Public Health Laboratory Surveillance and Diagnosis of Japanese Encephalitis: Time to Revisit.

Objective: We assessed detection of recent Japanese encephalitis virus infection using recommended strategy. Methods: Cross-sectional community-based study conducted in 12 villages in Kushinagar, Uttar-Pradesh, India in 2012-13. Recent infection with Japanese encephalitis virus in 239 healthy children aged 1-15 year was detected using a combination of serology and molecular methods. Results: 24 (10%) children showed recent infection; 2 by serology and 22 by molecular method. Symptomatic cases were estimated as 626 in Kushinagar against reported 139 in all age groups across the state. Conclusion: Lower positivity using recommended serology suggests major gap in existing surveillance and diagnostic protocols and estimation of burden of Japanese encephalitis.

Do joint national committee VII criteria also need to take non pharmacological measures into consideration? – Empirical evidence from slum resettlement colony from Delhi.

Background: Currently Joint National Committee (JNC) VII criteria are used worldwide to diagnose hypertension but it does not take non pharmacological measures into consideration. Also, it does not consider Indian system of medicine. Objectives: To assess whether JNC VII in its present form is valid to diagnose hypertension correctly or revision is required especially for Indian communities where such practices are prevalent. Material and methods: The present community based cross-sectional study was carried out in nand nagri, a slum resettlement of East Delhi which comes under field practice area of the Department of Community Medicine, UCMS, Delhi from August 2010 to February 2012. Total 310 subjects aged 20- 59 years were selected through multistage systematic random sample. Though the blood pressure cut-offs considered in our criteria was similar to the JNC VII cut-offs (SBP ³140 mmHg and or DBP ³90 mmHg), the difference was in the last part of JNC VII definition of hypertension i.e. treatment by anti hypertensive medicines; our criteria comprised of this statement as “any anti hypertensive measure”. Chi-square (χ²) test was applied for analysis. Results: Overall 54 were found to have hypertension by JNC VII criteria whereas 61 by our criteria. Seven patients who were not hypertensive by JNC VII but hypertensive by our criteria and the difference was found to be statistically highly significant (p<0.001). Exercise was the most common non pharmacological measure adopted by male gender where as in females, salt restriction was the most common measure adopted Conclusion: Our study emphasized inclusion of non-drug therapy measures into consideration while making diagnosis of hypertension in our setup.

Prevalence and predictors of hypertension among residents aged 20–59 years of a slum‑resettlement colony in Delhi, India.

Background: Slum‑resettlement communities are increasingly adopting urban lifestyles. The aim of this study was to assess the prevalence and identify correlates of hypertension among residents aged 20–59 years of a slum‑resettlement colony. Materials and Methods: A community‑based cross‑sectional study was done from 2010 to 2012 in NandNagri, a slum‑resettlement area in east Delhi. 310 participants aged 20–59 years were enrolled through multistage systematic random sampling. Each study subject was interviewed and examined for raised blood pressure; data on risk factors including smoking, alcohol intake, physical activity and salt consumption were also collected. Data were analysed by use of univariate and multivariate regression. Results: The overall prevalence of hypertension was 17.4% and 35% participants were prehypertensive. On multiple logistic regression, age 40–49 years (P = 0.020) and 50–59 years (P = 0.012), clerical/professional occupation (P = 0.004), abnormal waist circumference (≥90 cm in males and ≥ 80 cm in females; P = 0.001), positive family history of hypertension in both parents (P = 0.013) and above‑average daily salt intake (P = 0.000) were significantly associated with hypertension. Conclusions: These findings indicate that hypertension is a significant health problem in the study population. Many study participants diagnosed with prehypertension are at risk of developing hypertension, thus immediate public‑health interventions are indicated.

Comparación de programas de formación en investigación poblacional / Comparing programmes of medical undergraduate training in population-based research

Introducción: La formación sistemática en investigación poblacional fue incorporada para los estudiantes universitarios en una Facultad de Medicina en India en 1993. Inicialmente, se pensó que el período de pasantía de 3 meses en medicina comunitaria durante el internado sería el más apropiado para esta experiencia educativa. De este modo se inició el Programa 1. Métodos: Sobre la base de la información obtenida de los estudiantes, el programa de formación se adelantó a la fase paraclínica en 1999. El Programa 2 se integró dentro de los 10 meses de pasantía en medicina comunitaria. Resultados: Alrededor de la mitad de los estudiantes manifestaron su disposición a conservar el interés en la investigación poblacional luego de terminar su pasantía en medicina comunitaria. Los motivos principales para la falta de voluntad al respecto fueron: la falta de contribución para la admisión en los cursos de posgrado; el bajo nivel de interés personal en la investigación poblacional; y la relativa falta de utilidad en las potenciales responsabilidades laborales. Los factores que más dificultaron el aprendizaje para los internos fueron la corta duración y la programación temporal inapropiada del curso, mientras que para los estudiantes paraclínicos fue que el programa no los incentivaba en términos de puntaje. Cuando se les solicitó que sugirieran el período más adecuado para realizar la formación en investigación poblacional, casi la mitad eligió la fase paraclínica (48.9%).

