Open versus Closed Suctioning Among Mechanically Ventilated Pediatric Patients: A Randomised Control Trial.

OBJECTIVES: To compare the difference in efficacy of closed tracheal suction system (CTSS) to open tracheal suction system (OTSS) in reducing incidence of ventilator associated pneumonia (VAP). Also to evaluate their efficacy in stabilizing cardio-respiratory parameters, reducing mortality and duration of intubation. METHODS: This study was a single centre, parallel group, open label, randomized controlled study with an equal allocation (1:1) in pediatric patients requiring mechanical ventilation. A specific suction system of CTSS or OTSS was assigned to the two groups based on randomization. All the demographic, clinical, laboratory parameters and treatment outcomes were noted in the preformed sheet. RESULTS: Total 116 eligible pediatric ventilated patients were studied. Total incidence of VAP was 9 (7.75%) of which 3 occurred in open and 6 in closed suction group. Rate of VAP was similar among both the groups with RR 2.11 (95% CI 0.50-8.9). However, significant number of infection-related ventilator associated condition (IVAC) were found in CTSS (17) compared to OTSS (6) group with RR 3.5 (95% CI 1.3-9.9). SpO2 was better maintained in the CTSS group post-suction (p = 0.001). Incidence of mortality and intubation days were similar between both groups. CONCLUSIONS: Incidence of VAP was similar between open and closed suction groups.

Risk factors and outcome of acute kidney injury in children with snake envenomation.

Our study evaluates the risk factors of acute kidney injury (AKI) in children with snake envenomation. Out of 145 cases, 54 (37%) developed AKI. Unsurprisingly, the mortality increased with oliguria and higher levels of creatinine. Bleeding manifestations were also more common among the AKI group.

Intrinsic insights to antimicrobial effects of Nitrofurantoin to multi drug resistant Salmonella enterica serovar Typhimurium ms202.

Emerging multidrug resistant (MDR) serovar of Salmonella has raised the concern of their impactful effect on pathogenic infection and mortality in human lead by the enteric diseases. In order to combat the battle against these MDR Salmonella pathogen, new drug molecules need to be evaluated for their potent antibacterial application. This study evaluates the mechanistic antimicrobial effect of nitrofurantoin against a MDR strain of Salmonella named S. enterica Typhimurium ms202. The antimicrobial effect of nitrofurantoin was studied through experimental and computational approach using standard microbiological and molecular techniques like growth curve analysis, live-dead analysis, oxidative stress evaluation using high throughput techniques like flow cytometry and fluorescent microscopy. The result showed a potent dose dependent antibacterial effect of nitrofurantoin against S. enterica Typhimurium ms202 with a MIC value of 64 µg/ml. Moreover, the mechanistic excavation of the phenomenon described the mechanism as an effect of molecular interaction of nitrofurantoin molecule with membrane receptor proteins OmpC of S. enterica Typhimurium ms202 leading to internalization of the nitrofurantoin heading towards the occurrence of cellular physiological disturbances through oxidative stress impeded by nitrofurantoin-Sod1 C protein interaction. The results indicated towards a synergistic effect of membrane damage, oxidative stress and genotoxicity for the antibacterial effect of nitrofurantoin against S. enterica Typhimurium ms202. The study described the potent dose-dependent application of nitrofurantoin molecule against MDR strains of Salmonella and guided towards their use in further discovered MDR strains.

Redefining Lobe-Wise Ground-Glass Opacity in COVID-19 Through Deep Learning and its Correlation With Biochemical Parameters.

