Prevalence of tuberculosis in Faridabad district, Haryana State, India.

Background & objectives: Epidemiological information on tuberculosis (TB) has always been vital for planning control strategies. It has now gained further importance for monitoring the impact of interventions to control the disease. The present study was done to estimate the prevalence of bacillary tuberculosis in the district of Faridabad in Haryana State of India among persons aged older than 15 years. Methods: In this cross-sectional study, residents of Faridabad district were assessed for the prevalence of tuberculosis. Twelve rural and 24 urban clusters with estimated populations of 41,106 and 64,827 individuals were selected for the study. Two sputum samples were collected from individuals found eligible for inclusion. The samples were also cultured by modified Petroff’s method and were examined for growth of Mycobacterium tuberculosis once a week for eight weeks. A person found positive by smear and/or culture was identified as sputum-positive pulmonary TB positive. Results: A total of 105,202 subjects were enumerated in various clusters of the Faridabad district. There were 50,057 (47.58%) females and 55,145 (52.42%) males. Of these 98,599 (93.7%) were examined by the study group (47,976 females; 50,623 males). The overall prevalence of sputum smear or culture positive pulmonary tuberculosis in our study was found to be 101.4 per 100,000 population. Interpretation & conclusions: The present results showed that the prevalence of sputum positive pulmonary tuberculosis was higher in Faridabad district than the notification rates recorded by the World Health Organization for the contemporary period, a disparity that could be explained by a difference in case detection strategy employed for the study.

Teaching community medicine to medical undergraduates—learning by doing: Our experience of rural posting at All India Institute of Medical Sciences, New Delhi, India.

Background. The goal of medical education is to ensure that the medical graduate has acquired broad public health competencies needed to solve the health problems of the community. We present the current teaching of community medicine to medical students of the All India Institute of Medical Sciences (AIIMS), New Delhi during their 5-week posting at the rural centre at Ballabgarh, Haryana. Methods. The teaching activities consist of field visits to different levels of health facilities and meeting with health workers, epidemiological exercises, a community-based exercise, posting in inpatient and outpatient departments of a secondary hospital, and domiciliary visits to families of patients. These are spread over 80 sessions of about 200 hours. There is very little didactic teaching and the assessment is broad-based. The evaluation of the posting was based on comparison of blinded pre- and post-posting assessments as well as anonymous feedback of the posting by the students. Results. There was a significant increase in the mean scores of all components of the posting—epidemiology (5.1 to 8.4), health systems (6.8 to 9.3) and clinical (8.0 to 10.8). The posting did not result in a better understanding of a public health approach as compared to a clinical approach. The feedback provided by students was generally positive for all activities with 94% of them rating it as good or very good. Conclusion. The teaching of community medicine can be made more practical and interesting without compromising on learning. However, despite such a programme, getting medical students to develop a public health approach is a daunting task.

Determinants of Neonatal Mortality in Rural Haryana: A Retrospective Population Based Study.

Objective: To identify the determinants of neonatal mortality. Study design: Nested case-control study. Study setting: 28 villages under the intensive field practice area of Comprehensive Rural Health Services Project, Ballabgarh, Haryana serving a population of 87,016, as on 31st December 2009. The study period was from 2005 to 2009. Methods: The data were obtained from Health Management Information System and analyzed using multivariate logistic regression analysis. A hierarchical approach was used to analyze the factors associated with neonatal deaths, using community level factors, socio-economic status and biological determinants. The population attributable fractions were estimated for significant variables. Results: The total live births during the study period were 10392 and neonatal deaths were 248. The infant and neonatal mortality rates during the study period were 45.6 and 23.8 per 1000 live births, respectively. Socio-economic determinants (Low educational status of parents [OR 2.1, 95% CI; 1.4, 3.3]; father’s occupation [OR 1.8, 95% CI; 1.0, 3.0]; Rajput caste [OR 2.0, 95% CI; 1.2, 3.4] appeared to explain a major fraction (45.7%) of neonatal deaths. Community level factors (villages with no health facility [OR 1.5, 95% CI; 1.0, 2.1]; villages with population >6000 [OR 1.7, 95% CI; 1.2, 2.5]) were associated with 27.3% of all neonatal deaths. Proximate determinants (early childbearing age of mother (<20 years) [OR 2.0, 95% CI; 1.2, 3.2]) were least important. All the three level of variables seemed to act independently with little mediation among them. Conclusion: Neonatal mortality is affected by socioeconomic, community level and proximate biological determinants.

