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The relationship between rind scarring [caused by Brevipalpus phoenicis (Geijskes), Scirtothrips citri (Moulton) and wind] and physiochemical parameters was studied in three main kinnow producing zones of Punjab (Abohar, Ludhiana and Hoshiarpur), India. The results showed a nonsignificant increase in TSS value with increase in rind damage (caused by mites + thrips + wind) upto 50% but later on it was significantly decreased with increase in damage from 50 to 100%. Other parameters like vitamin C, phenols (pulp and peel), pectin, total carotenoids and fruit firmness were decreased with the increment in damage and lowest values were observed in 100% damaged fruits but the titrable acidity and sugars (non reducing, reducing & total sugar) parameters were not affected by rind scarring. The wind damaged fruits showed noncomparable data for all studied physiochemical parameters which indicated that wind doesn't affect the fruit quality. It may also be concluded that only thrips and mites are responsible for deterioration of kinnow fruits quality. [ABSTRACT FROM AUTHOR]

Recent evidence shows a noticeable reduction in the glacier mass in the Himalaya due to increasing temperatures, and therefore the downstream water availability is becoming uncertain. This study analyse the effect of changes in the Gangotri glaciers (i.e. thickness), including Raktavaran and Chaturangi regions, on the melt runoff (2011-2020) by coupling two models: Glacier Bed Topolology (GlabTop2) and Spatial Process in Hydrology (SPHY). This study performs the two-step calibration approach utilizing the observed discharge and Moderate Resolution Imaging Spectroradiometer (MODIS) snow cover data. The R² values for SPHY-modelled runoff (Q) and observed Q at Bhojwasa are found comparable (~0.73 on a daily scale) and the proportions of glacier Q and snow Q in total Q are computed as 22.11% and 66.91%, respectively. In comparison to Chaturangi and Raktavaran, Gangotri glaciers experienced a higher rate of change in thickness, and a reduction of ~9.40% in the mean glacier thickness is calculated during 2011-2020. [ABSTRACT FROM AUTHOR]

Background: Though diabetes mellitus (DM) is a well-recognised risk factor for onychomycosis (OM), the epidemiology of OM in diabetic patients remains largely unexplored, especially from the Indian subcontinent. Aims and objectives: To estimate the prevalence of OM in diabetic patients, to identify and analyse risk factors, and correlate the severity of nail changes with glycemic control (HBA1c). Methods: This cross-sectional, analytical study involved 300 diabetic patients. Patients with the clinical diagnosis of OM, supplanted by at least two of the four tests (KOH, culture, onychoscopy and nail histopathology) were considered cases of OM. Demographic and haematological profile was analysed using chi-square test/Fischer's exact test. Logistic regression was applied to assess the independent risk factors. Results: The prevalence of OM in DM patients was 34% (102/300) and significant risk factors included; age >60 years, male gender, closed shoes, disease duration >5 years, high BMI (>25) and lack of awareness about nail changes. Distal and lateral subungual OM (78%) was the commonest presentation followed by proximal subungual OM, superficial OM and total dystrophic OM. Correlation between HbA1c and the number of nails involved was found to be significant. Limitations: As cases were recruited from a hospital setting, there could be chances of Berksonian bias. Conclusion: The prevalence of OM in diabetic patients is high and the severity of nail changes correlates with HbA1C levels. It is important to diagnose OM early in order to treat and prevent complications. [ABSTRACT FROM AUTHOR]

The availability of relatively low-cost and safer DAA treatment for HCV and evidence-based SUD treatment services has made it possible to decentralize and integrate co-occurring SUD and HCV care even in the LMIC. This led to treatment denial, worsening of the clinical condition, and even death.[14] However, there has been a significant improvement in HCV treatment, and we have witnessed a paradigm shift from interferon-based treatment to direct-acting antivirals (DAA). Hepatitis C (HCV) and hepatitis B (HBV) are two major blood-borne viral infections that affect patients with intravenous drug use (IDU). Integration of treatment for SUD and HCV can help increase treatment access for the substance-using population.[9] Various approaches are used to integrate HCV treatment with SUD care services. [Extracted from the article]

The 2019 extreme positive Indian Ocean dipole drove climate extremes over Indian Ocean rim countries with unclear carbon‐cycle responses. We investigated its impact on net biome productivity (NBP) and its constituent fluxes, using the Global Carbon Assimilation System (GCASv2) product, process‐based model simulations from TRENDYv9, and satellite‐based gross primary productivity (GPP). By distinguishing two separate regions, the India‐Africa and Asia‐Pacific, GCASv2 indicated enhanced terrestrial carbon uptake of 0.23 ± 0.20 PgC and release of 0.38 ± 0.15 PgC, respectively, during September–December (SOND) 2019. These NBP anomalies had comparable magnitudes to those following the 2015 extreme El Niño which, however, caused the consistent carbon release in both regions. The TRENDYv9 model ensemble confirmed these NBP responses, albeit with smaller magnitudes. These regional NBP anomalies were related to soil moisture variations with a dominant role of GPP. Understanding the impact of IOD provides new insights into mechanisms driving interannual variations in regional carbon cycling. Plain Language Summary: The extreme Indian Ocean Dipole (IOD) can drive climate extremes, such as floods, heatwaves, droughts, and wildfires, over the Indian Ocean rim countries. However, responses of regional terrestrial carbon cycling to IOD remained unclear. We used the net biome productivity (NBP) from an atmospheric inversion and multiple terrestrial biosphere models to demonstrate an enhanced terrestrial carbon uptake and release over the India‐Africa and Asia‐Pacific regions, respectively, during the extreme positive IOD (September–December) in 2019. These IOD‐induced regional NBP anomalies showed comparable magnitudes but different patterns to those following the 2015 extreme El Niño. Along with the more frequent extreme IOD under future greenhouse warming, IOD will be an important mechanism driving interannual variations in regional carbon cycling. Key Points: The 2019 extreme positive Indian Ocean Dipole caused the enhanced land carbon uptake over India‐Africa and release over Asia‐Pacific during September–DecemberThese regional net biome productivity (NBP) anomalies were closely related to soil moisture variations with a dominant role of gross primary productivityThese Indian Ocean Dipole‐induced regional NBP anomalies showed comparable magnitudes but different patterns to those following the 2015 extreme El Niño [ABSTRACT FROM AUTHOR]

Background: Quality management in healthcare is critical for hospitals and everyone in the loop —from physicians to support staff—needs to be aware of and involved in this process. Objectives: To assess the perception of employees about the quality management system (QMS) implemented at a tertiary care eye hospital in north India and to use it to identify scope for further improvement. Methods: This cross-sectional mixed-method study involved both questionnaire-based survey and an in-depth interview by a third party. The questionnaire had 12 questions to assess the changes in culture, infrastructure, environment, system, operation theatre and outpatient department. Employees shared their opinion about improvements brought by the QMS in eight years. Respondents were divided into five groups based on their job description: (i) doctors, (ii) technical staff (nursing/operation theatre/laboratory), (iii) optometrists/opticians/audiologists, (iv) patient care executives and (v) human resources/administration/others. Results: Of the 73 employees interviewed, 94.5% perceived an improved treatment and care process and 91.8% perceived improved treatment results. According to 83.6% of the employees, they were encouraged to report patient safety concerns and 71.2% saw improved incidence and adverse event management. The QMS has increased patient satisfaction according to 83%, while 91.8% felt it improved the profile of the hospital. The employees stated no negative effects of the QMS except a long waiting time of the patients and the duplication of paperwork. Conclusion: QMS has brought many positive changes across the hospital. Still, there is scope to reduce the patient waiting time and paperwork duplication. [ABSTRACT FROM AUTHOR]

