Antibiotic consumption in secondary and tertiary hospitals in Colombia: national surveillance from 2018-2020 / Consumo de antibióticos en hospitales de segundo y tercer nivel en Colombia: vigilancia nacional entre 2018 y 2020 / Consumo de antibióticos em hospitais secundários e terciários da Colômbia: vigilância nacional de 2018 a 2020

ABSTRACT Objective. To assess the compliance in secondary and tertiary level hospitals with monthly reporting of antibiotic consumption to the Colombian National Public Health Surveillance System (SIVIGILA-INS), and to describe reported antibiotic consumption during 2018-2020. Methods. This study involved a secondary analysis of antibiotic consumption data reported to SIVIGILA-INS. Frequency of hospital reporting was assessed and compared against expected reports, disaggregated by intensive care units (ICU)/non-ICU wards and geographical regions. Consumption was expressed as defined daily dose (DDD) per 100 occupied beds for seven antibiotics. Results. More than 70% of hospitals reported antibiotic consumption at least once in each of the three years (79% in ICU and 71% in non-ICU wards). Of these, ICU monthly reporting was complete (12 monthly reports per year) for 59% in the period 2018-2019 but only 4% in 2020. Non-ICU reporting was complete for 52% in 2019 and for 2% in 2020. Most regions had an overall decrease in reporting in 2020. Analysis of antibiotic consumption showed an increase for piperacillin/tazobactam, ertapenem, and cefepime from 2019 to 2020. Conclusions. There were gaps in the consistency and frequency of reporting. Efforts are needed to improve compliance with monthly reporting, which declined in 2020, possibly due to the COVID-19 pandemic. Non-compliance on reporting and data quality issues should be addressed with the hospitals to enable valid interpretation of antibiotic consumption trends.

RESUMEN Objetivo. Evaluar el cumplimiento de los hospitales de segundo y tercer nivel en la presentación mensual de información sobre el consumo de antibióticos en el Sistema Nacional de Vigilancia en Salud Pública de Colombia (SIVIGILA-INS) y describir el consumo de antibióticos reportado en el período 2018-2020. Métodos. Este estudio incluyó un análisis secundario de los datos del consumo de antibióticos reportado en SIVIGILA-INS. Se evaluó la frecuencia de los informes hospitalarios y se comparó con los informes esperados, desglosados por unidad de cuidados intensivos (UCI) y otros servicios distintos a la UCI, y por región geográfica. El consumo se expresó en dosis diaria definida (DDD) por 100 camas ocupadas para siete antibióticos. Resultados. Más del 70% de los hospitales notificaron el consumo de antibióticos al menos una vez en cada uno de los tres años (79% en la UCI y 71% en los servicios distintos a la UCI). De estos, el 59% de las UCI completaron los informes mensuales (12 informes en un año) entre el 2018 y el 2019, pero solo el 4% en el 2020. El 52% de los servicios distintos a la UCI completó los informes en el 2019 y el 2% en el 2020. En la mayoría de las regiones hubo una disminución general de la notificación en el 2020. El análisis del consumo de antibióticos mostró un aumento de piperacilina/tazobactam, ertapenem y cefepima del 2019 al 2020. Conclusiones. Se encontraron disparidades en la coherencia y en la frecuencia de la presentación de informes. Es necesario destinar esfuerzos para mejorar el cumplimiento de la notificación mensual, que disminuyó en el 2020 posiblemente debido a la pandemia de COVID-19. La falta de cumplimiento en la presentación de los reportes y los problemas de calidad de los datos deben abordarse con los hospitales para facilitar la interpretación válida de las tendencias de consumo de antibióticos.

