Is Inclusion of informed consent associated with HIV seropositivity rate? findings from 2017 HIV sentinel surveillance among men having sex with men in select states of India

Background

During round 2017 of HIV Sentinel Surveillance (HSS) for men who have sex with men (MSM) in India, sampling strategy was changed from consecutive sampling to random sampling, and recruitment was conditioned on informed written consent.

Objective

The study aimed to explore whether inclusion of informed consent is associated with HIV seropositivity rates among MSM population in select four states of Central India.

Methods

The cross-sectional study was conducted in four states of Delhi, Jharkhand, Uttar Pradesh, and Uttarakhand that were supervised by All India Institute of Medical Sciences, New Delhi. We did analysis of data collected during 2017 HSS, supplemented with additional program data from targeted intervention (TI) sites. All nine MSM sites in four states were included. Participants were defined as all those MSM who participated in HSS 2017 irrespective of whether they were mentioned in the random list or were selected by the TI partner. The MSM in the random list who either refused to participate or could not be contacted even after three attempts were classified as "nonparticipants." Seropositivity of both groups was compared. Descriptive statistics were derived.

Results

Overall nonparticipation rate was 14.7%, the highest being in Jharkhand (26%) and lowest in Uttarakhand (6.8%). Overall HIV positivity rate was significantly higher (P < 0.001) in nonparticipants (4.2%) when compared to participants (1.42%).

Conclusion

The change in sampling strategy and introduction of written informed consent for recruitment of high-risk groups in HSS 2017 round could have led to an underestimation of HIV seropositivity rate among MSM in the states in Central Zone.

Prevalence of knee osteoarthritis, its determinants, and impact on the quality of life in elderly persons in rural Ballabgarh, Haryana

Background:

Osteoarthritis (OA) is the most common type of arthritis and a very common disease of elderly. It is one of the leading causes of disability. The present study was conducted to estimate the burden of the knee OA among rural elderly.

Methods:

A community-based cross-sectional study was conducted among 500 randomly selected elderly resident of rural Ballabgarh, Haryana. A semi-structured interview schedule was used by a trained investigator for face-to-face interview, clinical examination of knee using American College of Rheumatology criteria, and quality of life assessment using WHOQOL-BREF.

Results:

Almost two-third of the participants among 454 elderly recruited, suffered from knee OA (292, 64.3%) had knee OA. History of a knee injury, a family history of knee pain, current physical activity and smoking status were found to be significantly associated with knee OA, in multivariate logistic regression model. Elderly suffering from knee OA had significantly lower quality-of-life scores contrasted to those not (p-value < 0.001). The scores were significantly lower for all the domains (P-value <0.001) among elderly suffering with the knee OA, with the maximum effect seen in psychological, and physical domain.

Conclusion:

Rural elderly of Ballabgarh, Haryana, had a high burden of knee OA. Elderly suffering from knee OA had significantly lower perception of their quality of life most affected is the psychological and physical domains of quality of life.

A rapid review of pre-exposure prophylaxis for HIV in the Asia-Pacific region: recommendations for scale up and future directions

Decline in new HIV infections in the Asia-Pacific region (APAC) continues to be slow, emphasising the importance of scaling up new HIV prevention strategies, such as pre-exposure prophylaxis (PrEP). To help inform PrEP rollout in APAC, we conducted a rapid review of published literature on PubMed from 2015 to 2020, to assess feasibility, implementation strategies, cost-effectiveness, and availability of national policies and guidelines; for the latter, we also did an expanded Internet search. This review focussed on nine countries contributing >95% of new infections in this region. A total of 36 PrEP-related studies conducted among men who have sex with men, female sex workers, and transgender women were included, of which 29 were quantitative, six were qualitative and one was a mixed-method study. Most of the studies have addressed the availability and acceptability of PrEP, whereas cost-effectiveness of any approach was assessed by limited studies. Limited published information was available about national PrEP policies and guidelines; of the selected nine countries, five have adopted the recommended World Health Organization PrEP policy of which four have integrated it in their national HIV response. HIV risk perception concerns about safety, side-effects, stigma, and affordability were major challenges to PrEP acceptance. Community-based implementation has the potential to address these. Limited evidence suggested merging PrEP implementation with ongoing targeted intervention and treatment programs could be a cost-effective approach. To stem the epidemic, newer effective prevention strategies, like PrEP, should be urgently adopted within the context of combination HIV prevention approaches.

