A multi-centric, single-blinded, randomized, parallel-group study to evaluate the effectiveness of nasoalveolar moulding treatment in non-syndromic patients with complete unilateral cleft lip, alveolus and palate (NAMUC study): a study protocol for a randomized controlled trial.

BACKGROUND: Cleft lip and palate (CLP) are among the most common congenital anomaly that affects up to 33,000 newborns in India every year. Nasoalveolar moulding (NAM) is a non-surgical treatment performed between 0 and 6 months of age to reduce the cleft and improve nasal aesthetics prior to lip surgery. The NAM treatment has been a controversial treatment option with 51% of the cleft teams in Europe, 37% of teams in the USA and 25 of cleft teams in India adopting this methodology. This treatment adds to the already existing high burden of care for these patients. Furthermore, the supporting evidence for this technique is limited with no high-quality long-term clinical trials available on the effectiveness of this treatment. METHOD: The NAMUC study is an investigator-initiated, multi-centre, single-blinded randomized controlled trial with a parallel group design. The study will compare the effectiveness of NAM treatment provided prior to lip surgery against the no-treatment control group in 274 patients with non-syndromic unilateral complete cleft lip and palate. The primary endpoint of the trial is the nasolabial aesthetics measured using the Asher McDade index at 5 years of age. The secondary outcomes include dentofacial development, speech, hearing, cost-effectiveness, quality of life, patient perception, feeding and intangible benefits. Randomization will be carried out via central online system and stratified based on cleft width, birth weight and clinical trial site. DISCUSSION: We expect the results from this study on the effectiveness of treatment with NAM appliance in the long term along with the cost-effectiveness evaluation can eliminate the dilemma and differences in clinical care across the globe. TRIAL REGISTRATION: ClinicalTrials.gov CTRI/2022/11/047426 (Clinical Trials Registry India). Registered on 18 November 2022. The first patient was recruited on 11 December 2022. CTR India does not pick up on Google search with just the trial number. The following steps have to be carried out to pick up. How to search: ( https://ctri.nic.in/Clinicaltrials/advsearch.php -use the search boxes by entering the following details: Interventional trial > November 2022 > NAMUC).

Where do mothers take their children for pneumonia care? Findings from three Indian states.

Childhood pneumonia accounts for 17% of IMR in India, posing a major health burden. With cultural beliefs influencing care seeking behaviour and disparities existing in health infrastructure across the country, an understanding of the underlying issues merits exploration. Study assessed prevalence of probable pneumonia and examined care seeking behaviour of mothers in three states, Madhya Pradesh (MP), Uttar Pradesh (UP) and Tamil Nadu (TN). This mixed methods study involved a household survey and qualitative interviews with mothers in three districts from each state. Households with children aged 2-59 months were screened to identify those with probable pneumonia; sub-sample of mothers participated in qualitative interviews. Care seeking behaviour was explored in the context of recognition of symptoms, nature of first care provided, time when care was sought outside the home and choice of health provider. Overall 17,442 children from 13,544 households were screened, of which 729 (MP), 752 (UP) and 713 (TN) children respectively, were identified with probable pneumonia; 72 mothers participated in the qualitative interviews. Three months period prevalence was estimated in study districts at 22.2%-MP 13.3%-UP and 8.4%-TN. Most mothers in MP and UP were not perceptive to severity of illness; type of care sought was often inappropriate, delayed, with home remedies and visits to unqualified care providers being their first response. In contrast, in TN, use of home remedies was minimal, going to untrained care providers, non-existent and more than 90% mothers sought appropriate care. Private doctors were the preferred choice among all mothers but utilization of government care was highest in TN (20%). Community health workers were underutilized, with less than 10% mothers consulting them. Need for educating mothers about appropriate care seeking and development of good health infrastructure as essential to attainment of better child health indices are advocated.

Understanding the socio-economic and sexual behavioural correlates of male circumcision across eleven voluntary medical male circumcision priority countries in southeastern Africa.