During COVID-19 pandemic qRT-PCR, CT scans and biochemical parameters were studied to understand the patients' physiological changes and disease progression. There is a lack of clear understanding of the correlation of lung inflammation with biochemical parameters available. Among the 1136 patients studied, C-reactive-protein (CRP) is the most critical parameter for classifying symptomatic and asymptomatic groups. Elevated CRP is corroborated with increased D-dimer, Gamma-glutamyl-transferase (GGT), and urea levels in COVID-19 patients. To overcome the limitations of manual chest CT scoring system, we segmented the lungs and detected ground-glass-opacity (GGO) in specific lobes from 2D CT images by 2D U-Net-based deep learning (DL) approach. Our method shows accuracy, compared to the manual method (  âˆ¼ 80%), which is subjected to the radiologist's experience. We determined a positive correlation of GGO in the right upper-middle (0.34) and lower (0.26) lobe with D-dimer. However, a modest correlation was observed with CRP, ferritin and other studied parameters. The final Dice Coefficient (or the F1 score) and Intersection-Over-Union for testing accuracy are 95.44% and 91.95%, respectively. This study can help reduce the burden and manual bias besides increasing the accuracy of GGO scoring. Further study on geographically diverse large populations may help to understand the association of the biochemical parameters and pattern of GGO in lung lobes with different SARS-CoV-2 Variants of Concern's disease pathogenesis in these populations.

Overt and Covert Delinquency: Socio-Demographic Correlates in Justice-Involved Adolescent Males.

Delinquent offenses among adolescents is an important public health concern worldwide and has been increasing at an alarming rate in India. The study aimed to assess the prevalence and pattern of delinquency among justice-involved adolescent (JIA) males and determine the associated socio-demographic factors. This cross-sectional study was carried out during the year 2016 to 2019 among 178 male inmates (aged 10-18 years) of an observation home situated at Berhampur city in the state of Odisha, India. More than half (52.8%) of the JIA males committed overt delinquent acts and 47.2% committed covert delinquent acts. Drug trafficking (34.5%) tops the list among different covert delinquent acts followed by stealing things (33.3%) whereas rape (62.8%) was the most frequently committed overt delinquent act followed by murder (25%). Results of the multivariate analysis revealed that older age {adjusted odds ratio (aOR): 4.05; 95% CI [1.73, 9.51]}, lower education status of mother (aOR: 2.81; 95% CI [1.09, 7.22]), single parenthood (aOR: 4.58; 95% CI [1.27, 16.58]), and non-supportive parenting (aOR: 3.13, 95% CI [1.44, 6.80]) were significantly associated with overt delinquency in JIA males. The prevalence of overt delinquency among JIA males was high. Interventional measures incorporating these determinants should be designed to address overt delinquency in this population.

Genome analysis and virulence gene expression profile of a multi drug resistant Salmonella enterica serovar Typhimurium ms202.

BACKGROUND: In India, multi-drug resistance in Salmonella enterica serovar Typhimurium poses a significant health threat. Indeed, S. Typhimurium has remained unknown for a large portion of its genome associated with various physiological functions including mechanism of drug resistance and virulence. The whole-genome sequence of a Salmonella strain obtained from feces of a patient with gastroenteritis in Odisha, India, was analyzed for understanding the disease association and underlying virulence mechanisms. RESULTS: The de novo assembly yielded 17 contigs and showed 99.9% similarity to S. enterica sub sp enterica strain LT2 and S. enteric subsp salamae strain DSM 9220. S. Typhimurium ms202 strain constitutes six known Salmonella pathogenicity islands and nine different phages. The comparative interpretation of pathogenic islands displayed the genes contained in SPI-1 and SPI-2 to be highly conserved. We identified sit ABCD cluster regulatory cascade in SPI-1. Multiple antimicrobial resistance genes were identified that directly implies antibiotic-resistant phenotype. Notably, seven unique genes were identified as "acquired antibiotic resistance". These data suggest that virulence in S. enterica Typhimurium ms202 is associated with SPI-1 and SPI-2. Further, we found several virulent genes encoding SPI regions belonging to type III secretion systems (T3SS) of bacteria were significantly upregulated in ms202 compared to control LT2. Moreover, all these genes were significantly downregulated in S. enterica Typhimurium ms202 as compared to control LT2 on adding Mn2+ exogenously. CONCLUSIONS: Our study raises a vital concern about the potential diffusion of a novel multi-drug resistant S. enterica Typhimurium ms202. It justifies this clinical pathogen to demonstrate a higher degree survival due to higher expression of virulent genes and enhanced ability of metallic ion acquisition.