Access and utilization of sanitation facilities in a Rural Area of Haryana, North India

Background

Ensuring universal access to sanitation in households is essential for public health.

Objectives

The objective of the study was to assess the availability of sanitary latrine at the household level and its use at the individual level in a rural area and factors associated with availability and use of sanitary latrine.

Methods

This cross-sectional study was conducted from December, 2016 to January 2017 (mention month and year) at the rural Health and Demographic Surveillance Site, Ballabgarh, in district Faridabad, Haryana, North India. A total of 16,896 households were studied. House-to-house visits were made by trained health workers who conducted interviews regarding availability and pattern of use of sanitary latrine in the household. The health worker also observed the type of sanitation facility, its functional status, availability of water, and hand-washing facility.

Results

Individual household latrine (IHL) was present in 87.3% of the households. An improved sanitation facility was available in 84.8% of the households, while 15.2% of the households had unimproved or no sanitation facility. Hand-washing facility along with improved sanitation was present in 70.4% of the households. Nonavailability of latrine among socially disadvantaged communities (scheduled caste households) was significantly higher (19.4%) as compared to other castes (10.4%) (P < 0.001). A significantly higher proportion of households below poverty line (28.9%) lacked IHL as compared to those above the poverty line (11.0%) (P < 0.001). Nearly 11% of the individuals reported open defecation.

Conclusion

The availability of sanitary latrines in the study area was high. Nonavailability of in-house sanitary latrine was higher among economically poor households and those belonging to socially disadvantaged communities.

Burden of influenza-associated respiratory and circulatory mortality in India, 2010-2013

Background

Influenza causes substantial morbidity and mortality worldwide, however, reliable burden estimates from developing countries are limited, including India. We aimed to quantify influenza-associated mortality for India utilizing 2010-2013 nationally representative data sources for influenza virus circulation and deaths.

Methods

Virological data were obtained from the influenza surveillance network of 10 laboratories led by National Institute of Virology, Pune covering eight states from 2010-2013. Death data were obtained from the nationally representative Sample Registration System for the same time period. Generalized linear regression with negative binomial distribution was used to model weekly respiratory and circulatory deaths by age group and proportion of specimens positive for influenza by subtype; excess deaths above the seasonal baseline were taken as an estimate of influenza-associated mortality counts and rates. Annual excess death rates and the 2011 India Census data were used to estimate national influenza-associated deaths.

Results

Estimated annual influenza-associated respiratory mortality rates were highest for those ≥65 years (51.1, 95% confidence interval (CI) = 9.2-93.0 deaths/100 000 population) followed by those <5 years (9.8, 95% CI = 0-21.8/100 000). Influenza-associated circulatory death rates were also higher among those ≥65 years (71.8, 95% CI = 7.9-135.8/100 000) as compared to those aged <65 years (1.9, 95% CI = 0-4.6/100 000). Across all age groups, a mean of 127 092 (95% CI = 64 046-190,139) annual influenza-associated respiratory and circulatory deaths may occur in India.

Conclusions

Estimated influenza-associated mortality in India was high among children <5 years and adults ≥65 years. These estimates may inform strategies for influenza prevention and control in India, such as possible vaccine introduction.

Global status of knowledge for prevention and emergency management of traumatic dental injuries in dental professionals: Systematic review and meta-analysis

BACKGROUND

Dental professionals are the primary care providers for traumatic dental injuries (TDI). The dental traumatology literature has a number of studies evaluating the knowledge of dental professionals from different parts of the world but its global status is unknown. Hence, the aim of this systematic review was to assess the global status of knowledge for the prevention and emergency management of TDI in dental professionals and to provide recommendations for future research.

MATERIALS AND METHODS

The protocol was designed as per the PRISMA guidelines and registered in PROSPERO (CRD42020192381). A broad-based search using text words and MeSH terms was performed in established databases as per a pre-defined strategy without any distinction of language and year of publication. Studies without details of the questionnaire, knowledge score, validity and reliability were excluded. Data extraction was performed, risk of bias assessment was done using the Joanna Briggs Institute's critical appraisal tool, and a meta-analysis was performed.

