Search

The current analysis is a part of an ongoing observational study that began in February 2021 in the Sir Sunder Lal Hospital (Varanasi, Uttar Pradesh) in northern India and is expected to continue until June 2022. This analysis aimed to delineate the clinical presentation and risk factors of occurrence and severity of COVID-19 in vaccinated individuals. The study enrolled health-care workers and the elderly receiving the COVID-19 vaccine at one of three centers linked to the study hospital. The participants received the ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccine based on the chimpanzee adenovirus platform (manufactured in India by the Serum Institute of India). The adenovirus codes for the spike (S) protein of SARS-CoV-2. Participants were contacted by phone at pre-decided intervals and questioned about the occurrence of COVID-19, clinical presentation, severity, and persistence of symptoms. A logistic regression analysis was performed to predict the risk factors of occurrence and severity of COVID-19. Of the 1,500 participants included in the analysis, 418 developed COVID-19 (27.9%). Fever was the most common symptom (72%), followed by cough (34%) and rhinitis (26%). Cardiovascular involvement was seen in more than 2% of individuals, and 11% had post-COVID-19 complaints. Regression analysis showed 1.6 times greater odds of contracting the disease in females and in those younger than 40 years, 1.4 times greater odds in individuals who were overweight, and 2.9 times greater odds in those receiving only one dose, compared with respective comparators. Individuals receiving two doses at a gap of ≤ 30 days had 6.7 times greater odds of infection than those receiving at a > 60-day interval. There was no association between COVID-19 occurrence in the vaccinees and pre-vaccination history of SARS-CoV-2 infection. Males were at a 3.6 times greater risk, and persons with preexisting lung disease—mainly asthma—had a 5.9 times greater risk of experiencing moderate to severe COVID-19 than comparators. While an extended interval between the two vaccine doses seems to be a better strategy, gender differences and an association of asthma phenotypes with COVID-19 need to be explored.

Background: Public perception of mental illness is critical for successful treatment seeking behaviour as well as for early diagnosis and surveillance of disease. Two hundred eleven young patients were interviewed at Department of psychiatry, Sir Sunderlal Hospital, Varanasi with the help of consecutive sampling method. Objective: To assess the opinion towards mental illness among young adults by using the opinion on mental illness scale (OMI). Methods: Data was collected using the opinion about mental illness scale (OMI) which consists of 51 questions out of which, 15 questions directly related to the cause, care, and management of mental illness were randomly selected and analyzed. Analysis was done showing Percentage and chi-square tests to see the significance of scores between the respondents. Results: The finding shows that more than 70% of respondents believe that mental illness is a consequence of bad behavior, lack of willpower, or negative beliefs and gap in the treatment seeking behavior and understanding the cause of disease was found. Conclusions: Opinions on Mental health have received increasing attention as a useful strategy to promote early identification of mental illness, reduce stigma and enhance help-seeking behaviors. As part of the National Mental Health Programme, there is a need to raise awareness in order to enhance understanding of mental illness in facilitating early diagnosis and treatment of disease.

Background: Emergency Obstetrics care is an integrated strategy developed by the WHO, UNFPA and UNICEF that aims to equip health facilities with the capacity to provide evidence based, cost effective interventions to attend the leading causes of maternal mortality. Methods: A community based cross sectional study was conducted between April 2019 - July 2020. A total of 201 women who delivered in the last 6 months and had complications during their pregnancy were interviewed to find out accessibility and quality emergency obstetric Care (EmOC) services. Facility assessment was also done at two health facilities of Chiraigaon block for the assessment EmOC. Results: Findings show that only 41.8% respondents were able to reach the government health facilities in less than half-an-hour. Out of the total respondents who utilized government health facilities for EmOC, only 19% were attended by the health providers within 1 hour. Conclusion: Low percentage of respondents with complications were reaching the health facility within 30 minutes. Therefore, there is a strong need for strengthening of basic EmOC services at health facilities .

The BBV152 coronavirus disease 2019 (COVID-19) vaccine (COVAXIN) has recently been approved for adolescents.We provide the first real-world safety data of COVAXIN use in adolescents and compare with adults.A prospective observational study was initiated in January 2022. Enrolled adolescents and adults were contacted by telephone after 14 days of receiving the BBV152 vaccine. The primary outcome was vaccine safety assessed as rate of adverse events following immunization (AEFIs). Severity grading of AEFIs was done using the Food and Drug Administration (FDA) scale. Interim results are presented.A total of 698 adolescents and 326 adults were enrolled. AEFIs after the first dose developed in 243 out of 670 adolescents (36.3%), with 21% reporting only local AEFIs and 15.2% reporting systemic AEFIs. Among 340 adolescents who had received the second dose of vaccine, 129 (37.9%) developed AEFIs, with only local involvement in 20.3% and systemic involvement in 17.6%. Injection site pain and fever were the common AEFIs. The majority of AEFIs were mild-moderate. Nearly 0.9% of adolescents receiving the first dose reported severe AEFIs. Atypical AEFIs were observed in 0.6-0.9% of adolescents. The majority of the AEFIs resolved in 1-2 days. AEFIs were persistent in 2% of adolescents at day 14 after the second dose, and also in 3.7% of adults overall at follow-up. No difference was observed in AEFI incidence and patterns between adolescents and adults. Regression analysis showed females and those with a history of allergy to be, respectively, at 1.6 times and 3 times increased risk of AEFIs among adolescents.COVAXIN carries an overall favorable short-term safety profile in adolescents. The observed AEFI rates in adolescents are much lower than that reported with mRNA vaccines, but head-head comparisons in the same population are required to generate relative vaccine safety data. Female adolescents and those with a history of allergy need watchfulness for severe and persistent AEFIs. With some AEFIs persisting at 14 days, a longer follow-up is recommended to strengthen the safety data of COVAXIN.