Background: Microbes become unresponsive to the drugs used to treat infections due to their ability to acquire antimicrobial resistance. Aims: The present research aimed to study the patterns of phenotypic and genotypic antimicrobial resistance in Staphylococcus spp. isolated from goat milk. Methods: A total of 200 milk samples were collected to isolate Staphylococcus spp. from mastitic and healthy goats from Punjab state, India. The isolates were then identified biochemically and molecularly (polymerase chain reaction (PCR)). An antibiotic sensitivity test was conducted using 15 different antibiotics. Molecular detection of antibiotic resistance genes was done using PCR. Chi-square test was done to study the association between genotypic and phenotypic resistance patterns among the isolates. Results: A total of 47 Staphylococcus spp. were isolated of which 33 and 14 isolates were respectively coagulase positive and negative. The isolates phenotypically showed the highest resistance to Penicillin G (P) (91.4%). Methicillin resistant Staphylococcus aureus (MRSA) was found 56.25%. Amongst the antibiotic resistance genes, tetK (87.23%) was the most prevalent isolated gene followed by blaZ (85.10%), mecA (48.93%), and tetM (14.89%). Statistical analysis revealed that the genotypic and phenotypic resistance patterns were significantly associated with penicillin and methicillin (MET) resistances. Conclusion: The high prevalence of antibiotic-resistant Staphylococcus spp., especially MRSA, in goat milk is of concern and needs to be addressed in this area. [ABSTRACT FROM AUTHOR]

Background: Mastitis is a multi-etiological disease. It leads to physical, chemical and bacteriological changes in milk and pathological changes in glandular tissues. In the present study, prevalence of mastitis causing organisms with special reference to Pseudomonas aeruginosa and its antibiotic resistance pattern was studied as Pseudomonas spp. is an important organism in harbouring and transmission of antibiotic resistance in environment. Methods: One hundred and one milk samples from mastitic cattle and buffaloes from farms in and around Ludhiana and mastitis cases presented in veterinary clinical complex, GADVASU, Ludhiana, Punjab, India were collected from August 2018 till April 2019. All the samples were processed for isolation of bacteria using different media viz., BHI, EMB, MLA, Cetrimide Agar, BP Agar, Edward’s medium and Blood Agar. After the isolation, all the organisms were subjected to cultural, morphological, biochemical tests and PCR for confirmation. All these isolates (except Bacillus spp. and Serratia marcescens) were screened for their antimicrobial resistance against 15 commonly used antibiotics viz., chloramphenicol, erythromycin, tetracycline, amoxycillin, co-trimoxazole, ciprofloxacin, gentamicin, cephalexin, ofloxacin, sparfloxacin, gatifloxacin, teicoplanin, azithromycin, vancomycin and doxycycline. Result: Out of a total of 101 samples, 86 samples yielded bacterial growth. Out of these 86 samples, 76 (88.37%) samples had a single bacterial growth whereas rest 10 (11.63%) samples had more than one bacterial growth. It was observed after the organisms were subjected to cultural, morphological, biochemical tests and PCR that, a total of 33 (34.02%) Staphylococcus aureus, 24 (24.74%) Escherichia coli, 16 (16.49%) Klebsiella pneumoniae, 5 (5.15%) Pseudomonas aeruginosa, 2 (2.06%) Streptococcus agalactiae, 12 (12.37%) Bacillus spp. and Serratia marcescens 5 (5.15%) were isolated. It was observed that Pseudomonas aeruginosa showed resistance against most of the antibiotics and was sensitive only for ofloxacin (80%) and gentamicin (40%). [ABSTRACT FROM AUTHOR]

Sargassum ilicifolium (Turner) C. Agardh (SI) and Padina tetrastromatica (Hauck) (PT) are tropical and sub-tropical brown algae, found in the coastal region of India. In the present study, the cognitive enhancing activity of chloroform and ethanol extract of SI and PT (CSI, ESI & CPT, EPT) was investigated in scopolamine- induced amnesic mice using the Passive avoidance (PA) test. In addition, the effect on brain oxidative enzymes and acetylcholinesterase (AChE) was also evaluated using a spectrophotometer. The results of this study indicated that CSI (600 mg/kg), ESI (600 mg/kg), as well as CPT (600 mg/kg), significantly increased Step-Down Latency compared to scopolamine treated group, indicated that, CSI, ESI and CPT significantly (p < 0.01) reversed memory deficit produced by scopolamine. Further, administration of CSI (600 mg/kg), ESI (600 mg/kg), as well as CPT (600 mg/kg), produced a significant (p < 0.01) fall in Malondialdehyde and increased in Reduced glutathione activity, indicated that CSI, ESI, and CPT exert a protective effect against oxidative damage induced by scopolamine. Also, it was found that, CSI (600 mg/kg), ESI (600 mg/kg) and CPT (600 mg/kg) significantly (p < 0.05) inhibit AChE activity. These findings resemble the effect of the standard anti-amnesic drug Piracetam. In conclusion, chloroform and ethanol extract of SI and PT shows significant cognitive-enhancing activities by the inhibition enzyme AChE and by the regulation of the oxidative enzymes in scopolamine-induced amnesic mice. However, further research is essential to explore the exact mechanism underlying this activity. [ABSTRACT FROM AUTHOR]

Background: The current study was planned at a tertiary centre in northern India to develop and validate a Diagnostic and Statistical Manual-5 (DSM-5)-based diagnostic tool and design a severity score for attention deficit hyperactivity disorder (ADHD) in children aged 6-18 years. An existing DSM-IV-based tool, INDT (International Clinical Epidemiology Network [INCLEN] diagnostic tool) for ADHD has been modified and named All India Institute of Medical Sciences (AIIMS)-modified INDT ADHD tool.Method: The first phase was development of the tool and the second phase was validation of the same against the gold standard of diagnosis by the DSM-5. A severity score was developed for ADHD in concordance with the Conners rating scale.Results: The tool was validated in 66 children with a sensitivity and specificity of 100 per cent and 90 per cent, respectively. A cut-off score of 12 was decided for labelling severity of ADHD, which corresponded to 63 in the Conners rating scale.Conclusion: This diagnostic tool for ADHD based on DSM-5 has acceptable psychometric properties. The severity score will be useful for prognostication, monitoring treatment response, and designing intervention trials. [ABSTRACT FROM AUTHOR]

There is paucity of evidence on cost of antiretroviral therapy (ART) delivered through the public sector in India. Moreover, the Government of India is considering changing the criteria for introduction of ART to HIV patients, which is likely to have significant economic implications. In this paper, we assess the health system cost of ART services at two levels of health care delivery. Bottom-up costing was used to collect data on capital and recurrent resources consumed over a period of one year (April 2014–March 2015). Capital costs were annualized and shared costs apportioned to calculate annual and unit costs of providing ART care. Sensitivity analysis was undertaken to measure the extent of uncertainty in input prices. The annual per capita cost of ART therapy was INR 48,975 (USD738) in the Centre of Excellence (COE) and INR 24,954 (USD376) in the ART centre. Drugs contributed around 70% and 65% of total annual cost, followed by human resource (19% each) and capital cost (7%; 12%) in COE and ART centres, respectively. These provide a comprehensive assessment of the cost of ART care in India. The study estimates could be used for planning of services, as well as undertaking further cost-effectiveness studies. [ABSTRACT FROM AUTHOR]

