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ABSTRACT: Insecticide-treated mosquito nets are effective in reducing malaria transmission and mortality, yet they are underused for prevention. In this study, 561 households in 33 clusters were surveyed to estimate the coverage of net ownership and the frequency of use according to selected characteristics. Of the 540 participating household heads, 247 (46%) owned mosquito nets. Of 1681 individuals in households with mosquito nets, 1359 (81%) used the nets. A household monthly income > or =2000 Indian rupees (US$45) was strongly associated with mosquito net ownership (prevalence ratio=12, 95% CI 7.8-82). Factors independently associated with net use in multivariate analysis included age < 35 years (P<0.001), sleeping inside (P<0.001), use of repellent (P=0.03) as well as knowledge that mosquitoes cause malaria (P=0.002) and that malaria is severe in children (P<0.001). Whilst household income is the strongest determinant of mosquito net ownership, selected knowledge elements are associated with net use. It is necessary to improve financial accessibility to nets and to communicate that malaria is a disease transmitted by mosquitoes that could be fatal in children.
Transactions of the Royal Society of Tropical Medicine and Hygiene 02/2010; 104(6):423-8. · 2.16 Impact Factor
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ABSTRACT: In November 2003, an outbreak (41 cases; attack rate-4.3%; no deaths) of severe diarrhoea was reported from a village in Orissa, eastern India. Thirteen of these cases were hospitalized. A matched case-control study was conducted to identify the possible exposure variables. Since all wells were heavily chlorinated immediately after the outbreak, water samples were not tested. The cases were managed symptomatically. Descriptive epidemiology suggested clustering of cases around one public well. Vibrio cholerae El Tor O1, serotype Ogawa was isolated from four of six rectal swabs. The water from the public well was associated with the outbreak (matched odds ratio: 12; 95% confidence interval 1.2-44.1). On the basis of these conclusions, access to the well was barred immediately, and it was protected. This investigation highlighted the broader use of field epidemiology methods to implement public-health actions guided by epidemiologic data to control a cholera epidemic.
Journal of Health Population and Nutrition 10/2009; 27(5):646-51. · 0.95 Impact Factor
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ABSTRACT: Leptospirosis outbreaks occur frequently in North and South Andaman Islands but not in Middle Andaman. In 2002, an outbreak appeared in Middle Andaman for the first time. Although a study on risk factors was conducted in North Andaman, it used seropositivity to define leptospirosis. Since seropositivity might not indicate current leptospiral infection and as no study on risk factors was conducted in Middle Andaman, we carried out this study to identify the risk factors during the outbreak.
A suspected outbreak of leptospirosis occurred in Rangat of Middle Andaman during October - November 2002. Suspected cases were screened for leptospirosis using microscopic agglutination test (MAT). Fifty two patients confirmed to have leptospirosis based on rising titres in MAT on paired sera, and 104 age, sex and neighbourhood seronegative matched controls, were included in the study. A conditional multiple regression by backward elimination process was carried out with acute leptospirosis as the dependent factor and various environmental, occupational and behavioural factors as independent factors. A stratified analysis was also carried out.
The presence of cattle in the house, drinking stream water, contact with garbage, walking barefoot and standing in water while working were identified as significant factors associated with leptospirosis. Stratified analysis showed a dose response relationship between number of cattle in the house and the risk of leptospiral infection suugesting that cattle could be a source of infection.
Identification of the potential risk factors would help understand the transmission dynamics of the disease and formulate public health interventions.
The Indian journal of medical research 07/2009; 130(1):67-73. · 1.84 Impact Factor
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ABSTRACT: To identify risk factors for typhoid and propose prevention measures.
Case-control study; we compared hospital-based typhoid cases defined as fever>38 degrees C for >or=3 days with four-fold rise in 'O' antibodies on paired sera (Widal) with community, age and neighbourhood matched controls. We obtained information on drinking water, fruits, vegetables, milk products and sanitation; and calculated matched odds ratios (MOR) and attributable fractions in the population (AFP) for the risk factors or failure to use prevention measures.