RESULTS

Sixteen studies, which had been published between 2008 and 2020, were included for qualitative synthesis. Most of them were cross-sectional, used convenience sampling and evaluated knowledge for avulsion. Previous dental trauma training was undertaken by <50% of the participants of five studies, <50% knew about the correct approach in management of complicated crown fractures in three studies and ≤60% in four studies knew the critical time for replantation. There was insufficient level of knowledge in >50% of the included studies. High risk of bias was found in three studies.

CONCLUSION

The knowledge level in several areas of the world was unknown. The studies lacked uniformity in methods and well-designed questionnaires and they revealed insufficient levels of knowledge among dental professionals.

Prevalence of hypertension among adolescents (10-19 years) in India: A systematic review and meta-analysis of cross-sectional studies

BACKGROUND

Despite the well-known short-term and long-term ill effects of elevated blood pressure in children and adolescents, pooled data on its burden among Indian adolescents have not yet been synthesized.

OBJECTIVES

We did a systematic review with meta-analysis to calculate the pooled prevalence of hypertension among adolescents (10-19 years) in India.

METHODS

We searched PubMed, Embase, Cochrane library, Google Scholar and IndMed, and included cross-sectional studies reporting data on hypertension prevalence among 10 to19 years old and published in English language from their inception till 1st March 2020. Modified New castle Ottawa scale was used to assess risk of bias based on research design, recruitment strategy, response rate and reliability of outcome determination. A random effects model was used to estimate pooled prevalence, and heterogeneity was assessed using Cochrane's Q statistic test of heterogeneity and I2 statistic. To explore the heterogeneity, we did a meta-regression, and sub-group analyses based on region, study setting and number of blood pressure readings.

RESULTS

Out of 25 studies (pooled sample of 27,682 participants) six studies were of high, eighteen of moderate, and one was of low quality. The prevalence of hypertension across studies ranged from 2% to 20.5%, with a pooled estimate of 7.6% (95% CI: 6.1 to 9.1%), I2 = 96.6% (p-value <0.001). Sub-group analysis restricted only to the western India demonstrated a smaller heterogeneity (I2 = 18.3%). In univariate model of meta-regression, diagnostic criteria was significantly associated with pooled prevalence (-4.33, 95%CI: -7.532, -1.134).

CONCLUSION

The pooled prevalence of hypertension among adolescent in India is 7.6% with substantial heterogeneity between the studies. To tackle the high prevalence of hypertension among adolescents, early detection by screening under school health programme and opportunistic screening at Paediatric OPD should be implemented by Policy makers.

Community action for people with HIV and sex workers during the COVID-19 pandemic in India

Sex workers have been one of the marginalized groups that have been particularly affected by India's stringent lockdown in response to the coronavirus disease 2019 (COVID-19) pandemic. The sudden loss of livelihood and lack of access to health care and social protection intensified the vulnerabilities of sex workers, especially those living with HIV. In response, Ashodaya Samithi, an organization of more than 6000 sex workers, launched an innovative programme of assistance in four districts in Karnataka. Since access to antiretroviral therapy (ART) was immediately disrupted, Ashodaya adapted its HIV outreach programme to form an alternative, community-led system of distributing ART at discreet, private sites. WhatsApp messaging was used to distribute information on accessing government social benefits made available in response to the COVID-19 pandemic. Other assistance included advisory messages posted in WhatsApp groups to raise awareness, dispel myths and mitigate violence, and regular, discreet phone check-ins to follow up on the well-being of members. The lessons learnt from these activities represent an important opportunity to consider more sustainable approaches to the health of marginalized populations that can enable community organizations to be better prepared to respond to other public health crises as they emerge.

Prevalence of anemia among elderly persons residing in old age homes in national capital territory, Delhi, India

Background

Anemia is a common morbidity in elderly persons (aged 60 years or above). In India, in recent years, the number of old age homes (OAHs) and the residents living in them has increased significantly.

Objective

The aim of this study was to estimate the prevalence of anemia among elderly persons living in OAHs.

Methods

This was a cross-sectional study among individuals living in OAH in Delhi, India. Using combination of location and type of OAH, 28 clusters of almost equal sizes were created, of which 13 clusters were randomly selected, and all elderly persons living therein were selected for the study. Sociodemographic profile was recorded using a self-designed, semistructured interview schedule. Hemoglobin (Hb) was estimated using HemoCue Hb 201+ system. Binary Logistic regression was used to assess the socioeconomic determinants of anemia.