Approximately 3 billion people worldwide cook with solid fuels, such as wood, charcoal, and agricultural residues. These fuels, also used for residential heating, are often combusted in inefficient devices, producing carbonaceous emissions. Between 2.6 and 3.8 million premature deaths occur as a result of exposure to fine particulate matter from the resulting household air pollution (Health Effects Institute, 2018a; World Health Organization, 2018). Household air pollution also contributes to ambient air pollution; the magnitude of this contribution is uncertain. Here, we simulate the distribution of the two major health-damaging outdoor air pollutants (PM 2.5 and O3) using state-of-the-science emissions databases and atmospheric chemical transport models to estimate the impact of household combustion on ambient air quality in India. The present study focuses on New Delhi and the SOMAARTH Demographic, Development, and Environmental Surveillance Site (DDESS) in the Palwal District of Haryana, located about 80 km south of New Delhi. The DDESS covers an approximate population of 200 000 within 52 villages. The emissions inventory used in the present study was prepared based on a national inventory in India (Sharma et al., 2015, 2016), an updated residential sector inventory prepared at the University of Illinois, updated cookstove emissions factors from Fleming et al. (2018b), and PM 2.5 speciation from cooking fires from Jayarathne et al. (2018). Simulation of regional air quality was carried out using the US Environmental Protection Agency Community Multiscale Air Quality modeling system (CMAQ) in conjunction with the Weather Research and Forecasting modeling system (WRF) to simulate the meteorological inputs for CMAQ, and the global chemical transport model GEOS-Chem to generate concentrations on the boundary of the computational domain. Comparisons between observed and simulated O3 and PM 2.5 levels are carried out to assess overall airborne levels and to estimate the contribution of household cooking emissions. Observed and predicted ozone levels over New Delhi during September 2015, December 2015, and September 2016 routinely exceeded the 8 h Indian standard of 100 µ g m -3 , and, on occasion, exceeded 180 µ g m -3. PM 2.5 levels are predicted over the SOMAARTH headquarters (September 2015 and September 2016), Bajada Pahari (a village in the surveillance site; September 2015, December 2015, and September 2016), and New Delhi (September 2015, December 2015, and September 2016). The predicted fractional impact of residential emissions on anthropogenic PM 2.5 levels varies from about 0.27 in SOMAARTH HQ and Bajada Pahari to about 0.10 in New Delhi. The predicted secondary organic portion of PM 2.5 produced by household emissions ranges from 16 % to 80 %. Predicted levels of secondary organic PM 2.5 during the periods studied at the four locations averaged about 30 µ g m -3 , representing approximately 30 % and 20 % of total PM 2.5 levels in the rural and urban stations, respectively. [ABSTRACT FROM AUTHOR]

Background: Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden.Methods and Findings: We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population.Conclusions: The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions. [ABSTRACT FROM AUTHOR]

Emissions of airborne particles from biomass burning are a significant source of black carbon (BC) and brown carbon (BrC) in rural areas of developing countries where biomass is the predominant energy source for cooking and heating. This study explores the molecular composition of organic aerosols from household cooking emissions with a focus on identifying fuel-specific compounds and BrC chromophores. Traditional meals were prepared by a local cook with dung and brushwood-fueled cookstoves in a village in Palwal district, Haryana, India. Cooking was done in a village kitchen while controlling for variables including stove type, fuel moisture, and meal. Fine particulate matter (PM2.5) emissions were collected on filters, and then analyzed via nanospray desorption electrospray ionization-high-resolution mass spectrometry (nano-DESI-HRMS) and high-performance liquid chromatography-photodiode array-high-resolution mass spectrometry (HPLC-PDA-HRMS) techniques. The nano-DESI-HRMS analysis provided an inventory of numerous compounds present in the particle phase. Although several compounds observed in this study have been previously characterized using gas chromatography methods a majority of the species in the nano-DESI spectra were newly observed biomass burning compounds. Both the stove (chulha or angithi) and the fuel (brushwood or dung) affected the composition of organic aerosols. The geometric mean of the PM2.5 emission factor and the observed molecular complexity increased in the following order: brushwood-chulha (7.3 ± 1.8 g kg-1 dry fuel, 93 compounds), dung-chulha (21.1 ± 4.2 g kg-1 dry fuel, 212 compounds), and dung-angithi (29.8 ± 11.5 g kg-1 dry fuel, 262 compounds). The mass-normalized absorption coefficient (MACbulk) for the organic-solvent extractable material for brushwood PM2.5 was 3.7 ± 1.5 and 1.9 ± 0.8 m² g-1 at 360 and 405 nm, respectively, which was approximately a factor of two higher than that for dung PM2.5. The HPLC-PDA-HRMS analysis showed that, regardless of fuel type, the main chromophores were CxHyOz lignin fragments. The main chromophores accounting for the higher MACbulk values of brushwood PM2.5 were C8H10O3 (tentatively assigned to syringol), nitrophenols C8H9NO4, and C10H10O3 (tentatively assigned to methoxycinnamic acid). [ABSTRACT FROM AUTHOR]

Background: Health research in low- and middle- income countries (LMICs) is often driven by donor priorities rather than by the needs of the countries where the research takes place. This lack of alignment of donor's priorities with local research need may be one of the reasons why countries fail to achieve set goals for population health and nutrition. India has a high burden of morbidity and mortality in women, children and infants. In order to look forward toward the Sustainable Development Goals, the Indian Council of Medical Research (ICMR) and the INCLEN Trust International (INCLEN) employed the Child Health and Nutrition Research Initiative's (CHNRI) research priority setting method for maternal, neonatal, child health and nutrition with the timeline of 2016-2025. The exercise was the largest to-date use of the CHNRI methodology, both in terms of participants and ideas generated and also expanded on the methodology.Methods: CHNRI is a crowdsourcing-based exercise that involves using the collective intelligence of a group of stakeholders, usually researchers, to generate and score research options against a set of criteria. This paper reports on a large umbrella CHNRI that was divided into four theme-specific CHNRIs (maternal, newborn, child health and nutrition). A National Steering Group oversaw the exercise and four theme-specific Research Sub-Committees technically supported finalizing the scoring criteria and refinement of research ideas for the respective thematic areas. The exercise engaged participants from 256 institutions across India - 4003 research ideas were generated from 498 experts which were consolidated into 373 research options (maternal health: 122; newborn health: 56; child health: 101; nutrition: 94); 893 experts scored these against five criteria (answerability, relevance, equity, innovation and out-of-box thinking, investment on research). Relative weights to the criteria were assigned by 79 members from the Larger Reference Group. Given India's diversity, priorities were identified at national and three regional levels: (i) the Empowered Action Group (EAG) and North-Eastern States; (ii) States and Union territories in Northern India (including West Bengal); and (iii) States and Union territories in Southern and Western parts of India.Conclusions: The exercise leveraged the inherent flexibility of the CHNRI method in multiple ways. It expanded on the CHNRI methodology enabling analyses for identification of research priorities at national and regional levels. However, prioritization of research options are only valuable if they are put to use, and we hope that donors will take advantage of this prioritized list of research options. [ABSTRACT FROM AUTHOR]

