Prevalence of caesarean section and womens' attitude towards caesarean section in Manipur, North-Eastern India

Background: The rapid increase of caesarean section (CS) rate throughout the world has become a serious public health issue since the level of CS is well above the WHO (1985) recommended 15% and it is increasing over time. Objectives of the study was to determine the prevalence of caesarean section and women’s attitudes towards CS, to investigate rural-urban differences and any associated factors between attitude with socio-demographic factors.Methods: A cross-sectional study was conducted in urban and rural areas of three districts of Manipur from 2015 to 2017 among 600 eligible married women aged 18-35 years selected by simple random sampling. Household was taken as sampling unit and electoral roll (2013) as sampling frame. An interview schedule was used for data collection. Descriptive statistics like mean, SD, proportion and inferential statistics like χ2 test was used. p-value 0.05 was considered as statistically significant.Results: Mean age of the participants was 29.7±4.6 years. The overall prevalence of CS rate was 18.5% and the first child CS rate was 19.9% and majority of them belongs to 30-35 age groups. Majority of the women (84.2%) have neutral attitude and only 7.6% have favorable attitude towards CS. Favorable attitude towards CS was more among women who married at ≥30 years, whose husband was >30 years and was a government employee and who ever had CS.Conclusions: Although the prevalence of CS is well above the WHO (1985) recommendation. Majority still preferred vaginal delivery and the demand for CS is low in the present setting.

Child rearing practices in a rural community in Manipur: a cross-sectional study

Background: The child rearing practices differ in communities, depending on their social customs, traditional beliefs and prejudices. Understanding these practices is important for the successful delivery of health messages and services. The present study was conducted in a rural setting to determine the child rearing practices as well as to determine its association with relevant socio-demographic factors.Methods: This cross-sectional study was conducted among 369 mothers residing in Kshetrigao area under Kshetrigao Urban Health Centre, Porompat, Imphal East. A pre-tested interview schedule developed by the investigator was used for data collection. Descriptive statistics like mean, percentage and proportion as well as chi-square and t-test were used for data analysis.Results: Majority (79%) of the mothers breast-fed their newborn within 6 hours after birth. Almost half (46%) of the mothers gave pre-lacteal feeds to their newborn. Majority of the mothers (57%) did not practice exclusive breastfeeding. About 90% of the children were completely immunized for age. Mothers who got married before the age of 20 years, being Muslim and who had caesarean section were significantly less likely to practice exclusive breast feeding (p value of 0.025, 0.012 and 0.000 respectively). Children whose mother belongs to Muslim religion, lower educational status, lower family income and who delivered at home were significantly less likely to be completely immunized (p value of 0.001, 0.003, 0.014 and 0.003 respectively).Conclusions: Giving pre-lacteal feed and not practicing exclusive breast-feeding were very common among the studied population.

A descriptive study on prevalence pattern of Japanese encephalitis in State of Manipur

Background and Objective: Japanese encephalitis (JE) surveillance is not well established in many countries, and laboratory confirmation is challenging, the true extent and prevalence of the virus and burden of disease are not well understood. It is estimated that 67,900 clinical cases of JE occur annually despite the widespread availability of vaccine, with approximately 13,600–20,400 deaths and an overall incidence rate of 1.8/100,000 in the 24 countries with JE risk. The present study aimed at determining the prevalence rate (PR) and distribution (time, place and person) of JE cases in Manipur. This descriptive study was conducted over 24-month period (2016–2017). Materials and Methods: A total of 1770 cases of acute encephalitis syndrome tested for JE including 251 confirmed JE were diagnosed by IgM antibody-capture enzyme-linked immunosorbent assay. Results: The JE cases were most commonly reported in the age group of >15 years. Most of JE prevalence was seen in rural distribution in our study. There is a strong seasonal pattern of JE occurrence in Manipur which peaked in July–August and declined by October each year, which corresponds to the monsoon season. The JE cases were reported in all the districts of the state expanding in the plains and hill regions. Conclusions: The changing pattern of JE cases among different age groups was also observed in our study. The present study reveals the changing pattern of the prevalence of JE in the State of Manipur and initiated a systematic approach of JE surveillance also highlights the need for further expanding of surveillance across the state.