BACKGROUND: Male circumcision (MC) has been demonstrated to be effective and cost-effective for HIV/AIDS prevention. Global guidance to adopt this intervention was announced in 2007 for countries with high HIV/AIDS prevalence and low MC prevalence. However, scale up of voluntary medical male circumcision (VMMC) programs in MC priority countries have been slow. Many of these countries have particular cultural barriers that impede uptake of this effective intervention. This analysis explored correlates of MC status among men and their socio-economic, health and sexual behaviour factors using DHS data (2006-2011) from 11 MC priority countries. METHODS: Our analysis included univariate unadjusted analyses for individual countries and the region (by combining all countries into one dataset) and a multiple logistic regression model. RESULTS: Individual country results vary widely but alignment was mostly found between unadjusted analyses and multiple logistic regression model. The model found that men who are of the Muslim faith, reside in urban areas, have higher or secondary education attainment, hold professional occupations, and be in the richest wealth quintile are more likely to be circumcised. Circumcision is also positively correlated with lower reports of STIs, safe sexual behaviour, and HIV/AIDS prevention knowledge. CONCLUSIONS: Since the data collected predate VMMC program launch in these countries, results can only indicate baseline associations. However, characteristics of these existing circumcision practices may be utilized for better population targeting and program management to achieve higher impact with this effective prevention strategy.

Prevention of Parent to Child Transmission (PPTCT) program data in India: an emerging data set for appraising the HIV epidemic.

BACKGROUND: Evidence based resource allocation and decentralized planning of an effective HIV/AIDS response requires reliable information on levels and trends of HIV at national and sub-national geographic levels. HIV sentinel surveillance data from antenatal clinics (HSS-ANC) has been an important data source to assess the HIV/AIDS epidemic in India, but has a number of limitations. We assess the value of Prevention of Parent to Child Transmission (PPTCT) programme data to appraise the HIV epidemic in India. METHODS/FINDINGS: HIV data from PPTCT sites were compared to HSS-ANC and general population level surveys at various geographic levels in the states of Karnataka, Maharashtra and Andhra Pradesh. Chi-square tests were used to ascertain statistical significance. PPTCT HIV prevalence was significantly lower than HSS-ANC HIV prevalence (0.92% vs. 1.22% in Andhra Pradesh, 0.65% vs. 0.89% in Karnataka, 0.52% vs. 0.60% in Maharashtra, p<0.001 for all three states). In all three states, HIV prevalence from PPTCT centres that were part of the sentinel surveillance was comparable to HSS-ANC prevalence but significantly higher than PPTCT centres that were not part of the sentinel surveillance. HIV prevalence from PPTCT data was comparable to that from general population surveys. In all three states, significant declines in HIV prevalence between 2007 and 2010 were observed with the PPTCT data set. District level analyses of HIV trends and sub-district level analysis of HIV prevalence were possible using the PPTCT and not the HSS-ANC data sets. CONCLUSION: HIV prevalence from PPTCT may be a better proxy for general population prevalence than HSS-ANC. PPTCT data allow for analysis of HIV prevalence and trends at smaller geographic units, which is important for decentralized planning of HIV/AIDS programming. With further improvements to the system, India could replace its HSS-ANC with PPTCT programme data for surveillance.

Preparedness for tobacco control among postgraduate residents of a medical college in bangalore.