In India, research prioritization in Maternal, Newborn, and Child Health and Nutrition (MNCHN) themes has traditionally involved only a handful of experts mostly from major cities. The Indian Council of Medical Research (ICMR)-INCLEN collaboration undertook a nationwide exercise engaging faculty from 256 institutions to identify top research priorities in the MNCHN themes for 2016-2025. The Child Health and Nutrition Research Initiative method of priority setting was adapted. The context of the exercise was defined by a National Steering Group (NSG) and guided by four Thematic Research Subcommittees. Research ideas were pooled from 498 experts located in different parts of India, iteratively consolidated into research options, scored by 893 experts against five pre-defined criteria (answerability, relevance, equity, investment and innovation) and weighed by a larger reference group. Ranked lists of priorities were generated for each of the four themes at national and three subnational (regional) levels [Empowered Action Group & North-Eastern States, Southern and Western States, & Northern States (including West Bengal)]. Research priorities differed between regions and from overall national priorities. Delivery domain of research which included implementation research constituted about 70 per cent of the top ten research options under all four themes. The results were endorsed in the NSG meeting. There was unanimity that the research priorities should be considered by different governmental and non-governmental agencies for investment with prioritization on implementation research and issues cutting across themes. [ABSTRACT FROM AUTHOR]

Background: Persistent high levels of under-nutrition in India despite economic growth continue to challenge political leadership and policy makers at the highest level. The present inductive enquiry was conducted to map the perceptions of mothers and other key stakeholders, to identify emerging drivers of childhood under-nutrition.Methods: We conducted a multi-centric qualitative investigation in six empowered action group states of India. The study sample included 509 in-depth interviews with mothers of undernourished and normal nourished children, policy makers, district level managers, implementer and facilitators. Sixty six focus group discussions and 72 non-formal interactions were conducted in two rounds with primary caretakers of undernourished children, Anganwadi Workers and Auxiliary Nurse Midwives.Results: Based on the perceptions of the mothers and other key stakeholders, a model evolved inductively showing core themes as drivers of under-nutrition. The most forceful emerging themes were: multitasking, time constrained mother with dwindling family support; fragile food security or seasonal food paucity; child targeted market with wide availability and consumption of ready-to-eat market food items; rising non-food expenditure, in the context of rising food prices; inadequate and inappropriate feeding; delayed recognition of under-nutrition and delayed care seeking; and inadequate responsiveness of health care system and Integrated Child Development Services (ICDS). The study emphasized that the persistence of child malnutrition in India is also tied closely to the high workload and consequent time constraint of mothers who are increasingly pursuing income generating activities and enrolled in paid labour force, without robust institutional support for childcare.Conclusion: The emerging framework needs to be further tested through mixed and multiple method research approaches to quantify the contribution of time limitation of the mother on the current burden of child under-nutrition. [ABSTRACT FROM AUTHOR]

Background: Under-five children in India continue to die from causes that can either be treated or prevented. The data regarding causes of death, community care-seeking practices, and events prior to death are needed to guide and refine health policies for achieving national goals and targets. Materials and Methods: A cross-sectional survey covering rural areas of 16 districts from eight states across India was conducted to understand the causes of deaths and the health-seeking patterns of caregivers prior to the death of such children. Mothers of the deceased children were interviewed. The physician review process was used to assign cause of death. The qualitative data were analyzed as per standard methods, while STATA version 10 was used for analysis of quantitative data. Findings: A total of 1,488 death histories were captured through verbal autopsy. Neonatal etiologies, acute respiratory infection (ARI), and diarrhea accounted for approximately 63.1% of all deaths in the under-five age group. The causes of death in neonates showed that birth asphyxia, prematurity, and neonatal infections contributed to more than 67.5% of all neonatal deaths, while in children aged 29 days to 59 months, ARI and diarrhea accounted for 54.3% of deaths. Care providers of 52.6% of the neonates and 21.7% of infants and under-five children did not seek any medical care before the death of the child. Substantial delays in seeking care occurred at home and during transit. For those who received medical care, there was an apparent amongst in their caregivers toward private health providers. Conclusion: The deaths of neonates and postneonates taken to any health facilities highlight the need for providing equitable and high-quality health services in India. The findings could be used for policy planning and program refinement in India. [ABSTRACT FROM AUTHOR]

The article discusses the potential of leveraging competitive advantages of markets to address childhood obesity in India, with studies showing lifestyle and eating behaviour influenced by market, particularly in the marketing of processed food to target children. Topics discussed include adverse health outcomes faced by overweight or obese children like metabolic problems, prevalence of the rue of market in society, and the concept of Whole of society (WoS) to prevent childhood obesity.

The author discusses the Indian government's budgetary interventions to boost its processed food industry as processed and packaged foods are increasingly being consumed by every household in its rural and urban areas. Topics discussed include the influence of policy initiatives on the consumption of salt, sugar and fat and efforts of the World Health Organization in working with network of governments in Europe and the East Mediterranean region for taking sustainable actions on salt reduction.

India has experienced a rising prevalence of cardiometabolic risk factors in the past 15 years: the prevalence of diabetes has increased from 5.9% to 9.1%, hypertension from 17.2% to 29.2%, and obesity from 4% to 15%. The increase is among all socioeconomic groups and in urban and rural populations, though the quantum of change varies. A concomitant increase in per capita consumption of sugar from 22 to 55.3 g/day and total fat from 21.2 to 54 g/day was observed, with significant differences between states of high and low human development index (HDI). Per capita consumption of sugar, salt, and fat is consistently and significantly associated with overweight and obesity but variably associated with the occurrence of hypertension and diabetes. Market research shows that approximately 50-60% of total salt, sugar, and fat in Indian markets is procured by bulk purchasers, generally for manufacturing processed food items. This sector of the Indian economy is among the fastest growing, with several policy incentives. It is not clear from most of the data sets whether available information on per capita sugar, salt, and fat consumption has considered the contribution of processed and ready-to-eat food items. The unprecedented changes of rapid urbanization, mechanization, and globalization demand close monitoring of social, developmental, and economic determinants. This paper provides pieces of evidence to justify a whole-of-society (WoS) framework for monitoring the inputs, processes, and behavioral components of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS) in India. [ABSTRACT FROM AUTHOR]

Late blight caused by Phytophthora infestans is one of the most dreaded diseases of potato worldwide and cause significant loss in production. The pathogen is highly variable and adapt to the newly bred varieties and fungicides. Population of P. infestans in most of the countries has changed dramatically and original A1 has almost been displaced by more virulent A2 strain. In India, A2 mating type was recorded in 1990s and now it has displaced the A1 in temperate highlands while in sub-tropical plains still A1 is dominating. Virulence to all major resistance genes has been recorded and in India the racial complexity has reached to its zenith resulting in breakdown of many disease resistant varieties. Indiscriminate use of metalaxyl based fungicides has led to the development of metalaxyl resistance world over including India, which has necessitated the use of additional systemic molecules for the management of this disease. The population of P. infestans characterized using molecular markers has led to better understanding of pathogen at molecular level. Mitochondrial DNA haplotyping of P. infestans has revealed that mt Ia is displacing the other haplotypes globally at a faster rate including India. Relationship between P. infestans and the weather is well understood and has been utilized for developing disease forecasting models and decision support systems across the globe including India. An increasing severity of late blight in many potato growing areas, a shift in pathogen population toward increased specific virulence and an increasing tolerance to the most effective late blight specific fungicides suggests a need to develop an appropriate disease management strategy based on information technology. [ABSTRACT FROM AUTHOR]

