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Adolescents and young adult comprise a significant proportion of India’s population. Although, this group of the population faces serious challenges to their health and well-being. To promote their health and well-being, Centre of Excellence (CoE) at King George’s Medical University, Lucknow, India, serves as an advanced care facility for 10–24-year-old adolescents and young adult women. This paper reports the socio-demographic characteristics of, and health services availed to adolescents and young adults who are visiting the CoE in Lucknow, India. A total of 6038 beneficiaries received clinical services during June 2018–March 2022. Out of total clinical services, 38.37% counselling and 37.53% referral services were utilised. Menstruation (46.29%), sexual and reproductive (28.19%), nutrition (5.91%), and mental health (1.67%) related problems were highly reported. The age of beneficiaries is classified into three categories, i.e., 10–14, 15–19, and 20–24 years. Prevalence of overweight was highest among adolescents aged 20–24 years compared to other age groups. Other than nutrition, late-adolescent girls (15–19) faced more health problems than their counterparts. The percentage of beneficiaries decreased significantly during and post the COVID-19 period (

BACKGROUND Monitoring ocular morbidity among pediatric patients requires regular follow-up visits. We found that the follow-up rate was poor among children in our setting. Therefore, we intended to assess the effectiveness of 2 interventions—(1) counseling and (2) SMS text messaging and phone calls—to improve the follow-up rates. OBJECTIVE This study aimed to evaluate the effectiveness of 2 interventions, counseling and SMS and phone calls group, as well as a routine standard care for improving the follow-up rate of pediatric patients. METHODS A Nonrandomized, quasiexperimental design was used. Children (aged 0-16 years) with ocular conditions requiring at least 3 follow-up visits during the study period were included. A total of 264 participants were equally allocated to the 3 intervention groups of (1) counseling, (2) SMS and phone calls, and (3) routine standard care group. A 20-minute counseling session by a trained counselor with the provision of disease-specific leaflets were given to those in the counseling group. For the second intervention group, parents of children received an SMS text 3 days before and a phone call 1 day before their scheduled follow-up visits. Participants allocated for the routine standard care group were provided with the existing services with no additional counseling and reminders. Participants attending 3 follow-ups within 2 days of the scheduled visit date were considered compliant. The difference in and among the proportion of participants completing all 3 follow-up visits in each group was assessed. RESULTS The demographic characteristics of the participants were similar across the study groups. Only 3% (8/264) of participants completed all 3 follow-up visits, but overall compliance with the follow-up, as defined by the investigators, was found to be only 0.76% (2/264). There was no statistically significant difference in the proportion of follow-up between the intervention groups. However, the proportion of participants attending the first and second follow-ups, as well as the overall total number of follow-ups, was more in the SMS and phone-call group followed by the counseling group. CONCLUSIONS We did not find any evidence on the effectiveness of our interventions to improve the follow-up rate. The primary reason could be that this study was conducted during the COVID-19 pandemic. It could also be possible that the intensity of the interventions may have influenced the outcomes. A rigorously designed study during the absence of any lockdown restrictions is warranted to evaluate intervention effectiveness. The study also provides useful insights and highlights the importance of designing and systematically developing interventions for improving the follow-up rate and ensuring a continuum of care to children with visual disabilities in Nepal and similar contexts. CLINICALTRIAL ClinicalTrials.gov NCT04837534; https://clinicaltrials.gov/ct2/show/NCT04837534 INTERNATIONAL REGISTERED REPORT RR2-10.2196/31578

This study aims to estimate the prevalence of human papillomavirus (HPV) vaccine usage and determine the factors for awareness about HPV vaccine among women in reproductive age group.This is a cross-sectional survey under a cervical cancer prevention study. The sample size was 1020 women, aged 15-49 years [550 in Delhi and 470 in Rohtak]. Bivariate analysis and Fisher exact test along with binary logistic regression analysis were used to determine the factors for awareness.About 18.0 % [Delhi: 24.2 % and Rohtak: 10.9 %] of the respondents had heard about the vaccine against cervical cancer. The women aged more than 30 years [AOR: 1.35; CI: 0.94, 1.94] were more likely to be aware of cervical cancer vaccine as compare to women of 30 years and less. However, the women from Rohtak [AOR: 0.90; CI: 0.48, 1.66] were less likely to be aware of vaccine against cervical cancer in reference to women aged 30 years and more [AOR: 1.61; CI: 1.01, 2.56] from Delhi. About 0.6 % [Delhi: 1.1 % and Rohtak: 0.0 %] of the respondents had received HPV vaccine.Women tend to have limited knowledge about cervical cancer vaccine and immunisation practices. The women's demographic makeup varied significantly between the two sites, i.e , Rohtak and Delhi, which had an impact on how well they understood and utilised the cervical cancer vaccination. It is worth mentioning that none of the women from Rohtak had received the immunisation. The awareness of the cervical cancer vaccine among women from the Rohtak was lower than the Delhi women.

