable blood sugar, no history of cardiovascular events and proliferative retinopathy were considered as 'eligible' for primary care management.

RESULTS

Of the total 1002 PWDs, mean (SD) age was 56 (12) years; 62% were male and 81% were from rural areas. About half (49%) of them were on insulin, and 52% had comorbidities. In total, 45.6% (95% CI: 42.3-48.8%) were eligible to be managed at PHCs. Among those who were eligible, 46.6% were willing to go back to PHCs. Males (APR = 1.16), people with diabetes for more than 10 years (APR = 1.23), and the presence of comorbidities (APR = 1.13) were significantly associated with unwillingness. Quality of medicines (46%) and poor facilities (40%) at PHCs were the main reasons for unwillingness.

CONCLUSIONS

About half of the PWDs availing care at tertiary hospitals can be managed at primary care settings; of those, only half were willing to receive care at PHCs.

Video teleconsultation services for persons with epilepsy during COVID-19 pandemic: An exploratory study from public tertiary care hospital in Southern India on feasibility, satisfaction, and effectiveness

PURPOSE

During the COVID-19 pandemic, there is a large unmet need for follow-up services, particularly for chronic diseases such as epilepsy. Alternative methods to reach these people have become necessary. We assessed the feasibility, satisfaction, and effectiveness of video teleconsultation using mobile phones for managing persons with epilepsy (PWEs) on follow-up at a tertiary care center in the southern part of India.

PATIENTS AND METHODS

We included PWEs aged 18 years and over who have been evaluated in person within the past six months, with details available in electronic health records (EHRs), and advised regular follow-up after getting telephonic consent. We excluded those requiring emergency care and those seeking teleconsultation for new symptoms. Participants were sent a message in English and in the local language about the possibility of a video teleconsultation. If willing, they were informed about the date, time, and technical requirements such as smartphones, browsing facilities, etc. Feasibility and effectiveness were assessed. Satisfaction/acceptability was assessed using Telemedicine Satisfaction Questionnaire.

RESULTS

From June 2020 to October 2020, we selected 336 PWEs after screening 1100 records, and we tried video teleconsultation in 141 (41.8%) PWEs. We achieved successful video connections in 95 (28.2%) and audio consultations in 46 (13.6%). The median duration for calling the participants, making successful connections, and consultation was 8 (5-14) min. The majority required two (47.4%) or three (32.6%) attempts. Sixty-five PWEs (68.4%) used caretaker's mobile phones. We gave prescriptions to all, and 18 received new drugs. Out of 95 PWEs, 90% either 'agreed' or 'strongly agreed' on 12 out of 14 telemedicine satisfaction questions.

CONCLUSION

Although we need to make video teleconsultation more feasible, our synchronous mobile video teleconsultation model is an effective and acceptable method to follow up PWEs. This real-time model has the advantage that it does not require any mobile application to be downloaded and installed. Further studies are needed to evaluate methods to improve the reach of these services particularly to vulnerable groups of the population.

Quality of life and its determinants among sewage workers: A cross-sectional study in Puducherry, South India

Background

There is a paucity of information on sewage worker's quality of life (QoL). Hence, we aimed to assess the QoL and its associated factors among sewage workers in Puducherry, coastal south India.

Materials and Methods

A total of 210 sewage workers were included in the study. QoL was assessed using a validated Tamil version of WHO QoL-BREF. The association of QoL with age, educational status, residence area, self-reported chronic illness, use of protective measures, tobacco and alcohol use was assessed by univariate analysis. Multiple linear regression analysis was used to assess the independent factors associated with QoL.

Results

Overall mean (standard deviation) score of QoL was 56.9 (9); mean score of social relationship domain was comparatively lower than physical, psychological and environmental domains. Current tobacco and alcohol uses were 17% and 67%, respectively, while alcohol use during work (entering sump) was 5%. At least one morbidity was present among 94 (45%) subjects. About half (47%) used at least one protective measure while entering the drainage sump. Age group above 50 years, below primary level education, presence of chronic illness, smokers and alcohol users had significantly lower QoL score.

Conclusions

Social relationships' domain of QoL was very low among sewage workers. The majority of them do not use any personal protective devices and almost half had chronic illnesses.

Non-exclusive breastfeeding amongst high-risk children: Factors and barriers associated with non-exclusive breastfeeding at a tertiary care hospital in Southern India

Background

In the first 6 months of life, non-exclusive breastfeeding (NEBF) is estimated to be the cause of 1.4 million deaths worldwide and contributes to 10% of the disease burden in under-five children.

