Prevalence of Airflow Obstruction as Measured by Spirometry, in Rural Southern Indian Adults.

Rural population-based estimates of airflow obstruction based on spirometry are unavailable from southern India. This study assessed the prevalence of spirometry-defined airflow obstruction in Vellore, Tamil Nadu.A cross sectional survey was done in nine villages, among adults aged ≥30 years, where previous cardiovascular surveys had been conducted (1994, 2011). Population proportional to size sampling was used to select 20 clusters, with sampling from all streets proportional to the number of households. One person randomly selected per household was interviewed for symptoms and risk factors. A respiratory therapist performed pre and post bronchodilator spirometry on all, following American Thoracic Society criteria. Airflow obstruction was defined as pre-bronchodilator Forced Expiratory Volume 1 s/Forced Vital Capacity (FEV1/FVC) < Lower Limit of Normal (LLN, derived from local prediction equations) and compared to other criteria.Of 1015 participants, 787 completed technically acceptable spirometry. The prevalence of airflow obstruction was 9.0% (95% CI: 5.8%-9.6%, 71). Fixed obstruction (post bronchodilator FEV1/FVC < LLN) was 4.6% (95% CI: 3.1%-6.1%, 36), and 4.1% (95% CI: 2.7%-5.5%, 32) using post bronchodilator FEV1/FVC < 70%. The GOLD criteria missed 56% (40) of those with airflow obstruction, of which 87.5% were females. Although 63.4% with airflow obstruction had moderate to severe disease, 82.2% were not on treatment and only 48.9% reported symptoms in the previous year.This study estimates prevalence of airflow obstruction based on spirometry in rural southern India. Despite significant impairment on spirometry, majority were undiagnosed, and half did not report symptoms.

Admissions to a sick new born care unit in a secondary care hospital: Profile and outcomes.

BACKGROUND: To reduce neonatal mortality in North Bihar, evidence is required about the impact of sick newborn care units (SNCUs) in secondary level hospitals on mortality at the end of the neonatal period. OBJECTIVES: The objective of the study is to assess the profile of neonates admitted to an SNCU and the outcome at the completion of neonatal period. METHODS: A cohort of neonates admitted from March to June 2014 to an SNCU was assessed through family interviews and hospital records. Demographic details (age, sex, and socioeconomic status) and clinical details (antenatal care, birthplace, weight, diagnosis, and family history) were documented. Follow-up was done at discharge or death or referral and the completion of neonatal period. The primary outcome was survival at the completion of neonatal period. Secondary outcomes were case fatality rate at discharge and weight gain. RESULTS: Of 210 neonates assessed, 87.6% (95% confidence interval [CI] 82.4-91.4) survived till the end of the neonatal period. The case fatality rate at the time of discharge was 0.9% (95% CI 0.3-3.4). Majority of the diagnoses were infections, hyperbilirubinemia, and infant of diabetic mother. Mean weight gain at the end of neonatal period (n = 157) was 706 g (P = 0.00). Sex ratio at admission was 567 girls to 1000 boys (95% CI 428/1000-751/1000). No neonate from lower socioeconomic families was admitted. CONCLUSIONS: SNCUs in remote areas can bring down neonatal mortality in North Bihar. Unequal access of SNCUs services to girls and lower socioeconomic groups highlighted the existing barriers which require attention.

Curriculum development for a module on noncommunicable diseases for the master of public health program.

BACKGROUND: As the burden of noncommunicable diseases (NCDs) has been rising globally, various educational programs have introduced chronic disease epidemiology teaching, which is now a component of most of the Master of Public Health (MPH) programs. However, the process of curriculum development for these courses has not been adequately documented for use by educators planning such courses. METHODS: A detailed process of curriculum development based on David Kern's six-step approach was undertaken for a 2-week course on NCDs, as part of the MPH program of a tertiary institution in South India. The processes were documented so that the method of curriculum development for such a course could be made available for educators across this field. RESULTS: The course on NCDs was carried out over 73 learning hours (2 weeks) for a group of MPH students including medical, dental, allied health, and nursing graduates. Evaluation of the revised curriculum at the end of the 2 weeks revealed that mean scores for knowledge and confidence in skills increased by 50% (11.1-16.6, t-test, P < 0.001) and 79% (3.3-5.9, t-test, P = 0.002), respectively, from baseline scores. DISCUSSION: The revised curriculum was effective in improving knowledge and confidence in epidemiological skills. The documented process of curricular development using standard methods if made publicly available can be of use to those involved in planning similar educational programs for students of public health.

