Implementation Research: The Need of the Hour

Formative research creates evidence. Evidence-based interventions are implemented in community settings. In the past, evidence-based interventions have failed to get desired outcomes. The tuberculosis control program despite being evidence based did not succeed at the beginning. Similarly, evidence-based treatment of hypertension and diabetes has not yet controlled these diseases. This is where the role of implementation research (IR) starts. IR either as part of evidence-based research or independently should be a part of health programs so that the program shall be able to ensure feasibility, fidelity, penetration, acceptability, sustainability, efficiency, effectiveness, and equity

Burden of sickle cell disease in tribal students in Maa-Baadi institutions in southern Rajasthan - A pilot study

Background & objectives: Sickle cell disease (SCD), an inherited disorder of erythrocytes, is highly prevalent in the tribal population of India. The tribal population of India is approximately 100 million and it is necessary to identify the magnitude of this problem. Furthermore, the prevalence of the disease is unknown among the five million tribal people of southern provinces of Rajasthan. In this study, we intended to determine the prevalence and characteristics of sickle cell disorder among the tribal inhabitants of southern Rajasthan. Methods: This cross-sectional study was conducted among the tribal students of the Maa-Baadis and hostels situated in the five tribal sub-plan districts of Rajasthan. Maa-Baadi centres are located in every village, whereas for every four to five villages, one hostel is allocated to accommodate the tribal students. The screening for SCD was done by solubility test and electrophoresis was used for confirmation. Results: A total of 36,752 tribal students were screened from 1,006 Maa-Baadi centres and 243 hostels. The prevalence of SCD among the tribal students was 5.8 per cent. The prevalence of heterozygous and homozygous conditions was 5.61 and 0.17 per cent, respectively. Among the five sub-plan districts, the highest prevalence was observed in Sirohi district (10.5%) followed by Banswara (7.42%), Udaipur (6.53%), Pratapgarh (5.51%) and Dungarpur (1.89%). Among the four major tribes belonging to these districts, the highest prevalence was recorded in Garasia tribes (13.81%). The history of leg ulcers and the mean pulse rate were significantly high in SCD individuals. Interpretation & conclusions: SCD is a significant problem among the tribes of southern Rajasthan, with the highest prevalence among the Garasia tribe. The present study recommends that a structured screening programme targeting the entire tribal population with appropriate counselling as well as providing treatment through the existing health system is the need of the hour.

Spatial Epidemiology of COPD in Delhi, India

Introduction?Chronic obstructive pulmonary disease (COPD) and bronchial asthma are the most common chronic respiratory illnesses. COPD is one of the three most common causes of death worldwide. The main burden of mortality from COPD is seen in Latin America, sub-Saharan Africa, India, China, and South-East Asia. Absence of true prevalence values and mortality burden hinder planning and operationalization of public health interventions for prevention, control, and treatment of the disease. Further, the aggregated value of prevalence estimates calculated for a whole city or a larger geographical area does not provide the location of patients and presence of locally prevalent risk factors. The objective of this study was to understand the spatial distribution of COPD in a large, highly polluted city of a developing country. Materials and Methods?A cross-sectional community-based study was conducted in the National Capital Territory of Delhi (NCTD). All surveyed households were geocoded. GOLD screening criteria and pulmonary function tests using portable digital spirometer were used for diagnosis of COPD. Results?Results are presented as a series of maps depicting spatial epidemiology. Overall prevalence rate was 9.8/1,000 population. Highest prevalence was seen in industrial area. Most of the spatial hotspots were seen in industrial and slum areas. Similarly, Kernel density was also highest in industrial area. Conclusion?In the city of NCTD, we found the COPD being distributed in all types of habitations but spatial distribution helped us understand clustering of cases and compare prevalence rates in subunits of residential clusters within a metropolitan city.