RESUMO Objetivo. Avaliar o cumprimento da exigência de notificar mensalmente o consumo de antibióticos em hospitais secundários e terciários ao Sistema Nacional de Vigilância em Saúde Pública da Colômbia (SIVIGILA-INS) e descrever o consumo informado de antibióticos de 2018 a 2020. Métodos. Este estudo envolveu uma análise secundária dos dados de consumo de antibióticos enviados para o SIVIGILA-INS. A frequência de notificação pelos hospitais foi avaliada e comparada com a frequência esperada. Os dados foram desagregados entre unidades de terapia intensiva (UTIs) e enfermarias gerais e por regiões geográficas. O consumo foi expresso como dose diária definida (DDD) por 100 leitos ocupados para sete antibióticos. Resultados. Mais de 70% dos hospitais notificaram consumo de antibióticos pelo menos uma vez em cada um dos três anos (79% na UTI e 71% nas enfermarias gerais). Entre eles, 59% dos hospitais enviaram todas as notificações relativas a UTIs (12 notificações mensais) no período de 2018 a 2019, mas apenas 4% o fizeram em 2020. No caso das enfermarias gerais, 52% dos hospitais enviaram todas as notificações em 2019 e 2% o fizeram em 2020. A maioria das regiões teve uma diminuição geral no número de notificações enviadas em 2020. A análise do consumo de antibióticos revelou um aumento no uso de piperacilina/tazobactam, ertapeném e cefepima de 2019 para 2020. Conclusões. Houve lacunas na uniformidade e frequência das notificações. São necessários esforços para melhorar o cumprimento da exigência de notificações mensais, que, possivelmente devido à pandemia de COVID‑19, diminuiu em 2020. Problemas relacionados ao não cumprimento da exigência de notificação e à qualidade dos dados devem ser resolvidos junto aos hospitais para permitir uma interpretação válida das tendências de consumo de antibióticos.

Bloodstream infections and antibiotic resistance at a regional hospital, Colombia, 2019-2021 / Infecciones del torrente sanguíneo y resistencia a los antibióticos en un hospital regional en Colombia, 2019-2021 / Infecções de corrente sanguínea e resistência a antibióticos em um hospital regional, Colômbia, 2019-2021

ABSTRACT Objectives. To assess antibiotic susceptibility of World Health Organization (WHO) priority bacteria (Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Salmonella spp., Staphylococcus aureus, and Streptococcus pneumoniae) in blood cultures at the Orinoquía regional hospital in Colombia. Methods. This was cross-sectional study using routine laboratory data for the period 2019-2021. Data on blood samples from patients suspected of a bloodstream infection were examined. We determined: the total number of blood cultures done and the proportion with culture yield; the characteristics of patients with priority bacteria; and the type of bacteria isolated and antibiotic resistance patterns. Results. Of 25 469 blood cultures done, 1628 (6%) yielded bacteria; 774 (48%) of these bacteria were WHO priority pathogens. Most of the priority bacteria isolated (558; 72%) were gram-negative and 216 (28%) were gram-positive organisms. Most patients with priority bacteria (666; 86%) were hospitalized in wards other than the intensive care unit, 427 (55%) were male, and 321 (42%) were ≥ 60 years of age. Of the 216 gram-positive bacteria isolated, 205 (95%) were Staphylococcus aureus. Of the 558 gram-negative priority bacteria isolated, the three most common were Escherichia coli (34%), Klebsiella pneumoniae (28%), and Acinetobacter baumannii (20%). The highest resistance of Staphylococcus aureus was to oxacillin (41%). For gram-negative bacteria, resistance to antibiotics ranged from 4% (amikacin) to 72% (ampicillin). Conclusions. Bacterial yield from blood cultures was low and could be improved. WHO priority bacteria were found in all hospital wards. This calls for rigorous infection prevention and control standards and continued surveillance of antibiotic resistance.