Background: Understanding the reasons for HIV serostatus disclosure and nondisclosure and how these reasons differ by certain characteristics of the people living with HIV/AIDS (PLWHA) is important for effective HIV prevention intervention strategies. Objectives: This study was undertaken to investigate/identify the reasons for disclosure and nondisclosure of HIV serostatus by PLWHA, and to find out any association between the reasons for disclosure or nondisclosure and certain demographic and clinical characteristics, i.e. age, gender, WHO clinical stage and CD4 count of the study population. Methods: A cross-sectional study was conducted among all patients of 18-49 years with confirmed HIV infection registered at the antiretroviral therapy (ART) center of a tertiary care hospital in eastern Uttar Pradesh, India for one year, from July 2017 to June 2018. Results: The most common reason for disclosure of HIV serostatus was the presence of any family member at the time of collection of HIV test report (68.5%), and the most common reason for not disclosing the serostatus was stigmatization (68%). The reasons for disclosure was found to be associated with the WHO clinical stage of the respondents (p

BackgroundThe BBV152 COVID-19 vaccine (COVAXIN) has recently been approved for adolescents. We provide the first real world safety data of COVAXIN use in adolescents and compare this with adults.MethodsA prospective observational study is being conducted since January 2022. Enrolled adolescents and adults were contacted telephonically after 14 days of receiving the BBV152 vaccine. Primary outcome was vaccine safety assessed as rates of adverse events following immunization (AEFI). Severity grading of AEFIs was done using the FDA scale.FindingsA total of 698 adolescents and 326 adults were enrolled. AEFIs occurred in 36.3% adolescents after first and in 37.9% after second dose. Systemic involvement was seen in 15-17% adolescents. Injection site pain and fever were the common AEFIs. Majority of AEFIs were mild-moderate. Severe and atypical AEFIs were observed in 0.9% and 0.6% adolescents respectively. Majority of AEFIs recovered in 1-2 days. In >2% adolescents, AEFIs were persisting at 14-day follow-up since the second dose. No difference in AEFI incidence and patterns was observed between adolescents and adults. Regression analysis showed females and those with history of allergy to be respectively at 1.5-times and 3-times increased risk of AEFIs among adolescents.InterpretationCOVAXIN carries an overall favorable short term safety profile in adolescents. The observed AEFI rates in adolescents are much lower than that reported with mRNA vaccines. Female adolescents and those with history of allergy need watchfulness. With some AEFIs persisting at 14 days, a longer follow-up is recommended to strengthen the safety data of these vaccines.FundingNo funding support

BackgroundThere is paucity of real-world data on COVID-19 vaccine effectiveness and safety from cohort designs. The current study aimed to evaluate vaccine performance during second wave in India. It also aimed to determine adverse events of significant concern (AESCs), and to ascertain the effect of vaccination on persistent health issues in individuals post COVID-19.MethodsA cohort study was conducted from July-2021 to December-2021 in a tertiary hospital of north India. The primary outcome was vaccine-effectiveness against COVID-19. Secondary outcomes were AESCs, and persistent health issues in those receiving vaccine. Regression analyses were performed to determine risk factors.ResultsIn 2760 healthcare workers (HCWs) included, 1033 COVID-19 events were reported. Around 6-17% vaccine effectiveness was observed against COVID-19 occurrence. One dose-recipients were at 1.6-times increased risk of COVID-19. Prior SARS-CoV-2 infection was a strong independent protective factor against COVID-19 (aOR 0.66). Full vaccination reduced moderate-severe COVID-19 by 57%. Those with lung disease were at 2.5-times increased risk of moderate-severe COVID-19. AESCs were observed in 1.3% including one case each of myocarditis and severe hypersensitivity. Individuals with hypothyroidism were at 5-times and those receiving vaccine after recovery from COVID-19 were at 3-times higher risk of persistent health issues.ConclusionCOVID-19 vaccination reduced COVID-19 severity but offered marginal protection against occurrence. Relationship of asthma and hypothyroidism with COVID-19 outcomes necessitates focused research. Independent protection of prior SARS-CoV-2 infection was high and persistent health issues were common in individuals receiving vaccine post COVID-19. Recommendations of vaccinating those recovered from COVID-19 need further studies.

Background: The Mother and Child Tracking System (MCTS) portal captures and tracks all pregnant women right from conception up to 42 days after delivery and all children below five years. Objectives: This study was conducted to find out the technical, behavioral and organizational factors that affect the process and performance of MCTS. Material and Methods: This was an exploratory qualitative study conducted in Varanasi district by using multistage random sampling method. Data were collected by in-depth interviews of 48 health care providers. Results: Majority of the ANMs and ASHAs were not aware of the meaning of “Tracking System” and the use of MCTS ID. Inappropriate training of ASHAs, absence of supervision and monitoring by ANMs, overburdened DEOs and ANMs, poor internet connection, slow server speed, software problem and frequent power failures were identified as major factors for poor performance of MCTS. Conclusion: The most effective measure to improve the performance of MCTS would be to properly train grass root level workers so that more efficient data can be fed into MCTS.