ROLE OF ADVERTISING IN CONSUMER'S BUYING DECISION : A REVIEW OF LITERATURE

Literature review is an account of what has been published in connection with this research. The main purpose is to gain knowledge and ideas based on the previous establishment and get to know what their strength and weakness are in order to further enhance and upgrade the integration. It identifies the work done by other authors. This paper describes explores various studies that are related with role of advertising in consumer's buying decision

AtMBD4: A methylated DNA binding protein negatively regulates a subset of phosphate starvation genes

DNA methylation is an important epigenetic modification that governs transcriptional regulation. The methylation mark isread by a special class of proteins called methyl-CpG-binding domain proteins. The role of DNA methylation has beenfound in X-chromosome inactivation, genomic imprinting, transposon silencing, and self-incompatibility. Recently,remodeling of global DNA methylation was demonstrated in Arabidopsis during low phosphate availability. The presentstudy reports that AtMBD4 gene of Arabidopsis negatively regulates phosphate starvation. The T-DNA insertion mutation atthe AtMBD4 locus exhibited altered root architecture as compared to wild-type plants. Using microarray hybridization andanalysis, an increased transcript accumulation of 242 genes was observed in the mutant. Many of these genes were relatedto phosphate transporters and transcription factors, involved in phosphate starvation response. Comparison of data ofatmbd4 mutant with publicly available microarray data of phosphate starvation response indicated the role of AtMBD4protein in phosphate starvation response. Further, promoter analysis of up-regulated genes suggested that cis-regulatoryelements like MBS, W-box, and B1BS are more prominent in the promoters of up-regulated genes. Upon performing amethylation-specific PCR, a decreased DNA methylation in the promoter regions of up-regulated genes was observed. Theaccumulation of anthocyanin and inorganic phosphate in the atmbd4 mutant was found to be higher than the wild-typeplant. Altered root morphology, up-regulation of phosphate starvation-induced genes in atmbd4 mutant suggests thatAtMBD4 negatively regulates the phosphate starvation response.

Assessment of timely immunization in an urbanized agglomeration of East Delhi, India

Background: The under-5 mortality rate in India has shown a decline in the last few decades. However, there is still a lot of work to be done for our country to achieve sustainable developmental goals. One of the factors contributing to child survival is immunization coverage, but high coverage does not mean timely vaccination. ‘On time’ immunization is an important yet little researched factor shielding a child from susceptibility to vaccine preventable diseases. This study aims at assessing the extent of timely immunization and predictors of intentional delay in vaccination of children.Methods: A cross-sectional study was conducted in East Delhi among caregivers having a child in the age group of 13-24 months. Sample size was calculated at 95% confidence limit and 3.5% absolute precision. The final sample size obtained was 350.Results: The percentage of fully and timely vaccinated children is 67.1%, whereas children fully vaccinated but with a delay of 4 weeks from the recommended age of administration is 19.7%. Partial vaccination was found in 11.2% of children and 2% of children were found to be not vaccinated. The most common reason for delay in immunization was pain at the time of administration leading baby cries and fear of needles (26.1%), followed by bad experience with previous vaccination (11.6%). Fear of side effects (14.5%) and being denied vaccination without card (11.6%) were other reasons.Conclusions: The immunization program should include timely completion of vaccination as a quality indicator. Delayed immunization can lead to epidemics in the community and threaten the goal of elimination of vaccine preventable diseases. Improving timeliness can be successfully achieved if the reasons for delay are taken into account.

Application of GIS in public health in India: A literature-based review, analysis, and recommendations.

The implementation of geospatial technologies and methods for improving health has become widespread in many nations, but India's adoption of these approaches has been fairly slow. With a large population, ongoing public health challenges, and a growing economy with an emphasis on innovative technologies, the adoption of spatial approaches to disease surveillance, spatial epidemiology, and implementation of health policies in India has great potential for both success and efficacy. Through our evaluation of scientific papers selected through a structured key phrase review of the National Center for Biotechnology Information on the database PubMed, we found that current spatial approaches to health research in India are fairly descriptive in nature, but the use of more complex models and statistics is increasing. The institutional home of the authors is skewed regionally, with Delhi and South India more likely to show evidence of use. The need for scientists engaged in spatial health analysis to first digitize basic data, such as maps of road networks, hydrological features, and land use, is a strong impediment to efficiency, and their work would certainly advance more quickly without this requirement.

Hepatitis C virus (HCV) infection & risk factors for HCV positivity in injecting & non-injecting drug users attending a de-addiction centre in northern India.

