A cross-sectional study on factors including HIV testing and counselling determining unsafe injecting practices among injecting drug users of Manipur.

In India, a steep increase in the prevalence of HIV (0% to 50% within six months) among the IDUs has been reported in Manipur, a north eastern state in 1990. In spite of large scale intervention program like educational campaign and widespread voluntary HIV testing in this state, the infection has quickly spread to the heterosexual population at large. The determinants of risk taking behaviors like sharing of unclean needle among the IDU population has been explored in this paper. A cross sectional study has been carried out among all of the 488 IDUs who attended any detoxification centers and prison during last two years at Imphal, the capital city of this state. Self reported behaviors based on the pre-scheduled interview were recorded and participation rate was satisfactory. The data was compared to a similar survey carried out by us in 1990. Although there has been decline in risk behavior among the IDUs, a logistic regression analysis reveals that unsafe needle sharing behavior is not influenced by the knowledge on HIV transmission, educational status or history of HIV testing or serostatus of the individual. The limitation of cross sectional nature of the study, bias due to collection of data in prison, self reported behavior, possible differences with street samples of the addict are discussed.

Clinical features of HIV infection in drug users of Manipur.

BACKGROUND. The human immunodeficiency virus was first detected in young intravenous drug users in Manipur in 1989 and it quickly reached a high prevalence in this group. Diagnostic facilities are scarce and it is thus important to suspect the presence of the infection by its clinical features. METHODS. We did a cross-sectional survey for 13 months among residents of different detoxification centres of Imphal, Manipur, to study the sensitivity, specificity and positive predictive values of different signs and symptoms occurring at the early phase of the infection. RESULTS. Most of the young injectors in this survey were found to be in the early phases (stage I 43%; stage II 32%; stage III 15% and stage IV 9.9%) of the World Health Organization clinical staging of human immunodeficiency virus infection and disease. Herpes zoster, oral candidiasis, pruritic papular eruptions, jaundice and lymphadenopathy had positive predictive values of 100%, 100%, 93%, 93% and 88% respectively. Cryptosporidial diarrhoea and tuberculosis (pulmonary and extrapulmonary) were also encountered. CONCLUSION. Intravenous drug users in Manipur who have human immunodeficiency virus infection suffer from different opportunistic infections which give rise to clinical features that are easily recognizable. It is important to be aware of these in areas which lack diagnostic facilities for confirming the infection.

Implementation of ORT: some problems encountered in training of health workers during an operational research programme.

During an operational research study on implementation of oral rehydration therapy in a block of West Bengal, India, amongst a population of 2, 16,805, a total of 171 Community Health Guides and 152 Anganwadi Workers were initially trained for one working day by lectures and slides about diarrhoea case management at the community level. The training was evaluated after two months and found to be inadequate. The workers were then retrained with modern approach using a module (prepared in local language) as suggested by World Health Organisation. The level of retention of the imparted knowledge of Health Workers for different items 2-3 months after training with lectures and slides ranged between 5-25% except preparation of ORS which was 80%. With the use of modules, 47-98% of health workers could retain the same knowledge 3 months after the training. The knowledge thus acquired were sustained even after 12 months of training to a level which was still much better than that retained 2 months after training with slides and lectures. However some of the items like indication of use of Home Available Fluids, dosage of ORS and when to refer a diarrhoea case to health facility were more difficult to recall after one year. This possibly indicates need for in-service training of grassroot level health workers at suiTable interval.

Herpes zoster in an HIV-positive 14-month-old baby.

BACKGROUND. In Manipur, a state in northeast India bordering Myanmar, within one year of reports of a high human immunodeficiency virus (HIV) seroprevalence among young injecting drug users, there has been a rapid spread of HIV infection in the general population. METHODS. Since 1990 our unit, together with the Medical Directorate, Government of Manipur, has studied different aspects of this epidemic, especially the natural history of HIV in this setting. RESULTS. Here we report the first case of herpes zoster in a 14-month-old HIV-positive baby (diagnosed by the polymerase chain reaction). The case was referred to our clinic by one of our patients residing in the same locality as the child and presently working as a counsellor in a drug detoxification-cum-rehabilitation centre at Imphal, Manipur. Dual infection of HIV and herpes zoster was also found in several other members of the same family. CONCLUSION. This report of perinatally acquired HIV infection in an environment of injecting drug users in India might help in understanding the course of paediatric HIV infection here.

An outbreak of acute diarrhoeal disease amongst tribal population in Tripura.

A massive outbreak of acute diarrhoeal diseases occurred during March-April, 1992 in the north district of Tripura. Investigation of the outbreak revealed Vibrio cholerae 01 biotype ElT or as the main etiologic agent in 50 per cent of patients. The outbreak which started amongst the tribal population might have spread due to prevailing illiteracy, poverty, low personal and domestic hygiene and vulnerable water sources (chhara water).