In the last two decades, India has witnessed a dramatic rise in the consumption of packaged foods, especially among adolescents. Food labelling is often recognised as an instrumental population-based approach which can enable consumers to make informed food choices by providing all the necessary details about the food product on the packaging. In the Indian context, where adolescent obesity and the ensuing non-communicable diseases are escalating, it is crucial to understand adolescents' views on the use of non-nutritious packaged foods and food labels. Therefore, the aim of this qualitative inquiry was to explore Indian adolescents' perceptions regarding the consumption of packaged food and use of food labels. Convenience sampling was employed to recruit 29 boys and 15 girls (aged 10-19 years) from rural Varanasi, India. Semi-structured, face-to-face interviews were conducted in the local language. Interview recordings were transcribed verbatim and translated to English. Narrative data were subjected to thematic analysis using NVivo software program. The adolescents reported frequent consumption of packaged food like potato chips, biscuits, chocolates, deep-fried Indian snacks both at school and home. Packaged foods were regarded as tasty, safe, and fresh. Brand name, date of expiry and cost were often read by the study respondents. Nevertheless, they reported difficulty in understanding other components of the label (e.g., nutrition information) and they were not aware of the negative impact of consuming unhealthy packaged foods. Nearly all the respondents insisted that food labels should be written in the local language for easy understanding. These emerging findings underscore the need to design school-based food literacy programs for vulnerable Indian adolescents to address obesity and diet-related complications in early adulthood.

Background: Varying protection rates have been observed with approved COVID-19 vaccines post-approval, in various real-world studies. However, little data exists on the clinical presentation and risk factors of occurrence and severity of COVID-19 in vaccinated individuals. The aim of the present study is to describe the patterns of presentation of COVID-19 in vaccinated individuals, and to determine the predictors of occurrence of COVID-19 and the predictors of severity in the vaccinated.Methods: The study is a part of a prospective observational study ongoing since February 2021 in a tertiary teaching and research hospital of northern India. Individuals recruited in this study belong to a high-risk group comprising health care workers and elderly. COVISHIELD, based on ChAdOx1 nCoV-19 platform was the vaccine received by the participants based on policy on allocation.Primary outcomes of the study are the short term and long-term adverse events following immunization (AEFI) with COVID-19 vaccines. Secondary outcomes include the rates of occurrence of COVID-19 and severity of COVID-19. Data on these have been already reported. The clinical presentation, typical and atypical manifestations, time to symptomatic recovery and patterns of post-COVID-19 complaints were analysed in the current study. Logistic regression analysis was performed to predict the risk factors of occurrence of COVID-19 in the vaccinated and the determinants of severe forms of the disease in this group.Findings: 1500 individuals completed at least two month follow up. Of these, 418 developed laboratory confirmed or suspected COVID-19. Fever was the commonest symptom (72%), followed by features of rhinitis (41%) and cough (34%). Nearly 12% individuals had only one symptom or none. Cardiovascular involvement was seen in more than 2% of affected. Time to symptomatic recovery varied from 1-75 days and 11% had post COVID-19 complaints at two month follow up, most common being generalized weakness. Results of regression analysis showed 1.6 times higher odds of contracting the disease in females and young individuals < 40 years of age (P 60 days (P=0.01).With respect to severity, males and those receiving only one dose each had 3 times higher odds of suffering from moderate to severe COVID-19 compared to females and fully vaccinated. Persons with pre-existing lung disease, such as asthma had 6 times higher odds of suffering from moderate to severe COVID-19 (P=0.024). No association with the occurrence or severity of disease was observed with any other co-morbidity or the use of renin-angiotensin-aldosterone system (RAAS) blockers.Interpretation: Sex wise differences exist with respect to occurrence and severity of COVID-19. Two doses of vaccine, compared to one dose provide considerable protection against occurrence as well as severity. Full vaccination with extended dosing interval should be the optimal strategy and should be carried out when the community burden of cases is negligible. Future studies are needed to explore the sex wise differences in the propensity and severity of COVID-19. Further, the risk association of asthma phenotypes with COVID-19 needs to be investigated.Funding: The study received no funding support