Perception of unintentional childhood injuries among mothers in rural South India.

Parental perception of safe and risk-free environment is critical in the prevention of unintentional childhood injury. In this cross-sectional study, hundred mothers from 13 clusters were interviewed to assess the perception of mothers regarding the risks and hazards leading to unintentional childhood injuries from March to April 2013. A tool developed by Glik et al. was used. Mothers' perception of likelihood of injury from hazards such as household door and drawers, small toys, plastic bags, and cribs was poor. Mothers had a poor perception of injury by entrapment in refrigerators, choking, and strangulation by a rope. Age, education, and literacy (P < 0.05) were found to be significant predictors of perception of risk and hazard. Very few mothers (9%) believed injuries can be completely prevented and illiteracy (P < 0.05) was associated with poor perception on prevention. Health education should focus on improving maternal perception which may bring positive impact on prevention.

Prevalence of risk factors for non-communicable diseases in rural & urban Tamil Nadu.

BACKGROUND & OBJECTIVES: Surveillance of risk factors is important to plan suitable control measures for non-communicable diseases (NCDs). The objective of this study was to assess the behavioural, physical and biochemical risk factors for NCDs in Vellore Corporation and Kaniyambadi, a rural block in Vellore district, Tamil Nadu, India. METHODS: This cross-sectional study was carried out among 6196 adults aged 30-64 yr, with 3799 participants from rural and 2397 from urban areas. The World Health Organization-STEPS method was used to record behavioural risk factors, anthropometry, blood pressure, fasting blood glucose and lipid profile. Multiple logistic regression was used to assess associations between risk factors. RESULTS: The proportion of tobacco users (current smoking or daily use of smokeless tobacco) was 23 per cent in the rural sample and 18 per cent in the urban, with rates of smoking being similar. Ever consumption of alcohol was 62 per cent among rural men and 42 per cent among urban men. Low physical activity was seen among 63 per cent of the urban and 43 per cent of the rural sample. Consumption of fruits and vegetables was equally poor in both. In the urban sample, 54 per cent were overweight, 29 per cent had hypertension and 24 per cent diabetes as compared to 31, 17 and 11 per cent, respectively, in the rural sample. Physical inactivity was associated with hypertension, body mass index (BMI) ≥25 kg/m[2], central obesity and dyslipidaemia after adjusting for other factors. Increasing age, male sex, BMI ≥25 kg/m[2] and central obesity were independently associated with both hypertension and diabetes. INTERPRETATION & CONCLUSIONS: Diabetes, hypertension, dyslipidaemia, physical inactivity and overweight were higher in the urban area as compared to the rural area which had higher rates of smokeless tobacco use and alcohol consumption. Smoking and inadequate consumption of fruits and vegetables were equally prevalent in both the urban and rural samples. There is an urgent need to address behavioural risk factors such as smoking, alcohol consumption, physical inactivity and inadequate intake of fruits and vegetables through primary prevention.

Prevalence of Congenital Anomalies in a Secondary Care Hospital in South India: A Cross-Sectional Study.

OBJECTIVE: To study the prevalence and types of congenital anomalies that present at birth in a secondary-level hospital in South India and its contribution to perinatal mortality. MATERIALS AND METHODS: A total of 36,074 births over 10 years, from 2003 to 2013, were studied for the prevalence of gross congenital malformations at birth. It was a descriptive, cross-sectional study using data from the birth register and available medical records. RESULTS: The incidence of birth defects was 12.5 per 1000 live births, with musculoskeletal disorders being the commonest, followed by craniovertebral anomalies. The prevalence of anomalies over the past 10 years has not shown any significant change (p= 0.555). DISCUSSION: The high prevalence of neural tube defects indicates the need for periconceptional folic acid supplementation and early detection of anomalies, which would help in timely management. Detection of musculoskeletal anomalies would help in counseling patients antenatally.

