Challenges faced by frontline health managers during the implementation of COVID-19 related policies in India: A qualitative analysis

Background & objectives: The COVID-19 pandemic exposed the strengths and weaknesses of the healthcare systems across the world. Many directives, guidelines and policies for pandemic control were laid down centrally for its implementation; however, its translation at the periphery needs to be analyzed for future planning and implementation of public health activities. Hence, the objectives of this study were to identify the challenges faced by frontline health managers in selected States in India during the pandemic with regard to implementation of the COVID-19-related policies at the district level and also to assess the challenges faced by the them in adapting the centrally laid down COVID-19 guidelines as per the local needs of the district. Methods: A qualitative study using the grounded theory approach was conducted among frontline district-level managers from eight different States belonging to the north, south, east and west zones of India. The districts across the country were selected based on their vulnerability index, and in-depth interviews were conducted among the frontline managers to assess the challenges faced by them in carrying out COVID-19 related activities. Recorded data were transcribed verbatim, manually coded and thematically analyzed. Results: Challenges faced in implementing quarantine rules were numerous, and it was also compounded by stigma attached with the disease. The need for adapting the guidelines as per local considerations, inclusion of components of financial management at local level, management of tribal and vulnerable populations and migrants in COVID context were strongly suggested. The need to increase human resource in general and specifically data managers and operators was quoted as definite requirement. Interpretation & conclusions: The COVID-19 guidelines provided by the Centre were found to be useful at district levels. However, there was a need to make some operational and administrative modifications in order to implement these guidelines locally and to ensure their acceptability.

The Approach of Anatomists towards Voluntary Body Donation: Inspiring or Dispiriting???

Background: Body donation is a noble act towardscontributing to medical education and research.Although anatomists encourage the general populationto donate bodies, the attitude of anatomists towarddonating their bodies is less discussed in the literature.Aim and Objectives: The present study was conductedto obtain the knowledge, attitude and practice ofanatomists towards voluntary body donation. Materialand Methods: The study was conducted among theanatomists of different Medical Colleges of SouthIndia. To assess the knowledge, attitude, and practicesof voluntary body donation, a semi-structuredquestionnaire was designed and distributed to theanatomists. Results: The study involved 102anatomists. The majority 58.3% stated that the primarysource of supply of cadavers was from the bodydonation program. When it came to voluntary bodydonation, only 32.4% of the anatomists were willing todonate their bodies. The facilitating factors forwillingness to donate were contributions to medicaleducation 60.3%, personal satisfaction 7.4%,motivation to the general public 4.4%, andencouragement from a close friend/ colleague 2.9%.The factors that abstained individuals from donatingwere: restriction from family members 30.9%, malhandling of the cadavers 29.4%, and ritual beliefs20.6%. Conclusion: The approach of anatomiststowards donating their bodies is not promising. It maydiscourage the general public from donating theirbodies. Therefore, it is equally important to inspire andencourage the anatomists towards body donation.

Effect of Diabetes on the Male Reproductive System­A Histomorphological Study

Introduction Type 1 diabetes is an autoimmune disorder characterized by lack of insulin production by the ß cells of the pancreas. This lack of insulin causes a variety of systemic effects on the metabolism of the body, one of which is reproductive dysfunction. The present study investigates the effects of diabetes on the male reproductive system of streptozotocin (STZ)-induced diabetic rats. Material and Methods A total of 18 adult male Wistar rats weighing between 250 and 300 g were included in the present study. The animals were divided into normal and diabetic groups. The diabetic group was further subdivided into 2 subgroups with durations of 24 and 48 days. A single dose of STZ (40 mg/kg body weight) was administrated intraperitoneally to the animals of the diabetic group. After the planned duration, the testes and epididymides were dissected, and their gross weight was measured. The tissues were then processed for histological study. Results The gross weight of the testes and epididymides in diabetic rats at 24 and 48 days showed a decrease in comparison to the control. (p < 0.01 for testes and epididymides). Diabetic animals presented a significant decrease in the diameter of the seminiferous tubules compared with the control group (p < 0.01). The epididymides in the diabetic groups showed a considerable reduction in the tubular surface area compared with the control group (p < 0.01). There was also a reduction in the mean diameter, which was measured using the maximum and minimum diameter of the tubules (p < 0.01). Conclusion The present study is an insight into the adverse effects that diabetes can have on the tissue structure of the testes, of the epididymides, and ultimately on the process of spermatogenesis.