Background: In randomized controlled settings, vaccine efficacy close to 70% against symptomatic COVID-19 has been demonstrated by the ChAdOx1 nCoV-19 vaccine which is a recombinant chimpanzee adenovirus based vaccine expressing the SARS-CoV-2 spike protein. Post approval studies are however necessary to validate the findings in the real world.Methods: A prospective observational study is being conducted in a tertiary hospital of north India since 5th February 2021 with the primary objective of determining safety of COVID-19 vaccines and the secondary objective of assessing the rate of occurrence of COVID-19 in vaccinated group. High risk group comprising health care workers, other frontline workers (police, sanitary workers etc) and elderly citizens who were initially focus groups for vaccine roll-out in India, were enrolled in the study. The study included all vaccine recipients who provided consent and were enrolled at the time of receiving the first or second dose of COVISHIELD vaccine, and followed up telephonically.Results: Among 1650 enrolled vaccine recipients, 1500 participants of the study (Female/Male: 472/1028; mean age 38.8 years) completed at least 2 months of follow-up, after the second dose. The common comorbidities in study participants were hypertension (170, 11.3%), diabetes (142, 9.5%), and hypothyroidism (54, 3.6%). Of those who received a single dose of vaccine (n=65), laboratory confirmed SARS-CoV-2 infection was observed in 27 individuals (41.5%) and 3 were suspects. Severity wise, infections were mild in 21 out of 30 (70%) cases, moderate in five (16.7%) and severe in two (6.7%). Of those who received both doses of vaccine (n=1435), 388 were diagnosed as confirmed or suspect cases of SARS-CoV-2 infection. Of these 388, RT-PCR positivity was seen in 271 (18.9%) individuals, 82 (5.7%) were labelled as ‘suspects’ and 35 (2.4%) were RT-PCR negative suspects. Severity wise, majority of SARS-CoV-2 infections were ‘mild’ (331/388, 85.3%), followed by ‘moderate’ (33/388, 8.5%) and ‘severe’ (6/388, 1.5%). 404 out of the 1500 total participants were doctors including consultant/teaching faculty, resident doctors, and those in general practice. Among the 377 doctors who received both doses of vaccine, 160 were diagnosed as confirmed or suspect cases of SARS-CoV-2 infection. Of these, 131 (34.7%), 17 (4.5%) and 12 (3.2%) were laboratory confirmed cases, ‘suspects’ and RT-PCR negative suspects respectively. The infection was asymptomatic, ‘mild’, ‘moderate’ and ‘severe’ in 9 (5.6%), 130 (81.3%), 16 (10%) and 5 (3.1%) respectively. Breakthrough infections occurring at > 14 days after receiving the second dose were seen in 148 doctors who received both doses (39.2%), or 119 doctors (31.6%) if only laboratory confirmed cases were considered. Four deaths occurred in the study participants during the study period, two in partially vaccinated group and two in fully vaccinated group. Two of these participants, both in partially vaccinated group had developed SARS-CoV-2 infection during their follow-up.Conclusion: The disproportionately high occurrence of SARS-CoV-2 infection and COVID-19 in priority vaccinated groups in our study can be explained to some extent by the existence of variants such as the delta which might have escaped the vaccine generated immune protection. Despite the high incidence, the severity of COVID-19 was observed to be low. Since the ongoing study was primarily focused on adverse events following immunization (AEFIs) and enrolled only vaccinated individuals, the secondary outcome results lack a control unvaccinated group. However, the result of this preliminary analysis necessitates vigorous research on the performance of vaccines against variants, optimal timing of vaccination, need for boosters, and also optimal timings of effectiveness studies to guide future vaccination policy.

Background We provide the first post-approval safety analysis of COVISHIELD in health care workers (HCWs) in northern India. Methods This continuing prospective observational study (February 2021 to May 2022) enrolled participants ≥18 years receiving COVISHIELD vaccination. Primary outcome was safety and reactogenicity. Categories (FDA toxicity grading) and outcomes of adverse events following immunization (AEFIs) were recorded, causality assessment performed, and risk factors analysed. Findings We present the results of an interim analysis of 804 participants. AEFIs following first dose were reported in 321 (40%; systemic involvement in 248). Among 730 participants who completed a 7-day follow-up post second dose, AEFIs occurred in 115 (15.7%; systemic in 99). Majority of AEFIs were mild-moderate and resolved spontaneously. Serious AEFIs, leading to hospitalization was noticed in 1 (0.1%) participant with suspicion of immunization stress related response (ISRR). AEFIs of grade 3 severity (FDA) were recorded in 4 participants (0.5%). No deaths were recorded. Regression analysis showed increased risk of AEFIs in younger individuals, a two times higher odds in females, those with hypertension or with history of allergy; and three times higher odds in individuals with hypothyroidism. Interpretation COVISHIELD carries an overall favourable safety profile with AEFI rates much less than reported for other adenoviral vaccines. Females, those with hypertension, individuals with history of allergy and hypothyroidism may need watchful vaccine administration. This being an interim analysis and based on healthcare workers who may not reflect the general population demographics, larger inclusive studies are warranted for confirming the findings. Funding No funding support.