RESUMEN Objetivos. Evaluar la sensibilidad a los antibióticos de las bacterias incluidas en la lista prioritaria de la Organización Mundial de la Salud (OMS) (Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Salmonella spp., Staphylococcus aureus y Streptococcus pneumoniae) en hemocultivos en el Hospital Regional de la Orinoquía en Colombia. Métodos. Se trata de un estudio transversal que empleó datos rutinarios de laboratorio del período comprendido entre los años 2019 y 2021. Se examinaron datos de muestras de sangre de pacientes con presunción clínica de infección del torrente sanguíneo. Se determinó el número total de hemocultivos realizados y la proporción cultivos con resultados, las características de los pacientes con bacterias prioritarias, así como el tipo de bacterias aisladas y los patrones de resistencia a los antibióticos. Resultados. De 25 469 hemocultivos realizados, se aislaron bacterias en 1628 (6%); 774 (48%) con agentes patógenos prioritarios de la OMS. La mayoría de las cepas bacterianas prioritarias aisladas (558; 72%) eran gramnegativas y 216 (28%), organismos grampositivos. La mayoría de los pacientes con bacterias prioritarias (666; 86%) fueron hospitalizados en salas distintas de la unidad de cuidados intensivos, 427 (55%) eran varones y 321 (42%) tenían 60 años o más. De las 216 bacterias grampositivas aisladas, 205 (95%) eran Staphylococcus aureus. De las 558 bacterias prioritarias gramnegativas aisladas, las tres más comunes fueron Escherichia coli (34%), Klebsiella pneumoniae (28%) y Acinetobacter baumannii (20%). La mayor resistencia de Staphylococcus aureus fue a la oxacilina (41%). Entre las bacterias gramnegativas, la resistencia a los antibióticos varió del 4% (amikacina) al 72% (ampicilina). Conclusiones. El aislamiento de bacterias en los hemocultivos fue bajo y podría mejorarse. Se encontraron bacterias de la lista prioritaria de la OMS en todas las salas del hospital, por lo que es necesario aplicar rigurosas normas de prevención y control de infecciones y realizar una vigilancia continua de la resistencia a los antibióticos.

RESUMO Objetivos. Avaliar a suscetibilidade a antibióticos das bactérias consideradas prioritárias pela Organização Mundial da Saúde (OMS) (Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Salmonella spp., Staphylococcus aureus e Streptococcus pneumoniae) em hemoculturas coletadas no hospital regional de Orinoquía na Colômbia. Métodos. Estudo transversal utilizando dados laboratoriais de rotina do período 2019-2021. Foram examinados os dados de amostras de sangue de pacientes com suspeita de infecção de corrente sanguínea. Determinamos o número total de hemoculturas realizadas e a proporção de culturas com rendimento, as características dos pacientes com bactérias prioritárias, e o tipo de bactéria isolada e padrões de resistência a antibióticos. Resultados. Das 25.469 hemoculturas realizadas, 1.628 (6%) foram positivas para bactérias, sendo que 774 (48%) dessas bactérias eram da lista de agentes patogênicos prioritários da OMS. A maioria das bactérias prioritárias isoladas (558; 72%) eram gram-negativas e 216 (28%) eram gram-positivas. A maioria dos pacientes com bactérias prioritárias (666; 86%) estava internada em enfermaria, e não em unidade de terapia intensiva. 427 (55%) eram homens e 321 (42%) tinham ≥ 60 anos de idade. Das 216 bactérias gram-positivas isoladas, 205 (95%) eram Staphylococcus aureus. Das 558 bactérias gram-negativas prioritárias isoladas, as três mais frequentes foram Escherichia coli (34%), Klebsiella pneumoniae (28%) e Acinetobacter baumannii (20%). O Staphylococcus aureus apresentou maior resistência à oxacilina (41%). Entre as bactérias gram-negativas, a resistência aos antibióticos variou entre 4% (amicacina) e 72% (ampicilina). Conclusões. O rendimento bacteriano das hemoculturas foi baixo e pode ser melhorado. As bactérias consideradas prioritárias pela OMS foram encontradas em todas as enfermarias do hospital. Os achados exigem normas rigorosas de prevenção e controle de infecção, e vigilância contínua da resistência bacteriana a antibióticos.

High levels of antimicrobial resistance in Escherichia coli and Salmonella from poultry in Ecuador / Niveles elevados de resistencia antimicrobiana de las bacterias Escherichia coli y Salmonella en aves de corral en Ecuador / Altos níveis de resistência aos antimicrobianos em Escherichia coli e Salmonella de aves de criação no Equador