A Five Year Study of Profile of Leprosy Patients attending a Tertiary Care Hospital in Manipur

This retrospective study was conducted to analyze the profile of leprosy patients who attended the OPD of a Tertiary Care Hospital in the state of Manipur, the Indian state with lowest prevalence of the disease. In this study demographic and clinical details of all leprosy patients attending Dermatology OPD for 5 years period from January 2011- December 2015 were analyzed from the departmental records. Of the 59 patients male to female ratio was 1.95:1. Major group of patients (42.4%) belonged to middle age group (20-40 years). Children (< 14 years) constituted 6.5%. 52.5% of the patients presented with mixed cutaneous and neural symptoms. Multibacillary cases clearly outnumbered paucibacillary (91.6%). The most common clinical type was borderline tuberculoid (38.9%) followed by indeterminate and lepromatous leprosy (15.3% each). Pure neuritic (5.1%) was the least common type. 15.3% patients developed type 1 reactions while 6.8% had type 2 reactions. 16.9% patients had grade 1 deformity of hands and feet while 11.9% had grade 2 deformity. Though the state is having low prevalence compared to national level, leprosy eradication programmes should be continued effectively and expanded to improve access in all regions of state.

Traditional Usage of Ethnomedicinal Plants in Treating Liver Disorders at Manipur, North East India

History ensures that, plants with its medicinal usage are always being the topic of attraction for the researchers. Medicinal plants can be used for the various purposes, for example healing pain, treating ailments or any other health issues. Gastrointestinal diseases more specifically liver disorders are treated with the help of these medicinal plants. Manipur is considered to be the place where liver disorders are primarily treated with the help of these medicinal plants by local health care providers, which emphasize the attributes of these plants in health care system. Following this aspect the study was carried out at three different districts namely Bishnupur, Kakching and Thoubal, that includes Ethnobotanical field surveys conducted from 2012-14, by covering traditional healers of Meitei community. Collected information from the surveys was analyzed and the target plants were identified. Disease Consensus Index was calculated on the basis of collected information to determine most significant plants. A total of 52 plant species of 34 distinct families are used as hepatoprotective medicinal plants amongst which the highest Disease Consensus Index (DCI) value was found in the species named Engelhardtia spicata Lechen; ex Blume. From these ethno pharmacological data plants with highest hepatoprotective values are identified.

Hoarseness Due to Penicillium Marneffei Infection-An Unusual Presentation

Penicillium marneffei is a dimorphic fungus causing infection mainly in immunocompromised individuals, especially those with HIV infection. Penicillium marneffei is an important opportunistic pathogen of HIV infection in South East Asia including Manipur. Common clinical manifestations are fever, cough, weight loss, generalised lymphadenopathy, and papulonodular eruptions. We report an unusual case of HIV patient with Penicillium marneffei infection presenting as hoarseness

High burden of hepatitis C & HIV co-infection among people who inject drugs in Manipur, Northeast India.

Background & objectives: It is well documented that the Northeast State of Manipur in India has been dealing with the dual problems of injecting drug use and HIV for the last two decades, but the hepatitis C problem has not been so well characterized. The aim of this study was to assess the prevalence of hepatitis C virus (HCV) infection and HCV/HIV co-infection among people who inject drugs (PWID) in Manipur, and identify factors associated with infection. Methods: Data were obtained from the Integrated Behavioural and Biological Assessment (2009-2010), a cross-sectional survey among 821 male PWID in two districts of Manipur (Churachandpur and Bishnupur). Information about drug use, sexual and injecting risk behaviours, and exposure to interventions was obtained, and biological specimens tested for HIV and HCV. Logistic regression analyses identified factors associated with HCV infection and HCV/HIV co-infection. Results: HCV prevalence was 74 per cent (91% Churachandpur, 56% Bishnupur), and HCV/HIV co-infection was 29 per cent (38% Churachandpur, 21% Bishnupur). Among the 31 per cent of HIV positive PWID, 95 per cent were co-infected. HCV infection was associated with district, longer duration of injecting, injecting at least once daily, generally injecting with a used needle and syringe, and having had an HIV test. HCV/HIV co-infection was associated with district, older age, being employed, being widowed/divorced, longer duration of injecting, and feeling at risk of HIV infection. Interpretation & conclusions: The HCV/HIV co-infection among PWID in Manipur was very high, highlighting the urgent need for effective prevention, diagnosis and treatment.

Unit Cost of Education in Government Higher Secondary Schools of Imphal, Manipur.

This paper is an attempt to discuss the various aspects of Unit Cost of Education in Government Higher Secondary Schools of Imphal, Manipur, India.

