Spectacle compliance postcataract surgery significantly improved vision function-related quality of life of adult patients in India: Evidence from a multicenter longitudinal cohort study.

BACKGROUND: Cataract is the leading cause of avoidable blindness globally. This study aims to measure the changes in Vision function-related quality of life (VFQoL) before and after cataract surgery and identify the predictors of an improvement in these outcomes. METHODS: A multicenter, longitudinal cohort study was conducted. Patients with first eye cataracts were interviewed before and 6 months after cataract surgery. Multiple classification analysis (MCA) was performed to assess variation in the intensities of mean change scores for general function, psychosocial impact, and visual function with select factors. RESULTS: A total of 747 participated in the baseline assessment. The 6-month follow-up rate was 86.5%. The mean general function, psychosocial impact, and visual function scores were 35.3 (±8.6), 12.5 (±3.4), and 8.3 (±3) in the baseline and 17 (±5.3), 6 (±2.2) and 3.8 (±1.3) in the follow-up assessments, respectively. In MCA, patients using spectacles postsurgery (ß 0.111) and those having a very good postoperative visual acuity (ß 0.098) had the most impact on general function. Patients reporting no ocular complaints postsurgery had a relatively higher effect on the psychosocial impact, (ß 0.168) and similarly, patients using spectacles postsurgery and those aged 70 and older had the most impact on the visual function scores (ß 0.146 and 0.126), respectively. CONCLUSION: Cataract surgery is associated with meaningful improvements in vision and VFQoL in general. The determinants of better VFQoL include the usage of spectacles postsurgery. Strategies to further improve patient participation in postoperative review visits are needed for spectacle provision and patient education regarding spectacle use and compliance is imparted during such visits.

Social-emotional issues among children with strabismus higher than among non-strabismus children in Western India.

Purpose: Data on social-emotional aspects among children with strabismus in India are scanty. We compared the emotional symptoms (ES), loneliness and social dissatisfaction (LSD), and self-esteem (SE) and their associated risk factors among children with and without strabismus in India. Methods: A cross-sectional case-control study design was used to recruit 101 children with strabismus aged 8 to 18 years and a control group of 101 children that were age- and gender-matched. Interviews were performed using standardized scales to assess ES, LSD, and SE. Variations in the intensity of ES, LSD, and SE were assessed using multiple classification analysis (MCA). Results: A total of 202 children participated in the study. The mean ES, LSD, and SE scores were 3.4 (standard deviation [SD] 1.9), 48.4 (SD 3.2), and 22.1 (SD 3.8) for the strabismus group and 1.8 (SD 1.5), 33.3 (SD 3), and 31.3 (SD 2) for the non-strabismus group, respectively. Among the strabismus group, the highest levels of mean ES, LSD, and SE scores were observed among children facing problems in performing daily tasks. Amongst the non-strabismus group, children studying at the primary level and those facing neglect had the highest mean scores. In MCA, being affected with strabismus had the highest effect on the intensity of ES, LSD, and SE with a beta (ß) value of 0.223 (P = 0.016), 0.922 (P < 0.001), and 0.853 (P < 0.001). Conclusion: A significantly high proportion of children with strabismus deal with elevated levels of ES, LSD problems, and low SE as compared with non-strabismus children, highlighting the need to address the poor social-emotional health of children.

A Multisite Longitudinal Investigation of Psychological Outcomes Following Cataract Surgery in India.

Background: Systematic data on mental health issues among adults with cataracts are not available from India. This study explored the impact of cataract surgery on depressive and generalized anxiety (GA) symptoms in an adult Indian sample. Methods: A multicenter, prospective, longitudinal cohort study was conducted. Subjects were recruited from four tertiary eye hospitals to assess depression, GA, and associated risk factors. A follow-up survey was carried out at 6 (n = 273, group 1), 12 (n = 198, group 2), or 18 months (n = 105, group 3) post-cataract surgery. Variations in the intensity of depression and GA were assessed using multiple classification analysis (MCA). Results: A total of 576 patients completed both baseline and follow-up assessments. The mean (SD) depression score was 25.6 (8.5) before surgery and 8.6 (7.7), 9.9 (7), and 9.8 (6.8), respectively, post-surgery for the three groups on the Center for Epidemiologic Studies Depression scale (CES-D). The mean GA score was 6.7 (4.2) at baseline and 1.1 (2.3), 1 (1.8), and 0.6 (1.3) after surgery on the Generalized Anxiety Disorder scale (GAD-7). MCA showed that factors with the highest impact on the mean change scores for both depressive and GA symptoms were restoration of vision post-surgery (ß = 0.381 and 0.185) in group 1, regaining functional independence and female sex in group 2 (ß = 0.192 and 0.23), and the presence of ocular comorbidities in the fellow eye (ß = 0.36 and 0.315) in group 3. Conclusion: Mental health symptoms improved significantly post-cataract surgery across the three groups. The urgent need to invest in strategies that enable early cataract case detection and treat ocular anomalies in the fellow eye is highlighted.