Results

The study included 334 elderly persons, with a mean (standard deviation [SD]) age of 75.2 (8.6) years and mean (SD) Hb of 11.6 (1.7) g/dL. The mean (SD) Hb in men was 12.1 (1.7) g/dL compared to 10.9 (1.5) g/dL among women (P < 0.0001). The overall prevalence of anemia was 68.7% (95% confidence interval 63.9, 73.4); among those who were anemic, 47.4% had mild anemia, 47.0% had moderate anemia, and 5.6% had severe anemia. The prevalence of mild anemia was 45% in men compared to 24.8% in women. The odds of anemia among ≥80 years was 2 times that among 60-69 years (P < 0.029).

Conclusions

The prevalence of anemia among elderly persons in OAHs is high in Delhi, India and increased with age.

Prevalence and Determinants of Anemia among Adult Males in a Rural Area of Haryana, India

Anemia is an under-recognized morbidity among adult males causing significant productivity loss. A study was done among adult males (≥18 years) in a rural area of Haryana, India to estimate the prevalence and determinants of anemia and to explore their attitude and beliefs about anemia. Mixed methods approach was adopted. A total of 1219 participants were selected by multi-stage simple random sampling for the cross-sectional study and were administered a questionnaire followed by hemoglobin measurement using HemoCue method. Six focus group discussions were conducted. Age adjusted prevalence of anemia was 27.9% [95% confidence interval (95% CI): 27.4–28.4%]. Anemia was found to be positively associated with age more than 50 years (OR: 2.7 (95% CI: 1.7–4.2) in age group 50–59 years and 3.6 (95% CI: 2.3–5.6) in age group ≥60 years as compared with age group 18–24 years) and presence of chronic co-morbidity (OR: 2.0; 95% CI: 1.2–3.2). There were misconceptions among study participants about the role of specific dietary factors in causation of anemia. Poor purchasing capacity was cited as main reason for not consuming iron rich diet. Anemia was a common morbidity in this study population.

Intravenous Iron sucrose and change in hemoglobin, ferritin, and oxidative stress markers among moderately anemic pregnant women attending a secondary care level Hospital in Northern India

Background

Intravenous iron is associated with oxidative stress, and very few studies have assessed change in oxidative stress markers post infusion.

Objectives

The study aimed to measure the change in levels of hemoglobin (Hb), serum ferritin, and select oxidative stress markers (malondialdehyde [MDA], superoxide dismutase [SOD], and ferric reducing ability of plasma [FRAP]) 4 weeks following the administration of intravenous iron sucrose (IVIS) among moderately anemic pregnant women who were attending a secondary-level health-care facility, Haryana, North India.

Methods

An observational study was conducted (May 2016 to Jan 2018) among pregnant women receiving intravenous iron sucrose i.e., IVIS (300 mg per dose) diluted in 300 mL of normal saline over 20-45 min and were followed up for a period of 4 weeks after the last dose of IVIS (end line). The study outcomes were measured in the levels of Hb, serum ferritin, MDA, SOD, and FRAP from the baseline to the end line.

Results

The mean (95% confidence interval) change in the Hb and serum ferritin level 4 weeks after the last dose of IVIS was an increase of 2.5 (2.1-3.0) g/dL (P < 0.001) and 63.0 (44.7-81.3) ng/mL (P < 0.001), respectively. There were no significant changes (baseline to end line) in mean (standard deviation [SD]) MDA level and mean (SD) FRAP level. The mean (SD) SOD level declined significantly (2.2 [0.4] U/mL to 1.6 [0.5] U/mL [P < 0.001]). No life-threatening adverse events were encountered during the study.

Conclusion

IVIS was well tolerated and effective in treating moderate anemia in pregnancy. Body iron store was replenished following IVIS administration. There was no increase in oxidative stress following IVIS therapy.