ABSTRACT Objective. To describe antimicrobial resistance profiles of Escherichia coli and Salmonella spp. isolated from chicken carcasses and the antimicrobials commonly used in animals in Ecuador and provide information on antimicrobial resistance patterns for implementing evidence-based corrective measures. Methods. Meat samples were collected from chicken carcasses in 199 slaughterhouses across Ecuador as part of a national pilot study for monitoring antimicrobial resistance in agricultural sources in 2019. Samples were tested for E. coli and Salmonella spp. Sensitivity to 10 critically important and three highly important antimicrobials (from a human health perspective) was assessed. The country report submitted to the World Organization for Animal Health was accessed to extract the quantity of antimicrobials produced or imported for use in animals. Results. Of 383 samples, E. coli was isolated from 148 (39%) and Salmonella spp. from 20 (5%) samples. Ninety percent of the isolates were resistant to at least one critically important antimicrobial. Resistance was highest to erythromycin (E. coli 76%; Salmonella spp. 85%) and tetracycline (E. coli 71%; Salmonella spp. 90%). Critically or highly important antimicrobials (colistin, tetracycline, trimethoprim/sulfamethoxazole) formed the bulk (87%) of antimicrobials used in animals as per the World Organization for Animal Health report. Conclusions. High prevalence of antimicrobial resistance in poultry in Ecuador calls for the development of guidelines and regulations on the use of antimicrobials and for engagement with livestock producers. The existing surveillance system needs to be strengthened to improve the monitoring of antimicrobial use and evolving resistance patterns.

RESUMEN Objetivo. Describir los perfiles de resistencia antimicrobiana de las bacterias Escherichia coli y Salmonella spp. aisladas en carne de pollo y los antimicrobianos comúnmente empleados en animales en Ecuador, así como proporcionar información sobre los patrones de resistencia a los antimicrobianos para poner en marcha medidas correctivas basadas en la evidencia. Métodos. Se recogieron muestras de carne de pollo en 199 mataderos de todo Ecuador en el marco de un estudio piloto nacional para monitorear la resistencia a los antimicrobianos en fuentes agrícolas en el 2019. Se analizaron las muestras en busca de E. coli y Salmonella spp. Se evaluó la sensibilidad a diez antimicrobianos de importancia crítica y tres muy importantes (para la salud humana). Se accedió al informe de país presentado ante la Organización Mundial de Sanidad Animal para obtener la cantidad de antimicrobianos producidos o importados para su uso en animales. Resultados. De 383 muestras, se aisló E. coli en 148 (39%) y Salmonella spp. en 20 (5%). En total, 90% de las cepas aisladas fueron resistentes a al menos un antimicrobiano de importancia crítica. Hubo una mayor resistencia a la eritromicina (E. coli: 76%; Salmonella spp.: 85%) y a la tetraciclina (E. coli: 71%; Salmonella spp.: 90%). Los antimicrobianos de importancia crítica o muy importantes (colistina, tetraciclina, trimetoprima/sulfametoxazol) constituyeron la mayor parte (87%) de los antimicrobianos empleados en animales según el informe de la Organización Mundial de Sanidad Animal. Conclusiones. Debido a la alta prevalencia de la resistencia a los antimicrobianos en las aves de corral en Ecuador, son imprescindibles la elaboración de directrices y regulaciones sobre el uso de antimicrobianos y el compromiso con los productores pecuarios. Es necesario fortalecer el sistema de vigilancia existente para mejorar el seguimiento del uso de antimicrobianos y de la evolución de los patrones de resistencia.

RESUMO Objetivo. Descrever perfis de resistência aos antimicrobianos em Escherichia coli e Salmonella spp. isoladas de carcaças de frango e os antimicrobianos comumente usados em animais no Equador e fornecer informações sobre padrões de resistência aos antimicrobianos para implementar medidas corretivas baseadas em evidências. Métodos. Foram coletadas amostras de carne de carcaças de frango em 199 abatedouros em todo o Equador como parte de um estudo piloto nacional para monitorar a resistência aos antimicrobianos de origem agrícola em 2019. Foram testadas amostras de E. coli e Salmonella spp. Foi avaliada a sensibilidade a 10 agentes antimicrobianos de importância crítica e três agentes antimicrobianos muito importantes (do ponto de vista da saúde humana). O relatório do país apresentado à Organização Mundial de Saúde Animal foi acessado para extrair a quantidade de antimicrobianos produzidos ou importados para uso em animais. Resultados. De 383 amostras, E. coli foi isolada em 148 (39%) e Salmonella spp. em 20 (5%). Noventa por cento dos isolados foram resistentes a pelo menos um antimicrobiano de importância crítica. A resistência foi maior à eritromicina (E. coli, 76%; Salmonella spp., 85%) e à tetraciclina (E. coli, 71%; Salmonella spp., 90%). Antimicrobianos de importância crítica ou muito importantes (colistina, tetraciclina, trimetoprim/sulfametoxazol) responderam pela maior parte (87%) dos antimicrobianos utilizados em animais, conforme o relatório da Organização Mundial de Saúde Animal. Conclusões. A alta prevalência de resistência aos antimicrobianos na avicultura no Equador exige o desenvolvimento de diretrizes e regulamentos sobre o uso de antimicrobianos e o envolvimento com os produtores de gado e avícolas. O sistema de vigilância existente precisa ser reforçado para melhorar o monitoramento do uso de antimicrobianos e a evolução dos padrões de resistência.