Community perspectives on alcohol use among a tribal population in rural southern India.

BACKGROUND: Alcohol use is common in many cultures. Excessive use of alcohol adversely impacts individuals, families and communities. Medicine, which uses biomedical models and perspectives, views alcohol dependence as a disease. Alcohol use and dependence are complex societal problems, which need to be viewed through multidisciplinary approaches and corrected by adopting intersectoral efforts involving local communities. METHODS: We used qualitative methods such as focus group discussions and in-depth interviews to document perspectives on alcohol use among a tribal community in southern India. We recorded traditional norms, changing patterns of use of alcohol and its consequences for individuals, families and the community. RESULTS: Eight focus group discussions and eleven in-depth interviews were conducted. Though consumption of alcohol is part of the local culture, changes in occupation and availability of alcohol has made its consumption a problem. The introduction and easy availability of Indian-made foreign liquor, which is stronger than the locally brewed variety, in government-run outlets has changed the culture of drinking at festivals to drinking more often. This leads to public fights, domestic violence and increasing mortality and morbidity due to road traffic incidents and ill health. The age of initiation into drinking has decreased. CONCLUSION: The introduction of non-traditional and commercial alcohol use has put a heavy price on tribal and rural people. Community-based interventions targeting young children and adolescents may pay more dividends than pursuing purely medical treatments for problem drinkers.

A community based case control study on determinants of perinatal mortality in a tribal population of southern India.

INTRODUCTION: Perinatal mortality rate has been regarded as an indicator of the quality of prenatal, obstetric and neonatal care in an area, which also reflects the maternal health and socioeconomic environment. The objective of the current study was to identify causes and risk factors for perinatal deaths among the tribal population in Jawadhi Hills, Tamil Nadu, southern India. METHODS: A community-based case control study design was used, where a case was a perinatal death and controls were from a sampling frame of all children who were born alive in the same area ±7 days from the day of birth of the case. The WHO Standard International Verbal Autopsy form was used to arrive at the cause of death. Univariate and multivariate analyses for factors associated with perinatal deaths were done. RESULTS: A total of 40 cases, including 22 early neonatal deaths and 18 stillbirths, and 110 controls were included in the study. Among the perinatal deaths, 40% were born prematurely. Sepsis (17.5%) and birth asphyxias (12.5%) were the major causes of deaths. In the final logistic regression model, parity ≥4 (odds ratio [OR] 5.75 [95% confidence interval (CI) 1.88-17.54]), preterm births (OR 5.62 [95% CI 2.12-16.68]) and time to reach the nearest health facility more than two hours (OR 2.51 [95% CI 1.086.73]) were significantly associated with the perinatal deaths. CONCLUSIONS: Prematurity, poor accessibility and a high parity were significantly associated with perinatal deaths in the tribal population of Jawadhi Hills.

Genetic characterization of Spinocerebellar ataxia 1 in a South Indian cohort.