The 123 typhoid cases (median age: 25 years, 47% female) and 123 controls did not differ with respect to baseline characteristics. Cases were less likely to store drinking water in narrow-mouthed containers (MOR: 0.4, 95% CI: 0.2-0.7, AFP 29%), tip containers to draw water (MOR: 0.4, 95% CI: 0.2-0.7, AFP 33%) and have home latrines (MOR: 0.5, 95% CI: 0.3-0.8, AFP 23%). Cases were more likely to consume butter (OR: 2.3, 95% CI: 1.3-4.1, AFP 28%), yoghurt (OR: 2.3, 95% CI: 1.4-3.7, AFP 34%) and raw fruits and vegetables, including onions (MOR: 2.1, 95% CI: 1.2-3.9, AFP 34%), cabbages (OR: 2.8, 95% CI: 1.7-4.8, AFP 44%) and unwashed guavas (OR: 1.9, 95% CI: 1.2-3, AFP 25%).
Typhoid was associated with unsafe water and sanitation practices as well as with consumption of milk products, fruits and vegetables. We propose to chlorinate drinking water at the point of use, wash/cook raw fruits and vegetables and ensure safer preparation/storage of local milk products.
Tropical Medicine & International Health 05/2009; 14(6):696-702. · 2.80 Impact Factor
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ABSTRACT: To identify risk factors for scrub typhus in Darjeeling, India, we compared 62 scrub typhus cases (acute fever with eschar and specific IgM) with 62 neighbourhood controls. Cases were more likely to live close to bushes [matched odds ratio (MOR) 10; 95% CI 2.3-63] and wood piles (MOR 3.5; 95% CI 1.5-9.5), to work on farms (MOR 10; 95% CI 2.7-63), to observe rodents at home (MOR 3.6; 95% CI 1.4-11) and at work (MOR 9; 95% CI 2.4-57), and to rear domestic animals (MOR 2.4; 95% CI 1.1-5.7). Cases were less likely to wash after work (MOR 0.4; 95% CI 0.1-0.9) and change clothes to sleep (MOR 0.2; 95% CI 0.1-0.5). A cleaner, rodent-controlled environment may prevent exposure to scrub typhus. Personal protection measures and better hygiene could further reduce individual risk.
Transactions of the Royal Society of Tropical Medicine and Hygiene 04/2009; 103(11):1153-8. · 2.16 Impact Factor
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ABSTRACT: This study examines psycho-social impact of HIV and quality of life of 646 HIV-infected persons from a major government sexually transmitted disease (STD) clinic in South India. In this cross-sectional study, data was collected using interview schedule and scales. Nearly 70% had problems in parenting their children after acquiring the infection. Most (88%) of the respondents reported of seeking help from their family members, relatives or close friends at the time of their illness. Among the four categories of stigma, most of them (96%) reported perceived stigma whereas actual stigma was mentioned by only 33%. All four categories of stigma were experienced on a higher proportion by females than males (p<0.05). Each type of stigma was significantly associated with each domain of quality of life of the respondents (p<0.005). Respondents who reported of actual stigma (33%) had significantly good quality of life in their physical domain (49%), psychological domain (48%) and environmental domain (44%). Multivariate analysis showed that gender and marital status had significant association with quality of life. The findings of the study underscore the need for enabling environment through "human force" to uplift their social status and to have a better quality of life.
AIDS Care 03/2009; 21(4):473-81. · 1.60 Impact Factor
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ABSTRACT: We investigated two sequential outbreaks of severe diarrhoea in two neighbouring villages of Orissa, in 2005. We conducted descriptive and matched case-control studies. The attack rates were 5.6% (n=62) and 5.2% (n=51), respectively, in the first and second villages. One death was reported in the second village (case fatality 2%). We identified that consumption of milk products prepared in the household of the index case [matched odds ratio (mOR) 5.7, 95% confidence interval (CI) 1.7-30] in the first village, and drinking well water in the second village were associated with the illness (mOR 4.7, 95% CI 1.6-19). We isolated Vibrio cholerae El Tor O1 Ogawa from stool samples from both the villages. Mishandling of milk products led to a cholera outbreak in the first village, which led to sewerage contamination of a well and another outbreak in the second village. Environmental contamination should be expected and prevented during cholera outbreaks.