A Clinical Study Of Peripheral Extra Pulmonary Tubercular Lymphadenopathy

Background & Objectives: Since an ancient time tuberculosis is a widely distributed in all over world more particularly in a country like India. Extra–pulmonary involvement is also common in which Peripheral lymphnode involvement is the commonest form of extra–pulmonary mycobacterial disease and cervical region is the most frequent site nowadays, there is increased incidence of Tuberculous lymphadenitis due to increased prevalence of HIV. Even with the best treatment available, tuberculosis of lymphnode still remains a problem for the clinician, because of late diagnosis, poverty and ignorance of symptoms. Hence this study has been undertaken to evaluate tuberculosis cervical lymphadenitis with special emphasis based on FNAC. Surgical excision biopsy followed by histopathological examination is time consuming, costly, required hospitalization, pre and post procedure complications hence patients compliance is poor. While fine needle aspiration cytology is simple, rapid, cheaper and outpatient department procedure. The success rate of diagnosis from FNAC is around 75–90% in various studies. Methods: A prospective, observational study was conducted among the patients who attended Tuberculosis & Respiratory Diseases Department from June 2011 to March 2013 in a tertiary care hospital with features of Peripheral Extra pulmonary Tubercular Lymphadenopathy. A total of 124 cases of peripheral extra pulmonary tubercular Lymphadenopathy were studied from June 2011 to March 2013. A detailed history, complete physical examination, various laboratory work and radiological studies carried out. Diagnosis of TB made by histopathological & Tuberculin test was done with 10 TU PPD (0.1 ml) on left forearm and reading was taken after 48 hours. Majority patients were sent to pathology department for fine needle aspiration cytology of affected gland. Patients were having private FNAC report suggestive of tuberculous lymphadenitis were also considerd in study. Result: In the present study of 124 patients having Tuberculous Lymphadenopathy, the commonest age group affected is below 40 years (85% patients).Females are affected more than males (M:F ratio 1:1.03). With most of the patients coming from lower socioeconomic status. Majority of patients (72%) were presented with painless swelling in neck and 91% patients had attended health facility within 3 months.Family history positive in 04 (03%) of patients. Most of the time in tuberculous lymphadenopathy patients present with swelling only i.e 106 (86%) and 18 (14%) patients with either cold abscess or pus discharge so simple lymph node enlargement is common. 67 % patients show raised ESR. It may help in supportive diagnosis of tuberculous aetiology.67% patients show tuberculin test positive which also may help in diagnosis of tubercular aetiology. 10(08%) patients of lymphadenopathy had abnormal chest radiogram. Majority of the patients have normal leukocyte count with normal lymphocyte.Only 03 patients are found sputum positive in 124 tubercular lymphadenitis patients.It might be due to direct spread of infection from tonsil to regional lymphnode.Primary infection may occur in lymphoid tissue of tonsil.Only 1 patient is found HIV reactive in this study.This might be due to less HIV prevalence in rural population. Conclusion: It was observed that cervical region lymph node was more commonly involved and fine needle aspiration cytology (FNAC) was found to be a safe, useful, reliable, effective method for early diagnosis of tubercular lymphadenitis and early institution of definitive therapy. It is a comparatively cheap and less time consuming method. Adults are more affected than old people and females are affected more than males. ESR help in supportive diagnosis of Tuberculous etiology and tuberculin test positive also may help in diagnosis of tubercular etiology.