Study of Post Traumatic Stress Symptomatology in Adolescent Girls.

Background: Exceptionally stressful life events are known to cause severe psychological symptoms especially in the more vulnerable women and children. Objective : The psychological morbidity of students of secondary school victims of stampede were studied. Methods : Students of secondary school victims of stampede were assessed during their admission at tertiary care teaching hospital and cross-sectional assessment was done after eight weeks of the trauma. Using General Health Questionnaire (GHQ), Child’s Reaction to Traumatic Events Scale-Revised (CRTES-Revised). Results : Four (30%) of the admitted children developed acute stress disorder. 22 children were in high distress group and 5 in moderate distress group on CRTESQ-R on assessment after eight weeks. The preliminary findings of the study suggest high levels of psychological morbidity in stampede victims and its implications are being discussed. Conclusions: The high levels of psychological morbidity in stampede victims suggest the need for immediate intervention by mental health professionals in terms of providing both non pharmacological - individual and family counseling, psychotherapy and pharmacological interventions.

Seasonal hyper acute pan uveitis--recent scenario in Nepal.

Seasonal hyperacute panuveitis (SHAPU), characterized by an unusual form of unilateral severe hyper acute diffused intraocular inflammation, is one of the mysterious eye diseases of which the definite cause and treatment remains yet to be tound out. In this study, a total of six cases were included. Aqueous and vitreous samples were subjected to direct microscopy and culture (bacterial or fungal). Of the six cases included, two yielded Streptococcus pneumoniae and one Acinetobactor sp. on culture. All three culture positive samples showed pus cells in direct microscopic examination (gram stain). All cases were subjected to vitrectomy and intravitreal antibiotic and steroid injection, along with oral antibiotics and steroid. Five cases were also treated with antiviral agent. After treatment four cases showed reversal of hypotony and three cases recovered some vision.

Study on maternal consciousness among Nepalese mothers in Kathmandu, Nepal.

Present study was carried out to study the status of maternal consciousness among Nepalese women living in Kathmandu. Of the total 360 mothers of different ethnic groups included in this study, only 55.5% mothers were found to have a positive feeling regarding their pregnancy (pregnancy is a wonderful event for women) (strongly positive 16.6%; positive 39.2%). Over one-forth of the mothers (27.7%) had negative feelings (strongly negative 8.8%; negative = 19.0%) and 14.4% had neither positive nor negative feeling. Among the different ethnic groups, Launa (Tamang/Sherpa) ethnic had highest rate (nearly two-third) of positive feeling towards pregnancy. However, the positive feeling towards born baby was very high (77.9%). The level of feeling of love to their baby was different in different ethnic groups. Compared with other population groups, Dalits had higher level of positive feelings about giving a child birth, childcare and self-sacrifice for the shake of children.

Causative agents of urinary tract infections in children and their antibiotic sensitivity pattern: a hospital based study.

A retrospective study was conducted to find out the causative agents of urinary tract infection (UTI) in children and their antibiotic sensitivity pattern among Nepalese children. This was done at Kanti Children's Hospital in Kathmandu (Nepal) by analyzing the records of urine samples collected for culture and sensitivity tests over a period of six months (April to November, 2007). Of the total 1878 mid-stream urine samples collected from suspected cases of UTI, 538 (28.6%) were positive for pathogenic organisms. There was no significant difference in growth positive rate in two genders (M: 51.7% and F: 48.3%). Of the various pathogenic organisms isolated, Escherichia coli constituted for 93.3% followed by Proteus sp, Klebsiella sp, Citrobacter sp, Staphylococcus aureus and others. E. coli was found to be most sensitive to amikacin, chloramphenicol, nitrofurantoin and ofloxacin and least sensitive to most commonly used drugs like cephalexin, nalidixic acid, cotrimoxazole and norfloxacin.

Intestinal parasitosis among subjects undergoing cataract surgery at the eye camps in rural hilly areas of Nepal.