BACKGROUND: Tobacco use is a major cause of avoidable mortality. Postgraduate doctors in training are an important group of physicians likely to influence patients' tobacco use/cessation. OBJECTIVE: To assess preparedness for tobacco control among clinical postgraduate residents of a medical college in southern India. MATERIALS AND METHODS: A cross-sectional study was undertaken among all clinical postgraduate residents enrolled in St. John's Medical College, Bangalore, to assess knowledge, attitude, and practice regarding tobacco cessation in their patients. A self-administered, anonymous questionnaire was used. Simple descriptive analysis was undertaken. RESULTS: The overall response rate was 66% (76/116). Mean (S.D.) knowledge score on tobacco use prevalence and disease burden was 6.2 (2.0) out of 10. About 25% of them were not aware of nicotine replacement therapy as a treatment option for tobacco cessation. Nearly two thirds of them expected their patients to ask for assistance with quitting and nearly half were sceptical about patients' ability to quit. While 80% of them enquired routinely about tobacco use in their patients, only 50% offered advice on quitting and less than a third assessed readiness to quit or offered assistance with quitting in their patients. CONCLUSION: Our study revealed suboptimal levels of knowledge and tobacco cessation practice among postgraduate residents. Attitudes toward tobacco cessation by their patients was however generally positive and there was substantial interest in further training in tobacco control. Reorienting postgraduate medical education to include tobacco control interventions would enable future physicians to be better equipped to deal with nicotine addiction.

Study of the effects of hydrogen cyanide exposure in Cassava workers.

BACKGROUND: Hydrogen cyanide is the chemical responsible for tissue hypoxia. Chronic exposure to HCN may cause neurological, respiratory, cardiovascular and thyroid defects. Onset of symptoms depends on dose and duration of exposure. Large scale of Cassava processing could be disastrous due to discharge of hydrocyanic acid into the air. Cassava processing is the major industrial work in and around Salem. Hence the present study is taken to assess the effects of HCN exposure in Cassava workers. MATERIALS AND METHODS: Thirty-nine workers from a Cassava processing unit at Salem and age-matched controls of the same economic status were taken up for this study. Clinical history was obtained with a questionnaire and their Blood sugar, lipid profile, serum total protein, urea, creatinine, AST, ALT and T(3), T(4), TSH were estimated using a fasting blood sample and AIP was calculated. Statistical analysis was done by student t test. RESULTS: Our study reveals a significant increase in triglyceride in Cassava workers when compared to the control. Atherogenic index of plasma (AIP) is statistically highly significant. A significant decrease was seen in T(4.) CONCLUSION: An increase in TGL and AIP shows a higher degree of cardiovascular risk. A decrease in T4 suggests an insufficient iodine uptake by thyroid gland. Hence a periodic medical evaluation should be done on such workers for their safety and to prevent the health hazard.

Tobacco use habits and beliefs among undergraduate medical and nursing students of two cities in southern India.

BACKGROUND: Unless effective tobacco control is in place, most tobacco-related deaths in the coming decades are likely to be seen in low- and middle-income countries. Tobacco surveillance among medical students offers an opportunity to assess the preparedness for tobacco control among future healthcare professionals in India. METHODS: We did a cross-sectional survey in two cities (Bangalore and Coimbatore) of India. The participants were third year undergraduate students from 7 medical colleges and 6 nursing colleges. A self-administered questionnaire was used to elicit information on tobacco use, exposure to environmental tobacco smoke, knowledge on disease burden and attitudes towards tobacco control. RESULTS: Overall, 829 of 985 eligible students (84.1%) participated in the survey. About 14.5% (95% CI 12.0-17.0) of students had ever used tobacco. Current tobacco use was reported by 1.6% (95% CI 0.8-2.4) of students; 1.5% (95% CL 0.7-2.3) were current smokers and 0.4% (95% CI 0.1-0.7) were current chewers. The rates of smoking among male medical, female medical and female nursing students were 4.0%, 0.3% and 0%, respectively (p < 0.001). About 1 in 6 students reported frequent exposure to environmental tobacco smoke within their homes and over 1 in 4 reported frequent exposure outside the home environment. Median knowledge score on tobacco-related burden was 5/10. More than 80% favoured ban on tobacco sales to adolescents, tobacco advertising and tobacco use in public places. Over 90% reported interest in further training in tobacco control. CONCLUSION: This scenario of comparatively low levels of tobacco use, positive attitudes towards tobacco control and suboptimal levels of knowledge coupled with a high interest in having further knowledge on tobacco control points to the need for a comprehensive curriculum for training in tobacco control that meets national requirements.