Prevalence of Hashimoto’s Thyroiditis and Its Association with Vitamin D Deficiency in West Bengal, India.

Objective: The aim of our study is to screen the prevalence of Hashimoto’s Thyroiditis and to evaluate a correlation between 25(OH)Vitamin D deficiency and AITD in hypothyroid patients of West Bengal. Study Design: Ethical clearance was received for the study. 130 patients from the Medicine OPD of Ramakrishna Mission Seva Pratishthan (RKMSP) and 100 healthy individuals were included in the study from March to July 2015. Methodology: Brief clinical history was taken from all the subjects and serum 25(OH)Vitamin D, Thyroid Stimulating Hormone (TSH), Thyroid peroxidise antibody (TPOab), Parathyroid hormone (PTH) were estimated by Cobas e 601 Immuno assay auto-analyzer. Results: 48.4% (63/130) of the screened patients were found to have AITD with elevated level of anti-TPO in their serum. The prevalence of vitamin D deficiency was significantly higher in patients with AITD compared to controls (Group I: 14.67±4.51; Group II: 11.26±2.8 vs Control: 28.66±8.3 respectively, p<0.0001). There was a significant inverse association between serum 25(OH)D and Hashimoto’s Thyroiditis established by the negative r values (Group I: r = -0.2 , p=0.03; Group II: r = -0.5, p=0.013 vs Control: r=0.07, p=0.48). Conclusion: It has been demonstrated from this study that all the patients with Hashimoto’s Thyroid disorder had significantly low serum 25(OH)vitamin D suggesting its involvement in the pathogenesis of AITD.

Vector control interventions for visceral leishmaniasis elimination initiative in South Asia, 2005-2010.

The Visceral Leishmaniasis (VL) Elimination Initiative in the Indian subcontinent was launched in 2005 as a joint effort between the governments in the Region (India, Nepal and Bangladesh) and the World Health Organization (WHO). The objective is to reduce the annual VL incidence below 1/10,000 inhabitants by 2015 based on detection and treatment of VL cases and vector control. We present here a review of studies published in the period 2005-2010 on the efficacy of different tools to control Phlebotomus argentipes. The review indicates that the current indoor residual spraying (IRS) and novel vector control methods mainly insecticide treated nets (ITN) have low effectiveness for several reasons. Efforts to improve quality of IRS operations and further research on alternative and integrated vector control methods need to be promoted to reach the VL elimination target by 2015.

Community Participation in Two Vaccination Trials in Slums of Kolkata, India: A Multi-level Analysis.

This study aims at understanding the individual and community-level characteristics that influenced participation in two consecutive vaccine trials (typhoid and cholera) in urban slums of Kolkata, India. The study area was divided into 80 geographic clusters (communities), with 59,533 subjects aged ≥2 years for analysis. A multi-level model was employed in which the individuals were seen nested within the cluster. Rates of participation in both the trials were nearly the same; those who participated in the initial trial were likely to participate in the subsequent cholera vaccine trial. Communities with predominantly Hindu population, lower percentage of households with an educated household head, or lower percentage of households owning a motorbike had higher participation than their counterparts. At individual scale, higher participation was observed among younger subjects, females, and individuals from households with a household head who had no or minimal education. Geographic patterns were also observed in participation in the trials. The results illustrated that participation in the trial was mostly influenced by various individual and community-level factors, which need to be addressed for a successful vaccination campaign.

Multi-center surveillance for pneumonia & meningitis among children (<2 yr) for Hib vaccine probe trial preparation in India.