Present study investigated the intestinal parasitosis among 221 subjects undergoing cataract surgery (M: 129 and F: 92; aged 13-86 years) at the eye camps in three rural hilly districts (Ramechhap, Sindhupalchok and Dhading) in 2006. Stool samples collected in clean, dry, screw capped plastic containers were examined locally by direct smear technique and anti-parasitic drugs were distributed to parasite positive subjects. The remaining stool samples were fixed with 10% formal-saline, transported to Shi-Gan Health Foundation/Nat'l Inst of Trop Med and Public Health Research, Kathmandu and re-examined by formal-ether sedimentation technique. A total of 148 samples (66.9%) were positive for some kind of intestinal parasites (F: 68.5% and M: 65.9%; P > 0.05). Ramechhap (Manthali) and Sindhupalchok (Chautara) had higher positive rate (71.8% and 70.7%, respectively) than in Dhading (Salyantar) (60.0%) (P > 0.05). Tibeto-Burman (indigenous nationalities) ethnic group had highest positive rate (70.1%) compared with Indo-Aryan (64.7%) and Dalits (57.7%). Subjects without toilet (latrine) had marginally higher positive rate (69.7%) than those having toilet at their home (65.5) (P> 0 .05). Age was independent of positive rate. Vegetarians had marginally higher parasitic infection rate compared to their non-vegetarian counterparts. Helminths were more common than protozoa. Overall, hookworm was the commonest parasite detected. However, Ascaris was common in Dhading District. Entamoeba histolytica was most common among protozoa and was followed by Cyclospora and others.

Lipid profile of adult Nepalese population.

Dyslipidemia is one of the major risk factors of coronary artery disease. Present study was aimed to find out the lipid profile of non-diabetic adult Nepalese population (n = 454; M: 180 and F: 274; Mean age: 42.8+/-15.5 years). The mean +/- SD (mg/dl) level of total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) was 184+/-50.7, 147.4+/-79.9, 111.9+/-42.0 and 45.0+/-11.7, respectively. All lipid levels except LDL were higher among 41 to 60 years age group while LDL was higher among participants aged >60 years. Desirable TC level (<200 mg/dl) was found in 78.0% of the total population while the normal TG (<150 mg/dl) and LDL (<129 mg/dl) was found in 61.5% and 72.0%, respectively. High TC (> or =240 mg/dl) and very high TG (> or =500 mg/dl) and LDL (> or =190 mg/dl) were found in 8.8%, 2.6% and 5.8% of participants, respectively. Higher HDL level (40 mg/dl) was seen in 60.0% of the total population. Higher percentage of women than men (65.3% vs 52.2%) had >40 mg/dl HDL level. Nornal lipid profile (TC <200 mg/dl, TG <150 mg/dl, LDL <129 mg/dl, HDL >40 mg/dl) was seen in 26.7% of participants, and was higher in females (32.1%) than in males (18.3%). The overall mean cholesterol level was within normal limit. Mean LDL level showed increasing trend with age and about one fourth of participants had normal lipid profile.

Morbidity profile of paediatric inpatents at a community health centre and a nearby [correction of near by] district hospital in northern India.

The study was conducted to ascertain the morbidity profile among children by retrospective review of inpatient data of children admitted to Comprehensive Rural Health Services Project (CRHSP), Ballabgarh, a model CHC and Badshah Khan (B.K.) hospital, Faridabad, a district hospital over a period of one year. Diarrhea and pneumonia comprised 64% of all admissions at the model CHC and 30% at the district hospital. Thalassemics requiring blood transfusion formed 21% of inpatients at the district hospital. Common paediatric ailments can be managed appropriately at CHC level, provided the infrastructure as recommended by Indian Public Health sandards for CHC under National Rural Health Mission (NRHM) is available. The blood bank or blood storage facility at a CHC is desirable.

Quality assurance of annual HIV sentinel surveillance 2006: experience of regional institute, central zone.

National AIDS Control Organisation (NACO) identified five regional institutes (RIs) to monitor and supervise the 2006 round of annual HIV sentinel surveillance. The task mandated was quality control of both epidemiological data collection and HIV testing. The team at RI consisted of epidemiologist and microbiologist. We describe here the process of quality control and the quality of surveillance in the states of Uttar Pradesh, Uttarakhand, Bihar, Jharkand, and Delhi. The supervisors visited almost 90% of the sentinel sites. Performance of vast majority of the sentinel sites (92%) was satisfactory. The testing laboratories were found to be adhering to standard operating procedures. Concordance rate of test results between testing laboratory and the designated reference laboratory was high. Overall, the quality of sentinel surveillance was good. The lacunae found during the visit have been enumerated along with the recommendations for future surveillance round.

Seasonal distribution of enteropathogens detected from diarrheal stool and water samples collected in Kathmandu, Nepal.