The present study aims to estimate the prevalence and determine the factors for cervical cancer screening among women in the reproductive age group in Delhi and Rohtak, India.The data were utilized from a survey conducted as part of a larger study to increase the access to cervical cancer screening and care by MAMTA-Health Institute for Mother and Child in collaboration with the Health Departments of Palam, New Delhi, and Rohtak, Haryana between 2015 and 2017. Data pertaining to the socio-economic and demographic information along with the information related to cervical cancer screening were utilized for the present study. The sample size was 1020 women in reproductive age group. Descriptive statistics (percentage and frequency distribution), bivariate analysis along with multivariable analysis were done to represent the results. The Fisher exact test was used to test the level of significance during bivariate analysis.About 35.2% [Delhi: 44.9% and Rohtak: 23.8%] of the respondents had heard about cervical cancer screening. Further about 3.9% [Delhi-2.9% and Haryana-5.1%] had screened for cervical cancer. Women who had heard about cervical cancer were five times more likely to go for screening [aOR: 5.27; CI: 2.53,10.96]. It was found that women over 30 years of age had 12.04 significantly higher odds of going for cervical cancer screening in reference to women aged 30 years and less [aOR: 12.04; CI: 3.01,53.20]. Women from households with a monthly income of more than 15000 had 2.98 significantly higher odds of going for cervical cancer screening in reference to women from households with an income of 5000 and less [aOR : 2.98; CI: 1.12,9.09].Findings suggest that awareness about cervical cancer screening test along with its thorough knowledge about its benefits would be an effective intervention to increase the uptake of cervical cancer screening.

Background Monitoring ocular morbidity among pediatric patients requires regular follow-up visits. We found that the follow-up rate was poor among children in our setting. Therefore, we intended to assess the effectiveness of 2 interventions—(1) counseling and (2) SMS text messaging and phone calls—to improve the follow-up rates. Objective This study aimed to evaluate the effectiveness of 2 interventions, counseling and SMS and phone calls group, as well as a routine standard care for improving the follow-up rate of pediatric patients. Methods A Nonrandomized, quasiexperimental design was used. Children (aged 0-16 years) with ocular conditions requiring at least 3 follow-up visits during the study period were included. A total of 264 participants were equally allocated to the 3 intervention groups of (1) counseling, (2) SMS and phone calls, and (3) routine standard care group. A 20-minute counseling session by a trained counselor with the provision of disease-specific leaflets were given to those in the counseling group. For the second intervention group, parents of children received an SMS text 3 days before and a phone call 1 day before their scheduled follow-up visits. Participants allocated for the routine standard care group were provided with the existing services with no additional counseling and reminders. Participants attending 3 follow-ups within 2 days of the scheduled visit date were considered compliant. The difference in and among the proportion of participants completing all 3 follow-up visits in each group was assessed. Results The demographic characteristics of the participants were similar across the study groups. Only 3% (8/264) of participants completed all 3 follow-up visits, but overall compliance with the follow-up, as defined by the investigators, was found to be only 0.76% (2/264). There was no statistically significant difference in the proportion of follow-up between the intervention groups. However, the proportion of participants attending the first and second follow-ups, as well as the overall total number of follow-ups, was more in the SMS and phone-call group followed by the counseling group. Conclusions We did not find any evidence on the effectiveness of our interventions to improve the follow-up rate. The primary reason could be that this study was conducted during the COVID-19 pandemic. It could also be possible that the intensity of the interventions may have influenced the outcomes. A rigorously designed study during the absence of any lockdown restrictions is warranted to evaluate intervention effectiveness. The study also provides useful insights and highlights the importance of designing and systematically developing interventions for improving the follow-up rate and ensuring a continuum of care to children with visual disabilities in Nepal and similar contexts. Trial Registration ClinicalTrials.gov NCT04837534; https://clinicaltrials.gov/ct2/show/NCT04837534 International Registered Report Identifier (IRRID) RR2-10.2196/31578

Extreme heat and heat waves have been established as disasters which can lead to a great loss of life. Several studies over the years, both within and outside of India, have shown how extreme heat events lead to an overall increase in mortality. However, the impact of extreme heat, similar to other disasters, depends upon the vulnerability of the population. This study aims to assess the extreme heat vulnerability of the population of four cities with different characteristics across India. This cross-sectional study included 500 households from each city across the urban localities (both slum and non-slum) of Ongole in Andhra Pradesh, Karimnagar in Telangana, Kolkata in West Bengal and Angul in Odisha. Twenty-one indicators were used to construct a household vulnerability index to understand the vulnerability of the cities. The results have shown that the majority of the households fell under moderate to high vulnerability level across all the cities. Angul and Kolkata were found to be more highly vulnerable as compared to Ongole and Karimnagar. Further analysis also revealed that household vulnerability is more significantly related to adaptive capacity than sensitivity and exposure. Heat Vulnerability Index can help in identifying the vulnerable population and scaling up adaptive practices.

Early-stage cervical cancer diagnoses may be the consequence of timely medical care in the presence of symptoms which can be linked to awareness of the symptoms and risk factors. This study aims to determine the knowledge about risk factors and symptoms of cervical cancer and associated factors among women aged 20-49 years.Data were utilized from the survey under the intervention "Increasing access to cervical cancer screening and care through the community-centric continuum of care initiative in India" (2015). The sample size was 1,020 women in the age group of 20-49 years. Descriptive statistics, along with bivariate analysis, was done to represent the preliminary results. Multivariable regression analysis was used to represent the estimates.About 40.1% [Delhi: 56.9% and Rohtak: 20.4%] and 45.5% [Delhi: 52.2% and Rohtak: 37.7%] of respondents had good knowledge about risk factors and symptoms of cervical cancer, respectively. Respondents with primary educational status had an 86% significantly higher likelihood for good knowledge about identified risk factors of cervical cancer [ adjusted odds ratio (aOR): 1.86; CI: 1.12-3.10]. Respondents who were married or widowed/divorced/separated had significantly higher odds for good knowledge about identified risk factors and symptoms of cervical cancer in reference to respondents who were never married. Respondents from Rohtak had 72% and 35% significantly higher odds for good knowledge about identified risk factors [aOR:0.28; CI: 0.21,0.39] and symptoms [aOR:0.65; CI: 0.48,0.88] of cervical cancer, respectively, in reference to respondents from Delhi.Overall awareness about cervical cancer and Human papillomavirus (HPV) as the causative agent was low, more so in Rohtak. This is extremely worrisome as blocking HPV infection is one of the most effective ways to prevent cervical cancer. Moreover, the knowledge about the risk factors and symptoms of cervical cancer is also inadequate, particularly in women from Rohtak.