Background: The objectives of the study were to compare the performance of line probe assay (GenoType MTBDRplus) with solid culture method for an early diagnosis of multidrug resistant tuberculosis (MDR-TB), and to study the mutation patterns associated with rpoB, katG and inhA genes at a tertiary care centre in north India. Methods: In this cross-sectional study, 269 previously treated sputum-smear acid-fast bacilli (AFB) positive MDR-TB suspects were enrolled from January to September 2012 at the All India Institute of Medical Sciences hospital, New Delhi. Line probe assay (LPA) was performed directly on the sputum specimens and the results were compared with that of conventional drug susceptibility testing (DST) on solid media [Lowenstein Jensen (LJ) method]. Results: DST results by LPA and LJ methods were compared in 242 MDR-TB suspects. The LPA detected rifampicin (RIF) resistance in 70 of 71 cases, isoniazid (INH) resistance in 86 of 93 cases, and MDR-TB in 66 of 68 cases as compared to the conventional method. Overall (rifampicin, isoniazid and MDR-TB) concordance of the LPA with the conventional DST was 96%. Sensitivity and specificity were 98% and 99% respectively for detection of RIF resistance; 92% and 99% respectively for detection of INH resistance; 97% and 100% respectively for detection of MDR-TB. Frequencies of katG gene, inhA gene and combined katG and inhA gene mutations conferring all INH resistance were 72/87 (83%), 10/87 (11%) and 5/87 (6%) respectively. The turnaround time of the LPA test was 48 hours. Conclusion: The LPA test provides an early diagnosis of monoresistance to isoniazid and rifampicin and is highly sensitive and specific for an early diagnosis of MDR-TB. Based on these findings, it is concluded that the LPA test can be useful in early diagnosis of drug resistant TB in high TB burden countries. [ABSTRACT FROM AUTHOR]

A total of seventy actinomycetes were isolated from rhizospheric soils of cropping regions from uttranchal, India. Functional characterization of all isolates revealed that, a total of 41, 25, 12 and 8 isolates were positive for nitrate reduction, cyanogenesis, amylase and protease production respectively. Antimicrobial attributes includes a total of fourteen isolates were showing positive results against Bacillus subtilis, Macrophomina phaseolina and Fusarium udum, respectively. All isolates were showing resistant towards 16µgmL-1, however, 10 and 4 isolates showed tolerance up to 40 and 80µgmL-1, respectively. Primitive identification on the basis of morphological characteristics followed by chemotaxonomic level was belonging to Streptomyces, Actinopolyspora, Saccharopolyspora, Actinomadura, Nocardiopsis, Micromonospora and Actinoplanes, respectively. Molecular characterization including ARDRA analysis of all isolates by using HhaI, HaeIII and TaqI restriction endonuclease revealed that, a total 20, 16 and 8 cluster were formed at >70, 50 and 30% similarity coefficient value, respectively. [ABSTRACT FROM AUTHOR]

During a period of 20 months, 1467 children suffered from 1663 diarrheal attack in a rural community of Haryana. As many as 23 diarrhoea related deaths were recorded. Although diarrheal attack /100children were similar in different nutritional groups (P>0.05), the case fatality rate (%) was higher In grade III (7.69; P<0⋅001) as compared to normal (0⋅32) and grades 1 (0⋅49) nod II (2⋅23) real malnutrition. The mortality was higher in protracted diarrhoea (P<0.001) than when the duration was <2wk (0⋅7%,). Twenty one (91⋅3%,) of the 23 children who died, had sought treatment from a practicing physician (6), hospital (6) or local dispensary. Oral rehydration therapy was used in 38⋅7 per cent of diarrhoeal episodes. Past malnutrition, protracted diarrhoeal illness and non-me of ORT appear to be Important associated factors In diarrhoeal mortality in a rural community. [ABSTRACT FROM AUTHOR]

The article discusses culture which is defined as a way of life common to a group of people, including a collection of beliefs and attitudes, shared understandings and patterns of behaviour so that people can life together in harmony. It cites Indian culture that remains unchanged in its basic structure and is deeply rooted in the people's heart, mind and soul. It says that Indian culture is distinctive due to its rich tradition and values that follow the goal of Satyam, Shivam and Sundaram.

Throughout the world, the tsunami generation potential of some large under-sea earthquakes significantly contributes to regional seismic hazard, which gives rise to significant risk in the near-shore provinces where human settlements are in sizeable population, often referred to as coastal seismic risk. In this context, we show from the pertinent GPS data that the transient stresses generated by the viscoelastic relaxation process taking place in the mantle is capable of rupturing major faults by stress transfer from the mantle through the lower crust including triggering additional rupture on the other major faults. We also infer that postseismic relaxation at relatively large depths can push some of the fault segments to reactivation causing failure sequences. As an illustration to these effects, we consider in detail the earthquake sequence comprising six events, starting from the main event of Mw =7.5, on 10 August 2009 and tapering off to a small earthquake of Mw =4.5 on 2 February 2011 over a period of eighteen months in the intensely seismic Andaman Islands between India and Myanmar. The persisting transient stresses, spatio-temporal seismic pattern, modeled Coulomb stress changes, and the southward migration of earthquake activity has increased the probability of moderate earthquakes recurring in the northern Andaman region, particularly closer to or somewhat south of Diglipur. [ABSTRACT FROM AUTHOR]

Thirty-two Lactobacilli strains were isolated from four samples of camel cheese collected from Bikaner, India. These isolates were identified based on phenotypic and genotypic characteristics. Sequencing of 16S rDNA was performed for species identification and diversity analysis. Lactobacillus delbrueckii and Lb. fermentum were found to be dominant species followed by Lb. plantarum and Lb. casei. On evaluation of technological properties of these isolates, 20 isolates were observed to be good acid producers, eight were found positive for citrate utilisation and 11 showed presence of Prtp gene. Isolates obtained can be potential for development of defined strain starter for camel cheese. [ABSTRACT FROM AUTHOR]

Streptomycetes is one of the most important genera, representing up to 70% population among all soil actinomycetes. We investigated the genotypic diversity of culturable Streptomycetes, freshly isolated from thirty-eight different soil samples (wheat cropping system) from Indo-Gangetic Plains of India. A total of 238 morphologically distinct actinomycetes colonies were isolated and clustered together by restriction fragment length polymorphism analysis of 16S rRNA gene. Identification of representative isolates from each cluster was carried out by micro/macroscopic analysis as well as biochemical characterization, and further confirmed by 16S rRNA sequencing (sequences were submitted in public database, NCBI). [ABSTRACT FROM AUTHOR]

The baiting bag method was found to be useful for isolating antagonistic actinomycetes from terrestrial habitat. Out of total 110 actinomycetes isolated from rhizospheric and non-rhizospheric soil of Indo Gangetic Plains (IGP) of India, 9 isolates exhibited aggressive antagonism against Rhizoctonia solani, screened through dual culture, well diffusion and sealed plate technique. Maximum growth inhibition was recorded up to 50% under well diffusion ( S. toxytricini vh22) and 52.6% in a direct confrontation (Actinomycetales bacterium vh41). Whereas maximum disease suppression (53.33%) under green house condition was achieved on seedling treated with S. tricolor vh85. Scanning electron microscopy of antagonists and pathogen interaction exhibited pore formation and hyphal degradation of test pathogen. Physiological and molecular characterization of selected isolates showed wide diversity and uncommon species has been encountered through the selective isolation technique. [ABSTRACT FROM AUTHOR]

