Polymerase Spiral Reaction (PSR) as a point-of-care diagnostic assay: A systematic review.

INTRODUCTION: The current systematic review aimed to collect and analyze the comprehensive evidence regarding Polymerase Spiral Reaction (PSR) and to estimate its diagnostic performance and usefulness as a point-of-care (PoC) assay. METHODS: Literature was retrieved systematically from 2015 to 2023 from PubMed and Scopus. Studies were screened and selected against pre-determined inclusion and exclusion criteria. Quality assessment and risk of bias were critiqued using QUADAS-2. A systematic, qualitative narrative synthesis was employed to synthesize the data. RESULTS: 11 studies were selected for the systematic review, testing diseases in humans utilizing PSR. Only 2 studies clinically validated the test with a sample size > 150. 5 studies were of poor quality; 3 studies were of moderate quality and 3 studies were deemed to be of high quality. 3 studies quantified the diagnostic throughput and reported clinical sensitivity and specificity of PSR approaching to be > 92% and ~ 100%, respectively. CONCLUSION: Polymerase spiral reaction promises to be an optimistic isothermal assay; however, a huge research gap can be attributed to the lack of statistical and clinical evidence to validate the assay. Adequate research, focused on optimization, coupled with statistical and clinical validation, can help in estimating its true diagnostic potential and applicability. REGISTRATION AND PROTOCOL: A detailed protocol of this review is registered and available in Prospero (registration number CRD42023406265).

Spatio-temporal epidemiology and associated indicators of COVID-19 (wave-I and II) in India.

The spatio-temporal distribution of COVID-19 across India's states and union territories is not uniform, and the reasons for the heterogeneous spread are unclear. Identifying the space-time trends and underlying indicators influencing COVID-19 epidemiology at micro-administrative units (districts) will help guide public health strategies. The district-wise daily COVID-19 data of cases and deaths from February 2020 to August 2021 (COVID-19 waves-I and II) for the entire country were downloaded and curated from public databases. The COVID-19 data normalized with the projected population (2020) and used for space-time trend analysis shows the states/districts in southern India are the worst hit. Coastal districts and districts adjoining large urban regions of Mumbai, Chennai, Bengaluru, Goa, and New Delhi experienced > 50,001 cases per million population. Negative binomial regression analysis with 21 independent variables (identified through multicollinearity analysis, with VIF < 10) covering demography, socio-economic status, environment, and health was carried out for wave-I, wave-II, and total (wave-I and wave-II) cases and deaths. It shows wealth index, derived from household amenities datasets, has a high positive risk ratio (RR) with COVID-19 cases (RR: 3.577; 95% CI: 2.062-6.205) and deaths (RR: 2.477; 95% CI: 1.361-4.506) across the districts. Furthermore, socio-economic factors such as literacy rate, health services, other workers' rate, alcohol use in men, tobacco use in women, overweight/obese women, and rainfall have a positive RR and are significantly associated with COVID-19 cases/deaths at the district level. These positively associated variables are highly interconnected in COVID-19 hotspot districts. Among these, the wealth index, literacy rate, and health services, the key indices of socio-economic development within a state, are some of the significant indicators associated with COVID-19 epidemiology in India. The identification of district-level space-time trends and indicators associated with COVID-19 would help policymakers devise strategies and guidelines during public health emergencies.

Epidemiology of scrub typhus and other rickettsial infections (2018-22) in the hyper-endemic setting of Mizoram, North-East India.

BACKGROUND: In the past decade, scrub typhus cases have been reported across India, even in regions that had no previous history of the disease. In the North-East Indian state of Mizoram, scrub typhus cases were first recorded only in 2012. However, in the last five years, the state has seen a substantial increase in the scrub typhus and other rickettsial infections. As part of the public health response, the Mizoram Government has integrated screening and line listing of scrub typhus and other rickettsial infections across all its health settings, a first in India. Here we detail the epidemiology of scrub typhus and other rickettsial infections from 2018-2022, systematically recorded across the state of Mizoram. METHODOLOGY/PRINCIPAL FINDINGS: The line-listed data positive for scrub typhus and other rickettsial infections identified by rapid immunochromatographic test and/or Weil-Felix test from 2018-22 was used for the analysis. During this period, 22,914 cases of rickettsial infections were recorded, out of which 19,651 were scrub typhus cases. Aizawl is the worst affected, with 10,580 cases (46.17%). The average incidence of rickettsial infections is 3.54 cases per 1000 persons-year, and the case fatality rate is 0.35. Only ∼2% of the reported scrub typhus cases had eschar. Multivariate logistic regression analysis indicate patients with eschar (aOR = 2.5, p<0.05), occupational workers [farmers (aOR:3.9), businessmen (aOR:1.8), construction workers (aOR:17.9); p<0.05], and children (≤10 years) (aOR = 5.4, p<0.05) have higher odds of death due to rickettsial infections. CONCLUSION: The integration of systematic surveillance and recording of rickettsial diseases across Mizoram has shed important insights into their prevalence, morbidity, and mortality. This study underscores the importance of active surveillance of rickettsial infections across India, as the burden could be substantially higher, and is probably going undetected.

