Pavani K Ram

Publications (9)30.74 Total impact

• Article: Examining the use of oral rehydration salts and other oral rehydration therapy for childhood diarrhea in Kenya.

  Lauren S Blum, Prisca A Oria, Christine K Olson, Robert F Breiman, Pavani K Ram
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  ABSTRACT: Reductions in the use of oral rehydration therapy (ORT) in sub-Saharan Africa highlight the need to examine caregiver perceptions of ORT during diarrheal episodes. Qualitative research involving group discussions with childcare providers and in-depth interviews with 45 caregivers of children < 5 years of age who had experienced diarrhea was conducted in one rural and urban site in Kenya during July-December 2007. Diarrhea was considered a dangerous condition that can kill young children. Caregivers preferred to treat diarrhea with Western drugs believed to be more effective in stopping diarrhea than ORT. Inconsistent recommendations from health workers regarding use of oral rehydration solution (ORS) caused confusion about when ORS is appropriate and whether it requires a medical prescription. In the rural community, causal explanations about diarrhea, beliefs in herbal remedies, cost, and distance to health facilities presented additional barriers to ORS use. Health communication is needed to clarify the function of ORT in preventing dehydration.
  The American journal of tropical medicine and hygiene 12/2011; 85(6):1126-33. · 2.59 Impact Factor
• Article: Community case management of childhood diarrhea in a setting with declining use of oral rehydration therapy: findings from cross-sectional studies among primary household caregivers, Kenya, 2007.

  Christine K Olson, Lauren S Blum, Kinnery N Patel, Prisca A Oria, Daniel R Feikin, Kayla F Laserson, Annah W Wamae, Alfred V Bartlett, Robert F Breiman, Pavani K Ram
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  ABSTRACT: We sought to determine factors associated with appropriate diarrhea case management in Kenya. We conducted a cross-sectional survey of caregivers of children < 5 years of age with diarrhea in rural Asembo and urban Kibera. In Asembo, 61% of respondents provided oral rehydration therapy (ORT), 45% oral rehydration solution (ORS), and 64% continued feeding. In Kibera, 75% provided ORT, 43% ORS, and 46% continued feeding. Seeking care at a health facility, risk perception regarding death from diarrhea, and treating a child with oral medications were associated with ORT and ORS use. Availability of oral medication was negatively associated. A minority of caregivers reported that ORS is available in nearby shops. In Kenya, household case management of diarrhea remains inadequate for a substantial proportion of children. Health workers have a critical role in empowering caregivers regarding early treatment with ORT and continued feeding. Increasing community ORS availability is essential to improving diarrhea management.
  The American journal of tropical medicine and hygiene 12/2011; 85(6):1134-40. · 2.59 Impact Factor
• Source

  Available from: Iqbal Kabir Jahid

  Article: Variability in Hand Contamination Based on Serial Measurements: Implications for Assessment of Hand-Cleansing Behavior and Disease Risk

  Pavani K. Ram, Iqbal Jahid, Amal K. Halder, Benjamin Nygren, M. Sirajul Islam, Stewart P. Granger, John W. Molyneaux, Stephen P. Luby
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  ABSTRACT: Measuring hand contamination at critical times, such as eating, can be challenging. We examined whether hand contamination measured at random, such as on arrival (initial), predicts contamination at critical times. Mothers of young children in Bangladesh rinsed both hands in 200 mL of ringer’s solution. We compared results of serial samples with respect to fecal coliform counts. Among 39 mothers, the geometric mean of fecal coliforms was 307 colony-forming units (cfu)/100 mL at initial collection and 3,001 cfu/100 mL during critical times ( P = 0.0006). There was no correlation between initial and critical time fecal coliform counts ( R = 0.13, P = 0.43). The mean difference between initial and critical time counts was 3.5 (standard deviation = 1.4) on the log base-10 scale. Contamination of the same subjects’ hands varied substantially within a few hours. Because hand contamination measured at random cannot reliably predict hand contamination at times of potential pathogen transmission, single random hand rinses are not valid proxy measures for handwashing behavior.
  The American journal of tropical medicine and hygiene 11/2011; 84:510-16. · 2.59 Impact Factor
• Article: Variability in hand contamination based on serial measurements: implications for assessment of hand-cleansing behavior and disease risk.