High ambient temperature is a key public health problem, as it is linked to high heat-related morbidity and mortality. We intended to recognize the characteristics connected to heat vulnerability and the coping practices among Indian urbanites of Angul and Kolkata. In 2020, a cross-sectional design was applied to 500 households (HHs) each in Angul and Kolkata. Information was gathered on various characteristics including sociodemographics, household, exposure, sensitivity, and coping practices regarding heat and summer heat illness history, and these characteristics led to the computation of a heat vulnerability index (HVI). Bivariate and multivariable logistic regression analyses were used with HVI as the outcome variable to identify the determinants of high vulnerability to heat. The results show that some common and some different factors are responsible for determining the heat vulnerability of a household across different cities. For Angul, the factors that influence vulnerability are a greater number of rooms in houses, the use of cooling methods such as air conditioning, having comorbid conditions, the gender of the household head, and distance from nearby a primary health centre (PHC). For Kolkata, the factors are unemployment, income, the number of rooms, sleeping patterns, avoidance of nonvegetarian food, sources of water, comorbidities, and distance from a PHC. The study shows that every city has a different set of variables that influences vulnerability, and each factor should be considered in design plans to mitigate vulnerability to extreme heat.

BACKGROUND The follow-up of pediatric patients ensures regular ocular morbidity monitoring and better treatment outcome. Hiralal Santudevi Pradhan Institute of Ophthalmic Science (Bharatpur Eye Hospital [BEH]) noticed that the follow-up rate was only 22% among its pediatric patients. Several factors like lack of awareness and forgetfulness among patients may contribute to a lower number of follow-up visits. Therefore, BEH decided to find if counseling and reminders through SMS text messaging and phone calls would improve the follow-up rates. OBJECTIVE This study aims to evaluate the impact of interventions like counseling and reminder SMS text messaging and phone calls in improving the follow-up rate of pediatric patients. METHODS This is a public health intervention study being conducted using quantitative analysis. All children (0-16 years) with ocular conditions requiring at least 3 follow-up visits in the study period will be included. In all, 264 participants will be allocated to 3 groups: routine standard care, counseling, and reminders with SMS text messaging and phone calls. In counseling, patients will take part in 20-minute counseling sessions with trained counselors at each visit, and information leaflets will be provided to them. In the reminder SMS text messaging and phone call group, patients will receive an SMS text message 3 days prior and a phone call 1 day prior to their scheduled visits. Patients attending within 2 days of the scheduled date will be considered compliant to follow-up. The proportion of patients completing all the follow-up visits in each group will be assessed. Informed consent will be taken from parents and children. Univariate and multivariate analyses will be conducted. RESULTS The ethical approval for this study has been obtained from the Ethical Review Board (ERB) of Nepal Health Research Council (ERB protocol registration #761/2020 P). The data collection was initiated on January, 24, 2021, but due to the COVID-19 pandemic, as of September 2021, we have only been able to enroll 154 of the planned 264 participants (58.3% of the sample size). CONCLUSIONS This study will reliably document not only the factors associated with follow-up rate through an intervention package (counseling and reminders through SMS text messaging and phone calls) but also the cost effectiveness of the intervention package, which can be applied in all the departments of the hospital. CLINICALTRIAL ClinicalTrials.gov NCT04837534; https://clinicaltrials.gov/ct2/show/NCT04837534 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/31578

The health ministry of India has released three National Health Policies (NHPs) since independence. These are guiding documents for the government for their health-related expenditure. Till 2017, India allocated central resources through five-year plans (FYPs) formed by the Planning Commission. Thereafter, the newly formed National Institution of Transforming India or the National Institute for Transforming India (NITI) Aayog released its first 3-year action agenda for different sectors. We study the translation of these policies in practice, by comparing policy recommendations with the FYPs. This article also compares the recommendation of the NHP, 2017 with the first 3-year agenda of the NITI Aayog. This explorative analysis also studies the cohesion between the three policies. Hence, it helps to identify five key issues in translating these policies to practise for and provides suggestions. Our study indicates that the NHPs in India need to be released frequently while incorporating tools of accountability, need to generate evidence on which policy decisions can be made, need to be inter-sectoral, but coordinated within different agencies of the government and need to have cohesion with budgetary allocations for allowing a better analysis.