Refractive errors, road traffic accidents and long-term spectacle compliance amongst commercial taxi drivers in a major North-East Indian city.

Purpose: To assess the prevalence of refractive error (RE) and its association with road traffic accidents (RTAs) and the subsequent long-term spectacle compliance and adherence to suggested appropriate strategies In Shillong, India. Methods: This: prospective study was conducted between July and October 2019 among commercial taxi drivers (CTDs), with follow-up interviews conducted with a subset of respondents to assess long-term spectacle compliance after a year. Gross ophthalmologic examination was performed, including visual acuity and refraction. Descriptive statistics and Chi-square tests were conducted to assess the association between the type of REs, spectacle compliance, and selected sociodemographic and clinical variables. Multiple logistic regression was performed for analysis of the association between RTAs and sociodemographic, clinical, and work characteristics variables. Results: A total of 382 (95.5%) CTDs completed interviews and gross eye examination. The prevalence of any RE in the worst eye was 28.8% (95% CI: 24.3-33.6). Presbyopia with or without distance vision was the commonest type of RE with 21.7% (95% CI: 17.7%-26.2). Among those who were prescribed spectacles, 70.5% needed near correction. Drivers with RE were nearly two times (OR: 2.6; 95% CI: 1.4-5.1) more likely to be involved in RTAs compared to those without any RE. Long-term spectacle compliance was at 40.9%. The predominant barrier reported for spectacle compliance was "can manage well without spectacles." Conclusion: This survey has demonstrated a significant relationship between poor vision and occurrence of RTAs. There is an urgent need for tailor-made targeted interventions to address the eye health needs of CTDs in India.

Depressive and generalized anxiety symptoms in adults awaiting cataract surgery in India.

Background Systematic data on mental health issues among adults awaiting cataract treatment are not readily available in India. We explored the prevalence and predictors of depressive and generalized anxiety (GA) symptoms in a cohort of adults awaiting cataract surgery. Methods Our study is based on data from baseline assessments which were conducted as part of a multicentre prospective, longitudinal cohort study. Subjects were recruited from four eye hospitals to assess depression and GA and associated risk factors using standardized scales, i.e. Center for Epidemiologic Studies-Depression Scale (CES-D) and Generalised Anxiety Disorder (GAD-7). Variation in the intensity of depression and GA was assessed using multiple classification analysis (MCA). Results A total of 813 adults awaiting cataract surgery participated, of whom 456 (56.1%) were men. The mean (SD) CES-D and GAD-7 scores were 24.6 (7.8) and 6.3 (SD 4.2) for men and 25.8 (8.9) and 6.9 (4.4) for women, respectively. The overall prevalence of depression score of >16 was 87.4% (95% confidence interval [CI] 84.7%- 89.6%), and GA score of >10 was 57.1% (95% CI 53.5%-60.7%). The prevalence of comorbid depressive and anxiety symptoms was 56.6% (95% CI 52.9%- 60.2%). MCA showed that being neglected and mistreated by family/friends because of vision condition and facing difficulty and requiring help with daily tasks had the highest effect on the intensity of both depression (beta=0.254 and 0.238, respectively) and GA (beta=0.219 and 0.211, respectively). Conclusion The majority of adults with untreated cataract had both depressive and GA symptoms. These findings could be used for planning mental health interventions for adults awaiting cataract surgery.

Permanent Anterior Teeth Fractures and its Impact on Oral Health-Related Quality of Life among 8-15-Year-Old Schoolchildren of Chennai City - A Cross-Sectional Survey.