COVID-19 and its associated regulatory measures including lockdowns, curfews, and physical distancing norms have significantly affected individual's dietary and culinary behaviours. Although there is ample empirical evidence available on dietary changes within the Indian context, very limited evidence exists about the factors influencing these dietary modifications and changes in culinary behaviours during COVID-19 lockdown. Therefore, the aim of this qualitative study was to explore the views of Indian household food gatekeepers towards meal planning, food purchasing, and meal preparation during the pandemic and its associated lockdowns. A convenience sample of 34 female gatekeepers from the Mumbai metropolis participated in online interviews. Interviews were conducted in English and Hindi (then translated in English), audio-recorded and transcribed verbatim. Underpinned by Template Analysis technique, transcribed data were analysed manually and using the NVivo software program. The interview structure guided the development of themes. The emerging themes included were: Increased household cooking; Involvement of children and male members in food-related activities; Experimentation in the kitchen; Adoption of meal planning skills; Increase in online food shopping; Bulk buying; Shortage of food items; Reduced consumption of outside home food; Increased variety of home-cooked meals; Increase in snacking and overall food intake; Determinants of food choices; and Family meals-a new norm. In the light of these findings, developing family-focussed, web-based nutrition programs to enhance gatekeepers' and their families' food literacy including declarative and procedural nutritional knowledge would be beneficial. The importance of organisational culinary behaviours such as planning meals in advance, shopping with a food list should be promoted to prevent hoarding and subsequently reduce strain on the food supply system. With a surge in domestic cooking, low cost nutritious recipes with the use of local and seasonal produce should be emphasized promoting healthy eating among the gatekeepers and their family members. The inclusion of food studies in the school curriculum will facilitate the development of culinary skills among children and youth. Also, there is a need for further research and surveillance to strengthen understanding of sustainability of healthy culinary behaviours practiced during the pandemic.

Background Bangladesh, India, and Nepal aim for the elimination of Visceral Leishmaniasis (VL), a systemic parasitic infectious disease, as a public health problem by 2020. For decades, male patients have comprised the majority of reported VL cases in this region. By comparing this reported VL sex ratio to the one observed in population-based studies conducted in the Indian subcontinent, we tested the working hypothesis that mainly socio-cultural gender differences in healthcare-seeking behavior explain this gender imbalance. Methodology/Principal findings We compared the observed sex ratio of male versus female among all VL cases reported by the health system in Nepal and in the two most endemic states in India with that observed in population-based cohort studies in India and Nepal. Also, we assessed male sex as a potential risk factor for seroprevalence at baseline, seroconversion, and VL incidence in the same population-based data. The male/female ratio among VL cases reported by the health systems was 1.40 (95% CI 1.37–1.43). In the population cohort data, the age- and study site-adjusted male to female risk ratio was 1.27 (95% CI 1.08–1.51). Also, males had a 19% higher chance of being seropositive at baseline in the population surveys (RR 1.19; 95% CI 1.11–1.27), while we observed no significant difference in seroconversion rate between both sexes at the DAT cut-off titer defined as the primary endpoint. Conclusions/Significance Our population-based data show that male sex is a risk factor for VL, and not only as a socio-cultural determinant. Biological sex-related differences likely play an important role in the pathogenesis of this disease., Author summary Visceral Leishmaniasis (VL) is a parasitic disease that is lethal if not treated timely and mainly affects impoverished populations. Bangladesh, India, and Nepal have targeted the elimination of this disease as a public health problem by 2020. The majority of VL patients attending the health services are male, and this is usually attributed to unequal access to health care for men and women in this sociocultural context. We analyzed two large datasets obtained in population surveillance projects, including regular door-to-door screening for VL, in India and Nepal. Thereby we minimized any potential differences in access to health care between both sexes, as every suspect VL case occurring in the community received a full diagnostic work-up, and the research project facilitated transport to treatment centers if needed. By comparing the observed sex ratio in the health services records with those of the population surveillance records, we aimed to reach meaningful conclusions about the pathway through which male gender exerts its leverage for increasing VL risk: socio-cultural determinants blocking women from accessing care (nurture) or biological factors (nature) making men more vulnerable to VL. Because in the population-based age adjusted-data, male VL cases were significantly more frequent than female, our findings strongly suggest that in the Indian subcontinent, biological differences between men and women play a more critical role in the pathogenesis of VL than previously assumed, and the observed male predominance in VL cases in health services cannot be explained by socio-cultural factors only. Moreover, data show that above the age of 14 years, males are seropositive more often than females and are at higher risk to develop VL disease.