Background: COVID-19 has been a pandemic and global disaster since the beginning of 2020. However, there is a lack of city/locale based studies on status and trends of COVID-19 in India. Aim: The study aims to report the tests, total cases, cases per age group, zone wise confirmed cases and the status of hospitalization / home quarantining for COVID-19 for the smart city of Vadodara. Methods: A retrospective secondary data analysis conducted on all the COVID-19 cases reported from 3rd April to 15th September 2020 for the city of Vadodara. Data were accessed through the Website of Vadodara Municipal Corporation and analyzed on cumulative number of tests, positive cases, deaths and patients’ recovery for comparison of Vadodara with the State, National and International statistics. Results: COVID-19 was found to be more prevalent among males. The age group of 51-60 years had the highest number of cases. The number of deaths was highest in the age group of 61-70 years. Nonetheless, case fatality rate was highest in the age group of 71-80 years. Vadodara also has shown a steady decrease in test positivity rate and fared better in terms of recovery rate as compared to Gujarat, India and the world. However, 15 day moving average of positive cases and deaths indicated that there will be an increase of the cases in near future. Conclusion: Vadodara showed positive trends in managing the COVID-19 pandemic. Vadodara administration had managed to reduce the case fatality rate as compared to Gujarat, India and rest of the world.

Background: High ambient temperature is a significant public health problem as it is associated with high heat related morbidity and mortality. We aimed to identify the factors associated with heat vulnerability, and the coping practices among Indian urbanites of Angul, and Kolkata.Methods: A cross-sectional study included 500 households (HHs) from each city with almost equal distribution of slum and non-slum HHs in the year 2020. Information was collected on sociodemographic, household characteristics, exposure, sensitivity and coping practices to heat and the heat illness history reported during the summer. Factors were computed to a Heat Vulnerability Index (HVI). Bi-variate and multi-variable logistic regression analysis used with HVI as the outcome variable to identify the determinants of high vulnerability to heat.Result: The results have shown that some common and some different factors are responsible for determining heat vulnerability of a household across different cities. For Angul, the factors which influence vulnerability are more number of rooms in houses, use of cooling methods like ACs, having co-morbid conditions, gender of household head and distance from nearby PHC. For Kolkata, the factors are unemployment, income, number of rooms, sleeping pattern, avoidance of non-veg food, sources of water, Co-morbidities and distance from the PHC.Conclusion: The study shows that every city has different set of variables that influence vulnerability and each factor should be considered for designing plans to mitigate vulnerability to extreme heat.

Corona virus has taken up the limelight in the sector of disasters since its arrival, however since then the world has faced various other major and minor hazards which have turned into disasters. Be it the Beirut explosion or the Air-India plane crash, disasters have been continuously creating trouble for people. Being in the same time as Covid-19, these disasters can be labelled as parallel disasters. Parallel disasters are difficult to manage as they have a cumulative impact. Sometimes there are multiple hazards and sometimes one hazard leads to another, both the times disaster management becomes very difficult. However, there is one factor in the form of public health which can strengthen the resilience of the population and thus decrease the cumulative impact without even interacting directly with the disaster. In this article, we look at various types of disaster which, along with Covid-19, which have either caused havoc or have the potential to become catastrophes, in the Indian context. The article will look at natural disasters like floods, earthquakes, cyclones and the very devastating heat waves along with man-made disasters like industrial disasters and oil spills. The article will also give a considerable heed to epidemics in the form of Covid-19. We will touch upon the topic of disaster management for all the mentioned disasters which can act as parallel disasters in India and look at why public health can be an important element in management of parallel disasters. Finally the article will talk about the Indian disaster management policy and institutional framework and look at where and how parallel disasters and public health systems can be incorporated in it.

Background: Ample information is available on extreme heat associated mortality for few Indian cities, but scant literature is available on effect of temperature on spatial variability of all-cause mortality for coastal cities. Objective: To assess the effect of daily maximum temperature, relative humidity and heat index on spatial variability of all-cause mortality for summer months (March to May) from 2014 to 2015 for the urban population of Surat (coastal) city. Materials and Methods: Retrospective analysis of the all-cause mortality data with temperature and humidity was performed on a total of 9,237 deaths for 184 summer days (2014-2015). Climatic and all-cause mortality data were obtained through Tutiempo website and Surat Municipal Corporation respectively. Bivariate analysis performed through SPSS. Observations: Mean daily mortality was estimated at 50.2 ± 8.5 for the study period with a rise of 20% all-cause mortality at temperature ≥ 40°C and rise of 10% deaths per day during extreme danger level (HI: > 54°C) days. Spatial (Zone wise) analysis revealed rise of 61% all-cause mortality for Southeast and 30% for East zones at temperature ≥ 40°C. Conclusions: All-cause mortality increased on high summer temperature days. Presence of spatial variation in all-cause mortality provided the evidence for high risk zones. Findings may be helpful in designing the interventions at micro level.

The demographic transition with rapid urbanisation corresponds with the challenges of urban infrastructure development. Urban health is an outcome of complex interaction of many urban factors including governance and finance. Coupled with this, climate change has overarching influence on these factors and a challenge to development, health and survival. Therefore, understanding impact of climate change with reference to urban health and development should be on high priority. Changes in climatic patterns may alter the distribution of vector species and increase its spread in new areas. An increase in temperature and relative humidity may enlarge the transmission window. Effluent emissions to water bodies and salination of rivers through sea level rise may increase the incidence of water borne diseases. Deaths due to heat wave are reported from several parts of the country. Every city is different and success of city specific urban health programme depends on city specific planning as well as public health preparedness for climate change. Hence, study of Climate and Health brings out threshold levels of climate resilience. Surat city experience of Urban health revealed that good governance and Finance were considered most important factors including Urban health system, community participation, Inter-sectoral convergence, disease surveillance, health information system, Public–private partnership, participation of academic institutions and cross learning. One of the major advocacy areas UHCRC is embarking in is ‘Inclusion of Climate resilience in Health and Health in Climate Resilience Planning’.