BACKGROUND: Tooth fracture is not only a distressing experience on the physical level of a child, but it may also have an effect on emotional and psychological levels. This study aims to assess the permanent anterior teeth fractures and their impact on Oral Health-Related Quality of Life (OHRQoL) among 8-15-year-old schoolchildren of Chennai city. MATERIALS AND METHODS: Thirty schools were randomly selected by stratified random sampling. All school-going children aged 8-15 years were invited to participate. A total of 7247 children were screened and 628 children with permanent anterior teeth fractures were included. Data were collected using Child Oral Health Impact Profile questionnaire. In addition, questionnaire addressing sociodemographic data and factors influencing permanent anterior teeth fractures were recorded. Descriptive statistics was performed to characterize the sample. One-way analysis of variance and Tukey's honestly significant difference post hoc tests was applied for multiple pair-wise comparisons. RESULTS: The prevalence of permanent anterior teeth fracture was found to be 8.7%. The type of school had highly significant (P < 0.001) influence on the impact of permanent anterior teeth fracture on OHRQoL with negative OHRQoL among the corporation schools. The study participants of corporation schools had negative OHRQoL with significant difference in oral health well-being (P < 0.001) and self-image (P = 0.014). CONCLUSION: All the children reporting with tooth fractures had negative OHRQoL. The study stresses the importance of promoting good oral health-care practices to prevent oral disease in children and to meet children's unmet oral health-care needs.

Association of COL1A2 (PvuII) gene polymorphism with risk and severity of dental fluorosis - A case control study.

INTRODUCTION: Dental fluorosis is a foremost public health problem in many countries, including India. Very few studies investigated gene polymorphism and risk of dental fluorosis. Genetic polymorphisms in Collagen Type I, alpha 2 (COL1A2) gene, found to be linked with bone pathogenesis, may affect the tooth formation resulting in the vulnerability to dental fluorosis. AIM: To assess the association between COL1A2 (PvuII) gene polymorphism and risk as well as severity of dental fluorosis. METHODS: The present case control study was conducted among participants with (n = 60) and without (n = 60) dental fluorosis. Dental fluorosis was assessed using Modified Dean's fluorosis index (1942). The PvuII polymorphisms (in exon 25) inside the COL1A2 gene were genotyped by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) procedure. Statistical analysis were carried out with Chi-square test and Odds Ratio (OR) was determined with multivariate logistic regression analysis. RESULTS: The genetic polymorphism in COL1A2 PvuII was found to be associated with the risk of dental fluorosis which was highly significant (p < 0.001). The odds ratio was 31.4 times [OR = 31.9, 95% CI: 3.9-48.7] higher for the homozygous PP genotype group and 4.0 times [OR = 4.0, 95% CI: 1.0-10.7] higher for the heterozygous Pp genotype. CONCLUSION: Genetic polymorphism of COL1A2 was found to be associated with dental fluorosis. The present study provides an insight for identification of the population who may subsist at risk of developing dental fluorosis in their later life.

Decreasing cost of public sector first-line ART services in India from 2007-2008 to 2015-2016.

INTRODUCTION: India has scaled-up antiretroviral treatment (ART) in public sector facilities, but data to understand time trends of average cost of ART are limited. MATERIALS AND METHODS: Cost and output data were collected at all public sector ART centres in undivided Andhra Pradesh (high-HIV burden state) and Rajasthan (low-HIV burden state) in India from fiscal year 2007-2008 to 2012-2013. Average cost per patient for first-line ART, and its relation with scale of services, were assessed. Using data on scale of services, the average cost was estimated up to 2015-2016. Break-even point was estimated from average and marginal cost functions. Costs were adjusted to 2015 constant price. RESULTS: The average cost per patient alive and on ART in 2015-2016 was US$162 in undivided Andhra Pradesh and US$186 in Rajasthan, which was 51.4% and 35.8% lower than in 2007-2008, respectively. Average ART drug cost declined by 27.2% during this period, and was 70.9% and 61.5% of the total ART cost in the two states in 2015-2016. The average cost other than ART drugs declined by 73.1% and 45.7%, with the number of patients served increasing 7 and 14.2 times, respectively. Average cost other than ART drugs had a significant negative relation with scale (R2 = 86.4%-82.8%, p<0.001). Break-even analysis suggested that 47.5% and 58.8% of the ART centres in undivided Andhra Pradesh and Rajasthan, respectively, were functioning below optimal scale in 2015-2016. The estimated total economic cost of first-line ART services provided in the public sector in India in fiscal year 2015-2016 was US$ 151 million; it would be US$ 216.1 million to provide this to all eligible persons in India. CONCLUSION: The average cost of providing first-line ART has declined in India, and further reduction is possible if the optimal scale of services is achieved. These findings can inform resource requirement for the ART programme in India.