Opportunistic Strongyloides Stercoralis Infection in an Immunocompromised Patient.

Strongyloides stercoralis is an intestinal nematode that infects human percutaneously and has a complex life cycle including a direct, an autoinfective and a non-parasitic freeliving developmental cycle. Strongyloidiasis has a worldwide distribution, and usually causes mild or asymptomatic infection. However hyperinfection syndrome can cause significant morbidity and mortality in immunocompromised states such as malignancy, HIV infection, or immunosuppressive agent administration. We report a case of a 37-year old male HIV positive patient admitted in male medical ward, RIMS with severe diarrhoea, pain abdomen, generalized weakness and history of diarrhoea off and on for past one month. His CD4+ T- lymphocyte count was 116 cell/microlitre and the patient was on antiretroviral therapy. Stool examination reveals larvae of Strongyloides stercoralis. Stool culture was negative for pathogenic bacteria and fungi. Special staining for detection of intestinal coccidian parasites and microsporidiosis was also negative .The patient was successfully treated with combined therapy of albendazole(400mg) and ivermectin(6mg) daily for 3days.

Outbreak of dengue virus serotype-2 (DENV-2) of Cambodian origin in Manipur, India - Association with meteorological factors.

Background & objectives: Dengue is a major health problem in many parts of India and its neighbouring countries. Dengue cases have not been reported from Manipur, a northeastern State of India till 2007. But, the sudden outbreak of fever with febrile illness during 2007 and 2008, suspected to be dengue/dengue haemorrhagic fever was investigated to detect the causative agent. Potential impact of climatic variables on dengue transmission has been documented and hence the association between climatic factors, entomological parameters and dengue cases was also analysed. Methods: Forty two and 16 blood samples were collected from patients suspected to have dengue infection in the year 2007 and 2008, respectively. Viral RNA was extracted from serum samples and subjected to multiplex one step RT-PCR assay. Dengue specific amplicons were sequenced and phylogenetic analysis was carried out. Multiyear trend analysis and ‘t’ test were performed for the comparison of different meteorological variables between the years 2000-2004 and 2005-2008. Results: The aetiological agent was found to be DENV-2 and the phylogenetic analysis showed that the isolate was similar to that of Cambodian isolate. There was a significant difference in minimum temperature (P<0.05), Relative humidity - morning hours (P<0.001), relative humanity - afternoon hours (P<0.01) and cumulative precipitation (P< 0.05) between the years 2000-2004 and 2005-2008. Interpretation & conclusions: The sudden outbreak of dengue fever in Manipur State occurred was possibly due to the increased temperature, relative humidity and decrease in cumulative precipitation. These climatic factors would have contributed to the Aedes mosquito abundance and increased virus transmission. Proper diseases surveillance system integrated with meteorological warning system and management of vector breeding sites will prevent such outbreaks in future.

Dietary supplies of iodine & thiocyanate in the aetiology of endemic goitre in Imphal East district of Manipur, north east India.

Background & objectives: The present investigation was undertaken to study the iodine nutritional status of school children of Imphal east district in Manipur where endemic goitre persists during post-salt iodization phase along with the investigation of the factors responsible for the occurrence of goitre endemicity. Methods: A total of 1,286 children (6-12 yr) were clinically examined for goitre from study areas of Imphal east district. A total of 160 urine samples were collected and analyzed to measure urinary iodine and thiocyanate levels. Iodine content was measured in 140 salt samples and 16 drinking water samples. Results: Overall goitre prevalence was about 30 per cent (grade 1-24.7%; grade 2-5.3%) and median urinary iodine level was 17.25 μg/dl. The mean urinary thiocyanate level was 1.073 + 0.39 mg/dl. Iodine/thiocyanate ratio (μg/mg) was in the ranges from 15.65 to 22.34. The mean iodine content in drinking water samples was 2.92 + 1.75 μg/l and 97.8 per cent of edible salts had iodine level above 15 ppm at the consumption point. Interpretation & conclusion: Our findings showed that in spite of no biochemical iodine deficiency, iodine deficiency disorders (IDD) is a serious public health problem in Imphal east district of Manipur. The consumption pattern of certain plant foods containing thiocyanate (or its precursors) was relatively high that interfere with thyroid hormone synthesis resulting in the excretion of more iodine. Thus, the existing dietary supplies of thiocyanate in relation to iodine may be a possible aetiological factor for the persistence of endemic goitre in the study region during post salt iodization period.