Introduction Post-kala-azar dermal leishmaniasis (PKDL) is a skin manifestation that is a late clinical outcome of visceral leishmaniasis (VL). Its presentation is similar to leprosy, and the differential diagnosis is not always easy. In VL endemic rural areas of Bihar, India, both infectious diseases co-exist. This observational study aimed to determine the prevalence and distribution of both conditions in an area that had until recently been highly endemic for VL. Methods We conducted a door-to-door survey in an area that belongs to the Health and Demographic Surveillance Site (HDSS) of Muzaffarpur, Bihar, India. Within the HDSS we selected the villages that had reported the highest numbers of VL cases in preceding years. All consenting household members were screened for skin conditions, and minor conditions were treated on the spot. Upon completion of screening activities at the level of a few villages, a dermatology clinic (“skin camp”) was conducted to which suspect leprosy and PKDL patients and other patients with skin conditions requiring expert advice were referred. We studied the association between distance from an index case of leprosy and the probability of disease in the neighborhood by fitting a Poisson model. Results We recorded a population of 33,319, out of which 25,686 (77.1%) were clinically screened. Participation in skin camps was excellent. Most common conditions were fungal infections, eczema, and scabies. There were three PKDL patients and 44 active leprosy patients, equivalent to a prevalence rate of leprosy of 17.1 per 10,000. Two out of three PKDL patients had a history of VL. Leprosy patients were widely spread across villages, but within villages, we found strong spatial clustering, with incidence rate ratios of 6.3 (95% C.I. 1.9–21.0) for household members and 3.6 (95% C.I. 1.3–10.2) for neighbors within 25 meters, with those living at more than 100 meters as the reference category. Discussion Even in this previously highly VL endemic area, PKDL is a rare condition. Nevertheless, even a single case can trigger a new VL outbreak. Leprosy is also a rare disease, but current prevalence is over 17 times the elimination threshold proclaimed by WHO. Both diseases require continued surveillance. Active case finding for leprosy can be recommended among household members and close neighbors of leprosy patients but would not be feasible for entire populations. Periodic skin camps may be a feasible and affordable alternative., Author summary We describe a survey for post kala azar dermal leishmaniasis (PKDL) and leprosy carried out in a surveillance site in Bihar, India, that has until recently been highly endemic for visceral leishmaniasis (VL). Both leprosy and VL are subject to elimination initiatives, for both diseases the target prevalence is set at less than 1 case per 10,000 population. PKDL, a dermatological sequel of VL, is important because it can act as a reservoir for VL in inter-epidemic periods. So far very little is known about prevalence of PKDL in India and the frequency of PKDL among former VL patients. Our survey was population based, allowing us to assess PKDL prevalence not only among former VL patients but also among those not known to have suffered from VL in the past. We conducted door-to-door screening and suspect cases of leprosy and PKDL were referred to a ‘skin camp’, an outreach consultation for skin conditions at village level. We recorded geographic coordinates of each household screened, thus we were able to explore spatial associations. Participation in the survey and in the skin camps was very good. On a population of over 25,000 screened we found only three PKDL cases but 44 active leprosy patients. For leprosy this equates to a prevalence of 17.1 per 10,000, way above the elimination threshold. Of our three PKDL cases, two had occurred in known former VL cases, one was in a person who reported never to have suffered from VL. For leprosy we found strong spatial associations with a six-fold increase in risk for household members but also a three to four-fold increase for neighbors at less than 25 meters. The three PKDL cases were from three different villages, their numbers were too low for any meaningful spatial analysis. We conclude that leprosy is still a major problem in the area that requires more efforts. Active screening of household contacts is rational but should be extended to nearby neighbors. Though relatively efficient, this approach would miss out on the bulk of leprosy patients. PKDL is a rare condition but needs to be kept under surveillance. Skin camps can provide a feasible alternative to door-to-door screening, allowing to target both conditions simultaneously.

Background: Lack of male spouse involvement can affect the delays in the decision to take health care facilities, these are the main contributing factor for increasing maternal mortality and child death ratio. Men involvement in reproductive and sexual health including child health is important in reducing teenage pregnancy, maternal mortality, infant mortality, risky abortions, and total fertility rate. This study aimed to assess the awareness and practices of male spouse in maternal care services in rural areas. Methods: This is a community-based and cross-sectional study which was undertaken in randomly selected four villages of Kashi Vidyapeeth block, Varanasi. Total enumeration of women from the selected villages delivered within last 3 years was done and their husbands were interviewed by using a pre-designed, pretested interview schedule. Data on socioeconomic and demographic characteristics, awareness of various aspects and antenatal and postnatal care were collected and analyzed with SPSS 20 trial version. Results: Out of the total 130 interviewed male spouse (respondents), only 9.8% knows about minimum four antenatal visits. 26.9% were aware about the health related problems during pregnancy and only 7.7% were aware about the danger signs. Janani Suraksha Yojna was known to 11.5% only. 22.4% respondents accompanied their wife for antenatal registration and36.2% for T. T vaccination but 70.2% were present in the hospital during delivery. Logistic regression analysis shows that education of respondents is a key determinant of their involvement during pregnancy. Conclusions: This study identified overall low awareness of male spouse about antenatal visits and involvement during antenatal care. Therefore, there is a strong need to re-strategize the involvement of male spouse in reproductive health including antenatal period.

Introduction: Up until now, poor menstrual hygiene in developing countries has been an insufficiently acknowledged problem. The lack of attention to this issue is striking as we cannot achieve several Millennium Development Goals (MDGs), that is, 2, 3 4,5, and5B. This study aimed to assess the level of awareness about menarche and hygienic practices during menstruation in context of schooling . Materials and Methods: Community-based cross-sectional study using a mix method approach (qualitative and quantitative). It was conducted among 650 adolescent girls in the field practice area of Rural Health and Training Centre, Chiraigaon block of district Varanasi between January and June2011. Pretested, semistructured interview schedule was used. Data were analyzed statistically by using Statistical Package for Social Sciences (SPSS) software. Results: Out of the total 650 respondents, 590 (90.78%) had attained menarche at the time of interview and only one-third of the respondents (29.4%) were aware of menstruation before menarche and sisters (55%) played the key role in providing information to them. Only 31% respondents were using sanitary pads during menstruation. Self-reported reproductive tract infection (RTI) was observed more in respondents not maintaining hygienic practices (6.6%) as compared to those maintaining hygiene (2.6%). Conclusion and Recommendations: From the Focus Group Discussions (FGDs) as well as quantitative survey it was observed that the awareness about menarche before its onset was still poor in rural areas. Significant association (P < 0.05) was observed between respondent education and their awareness about menarche before its onset. Therefore, it is recommended that teachers can play an influential role in informing them about changes during adolescence, especially about menarche and other issues related to menstruation. As per the present study, sisters and mothers were the major source of information. Therefore, there is a need for the provision of comprehensive family life education for the parents also.