Prevalence and factors associated with incomplete immunization among children aged 12 to 35 months in Eswatini: analysis of the Eswatini multiple indicator cluster survey.

Introduction: incomplete childhood immunization is a significant public health challenge as children continue to succumb to vaccine-preventable diseases in most developing countries. Studies on childhood immunization conducted in Eswatini are sparse. Therefore, the present study assessed the prevalence of incomplete childhood immunization in Eswatini and further explored associated factors among children aged 12 to 35 months. Methods: using data from Eswatini multiple indicator cluster survey 5 (EMICS5), a cross-sectional analysis with 978 children aged 12 to 35 months was conducted. This is the latest available data in the public domain. The survey was conducted from July 2014 to October 2014. The primary outcome variable was incomplete immunization. Univariate and multivariate logistic regressions were used to examine the association between selected variables and incomplete immunization. Results: the mean age of the children was 23.45±6.92 months, 50.2% were boys, and 74.1% lived in rural areas. The prevalence of incomplete immunization was 31.5%. Increased child´s age, being a girl, increased caregiver´s age, and increased number of children under-five years in the household and residing in the Manzini or Hhohho region were significantly associated with incomplete immunization. Conclusion: the EMICS 5 revealed a high prevalence of incomplete immunization in Eswatini. Health promotion activities such as empowering women and caregivers of children through health education about child health should be emphasized. Where feasible, outreach services and door-to-door immunization should be strengthened to improve immunization coverage in the country and cover dropouts.

Prevalence and associated factors of cardiovascular diseases among men and women aged 45 years and above: Analysis of the longitudinal ageing study in India, 2017-2019.

OBJECTIVE: Epidemiological studies on the prevalence and associated factors of cardiovascular diseases (CVDs) representative of all states of India among middle-aged and elderly are not much reported. The present study estimates the prevalence and associated factors of cardiovascular diseases across Indian states among men and women aged ≥45 years. METHODS: We used data from the Longitudinal Ageing Study in India wave 1 (2017-2019), which included a final analytical sample size of 56,935 adults and their spouses aged 45 years and above. We estimated CVDs prevalence for sociodemographic and behavioural variables, and multivariable logistic regression was used to assess the association between behavioural factors and CVDs in both men and women. RESULTS: The prevalence of CVDs was 5.2% among adults ≥45 years (women: 4.6%; men: 5.9%), hypertension was 46.7% (women:48.9%; men:44%). Men and women have a similar prevalence of diabetes (11.9%) and cholesterol (2.3%). Prevalence of physical inactivity was 30.3% (women:27%; men:34.1%). Hypertension (adjusted odds ratio; aOR women:2.60, 95% CI: 2.08-3.25, men:1.88, 95% CI 1.54-2.29), hypercholesterolemia (aOR women:1.70; 95% CI 1.07-2.69, men 3.55; 95% CI 2.66-4.74), diabetes (aOR women:2.53; 95% CI 1.83-3.51, men:1.77 95% CI 1.44-2.17), obesity, physical inactivity, and smoking in men were significantly associated with CVDs. CONCLUSION: The prevalence of CVDs and lifestyle risk factors among middle-aged and elderly poses severe concerns regarding noncommunicable disease (NCD) healthcare services provided in a lower-middle-income country like India. The key to preventing CVDs is controlling hypertension, diabetes, hypercholesterolemia, and increasing physical activity among adults aged ≥45 years.

Spatial epidemiology of acute respiratory infections in children under 5 years and associated risk factors in India: District-level analysis of health, household, and environmental datasets.