Epidemiology and Infection 02/2009; 137(6):906-12. · 2.84 Impact Factor
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ABSTRACT: In Kurseong, Darjeeling District, India, malaria caused concern but insufficient information was available. We analysed surveillance data to estimate the burden of malaria and to examine trends. Confirmed malaria reports were reviewed and climatic records were collected. The annual parasite incidence (API; number of cases/population) and the annual blood examination rate (ABER; number of slides examined/population) were calculated to assess case detection activities, and the slide positivity rate (SPR; number of slides positive/total number examined) was calculated to assess transmission trends. The API increased from 2 to 7.8 per 1000 population between 2000 and 2004 (no deaths), with a high incidence among all age groups. Two foothill areas with forests and slow-moving streams accounted for 88% of the 697 cases in 2004. The average 2000-2004 ABER was 4.8%, below the 10% examination target of the National Anti-Malaria Programme. The proportion of Plasmodium falciparum increased from 62% in 2000 to 77% in 2004. More than 50% of P. falciparum in the area were chloroquine resistant. The SPR increased from 8.1% in 2000 to 11.9% in 2004 and peaked during monsoons. Annual rainfall increased from 2000 to 2003. Malaria transmission increased, with an increasing proportion of P. falciparum in a context of resistance to chloroquine. We recommend increasing case detection and using artemisinin-based combination therapy to treat P. falciparum malaria.
Transactions of the Royal Society of Tropical Medicine and Hygiene 10/2008; 103(7):691-7. · 2.16 Impact Factor
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ABSTRACT: A large outbreak of hepatitis E occurred in 2005 in Hyderabad, Andhra Pradesh, India. A total of 1611 cases were reported between 1 March and 31 December 2005 (attack rate 40/100,000). The epidemic curve suggested a continuing common source outbreak. Cases were centred around open sewage drains that crossed the old city. The attack rate was significantly higher in neighbourhood blocks supplied by water supply lines that crossed open drains (203/100,000) than in blocks supplied by non-crossing water pipes with a linear trend (38/100 000, P<0.00001). Crossing water pipelines were repaired and the attack rates declined.
Epidemiology and Infection 07/2008; 137(2):234-40. · 2.84 Impact Factor
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Axel Kroger,
V Pannikar,
M T Htoon,
A Jamesh,
K Katoch,
P Krishnamurthy,
K Ramalingam,
Shen Jianping,
Vitthal Jadhav, M D Gupte,
P Manickam
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ABSTRACT: To describe the rationale, design and preliminary results of an open trial of 6 months uniform multi-drug therapy (U-MDT) for all types of leprosy patients assuming a cumulative relapse rate not exceeding 5% over 5 years of follow-up.
We intended to recruit 2500 patients each in multi-bacillary (MB) and pauci-bacillary (PB) groups from India (five centres) and China (two centres). Standardized clinical criteria were used to assess skin lesions in the field.
A total of 2912 patients enrolled from November 2003 to May 2007 (India, 2746; China, 166). MB patients constituted 39% and 3% had grade 2 disability. During follow-up, 27 patients (0.9%) developed new lesions. Of these, 78% were on account of reactions. Six patients had clinically confirmed relapse. Clofazimine-related skin pigmentation was short-lived and was acceptable to patients. We analysed data for clinical status of skin lesions. About 2.9% of patients were lost to follow-up; 85.9% completed treatment, of whom 19% had inactive skin lesions. PB patients responded better than MB patients (27%vs. 6%; P < 0.001). At the end of the first (n = 2013) and second year (n = 807) of follow-up post-U-MDT, in 49% and 46% patients, lesions were inactive, respectively (59% and 57% in PB, 37% and 28% in MB; P < 0.001).
U-MDT appears to be promising with respect to clinical status of skin lesions.