Background: HIV serostatus disclosure plays an important role in reducing the risk of HIV transmission. However, its negative effects may include rejection, assault, separation, divorce, stigma, and discrimination. Objectives: This study was undertaken to find out the proportion of HIV-positive serostatus disclosure to any family member and different factors influencing disclosure among people living with HIV/AIDS (PLWHA). Methods: A cross-sectional study was conducted among all patients aged 18–49 years with confirmed HIV infection registered at the antiretroviral therapy center of a tertiary care hospital in eastern part of Uttar Pradesh, India, for the duration of 1 year, from July 2017 to June 2018. Results: Most of the respondents were aged 30–49 years (79.9%), male (63.2%), married (85.4%), rural residents (60.4%), Hindu (96.5%), literate (84%), employed/driver (61.8%), and belonged to lower/lower middle class (62.6%). The rate of disclosure of HIV-positive status to any family member was quite high in this study (238/288 or 82.6%), among which 92.9% (221/238) to the spouse only. The number of sexual partners before disclosure, educational status, and socioeconomic status of the respondents were found to be independent predictors of disclosure of HIV-positive status to any family member (P < 0.05). Conclusions: This study indicates the need of giving more emphasis on creating awareness regarding the importance of HIV serostatus disclosure to any family member, especially to spouse, and encourage all PLWHA in the community to disclose their status. Effective strategies also need to be evolved that will target those not likely to disclose their status to anybody.

Objective To assess the rate of default from treatment in the Visceral Leishmaniasis (VL) Elimination Program and to identify risk factors and its underlying causes. Methods Case control study conducted between December 2009 and June 2012 in three Primary Health Centres (PHC) of Muzaffarpur District, India. Patients who defaulted from treatment from the PHCs were considered as “cases”, and those who completed their treatment as “controls”. Two controls were included in the study for each case. Respondents’ opinion and satisfaction with the services provided at the PHCs was also elicited. Logistic regression was performed to assess the contribution of socio-demographic variables on patient status, and a discriminant analysis was used (after decomposing the original data) to identify factors that can predict the patient status as defaulter or not, based on factor scores of the components as predictor variables. Results During the study period 16.3% (89/544) of patients defaulted. 87 cases and 188 controls were interviewed through a semi-structured questionnaire. Women had a higher risk for default (OR 1.8, 95% CI 1.1-3.0). Treatment received was miltefosine in 55.6% and sodium stibogluconate (SSG) in 44.4%. Most (86%) defaulters completed their treatment at other health care facilities; 70% of them preferred non-governmental institutions. Most-cited reasons for default were seeking a second opinion for VL treatment and preferring to be treated in specialized VL centers. Discriminant analysis showed only one significant predictor: dissatisfaction with the medical care received in PHCs. Conclusion Efforts are needed to enhance the quality of VL care at PHC level, which will be beneficial in increasing treatment completion rates. This article is protected by copyright. All rights reserved.

Background: Data on awareness of adolescent's on the legal and social issues/acts related to reproductive health, especially in rural areas, are scarce. Objectives: The aim of the present cross-sectional study is to assess the awareness level of legal and social issues related to reproductive health and its association with the various individual and family/household level characteristics. Methods: 650 adolescent girls in the age group of 15–19 years were interviewed with the help of pretested and semistructured questionnaire and focus group discussions were also conducted for qualitative findings in Chiraigaon block of district Varanasi. Results: It was observed that 42.9% of the respondents were aware of legal age of marriage, 14.9% knew about the right age of childbearing. Dowry prohibition act and domestic violence act were known to 46% and 27% respondents, respectively, and only 2.6% were aware of medical termination of pregnancy act. Logistic regression analysis shows the significant effect of education on awareness of legal age of marriage, right age of childbearing, domestic violence, and dowry prohibition acts, which is also supported by qualitative findings. Conclusion: All the important legal issues/acts should be included in high school curriculum and female teachers should be involved in training program for adolescents. Role of mass media in creating awareness about these issues in their routine programs should be ascertained. Accredited Social Health Activist and Anganwadi workers should be aware of and include these issues/acts in adolescent meetings.