Acute Poisoning in children is still an important public health problem and represents a frequent cause of admission in emergency rooms . Objective: To determine the frequency of pattern and factors leading to acute poisonings and outcome in children presenting to emergency room at tertiary care hospital Method: A descriptive study conducted in national institute of child health from September 10, 2015 to March 09, 2016. All children age 2 to 12 years with history of accidental poisoning and with duration of ingestion less than 6 hours were enrolled. Descriptive and bivariate analysis has been conducted through SPSS. Results: Kerosene was the most factor observed in 69 (47.3%) patients, organophosphorus 37 (25.3%), alkali 28 (19.2%) and acid in 12 (8.2%) patients. Majority of the children admitted for > 24 hours due to acute poisoning. Conclusion: The findings of the study showed kerosene as the most common pattern. Awareness generation and interventions are the need of hour. Keywords: Kerosene oil, Poisoning, emergency room

Background: Neonatal necrotizing enterocolitis [NEC], characterized by intestinal necrosis and pneumatosis intestinal, is the most common gastrointestinal emergency in the premature newborns[1] . The disease has an incidence rate of 2 to 5% in premature infants. The incidence rate increases to 13% in those weighing 1,500 gram at birth. NEC has a mortality rate of 10 to 55%. Objective: To determine the frequency of necrotizing enterocolitis in preterm neonates along with their outcome during stay in hospital. Methods: All premature newborn with morbidity admitted at Neonatal Intensive Care Unit [NICU] the Children Hospital, PIMS, Islamabad were screened for enrolment. A total of 156 premature newborn who fulfilled the inclusion criteria were enrolled in the current study. The duration of study was 6 months. At the time of enrolment, demographic characteristics of all the enrolled babies were obtained and noted on the proforma specially designed for the study. Delivery complications, enteral feeding status and resuscitation at birth were also noted. Each baby was assessed for the diagnosis of NEC. Those who were diagnosed to have NEC where then followed for outcome. The outcome of study was either discharged [n=35] or died [n=12] during the hospital stay. Results: During the study period a total of 156 babies were enrolled. Out of 156 babies, 47 [30.1%] babies were diagnosed to have NEC. The mean [SD] age of babies with NEC in this study was 7.8 [±4.1] days. Out of 47, 29 [62.0%] babies were aged up to 8 days. Out of 47 babies with NEC, 27 [57.0%] babies were male. Out of 47 babies with NEC, 26 [55.3%] babies were residence of urban areas. The mean [SD] gestational age was 32.1 [±3.4] weeks. Out of 47 babies with NEC, 30 [63.8%] babies with NEC had gestational age of 32 weeks or more. The mean [SD] weight was 1,813.7 [±283.4] grams. Out of 47 babies with NEC, 29 [61.7%] babies had weight less than 2,000 grams. Out of 47 babies with NEC, 28 [59.6%] babies with NEC were fed on formula milk. Out of 47 babies with NEC, 36 [76.6%] mothers had complications during the time of delivery. Out of 47 babies, 28 [60%] mothers had PROM. Out of 47 babies with NEC, 18 [38.3%] babies had hypoxic ischemic encephalopathy. Out of 47 babies with NEC, 28 [59.6%] babies with NEC were resuscitated at the time of birth. Out of 47 babies with NEC, 18 [38.3%] babies showed complete resolution, 11 [23.4%] babies showed partial resolution with residual disability, 6 [12.8%] babies with NEC showed no improvement whereas 12 [25.6%] babied died during their stay in the hospital. Conclusions: Our study shows that out of 156 babies admitted and enrolled in our study, 47 [30.1%] were diagnosed to have NEC. Out of these 47 babies with NEC, 35 [74.4%] survived with 18, 11 and 6 babies showed complete resolution, partial resolution with residual disability, and no improvement respectively, while 12 [25.6%] were died during their hospital stay. However, there is a need to conduct further research including a multi-centre, large sample size study to investigate the burden of NEC in Pakistan.

Objective: To compare clinical efficacy and side effects of oral misoprotol with vaginal misoprostol for termination of second trimester pregnancy. Design: Interventional Quasi experimental. Setting: Gynae Unit III, Liaquat University Hospital, Hyderabad. Period: 1st March 2006 to 31st August 2006. Methodology: Sixty patients were selected with thirty in each group i.e thirty for oral route (group A) and thirty for vaginal route(group B). The patients included in this study were those having singleton pregnancy with gestational age between 12 to 26 weeks requiring termination of pregnancy. A dose of 100ug to 200ug was used with maximum of 1200ug in each group of patients. Results: The subjects of either group were similar with respect to mean age, height, weight, parity, gestational age and pre induction Bishop Score. The success rate in group A was 94.4% as compared to group B was 86.8%. intra uterine death was the commonest indication in both groups found in 46.7% women of vaginal misoprostol group and 50% women of oral misoprostol group. Surgical evacuation was needed in 36.7% women of oral misoprostol group and 16.7% women of vaginal misoprostol group. Conclusions: The present study shows misoprostol to be effective for mid trimester abortions, both orally and vaginally, the later route is preferable because it requires lesser doses and produces a shorter induction – abortion interval. However safety data are needed to guide the route choice and well designed studies are necessary.