A Cadaveric Study Of The Internal Occipital Crest And Vermian Fossa With Its Clinical Significance

Background: The anatomical variabilities of the internal occipital crest (IOC) and vermian fossa (VF) may influencethe related dural venous sinuses and further effect the flow of the cerebrospinal fluid. It is also associated withthe pathologies around the foramen magnum like Arnold Chiari malformation, certain cases of cerebellar corticaldysplasia.Aim: The present study was designed to explore and evaluate the morphological and morphometric details of theIOC and VF.Materials and Methods: The study was conducted on 40 adult cadavers (23 males & 17 females). The morphologyand morphometry of IOC and VF were studied. Based on the observations, the VF was classified into five types:Type 1- classical (well defined fossa), Type II-short triangular, Type III- elongated triangular, Type IV-quadrangularand Type V-deviated.Results: The IOC was found to be variable both in terms of morphology and morphometry. The morphologicalobservations included varied shapes, i.e., sharp (65%), blunt (30 %) and ill-defined (5 %). The length of the IOCwas also variable with a mean length of 2.97 ± 0.16 cm. The mean width at upper, middle and lower levels were0.9 ± 0.10 cm, 0.75 ± 0.17 cm, 1.10 ± 0.12 cm respectively.The incidence of the VF was found to be about 80%. The VF was classified into types based on its varied shape:classical (Type I ;56.25 %), short triangular (Type II ;21.87%), elongated triangular (Type III;12.5%) and quadrangular(Type 1V;6.25 %) respectively. In one specimen, the VF was deviated to the left side (type V ;3.12%). The mean lengthand width of the fossa were 1.67±0.34 cm and 1.80±0.34 cm respectively.Conclusion: The present study on the morphology and morphometry of the IOC and the VF may serve as databaseand further help clinicians to improve the diagnosis and therapeutic performances in the posterior cranialfossa.

A cadaveric study of the testicular artery and its clinical significance / Um estudo da artéria testicular em cadáveres e sua relevância clínica

Abstract Background Knowledge of testicular artery variations is vital to ensure that they are not neglected during a variety of different operative techniques, since damage can cause testicular atrophy. Objectives The present study was therefore intended to identify variants in the origin and course of the testicular arteries. An attempt was made to classify the arteries based on their various origins. Methods This study examined 42 formalin-fixed cadavers of 40 to 70-year-old adult males. Variant origins of the testicular artery were identified and classified. Variations in the origin and course of the artery were colored, photographed, and documented. The distances between the origins of the testicular arteries and the mid-points of the origins of the renal arteries were measured. Results Testicular arteries were classified into four categories on the basis of origin. This variability was defined in relation to the renal and inferior mesenteric arteries. The mean distance between the origin of the testicular artery and the mid-point of the origin of the renal artery were 3.08 and 3.47 cm, on the right and left sides respectively. Variations were almost exclusively found on the left side. The variations observed included multiple arterial twigs forming the testicular artery, suprarenal arteries arising from the testicular artery, and testicular artery duplication. Conclusion This study provides an insight into variations in the testicular artery and proposes a classification which could help surgeons during a variety of procedures on the male abdomen and pelvis.

Resumo Contexto O conhecimento de variações da artéria testicular é vital para assegurar que essas artérias não serão negligenciadas durante a realização de diferentes técnicas operatórias, já que qualquer dano poderia causar atrofia testicular. Objetivos Este estudo teve como objetivo identificar variações na origem e no trajeto das artérias testiculares. Foi feita uma tentativa de classificar as artérias com base em suas diferentes origens. Métodos Este estudo examinou 42 cadáveres de adultos do sexo masculino com idade entre 40 e 70 anos preservados em formol. As diferentes origens da artéria testicular foram identificadas e classificadas. Variações na origem e no trajeto da artérias foram coloridas, fotografadas e documentadas. Foram medidas as distâncias entre a origem das artérias testiculares e o ponto médio da origem das artérias renais. Resultados As artérias testiculares foram classificadas em quatro categorias com base em sua origem. Essa variabilidade foi definida com relação às artérias renal e mesentérica inferior. A distância média entre a origem da artéria testicular e o ponto médio da origem da artéria renal foi de 3,08 e 3,47 cm nos lados direito e esquerdo, respectivamente. As variações foram encontradas quase exclusivamente no lado esquerdo. As variações observadas incluíram múltiplos ramúsculos formando a artéria testicular, artérias suprarrenais surgindo a partir da artéria testicular, e duplicação da artéria testicular. Conclusão Este estudo traz informações sobre variações da artéria testicular e propõe uma classificação que poderia ajudar os cirurgiões durante diferentes procedimentos realizados no abdome e na pelve de pacientes do sexo masculino.