The Ashodaya PrEP project: Lessons and implications for scaling up PrEP from a community-led demonstration project among female sex workers in Mysore, India

To inform PrEP roll out, Ashodaya Samithi, a sex workers' collective, conducted a community-led prospective demonstration project among female sex workers in Mysore and Mandya, India. Following a community preparedness phase and pre-screening, participants were recruited for clinical screening and enrolment, provided PrEP as part of combination HIV prevention, and followed for 16 months. Adherence was measured by self-reported pill intake and by tenofovir blood level testing among a subset of participants. Of the 647 participants enrolled, 640 completed follow-up. Condom use remained stable and no HIV seroconversions occurred. Self-reported daily PrEP intake over the last month was 97.97% at the end of the study. Tenofovir blood levels >40 ng/mL (consistent with steady state dosing) were detected among 80% (n = 68/85) and 90.48% (n = 76/84) of participants at month 3 and 6, respectively. Our study holds important insights for rolling out PrEP in community settings as part of targeted HIV prevention interventions.

Serum calcium level among pregnant women and its association with pre-eclampsia and delivery outcomes: A cross-sectional study from North India

Background:

Calcium requirement increases during pregnancy, thereby increasing the chances of developing hypocalcaemia. Hypocalcaemia may be associated with pregnancy-related complications. Therefore, we planned this study to estimate the prevalence of hypocalcaemia among pregnant women attending secondary care hospital, and to study the association between hypocalcaemia and pregnancy outcomes.

Materials and Methods:

This study was conducted in a secondary level hospital at Ballabgarh, district Faridabad, Haryana, India. Consecutive pregnant women with gestation period more than 28 weeks were enrolled. Dietary calcium intake was ascertained using 24-hour dietary recall method. Serum calcium estimation was done by Biolis 24i auto analyser. Outcome of pregnancy (preterm delivery, low birth weight (LBW) babies, and neonatal mortality) was assessed telephonically 3 months after the enrolment.

Results:

A total of 696 pregnant women were enrolled in the study. Mean (SD) dietary calcium intake and serum calcium level was 796.4 (360.4) mg/day and 9.56 (0.94) mg/dl respectively. Prevalence (95% CI) of hypocalcaemia was 23.9% (20.8 – 27.2%). Serum total calcium level was not associated with dietary calcium intake (p-value = 0.36). Mean serum calcium level was significantly lower in mothers who had LBW babies. Pre-eclampsia, preterm delivery, and neonatal mortality were not associated with serum calcium level.

Conclusion:

Serum calcium level may not be related to dietary calcium level. Hence, the current recommendation of calcium supplementation during antenatal period appears to be inconclusive among our study population.

Intravenous ferric carboxymaltose rapidly increases haemoglobin and serum ferritin among pregnant females with moderate-to-severe anaemia: A single-arm, open-label trial

Background

. Infusion of ferric carboxymaltose (FCM) can correct iron deficiency anaemia in the second or third trimester of pregnancy. However, large-scale public health use of FCM is constrained by two issues. First, there is limited evidence on the efficacy and safety profile of FCM in the Indian context. Second, logistic challenges in administering FCM at a subdistrict healthcare setting have not been assessed. We aimed to measure the mean increase in haemoglobin (Hb) level 2 weeks after infusion of FCM to pregnant females with moderate-to-severe anaemia attending a subdistrict hospital in India.

Methods

. During June-December 2016, we did a single-arm, open-label trial among pregnant females with a gestation of 16-32 weeks, Hb 5.0-9.9 g/dl. FCM was infused (per Ganzoni formula) in a single session up to a maximum of 1000 mg of iron. Hb and s-ferritin levels were measured at recruitment, 2 weeks post-infusion and at delivery. Adverse events were noted.

Results

Seventy-seven pregnant females were enrolled with mean (SD) age 23.2 (3.1) years, gestation 27.6 (3.8) weeks and Hb 8.4 (0.9) g/dl. At 2 weeks post-infusion (n=63), the mean Hb level increased by 1.9 g/dl (95% confidence interval [CI] 1.6-2.3) and at delivery (n = 64) by 2.9 g/dl (95% CI 2.4-3.4). The median (interquartile range) (in ng/ml) for serum ferritin at baseline (n = 68), 2 weeks post-FCM infusion (n = 61) and at delivery (n = 39) was 6.3 (5.1-11.7), 275.4 (186.4-330.3) and 61.3 (42.5-132.0), respectively. No major adverse effects were reported.