BACKGROUND: Spinocerebellar ataxia type 1 (SCA1) is a late onset autosomal dominant cerebellar ataxia, caused by CAG triplet repeat expansion in the ATXN1 gene. The frequency of SCA1 occurrence is more in Southern India than in other regions as observed from hospital-based studies. However there are no reports on variability of CAG repeat expansion, phenotype-genotype association and founder mutations in a homogenous population from India. METHODS: Genomic DNA isolated from buccal mouthwash of the individuals in the cohort was used for PCR-based diagnosis of SCA1. Subsequently SNP's found within the ATXN1 loci were identified by Taqman allelic discrimination assays. Significance testing of the genotype-phenotype associations was calculated by Kruskal-Wallis ANOVA test with post-hoc Dunnett's test and Pearson's correlation coefficient. RESULTS: By genetic analysis of an affected population in Southern India we identified 21 pre-symptomatic individuals including four that were well past the average age of disease onset of 44 years, 16 symptomatic and 63 normal individuals. All pre-symptomatic cases harbor "pure" expansions of greater than 40 CAGs. Genotyping to test for the presence of two previously identified SNPs showed a founder effect of the same repeat carrying allele as in the general Indian population. We show that SCA1 disease onset is significantly delayed when transmission of the disease is maternal. CONCLUSIONS: Our finding of early disease onset in individuals with a paternally inherited allele could serve as valuable information for clinicians towards early detection of SCA1 in patients with affected fathers. Identification of older pre-symptomatic individuals (n = 4) in our cohort among individuals with a shared genetic and environmental background, suggests that second site genetic or epigenetic modifiers might significantly affect SCA1 disease progression. Moreover, such undetected SCA1 cases could underscore the true prevalence of SCA1 in India.

Melioidosis: a report of two cases.

Melioidosis is increasingly being reported from India in the past few years. Since it can mimic tuberculosis during the initial presentation, treatment with antituberculosis drugs is common. It should be considered in the differential diagnosis of any pyrexia of unknown origin. We report two cases of melioidosis that presented with pyrexia of unknown origin and a localized cutaneous abscess over the chest wall.

A proposed methodology of health education for inherited genetic disorders: Bag and Ball technique.

The life-threatening genetic blood disorder, thalassaemia, which causes decreased haemoglobin production, is preventable. Sociocultural determinants and the level of public health awareness must be used to adopt control measures of prevention. Identifying information gaps and educating the community about screening should be a priority, especially in areas with high disease burdens. A relevant health education technique, with which the audience can identify, can effectively bring understanding necessary effectively to sensitise the community. We propose the 'Bag and Ball' method, which includes role-play for health education specifically concerning inherited genetic disorders.

Prevalence and clustering of soil-transmitted helminth infections in a tribal area in southern India.

OBJECTIVES: To estimate the prevalence, spatial patterns and clustering in the distribution of soil-transmitted helminth (STH) infections, and factors associated with hookworm infections in a tribal population in Tamil Nadu, India. METHODS: Cross-sectional study with one-stage cluster sampling of 22 clusters. Demographic and risk factor data and stool samples for microscopic ova/cysts examination were collected from 1237 participants. Geographical information systems mapping assessed spatial patterns of infection. RESULTS: The overall prevalence of STH was 39% (95% CI 36%­42%), with hookworm 38% (95% CI 35­41%) and Ascaris lumbricoides 1.5% (95% CI 0.8­2.2%). No Trichuris trichiura infection was detected. People involved in farming had higher odds of hookworm infection (1.68, 95% CI 1.31­2.17, P < 0.001). In the multiple logistic regression, adults (2.31, 95% CI 1.80­2.96, P < 0.001), people with pet cats (1.55, 95% CI 1.10­2.18, P = 0.011) and people who did not wash their hands with soap after defecation (1.84, 95% CI 1.27­2.67, P = 0.001) had higher odds of hookworm infection, but gender and poor usage of foot wear did not significantly increase risk. Cluster analysis, based on design effect calculation, did not show any clustering of cases among the study population; however, spatial scan statistic detected a significant cluster for hookworm infections in one village. CONCLUSION: Multiple approaches including health education, improving the existing sanitary practices and regular preventive chemotherapy are needed to control the burden of STH in similar endemic areas.

Prevalence and determinants of hypertension among urban tribal communities in Nagaland, India-A community-based study.