Aims and Objectives

The objective of the study was to determine the prevalence of NEBF amongst the high-risk children and the factors associated with NEBF.

Methods

This cross-sectional study was conducted amongst high-risk babies admitted between August 2016 and February 2018 who also attended the high-risk follow-up clinic at the neonatology department. Data were collected using a pre-tested structured questionnaire. Chi-square test was used to determine the factors associated with NEBF and prevalence ratios (PR) with 95% confidence interval (CI) were calculated.

Results

Amongst 304 children, 56.3% were male and 87% had birth weight <2500 g. Nearly three-fourth of the mothers were <30 years of age. The prevalence of NEBF was 49.3% (95% CI: 43.7-55.0). There was a significant association of NEBF with employment status of the mother (PR = 1.45; 95% CI: 1.1-1.9), NEBF in previous child (PR = 2.3; 95% CI: 1.4-3.9) and EBF at the point of discharge (PR = 2.3; 95% CI: 2-2.6). The barriers reported by the mothers leading to NEBF were insufficient or less milk secretion, poor breastfeeding attachment, perceived thirst and poor maternal health.

Conclusion

One out of every two children admitted in neonatal intensive care unit were non-exclusively breastfed before 6 months of age. The employment status of mother, practice of exclusively breastfeeding the previous child and EBF at the time of discharge were significantly associated with NEBF.

Attenuation of baroreflex sensitivity and heart rate variability is linked to reduced levels of nitric oxide in pregnant women having risks of developing gestational hypertension

Purpose: Decreased baroreflex sensitivity (BRS) and sympathovagal imbalance (SVI) have been reported as a cardiovascular (CV) risk in gestational hypertension (GH). Nitric oxide (NO) has been implicated in pathophysiology of GH. In the present study, we assessed the link of CV risks (decreased BRS and SVI) to the plasma levels of NO in women having risk of developing GH. Materials and Methods: A total of 96 pregnant women having risk factors for GH were recruited for the study. The blood pressure variability (BPV), heart rate variability (HRV), plasma NO, marker of insulin resistance (HOMA-IR), lipid risk factors, inflammatory markers (hsCRP, interleukin-6), and malondialdehyde (MDA), the marker of oxidative stress (OS) were measured at 16^th and 36^th week. Link of various parameters to NO was assessed by correlation and multiple regression analysis. Results: Of HRV indices, parasympathetic components were decreased and sympathetic components were increased, BRS was decreased, NO was decreased, HOMA-IR, lipid risk factors, hsCRP, interleukin-6, and MDA were increased significantly at 36^th week compared to 16^th week of pregnancy. Most of the markers of cardiometabolic risk were correlated with NO. However, only the markers of CV risk (SVI and reduced BRS) were independently associated with decreased level of NO, but not the metabolic markers except interleukin-6. The independent contribution of BRS (β = 0.334, P < .001) to NO was found to be most significant. Conclusion: It was concluded that decreased BRS, SVI, and increased interleukin-6 are associated with reduction in NO in GH, which may possibly be linked to the development of CV risks in GH.

Experiences and Felt Needs of Women During Childbirth in a Tertiary Care Center: a Hospital-Based Cross-Sectional Descriptive Study

BACKGROUND

Childbirth experience is unique to every woman. Negative experience is detrimental to both mother and child. This study was undertaken to understand the positive and negative experience and felt need of women undergoing labor and the factors affecting them.

METHODOLOGY

This cross-sectional descriptive quantitative study was conducted among women who delivered in JIPMER and consented to participate through a questionnaire that captured four areas of childbirth experience. The study was carried out before the LaQshya guidelines were implemented.

RESULTS

Three hundred and seventy women completed the study. The mean age of women in this study was 24.5 years and 60% were primipara. Five women (1.3%) experienced physical abuse. Another 47 (12.7%) experienced disrespect in the form of scolding/insult/discrimination or nonconsented care. Three-fourths of the women wanted a relative (majority preferred their mother) with them, and 54% wanted a prayer hall in the labor room. On univariate analysis, no significant determinant was found for negative experience constituting disrespect and abuse. Complete pain relief as a need was found to be significantly higher (X2 = 11.0783, p < 0.004) in women of lower parity. The women educated beyond scholastic level felt that information given about delivery is inadequate when compared to participants who were illiterate or had primary education only.

CONCLUSIONS

In our hospital 12.7% women undergoing labor experienced disrespectful behavior and 1.3% experienced physical abuse. Need for prayer hall, complete pain relief and presence of relative was felt by more than half of the participants. We did not find any specific factor influencing the negative experience.