Conclusion

Infusion of FCM rapidly corrected anaemia, sustained its effect till delivery and replenished body iron reserves. FCM is safe and effective in treating anaemia in pregnant females in the second and third trimester at the subdistrict healthcare setting in India.

Anemia at the time of delivery and its association with pregnancy outcomes: A study from a secondary care hospital in Haryana, India

Maternal anemia has been reportedly associated with increased risk of maternal and fetal morbidity and mortality. Adverse pregnancy outcomes such as preterm birth, low birth weight, and stillbirth have been reported to be associated with anemia. However, different studies have shown inconsistent results. In the present study, we report the association between maternal hemoglobin levels at the time of delivery and outcomes among women at a secondary care hospital in northern India. Secondary analysis of routinely collected hospital data from January 2015 to December 2016 was carried out. Sociodemographic details, hemoglobin levels at the time of admission, and birth outcomes were retrieved from the records of women admitted for delivery. The outcomes were compared among anemic and nonanemic women. About 78% of the women were found to have anemia at the time of delivery. A significantly higher proportion of anemic women had preterm labor.

Validation of Point of Care Hemoglobin Estimation Among Pregnant Women Using Digital Hemoglobinometers (HemoCue 301 and HemoCue 201+) as Compared with Auto-Analyzer

Accurate and reliable point of care tests (POCTs) for hemoglobin estimation is essential for early diagnosis and management of anemia. This study was aimed to assess the reliability and validity of two versions of digital hemoglobinometer (HemoCue 201+ and HemoCue 301) compared to the gold standard Sysmex autoanalyzer for hemoglobin estimation. Pregnant women attending antenatal clinics of Primary Health Centre and a Sub Divisional Hospital in Haryana, India, were recruited. After obtaining consent, capillary blood samples were collected and tested for hemoglobin levels with digital hemoglobinometers (HemoCue 201+ and HemoCue 301). Among same pregnant women venous blood was collected and hemoglobin levels were estimated using autoanalyzer. Validity and reliability of POCTs compared to Sysmex autoanalyzer were reported. Of the 102 pregnant women included in the study, 44 (43%) were primigravida, with mean (SD) age of 23.3 (3.4) years. The mean (SD) of difference in hemoglobin levels using HemoCue 201+ was - 0.53 (1.01) and using HemoCue 301 was - 0.25 (0.85) g/dL as compared to auto-analyzer. Lin's concordance coefficient was 0.80 for HemoCue 201+ and 0.85 for HemoCue 301. Weighted Cohen's Kappa indicated moderate degree of agreement with the gold standard. Sensitivity (HemoCue 201+: 93%; HemoCue 301: 90%) and specificity (HemoCue 201: 76% HemoCue 301: 80%) for detecting anemia was similar for both the POCT devices. The digital hemoglobinometers used in the study had moderate degree of agreement and concordance with the autoanalyzer for hemoglobin estimation. HemoCue 301 had higher validity as compared to HemoCue 201+.

Pulmonary Involvement in Patients with Guillain-Barré Syndrome in Subacute Phase

OBJECTIVES

To evaluate the pulmonary function in Guillain-Barre syndrome (GBS) patients in subacute phase and find clinical correlates of pulmonary dysfunction.

METHODS

This was a single-center, prospective, cross-sectional, hospital-based study in GBS patients performed in Department of Neurological Rehabilitation at a tertiary care institute. Clinical examination for pulmonary function was done by measuring chest expansion. The pulmonary function tests were carried out by Spirometry kit Microquark Cosmed, Italy. Fatigue was assessed by Fatigue Severity Scale, disability status by Hughes Disability Scale (HDS), and muscle weakness by Medical Research Council sum scores.

STATISTICAL ANALYSIS

Statistical analysis was performed by Stata 11. The significance of P value was adjudged against an alpha of 0.05.

RESULTS

Twenty-eight patients were included with 17 (61%) men and mean age of 31 years. Median duration of symptoms was 16.5 days. There were 10 (36%) demyelinating and 18 (64%) axonal variants. Twenty-six (93%) patients scored more than 2 on HDS. All study participants reported fatigue. Twenty-two (78.6%) patients had chest expansion of <2.5 cm. Spirometry showed restrictive pulmonary dysfunction in 23 (79%) patients. Significant correlation was found between abnormal pulmonary function test and chest expansion (P = 0.003).