Background: There is a paucity of data on the burden and factors associated with hypertension among the Nagas (collective term for tribal ethnic groups predominantly residing in Nagaland) living in an urban environment. Insights from this study will aid in mapping focused community-based and primary care interventions for hypertension. Objectives: To determine the prevalence and risk factors associated with hypertension among Nagas aged 30-50 years residing in urban Dimapur, Nagaland. Methods: A community-based cross-sectional study was conducted between January and July 2019. This study screened 660 participants for hypertension using a digital blood pressure apparatus. A semi-structured questionnaire was used to assess the risk factors, and anthropometric measurements were recorded using standard guidelines. Results: The prevalence of hypertension and pre-hypertension was 25.9% and 44.5%, respectively. Non-modifiable risk factors such as male gender (adjusted odds ratio [AOR]: 2.02; 95% confidence interval [CI]: 1.32-3.09), age > 40 years (AOR: 2.32; 95% CI: 1.57-3.41), family history of hypertension (AOR, 1.87, 95% CI: 1.19-2.92) and modifiable risk factors such as current alcohol consumption (AOR: 2.05; 95% CI: 1.27-3.31), high/very high perceived stress (AOR: 2.15; 95% CI: 1.28-3.62), lack of participation in stress relief activities (AOR: 2.08; 95% CI: 1.17-3.71) and overweight/obesity (AOR: 2.26; 95% CI: 1.55-3.30) were independently associated with hypertension in this study. Conclusion: To avert an impending health crisis in this community, a multipronged approach involving primary-care/family physicians, culturally appropriate awareness, and targeted community-based screening programs with an adept referral system must be implemented to curtail this emerging threat.

Recalibration of the Framingham risk score for predicting 10-year risk of cardiovascular events: A non-concurrent rural cohort study from Tamil Nadu.

OBJECTIVE: To recalibrate the Framingham Risk Score-cardiovascular diseases (FRS-CVD) using 10-year mortality data and baseline risk factor data for a rural cohort and assess the effect of recalibration on proportion categorised as high risk. METHODS: Participants of a cardiovascular risk factor survey aged 30-64 years in 2011-12, from 9 villages of a rural block in Vellore, Tamil Nadu, were followed up for mortality till 2021, as part of an established demographic surveillance system. We calculated both lipid-based and Body Mass Index-based FRS-CVD risk scores, as well as recalibrated scores using risk factor data from the baseline survey and CVD mortality observed over 10 years. RESULTS: Based on original lipid-based FRS-CVD scores, 8.48% (109) of 1285 males had a 10-year CVD risk ≥30%, compared to 11.60% (149) with recalibrated scores. Among 1737 females, 1.50% (26) had a 10-year CVD risk of ≥30%, using original FRS-CVD scores, and 3.22% (56) using recalibrated scores. Similarly, for BMI based FRS-CVD scores, overall, 3.63% (110/3028) had a 10-year risk of ≥30%, compared to 6.64% (201) using recalibrated scores. The median 10-year FRS-CVD original score in males was 7.57 (IQR: 3.67-15.83), and 2.53 (IQR: 1.28-5.32) in females, compared to 8.95 (IQR: 4.35-18.52) and 3.79 (IQR: 1.92-7.93) respectively, for the recalibrated FRS-CVD risk scores. CONCLUSION: The recalibrated Framingham models showed a greater proportion of the population at risk of CVDs compared to the original FRS scores, with males having 2-3 times greater CVD risk scores compared to females.

Rural South Indian spirometry values show wide variation compared to existing prediction equations.

Background and Objective: India, a highly heterogeneous country, has no common reference standards for predicting spirometry values, with very few recent studies from south India. This study aimed to create reference equations for rural south Indian adults, based on a population-based survey in Vellore, south India and compare it with other equations from India. Methods: The data from 583 non-smoking, asymptomatic participants (30 years and older) from a spirometry-based survey for airflow obstruction (rural Vellore, 2018), were used to develop equations for FEV1, FEV1/FVC, and FVC. The dataset was divided for development (70%) and validation (30%), by gender. Differences between observed and predicted values were assessed using the new equations and comparisons made with other equations from India. Results: Predictions with Vellore rural equations were closest to the previous south Indian equations from urban Bangalore. However, the Bangalore equations led to overestimation of FVC values in males, and of both FEV1 and FVC values in females. Using the rural Vellore equations also led to a higher percent of males being classified as having airflow obstruction, compared to the Bangalore equations which underestimated airflow obstruction in this rural population. Comparison with previously derived Indian equations from other parts of the country showed pronounced variations. Conclusions: Our study reiterates the need for representative rural and urban studies of adults from various parts of India, to obtain region specific reference equations, given the wide variations in spirometry values in "normal" individuals, due to social heterogeneities of the Indian population and resulting complexities in defining normal.