Glycemic control and its associated factors among women with gestational diabetes mellitus in a tertiary care Centre, Puducherry, South India

Background:

Worldwide, one in ten pregnancies is related with diabetes; 87.6% of which are gestational diabetes mellitus (GDM). Maternal hyperglycaemia affects the successful progression of pregnancy.

Objectives:

To determine the proportion and the factors associated with poor glycaemic control among women with gestational diabetes.

Methods:

This hospital-based cross-sectional study was conducted in a tertiary care hospital, Puducherry, South India from September to October 2019. Pregnant women diagnosed as GDM and on treatment for at least one month were approached consecutively for the study. A fasting blood sugar (FBS) ≥92 mg/dl and postprandial blood sugar (PPBS) 1 hour ≥180 mg/dl or PPBS 2 hour ≥153 mg/dl were considered as poor glycaemic control.

Results:

A total of 301 women with GDM were included and the mean (SD) age was 27 (5) years. Of total, 29 (10%) reported GDM during their previous pregnancy and 95 (32%) got diagnosed before reaching the tertiary care hospital. Lifestyle modifications (77%) were the most common mode of management for GDM. Of total, 116 (38.5%; 95% CI 33%-44.3%) had poor glycaemic control. Multigravida women (46.9%) and those on pharmacological treatment for GDM had poor glycaemic control.

Conclusion:

One-third of women with GDM at a tertiary care centre had poor glycaemic control. Therefore, a novel approach to improve awareness about GDM control both among pregnant women and the medical fraternity is needed.

To start or to complete? - Challenges in implementing tuberculosis preventive therapy among people living with HIV: a mixed-methods study from Karnataka, India

Background: Isoniazid preventive therapy (IPT) has been shown to reduce the risk of tuberculosis (TB) among people living with HIV (PLHIV). In 2017, India began a nationwide roll-out of IPT, but there is a lack of evidence on the implementation and the challenges.

Objectives: Among PLHIV newly initiated on antiretroviral therapy (ART) from January 2017 to June 2018, to: (i) assess the proportion who started and completed IPT and (ii) explore reasons for non-initiation and non-completion from health-care providers’ and patients’ perspectives.

Methods: An explanatory mixed-methods study was conducted in two selected districts of Karnataka, South India. A quantitative phase (cohort analysis of routinely collected program data) was followed by a qualitative phase involving thematic analysis of in-depth interviews with providers (n = 22) and patients (n = 8).

Results: Of the 4020 included PLHIV, 3780 (94%) were eligible for IPT, of whom, 1496 (40%, 95% CI: 38%-41%) were initiated on IPT. Among those initiated, 423 (28.3%) were still on IPT at the time of analysis. Among 1073 patients with declared IPT outcomes 870 (81%, 95% CI: 79%-83%) had completed the six-month course of IPT. The main reason for IPT non-initiation and non-completion was frequent drug stock-outs. This required health-care providers to restrict IPT initiation in selected patient subgroups and earmark six-monthly courses for each patient to ensure that, once started, treatment was not interrupted. The other reasons for non-completion were adverse drug effects and loss to follow-up.

Conclusion: The combined picture of ‘low IPT initiation and high completion’ seen in our study mirrors findings from other countries. Drug stock-out was the key challenge, which obliged health-care providers to prioritize ‘IPT completion’ over ‘IPT initiation’. There is an urgent need to improve the procurement and supply chain management of isoniazid.

Willingness and yield of screening for hepatitis B among outpatients of a tertiary care centre, Puducherry, South India

India's National Viral Hepatitis Control Programme recommends screening outpatients for hepatitis B at tertiary care centres. We aimed to assess the yield of screening and reasons for refusal for testing. We included adult outpatients at a tertiary care centre, South India during September and October 2019. Participants' willingness to be tested and the reasons for refusal were noted. Fingerstick blood sample was tested for HBsAg using rapid kit. Of a total of 700 participants, 157 (22%, 95% CI: 19.4-25.7%) were unwilling to be tested. Men were more unwilling (26%) compared to women (19%) (aPR 1.90 95% CI: 1.22-2.94; p = 0.004). 'Lack of time' was the most common reason reported for refusal (10%). Of 543 participants tested, 15 (2.8%, 95% CI: 1.6-4.5%) were positive for HBsAg. Similar studies from other regions in India are required for the estimation of yield of opportunistic approach.

Willingness to quit tobacco and its correlates among Indian tobacco users-Findings from the Global Adult Tobacco Survey India, 2016-17

Background

Willingness to quit in a tobacco user forms the basis for future quit attempts and quitting successfully.