  Pavani K Ram, Iqbal Jahid, Amal K Halder, Benjamin Nygren, M Sirajul Islam, Stewart P Granger, John W Molyneaux, Stephen P Luby
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  ABSTRACT: Measuring hand contamination at critical times, such as eating, can be challenging. We examined whether hand contamination measured at random, such as on arrival (initial), predicts contamination at critical times. Mothers of young children in Bangladesh rinsed both hands in 200 mL of Ringer's solution. We compared results of serial samples with respect to fecal coliform counts. Among 39 mothers, the geometric mean of fecal coliforms was 307 colony-forming units (cfu)/100 mL at initial collection and 3,001 cfu/100 mL during critical times (P = 0.0006). There was no correlation between initial and critical time fecal coliform counts (R = 0.13, P = 0.43). The mean difference between initial and critical time counts was 3.5 (standard deviation = 1.4) on the log base-10 scale. Contamination of the same subjects' hands varied substantially within a few hours. Because hand contamination measured at random cannot reliably predict hand contamination at times of potential pathogen transmission, single random hand rinses are not valid proxy measures for handwashing behavior.
  The American journal of tropical medicine and hygiene 04/2011; 84(4):510-6. · 2.59 Impact Factor
• Article: Is structured observation a valid technique to measure handwashing behavior? Use of acceleration sensors embedded in soap to assess reactivity to structured observation.

  Pavani K Ram, Amal K Halder, Stewart P Granger, Therese Jones, Peter Hall, David Hitchcock, Richard Wright, Benjamin Nygren, M Sirajul Islam, John W Molyneaux, Stephen P Luby
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  ABSTRACT: Structured observation is often used to evaluate handwashing behavior. We assessed reactivity to structured observation in rural Bangladesh by distributing soap containing acceleration sensors and performing structured observation 4 days later. Sensors recorded the number of times soap was moved. In 45 participating households, the median number of sensor soap movements during the 5-hour time block on pre-observation days was 3.7 (range 0.3-10.6). During the structured observation, the median number of sensor soap movements was 5.0 (range 0-18.0), a 35% increase, P = 0.0004. Compared with the same 5-hour time block on pre-observation days, the number of sensor soap movements increased during structured observation by ≥ 20% in 62% of households, and by ≥ 100% in 22% of households. The increase in sensor soap movements during structured observation, compared with pre-observation days, indicates substantial reactivity to the presence of the observer. These findings call into question the validity of structured observation for measurement of handwashing behavior.
  The American journal of tropical medicine and hygiene 11/2010; 83(5):1070-6. · 2.59 Impact Factor
• Article: Burden of typhoid and paratyphoid fever in a densely populated urban community, Dhaka, Bangladesh.

  Aliya Naheed, Pavani K Ram, W Abdullah Brooks, M Anowar Hossain, Michele B Parsons, Kaisar Ali Talukder, Eric Mintz, Stephen Luby, Robert F Breiman
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  ABSTRACT: We conducted blood culture surveillance to estimate the incidence of typhoid and paratyphoid fever among urban slum residents in Dhaka, Bangladesh. Between January 7, 2003 and January 6, 2004, participants were visited weekly to detect febrile illnesses. Blood cultures were obtained at the clinic from patients with fever (≥38°C). Salmonella isolates were assayed for antimicrobial susceptibility. Forty Salmonella Typhi and eight Salmonella Paratyphi A were isolated from 961 blood cultures. The incidence of typhoid fever was 2.0 episodes/1000 person-years, with a higher incidence in children aged<5 years (10.5/1000 person-years) than in older persons (0.9/1000 person-years) (relative risk=12, 95% confidence interval (CI) 6.3-22.6). The incidence of paratyphoid fever was 0.4/1000 person-years without variation by age group. Sixteen S. Typhi isolates were multidrug-resistant (MDR). All S. Paratyphi isolates were pan-susceptible. The duration of fever among patients with an MDR S. Typhi infection was longer than among patients with non-MDR S. Typhi (16±8 vs. 11±4 days, p=0.02) and S. Paratyphi (10±2 days, p=0.04) infections. Typhoid fever is more common than paratyphoid fever in the urban Bangladeshi slum; children<5 years old have the highest incidence. Multidrug resistance is common in S. Typhi isolates and is associated with prolonged illness. Strategies for typhoid fever prevention in children aged<5 years in Bangladesh, including immunization, are needed.
  International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 03/2010; 14 Suppl 3:e93-9. · 2.17 Impact Factor
• Article: An outbreak of enterotoxigenic Escherichia coli associated with sushi restaurants in Nevada, 2004.