Puddling coarse-textured soils for rice culture in the irrigated tract of the Indo-Gangetic Plains causes high soil strength in the upper layers. This may adversely affect growth and yield of following upland crops. It is possible that no-tillage (NT) in wheat (without residues of preceding rice crop) could aggravate this problem and reduce fertilizer nitrogen (N) use efficiency. In certain production scenarios, NT has been reported to be advantageous because it allows for earlier planting of wheat by eliminating delays caused by tillage. This study examined the combined effects of two crop establishment options for wheat in relation to fertilizer N and planting time following puddled rice cultivation in an irrigated environment of Punjab, northwest India. Combinations of two establishment systems, NT-direct planting and conventional-tillage (CT) with soil disruption to 0.10 m depth in main plots, with two N rates, 120 and 150 kg ha-1 in subplots, were evaluated. Variation in planting time, 31 October (D1) and 7 and 10 November (D2), was used to evaluate effect of planting-earliness. Under D1 in NT, grain yield of wheat was comparable to that under D2 in CT. However, under no advancement of wheat planting in NT, grain yield was 0.2-0.3 t h-1 less than that in CT. This yield reduction in NT could be overcome by adding 30 kg ha-1 more fertilizer N suggesting that tillage enhanced N use efficiency. These tillage gains are ascribed to the greater extraction of profile stored and applied water and nutrients because of denser crop rooting caused by reduction in soil strength and less weed competition. Higher N use efficiency in CT suggests that farmers could achieve fertilizer N savings with this system. Comparing the tillage systems showed that NT was more cost-effective than CT even after accounting for the cost of additional fertilizer N (saving of Rs. 1685 ha-1) to overcome associated yield penalties under no advancement in planting time. [ABSTRACT FROM AUTHOR]

Objective: To gain an insight into the phenomenon of social resistance and rumors against pulse polio campaign. Design: Qualitative, community-based investigation, mapping perceptions of various stakeholders through in-depth interviews (IDIs), focus group discussions (FGDs), non-formal interactions and observations. Setting: Moradabad and JP Nagar districts of Uttar Pradesh. Subjects: IDIs (providers 33, mothers 33, community leaders 10); FGDs (providers 4, mothers 8) and non-formal interactions (156) with community leaders, parents, businessmen, journalists (Hindi and Urdu media), mobilizers, vaccinators and supervisors. Results: A distinct machination of social resistance and rumors against oral polio vaccine during supplementary immunization activities (SIA) was observed in some minority dominated areas. The pattern can be understood through a model that emerged through qualitative evidence. Inspite of all this, most parents in minority areas supported the SIAs. Only a few clusters from extremely marginalized sections continued to evade SIAs, with an endemic pattern. Through social osmosis, these rumors reached majority community as well and some parents were affected. However, in such cases, the resistance was sporadic and transient. Conclusion: While the program's focus was on microbiological issues, the obstacles to polio eradication lie in the endemicity of social (and/or cultural) resistance in some pockets, leading to clustering of perpetually unimmunized children - inspite of good coverage of SIAs at macro level. This may sustain low levels of wild poliovirus transmission, and there can be exceptions to the robustness of the pulse approach. A micro level involvement of volunteers from marginalized pockets of minorities might be able to minimize or eliminate this resistance. [ABSTRACT FROM AUTHOR]

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Background: India has the highest estimated burden of tuberculosis in the world, accounting for 21% of all tuberculosis cases world-wide. However, due to lack of systematic analysis using multiple markers the available information on the genomic diversity of Mycobacterium tuberculosis in India is limited. Methodology/Principal Findings: Thus, 65 M. tuberculosis isolates from New Delhi, India were analyzed by spoligotyping, MIRU-VNTR, large deletion PCR typing and single nucleotide polymorphism analysis (SNP). The Central Asian (CAS) 1 _DELHI sub-lineage was the most prevalent sub-lineage comprising 46.2% (n = 30) of all isolates, with shared-type (ST) 26 being the most dominant genotype comprising 24.6% (n = 16) of all isolates. Other sub-lineages observed were: East-African Indian (EAI)-5 (9.2%, n = 6), EAI6_BGD1 (6.2%, n = 4), EAI3_IND, CAS and T1 with 6.2% each (n = 4 each), Beijing (4.6%, n = 3), CAS2 (3.1%, n = 2), and X1 and X2 with 1 isolate each. Genotyping results from five isolates (7.7%) did not match any existing spoligopatterns, and one isolate, ST124, belonged to an undefined lineage. Twenty-six percent of the isolates belonged to the TbD1+ PGG1 genogroup. SNP analysis of the pncA gene revealed a CAS-lineage specific silent mutation, S65S, which was observed for all CAS-lineage isolates (except two ST26 isolates) and in 1 orphan. Mutations in the pncA gene, conferring resistance to pyrazinamide, were observed in 15.4% of all isolates. Collectively, mutations in the rpoB gene, the katG gene and in both rpoB and katG genes, conferring resistance to rifampicin and isoniazid, respectively, were more frequent in CAS1_DELHI isolates compared to non-CAS_DELHI isolates (OR: 3.1, CI95% [1.11, 8.70], P = 0.045). The increased frequency of drug-resistance could not be linked to the patients' history of previous anti-tuberculosis treatment (OR: 1.156, CI95% [0.40, 3.36], P = 0.79). Fifty-six percent of all new tuberculosis patients had mutations in either the katG gene or the rpoB gene, or in both katG and rpoB genes. [ABSTRACT FROM AUTHOR]

With improvement in economic and living conditions of the communities, the age of acquiring hepatitis A virus (HAV) infection is shifting from early childhood to adolescence and young adulthood. Such epidemiological shift leads to an increased incidence of symptomatic HAV infection, including heightened risk of liver failure. Data from India indicate that the population is no longer homogeneous for its HAV exposure profile. Occasional outbreaks of HAV and higher proportions of symptomatic cases are reported amongst older children and adults from different regions of the country. However, the heterogeneous exposure to HAV defies widespread use of the vaccine. The challenge is to recognize the susceptible pockets and take pre-emptive steps. In regions with rapid improvement in living standards and environmental hygiene, there is a need for regular surveillance through structured protocols that are able to identify early signs of epidemiological shift. This review discusses relevant issues and concerns to influence decision making for HAV vaccination in such transition societies. [ABSTRACT FROM AUTHOR]

Quinalphos residues were studied separately in the pulp and rind of kinnow mandarin fruits by following a standardized methodology and estimated on gas liquid chromatograph (GC) by employing nitrogen phosphorus detector. Following application of quanilphos (Ekalux 25EC) at 10.0 and 20.0 mL per tree (per 5 L of water) on kinnow mandarin fruits at both these dosages were found to be 0.05 and 0.16 mg/kg, respectively. These initial deposits were found to be less than its maximum residue limit (MRL) of 0.25 mg/kg. The corresponding values in the rind were found to be 0.65 and 1.64 mg/kg, respectively. These residue levels in the rind dissipated below the MRL in 5 and 15 days, respectively. The half-life value for quanilphos in the rind at single and double dosages were found to be 3.2 and 4.0 days, respectively. Low dissipation rate of quanilphos in the rind may be attributed to the fibrous nature of the peel where the insecticide can be adsorbed, high moisture content and oil based nature of the rind. The results clearly show that quanilphos does not penetrate into the pulp of the kinnow mandarin and the fruit is safe for consumption even after one day of the application at both these dosages. [ABSTRACT FROM AUTHOR]