Factors limiting the Northeast Indian elderly population from seeking cataract surgical treatment: Evidence from Kolasib district, Mizoram, India.

Purpose: Reliable data on the barriers to the uptake of cataract surgical services in the Northeast Indian states are scanty. The purpose of this study was to assess the barriers to uptake of cataract surgical services among elderly patients and suggest appropriate strategies to reduce these. Methods: A cross-sectional study was conducted among patients who failed to avail cataract surgical services, 6-12 months' postinitial diagnosis at a community eye health camp. Validated questionnaire was used to collect information through face-to-face interviews at the residence of the participants. Descriptive statistics and Chi-square tests were conducted to assess the association between the barriers quoted and sociodemographic variables. Results: A total of 140 (89.2%) individuals participated in the study, of whom 56 (40%) were aged between 71 and 80 years. The median age for men and women was 73.5 and 72.5 years, respectively. About 57% of participants were female patients. A total of 66 (47.1%) participants had borderline visual acuity followed by those with poor vision (41.4%, n = 58). "Bad roads/difficult terrain" (P = 0.009), "witnessed bad surgical outcomes in others" and "did not feel important" (P < 0.024), "poor overall health status" (P < 0.001), "lack of information" (P = 0.025) and "no escort" (P = 0.025) were significant barriers reported by this population. Conclusion: Most of the barriers reported in this study seem to be endogenous in nature and appear to be within the purview of the local eye care service provider to remedy. Counseling and targeted awareness and information, education, and communication strategies could nullify many of the barriers reported in this study.

Epidemiology of mental disability using Indian Disability Evaluation Assessment Scale among general population in an urban area of Puducherry, India.

BACKGROUND: There is paucity of information on epidemiology of mental disability in India. OBJECTIVE: The objective of this study was to assess mental disability, and to study the association between sociodemographic and comorbid chronic conditions with mental disability. MATERIALS AND METHODS: This community-based cross-sectional study was conducted among ≥5 years age group in an urban area attached to a Tertiary Care Medical Institute in Puducherry, India. Mental disability was assessed using Indian Disability Evaluation and Assessment Scale. Chronic morbid conditions and other associated factors were collected using pretested questionnaire. STATISTICAL ANALYSIS: Univariate and multiple logistic regression analysis. RESULTS: About 2537 subjects were covered with a response rate of 94.1%. Overall, the prevalence of mental disability was found to be 7.1% (181/2537). Among them, majority had mild mental disability (151, 83.4%), followed by moderate (21, 11.6%), severe (8, 4.4%), and profound (1, 0.6%) mental disability. Univariate analysis showed that age group status, marital status, education level, occupation, family type, religion, hypertension, joint pain, backache, current smoking, current alcohol use, and conflicts were associated with mental disability (P < 0.05). Multiple logistic regression analysis showed that male gender (adjusted odds ratio [AOR] =2.064), widowed status (AOR = 27.022), separated/divorced status (AOR = 16.674), currently married status (AOR = 18.487), being illiterate (AOR = 4.352), having 1st-10th standard education (AOR = 2.531), being in an unskilled (AOR = 0.287) or semiskilled/skilled occupation (AOR = 0.025), belonging to a nuclear family (AOR = 1.816), and absence of family conflicts (AOR = 0.259) were significantly associated with mental disability compared to their counterparts. CONCLUSION: Mental disability is more common in this area. Males, lesser education level, skilled or unskilled occupation, nuclear family, and conflicts were associated with mental disability after adjusting other variables. Multicentric cross-sectional analytical studies will explore the mental disability burden and its associated factors at regional or country level.

Association between maternal exposure to tobacco, presence of TGFA gene, and the occurrence of oral clefts. A case control study.