Objective

To determine the prevalence and correlates of willingness to quit among tobacco users in India using the Global Adult Tobacco Survey (GATS), India, 2016-2017.

Methods

GATS, 2016-17 was a multistage geographically clustered sample survey done among 74,037 individuals aged 15 years and above across all the states and two of the Union Territories of India. Data of all those reported using any form of tobacco were studied for past attempts to quit tobacco, advised to quit by a health care provider, and exposure to anti-tobacco messages delivered through various media and the correlation of these with the willingness to quit using multivariate analysis.

Results

Of the 21,085 current tobacco users in the survey, 11,679 (52.2%), were willing to quit all forms of tobacco. Multivariate analysis showed that those in younger age groups (OR: 1.39 [1.23-1.56]), higher education levels (OR 1.15 [1.05-1.18]), time of first tobacco use in the day being more than 60 min after waking up in the morning (OR 1.11 [1.03-1.2]), history of attempts to quit in the past 12 months (OR 1.78 [1.69-1.87]), those advised to quit by health care provider in the past 12 months (OR 1.11 [1.06-1.17]), those using single form of tobacco (OR 1.1 [1.05-1.17]), those exposed to anti-tobacco messages in newspapers/magazines (OR 1.1 [1.05-1.17]), and cinemas (1.14 [1.08-1.20]) were more willing to quit compared to their counterparts.

Conclusion

Enhanced publicizing of anti-tobacco messages through the currently employed media, and ensuring that doctors give a brief advice to quit during any contact with a tobacco user could improve the willingness to quit and the consequent quit rate, especially among those tobacco users who are in younger age groups and who have attempted to quit earlier.

Pathways to care among patients with severe mental disorders attending a tertiary health-care facility in Puducherry, South India

INTRODUCTION

Pathways to care can be defined as the pathway adopted by the patient to reach the appropriate health facility. In India, health workforce related to mental health care is inadequate. Persons with mental disorders approach different types of care providers. This study describes the number, sequence of care providers visited, and time gap between providers among individuals newly diagnosed with severe mental disorders.

MATERIALS AND METHODS

We conducted a facility-based descriptive study in the psychiatric outpatient department of a tertiary care center in South India between April and September 2017. All patients with any of the following diagnosis; acute psychosis, depression, bipolar disorder, or schizophrenia were included in the study. Information on number and sequence of care providers visited and the reasons for preference of providers were assessed using a validated World Health Organization questionnaire. Patients seeking care was summarized as numbers.

RESULTS

Of the total 150 participants, 86 (57%) were females and the mean (standard deviation) age was 35 (11.5) years. The first point of contact were traditional healers in 52 (34.7%) participants, general hospitals in 23 (15.3%), and psychiatric services in the remaining 75 (50%). The patients with schizophrenia and bipolar disorder had greater delays in accessing psychiatric care when compared to other disorders. Median (interquartile range) number of care providers visited till the diagnosis made was 2 (1-3). The availability and recommendation by close relatives were the major reasons for the preference of traditional healers.

CONCLUSIONS

One-third of patients visited traditional healers as the first point of contact and about half visited the psychiatric facilities directly.

Effect of COVID19 pandemic and national lockdown on persons with diabetes from rural areas availing care in a tertiary care center, southern India

BACKGROUND AND AIMS

COVID-19 pandemic and lockdown measures to contain it have affected health care services globally. This study aims to assess the effect and urban-rural differences of COVID19 pandemic on diabetes care.

METHODS

This cross-sectional study was conducted among persons with diabetes (PWDs) registered for care at a diabetes clinic of a tertiary care center in Southern India. We collected following information by telephonic interviews: physician consultations, access to diabetes medications and blood sugar tests, use of telemedicine services, out of pocket expenditure and psychological morbidity.

RESULTS

A total of 350 PWDs were interviewed. Majority were male (78%) and from rural areas (79%). One fourth (24%) met any physician for diabetes care at least once during lockdown. PWDs from rural areas mainly consulted a physician in a private clinic (55%) compared to urban areas (26%). Two third (65%) availed medications from private medical shops. Almost half (46%) got their blood sugar tested during and majority of them (81%) reported unsatisfactory glycemic control. Only few (5%) was aware and three utilized telemedicine services. Almost all (99%) spent money (US $ 8.3) for diabetes care. One third (33%) had moderate or high psychological distress.

CONCLUSIONS

Majority of PWDs did not consult a physician during lockdown. Cost of care was high. Measures to improve utilisation of telemedicine services and peripheral health facilities are needed.