Immunoinformatic approach employing modeling and simulation to design a novel vaccine construct targeting MDR efflux pumps to confer wide protection against typhoidal Salmonella serovars.

Overcoming multi drug resistance is one of the crucial challenges to control enteric typhoid fever caused by Salmonella typhi and Salmonella paratyphi. Overexpression of efflux pumps predominantly causes drug resistance in microorganisms. Therefore, immunotherapy targeting the various efflux pumps antigens could be a promising strategy to increase the success of vaccines. An immunoinformatic approach was employed to design a Salmonellosis multi-epitope subunit vaccine peptide consisting of linear B-cell and T-cell epitopes of multidrug resistance protein families including ATP Binding Cassette (ABC), major facilitator superfamily (MFS), resistance nodulation cell division (RND), small multidrug resistance (SMR), and multidrug and toxin extrusion (MATE). The selected epitopes exhibited conservation in both S. typhi and S. paratyphi and thus could be helpful for cross-protection. Further, the final vaccine construct encompassing the peptides, adjuvants and specific linker sequences showed high immunogenicity, solubility, non-allergenic, nontoxic, and wide population coverage due to strong binding affinity to maximum HLA alleles. The three-dimensional structure was predicted, and validated using various structure validation tools. Additionally, protein-protein docking of the chimeric vaccine construct with the TLR-2 protein and molecular dynamics demonstrated stable and efficient binding. Conclusively, the immunoinformatic study showed that the novel multi epitopic vaccine construct can simulate the both T-cell and B-cell immune responses in typhoidal Salmonella serovars and could potentially be used for prophylactic or therapeutic applications.Communicated by Ramaswamy H. Sarma.

Quality Assessment of Stillbirth Review: A Pilot Study in Ten High-Priority Districts in Odisha.

BACKGROUND: Stillbirth rate has shown less or no improvement in developing countries. India was estimated to have the largest number of stillbirths globally in 2015. Systematic review of stillbirths is a strategy that helps in identifying gaps in the care of a pregnant mother, and is a useful and comprehensive indicator of the quality of maternity care. OBJECTIVES: The objective of this study was to assess the quality of maternal care, and factors causing stillbirth, and to provide some doable plans to reduce its incidence in the Odisha state. MATERIALS AND METHODS: The stillbirth review was undertaken over 4-month timeline (August to November 2014) in ten high-priority districts (HPDs) of Odisha. It included development of tools, desk reviews, training of staffs, and data handling. The deaths were estimated from Annual Health Survey. It was compared to the estimated stillbirth of each district to get the underreporting/overreporting districts. A report was generated on stillbirth process indicators, and program indicators after completion of assessment. RESULTS: In the selected HPDs of Odisha, 4689 stillbirths were observed during the study period. However, the labor room register stated the reason of death in only 408 cases (8.7%). Further, at the time of admission, a provisional diagnosis could be made for only 3038 (64.7%) cases, of which 11% diagnosed as safe delivery resulted in stillbirth. CONCLUSIONS: The present study could contribute to a larger extent to address some of the gaps in the stillbirth review process in Odisha.

Prevalence and multidrug resistance in Salmonella enterica Typhimurium: an overview in South East Asia.

Acute/chronic gastroenteritis is caused by a few serovars of Salmonella enterica. Among different serovars, S. enterica Typhimurium is a potent pathogen that contributes significantly to self-limiting diarrhea related mortality worldwide. With no successful vaccine in hand against this pathogen, antibiotics are used as for gold standard for treatment against Salmonella induced gastroenteritis. Indispensably, rise in multi drug resistance against Salmonella Typhimurium poses challenge to treatment options. South East Asia, with 11 different countries, stands 3rd as super region for global burden of Salmonella induced gastroenteritis. In this review, we made an attempt to discuss on prevalence and multidrug resistance in Salmonella Typhimurium in 11 countries of South East Asia-the issue that has not been seriously addressed so far. By thorough analysis of reported data, we found varying frequencies for prevalence of Salmonella Typhimurium as well as subtle evidences on resistance of this pathogen to multiple antibiotics in different countries. Vietnam ranked top in terms of reports for prevalence and antimicrobial resistance. However, in countries such as Brunei and Timor Leste, no study has been performed so far to track the frequency of incidence and drug resistance of this pathogen. Our review, the first of its kind, emphasizes that, although the pathogen was not found as dominant serovar in South East Asia in last 20 years unlike sub-Saharan Africa, it may be still considered as a major threat in this region due to available evidences for infection in humans as well as contamination in several animal and food sources. More importantly, the importance as a public threat in this subregion of Asia is also due to resistance of this pathogen to multiple antibiotics. South East Asian countries showing incidence and multi drug resistance of Salmonella enterica Typhimurium in human and non-human sources (1969-2020). -Drug resistant S. enterica Typhimurium.