This cross-sectional study sought to identify household contextual determinants that might be associated with Mycobacterium tuberculosis infection as assessed by tuberculin skin test (TST) positivity among familial contacts of index patients of infectious pulmonary tuberculosis (TB) while controlling for the effects of individual-level factors. We analyzed data on TST results on 359 household contacts of 77 index cases of acid-fast bacilli (AFB) sputum smear-positive pulmonary TB using multilevel logistic regression analysis with characteristics of household contacts at the first level and that of households at the second level. The prevalence of M. tuberculosis infection as assessed by TST positivity among household contacts of index TB patients was 49.9% (179/359). After taking into account the individual-level risk factors, household-level contextual determinants significantly associated with contact's TST positivity were gender of index TB patient (adjusted odds ratio [OR] = 2.2; 95% confidence interval [CI]: 1.3-3.9%) and density of AFB sputum smear (adjusted OR = 3.2; 95% CI: 1.9-5.5%). Household variances in multilevel models indicated significant inter-household heterogeneity in TST positivity among contacts. This study provided the evidence for substantive effects of household-level contextual variables on the TST positivity among contacts of index TB patients. Thus, both individual-level and household-level characteristics need to be taken into account while prioritizing contacts for investigations to improve TB control and prevention in resource-constrained countries such as Pakistan.

A simulation study using Greenwood's chain-binomial model was carried out to elucidate the spread and control of Mycobacterium tuberculosis among the household contacts of infectious pulmonary tuberculosis (TB) patients. Based on the observed data, the maximum-likelihood estimates (±S.E.) of chain-binomial probabilities of intra-household M. tuberculosis transmission from an index case in 3-person and 4-person households were 0·313±0·008 and 0·325±0·009 respectively. The χ2 goodness-of-fit test of observed and simulated mean expected frequencies of cases revealed good fit for 3-person (P=0·979) and 4-person (P=0·546) households. With the assumption of varying risk of M. tuberculosis transmission across the households under β-distribution, goodness-of-fit tests of observed and mean simulated expected frequencies revealed the inadequacy of Greenwood's chain-binomial model both for 3-person (P=0·0185) and 4-person (PM. tuberculosis control strategy comprising efficient diagnosis, segregation and prompt antibiotic therapy of index pulmonary TB patients showed a substantial reduction of new cases among the household contacts in both household sizes. In conclusion, segregation coupled with prompt antibiotic therapy of the index case, chemoprophylaxis of M. tuberculosis-exposed household contacts, and the assessment of household environmental risks to devise and implement an educational programme may help reduce the TB burden in this and similar settings.

To study the prevalence of Group A beta haemolytic Streptococcus in patients with acute pharyngitis and correlation of Modified Centor Score and Rapid Antigen Detection Test.The multi-centre, prospective, cross-sectional study was conducted in 8 major cities of Pakistan between June 2012 and February 2013, and comprised patients presenting with acute pharyngitis. The subjects were above 3 years of age presenting to primary care physician with sore throat, temperature over 100.4 degrees F, tonsillar exudates and/or cervical adenopathy (duration of symptoms14 days). They were scored using Modified Centor Score and were tested with Rapid Antigen Detection Test for Group A beta haemolytic Streptococcus. SPSS 19 was used for statistical analysis.Of the 5140 patients, 1299 (25.3%) tested positive, for RADT Group A beta haemolytic Streptococcus in acute pharyngitis. There was no significant difference across different age groups (p0.08). There was a strong correlation between Modified Centor Score and Rapid Antigen Detection Test results (p0.001). Of the patients with positive result, 3 (0.4%) had a Modified Centor Scoreor = 0; 23 (1.8%) had score of 1; 152 (11.7%) had score of 2; 511 (39.3%) had score of 3; and 609 (46.9%) had Centor score ofor = 4.The prevalence of Group A beta haemolytic Streptococcus as a cause of acute pharyngitis was 25.3%. Modified Centor Score had a strong positive correlation with Rapid Antigen Detection Test in identifying Group A beta haemolytic Streptococcus as a cause of acute pharyngitis.

Background Verbal autopsy (VA) has been proposed to determine the cause of death (COD) distributions in settings where most deaths occur without medical attention or certification. We develop performance criteria for VA-based COD systems and apply these to the Registrar General of India’s ongoing, nationally-representative Indian Million Death Study (MDS). Methods Performance criteria include a low ill-defined proportion of deaths before old age; reproducibility, including consistency of COD distributions with independent resampling; differences in COD distribution of hospital, home, urban or rural deaths; age-, sex- and time-specific plausibility of specific diseases; stability and repeatability of dual physician coding; and the ability of the mortality classification system to capture a wide range of conditions. Results The introduction of the MDS in India reduced the proportion of ill-defined deaths before age 70 years from 13% to 4%. The cause-specific mortality fractions (CSMFs) at ages 5 to 69 years for independently resampled deaths and the MDS were very similar across 19 disease categories. By contrast, CSMFs at these ages differed between hospital and home deaths and between urban and rural deaths. Thus, reliance mostly on urban or hospital data can distort national estimates of CODs. Age-, sex- and time-specific patterns for various diseases were plausible. Initial physician agreement on COD occurred about two-thirds of the time. The MDS COD classification system was able to capture more eligible records than alternative classification systems. By these metrics, the Indian MDS performs well for deaths prior to age 70 years. The key implication for low- and middle-income countries where medical certification of death remains uncommon is to implement COD surveys that randomly sample all deaths, use simple but high-quality field work with built-in resampling, and use electronic rather than paper systems to expedite field work and coding. Conclusions Simple criteria can evaluate the performance of VA-based COD systems. Despite the misclassification of VA, the MDS demonstrates that national surveys of CODs using VA are an order of magnitude better than the limited COD data previously available.