Pre-hospital care and its association with clinical outcome of snakebite victims presenting at a tertiary care referral hospital in South India

Most snakebite victims in low- and middle-income countries continue to seek many forms of first aid therapy before reaching hospital, the commonest being the application of a tourniquet. Our study looked at a prospective cohort of 382 such patients to ascertain the association of pre-hospital care with clinical outcome, and found that 60% developed complications as compared to 36% who had no pre-hospital care (p < 0.001), with 10 fatalities in the former compared to only one in the latter. Pre-hospital care remains very common and definitely increases morbidity and mortality.

Neuronal Biomarkers in Predicting Neurodevelopmental Outcome in Term Babies with Perinatal Asphyxia

OBJECTIVE

To assess whether serum levels of neuronal biomarkers (S100 calcium-binding protein B and Neuron specific enolase) correlate with the neurodevelopmental outcome of term neonates at 18 mo who had hypoxic ischemic encephalopathy and underwent therapeutic hypothermia.

METHODS

This randomized controlled trial was conducted in a tertiary care teaching hospital, south India. There were 162 term infants with moderate to severe hypoxic ischemic encephalopathy who were randomized into 2 groups (Group A and B). Neonates in Group A and B received normothermia and therapeutic hypothermia respectively. Serum levels of neuronal biomarkers were estimated at 0, 24 (±1) and 72 (±1) h after birth using sandwich ELISA in both groups. All neonates were carefully monitored till discharge. Infants who survived the neonatal period were followed up in the high risk clinic for 18 mo and neurodevelopmental assessment was done using Developmental Assessment Scale for Indian Infants (DASII). Neurodevelopmental outcomes between the two groups were compared using Chi square test and neuronal biomarker levels between the groups were compared using Mann Whitney test.

RESULTS

The baseline maternal and neonatal characteristics in both groups were comparable. There was statistically insignificant lesser mortality in therapeutic hypothermia group compared to normothermia group with Risk Ratio (RR): 0.82 (28.2% vs. 34.5%, 95% CI: 0.52-1.29, p = 0.38). Among the survivors, children in therapeutic hypothermia group had better motor and mental scores compared to those in normothermia group at 18 mo. There was no significant correlation between S100B and Neuron specific enolase levels and neurodevelopmental outcome.

CONCLUSIONS

Serum levels of neuronal biomarkers (S100B and Neuron specific enolase) do not correlate with the long term neurodevelopmental outcome among these infants.

Risk factors for death during treatment in pulmonary tuberculosis patients in South India: A cohort study

OBJECTIVE

Identifying the risk factors for deaths during tuberculosis (TB) treatment is important for achieving the vision of India's National Strategic Plan of 'Zero Deaths' by 2025. We aimed to determine the proportion of deaths during TB treatment and its risk factors among smear positive pulmonary TB patients aged more than 15 years.

STUDY DESIGN

We performed a cohort study using data collected for RePORT India Consortium (Regional Prospective Observational Research in Tuberculosis).

SETTING

Revised TB Control Program (RNTCP) in three districts of South India.

PARTICIPANTS

The cohort consisted of newly diagnosed drug sensitive patients enrolled under the Revised National TB Control Program during 2014-2018 in three districts of southern India. Information on death was collected at homes by trained project staff.

PRIMARY OUTCOME MEASURES

We calculated 'all-cause mortality' during TB treatment and expressed this as a proportion with 95% confidence interval (CI). Risk factors for death were assessed by calculating unadjusted and adjusted relative risks with 95% CI.

RESULTS

The mean (SD) age was of the 1167 participants was 45 (14.5) years and 79% of them were males. Five participants (0.4%) were HIV infected. Among the males, 560 (61%) were tobacco users and 688 (75%) reported consuming alcohol. There were 47 deaths (4%; 95% CI 3.0-5.3) of which 28 deaths (60%) occurred during first two months of treatment. In a bi-variable analysis, age of more than 60 years (RR 2.27; 95%CI: 1.24-4.15), male gender (RR 3.98; 95% CI: 1.25-12.70), alcohol use in last 12 months (RR 2.03; 95%CI: 1.07-3.87), tobacco use (RR 1.87; 95%CI: 1.05-3.36) and severe anaemia (RR 3.53: 95%CI: 1.34-9.30) were associated with a higher risk of death. In adjusted analysis, participants with severe anaemia (<7gm/dl) had 2.4 times higher risk of death compared to their counterparts.

CONCLUSION

Though deaths during TB treatment was not very high, early recognition of risk groups and targeted interventions are required to achieve zero TB deaths.