Neonatal outcomes of pregnant women with COVID-19 in a developing country setup.

BACKGROUND: Current evidence on vertical transmission of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) and neonatal outcome among exposed newborns is emerging and posing a challenge for preventive interventions. Perinatal transmission to the neonates especially during breastfeeding and rooming in is also relatively unknown. METHODS: This prospective observational study was conducted in Kalinga Institute of Medical Science (KIMS), Odisha state from 1st May to 20th October 2020. A total of 165 neonates born to SARS-CoV-2 infected mothers were enrolled. Real time polymerase chain reaction (RT PCR) testing was done in first 32 neonates in initial 24 h of life. RESULTS: The clinical characteristics of 162 mothers & 165 neonates were analyzed. Mode of delivery was by caesarian section in most (n = 103, 60%) cases. Three (3/32, 9.4%) inborn and 6 outborn neonates were SARS-CoV-2 positive. Thirty-eight (23%) babies needed neonatal intensive care. Clinical characteristics of neonates were meconium-stained amniotic fluid (MSAF [23.63%]), prematurity (16.9%), respiratory distress (10.5%), moderate to severe hypoxic ischemic encephalopathy (3.6%), sepsis (7%) and hyperbilirubinemia (8.7%). Out of 138 stable babies kept on mother side and initiated breast feeding, none of them developed any signs and symptoms attributable to SARS-CoV-2. Five (3%) neonates died in COVID hospital of which one baby was SARS-CoV-2 positive. CONCLUSION: There was an increased rate of incidences of hypoxic ischemic encephalopathy, meconium stained liquor and cesarean section delivery in COVID hospital. We found a possible vertical transmission in 9.4% cases. None of the neonates developed sign and symptoms of SARS-CoV-2 infection during rooming in and breast feeding.

Insights into Plasmodium and SARS-CoV-2 co-infection driven neurological manifestations.

In malaria-endemic regions, people often get exposed to various pathogens simultaneously, generating co-infection scenarios. In such scenarios, overlapping symptoms pose serious diagnostic challenges. The delayed diagnosis may lead to an increase in disease severity and catastrophic events. Recent coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected various areas globally, including malaria-endemic regions. The Plasmodium and SARS-CoV-2 co-infection and its effect on health are yet unexplored. We present a case report of a previously healthy, middle-aged individual from the malaria-endemic area who suffered SARS-CoV-2 and Plasmodium falciparum co-infection. The patient developed severe disease indications in a short time period. The patient showed neurological symptoms, altered hematological as well as liver-test parameters, and subsequent death in a narrow time span. We hereby discuss the various aspects of this case regarding treatment and hematological parameters. Further, we have put forward perspectives related to the mechanism behind severity and neurological symptoms in this fatal parasite-virus co-infection case. In malaria-endemic regions, due to overlapping symptoms, suspected COVID-19 patients should also be monitored for diagnosis of malaria without any delay. The SARS-CoV-2 and Plasmodium co-infection could increase the disease severity in a short time span. In treatment, dexamethasone may not help in severe cases having malaria as well as COVID-19 positive status and needs further exploration.

Clinical Manifestations and Outcome of Scrub Typhus in Infants From Odisha.