Background Computer-coded verbal autopsy (CCVA) methods to assign causes of death (CODs) for medically unattended deaths have been proposed as an alternative to physician-certified verbal autopsy (PCVA). We conducted a systematic review of 19 published comparison studies (from 684 evaluated), most of which used hospital-based deaths as the reference standard. We assessed the performance of PCVA and five CCVA methods: Random Forest, Tariff, InterVA, King-Lu, and Simplified Symptom Pattern. Methods The reviewed studies assessed methods’ performance through various metrics: sensitivity, specificity, and chance-corrected concordance for coding individual deaths, and cause-specific mortality fraction (CSMF) error and CSMF accuracy at the population level. These results were summarized into means, medians, and ranges. Results The 19 studies ranged from 200 to 50,000 deaths per study (total over 116,000 deaths). Sensitivity of PCVA versus hospital-assigned COD varied widely by cause, but showed consistently high specificity. PCVA and CCVA methods had an overall chance-corrected concordance of about 50% or lower, across all ages and CODs. At the population level, the relative CSMF error between PCVA and hospital-based deaths indicated good performance for most CODs. Random Forest had the best CSMF accuracy performance, followed closely by PCVA and the other CCVA methods, but with lower values for InterVA-3. Conclusions There is no single best-performing coding method for verbal autopsies across various studies and metrics. There is little current justification for CCVA to replace PCVA, particularly as physician diagnosis remains the worldwide standard for clinical diagnosis on live patients. Further assessments and large accessible datasets on which to train and test combinations of methods are required, particularly for rural deaths without medical attention.

Background Physician-coded verbal autopsy (PCVA) is the most widely used method to determine causes of death (CODs) in countries where medical certification of death is uncommon. Computer-coded verbal autopsy (CCVA) methods have been proposed as a faster and cheaper alternative to PCVA, though they have not been widely compared to PCVA or to each other. Methods We compared the performance of open-source random forest, open-source tariff method, InterVA-4, and the King-Lu method to PCVA on five datasets comprising over 24,000 verbal autopsies from low- and middle-income countries. Metrics to assess performance were positive predictive value and partial chance-corrected concordance at the individual level, and cause-specific mortality fraction accuracy and cause-specific mortality fraction error at the population level. Results The positive predictive value for the most probable COD predicted by the four CCVA methods averaged about 43% to 44% across the datasets. The average positive predictive value improved for the top three most probable CODs, with greater improvements for open-source random forest (69%) and open-source tariff method (68%) than for InterVA-4 (62%). The average partial chance-corrected concordance for the most probable COD predicted by the open-source random forest, open-source tariff method and InterVA-4 were 41%, 40% and 41%, respectively, with better results for the top three most probable CODs. Performance generally improved with larger datasets. At the population level, the King-Lu method had the highest average cause-specific mortality fraction accuracy across all five datasets (91%), followed by InterVA-4 (72% across three datasets), open-source random forest (71%) and open-source tariff method (54%). Conclusions On an individual level, no single method was able to replicate the physician assignment of COD more than about half the time. At the population level, the King-Lu method was the best method to estimate cause-specific mortality fractions, though it does not assign individual CODs. Future testing should focus on combining different computer-coded verbal autopsy tools, paired with PCVA strengths. This includes using open-source tools applied to larger and varied datasets (especially those including a random sample of deaths drawn from the population), so as to establish the performance for age- and sex-specific CODs.

This cross-sectional study assessed the current situation of and factors associated with consumption of diabetic diet among 399 type 2 diabetes mellitus (T2DM) subjects from Ahmedabad, Western India. The study was performed with diagnosed (at least one year old) diabetic subjects who attended the Department of Diabetology, All India Institute of Diabetes and Research and Yash Diabetes Specialties Centre (Swasthya Hospital), Ahmedabad during July 2010-November 2010. The subjects completed an interviewer-administered questionnaire. The questionnaire included variables, such as sociodemographic factors, family history of diabetes, behavioural profile, risk profile (glycaemic status, hypertension, and obesity), and diet-related history (consumption of diabetic diet, consumption of low fat/skimmed milk, method of cooking, and sources for diet advice). Blood pressure, body mass index, glycosylated haemoglobin (HbA1c) level, and fasting lipid profile were measured. All analyses including multivariate logistic regression were conducted using SPSS, version 11.5. In total, 399 T2DM subjects (65% male, 35% female) with mean age of 53.16 +/- 7.95 years were studied. Although 73% of T2DM subjects were consuming diabetic diet, the good glycaemic control (HbA1c level7%) was achieved only in 35% of the subjects. The majority (75%) of the subjects had a positive family history of diabetes, and 52% were obese. In 77%, the main source of dietary advice was doctor. In 36%, the main methods of cooking were: boiling and roasting. The final multivariate model showed that visit to dietician, level of education, intake of low fat, and family history of diabetes were independent predictors for diabetic diet consumption among T2DM subjects. However, longitudinal and cohort studies are required to establish the association between consumption of diabetic diet and glycaemic control.