CONCLUSION

Pulmonary dysfunction in GBS is common even during subacute phase. It needs to be identified and managed appropriately for better clinical outcome.

Prevalence of fall, and determinants of repeat incidents of fall in older persons living in old age homes in the National Capital Territory of Delhi, India

Background

Fall is a common morbidity in older persons. In India, the number of old age homes and persons living in them are increasing. We studied the prevalence of fall among older persons living in old age homes.

Methods

We did a cross-sectional survey among persons aged 60 years or above, living in old age homes of Delhi, India. Information on location, type and bed-strength was collected for old age homes, and using their combination, 28 clusters of almost equal sizes (25-35) were created, of which, 13 were selected randomly to meet an estimated sample size of 340. All residents of the selected old age homes were recruited for the study. A self-developed, semi-structured interview schedule was used for recording the sociodemographic profile and history of fall in the past 6 months. Logistic regression was used to explore factors that might be associated with fall. Poisson regression was used to model the frequency of incidents of fall.

Results

A total of 335 older persons, with mean (SD) age of 75.2 (8.6) years were studied. At least 1 episode of fall was reported by 55 (16.4%), of whom, injury and disability were sustained by 54.5% and 23.3%, respectively. On multivariate logistic regression, for each additional morbidity, odds ratio of fall was 1.5 (95% confidence interval [CI] 1.09-1.95). Multivariate Poisson regression showed that age and tobacco use were significantly associated with the incidents of fall. For each unit increase in age, the incident rate ratio increased by 1.02 times (95% CI 1.01-1.03). Being a past user of tobacco had a statistically significant incident rate of 1.57 times (95% CI 1.01-2.45) compared to non-users of tobacco.

Conclusion

One-sixth of individuals living in old age homes had experienced a fall in the past 6 months. Measures should be taken to prevent falls in old age home settings in India.

Delivering community-led integrated HIV and sexual and reproductive health services for sex workers: A mixed methods evaluation of the DIFFER study in Mysore, South India

Introduction

Women in developing countries continue to face barriers to accessing sexual and reproductive health (SRH) services, with marginalized women facing increased challenges to accessing care. The Diagonal Interventions to Fast-Forward Enhanced Reproductive Health (DIFFER) project implemented a package of interventions for female sex workers and women from the general population which integrated horizontal health services for the general population with existing vertical targeted interventions aimed at sex workers with an aim to improve SRH and HIV services. We present an outcome evaluation of the DIFFER project in terms of uptake rates for SRH services among sex workers in Mysore, India.

Methods

Ashodaya Samithi, a sex worker-led organization, implemented the DIFFER strategy through their community-based clinic and a Well Women Clinic (WWC), established at a partner private hospital that provided SRH services for women living with HIV. Mixed methods were used to evaluate the intervention that included a baseline (2012–13) and end of project (2015–16) cross sectional surveys (CSS), focus group discussions (FGDs), key informant interviews, and analysis of service statistics from 2013–2016.

Results

The CSS found that condom use, STI testing, and treatment were high before, and throughout the intervention; cervical cancer screening and treatment increased significantly, from 11.5% to 56% (aOR 9.85, p<0.001) and HIV testing in the last 3 months increased from 26.3% to 73.3% (aOR 7.25, p<0.001). The proportion of sex workers using any SRH service in the past year doubled from 25.7% to 51.4% (aOR 2.91, p<0.001). Service statistics showed similar trends. The FGDs and key informant interviews showed that women and stakeholders held high levels of satisfaction with the strategy, and affirmed potential for scale up.

Conclusion

The DIFFER strategy demonstrated that SRH service uptake can occur in conjuction with HIV services offered to sex workers. This model of integrated service delivery has been accepted by policy makers and needs further analysis for scaling up.

Sustained progress, but no room for complacency: Results of 2015 HIV estimations in India

Background & objectives:

Evidence-based planning has been the cornerstone of India's response to HIV/AIDS. Here we describe the process, method and tools used for generating the 2015 HIV estimates and provide a summary of the main results.

Methods:

Spectrum software supported by the UNAIDS was used to produce HIV estimates for India as a whole and its States/Union Territories. This tool takes into consideration the size and HIV prevalence of defined population groups and programme data to estimate HIV prevalence, incidence and mortality over time as well as treatment needs.