OBJECTIVE: To study manifestations and outcome of scrub typhus in infants. METHODS: Case record analysis of infants with scrub typhus admitted to a tertiary care hospital, diagnosed by IgM ELISA from January 1, 2016 to December 31, 2019. RESULTS: Out of 374 children diagnosed with scrub typhus, 34 (9%) were infants. Chief presentation were fever 34 (100 %), feeding difficulty 24 (70.6%), lethargy 18 (52.9%) and irritability 15 (44.1%). Clinically, pallor 30 (88.2%), tachycardia 29 (85.3%), tachypnea 24 (70.6%), hepatosplenomegaly 30 (88.2%) and eschar 6 (17.6%) were detected. Significant laboratory parameters were anemia 33 (97.1%), leukocytosis 33 (97.1%), thrombocytopenia 17 (50%) and transaminitis 21 (63.6%). Pneumonia 18 (52.9%) was noticed as the major complication. Infants requiring intensive care 17(50%) had characteristic thrombocytopenia, hypoalbuminemia and transaminitis (P<0.05). They recovered well with doxycycline. CONCLUSIONS: Manifestation of scrub typhus in infants tends to be severe with combination of hematologic, pulmonary and hepatic involvement requiring intensive care. The response to doxycycline is good.

Childhood Intussusception after Introduction of Indigenous Rotavirus Vaccine: Hospital-Based Surveillance Study from Odisha, India.

OBJECTIVE: To study the epidemiology of intussusception in children < 2 y of age, postintroduction of Rotavac® (an indigenous oral rotavirus vaccine). METHODS: A multicenter hospital-based surveillance was conducted in Odisha from February 2016 to June 2019. The cases were diagnosed according to Brighton level-1 criteria. Data were collected regarding the time of onset, signs and symptoms, radiological diagnosis, management, complications, and outcome (discharged/died). RESULTS: One hundred and twenty children < 2 y of age were enrolled. The median age was 7 mo (M:F ratio = 2:1). The most common clinical feature was abdominal distention and blood in stool. The most common method for treatment was hydrostatic/pneumatic reduction. Median time (days) between symptom onset and admission was 2. Median (IQR) duration (days) of hospitalization was 5. Most common location of intussusceptions was ileo-colic. CONCLUSIONS: Hydrostatic/pneumatic reduction was possible in the majority presenting ≤ 48 h of symptom onset, and those presenting > 48 h mostly required surgical reduction. Intestinal resection was required in some cases presenting on day 5 of symptom onset. Majority of cases were managed by surgical reduction in Government facility.

Surveillance and Molecular Characterization of Rotavirus Strains Circulating in Odisha, India after Introduction of Rotavac.

OBJECTIVE: To know the rotavirus burden associated with acute gastroenteritis along with circulating genotypes among under-five children and to find out possible associations with different demographic and clinical predictors in a tertiary care teaching hospital in Bhubaneswar, Odisha. METHODS: A prospective acute gastroenteritis surveillance conducted from February 2016 to June 2019 at a tertiary care pediatric hospital in Bhubaneswar has enrolled 850 children under five years of age. The stool samples were tested for VP6 antigen of rotavirus by enzyme immunoassay (EIA) and hemi-nested multiplex PCR to find out VP7 (G type) and VP4 (P type) genes. The data was presented using mean ± SD, median (IQR) along with frequencies and percentages. RESULTS: Rotavirus positivity was found in 246 children (28.9%) with male: female ratio of 3:1. An increasing trend of rotaviral diarrheal cases was seen during the winter months. History of vomiting for 2 d, age group of 12-23 mo, and fever were significantly associated with rotavirus diarrhea having odd ratios of 1.80 (95% CI, 1.48, and 1.69, respectively). Among the genotypes, G3 and P8 were found to be most common in the present study. CONCLUSION: With the introduction of Rotavac in the state the overall rotaviral distribution has significantly changed. Children of 6-23 mo were the most affected age group in the study indicating the necessity of this vaccine in the early months of life.

DBCOVP: A database of coronavirus virulent glycoproteins.