OBJECTIVE: To determine the association between maternal tobacco use or exposure, presence of variant transforming growth factor alpha (TGFA) gene, and the occurrence of oral clefts. METHODS: The present case control study was carried out for 5 months in three tertiary government hospitals in Chennai city with a sample of 100 children (50 children with non syndromic cleft and 50 control) aged 0-24 months. The details of maternal risk factors during the period of gestation were recorded from case and control parents through a pre-validated questionnaire, following which blood samples from 92 children (46 case and 46 controls) based on consent were obtained and evaluated for TGFA gene polymorphism. RESULTS: A significant number of case mothers (48%) were exposed to secondhand smoke during the period of gestation than their control counterparts (24%) (P = 0.01) with an odds ratio of 2.46 (95% CI = 0.99-6.08). Electrophoresis of the restriction fragment length polymorphism (RFLP) product revealed the presence of the homozygous C1C1 allele in all the tested 92 samples with no homozygous C2C2 allele or heterozygous C1C2 allele. CONCLUSION: The present study has highlighted the role of passive smoking in the causation of non syndromic oral clefts in a developing country like India; however, the involvement of TGFA in causing the same disease in an ethnically Dravidian Indian population is uncertain. CLINICAL SIGNIFICANCE: The study has brought into forth the role of passive smoking in the development of oral clefts thereby warranting an effective public health policy to tackle the same.

Comparative evaluation of salt water rinse with chlorhexidine against oral microbes: A school-based randomized controlled trial.

BACKGROUND: Mouth rinse that is natural, safe, cost-effective, readily available and culturally acceptable is required as an adjunct to routine tooth brushing to combat dental diseases. The aim of present study was to compare the effectiveness of salt water rinse with chlorhexidine mouth rinse in reducing dental plaque and oral microbial count. MATERIALS AND METHODS: The Minimum Inhibitory Concentration (MIC) of salt water against S. mutans, L.acidophilus, A. actinomycetemcomitans and P. gingivalis was determined by Macrobroth Dilution method. Thirty participants were randomly allocated into study group (salt water rinse) and control group (chlorhexidine rinse). Baseline DMFS, defs and plaque scores were recorded. Baseline unstimulated saliva samples were collected by spitting method. Oral prophylaxis was done after baseline sample collection. The participants were advised to rinse the allocated mouthrinse for 5 days under the supervision of co- investigator. Pre- rinse (after oral prophylaxis) and Post -rinse (5th day of mouthrinsing) plaque examination and salivary microbial analysis was done. The collected salivary samples were immediately transported and streaked on the respective media for microbial count. RESULT: MIC of salt water was 0.7 M for S. mutans, A. actinomycetemcomitans and P. gingivalis and 0.8M for L. acidophilus. There was statistically significant reduction in the plaque scores, salivary S. mutans, L. acidophilus, A. actinomycetemcomitans and P. gingivalis count from baseline, pre-rinse to post-rinse in the study group (p=0.001) and control group (p=0.001). Salt water was as effective as chlorhexidine in reducing dental plaque (p = 0.19) and A. actinomycetemcomitans (p = 0.35) count and while chlorhexidine was superior against S. mutans (p = 0.001), L. acidophilus (p = 0.001) and P. gingivalis (p =0.001). CONCLUSION: Salt water rinse can be used as adjunct to routine mechanical plaque control for prevention of oral diseases.

Survival outcomes for first-line antiretroviral therapy in India's ART program.

BACKGROUND: Little is known about survival outcomes of HIV patients on first-line antiretroviral therapy (ART) on a large-scale in India, or facility level factors that influence patient survival to guide further improvements in the ART program in India. We examined factors at the facility level in addition to patient factors that influence survival of adult HIV patients on ART in the publicly-funded ART program in a high- and a low-HIV prevalence state. METHODS: Retrospective chart review in public sector ART facilities in the combined states of Andhra Pradesh and Telangana (APT) before these were split in 2014 and in Rajasthan (RAJ), the high- and a low-HIV prevalence states, respectively. Records of adults initiating ART between 2007-12 and 2008-13 in APT and RAJ, respectively, were reviewed and facility-level information collected at all ART centres and a sample of link ART centres. Survival probability was estimated using Kaplan-Meier method, and determinants of mortality explored with facility and patient-level factors using Cox proportional hazard model. RESULTS: Based on data from 6581 patients, the survival probability of ART at 60 months was 76.3 % (95 % CI 73.0-79.2) in APT and 78.3 % (74.4-81.7) in RAJ. The facilities with cumulative ART patient load above the state average had lower mortality in APT (Hazard ratio [HR] 0.74, 0.57-0.95) but higher in RAJ (HR 1.37, 1.01-1.87). Facilities with higher proportion of lost to follow-up patients in APT had higher mortality (HR 1.47, 1.06-2.05), as did those with higher ART to pre-ART patient ratio in RAJ (HR 1.62, 1.14-2.29). In both states, there was higher hazard for mortality in patients with CD4 count 100 cells/mm3 or less at ART initiation, males, and in patients with TB co-infection. CONCLUSIONS: These data from the majority of facilities in a high- and a low-HIV burden state of India over 5 years reveal reasonable and similar survival outcomes in the two states. The facilities with higher ART load in the longer established ART program in APT had better survival, but facilities with a higher ART load and a higher ratio of ART to pre-ART patients in the less experienced ART program in RAJ had poorer survival. These findings have important implications for India's ART program planning as it expands further.