High level of infection prevention and control in surveyed hospitals in Colombia, 2021 / Nivel avanzado de prevención y control de infecciones en hospitales de Colombia en el 2021 / Alto nível de prevenção e controle de infecções em hospitais da Colômbia, 2021

ABSTRACT Objective. This study aimed to determine the performance of infection prevention and control (IPC) programs in eight core components in level 2 and level 3 hospitals across all provinces in Colombia. Methods. This cross-sectional study used self-assessed IPC performance data voluntarily reported by hospitals to the Ministry of Health and Social Protection during 2021. Each of the eight core components of the World Health Organization's checklist in the Infection Prevention and Control Assessment Framework contributes a maximum score of 100, and the overall IPC performance score is the sum of these component scores. IPC performance is graded according to the overall score as inadequate (0-200), basic (201-400), intermediate (401-600) or advanced (601-800). Results. Of the 441 level 2 and level 3 hospitals, 267 (61%) reported their IPC performance. The median (interquartile range [IQR]) overall IPC score was 672 (IQR: 578-715). Of the 267 hospitals reporting, 187 (70%) achieved an advanced level of IPC. The median overall IPC score was significantly higher in private hospitals (690, IQR: 598-725) than in public hospitals (629, IQR: 538-683) (P < 0.001). Among the core components, scores were highest for the category assessing IPC guidelines (median score: 97.5) and lowest for the category assessing workload, staffing and bed occupancy (median score: 70). Median overall IPC scores varied across the provinces (P < 0.001). Conclusions. This countrywide assessment showed that 70% of surveyed hospitals achieved a self-reported advanced level of IPC performance, which reflects progress in building health system resilience. Since only 61% of eligible hospitals participated, an important next step is to ensure the participation of all hospitals in future assessments.

RESUMEN Objetivo. El objetivo de este estudio es determinar el desempeño de los programas de prevención y control de infecciones (PCI) en relación con ocho componentes básicos en hospitales de nivel 2 y 3 de todas las provincias de Colombia. Métodos. En este estudio transversal se emplearon datos de autoevaluación del desempeño de los programas de PCI informados voluntariamente al Ministerio de Salud y Protección Social por parte de los hospitales durante el 2021. Cada uno de los ocho componentes básicos de la lista de verificación de la Organización Mundial de la Salud incluidos en el Marco de evaluación de prevención y control de infecciones al nivel de establecimientos de atención de salud recibe una puntuación máxima de 100, y la puntuación general del desempeño del programa es la suma de las puntuaciones de estos componentes. Este desempeño se califica según la puntuación general como inadecuado (0-200), básico (201-400), intermedio (401-600) o avanzado (601-800). Resultados. De los 441 hospitales de nivel 2 y nivel 3, 267 (61%) informaron datos sobre su desempeño. La mediana (rango intercuartil [IQR]) de la puntuación general fue de 672 (IQR: 578-715). De los 267 hospitales que proporcionaron información, 187 (70%) alcanzaron el nivel avanzado. La mediana de la puntuación general fue significativamente mayor en los hospitales privados (690, IQR: 598-725) que en los hospitales públicos (629, IQR: 538-683) (p < 0,001). En el caso de los componentes básicos, las puntuaciones más altas fueron para la categoría que evalúa las directrices de PCI (puntuación mediana: 97,5) y más bajas para la categoría que evalúa la carga de trabajo, la dotación de personal y la ocupación de camas (puntuación mediana: 70). La mediana de las puntuaciones generales de PCI varió entre las provincias (p < 0,001). Conclusiones. Esta evaluación a nivel nacional mostró que el 70% de los hospitales encuestados lograron un nivel avanzado autoinformado del desempeño en cuanto a la PCI, lo que refleja el progreso en fortalecimiento de la resiliencia del sistema de salud. Dado que solo participó el 61% de los hospitales que reunían las condiciones, el siguiente paso importante es garantizar la participación de todos los hospitales en futuras evaluaciones.