Results:

India's national adult prevalence of HIV was 0.26 per cent in 2015. Of the 2.1 million people living with HIV/AIDS, the largest numbers were in Andhra Pradesh, Maharashtra and Karnataka. New HIV infections were an estimated 86,000 in 2015, reflecting a decline by around 32 per cent from 2007. The declining trend in incidence was mirrored in most States, though an increasing trend was detected in Assam, Chandigarh, Chhattisgarh, Gujarat, Sikkim, Tripura and Uttar Pradesh. AIDS-related deaths were estimated to be 67,600 in 2015, reflecting a 54 per cent decline from 2007. There were variations in the rate and trend of decline across India for this indicator also.

Interpretation & conclusions:

While key indicators measured through Spectrum modelling confirm success of the National AIDS Control Programme, there is no room for complacency as rising incidence trends in some geographical areas and population pockets remain the cause of concern. Progress achieved so far in responding to HIV/AIDS needs to be sustained to end the HIV epidemic.

Prevalence of dental caries and periodontal disease in a rural area of Faridabad District, Haryana, India

An oral health survey was conducted in 829 individuals in different age groups in Ballabhgarh, Haryana, India, to estimate the prevalence of Dental caries and Periodontal diseases. A survey tool was modified from WHO's STEPwise approach to surveillance and Oral Health Assessment form 2013 from recently released WHO Oral Health Survey: Basic Methods (5th Edition) keeping in mind the South East Asian region. Out of 28 villages, six villages were randomly selected. A random list of study participants (Age-sex specific) was generated from the pooled list of these 6 villages. Local health workes helped in inviting the specific subjects to one centralized location within each village/ locality. The subjects were examined by trained dental surgeons and recordings were done by trained assistants. The prevalence of dental caries in 5-7 year, 12-15 year, 35-44 year and 65-74 year was 33.2%, 31.3%, 64.9% and 50.1% respectively. The prevalence of Periodontal Disease in 35-44 year and 65-74 year found to be 65.2% and 90.4% respectively. Only 37 participants had mucosal lesions, of which leukoplakia and tobacco pouch keratosis was seen in majority. Using the adopted tool, the prevalence of dental caries was found to be highest in 35-44 year (64.9%) age group and the prevalence of periodontal disease was found to be high in 35-44 year (65.2%) age group and highest in 65-74 year (90.4%) age group. Oral health promotion efforts are required to prevent oro-dental diseases in the studied population.

Effect of intravenous iron sucrose on hemoglobin level, when administered in a standard-dose, to anemic pregnant women in rural Northern India

Introduction:

To combat anemia among pregnant women, in Haryana, Northern India, administration of intravenous iron sucrose (IVIS) was initiated in 2014 as a public-health measure. We assessed the effect of IVIS on hemoglobin (Hb) levels among the pregnant anemic women.

Methods:

Pregnant women identified as moderately or severely anemic (Hb <10.0 g/dL) in the second or third trimester during routine antenatal care were prescribed IVIS in a standard-dose of 400 mg given as 100 mg on alternate days. Neither dose calculation, nor allowance for iron-store, was included in this study. We analyzed the data collected between June 2014 and December 2015, at the two primary-health-centers, on Hb level (by HemoCue method) before start of the therapy (baseline), and 4-week or more after the last infusion (endline).

Results:

A total of 990 women received IVIS. Both baseline and endline Hg-levels were available for 763 (77%), who were included in the analysis. At baseline, the proportion of moderate and severe anemia was 87.94% and 12.06%, respectively. Mean (standard deviation)-Hb increased from 7.85 g/dL (0.80) at baseline, to 9.62 g/dL (1.30) at endline, with a mean increase of 1.76 g/dL (95% confidence interval 1.67, 1.85). The mean increase in Hb-level for pregnant women who had severe and moderate anemia at baseline was 2.54 g/dL and 1.65 g/dL, respectively. Overall, 15.33% of women achieved normal Hb-level by the time of endline measurement. No serious adverse reactions were reported during the observation period.

Conclusion:

Mean increase in Hb-level was 1.76 mg/dL. Severely anemic pregnant women had larger increase in Hb-level when compared with pregnant women with moderate anemia.