Comparative assessment of the prevalence of periodontal disease in subjects with and without systemic autoimmune diseases: A case-control study.

BACKGROUND: Immune mechanism shares a common pathway both for systemic autoimmune diseases and periodontal diseases. Scientific exploration of literature revealed limited studies on the association between systemic autoimmune diseases and periodontal diseases in India. AIM: The aim of the study is to find whether the presence of systemic autoimmune diseases in an individual is a risk factor for the development of periodontal disease. SETTINGS AND DESIGN: This was a hospital-based case-control study. MATERIALS AND METHODS: A sample of 253 patients with systemic autoimmune diseases, attending the Rheumatology Department of Government General Hospital, Chennai-3, and 262 patients without systemic autoimmune diseases, attending the outpatient department of the Tamil Nadu Government Dental College and Hospital, Chennai-3, constituted the case and control groups, respectively. Age, gender, and oral hygiene status matching was done. Oral hygiene status was assessed using oral hygiene index (OHI) and periodontal status was assessed using community periodontal index (CPI) and loss of attachment (LOA) index. STATISTICAL ANALYSIS: Statistical analysis was done using SPSS version 15 (SPSS Inc, 2006, Chicago). RESULTS: Results showed 99.2% and 73.9% prevalence of gingivitis and periodontitis, respectively, in the case group as compared to 85.5% and 14.9%, respectively, in the control group. There is no linear relationship between OHI scores and prevalence of periodontitis (CPI and LOA scores) in the case group. Patients suffering from systemic autoimmune diseases showed more prevalence of periodontal diseases irrespective of oral hygiene scores. CONCLUSION: It is postulated that the presence of systemic autoimmune diseases may pose a risk for the development of periodontal diseases.

Contact with HIV prevention programmes & willingness for new interventions among truckers in India.

BACKGROUND & OBJECTIVES: Systematic data on existing coverage and willingness for HIV prevention strategies among truckers are not readily available in India. The present study aimed to further the understanding on contact of truckers with existing HIV prevention services and to assess willingness for new HIV prevention strategies. METHODS: A total of 1,800 truck drivers and helpers aged 16-65 yr passing through Hyderabad were approached to assess contact made with HIV prevention programmes, history of previous HIV testing and their acceptance for circumcision, oral HIV testing, new medications to control HIV (PrEP) and telephonic counselling. Dried blood samples were collected on filter paper and tested for HIV. Multiple logistic regression was performed for analysis of association between contact with HIV prevention programme and socio-demographic, sexual risk behaviour variables and work characteristics. RESULTS: A total of 1,602 (89%) truckers gave interview and provided blood sample. Forty five truckers tested positive for HIV resulting in HIV prevalence of 2.8 per cent (95% CI 2.0-3.6%). Only 126 truckers (7.9%; 95% CI 6.5-9.2%) reported ever being contacted by staff providing HIV prevention interventions. Previous HIV testing was reported by19 per cent (95% CI 17.3-21.2%). Those reporting contact with HIV prevention programmes ever were more likely to have undergone HIV testing (odds ratio 3.6, 95% CI 2.4-5.4). The acceptance for pre-exposure prophylaxis (PrEP) was 87 per cent, oral HIV testing 98 per cent, and telephonic counselling 82 per cent, but was only 9 per cent for circumcision.Truckers who reported having sex with a man and those who halted regularly at dhabas were significantly more willing to undergo circumcision for HIV prevention (odds ratios 2.7, 95% CI 1.4-5.4 and 2.1, 95% CI 1.3-3.2, respectively). INTERPRETATION & CONCLUSIONS: Our findings showed that truckers had low contact with HIV prevention programmes, suggesting a need for urgent measures to reach this population more effectively. The willingness for new HIV interventions was high except for circumcision. These findings could be used for further planning of HIV prevention programmes for truckers in India.

Diarrhoeal diseases in developing countries: a situational analysis.