Since the emergence of SARS-CoV-1 (2002), novel coronaviruses have emerged periodically like the MERS- CoV (2012) and now, the SARS-CoV-2 outbreak which has posed a global threat to public health. Although, this is the third zoonotic coronavirus breakout within the last two decades, there are only a few platforms that provide information about coronavirus genomes. None of them is specific for the virulence glycoproteins and complete sequence-structural features of these virulence factors across the betacoronavirus family including SARS-CoV-2 strains are lacking. Against this backdrop, we present DBCOVP (http://covp.immt.res.in/), the first manually-curated, web-based resource to provide extensive information on the complete repertoire of structural virulent glycoproteins from coronavirus genomes belonging to betacoronavirus genera. The database provides various sequence-structural properties in which users can browse and analyze information in different ways. Furthermore, many conserved T-cell and B-cell epitopes predicted for each protein are present that may perform a significant role in eliciting the humoral and cellular immune response. The tertiary structure of the epitopes together with the docked epitope-HLA binding-complex is made available to facilitate further analysis. DBCOVP presents an easy-to-use interface with in-built tools for similarity search, cross-genome comparison, phylogenetic, and multiple sequence alignment. DBCOVP will certainly be an important resource for experimental biologists engaged in coronavirus research studies and will aid in vaccine development.

Climatic Parameters and Rotavirus Diarrhea Among Hospitalized Children: A Study of Eastern India.

Background: Rotavirus diarrhea is often referred as "winter diarrheal disease" as it causes nearly 50% of the pediatric hospitalizations during winter season. This study was done with the objective of bringing out the epidemiological nexus of rotavirus cases with different seasonal parameters like maximum, minimum temperature, humidity, and average rainfall. Methods: This prospective observational study was conducted in a tertiary care teaching hospital of Eastern India from February 2016 to December 2018. Data on daily maximum and minimum temperature, relative humidity, and rainfall were collected. Result: Of 964 children admitted, 768 stool samples were collected for rotavirus assay. A total of 222 children (29%) were positive. The maximum, minimum temperature, average rainfall, and average humidity of 83.4 mm, 79.2%, 28.1, and 21.9, respectively, were significantly associated with positive rotaviral cases. Conclusions: The incidence of rotavirus positivity cases was found to be inversely associated with average temperature, humidity, and rainfall. The knowledge about the seasonal pattern in a particular geographical area would help in the reallocation of hospital services (staff and bed) to tackle the epidemic or emergency situations resulting from clustering of cases.

Role of OB-Fold Protein YdeI in Stress Response and Virulence of Salmonella enterica Serovar Enteritidis.

An essential feature of the pathogenesis of the Salmonella enterica serovar Enteritidis wild type (WT) is its ability to survive under diverse microenvironmental stress conditions, such as encountering antimicrobial peptides (AMPs) or glucose and micronutrient starvation. These stress factors trigger virulence genes carried on Salmonella pathogenicity islands (SPIs) and determine the efficiency of enteric infection. Although the oligosaccharide/oligonucleotide binding-fold (OB-fold) family of proteins has been identified as an important stress response and virulence determinant, functional information on members of this family is currently limited. In this study, we decipher the role of YdeI, which belongs to OB-fold family of proteins, in stress response and virulence of S Enteritidis. When ydeI was deleted, the ΔydeI mutant showed reduced survival during exposure to AMPs or glucose and Mg2+ starvation stress compared to the WT. Green fluorescent protein (GFP) reporter and quantitative real-time PCR (qRT-PCR) assays showed ydeI was transcriptionally regulated by PhoP, which is a major regulator of stress and virulence. Furthermore, the ΔydeI mutant displayed ∼89% reduced invasion into HCT116 cells, ∼15-fold-reduced intramacrophage survival, and downregulation of several SPI-1 and SPI-2 genes encoding the type 3 secretion system apparatus and effector proteins. The mutant showed attenuated virulence compared to the WT, confirmed by its reduced bacterial counts in feces, mesenteric lymph node (mLN), spleen, and liver of C57BL/6 mice. qRT-PCR analyses of the ΔydeI mutant displayed differential expression of 45 PhoP-regulated genes, which were majorly involved in metabolism, transport, membrane remodeling, and drug resistance under different stress conditions. YdeI is, therefore, an important protein that modulates S Enteritidis virulence and adaptation to stress during infection.IMPORTANCES Enteritidis during its life cycle encounters diverse stress factors inside the host. These intracellular conditions allow activation of specialized secretion systems to cause infection. We report a conserved membrane protein, YdeI, and elucidate its role in protection against various intracellular stress conditions. A key aspect of the study of a pathogen's stress response mechanism is its clinical relevance during host-pathogen interaction. Bacterial adaptation to stress plays a vital role in evolution of a pathogen's resistance to therapeutic agents. Therefore, investigation of the role of YdeI is vital for understanding the molecular basis of regulation of Salmonella pathogenesis. In conclusion, our findings may contribute to finding potential targets to develop new intervention strategies for treatment and prevention of enteric diseases.