RESUMO Objetivo. Este estudo teve o objetivo de determinar o desempenho de programas de prevenção e controle de infecções (PCI) quanto a oito componentes centrais em hospitais secundários e terciários de todas as províncias da Colômbia. Métodos. Este estudo transversal utilizou dados de desempenho autoavaliado de PCI enviados voluntariamente pelos hospitais ao Ministério da Saúde e Proteção Social em 2021. Cada um dos oito componentes centrais da lista de verificação na Estrutura de Avaliação de Prevenção e Controle de Infecções da Organização Mundial da Saúde contribui com uma pontuação máxima de 100. A pontuação total de desempenho de PCI é a soma das pontuações nesses componentes. De acordo com a pontuação total, o desempenho de PCI é classificado nas seguintes categorias: inadequado (0-200), básico (201-400), intermediário (401-600) ou avançado (601-800). Resultados. Dos 441 hospitais secundários e terciários, 267 (61%) informaram o desempenho de PCI. A mediana (intervalo interquartil [IIQ]) da pontuação total de PCI foi 672 (IIQ: 578-715). Dos 267 hospitais que disponibilizaram informações, 187 (70%) alcançaram um nível de PCI avançado. A mediana da pontuação total de PCI foi significativamente maior nos hospitais privados (690, IIQ: 598-725) do que nos públicos (629, IIQ: 538-683) (p < 0,001). Entre os componentes centrais, as pontuações mais altas foram observadas na categoria de avaliação das diretrizes de PCI (pontuação mediana: 97,5), ao passo que as mais baixas ocorreram na categoria de avaliação da carga de trabalho, dotação de pessoal e taxa de ocupação de leitos (pontuação mediana: 70). As medianas das pontuações totais de PCI variaram entre províncias (p < 0,001). Conclusões. Esta avaliação nacional mostrou que 70% dos hospitais pesquisados alcançaram um nível avançado de desempenho autorrelatado de PCI, o que demonstra progresso no desenvolvimento de resiliência no sistema de saúde. Como apenas 61% dos hospitais elegíveis participaram, um próximo passo importante é assegurar a participação de todos os hospitais em futuras avaliações.

Is the Rule of Halves in Hypertension Valid Uniformly across India? A Cross-sectional Analysis of National Family Health Survey-4 Data

Background: Hypertension is widely prevalent across India. The rule of halves is commonly used to describe the attrition and gaps in the care cascade of hypertension management across detection, availing treatment, and having controlled blood pressure (BP) on treatment. Objectives: Using nationally representative data, we aimed to assess the rule of halves in hypertension management in different states of India and across sociodemographic, health system, and personal factors. Methods: A descriptive analysis of secondary data from the National Family Health Survey?4 was conducted. We included 770,662 individuals(112,122 men and 658,540 nonpregnant women) of 15–49 years of age. The proportion of individuals not aware of hypertension status among those with high BP, known hypertensives not availing of treatment, and uncontrolled BP among those on treatment were expressed as percentage with a 95% confidence interval (CI). Results: Of those with high BP, 48.5% (95% CI: 47.8%–49.3%) were not aware of their hypertensive status. Among known hypertensives, 72% (95% CI: 71.2%–72.8%) had not availed treatment for hypertension. Among those on treatment, 39.8% (95% CI: 38.7%–40.9%) had uncontrolled hypertension. Conclusion: The rule of halves of India shows that the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke has made relatively good progress with the detection of hypertension and achieving BP control among those on treatment. However, with three?fourth of known hypertensives not availing treatment, more dividends from the detection of hypertension efforts could be realized. The program needs to especially focus on ensuring the treatment for those detected with hypertension.