Recent data showed that there is no much reduction in diarrhoea related morbidity in developing countries. This is important in view of the Millennium Developmental Goal (MDG) to be achieved by 2015. This study reviewed and analyzed after gathering the recent literature information from Pubmed, internet and other sources. The authors discussed public health issues related to diarrhoeal diseases that include problem burden, determinants, intervention strategies, management, prevention and recent developments for control of diarrhoea among under-five children in developing countries. The study emphasizes the need for strengthening of comprehensive diarrhoeal disease prevention strategy at primary level including improvement of water quality, hygiene and sanitation, along with provision of oral rehydration solution and zinc supplements, and research in the field of vaccine and cost effective interventions.

Candidate change agent identification among men at risk for HIV infection.

Despite limited HIV prevention potency, peer-based programs have become one of the most often used HIV prevention approaches internationally. These programs demonstrate a need for greater specificity in peer change agent (PCA) recruitment and social network evaluation. In the present three-phase study based in India (2009-2010), we first explored the nature of friendship among truck-drivers, a group of men at high risk for HIV infection, in order to develop a thorough understanding of the social forces that contribute to and maintain their personal networks. This was accomplished in the first two study phases through a combination of focus group discussions (n = 5 groups), in-depth qualitative interviews (n = 20), and personal network analyses (n = 25) of truck-drivers to define friendship and deepen our understanding of friendship across geographic spaces. Measures collected in phases I and II included friend typologies, discussion topics, social network influences, advice-giving, and risk reduction. Outcomes were assessed through an iterative process of qualitative textual analysis and social network analysis. The networks of truck-drivers were found to comprise three typologies: close friends, parking lot friends, and other friends. From these data, we developed an algorithmic approach to the identification of a candidate PCA within a high-risk man's personal network. In phase III we piloted field-use of this approach to identify and recruit PCAs, and further evaluated their potential for intervention through preliminary analysis of the PCA's own personal networks. An instrument was developed to translate what social network theory and analysis has taught us about egocentric network dynamics into a real-world methodology for identifying intervention-appropriate peers within an individual's personal network. Our approach can be tailored to the specifications of any high-risk population, and may serve to enhance current peer-based HIV interventions.

Behavioral surveillance of premarital sex among never married young adults in a high HIV prevalence district in India.

In a population-based representative sample of 2,475 never married persons aged 15-24 years from Guntur district of Andhra Pradesh state in India, 21.7% (95% CI 18.7-24.7) males and 4.6% (95% CI 2.2-7.0) females reported having had sex. Only 22.3% males and 6.3% females reported consistent condom use for premarital sex in the last 6 months. The strongest associations with premarital sex for males were current use of alcohol and tobacco, and for females were not living with parents currently and being an income earner. These findings can inform HIV prevention efforts among young adults in India.

Cost-effectiveness of HIV prevention interventions in Andhra Pradesh state of India.

BACKGROUND: Information on cost-effectiveness of the range of HIV prevention interventions is a useful contributor to decisions on the best use of resources to prevent HIV. We conducted this assessment for the state of Andhra Pradesh that has the highest HIV burden in India. METHODS: Based on data from a representative sample of 128 public-funded HIV prevention programs of 14 types in Andhra Pradesh, we have recently reported the number of HIV infections averted by each type of HIV prevention intervention and their cost. Using estimates of the age of onset of HIV infection, we used standard methods to calculate the cost per Disability Adjusted Life Year (DALY) saved as a measure of cost-effectiveness of each type of HIV prevention intervention. RESULTS: The point estimates of the cost per DALY saved were less than US $50 for blood banks, men who have sex with men programmes, voluntary counselling and testing centres, prevention of parent to child transmission clinics, sexually transmitted infection clinics, and women sex worker programmes; between US $50 and 100 for truckers and migrant labourer programmes; more than US $100 and up to US $410 for composite, street children, condom promotion, prisoners and workplace programmes and mass media campaign for the general public. The uncertainty range around these estimates was very wide for several interventions, with the ratio of the high to the low estimates infinite for five interventions. CONCLUSIONS: The point estimates for the cost per DALY saved from the averted HIV infections for all interventions was much lower than the per capita gross domestic product in this Indian state. While these indicative cost-effectiveness estimates can inform HIV control planning currently, the wide uncertainty range around estimates for several interventions suggest the need for more firm data for estimating cost-effectiveness of HIV prevention interventions in India.