Introduction Asymptomatic persons infected with the parasites causing visceral leishmaniasis (VL) usually outnumber clinically apparent cases by a ratio of 4–10 to 1. We assessed the risk of progression from infection to disease as a function of DAT and rK39 serological titers. Methods We used available data on four cohorts from villages in India and Nepal that are highly endemic for Leishmania donovani. In each cohort two serosurveys had been conducted. Based on results of initial surveys, subjects were classified as seronegative, moderately seropositive or strongly seropositive using both DAT and rK39. Based on the combination of first and second survey results we identified seroconvertors for both markers. Seroconvertors were subdivided in high and low titer convertors. Subjects were followed up for at least one year following the second survey. Incident VL cases were recorded and verified. Results We assessed a total of 32,529 enrolled subjects, for a total follow-up time of 72,169 person years. Altogether 235 incident VL cases were documented. The probability of progression to disease was strongly associated with initial serostatus and with seroconversion; this was particularly the case for those with high titers and most prominently among seroconvertors. For high titer DAT convertors the hazard ratio reached as high as 97.4 when compared to non-convertors. The strengths of the associations varied between cohorts and between markers but similar trends were observed between the four cohorts and the two markers. Discussion There is a strongly increased risk of progressing to disease among DAT and/or rK39 seropositives with high titers. The options for prophylactic treatment for this group merit further investigation, as it could be of clinical benefit if it prevents progression to disease. Prophylactic treatment might also have a public health benefit if it can be corroborated that these asymptomatically infected individuals are infectious for sand flies., Author Summary To study the association between positive serology for VL among asymptomatic persons and progression to disease, we analyzed combined data from two different cohort studies in which over 32,000 subjects were enrolled. All subjects were screened for presence of antibodies to L. donovani with DAT and rK39. After an interval of 6–12 months, a second round of surveys was conducted in which seroconvertors were identified, i.e. persons seronegative at baseline that had become seropositive in the interval between surveys. We subdivided the subjects according to serologic titers scored as negative, moderately positive or strongly positive. During follow-up we observed that the risk of progressing to disease was not very much different between seronegative and moderately seropositive subjects, but strongly increased for high titer seropositive subjects. This pattern was true for the initial serology, and even more pronounced among seroconvertors. Given the strongly increased risk of progression to disease among those with high DAT or rK39 titers, these data raise the question whether prophylactic treatment would be beneficial. The case for prophylactic treatment would be further strengthened if it could be shown that asymptomatically infected individuals are infectious to sand flies.

The eleventh author's name was incorrectly reported. The correct name is: Mary Edyth Wilson.

India lies on the cusp of a demographic transition. It is essential to all-round development of the youths of India. Recent times have witnessed an increase in substance use among younger population. In India forty percent of men use tobacco in some form and One-fifth of young men aged 15–24 consume alcohol. It is estimated that 7.6 million people worldwide died of substance abuse related causes. To find out the association of socio-demographic variables on the problem of substance abuse among male youth students a cross-sectional school based study was conducted from March 2013 to July 2015. By multistage random sampling 570 male youth students aged 15 to 24 years belonged to class 9th to graduates of all the schools and colleges of Chiraigaon Community Development Block was selected. Out of them 27 and 3 students were excluded from study due to unreliability of information and denial of consent. Finally 540 students were interviewed and thus obtained data was entered and analyzed by SPSS. Substance users were more in 20–24 yrs of age group belonging to general caste and having higher level of education. In upper class substance users was less as compared to non-users. Likelihood of Substance use was high among those whose fathers were skilled worker (35.7%) or doing some business (18.8%) and having extremes of education.

Background Active case detection (ACD) significantly contributes to early detection and treatment of visceral leishmaniasis (VL) and post kala-azar dermal leishmaniasis (PKDL) cases and is cost effective. This paper evaluates the performance and feasibility of adapting ACD strategies into national programs for VL elimination in Bangladesh, India and Nepal. Methods The camp search and index case search strategies were piloted in 2010-11 by national programs in high and moderate endemic districts / sub-districts respectively. Researchers independently assessed the performance and feasibility of these strategies through direct observation of activities and review of records. Program costs were estimated using an ingredients costing method. Results Altogether 48 camps (Bangladesh-27, India-19, Nepal-2) and 81 index case searches (India-36, Nepal-45) were conducted by the health services across 50 health center areas (Bangladesh-4 Upazillas, India-9 PHCs, Nepal-37 VDCs). The mean number of new case detected per camp was 1.3 and it varied from 0.32 in India to 2.0 in Bangladesh. The cost (excluding training costs) of detecting one new VL case per camp varied from USD 22 in Bangladesh, USD 199 in Nepal to USD 320 in India. The camp search strategy detected a substantive number of new PKDL cases. The major challenges faced by the programs were inadequate preparation, time and resources spent on promoting camp awareness through IEC activities in the community. Incorrectly diagnosed splenic enlargement at camps probably due to poor clinical examination skills resulted in a high proportion of patients being subjected to rK39 testing. Conclusion National programs can adapt ACD strategies for detection of new VL/PKDL cases. However adequate time and resources are required for training, planning and strengthening referral services to overcome challenges faced by the programs in conducting ACD.

Background. National VL Elimination Programs in India, Nepal and Bangladesh face challenges as home-based Miltefosine treatment is introduced.Objectives. To study constraints of VL management in endemic districts within context of national elimination programs before and after intervention.Methods. Ninety-two and 41 newly diagnosed VL patients were interviewed for clinical and provider experience in 2009 before and in 2010 after intervention (district training and improved supply of diagnostics and drugs). Providers were assessed for adherence to treatment guidelines. Facilities and doctor-patient consultations were observed to assess quality of care.Results. Miltefosine use increased from 33% to 59% except in Nepal where amphotericin was better available. Incorrect dosage and treatment interruptions were rare. Advice on potential side effects was uncommon but improved significantly in 2010. Physicians did not rule out pregnancy prior to starting Miltefosine. Fever measurement or spleen palpation was infrequently done in Bangladesh but improved after intervention (from 23% to 47%). Physician awareness of renal or liver toxicity as Miltefosine side effects was lower in Bangladesh. Bio-chemical monitoring was uncommon. Patient satisfaction with services remained low for ease of access or time provider spent with patient. Health facilities were better stocked with rK39 kits and Miltefosine in 2010.