Tropical Medicine & International Health 05/2008; 13(5):594-602. · 2.80 Impact Factor
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ABSTRACT: This study reports perception of STD clinic attendees of Government General hospital, Chennai, India towards free HIV testing. All STD clinic attendees who were eligible for the study (511), from January to April 2001 formed the study subjects. In all, 362 (71%) subjects responded to the question on perception of risk in getting HIV/AIDS. Among them 36% perceived that they were at risk of getting infected with HIV. There was a significant difference (P=0.01) between the genders, as more males perceived risk of getting HIV than females and, with the increase in number of sexual partners in a lifetime there was an increasing trend (p<0.0001) in the perception of risk. There were 244 (55%) subjects willing for HIV testing. A significant difference between the genders (p<0.0001) was observed, as more females were willing to accept free HIV testing than males. When adjusting the effect of co-variates such as gender, age, marital status and perception of risk in getting HIV, persons having two or more sexual partners in their life time were four times more willing to be HIV tested than persons with one sexual partner (OR=4; p=0.001). The findings in this study will help optimize HIV testing in at risk patient populations in India.
AIDS Care 01/2008; 20(1):26-34. · 1.60 Impact Factor
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ABSTRACT: Cardiovascular diseases (CVD) are leading cause of death in developing countries including India. The huge burden of CVD in Indian subcontinent is the consequence of the large population and high prevalence of cardiovascular risk factors. This study was done to determine the prevalence of cardiovascular risk factors in two industrial units in Chennai, India.
Survey of behavioural risk factors using structured questionnaires and anthropometric measurements were done for the study population. Blood samples were collected for the fasting plasma glucose and serum cholesterol. Trend chi-square was employed to test the linear trend.
The total study population included 2262 male subjects. Blood samples were collected for 2148 (95.0%) subjects. Age range was 18-69 years. Prevalence of major cardiovascular risk factors was: current smokers 462 (20.2%), body mass index > or = 23 kg/m2 1510 (66.8%), central obesity 1589 (70.2%), hypertension 615 (27.2%), diabetes mellitus 350(16.3%) and total cholesterol > or = 200mg/dl in 650(30.3%).
The study results indicated high prevalence of behavioural risk factors, central obesity, hypertension and diabetes in a select group of middle and high-income young urban males. The long-term follow-up in such settings will provide an opportunity to understand the influence of risk factors on cardiovascular disease outcomes.
The Journal of the Association of Physicians of India 11/2007; 55:771-6.
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ABSTRACT: As part of the global strategic plan to reduce the number of measles deaths in India, the state of Tamilnadu aims at > or =95% measles vaccination coverage. A study was conducted to measure overall coverage levels for the Poondi Primary Health Center (PPHC), a rural health-care facility in Tiruvallur District, and to determine whether any of the PPHC's six health subcenters had coverage levels <95%.
The Lot Quality Assurance Sampling (LQAS) method was used to identify health subcenters in the PPHC area with measles vaccination coverage levels <95% among children aged 12-23 months. Lemeshow and Taber sampling plans were used to determine that the measles vaccination status of 73 children aged 12--23 months had to be assessed in each health subcenter coverage area, with a 5% level of significance and a decision value of two. If more than two children were unvaccinated, the null hypothesis (i.e., that coverage in the health subcenter was low [<95%]) was not rejected. If the number of unvaccinated children was two or fewer, the null hypothesis was rejected, and coverage in the subcenter was considered to be good (i.e., > or =95%). All data were pooled in a stratified sample to estimate overall total coverage in the PPHC area.
For two (33.3%) of the six health subcenters, more than two children were unvaccinated (i.e., coverage was <95%). Combining results from all six health subcenters generated a coverage estimate of 97.7% (95% confidence interval = 95.7-98.8) on the basis of 428 (97.7%) of 438 children identified as vaccinated.
LQAS techniques proved useful in identifying small health areas with lower vaccination coverage, which helps to target interventions. Monthly review of vaccination coverage by subcenter and village is recommended to identify pockets of unvaccinated children and to maintain uniform high coverage in the PPHC area.
MMWR. Morbidity and mortality weekly report 05/2006; 55 Suppl 1:16-9.
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ABSTRACT: To analyze the trends of case detection and other indicators of leprosy in China during 1985-2002.
Data reported by each province were collected by China National Leprosy Database in Nanjing P.R. China. All data about registered cases were put into computer for analysis.