Background: In India, acute respiratory infections (ARIs) are a leading cause of mortality in children under 5 years. Mapping the hotspots of ARIs and the associated risk factors can help understand their association at the district level across India. Methods: Data on ARIs in children under 5 years and household variables (unclean fuel, improved sanitation, mean maternal BMI, mean household size, mean number of children, median months of breastfeeding the children, percentage of poor households, diarrhea in children, low birth weight, tobacco use, and immunization status of children) were obtained from the National Family Health Survey-4. Surface and ground-monitored PM2.5 and PM10 datasets were collected from the Global Estimates and National Ambient Air Quality Monitoring Programme. Population density and illiteracy data were extracted from the Census of India. The geographic information system was used for mapping, and ARI hotspots were identified using the Getis-Ord Gi* spatial statistic. The quasi-Poisson regression model was used to estimate the association between ARI and household, children, maternal, environmental, and demographic factors. Results: Acute respiratory infections hotspots were predominantly seen in the north Indian states/UTs of Uttar Pradesh, Bihar, Delhi, Haryana, Punjab, and Chandigarh, and also in the border districts of Uttarakhand, Himachal Pradesh, and Jammu and Kashmir. There is a substantial overlap among PM2.5, PM10, population density, tobacco smoking, and unclean fuel use with hotspots of ARI. The quasi-Poisson regression analysis showed that PM2.5, illiteracy levels, diarrhea in children, and maternal body mass index were associated with ARI. Conclusion: To decrease ARI in children, urgent interventions are required to reduce the levels of PM2.5 and PM10 (major environmental pollutants) in the hotspot districts. Furthermore, improving sanitation, literacy levels, using clean cooking fuel, and curbing indoor smoking may minimize the risk of ARI in children.

Prevalence and Associated Factors of Stroke among Older Adults in India: Analysis of the Longitudinal Aging Study in India-Wave 1, 2017-2018.

Introduction: Stroke is one of the leading causes of death and disability in India. Stroke survivors may suffer from lifelong physical and cognitive frailty. There is a need for more studies on the prevalence and determinants of this debilitating disease at the national level. Thus, assessing the factors associated with stroke is vital to developing appropriate preventive strategies in India. Methods: Data from the Longitudinal Aging Study in India wave 1 (2017-2018) are utilized for this analysis. The survey collected demographics, social, economic, and health data, including lifestyle factors and stroke, from 65,900 older adults ≥45 years representing all states and union territories. Stroke prevalence was calculated for each independent variable, and the differences were compared using the χ2 test. An unconditional multivariable logistic regression model was used to obtain the adjusted odds ratios (AOR) and 95% confidence intervals (CIs) of each lifestyle and socioeconomic variable for stroke prevalence. Results: The prevalence of self-reported stroke was 1.71% (95% CI: 1.61-1.80). Older adults with hypertension (AOR=3.69, 95% CI: 2.95-4.62), family history of stroke (AOR=3.09; 95% CI: 2.33-4.12), arrhythmias (AOR=2.27; 95% CI: 1.20-4.29), physical inactivity (AOR=1.91; 95% CI: 1.55-2.34) were strong contributors of stroke. Diabetes and high cholesterol individuals have 1.5 times more odds for stroke than those without those conditions. Increasing age (AOR=1.57 for 55-69 older adults, and AOR 2.05 for ≥70 years), male sex (AOR=1.75; 95% CI 1.36-2.26), and rich (AOR=1.58; 95% CI: 1.21-2.06) were also associated with increased odds for stroke. Conclusion: The prevalence of stroke was high among adults aged ≥45 years in India. Hypertension, family history of stroke, arrhythmias, and low physical activity were significant contributors to stroke. The findings suggest that preventing and controlling these lifestyle conditions and behaviors may help prevent stroke.

Social and housing indicators of dengue and chikungunya in Indian adults aged 45 and above: Analysis of a nationally representative survey (2017-18).