A total of 334 diarrheal fecal samples (from 210 males and 124 females) collected in Kathmandu, Nepal, were studied for various kinds of enteropathogens. Overall, 33% (111/334) fecal samples were positive for one or more enteropathogens. There was no difference in detection rates between males and females. Enteropathogen detection rates in summer, winter, spring, and autumn were 61% (40/66), 52% (45/87), 31% (25/81), and 25% (25/100), respectively. Altogether eight species of bacteria, three genera of viruses, and five species of protozoan parasites were detected with considerable seasonal variations. Among the bacterial isolates, enteropathogenic Escherichia coli topped the list followed by Vibrio sp. Only one sample had Shigella (S. sonnei). Rotavirus type A was the most frequently detected among the enteric viruses, followed by human enterovirus and human adenovirus, respectively. Among the enteric protozoan parasites, Giardia intestinalis was the most frequently detected followed by Cryptosporidium parvum. Detection of bacterial and protozoan pathogens showed a slightly high tendency in the summer season compared with that in the other seasons (p>0.05), whereas the detection of viruses was significantly high in the winter season (p<0.05). Of the total 57 water samples, 43 (75%) showed one or more bacterial species out of which 51% (22/43) were E. coli. Among the E. coli isolates, 68% were EPEC. Enterohemorrhagic E. coli (O157) was not detected.

Contamination of soil with helminth parasite eggs in Nepal.

Contamination of soil with helminth eggs in Kathmandu Valley (n=122) and outside of Valley (n=34) in Nepal was investigated with the use of centrifugal floatation technique using sucrose solution (sp gr 1.200). The overall soil contamination rate was 36.5% (57/156). The prevalence was uniform in Kathmandu Valley (36.9%) and outside of the valley (35.3%). A mean of six helminth eggs per sample were detected out of which more than half were embryonated (potentially infective). In Kathmandu Valley, soil contamination rate was higher (48.3%) during wet season compared with that observed in dry season (33.3%) but without significant difference (p>0.05). Multiple species of helminth eggs were detected in 22.8% of total positive samples (n=57). Altogether five species of nematoda (Ascaris lumbricoides, Toxocarta sp, Trichuris trichiura, Capillaria sp and Trichostrongylus sp) and two species of cestoda (Hymenolepis nana and H. diminuta) were recovered. A. lumbricoides was predominant in Kathmandu Valley while Trichostrongylus was the commonest one in outside of valley.

Toxoplasma antibody prevalence in Nepalese pregnant women and women with bad obstetric history.

Sera from randomly selected 345 pregnant Nepalese women aged 16-36 years and 13 women with bad obstetric history (BOH) were tested for the presence of Toxoplasma antibodies using microlatex agglutination (MLA) and ELISA methods. The overall prevalence was 55.4% (191/345). Prevalence was slightly higher (59.0%) in older age-group (27-36 years) compared with younger age-group (16-26 years) (52.2%). No significant difference in antibody prevalence in women belonging to two different ethnic-groups (Tibeto-Burmans 57.8%, Indo-Aryans 52.7%) was observed (p>0.05). MLA antibody titer ranged from 1:16 to 1:2,048. Over three-fourth of the women showed either high (1:510 or over) or low (1:16 or 1:32) antibody titer. Three percent (6/191) of MLA antibody positive subjects had Toxoplasma IgM antibodies by IgM-ELISA. All six IgM antibody positive pregnant women had MLA antibody titer of over 1:510. Of the total 13 women with BOH, 5 (38.5%) had Toxoplasma antibodies of which 2 (40.0%) were positive for Toxoplasma-IgM antibodies.

Cryptosporidium infection in HIV-seropositive and seronegative populations in southern Thailand.

The prevalence of Cryptosporidium infection in 61 HIV-seropositive and 61 HIV-seronegative subjects (aged less than one to 67-year-old) in Songkhla City, southern Thailand was studied by a centrifugal flotation technic using sucrose solution. Most of the HIV-seropositive subjects (72%) were 20 to 39 years old. Cryptosporidium oocysts were detected in 10% (6/61) of HIV-seropositive and in 2% (1/61) of HIV-seronegative subjects. Infection rates in these two groups, however, were not statistically significant (p > 0.05). The number of Cryptosporidium oocysts observed in 20 microscopic fields ranged between one and over 12,000. Among the seven Cryptosporidium-positive subjects, six were adults (18 to 42-year-old) and one was three-year-old child. All of the Cryptosporidium infected subjects were male, and two of them were passing formed (normal) feces. Biochemical findings revealed dishepatica in five of six Cryptosporidium infected HIV-seropositive subjects.

Use of polymerase chain reaction in the diagnosis of toxocariasis: an experimental study.