Non-health determinants of health and healthcare in Delhi.

With only 0.05% of the total area of the country, Delhi is home to 1.34% of India’s population. This creates enormous pressure on natural and man-made resources, and generates situations in which non-health determinants may take precedence over the conventional determinants directly associated with health and healthcare. With the rising advocacy on social determinants of health, several of these factors may rightly seem to be part of the broader territory of healthrelated variables, and in that context, they may be designated as conventional non-medical determinants. We discuss some more visible domains, such as demography, migration and floating population; the physical and biological environment; economic determinants; social determinants; legislation and enforcement, and underscore some less explored yet critical domains of the determinants related to culture, governance and politics. What emerges as a compelling reality is a wide differential in physical environment, urban planning and access to infrastructural inputs between the privileged and marginalized areas of Delhi. Inequities in physical quality of life are so gross that even a value-neutral, official narrative betrays them helplessly. We propose actionable areas to address some of the pressing non-health determinants of health and healthcare.

Impact of Health Education and Condom Distribution on Incidence of RTI/STI among The Newly Married Urban Poor Women in Delhi.

This study was carried out to find out the impact of a specially designed preventive intervention on menstrual and sexual hygiene practices and incidence of RTI/STI among the newly married women. A community based intervention study with controls was conducted in two resettlement colonies of Delhi. Total 74 subjects in intervention group and 71 subjects in the control group were studied. Each subject was followed up for 9 months every three monthly. The intervention package included education about menstrual and sexual hygiene, RTI/STIs and contraceptive usage, and packets of condoms. RTI/STI was diagnosed using syndromic approach. Only 2 and 8 subjects in the intervention and control group respectively used condoms (p>0.05 after adjustment). Practice of washing genitals improved in the intervention group (p<0.05 both with and without adjustment). 19 (25.68%) women in intervention and 22 (30.99%) in the control group (p=0.478) reported RTI/STI symptoms during study period; after adjusting for other variables OR=0.37 (p=0.007). 57.89% of RTI/STI patients consulted doctor in intervention group as compared to 18.18% in control group (p<0.05). Increasing awareness and providing intervention at the very beginning of sexual life of newly married women can modify some of the high risk behaviors and thus reduce the risk of acquiring RTI/STIs.

Reproductive health of newly married women residing in a resettlement colony of Delhi: A longitudinal study.

During the period immediately after marriage, women are neither assessed for their reproductive health nor given any intervention for the same. A community based longitudinal study was done to assess the status of reproductive health of newly married women in which 71 newly married women were followed for 9 months. Mean age at marriage was 20.24 (19.74-20.74) years. 76.06% were anemic. With time, proportion reporting menstrual complaints and RTI symptoms increased significantly (P<0.05). 29 (40.85%) reported menstrual complaints and 22 (30.99%) RTI symptoms. Only 14 (19.72%) subjects used contraceptive methods. 79% conceived within 9 months of marriage. Only 25% pregnancies got registered in first trimester. Reproductive and nutritional status of the newly married women was unsatisfactory.

Deconstructing social resistance to pulse polio campaign in two north indian districts.

Objective: To gain an insight into the phenomenon of social resistance and rumors against pulse polio campaign. Design: Qualitative, community-based investigation, mapping perceptions of various stakeholders through in-depth interviews (IDIs), focus group discussions (FGDs), non-formal interactions and observations. Setting: Moradabad and JP Nagar districts of Uttar Pradesh. Subjects: IDIs (providers 33, mothers 33, community leaders 10); FGDs (providers 4, mothers 8) and non-formal interactions (156) with community leaders, parents, businessmen, journalists (Hindi and Urdu media), mobilizers, vaccinators and supervisors. Results: A distinct machination of social resistance and rumors against oral polio vaccine during supplementary immunization activities (SIA) was observed in some minority dominated areas. The pattern can be understood through a model that emerged through qualitative evidence. Inspite of all this, most parents in minority areas supported the SIAs. Only a few clusters from extremely marginalized sections continued to evade SIAs, with an endemic pattern. Through social osmosis, these rumors reached majority community as well and some parents were affected. However, in such cases, the resistance was sporadic and transient. Conclusion: While the program’s focus was on microbiological issues, the obstacles to polio eradication lie in the endemicity of social (and/or cultural) resistance in some pockets, leading to clustering of perpetually unimmunized children - inspite of good coverage of SIAs at macro level. This may sustain low levels of wild poliovirus transmission, and there can be exceptions to the robustness of the pulse approach. A micro level involvement of volunteers from marginalized pockets of minorities might be able to minimize or eliminate this resistance.

Pandemic influenza imminent threat, preparedness and the divided globe.