Factors associated with utilization of antenatal care services among tribal women: A study of selected States.

Background & objectives: Despite various efforts by the Government of India, utilization of antenatal care (ANC) services continues to be low among women from rural areas particularly those belonging to the Scheduled Tribes. The present study was undertaken to examine the factors associated with the utilization of ANC services among women in four States including Rajasthan, Odisha, Chhattisgarh and Madhya Pradesh which constitute a good share of tribal population of the country. Methods: Data from third round of District Level Household and Facility Survey, 2007-08 (DLHS-3) have been used. Bivariate and multivariate analyses (logistic regression model) were used to study the association between the utilization of ANC services and the independent variables at individual, household and village levels along with the motivational factors (motivation by health workers and family members). Results: The utilization of ANC services among Scheduled Tribes women varied from about 4 per cent in Madhya Pradesh and Rajasthan to 10-14 per cent in Chhattisgarh and Odisha. Utilization was highest among those women with level of education 9th class and above (15-28%) and those women who visited health facility for pregnancy confirmation test (9-27%). Across the States, women who visited health facility for pregnancy testing (adjusted odds ratio, AOR = 1.5-2.5; P<0.001) except in Madhya Pradesh; registration of pregnancy (AOR = 2.1-4.5; P<0.01) and sought treatment of pregnancy related problems (AOR = 1.5-1.8; P<0.06) except in Rajasthan, were more likely to avail complete ANC services than their counterparts. Interpretation & conclusions: The utilization of antenatal care among Scheduled Tribe women across four States was very poor. The reasons behind non-utilisation include both socio-economic and health system factors. For improving ANC utilization among tribes, these factors need to be addressed with special emphasis on woman’s educational attainment of high school and above. In addition, the study highlighted the need to create awareness among both pregnant tribal women as well as her family members on the importance of early ANC care.

Histopathological Profile Of The Bronchogenic Carcinoma Among Saurashtra Region Of Gujarat.

Background: Bronchogenic carcinoma is a malignant neoplasm of the lung arising from the epithelium of the bronchus or bronchiole. The bronchogenic carcinoma is classified as Squamous cell carcinoma, Small cell carcinoma, Adenocarcinoma, Large cell Carcinoma and Adeno-squamous carcinoma. Methodology: 50 patients of known bronchogenic carcinoma from the P.D.U. Genral hospital and Medical College were included in the study; 48 patients were investigated as Fine Needle Aspiration Cytology for histopathological classification. Results: The commonest bronchogenic carcinoma was squamous cell carcinoma (42%) followed by adenocarcinoma (20%), small cell carcinoma (4%), adenosqumaous cell carcinoma (4%) and large cell carcinoma (2%). Conclusion: The histopathological examination of bronchogenic carcinoma cases is helpful for the management of the patients.

DIVA Vaccines: A Brief Review on its Novel Facets for the Eradication of Infections of Livestock and Poultry.

DIVA vaccines also known as Differentiating Infected from Vaccinated Animals help in the differentiation between infected and vaccinated animals. The first DIVA vaccines were known as marker vaccines. The term DIVA vaccine was coined in 1999 and the accompanying diagnostic tests were developed by J.T. van Oirschot and colleagues at the Central Veterinary Institute in Lelystad, The Netherlands [1], [2].

Levels, trends & predictors of infant & child mortality among Scheduled Tribes in rural India.