From 1985 to 2002, a total of 49,477 new leprosy cases had been detected. Among them, 69.5% were multibacillary cases and 25.4% had grade 2 disability. The child cases aged below 15 years accounted for 3.74% of total cases. Totally, 5824 cases and 303 cases relapsed after dapsone (DDS) mono-therapy and multidrug therapy (MDT), respectively. Case detection showed a marked reduction from 0.47/100,000 in 1985 to 0.18/100,000 in 1993 although there were several spurts due to operational factors. From 1994, case detection showed no significant decline. The grade 2 disability among new patients decreased from 31.4% in 1985 to 23.4% in 2002. The child case detection rate among new cases fluctuated between 2.70%-3.56% from 1999 to 2002. The incidence of relapse declined after the introduction of DDS mono-therapy. However, it increased after the introduction of MDT.
China experiences in leprosy control show that it will take a long time with continuing present leprosy control activities to bring down the case detection and other indicators to a very low level even after reaching the elimination goal of leprosy.
Chinese Medical Sciences Journal 07/2005; 20(2):77-82.
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ABSTRACT: In order to evaluate the usefulness of natural disaccharide (PGL1) and 35 kDa antigens based serology in diagnosis of leprosy and in detecting high risk groups for leprosy, this study was conducted in an endemic population in South India. Out of 3346 cases and their households and neighbouring household contacts, serum samples from 2994 and 2875 individuals were screened for antibodies against PGL1 and 35kDa antigens respectively. While the overall positivity for contacts and leprosy cases was 3.3% for PGL1 antibody, the positivity for 35 kDa antibody was 6.3%. The positivity for contact population was 2.7% and 5.4% for PGL1 and 35 kDa antibodies, respectively. Lepromatous and borderline lepromatous patients showed positivity of 35.1% for PGL1 antibody and 45.7% for 35 kDa antibody. Follow-up of contacts showed that the majority (>90%) remained seronegative for both the antibodies and most of the new cases emerged from the seronegative group. The study clearly indicates that specific serological assays are not sensitive enough for application, both for diagnosis and for identifying any individual at risk for leprosy in the south Indian endemic population.
Leprosy review 10/2004; 75(3):266-73. · 1.04 Impact Factor
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ABSTRACT: The concept of elimination of an infectious disease is different from eradication and in a way from control as well. In disease elimination programmes the desired reduced level of prevalence is set up as the target to be achieved in a practical time frame. Elimination can be considered in the context of national or regional levels. Prevalence levels depend on occurrence of new cases and thus could remain fluctuating. There are no ready pragmatic methods to monitor the progress of leprosy elimination programmes. We therefore tried to explore newer methods to answer these demands. With the lowering of prevalence of leprosy to the desired level of 1 case per 10000 population at the global level, the programme administrators' concern will be shifted to smaller areas e.g. national and sub-national levels. For monitoring this situation, we earlier observed that lot quality assurance sampling (LQAS), a quality control tool in industry was useful in the initially high endemic areas. However, critical factors such as geographical distribution of cases and adoption of cluster sampling design instead of simple random sampling design deserve attention before LQAS could generally be recommended. The present exercise was aimed at validating applicability of LQAS, and adopting these modifications for monitoring leprosy elimination in Tamil Nadu state, which was highly endemic for leprosy.
A representative sample of 64000 people drawn from eight districts of Tamil Nadu state, India, with maximum allowable number of 25 cases was considered, using LQAS methodology to test whether leprosy prevalence was at or below 7 per 10000 population. Expected number of cases for each district was obtained assuming Poisson distribution. Goodness of fit for the observed and expected cases (closeness of the expected number of cases to those observed) was tested through chi(2). Enhancing factor (design effect) for sample size was obtained by computing the intraclass correlation.
The survey actually covered a population of 62157 individuals, of whom 56469 (90.8%) were examined. Ninety-six cases were detected and this number far exceeded the critical value of 25. The number of cases for each district and the number of cases in the entire surveyed area both followed Poisson distribution. The intraclass correlation coefficients were close to zero and the design effect was observed to be close to one.