With generic consensus on certainty of an impending influenza pandemic, concerns are mounting about its devastating global impact. Preparedness and preventive approaches adopted by the nation states are polarised between resource rich and resource challenged countries. India has, rightly, taken a middle path. It seems that the non-pharmaceutical interventions would be the only preventive modality available in large parts of world. Production of any pandemic vaccine would take a minimum of 6 months after isolation of novel virus, and antivirals may not be available where they are required most. Efforts to create a universal pool of resources and stockpiles of antivirals, antibiotics and vaccines for use in first affected countries need to be strengthened with urgency.

Prevalence, awareness, treatment and control of hypertension among the elderly in a resettlement colony of Delhi.

BACKGROUND: With the increase of the elderly population in India, chronic diseases like hypertension are becoming an important public health problem. Thus, the present study was carried out to assess prevalence, awareness, treatment, and control of hypertension among elderly in a resettlement colony of Delhi. METHODS: A community-based cross-sectional survey was carried out, using systematic random sampling technique. A total of 294 (119 male and 175 female) subjects aged 60 years or more were studied. Of the total subjects, 210 (71%) were in 60-69 years, 57 (19.47%) were in 70-79 years, and 27 (9.2%) were more than 80 years of age. Blood pressure of each subject was measured on two visits, 1 week apart and was graded according to World Health Organization-International Society of Hypertension/VI Joint National Committee on Prevention, Detection, Evaluation, and Treatment of high blood pressure guidelines. Anthropometric variables and other associated risk factors were also studied. RESULTS: Hypertension was present in 116 subjects (39.5%), it was more among males 49 (41%) as compared to females 67 (38%). Among the hypertensive subjects, 60 (51.7%) were aware of their condition, 45 (39%) were on treatment, and 17 (14.67%) were controlled on treatment. Level of awareness and treatment were significantly higher among the females. Body mass index of 25 or more and alcohol consumption were found to be significantly associated with risk of having high blood pressure. CONCLUSION: Prevalence of hypertension in the present study was 39.5%, while level of awareness, treatment, and control were 50%, 39%, and 14.6%, respectively.

Social determinants and polio 'endgame': a qualitative study in high risk districts of India.

OBJECTIVES: To understand the perceptions and likely determinants that facilitate or act as barriers in implementing additional strategies for polio eradication: (a) accelerated delivery of mOPV1 (monovalent polio vaccine type 1); (b) use of IPV (inactivated polio vaccine); and (c) provision of incentives. DESIGN: QUALITATIVE. Rapid appraisal procedures (RAP) were adopted to derive the reality by synthesizing multiple sources of information; search for opinions, motivations, behaviors and attitudes of key stakeholders within their organizational and socio-cultural matrix. SETTING: Two districts of Uttar Pradesh - Moradabad and J P Nagar. SUBJECTS: Total 244 interactions were conducted; 33 interviews and 4 focussed group discussions (FGD) conducted with providers; 33 mothers (<5 years) and 10 leaders were interviewed; 8 FGD were conducted with mothers of under-fives. Informal interactions (156) were also conducted with village pradhans, religious leaders, parents, businessmen, journalists (Hindi and Urdu media), mobilizers, vaccinators and supervisors. RESULTS: Providers expressed reservation regarding accelerated rounds of OPV; scientific rationale of accelerated rounds is not clear to parents and leaders. Although technical advantages of introducing IPV exist, issues of logistical difficulties and injection safety emerged strongly. Providers and communities indicated a clear 'no' to the cash incentives but argued for developmental issues. Resistance to the program has declined over time but still the program is perceived as the "government's need, not ours". CONCLUSION: The polio eradication program is critically poised, an opportunity to intensify efforts for reducing inequities in health services and improve access of all children to the PHC services. Ongoing dialogue with local communities and strong political commitment would be essential to translate the technological innovations into a sustainable program.

Predictors of hypertension in an urban Indian population.

BACKGROUND, Several studies have reported that the increased risk of hypertension is mainly due to alcohol intake, lack of physical activity, nutritional factors like high fat intake, anthropometric parameters like body weight and waist-to-hip ratio, and metabolic disorders like diabetes mellitus. However, the extensive review of literature suggests that in different parts of the world, the predictive risk factors are associated with risk of hypertension in different combinations.The main objectives of this study were to determine the predictors of hypertension in an urban population of India, using the variables depicting lifestyle, nutrition, and environment. METHODS AND RESULTS, Secondary data collected through a cross-sectional survey in a population proportionate sample were analyzed. Sample size was calculated using prevalence of one of the predictors (obesity) from previous studies.Subjects aged between 15 and 54 years, residing in New Delhi for at least one year were included in the study (n = 494). The WHO STEPS instrument for noncommunicable disease risk factors (Core and Expanded version 1.2) was used for data col-lection.Bivariate logistic regression analysis showed that hypertensive individuals were twice more likely to be male, of significantly higher age, and more likely, had received college education.The full model of logistic regression analysis showed that sex, age, education, weight, and pulse rate were significant predictors of hypertension. CONCLUSION, The most parsimonious regression model included age, sex, educational status, body mass index, physical inactivity, and hip girth as predictors of hypertension. Risk of hypertension may be predicted early in a population by suitable screening procedures.