Background & objectives: the level of infant and child mortality is high among Scheduled Tribes particularly those living in rural areas. This study examines levels, trends and socio-demographic factors associated with infant and child mortality among scheduled tribes in rural areas. Methods: Data from the three rounds of the National Family Health Survey (NFHS) of India from 1992 to 2006 were analysed to assess the levels and trends of infant and child mortality. Univariate and multivariate Cox proportional hazard model were used to understand the socio-economic and demographic factors associated with mortality during 1992–2006. Results: Significant change was observed in infant and child mortality over the time period from 1992-2006 among Scheduled Tribes in rural areas. After controlling for other factors, birth interval, household wealth, and region were found to be significantly associated with infant and child mortality. Hazard of infant mortality was highest among births to mothers aged 30 yr or more (HR=1.3, 95% CI=1.1-1.7) as compared with births to the mother’s aged 20-29 yr. Hazard of under-five mortality was 42 per cent (95% CI=1.3-1.6) higher among four or more birth order compared with the first birth order. The risk of infant dying was higher among male children (HR = 1.2, 95% CI=1.1-1.4) than among female children while male children were at 30 per cent (HR=0.7, 95% CI=0.6-0.7) less hazard of child mortality than female children. Literate women were at 40 per cent (HR=0.6, 95% CI=0.50-0.76) less hazard of child death than illiterate women. Interpretation & conclusions: Mortality differentials by socio-demographic and economic factors were observed over the time period (1992-2006) among Scheduled Tribes (STs) in rural India. Findings support the need to focus on age at first birth and spacing between two births.

Socio-economic & household risk factors of malaria in tribal areas of Madhya Pradesh, central India.

Background & objectives: Malaria is a major public health problem in many states of the country, particularly, in Madhya Pradesh where both Plasmodium vivax and P. falciparum are endemic. Although many studies have been conducted to investigate risk factors for malaria, but only a few have examined household and socio-economic risk factors. The present study was, therefore, undertaken to explore the relationship of different socio-demographic, socio-economic and behavioural risk factors with malaria prevalence in tribal areas of Madhya Pradesh, India. Methods: This study was undertaken in all 62 villages of Bargi Primary Health Centre from May 2005 to June 2008. These villages comprised 7117 households with an average family size of five members. fortnightly fever surveys were conducted in all villages to assess prevalence of malaria infection in the community. The distinct univariate and multivariate logistic regression models were fitted on the data set. Results: The important socio-demographic risk factors like age of household head, social group, occupation and family size; socio-economic factors like type of walls of house, place of drinking water source, irrigated land, cash crop; and behavioural variables like place of sleeping, use of bed nets, etc. were found significantly associated with malaria in univariate analyses. in multivariate analyses only social groups, family size, type of walls of house, and place of sleeping had strong significant association with prevalence of malaria. Interpretation & conclusions: The study shows that in tribal areas where people are living in poor quality of houses with no proper use of preventive measures, malaria is firmly established. We conclude that community based interventions which bring improvement in standard of living, access to healthcare facilities and health awareness, will have a significant impact on malaria prevention in these areas.

Reaching tribal men to improve awareness to sexual morbidities Experience from Baiga tribe of Central India.

Background and objectives: Tribal men’s reluctance in sharing responsibilities as supportive partners in reproductive and sexual health matters debar women from their sexual rights coupled with their negligence in health care and lesser utilization of reproductive health facilities. As a matter of fact a large proportion of ill health particularly related to sexually transmitted infections (STIs) suffered not only by men but also by their spouses. The present study was planned among one of the primitive tribes of Madhya Pradesh to understand the knowledge of males about reproductive tract infection (RTI)/STI/HIV/AIDS, RTI symptoms suffered, perception on sexual health, utilization of health services and to improve the knowledge by intervention of need based IEC (information, education, communication) strategy. Method: The study was conducted among 400 currently married men in the age group of 15-40 yr in one of the primitive tribes, Baigas of Dindori district of Madhya Pradesh. Eighteen villages were explored in the study. The IEC intervention was made by using quasi-experimental before and after with control design. Result: The baseline data generated indicated that Baigas male were poorly informed about RTI (18%), STI (21.5%) and HIV/AIDS (10%). Further, men also projected misconception on different aspects of sexuality. Women’s views recorded also suggested a disturbing trend regarding male involvement in reproductive health particularly related to STIs. Interpretation & conclusions: After intervention of IEC targeting male population in age group 15 - 40 yr by adopting a before and after with controls design the awareness was improved significantly. The utilization of the health services was also improved significantly. The study recommends replication of the IEC strategy designed in other Baiga villages for improving the reproductive health of the tribe.