In this paper we report the usefulness of polymerase chain reaction technique in the diagnosis of visceral larva migrans in a mouse model. Liver samples obtained from two set of experimentally infected mice (10, 100, 1,000 and 10,000 embryonated Toxocara canis eggs per mouse) along with the eggs of T. canis, T. cati and Ascaris suum were included in this study. Polymerase chain reaction (PCR) was performed using Toxocara primers (SB12). The first PCR product electrophoresis revealed very thin positive bands or no bands in liver samples. However, on second PCR a clear-cut bands were observed. No positive band was shown by A. suum eggs. Our findings thus indicate the usefulness of PCR technic in the diagnosis of visceral larva migrans (VLM) in liver biopsy materials specifically by means of double PCR using the primer SB12.

Seroepidemiological study of Toxoplasma infection in central and western regions in Nepal.

The present study was carried out to ascertain the seroprevalence rate in different geographical areas in Central and Western Regions in Nepal. A total of 1,237 serum samples collected from Nuwakot (217), Kathmandu valley (402) and Chitawan (159) districts in Central Region, and Mustang (143), Surkhet (64) and Banke (252) districts in Western Region in Nepal were included in this study. Toxoplasma antibodies were detected by micro-latex agglutination (MLA) and enzyme linked immunosorbent assay (IgM-ELISA) methods. The seropositive rate in Central and Western Regions were found to be 48% and 49%, respectively; with an overall positive rate of 48 percent. Districtwise, the seropositive rate in Nuwakot, Kathmandu valley, Chitawan, Mustang, Surkhet and Banke districts were 38, 46, 64, 51, 67 and 44%, respectively. Interestingly, the relatively newly inhabited Surkhet district in Western Region and Chitawan district in Central Region showed significantly higher seropositive rate compared with those of two other districts in the respective Regions (p < 0.05). Ethnically, Tibeto-Burmans showed higher seropositive rates in Central Region (p > 0.05). In contrast, Indo-Aryans showed higher seropositive rate in Western Region (p > 0.05). Age related increase in seropositivity was observed only in Central Region. One percent of Toxoplasma antibody positive samples also showed Toxoplasma IgM antibody positivity.

Seroepidemiological study of Toxocara infection in Nepal.

Seroepidemiological study of Toxocara infection in Nepalese people aged more than fourteen years was carried out by enzyme linked immunosorbent assay (ELISA) using T. canis soluble embryonated egg antigen. Of the total 200 subjects included in this study, 162 (81%) were found to possess antibodies to Toxocara spp. Males showed higher (85%) antibody positive rates than females (77%). Inhabitants of Kathmandu valley showed higher antibody positive rates (84%) compared with those living outside of the valley (78%). These differences, however, were not significant statistically (p > 0.05). Ethnically, Newar, Rai/Limbu, Tamang/Sherpa, Brahmin/Chhetri, Jha/Yadavs, and others (Kami, Damai) showed Toxocara antibody positive rates of 85, 85, 83, 70, 77 and 100%, respectively. Half of the Toxocara antibody positive subjects (49%) showed an elevated level (two plus) of antibody.

Seroepidemiological study of toxoplasmosis in two different geographical areas in Nepal.

A total of 302 serum samples collected from Chitawan (159) and Mustang (143) districts of Nepal were included in this study. Anti-toxoplasma antibody was detected using micro-latex agglutination (MLA) and ELISA methods. An overall positive rate was found to be 57.9%. The positive rate in Chitawan was significantly higher (64.1%) (less than 1,000 m altitude) compared to that in Mustang (51.0%) (more than 3,000 m altitude) (p < 0.05). Females in Chitawan showed significantly higher positive rate (71.2%) compared to males (56.9%) (p < 0.05). On the contrary, though insignificantly, males showed higher positive rate (57.9%) compared to that of females (43.3%) in Mustang. Almost equal positive rate was observed among males in both study area. Females in Chitawan showed significantly higher (71.2%) positive rate compared to their counterparts in Mustang (43.3%) (p < 0.001). A slight increase in positive rate with age was observed in Chitawan while in Mustang a decreasing trend was noticed. Ethnically though statistically not significant, Indo-Aryans showed a higher positive rate (69.2%) compared to the positive rate shown by Tibeto-Burmans (63.1%) in Chitawan while the reverse was true in Mustang (Tibeto-Burmans: 53.8% and Indo-Aryans: 38.4%). Interestingly, 2.9% and 1.3% of MLA positive samples showed toxoplasma IgM antibody. None of the IgM positive samples were positive for toxoplasmic antigens.