Based on the LQAS exercises leprosy prevalence in the state of Tamil Nadu in India was above 7 per 10000. LQAS method using clusters was validated for monitoring leprosy elimination in high endemic areas. Use of cluster sampling makes this method further useful as a rapid assessment procedure. This method needs to be tested for its applicability in moderate and low endemic areas, where the sample size may need increasing. It is further possible to consider LQAS as a monitoring tool for elimination programmes with respect to other disease conditions.
International Journal of Epidemiology 05/2004; 33(2):344-8. · 6.41 Impact Factor
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ABSTRACT: To adapt and develop a method for finding out what proportion of the variation among small areas in the number of births to married women is excess (systematic) variation over and above the chance (random) variation.
We adopted a two-stage sampling procedure to select 20 sub-centres in south India. We contacted all households and collected information on recent births and socioeconomic variables from all ever married women aged 15-49 years. Systematic and random components of variance were estimated using Poisson regression, adjusting for socioeconomic factors.
Of the observed variance in fertility, 65% is explained by the estimated systematic variation. Though many important explanatory variables are considered, the systematic variance is significant mainly among illiterate women, those aged under 18 years at marriage, the marginalized population, and those with labourer husbands.
Poisson regression can be adapted to estimate the random and systematic components of variation in fertility among small areas. The systematic component of variance can further be adjusted for socioeconomic factors. Identification of the significant predictors will help health planners develop necessary interventions at the small area level.
International Journal of Epidemiology 09/2003; 32(4):639-44. · 6.41 Impact Factor
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ABSTRACT: The emergence of an outbreak of leptospirosis in a nurses' hostel in Chennai presented a challenge to identify and control the source of the outbreak. Sixty-nine residents and staff members were interviewed to assess exposure factors. Blood samples from the acute and convalescent patients were tested with the Microscopic Agglutination Test using the serovars prevalent in Chennai. Polymerase Chain Reaction (PCR) was conducted on serum and water samples. Based on preliminary investigation, control measures with standard hygienic measures were instituted. The attack rate was 35%. The epidemic curve suggested continuous or intermittent exposure to infection over a five-week period. Twenty residents (three asymptomatic) developed laboratory confirmed Leptospira icterohemorrhagiae. Residents collected water from an underground storage tank that was filled twice weekly from a mobile water tanker with a bucket on a rope, and the tank was usually left open. PCR tests confirmed the presence of leptospires from this water. Other control measures included cleaning the large backyard with its many stray dogs and rats, chlorinating water supplies, boiling drinking water and health education. No further cases occurred twelve days after implementing control measures. Access to clean water, not only for drinking but also for bathing, brushing and washing is essential to prevent water-borne outbreaks.
The Journal of communicable diseases 04/2003; 35(1):1-8.
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ABSTRACT: To determine prevalence of known diabetes in those more than 20 years of age in Chennai city.
Urban population was selected for the survey. Assuming the prevalence of known diabetes as 5.0% in those aged > 20 years, the cluster sample size calculated to estimate it with 95% CI and +/- 10% precision, was 25800 individuals of all ages. This population obtained from 200 households in each of 30 randomly selected corporation divisions of the city, was surveyed by social workers by house to house enquiry. General information and health status of every member of the household were recorded on prescribed forms. This survey was conducted during January-July, 1998.
Among 26,066 individuals of all ages 779 had known diabetes and 99.4% of them had type 2 diabetes. The prevalence of known diabetes was 2.9% for all ages and both sexes combined. Crude and age-standardized prevalence was 4.9% (95% CI 4.6-5.2) for those aged > 20 years. The standardized prevalence was 10.5% (95% CI 9.8 - 11.2) in those aged > or = 40 years. The prevalence was significantly high (P < 0.05) in females.
The prevalence of known diabetes was low in total population but increased in those aged > 20 and further increased in those aged > or = 40 years. The causes for high prevalence in > or = 40 year age group needs to be explored in this population.
The Journal of the Association of Physicians of India 11/2001; 49:974-81.
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M D Gupte
International Journal of Leprosy and Other Mycobacterial Diseases 07/2001; 69(2 Suppl):S10-3. · 0.22 Impact Factor