Background & objectives: Severe clinical pneumonia and meningitis caused by Haemophilus influenzae type b in children less than 5 yr old is preventable by use of Hib vaccine. However, data on Hib burden in India are limited. To support an evidence-based decision for Hib vaccine introduction in India, a vaccine probe study was planned. This paper presents the results of the preparatory phase for such a study, which aimed to determine the feasibility of conducting a randomized vaccine probe study and to estimate the incidence of all causes of pneumonia and meningitis. The preparatory study included population-based, hospital-based and carriage surveillance. Methods: Children aged 18-24 months and were enrolled at PGIMER, Chandigarh, CMC, Vellore and NICED, Kolkata, from July 2005 to December 2006. At the time of enrollment, parents were informed about the signs and symptoms of pneumonia and meningitis, and were encouraged to take the child to study hospitals for treatment. Hospitalized children less than two years of age suspected of having pneumonia and/or meningitis were enrolled in study hospitals, whether or not they were from the cohort population. Patients were examined clinically and received chest radiograph for suspected cases of pneumonia or lumbar puncture for suspected cases of meningitis. Blood culture was done for both pneumonia and meningitis patients. Cerebrospinal fluid (CSF) was tested for biochemistry, culture, latex agglutination test and polymerase chain reaction. Nasopharyngeal swabs were collected from healthy children less than 2 yr of age at immunization clinics to estimate Hib carriage. Results: A cohort of 17,951 children were recruited for the population-based arm. The incidence of severe clinical pneumonia ranged from 2717 to 7890 per 100,000 child-years of observation; suspected meningitis ranged from 1971 to 2433 per 100,000 child-years of observation. In the hospital-based study 7/90 (7.8%), 29/98 (29.6%) and 38/181 (21.0%) of CSF samples with cell count ≥100 WBCs/mm3 were purulent at Chandigarh, Kolkata and Vellore respectively. Of these purulent CSF samples, Hib was detected in 2, 6 and 11 cases, respectively. The Hib nasopharyngeal carriage prevalence ranged from 6.0 - 7.6 per cent. Interpretation & conclusions: Incidence of severe clinical pneumonia is comparable with other studies from India but that of suspected meningitis is higher. Although rates of Hib meningitis cannot be calculated from a hospital-based study, there is evidence of Hib meningitis in these study settings. Hib carriage prevalence indicates that Hib is present and circulating in these study areas. There is a significant burden of pneumonia and meningitis among children in India. Continued strengthening of laboratory capacity and bacterial surveillance systems are necessary.

Treatment Cost for Typhoid Fever at Two Hospitals in Kolkata, India.

The purpose of this study was to estimate treatment cost for typhoid fever at two hospitals in Kolkata, India. This study was an incidence-based cost-of-illness analysis from the providers’ perspective. Microcosting approach was employed for calculating patient-specific data. Unit costs of medical services used in the calculation were directly measured from the study hospital by standard method. The study hospitals were selected based on accessibility to data and cooperation. Eighty-three Widal-positive and/or cultureconfirmed patients with typhoid fever during November 2003–April 2006 were included in the study. Most (93%) patients were children. Eighty-one percent was treated at the outpatient department. The average duration of hospitalization for child and adult patients was 8.4 and 4.2 days respectively. The average cost of treating children, adults, and all patients was US$ 16.72, 72.71, and 20.77 respectively (in 2004 prices). Recalculation based on 80% occupancy rate in inpatient wards (following the recommendation of the World Health Organization) found that the cost of treating children, adults, and all patients was US$ 14.53, 36.44, and 16.11 respectively.

Factors associated with reported diarrhoea episodes and treatment-seeking in an urban slum of Kolkata, India.

In an urban slum in eastern Kolkata, India, reported diarrhoea rates, healthcare-use patterns, and factors associated with reported diarrhoea episodes were studied as a part of a diarrhoea-surveillance project. Data were collected through a structured interview during a census and healthcare-use survey of an urban slum population in Kolkata. Several variables were analyzed, including (a) individual demographics, such as age and educational level, (b) household characteristics, such as number of household members, religious affiliation of the household head, building material, expenditure, water supply and sanitation, and (c) behaviour, such as hand-washing after defecation and healthcare use. Of 57,099 study subjects, 428 (0.7%) reported a diarrhoea episode sometime during the four weeks preceding the interview. The strongest independent factors for reporting a history of diarrhoea were having another household member with diarrhoea (adjusted odds ratio [OR]=3.8; 95% confidence interval [CI] 3.3-4.4) and age less than 60 months (adjusted OR=3.7; 95% CI 3.0-4.7). The first choice of treatment by the 428 subjects was as follows: 151 (35%) had self- or parent-treatment, 150 (35%) consulted a private allopathic practitioner, 70 (16%) went directly to a pharmacy, 29 (7%) visited a hospital, 14 (3%) a homoeopathic practitioner, 2 (0.5%) an ayurvedic practitioner, and 12 (3%) other traditional healers. The choices varied significantly with the age of patients and their religion. The findings increase the understanding of the factors and healthcare-use patterns associated with diarrhoea episodes and may assist in developing public-health messages and infrastructure in Kolkata.