How good are we in detecting and screening for diabetes? Results from community-based survey in rural Puducherry, South India

Background: Early diagnosis is the mainstay for reducing complications associated with diabetes. Though blood sugar testing was made freely available, there is gap in utilization of the same. Hence, the current study was conducted to assess the detection gap in diabetes compared to regional estimates. Also, to assess the extent of screening and factors associated with not getting screened.Methods: A community based cross-sectional analytical study was conducted in the selected rural areas of Puducherry. House to house enumeration survey was conducted in the purposively selected rural areas during September-2016 to February-2017. Information on diabetes status, status of screening in last one year was collected from individuals aged more than eighteen years. Data was entered in Epidata 3.1 and analyzed using Stata 12 software. Percentages with 95% CI were used to estimate the detection gap in diabetes on comparing with regional estimates given by IDF (8.6%). Generalized Linear Models were used to assess the individual level characteristics associated with not screening for diabetes.Results: Of the total 1844 enumerated individuals, 1423 (78.6%) were above 18 years of age. The detection gap for diabetics based on IDF was 39% and based on DLHS-4 was 69.8%. Of the eligible individuals for screening 81.9% (95% CI: 79.7%-83.9%) were not screened for diabetes in last one year.Conclusions: With high detection gap and low utilization of screening, there is need for developing innovative strategies like task shifting, ICT utilization for screening and targeted screening.

Screening for autonomic neuropathy using validated non-invasive scale among diabetes patients treated in the selected primary health centres of Puducherry, India: an operational research

Background: Diabetes autonomic neuropathy (DAN) is a complication of diabetes which has direct implications on the mortality of diabetes patients. American Diabetes Association (ADA-2017) guidelines recommend early recognition and treatment of DAN. In this regard, we conducted a study among diabetic patients treated in the selected PHCs of Puducherry to determine the proportion with DAN and to assess the factors associated with DAN.Methods: A cross-sectional analytical study was conducted among diabetics and information on socio-demographic details, morbidity and behavioural risk factors were elicited using semi-structured interview schedule. The COMPASS-31 questionnaire was administered to assess the autonomic neuropathy symptoms. The data was captured using EpiCollect mobile app and analysed using Stata 12.0 software. The proportion of DAN was expressed as percentage with 95% confidence interval. The association between independent factors and DAN was assessed using multivariate generalized linear models. The prevalence ratio with 95% CI was used to express the strength of association.Results: Of the total 303 individuals with diabetes, 32 {10.6% (95% CI: 7.3%-14.6%)} were screened positive for autonomic neuropathy using COMPASS-31 scale. The number of individuals with diabetes who needed to be screened (NNS) for finding one with autonomic neuropathy was 10 (303/32).Conclusions: One in ten individuals with diabetes was screened positive for autonomic neuropathy. With good yield, there is need for including autonomic neuropathy screening as a component in the comprehensive care provided to diabetes patients in the primary health centres.

Attack rate and household secondary attack rate of acute conjunctivitis during an outbreak in South India: A community‑based survey.

Introduction: Knowledge on epidemiology of the disease in the contemporary world will help to develop appropriate strategies to curtail the transmission during an outbreak. This study was carried out during an outbreak of conjunctivitis in selected areas of Puducherry, South India, to assess the attack rate of conjunctivitis, identify factors associated with developing conjunctivitis and calculate household secondary attack rate (HSAR) of conjunctivitis and its correlates. Methodology: During December 2014, a community‑based survey was conducted in a selected urban and rural area in Puducherry, South India. Simple random sampling was used to select primary sampling units and systematic sampling to select households. All individuals in the selected households were studied. A questionnaire was used to obtain data on sociodemographic characteristics, conjunctivitis during September–November, 2014, and number of household contacts who developed conjunctivitis within 7 days of index case. The attack rate and HSAR of conjunctivitis was expressed as percentage. Multivariate logistic regression was used to find factors independently associated with developing conjunctivitis and also 100% HSAR. Results: Of 3193 study participants from 772 households, 509 (15.9%, 95% confidence interval 14.7–17.2%) had an attack of conjunctivitis during the reference period. Of the 772 households, 218 (28.2%) had at least one case of conjunctivitis. Of 218 households, 33 (15.1%) households had 100% HSAR. Lower age, not being unemployed, low socioeconomic status, and residing in rural area were independently associated with developing conjunctivitis. Index case being male and living in a household with ≥5 members were independently associated with 100% HSAR. Conclusion: In the outbreak under study, more than one‑fourth of households had at least one case of conjunctivitis and about one in every six individuals had an attack of conjunctivitis.