The upgraded Clinical Trials Registry India: a summary of changes.

The Clinical Trials Registry-India (CTRI) was launched on July 20, 2007 and since then has grown to become a significant contributor to the global pool of accessible clinical trial data. Trial registration in the CTRI is now mandatory. Currently more than 1,800 trials are registered in the CTRI.

Tuberculous Osteomyelitis of the bone flap following Craniotomy.

A patient of tuberculous osteomyelitis of the bone flap following craniotomy for acute subdural hemorrhage which was treated at Surat Municipal Institute of Medical Education & Research (SMIMER) from June 2010 has been reported. This report emphasizes the fact that while treating osteomyelitis of bone flap following craniotomy, possibility of tuberculosis should be considered, especially in our country. Treatment wise, the disease responded readily to routine anti-tubercular chemotherapy.

Seroprevalence of hepatitis B infection during pregnancy and risk of perinatal transmission.

Objectives To investigate the seroprevalence of hepatitis B surface antigen (HBsAg) in pregnant women and possible risk factors for perinatal hepatitis B virus (HBV) transmission. Methods Four thousand pregnant women were evaluated using history, examination, and test for serum HBsAg using commercial enzyme immunoassay kits. For HBsAg positive women, liver function tests and a test for hepatitis B e antigen (HBeAg) was done. HBV DNA analysis was done by polymerase chain reaction (PCR). Results Of 4,000 women studied, 37 (0.9%) tested positive for HBsAg. Of these 37 women, 6 (16%) presented with acute hepatitis and 31 (84%) were asymptomatic. The highest HBsAg positivity rate was seen in the age group of 21– 25 years (1.15%) followed by 26–30 years (0.86%). Assessment of risk factors revealed history of tattooing in 29/37 (78.4%) women. HBeAg was positive in 21 of 37 (56.8%) women. Of the 16 HBeAg negative women, 5 were positive for HBV DNA and anti-HBe antibody, 6 had only anti-HBe antibody and 5 had neither HBV DNA nor anti-HBe. Vertical transmission was seen in 65% (13/20) of babies born to mothers who were positive for HBeAg and HBV DNA. In contrast, it was only 9.1% (1/11) for babies born to mothers who were negative for both HBeAg and HBV DNA. Of the 25 babies delivered vaginally, 15 (60%) developed vertical transmission. None of the four babies delivered by elective cesarean section had evidence of vertical transmission. Conclusions Seroprevalence of HBsAg in antenatal women was found to be 0.9%. HBe-antigen and HBV DNA positivity was associated with a higher chance of vertical transmission

Inverse sampling to study disease burden of leprosy.

Background & objective: Estimation of disease burden due to leprosy by conventional sampling procedure is difficult due to large sample size requirement. In such situation, inverse sampling procedure could be a choice. A pilot study was undertaken to study the feasibility of adopting inverse sampling procedure over conventional sampling in an endemic area of Uttar Pradesh, India. Method: Two community development blocks one with low endemic, namely, Fatehganj, and other high endemic, Ramnagar, in Bareilly district of Uttar Pradesh, India, were selected. The Inverse sampling was adopted in Fatehganj and conventional cluster sampling was used in Ramnagar. As per the design of inverse sampling, 25 new cases of leprosy were to be detected from a population that could provide the cases. Under conventional sampling, a sample of 44,000 subjects (population) was targeted for the survey. Results: In Fatehganj, 25 new cases of leprosy were detected from a sample of 14734 individuals. In Ramnagar, a total of 63 new cases of leprosy were found after covering a sample of 44686 individuals. Both the techniques provided similar estimates. The precision obtained under inverse sampling was though less than that under conventional sampling but found to be more feasible and suitable for estimation of leprosy due to less population covered, time and cost. Interpretation & conclusion: Our findings showed that inverse sampling was advantageous over conventional sampling and could be adopted for the large scale survey at national level.