BACKGROUND: Dengue and chikungunya (CHIKV) are the two major vector-borne diseases of serious public health concern in India. Studies on socioeconomic and housing determinants of dengue and CHIKV at a pan-India level are lacking. Here, we took advantage of the recently carried out Longitudinal Ageing Study in India (LASI) carried out across all the states and Union Territories of India to study the social indicators of dengue and CHIKV in India. METHODS: LASI-1 (2017-2018) data on the self-reported period prevalence of dengue and CHIKV from 70,932 respondents aged ≥45 years were used for this analysis. The state-wise distribution of dengue and CHIKV was mapped. Prevalence was estimated for each study variable, and the difference was compared using the χ2 test. The adjusted odds ratios (AOR) of the socioeconomic and housing variables for dengue and CHIKV were estimated using the multiple logistic regression model. RESULTS: Urban residence is the major socio-economic indicator of dengue and CHIKV (dengue AOR: 1.57, 95% CI: 1.18-2.11; CHIKV AOR: 1.84, 95% CI: 1.36-2.49). The other notable indicator is wealth; rich respondents have higher odds of dengue and CHIKV. Adults older than 54 years and those with high school education and above are associated with a lower likelihood of dengue and CHIKV. In addition, CHIKV is associated with scheduled and forward castes, households with improper toilet facilities, open defecation, and kutcha house type. CONCLUSIONS: Despite the limitation that the data is only from adults ≥ 45, this analysis provides important insights into the socioeconomic and housing variables associated with higher odds of dengue and CHIKV in India. Understanding these determinants may assist in the national planning of prevention and control strategies for dengue and CHIKV.

Socio-economic and household determinants of malaria in adults aged 45 and above: analysis of longitudinal ageing survey in India, 2017-2018.

BACKGROUND: Even though malaria cases have drastically come down in the last decade, malaria remains a serious public health concern in many parts of India. National Framework for Malaria Elimination in India (2016-2030) has been launched with the goal to eliminate malaria by 2030. Understanding the socio-economic and household determinants of malaria at the national level will greatly aid India's malaria elimination efforts. METHODS: The data from Longitudinal Ageing Survey of India (LASI) Wave 1 (2017-2018) survey comprising 70,671 respondents ≥ 45 years across all the States and Union Territories were used for the analysis. Simple and multiple logistic regressions were used to obtain the unadjusted and adjusted odds ratio respectively of the socio-economic and household variables. RESULTS: The major socio-economic variables that increase the likelihood of malaria are caste ('scheduled tribes'), low education levels and rural residence. The scheduled tribes have 1.8 times higher odds of malaria than the scheduled castes (AOR: 1.8; 95% CI: 1.5-2.1). Respondents with high school education (6-12 grade) (AOR: 0.7; 95% CI: 0.6-0.8) and college education (AOR: 0.5; 95% CI: 0.4-0.6) had a very low risk of malaria than those with no school years. Rural residence and occupation (agriculture and allied jobs) also increases the odds of malaria. The major housing determinants are household size (≥ 6), housing type (kutcha), use of unclean fuel, outside water source, improper sanitation (toilet facilities) and damp wall/ceiling. CONCLUSIONS: The study has identified the major socio-economic and housing factors associated with malaria in adults aged 45 and above. In addition to vector and parasite control strategies in the tribal dominated regions of India, improving literacy and housing conditions may help India's malaria elimination efforts.

Knowledge and attitudes about the use of emergency contraception among college students in Tamil Nadu, India.

BACKGROUND: In India, a large number of pregnancies are unplanned resulting in unsafe and illegal abortion. For every legal abortion, 10 to 11 illegal abortions are occurring which endangers the health and survival of the women. In recent years, there is an increase in unwanted and unintended pregnancy at the early age group. Usage of emergency contraception (EC) can decrease the unwanted pregnancy and provide a healthier life. AIM: The aim of study is to assess the knowledge and attitude regarding EC among college students in Thiruvarur District, Tamil Nadu, India. METHODS: A cross-sectional study was conducted among the college students of Thiruvarur district, Tamil Nadu, India. A total of 758 students were selected by convenient sampling technique. Data was collected by administering a pretested semi-structured questionnaire. RESULTS: Out of 758 students, 183(24%) heard about EC. The commonest source of information was the internet 91 (49.7%). The majority 116 (63.4%) knew that it does not prevent STDs. Of those who were aware, 42% were aware of 42.6% are aware of the time limit to use EC. The knowledge level of about the EC was moderate (60.1%), and it was significantly (p < 0.05) more among students > 25 years old, married participants, students in private institution, of lower socio-economic status, Muslim students and days' scholars. The negative attitude towards EC was 59%. Nearly 38.8% believed that the EC will affect the next menstrual period, and 35.5% informed it will increase high risk behaviour among adults. The attitude level was significantly associated with the same factors associated with the awareness level with the factors Christian religion replacing Muslim and higher socioeconomic class replacing lower class participants. CONCLUSION: The knowledge level of the studied college students was moderate, and they mostly had negative attitude towards the EC. Reproductive health education should be given in educational institutions to promote awareness and to remove misconceptions about EC.