Background & objectives: Injecting drug use is a major route of hepatitis C virus (HCV) infection in India, but there may be other risk factors also. this study was carried out to determine the seroprevalence of anti-HCV antibody in injecting drug users (IDUs) vs. non-IDUs (NIDUs), and to study the risk estimates for HCV seropositivity in the total sample of substance users with regard to various demographic, clinical, behavioural and personality factors. Methods: the IDUs (n = 201) and NIDUs (n = 219) were assessed for demographic, clinical and behavioural information, and were rated on instruments for severity of dependence, risk behaviour and personality profiles. Anti-HCV antibody was tested by ELISA and confirmed by recombinant immunoblot assay (RIBA) test. Results: Almost one-third of the IDUs (64 of 201; 31.8%) were positive for anti-HCV antibody, as opposed to only seven (3.2%) of the NIDUs. The four risk factors strongly associated with HCV positivity in multivariate analysis were sharing syringe [Exp(B) 75.04; 95%CI 18.28-307.96; P<0.001], reuse of injection accessories (16.39; 3.51-76.92; P<0.001), blood transfusion (5.88; 1.63-21.23; P=0.007) and IDU status (3.60; 1.26-10.31; P=0.017). Other variables less strongly but significantly associated with HCV positivity were multiple sex partners, opioid dependence, risk behaviour scores, impulsivity, and lower age of onset of drug use. Interpretation & conclusions: Our study showed a high seroprevalence of anti-HCV antibody in IDUs. In the substance users, HCV positivity was significantly and independently associated with several clinical, behavioural, and personality risk factors.

Predictors of mortality among the neonates transported to referral centre in Delhi, India.

A descriptive study was conducted with an objective to determine the predictors of mortality among referred neonates and to ascertain their transport characteristics. A total of 300 consecutive neonates who were transferred to the centre were enrolled in the study. Following information were recorded: maternal details, birth details, interventions before transportation, details of transportation and neonatal condition at arrival. Detailed clinical assessment and management was done as per standard neonatal protocols. Birth weight <1 kg (OR 0.04; 95% CI: 0.006-0.295, P<0.01) and transportation time >1 hour (OR 5.58; 95% CI: 1.41-22.01, P=0.01) were found to be significant predictors for mortality among the transported neonate. Transport characteristics reflect road transport with limited utility of ambulances and lack of trained health personal. Hence to conclude, extreme low birth weight and prolonged transportation time were found to be significant predictors of neonatal mortality among the transported neonate.

Predictors of knowledge about malaria in India.

BACKGROUND & OBJECTIVES: Reduction of malarial morbidity and mortality is important to meet the overall objectives of reducing poverty and has been included in the Millennium Development Goals. To achieve these targets it is imperative to have active community participation to control malaria. Community participation in turn depends on people's knowledge and attitude towards the disease.This study was conducted to examine the factors that predict the knowledge of Indian population regarding malaria. A questionnaire based cross-sectional survey was conducted for data collection. RESULTS: Data were collected from 15,750 adult respondents using a pre-tested questionnaire representing urban, rural, tribal and slum population from 21 states. Knowledge about various aspects of malaria was tested using a structured questionnaire. Logistic regression analysis was applied to determine predictors of knowledge about etiology, clinical features, mode of transmission, prevention and control. INTERPRETATION & CONCLUSION: Common predictors of correct knowledge about etiology and clinical features of malaria were male sex and college education. Female sex, illiteracy and tribal population were more likely to have been associated with wrong beliefs about fatality of malaria. Being tribal respondent was the single most important predictor of inadequate knowledge. Similarly, use of smoke for killing of adult mosquito was predicted by rural or slum residence and illiteracy. All findings were based on logistic regression analysis. Geographical variations also influenced knowledge about malaria. It may be inferred that improvement in knowledge, attitude and practices related to malaria may be attained only after looking at its predictors at micro level. However, a strategic framework at national level is certainly needed to provide directions at local level.

Modification of small bowel microflora in chronic alcoholics with alcoholic liver disease.

The bacterial flora of the gastrointestinal tract plays an essential role in human physiology. Our aim was to study the pattern of change in bacterial microflora in the small intestines of patients with chronic alcoholic liver disease (ALD). Patients of ALD made up the test group and nonalcoholics served as controls. Duodenal (D2) biopsies were obtained by upper gastrointestinal endoscopy and processed immediately for microbiological analysis. Marked qualitative and quantitative alterations of small intestinal microflora was documented in chronic alcoholics. There was increased bacterial growth of both gram-positive cocci and gram-negative bacilli in the ALD group.