Perinatal Mortality and its Causes in a Rural Block in Tamil Nadu, Southern India: A Community-Based Nonconcurrent Cohort Study.

Background: Globally, over 130 million babies are born every year, and almost 8 million die before their first birthday. Data on perinatal mortality (PM) and its various causes are lacking in many parts of the world including India. Objectives: This study aimed to estimate stillbirth (SB), early neonatal, and PM rates and its causes over the last decade in a rural development block, India. Materials and Methods: This is a nonconcurrent cohort study, analyzing the births, SBs, and early neonatal deaths between January 2008 and December 2017. The World Health Organization-PM classification was used to allocate causes of death as well as maternal risk factors. Birth weights were classified using standard growth charts. Results: There were 20,704 births after 28 weeks gestation and where the fetus weighed more than 1000 g of which 285 were SBs. There were 20,419 live births with 229 early neonatal deaths. There was a significant decline in PM rate from 32 per 1000 to 11 per 1000. There was a decrease in the small for gestational age fetuses from 20% to 12.5%. The main cause for SBs was antepartum hypoxia (34.4%) and fetal growth disorders (26.3%). Complications of intrapartum events contributed to 32.8% of the early neonatal deaths. Conclusion: Steady decline in PM rate and in the number of small for gestational age fetuses over 10 years was seen. Pregnancy registration and follow-up help in giving us a better understanding of the causes of PM.

Feasibility, uptake and real-life challenges of a rural cervical and breast cancer screening program in Vellore, Tamil Nadu, South India.

BACKGROUND: Early detection of breast and cervical cancer by organized screening has been found to reduce mortality rates in trials, but documentation of programme results and challenges is rarely done from non-trial settings. This study reports results of a population-based cancer control programme in a rural block in Vellore, Tamil Nadu, population size (116,085), targeting a population of 18,490 women aged 25-60 years, between November 2014 and March 2018. METHODS: Village-based health education sessions were conducted by social workers, using trained volunteers and health workers to motivate eligible women. Screening was done at a secondary level hospital, by trained general physicians using visual inspection with acetic acid and clinical breast examination, followed by colposcopy, radiological imaging (breast) and biopsy as required. RESULTS: A total of 8 volunteers and 17 health workers motivated women for 93 health education and screening sessions, in 46 out of 82 villages. While 1,890/18,490 (10.2 per cent) were screened for breast cancer, 1,783 (9.6 per cent) were screened for cervical cancer, with a yield of 3.4/1,000 for cervical pre-cancer/cancer. The main challenges were creating time for screening activities in a busy secondary hospital and difficulty in ensuring treatment completion of screen-detected cases. CONCLUSIONS: Population-based cancer screening programs can be offered by secondary hospitals that also run primary care services, to increase screening rates. Clear referral systems need to be established, bearing in mind that social factors, especially poor family support, may pose a threat to treatment, in spite of easy availability of cure.

Hazardous use of alcohol among men in the tribal population of Jawadhi Hills, Tamil Nadu: Nature, prevalence, and risk factors.

BACKGROUND: Worldwide, hazardous use of alcohol is common among many cultures and societies and adversely impacts families and communities, with significant morbidity and mortality. Scheduled Tribes (STs) who are socially deprived and marginalised have higher rates of alcohol use. AIM: We attempted to determine the nature, prevalence, and risk factors associated with hazardous consumption of alcohol in the tribal community. METHODOLOGY: A cross-sectional study was conducted among adult male and permanent residents of Jawadhi hills. A total of 1200 men were interviewed. Study participants were chosen by Probability Proportionate to Size (PPS) sampling method. The questionnaire that documented socio-demographic characteristics and patterns of alcohol use was used. AUDIT tool was used to assess the hazardous use of Alcohol. Data were analysed using SPSS. RESULTS: Majority of the men were middle-aged, married, and were from lower socio-economic strata. A large proportion of men (65%) had a history of alcohol consumption in the last one year using one-year, of whom a quarter showed hazardous use (29%) and another quarter exhibited alcohol dependency (24%). Tobacco use, higher income and local alcohol production were found to be significant risk factors for Hazardous alcohol use. CONCLUSION: Alcohol consumption needs to be treated as a social problem and has to be tackled at the policy level. Population-based interventions, legislation, taxation, policies regarding the manufacture and sale of alcohol, are some of the ways to address this problem.