Prevalence of diarrhoeal diseases amongst tribals of Car Nicobar Island, India.

In a cross sectional study of total 14514 tribal Nicobarese people of Car Nicobar Island, an union territory of India, situated in Bay of Bengal, morbidity, mortality and treatment practices of diarrhoeal diseases of under-five children were surveyed. The incidence of diarrhoea (0.2 episode/ch.year), Crude death rate (3.6/1000) and IMR (31/1000 live births) were exceedingly low as compared to SouthEast Asian Countries including mainland of India. ORS utilisation rate was high (41%) as compared to the National figure (12.0%). This is the first study of it's kind carried out in this island and amongst the Nicobarese tribe in India. A preliminary study carried out among the mothers of the hospitalised children indicated that protective behaviours like breast feeding, hand washing, use of chlorinated water and proper disposal of stool were regularly being practiced by the community traditionally. An in-depth study on risk factors of diarrhoea in this island can yield useful clue for describing the same.

An operational study on implementation of oral rehydration therapy in a rural community of West Bengal, India.

An operational study of a 3-tier strategy for implementation of oral rehydration therapy (ORT) was conducted in a block of West Bengal with 216,825 population through the existing health services facilities. All the grassroot level, health workers including their supervisors at various levels were trained regarding the management of patients of diarrhoea with mild to moderate degree of dehydration, by ORT. Another block in the same district with similar demographic features where this intervention was not provided served as control. After 22 months of observation, it was evident that despite adequate training, the performance of Community Health Guides (CHGs) and Anganwadi Workers (AWWs) was not encouraging because of the low utilization of both home available fluids (32.0%) and oral rehydration solution (18.0%) in the study area. Similarly, diarrhoea associated mortality could not be reduced significantly. Lack of motivation and failure to maintain sustained level of skill by the CHGs and AWWs constitute the major bottlenecks for the successful implementation of the programme at the community level.

Effectiveness of oral rehydration salt solution (ORS) in reduction of death during cholera epidemic.

An extensive outbreak of acute gastroenteritis involving all age group of patients occurred during July-September, 1978 in the Central district of Manipur state. A total of 4469 cases occurred during the period. 45.7% of diarrhoea cases sampled and 47.6% of water samples collected from rivers were found to be positive for V.cholerae biotype EITor. Case fatality rate in this epidemic was exceptionally low (0.8%) which was attributed to the early domiciliary use of oral rehydration salt solution (ORS) in the affected villages. Utility of ORS in drastic reduction of case fatality rate during any epidemic situation was first of its kind in the Indian scene.

Multidrug resistant epidemic shigellosis in a village in west Bengal, 1984.

An out break of acute bacillary dysentery in a village called Dhamasin in Hooghly district of West Bengal was investigated during March 1984. Forty seven percent of families were affected. A total of 91 cases and 2 deaths occurred amongst 937 people giving an over all attack rate of 9.7% and a case fatality rate of 2.2 percent. Highest attack rate (22.7%) was observed in below one year age group. Multiple drug resistant Shigella dysentery type 1 strains were isolated for the first time from 6 out of 22 cases sampled at the domiciliary level. The organism was never isolated earlier during last ten years of surveillance in the infectious Diseases Hospital, Calcutta. Identification of nature of this outbreak and it's causative agent helped to realise the potentiality of extensive spread and paved the way for further investigations. Public health authorities were buffled as the rapid spread of the disease throughout the entire state of West Bengal could not be contained in spite of instituting all probable control measures on war footing.

Global review on ORT (oral rehydration therapy) programme with special reference to Indian scene.

This communication is an attempt to review the status and implementation of the Oral Rehydration Therapy in the programme for Control for Diarrhoeal Diseases. The Global and the Indian situations are separately discussed, with more emphasis on the latter. Use of Home Available Fluids (HAF), Salt Sugar Solution (SSS). Commercial packets of ORS and the Government supplied packets of ORS are also assessed.

Clinical & bacteriological profiles of shigellosis in Calcutta before & after an epidemic (1984-87).

Patients below 5 yr of age, hospitalised for shigellosis over a period of four years (1984-87), were studied. During the epidemic of bacillary dysentery (1984) isolation of different Shigella spp. as well as Shigella dysenteriae type 1 was high. Decreased isolation of Sh. dysenteriae type 1 and increased isolation of Sh. flexneri was observed during post-epidemic years (1985-87). Isolation of different Shigella spp. was always above 25 per cent from patients with dysentery and greater than 7 per cent from those with watery diarrhoea during the post-epidemic years. Higher incidence of shigellosis was observed amongst older children (greater than 3 yr). Most of the shigellosis patients complained of blood and mucus in stools. Vomiting was common among shigellosis patients presenting with watery diarrhoea whereas fever was commonly seen in patients with both dysentery and watery diarrhoea. Most patients of shigellosis presenting with blood and mucus in stools had no dehydration.