The aim of this observational study was to describe the profile of subjects with type 2 diabetes mellitus from Gujarat, India. The study was performed with newly-diagnosed 622 type 2 diabetic subjects who attended the Department of Diabetology, All India Institute of Diabetes and Research and Yash Diabetes Specialties Centre (Swasthya), Ahmedabad, during August 2006-January 2009. The subjects completed an interviewer-administered questionnaire. The questionnaire included variables, such as sociodemographic factors, presenting symptoms, risk profile (hypertension, obesity, dyslipidaemia, and glycaemic status), family history of diabetes, physical activity, and behavioural profile. Blood pressure, body mass index (BMI), glycosylated haemoglobin levels, and fasting lipid profile were measured. Descriptive and bivariate analyses were carried out using the SPSS software (version 11.5). In total; 622 type 2 diabetes mellitus (T2DM) cases with mean age of 47.7 +/- 10.9 years were studied. Of the 622 subjects, 384 (62%) were male. The majority (68%) of the T2DM subjects were obese, and 67% had a positive family history of diabetes. Renal dysfunctions and vision impairment were, respectively, found in 10% (n=62) and 9% (n=57) of the 622 T2DM subjects. The mean HbAlc level was 9.02 +/- 1.67%, and good glycaemic control (HbAlc level7%) was achieved only in 7.4% of the T2DM subjects. Results of chi-square analysis showed that higher BMI (or =25 kg/m2) was significantly associated with hypertension among the T2DM subjects (p0.01). There were significant differences (p0.05) between male and female subjects with respect to mean age, BMI, waist- and hip-circumference, and mean low-density lipoprotein (LDL) level. The results revealed that many factors, such as obesity, family history of diabetes, dyslipidaemia, uncontrolled glycaemic status, sedentary lifestyles, and hypertension were prevalent among the T2DM subjects. The characterization of this risk profile will contribute to designing more effective and specific strategies for screening and controlling T2DM in Gujarat, India.

To determine the frequency of hepatorenal syndrome in patients with chronic liver disease and ascites.A cross-sectional study.From July 2001 to March 2002 at Civil Hospital, Karachi.The study included 240 patients who were admitted in the Medical Wards of Civil Hospital, Karachi, during the study period. The subjects were diagnosed as having chronic liver disease and all of them had ascites. All the patients with renal dysfunction were identified and were worked up for hepatorenal syndrome and other causes of renal dysfunction.Of two hundred and forty (240) patients enrolled in the study, 148 were male (61.7%) and 92 were female (38.3%). Seventy-six (76) patients (31.6%) were found to have renal impairment as diagnosed by serum creatinine level of 1.5 mEq/L or greater. Six (6) patients showed improvement in their serum creatinine level (below 1.5 mg/dL) after receiving 1.5 liter of normal saline infusion and diuretic withdrawal. Eleven (11) patients were diagnosed to have primary renal disease based on urine analysis, urinary protein excretion and ultrasound examination. Six (6) patients were diagnosed to have renal dysfunction secondary to analgesic nephropathy and in seventeen (17) patients renal dysfunction was secondary to spontaneous bacterial peritonitis. The remaining 36 (47.4%) patients with renal dysfunction were diagnosed as suffering from hepatorenal syndrome based on the diagnostic criteria. This represents the frequency of 15% among patients with chronic liver disease and ascites.Hepatorenal syndrome is common complication in patients with cirrhosis and ascites. It was the most common cause of renal impairment in this series followed by other causes like spontaneous bacterial peritonitis, primary renal disease, analgesic nephropathy and hypovolemia.

To evaluate platelet count/ splenic size ratio as a non-invasive parameter to predict the presence and absence of esophageal varices in patients with cirrhosis of liver.An observational, cross- sectional study.The medical units of the Civil Hospital, Karachi, between October 2003 and October 2004.During one year of study, one hundred and thirteen (113) patients with cirrhosis of liver were studied. These patients were evaluated for the cause of chronic liver disease, ascites and splenic size by abdominal ultrasound, serum proteins and albumin, prothrombin time, complete blood count including platelet count and liver functions test. All the patients had upper GI endoscopy to determine if they had esophageal varices and were classified according to Child s-Pugh classification. It was determined if the platelet count/ splenic size ratio between the two groups was different and its relation to the presence or absence of esophageal varices was noted.Of the one hundred and thirteen (113) patients included in the study, 35(31%) were female and 78(69%) male. The mean age of these patients was 37.1(+/- 14.85) years. Thirty-eight patients had HBsAg, 59 had anti-HCV antibodies, 8 patients had both HbsAg and anti-HCV antibodies and the cause of cirrhosis in 8 patients was indeterminate. Fifty patients had ascites. Of 113 patients, 15(13.27%) were classified as Child s Pugh class A, 68(60.18%) in class B and 30(26.55%) in class C. Sixty-six (58.4%) patients had esophageal varices on upper GI endoscopy while 47(41.6%) had no endoscopic evidence of esophageal varices. The ratio between platelet count/ splenic size was found to be significantly (p0.001) different between patients who had esophageal varices and those who did not.Platelet count/splenic size ratio is an important and an independent parameter associated with the presence of esophageal varices.

Climate change and health hazards can be tackled by developing potential of adolescents from urban slums. The paper describes profile of adolescents in slums of flood vulnerable Surat city along with their climate change inclusive health perspective. Mixed methods were used: survey, focused groups and flood memory picturing. Adolescent shared 1/5th slum population. Assessment on schooling and health scales favours considering them as entitled resilience providers. Adolescents’ health perspective ranged from concrete information, say 90 percent named vector borne diseases (climate change associated health problems); to Abstract health concept. Slum experience enabled them to link health with climate change induced migration, livelihood, water scarcity, poverty, weather events and conflicts as stress sources. They recognized personal and environmental behaviour as health determinants. Peers, television and teachers were preferred health information sources. Perceived risk enabled adolescents to think possible mitigation and adaptation actions. Handholding can prove adolescents as resilience agents.