Association between domestic violence and unintended pregnancies in India: Findings from the National Family Health Survey-2 data.

Background. Violence against women, especially by their husbands, is a serious public health issue that is associated with physical, reproductive and mental health consequences. The association between physical violence and unintended pregnancies has not been explored in India. Methods. Data were drawn from the second round of the National Family Health Survey (NFHS-2), India conducted in 1998–99. Unintended pregnancy, defined as a pregnancy that was not wanted at the time of conception, was the dependent variable. A set of independent covariates such as age, place of residence, education, working status, religion, standard of living index, type of family, number of surviving sons, use of contraceptive methods, pregnancies terminated and physical mistreatment by the husband were evaluated using a step-wise multiple logistic regression model. Results. Multiple logistic regression analysis showed that women who had been physically mistreated by their husbands were 47% (OR 1.47; 95% CI 1.25–1.72) more likely to experience unintended pregnancies. Conclusion. Preventing physical violence against women by their husbands could reduce unintended pregnancies.

Improved estimates of India's HIV burden in 2006.

BACKGROUND & OBJECTIVE: HIV estimates in India were based on HIV sentinel surveillance (HSS) data and several assumptions. Expansion of sentinel surveillance to all districts and community based HIV prevalence measured by National Family Health Survey-3 (NFHS-3) in 2006 provided opportunity to replace many of the assumptions with evidence based information and improve the HIV estimate closer to reality. This article presents a detailed account of the methodology used for the 2006 HIV burden estimates for India. METHODS: State-wise adult HIV prevalence among different risk groups observed from HSS 2006 was adjusted for site level variations using a random effects model and for the previous four years the same was back calculated using trend equations derived from a mixed effects logistic regression model based on consistent sites prevalence. The adjusted HIV prevalence among the general population was calibrated to the estimates from NFHS-3. Overall point estimates of adult HIV prevalence in each State for 2002-2006 were derived from the UNAIDS Workbook and projected for the period 1985-2010. The results were put into Spectrum to derive estimates of the number of people living with HIV in all ages and other epidemic impacts. RESULTS: National adult HIV prevalence was 0.36 per cent (range 0.29-0.46%) and the estimated number of people living with HIV was 2.47 million (range 2.0-3.1 million) in 2006. The national adult HIV prevalence remains stable around 0.4 per cent between 2002 and 2006. The States with the highest estimated prevalence were Manipur, Nagaland and Andhra Pradesh. The States with the highest burden were Andhra Pradesh, Maharashtra, Karnataka and Tamil Nadu. INTERPRETATION & CONCLUSION: The improvement in the 2006 estimates of the HIV burden in India is attributable to the expanded sentinel surveillance and representative data from the population-based survey in 2006, combined with an improved analysis. Despite the downward revision, India continues to face a formidable challenge to provide prevention, treatment and care to those in need.

Risk factors for maternal mortality in Delhi slums: A community-based case-control study.

BACKGROUND: In order to develop, implement and evaluate policy for reducing maternal mortality, it is essential to study the risk factors associated with maternal deaths. AIMS: The study aims to determine the epidemiological risk factors and its related causes associated with maternal deaths in Delhi slums. MATERIALS AND METHODS: A community-based case-control study was designed, wherein snowball-sampling method was used to identify the maternal deaths (cases) in the community and circular systematic random sampling procedure was used to select the controls from the same area where a maternal death was found. STATISTICAL ANALYSIS: Data on 70 cases and 384 controls that had live births as the outcome of the pregnancy were analyzed. Logistic regression was applied to identify the risk factors. RESULTS: In the study population, most of the deliveries were conducted at home by untrained 'dais.' Cases were mostly illiterate, young, having high parity and no antenatal care taken during pregnancy (P CONCLUSIONS: The study findings suggest that women should be educated about the importance of antenatal registration and regular checkups. Untrained 'dais' should be trained to recognize the obstetric complications at an early stage and refer high-risk cases for adequate management. These preventive measures could help in reducing maternal mortality at the community level.