Out-of-pocket health expenditure on diarrheal illness among under-five children in a teaching hospital ins Odisha, India.

BACKGROUND: Diarrhea is the most common illness in children under 5 years of age, accounting for a financial burden for families in developing countries. OBJECTIVE: The aim of this study is to determine the out-of-pocket health expenditure for the management of diarrhoeal illness among the under-five children in in-patient and out-patient cases. METHODS: A cross-sectional study was conducted during January-April 2018 among 60 under-five children with diarrheal illness reporting to pediatric outpatient department (OPD) and 60 under-five children admitted to pediatric ward of a tertiary care teaching hospital. For determining the out-of-pocket health expenditure, both direct and indirect costs for the management of diarrheal illness were estimated both for out-patient and in-patient cases. The cost of the treatment has been presented as the cost of prehospital visits, during a hospital visit and posthospital visit. RESULTS: Overall, median out-of-pocket health expenditure for the management of diarrheal illness for out-patient and in-patient cases were Rs. 1186 (interquartile range [IQR]: Rs. 510) and Rs. 6385 (IQR: Rs. 5889), respectively. The median direct expenditure for OPD cases was Rs. 778.50 (IQR: Rs. 263) and indirect expenditure for OPD cases were Rs. 407.50 (IQR: Rs. 336) The median direct and indirect expenditure for inpatient cases were Rs. 3823 (IQR: Rs. 1942) and Rs. 2237 (IQR: Rs. 4256) respectively. Only 13% of in-patient cases had some kind of medical insurance. CONCLUSION: A considerable economic burden is faced by the families for treating diarrhea in under-five children. Improved access to safe drinking water and sanitation, promotion of hand hygiene, exclusive breastfeeding, rotavirus vaccination, and use of oral rehydration therapy will reduce hospitalization and out-of-pocket expenditure. The study findings recommend for appropriate policy for provision of financial protection while seeking health care services.

Quality Assessment of Maternal Death Review: A Pilot Study in 10 High Priority Districts of Odisha State, India.

BACKGROUND: Maternal death review (MDR) is a strategy that helps in identifying gaps in the care of a pregnant mother. OBJECTIVES: The objective is to assess the quality of MDR, causes of maternal mortality, and finding corrective action in 10 high-priority districts of Odisha. MATERIALS AND METHODS: MDR was undertaken by our team in 4-month timeline (August to November 2014). It included the development of tools, desk reviews, training of staffs, and data handling. The maternal deaths were estimated from the Annual Health Survey. It was compared to estimated maternal death of each district to get the under reporting/over reporting districts. A report was generated on MDR process indicators and program indicators after completion of the assessment. RESULTS: Only 129 (52%) of the 247 deaths found suitable for community-based MDR. The proportion of maternal death reported versus estimated was 247 versus 367. Correct diagnoses were reported in 120 cases. The classification of deaths was not mentioned in 74 cases. Maximum deaths (55%) were in 18-25 years of age group (the most common cause being anemia). Majority (50%) of the deaths occurred during the postnatal period and majority (67%) at the health facility. Only 61 (47%) had received antenatal check-ups. Facility-based MDR showed, Type 1 delay (denotes about seeking care) being the most common (53%). Inaccurate and incomplete information available was also found to compound the above problems in addition. CONCLUSIONS: The present study could contribute to a larger extent to address some of the gaps in the MDR process in the Odisha state.