Objectives: To understand the perceptions and likely determinants that facilitate or act as barriers in implementing additional strategies for polio eradication: (a) accelerated delivery of mOPV1 (monovalent polio vaccine type 1); (b) use of IPV (inactivated polio vaccine); and (c) provision of incentives. Design: Qualitative. Rapid appraisal procedures (RAP) were adopted to derive the reality by synthesizing multiple sources of information; search for opinions, motivations, behaviors and attitudes of key stakeholders within their organizational and socio-cultural matrix. Setting: Two districts of Uttar Pradesh -- Moradabad and J P Nagar. Subjects: Total 244 interactions were conducted; 33 interviews and 4 focussed group discussions (FGD) conducted with providers; 33 mothers (<5 years) and 10 leaders were interviewed; 8 FGD were conducted with mothers of under-fives. Informal interactions (156) were also conducted with village pradhans, religious leaders, parents, businessmen, journalists (Hindi and Urdu media), mobilizers, vaccinators and supervisors. Results: Providers expressed reservation regarding accelerated rounds of OPV; scientific rationale of accelerated rounds is not clear to parents and leaders. Although technical advantages of introducing IPV exist, issues of logistical difficulties and injection safety emerged strongly. Providers and communities indicated a clear 'no' to the cash incentives but argued for developmental issues. Resistance to the program has declined over time but still the program is perceived as the "government's need, not ours". Conclusion: The polio eradication program is critically poised, an opportunity to intensify efforts for reducing inequities in health services and improve access of all children to the PHC services. Ongoing dialogue with local communities and strong political commitment would be essential to translate the technological innovations into a sustainable program. [ABSTRACT FROM AUTHOR]

Background: Low-risk human papillomavirus (HPV) infections are related to the genesis of various benign lesions. In an isolated report available, HPVs have been implicated in the causation of skin tags too. Aims: The present study was designed to detect the existence of low-risk HPV types 6 and 11 in cutaneous soft fibromas (skin tag) in north Indians. Methods: A total of 37 cases of skin tags from various sites were analyzed. Highly sensitive and comprehensive polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) assays were done for the detection of low-risk HPV types 6 and 11. Results: The results revealed the presence of HPV DNA 6/11 in 48.6% of the skin tags examined by PCR-RFLP. Conclusion: This result corroborates the hypothesis that HPV plays a part in the etiology of benign lesions like cutaneous soft fibromas. The identification of HPV 6/11 in these lesions, which are benign proliferations of the skin, further expands the spectrum of HPV-linked lesions. [ABSTRACT FROM AUTHOR]

Introduction: Cervical cancer is the commonest cancer among Indian women. High-risk human papillomavirus (HPV) detection holds the potential to be used as a tool to identify women, at risk for subsequent development of cervical cancer. There is a pressing need for identifying prevalence of asymptomatic cervical HPV infection in the local population.Objective: To determine the prevalence of high-risk HPV DNA in women with benign cervical cytology.Materials and Methods: Women visiting the gynecology outpatient with varied complaints were subjected to Pap smear. Four hundred and seventy two samples were subjected to polymerase chain reaction, using consensus primers for low and high-risk HPV (types 6, 11, 16, 18, 31 and 33). The samples that were positive for HPV DNA were subsequently assessed for high-risk consensus primers, types 16, 18, 31 and 33 as well as for HPV type 16 and 18.Results: One hundred and seventy four (36.8%) women tested positive for HPV DNA. Thirty nine (8.2%) of the entire cohort tested positive for high-risk HPV. Fifteen samples were positive for type 16, 22 for type 18 and two for both types 16 and 18. A statistically higher prevalence of high-risk HPV was observed in poorly educated and rural groups. No association of HPV prevalence was noted with age, parity and age at marriage.Conclusion: The study generates epidemiological data of prevalence of sub-clinical HPV in the women visiting a tertiary care institute as well as peripheral health centres. The data generated will be useful for laying guidelines for mass screening of HPV, treatment and prophylaxis in the local population. [ABSTRACT FROM AUTHOR]

Objective To assess the cost and cost-effectiveness of the Public Private Mix DOTS (PPM-DOTS) strategy for tuberculosis (TB) control in India. Methods We collected data on the costs and effects of pilot PPM-DOTS projects in Delhi and Hyderabad using documentary data and interviews. The cost of PPM-DOTS was compared with public sector DOTS (i.e. DOTS delivered through public sector facilities only) and non-DOTS treatment in the private sector. Costs for 2002 in US$ were assessed for the public sector, private practitioners, and patients/attendants. Effectiveness was measured as the number of cases successfully treated. Findings The average cost per patient treated was US$ 111-123 for PPM-DOTS and public sector DOTS, and US$ 111-172 for non-DOTS treatment in the private sector. From the public sector's perspective, the cost per patient treated was lower in PPM-DOTS projects than in public sector DOTS programmes (US$ 24-33 versus US$ 63). DOTS implementation in either the public or private sectors improved treatment outcomes and substantially lowered costs incurred by patients and their attendants, compared to non-DOTS treatment in the private sector (US$ 50-60 for DOTS compared to over US$ 100 for non-DOTS). The average cost-effectiveness of PPM-DOTS and public sector DOTS was similar, at US$ 120-140 per patient successfully treated, compared to US$ 218-338 for non-DOTS private sector treatment. Incremental cost-effectiveness analysis showed that PPM-DOTS can improve effectiveness while also lowering costs. Conclusion PPM-DOTS can be an affordable and cost-effective approach to improving TB control in India, and can substantially lower the economic burden of TB for patients. [ABSTRACT FROM AUTHOR]

The paper highlights the changing scenario of the healthcare financing in India in the wake of globalisation process initiated during early 1990s and the structural changes taking place in the health sector. It attempts a status report of the health sector in India and raises issues related to accessibility, efficiency, and quality of the health delivery in the face of glaring inter-state variations and discouraging healthcare financing situation. The rising health needs particularly in the backward and low income states, sluggish health outcomes, dwindling budgetary allocations and heavy household out-of-pocket expenditure on health pose serious challenges to healthcare financing in India. The paper also discusses the issues likely to be further compounded as global institutions (such as the WTO) are supposed to ensure compliance to Intellectual Property Rights; but, unfortunately, can not provide for the healthcare needs of the poor in India in the face of rising health risks. [ABSTRACT FROM AUTHOR]

Directly Observed Treatment-Short Course (DOTS) has been a successful strategy in the global control of tuberculosis (TB) in adults. However, reports of implementation are scantily available in pediatric context. Present article reviews diagnostic uncertainties of TB in children commonly faced by physicians on account of the vague clinical presentations, unreliable tuberculin tests or TB score charts, non-specific hematological, biochemical or radiological evidence, difficulty in sputum expectoration and non-availability or ill-affordability of specialised tests. It also describes therapeutic problems arising due to the physician's inexpertise, child's incomprehensibility and parental anxiety. DOTS was found to be highly effective in 930 Indian children having TB over the 6-year study period, during which, a rise in number of cases with adult pattern of disease was also noted. The trend change in pediatric TB scenario is thought to have taken place due to malnutrition so widely prevalent in this country. Irrespective of the changing trend, DOTS strategy was found to be effective for all types of pediatric TB. A need, therefore, exists for quick resolution of the programme issues related to pediatric drug dispensing, physicians' reservations about acceptance of strategy in this age-group, service-utilisation of DOTS providers for the selected cases unable to visit DOTS centres and giving executional priority to children during ongoing expansion of Revised National TB Control Programme (RNTCP) in country. [ABSTRACT FROM AUTHOR]