Risk factors for severe acute malnutrition among children aged 6-59 months: A community-based case-control study from Vellore, Southern India.

BACKGROUND: Malnutrition plays an important role in the economic burden of society as well as the country. This study aimed to identify the various risk factors and determinants of severe acute malnutrition (SAM) as defined by WHO growth reference standards in children aged 6 months to 59 months living in Vellore. METHODS: A community-based case-control study matched for age (±2months), gender and location was done among the children of the age group 6- 59 months residing in both rural and urban Vellore. Children of age group 6-59 months with SAM according to WHO definition, i.e., weight for height of less than -3SD with or without nutritional oedema were classified as cases. Children with weight-for-height z-score more than -1 SD and MUAC ≥13.5cms were classified as controls. With 2 controls per case, the required sample size was 54 cases and 108 controls. A questionnaire used to identify the risk factors including dietary intake. Uni-variate and multivariate analysis was done to generate an odds ratio and 95% confidence interval for the risk factors. RESULTS: Majority of the cases 64.8% and 50% of the controls belonged to low SES. After adjusting all confounders, Severe Acute Malnutrition was significantly associated with birth weight <2.499kg [AOR- 8.95 (95% CI: 2.98-26.85)], not exclusively breastfed for 6 months [AOR 4.67 (95% CI: 1.72-12.65)], inadequate calorie intake [AOR 8.09 (95% CI: 3.15-20.82)] and mother being underweight [AOR 6.87 (95% CI: 1.92-24.55)]. CONCLUSION: Programs should be implemented to reduce the poor nutritional status of young girls and women in the reproductive age group. The importance of exclusive breastfeeding for the first six months, the time of weaning and appropriate feeding practice for the child should be emphasized to postnatal mothers during their hospital visits.

Treatment outcomes with daily self-administered treatment and thrice-weekly directly-observed treatment in two cohorts of newly-diagnosed, sputum-positive adults with pulmonary tuberculosis.

BACKGROUND: The Revised National Tuberculosis Control Program (RNTCP) envisages shifting from thrice-weekly to a daily anti-tuberculosis treatment (ATT) regimen. The potential merits and demerits of both regimens continue to be debated. METHODS: This retrospective study compared treatment outcomes in 191 HIV-negative, newly diagnosed, sputum-positive adults with pulmonary tuberculosis from Vellore district of Tamil Nadu who were treated at a private medical college during 2009 to 2012 with intermittent Directly Observed Treatment Short Course (intermittent DOTS cohort, n=132) or who opted for daily Self-Administered Treatment (daily SAT cohort, n=59). Treatment outcomes obtained from medical records were supplemented by interviews with consenting, traceable patients. RESULTS: The rates for the RNTCP-recommended sputum smear examinations were suboptimal (42% for daily SAT and 72% for intermittent DOTS). However, treatment success with daily SAT and intermittent DOTS (76.2% vs. 70.4%); default (11.9% vs. 18.2%); death (6.8% vs. 5.3%); treatment failure (5.1% vs. 4.6%); and relapse (0% vs. 1.5%) did not significantly differ. CONCLUSIONS: While evaluable treatment outcomes were not significantly different with daily SAT and intermittent DOTS, rates for timely smear examinations and for treatment success were lower, and for default higher, in both cohorts than comparable RNTCP data from Vellore district. Further strengthening of RNTCP facilities within private medical colleges and regular, real-time audits of performance and outcomes are needed if daily ATT regimen under the RNTCP is to succeed.