  Seema Jain, Lei Chen, Amy Dechet, Alan T Hertz, Debra L Brus, Kathleen Hanley, Brenda Wilson, Jaime Frank, Kathy D Greene, Michele Parsons, Cheryl A Bopp, Randall Todd, Michael Hoekstra, Eric D Mintz, Pavani K Ram
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  ABSTRACT: In August and November 2004, 2 clusters of diarrhea cases occurred among patrons of 2 affiliated sushi restaurants (sushi restaurant A and sushi restaurant B) in Nevada. In August 2004, a stool sample from 1 ill sushi restaurant A patron yielded enterotoxigenic Escherichia coli (ETEC). In December 2004, we investigated a third cluster of diarrhea cases among sushi restaurant B patrons. We defined a case as diarrhea in a person who ate at sushi restaurant B from 3 December through 13 December 2004. Control subjects were individuals who dined with case patients but did not become ill. Duplex polymerase chain reaction was used to detect genes coding for heat-stable and heat-labile enterotoxins of ETEC. One-hundred thirty patrons of sushi restaurant B reported illness; we enrolled 36 case patients and 29 control subjects. The diarrhea-to-vomiting prevalence ratio among patients was 4.5. Illness was associated with consumption of butterfly shrimp (estimated odds ratio, 7.2; 95% confidence interval, 1.1 to infinity). The implicated food was distributed to many restaurants, but only sushi restaurant B patrons reported diarrhea. We observed poor food-handling and hand hygiene practices at sushi restaurant B. Stool samples from 6 of 7 ill patrons and 2 of 27 employees who denied illness yielded ETEC. ETEC was identified as the etiologic agent of a large foodborne outbreak at a sushi restaurant in Nevada. Poor food-handling practices and infected foodhandlers likely contributed to this outbreak. Although ETEC is a well-documented cause of domestic foodborne outbreaks, few laboratories can test for it. Earlier recognition of ETEC infections may prevent subsequent outbreaks from occurring.
  Clinical Infectious Diseases 08/2008; 47(1):1-7. · 9.15 Impact Factor
• Article: Clinical value of Tubex and Typhidot rapid diagnostic tests for typhoid fever in an urban community clinic in Bangladesh.

  Aliya Naheed, Pavani K Ram, W Abdullah Brooks, Eric D Mintz, Md Anowar Hossain, Michele M Parsons, Stephen P Luby, Robert F Breiman
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  ABSTRACT: Tubex and Typhidot, rapid tests for typhoid fever, performed well in evaluations conducted in hospital settings among patients with culture-confirmed typhoid fever. We evaluated these tests in a community clinic in Bangladesh. Blood samples were obtained from 867 febrile patients for culture, Typhidot and Tubex tests. Considering the 43 blood culture-confirmed cases of typhoid fever as typhoid positive and the 24 other confirmed bacteremia cases as typhoid negative, Tubex was 60% sensitive and 58% specific, with 90% positive and 58% negative predictive values (NPVs); Typhidot was 67% sensitive and 54% specific, with 85% positive and 81% NPVs. When blood culture-negative patients and other bacteremia cases together were considered typhoid negative, positive predictive values were only 14% for Tubex and 13% for Typhidot, increasing to only 38% and 20% when restricted to patients with > or = 7 days of fever. We conclude that the value of Tubex and Typhidot tests for typhoid fever diagnosis in a community clinic in urban Bangladesh is low.
  Diagnostic Microbiology and Infectious Disease 08/2008; 61(4):381-6. · 2.53 Impact Factor
• Article: Household water disinfection in hurricane-affected communities of Louisiana: implications for disaster preparedness for the general public.

  Pavani K Ram, Elizabeth Blanton, Debra Klinghoffer, Mary Platek, Janet Piper, Susanne Straif-Bourgeois, Matthew R Bonner, Eric D Mintz
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  ABSTRACT: Thousands of Louisiana residents were asked to boil water because of widespread disruptions in electricity and natural gas services after Hurricane Rita. We sought to assess awareness of boil water orders and familiarity with household water disinfection techniques other than boiling. We conducted a cross-sectional survey in randomly selected mobile home communities in Louisiana. We interviewed 196 respondents from 8 communities, which had boil water orders instituted. Of 97 who were home while communities were still under orders to boil water, 30 (31%) were aware of the orders and, of those, 24 (80%) said the orders were active while they were living at home; of the 24, 10 (42%) reported boiling water. Overall, 163 (83%) respondents were aware of a method of water disinfection at the household level: boiling (78%), chlorination (27%), and filtration (25%); 87% had a container of chlorine bleach at home. Few hurricane-affected respondents were aware of boil water orders and of alternate water disinfection techniques. Most had access to chlorine and could have practiced household chlorination if disruption in natural gas and electricity made boiling impossible.
  American Journal of Public Health 05/2007; 97 Suppl 1:S130-5. · 3.93 Impact Factor