The Revised National Tuberculosis Control Programme (RNTCP), which incorporated the WHO DOTS strategy was introduced in India in the mid-1990s. An operational research project was conducted between 1996 and 1998 to assess the needs and perspectives of patients and providers in two chest clinics in Delhi, Moti Nagar and Nehru Nagar, during the introduction of the new strategy. This paper reports on the findings of the project, concentrating on information collected from 40 in-depth interviews with patient defaulters and from non-participant observations in clinics and directly observed treatment centres. In Moti Nagar chest clinic, 117 of 1786 (6.5%) patients and 195 of 1890 (10%) patients in Nehru Nagar left care before their treatment was complete. It was argued that the reasons for default stem from a poor correlation between patient and programme needs and priorities, and from particular characteristics of the disease and its treatment. Patient needs that were not met by the health system included convenient clinic timings, arrangements for the provision for treatment in the event of a family emergency and provision for complicated cases like alcoholics. The problems facing the provider were poor interpersonal communication with the health staff, lack of attention and support at the clinic, difficulty for patients to re-enter the system if they missed treatment and, in certain areas, long distances to the clinic. Problems related to diseases were inability of the staff to deal with drug side-effects, and patients' conception of equating well-being with cure. Simple, practical measures could improve the provision of tuberculosis (TB) treatment: more flexible hours, allowances for poor patients to reach the clinics and training health care staff for respectful communication and monitoring drug side-effects. The findings indicate a need to rethink the label of 'defaulter' often given to the patients. The important areas for future operational research is also highlighted. [ABSTRACT FROM AUTHOR]

The Revised National Tuberculosis Control Programme (RNTCP), based on the World Health Organization's DOTS strategy,* was introduced in India in the mid-1990s. This paper reports the findings from operational research studies in two pilot sites in New Delhi from 1996 to 1998. A variety of operational research methods were used, including semi-structured interviews, focus group discussions, non-participant observations and collection of data from the tuberculosis registers. The cure rates for the clinics were 71 and 75% with a default rate of 6 and 11%, respectively. An important finding was that health workers screened patients to determine their ability to conform to the direct observation of treatment element of the RNTCP. If the health worker was confident that the patient would comply and/or be easy to trace in the community in the event of 'default', they were provided with short-course treatment under the RNTCP. Other patients, largely those who were in absolute poverty, socially marginalized, itinerant labourers, poorly integrated in the city, were put on standard tuberculosis (TB) treatment as for the previous National TB Programme. The programme was evidently excluding the most vulnerable from the best available care. These findings demonstrate the potential dangers of target-driven programmes where there is an absence of support to both frontline health workers and patients. The paper also highlights the importance of operations research in helping to identify problems within TB programmes. [ABSTRACT FROM AUTHOR]

Evaluates the validation of iodine spot test kits for the analysis of iodine content in salt in India. Testing of kits with multiple observers involved; Use of spot testing kits in actual field conditions in India as compared with iodometric titration method; Implications on the prevention of iron deficiency diseases.

This survey was undertaken to estimate tetanus immunization coverage of adolescent girls in a selected rural community of Haryana and to ascertain the knowledge of these girls and their mothers about tetanus. The study period was between April 1996-March 1997. A 30-cluster immunization coverage house to house survey was carried out by a female social worker. The total population covered was 30,448. Twelve roadside villages were selectively chosen. Eleven year and 17 year old girls (210 in each group) were surveyed for coverage evaluation. For K.A.P. survey 114 girls (aged 17 years) and 98 mothers (of 11 year old girls) were interviewed. Chi square, percentage and 95% confidence interval were used for statistical analysis. Coverage for tetanus immunization was 44.3% among 17 year old girls and 26.7% among 11 year old girls. The coverage was better (35%) among school going girls as compared to non-school going girls (13%). Correct immunization schedule of pregnant women was told by 16 (7.5%) respondents. None of them told the correct immunization schedule for children. Death was told as the main danger from tetanus by 172 (81%) respondents. Most (98%) were aware of the role of clean-stump (umbilical cord) at the time of delivery in the etiology of tetanus neonatorum. Tetanus immunization coverage needs to be improved among adolescents. They also need to be educated on various aspects of tetanus. [ABSTRACT FROM AUTHOR]

Currently available evidence indicates that most parts of India still quality to be hyper-endemic regions and hence recommendations for vaccinations developed for low endemicity regions are not applicable. There are however, some pockets which showed evidence of distinct epidemiologic shift. There is need to identify geographic regions like Kerala which have potential for epidemic outbreaks through cyclic sero-epidemiological surveys. With economic development and consequent improvements in the levels of sanitation and quality of water supplies, more such areas will be identified. Efforts to improve sanitation and personal hygiene will remain as the most important and efficient intervention to retard the transmission of HAV. Unless a critical improvement in the living standards of our population is achieved, aim of eradicating HAV infection from the community is not realistic. Presently, the cost of three doses of HAV is exorbitant and the focus of HAV vaccination will have to be restricted to individual protection who are likely to remain unexposed till adulthood and can afford to pay for it. HAV Infection below 5 years is mostly asymptomatic. The most efficient use of resources will therefore be to offer HAV vaccine to high risk individuals beyond this age after screening for antibodies against HAV. [ABSTRACT FROM AUTHOR]

Etiological factors associated with portal hypertension in children influence the decision about therapy and the prognosis. This cross-sectional observational study was performed at a tertiary care centre in northern India from January, 1990 to December, 1994. Children below the age of 14 years with suspected portal hypertension were prospectively assembled into a cohort to determine the etiology and clinical profile of portal hypertension. Of the 115 patients with portal hypertension, 76.5% had extrahepatic portal hypertension (EHPH). Remaining 23.5% of the cases had intrahepatic and post-hepatic causes of portal hypertension. Children with EHPH had a significantly earlier onset of symptoms as compared to those with intrahepatic portal hypertension (p = 0.002) and bled significantly more frequently (p = 0.00). Forty per cent of patients with chronic liver disease (CLD) never had jaundice. History suggestive of potential etiological factors could be elicited in only 7% of EHPH patients. The commonest site of block in splenoportal axis was at the formation of the portal vein. An inverse relation of bleeding rates with duration of illness was seen in EHPH. Of the 10 CLD patients in whom liver biopsy could be done, cirrhosis was present in 6 patients. Understanding the natural history of EHPH and portal hypertension due to other etiologies may have significant implications in choosing the appropriate intervention and predicting the outcome. [ABSTRACT FROM AUTHOR]

The knowledge and attitudes regarding infant feeding practices were studied among those health personnel (doctors, nurses and dais) who were delivering M.C.H. services in the peripheral areas of Barmer District (W. Rajasthan). The study revealed that the health personnel under study are not fully aware of the correct infant feeding practices and thus their incorrect knowledge and attitudes when put into practice can have detrimental effects. This study highlights the need of continuing medical education and stepping up of pediatric training in undergraduate courses. [ABSTRACT FROM AUTHOR]

The article discusses global lessons derived from India's campaign to eliminate poliomyelitis. In particular, the social aspects of implementing India's programme are said to be as important as the technical ones. Also, oral vaccines were found to be effective in the most difficult regions. Needed remaining steps in eliminating polio in India are articulated. The Global Polio Eradication Initiative (GPEI), its success in reducing type 1 and 3 wild poliovirus, and associated strategic planning are mentioned.