Cost-effectiveness of the prevention of parent-to-child transmission guidelines of HIV in India.

Background: One of the modes of transmission of HIV infection in India is from mother-to-child. In 2014, Prevention of Parent-to-child Transmission (PPTCT) guidelines of HIV in India were implemented which included shifting from Option A to Option B and B+. The aim of the present study was to evaluate health and cost related outcomes after implementation of these new guidelines. Methods: A decision analytical model was used to compare the PPTCT Option A with the new WHO Option of B and B+. Transmissions in serodiscordant couples and infants at 18 months were considered as health outcomes. The estimation of the cost for PPTCT services and HIV treatment was done using Costing Tool for Elimination Initiatives (CTEI) developed by National Center for Global Health and Medicine (NCGM). Results: The reduction in transmission rates in HIV infants was 33%. In serodiscordant couples the reduction in risk of HIV transmission from Option A to Option B and B+ was 72% and 87%, respectively. The incremental cost-effectiveness ratio (ICER) per quality adjusted life years (QALY) gained by averting infant infection, and for both infant and partner was US$ 238 and US$ 181 for Option B and US$ 1265 and US$ 947 for Option B+, respectively. Conclusion: It was found that Options B and B+ are more cost-effective as compared to option A. This effectiveness further increases when prevention of partner infections in Option B and B+ is taken into account.

Kasurdi health and demographic surveillance system: A profile and way forward.

Kasurdi Health and Demographic Surveillance System (Kasurdi HDSS) was established at Rural Health Training Center Kasurdi on February 16, 2018. Kasurdi HDSS has been established to increase the research potential of medical colleges and develop real-time data for research purposes to study the changes in population demography, health, and health-care utilization. Kasurdi HDSS currently follows 2755 individuals living in 549 households. The system collects the data from the population through annual rounds conducted by postgraduate residents of the department of community medicine. The data are collected in the digital format with the help of android-based tablets. HDSS has collected demographic data, reproductive data, data on diseases such as tuberculosis and noncommunicable diseases, and socioeconomic data. The HDSS is in the process to upgrade its data management system to a more integrated platform, coordinated and guided by national/international standards, and data sharing policy.

A comparative analysis of control measures on-board ship against COVID-19 and similar novel viral respiratory disease outbreak: Quarantine ship or disembark suspects?

BACKGROUND: Management of novel viral respiratory disease outbreak on-board a ship with person-to-person transmission can be a public health challenge because of close proximity of inhabitants due to confined space and air-conditioned environment. It has a potential to be explosive, with high secondary attack rate (SAR) and cause significant morbidity and mortality. This study compares control measures instituted on-board two ships with similar outbreaks and recommends a standardized evidence-based outbreak response against them. METHODS: This is a descriptive study, showing comparative analysis of control measures instituted on-board two ships, a cruise ship in case of COVID-19 and a warship in case of H1N1 influenza, with novel viral respiratory disease outbreak, at different span of time. Data of the date of onset, clinical details, laboratory results, history of travel, history of contact with positive case and control measures initiated were collected, analysed and compared. RESULTS: Of the two ships compared, one was a cruise ship with 712 COVID-19 cases, with an attack rate (AR) of 19.2% and 13 deaths, and other a warship with 14 cases of H1N1 influenza and an AR of 4.83%. The epidemic curve for both the outbreaks was plotted to study time distribution. CONCLUSION: Active surveillance, early self-reporting and immediate disembarkation of the suspects, along with strict compliance of hand hygiene, cough etiquettes and disinfection enhancement, will help in early mitigation of the outbreak. Health education should be undertaken to impart evidence-based knowledge and alleviate fear of the unknown. Vaccination may not be present but if available should only be administered after strict risk-benefit, cost-benefit and effectiveness analysis.

Projections for novel coronavirus (COVID-19) and evaluation of epidemic response strategies for India.

BACKGROUND: The World Health Organization on 11 March 2020, declared COVID-19 as a pandemic. India initiated social distancing measures to combat the epidemic of COVID-19. The course of the epidemic of COVID-19 for India was predicted using stochastic probability-based mathematical modeling. METHODS: Data synthesis for the top few countries affected was studied for various factors affecting the epidemic. For projections of infected cases for India, the modified susceptible-exposed-infectious-removed/recovered framework modified for the effect of social distancing (Rho) was used. Simulation was carried out for 10,000 runs using Python. Projections for infected cases and hospitalization requirement were estimated. RESULTS: The epidemic curve will peak in the third week of June in India with 17,525,869 and 2,153,200 infected people with reproduction number of 1.8 and Rho of 0.7 and 0.6, respectively. Compared with the baseline scenario of no social distancing, for transmissibility with R0 = 1.8, the reduction in infections due to social distancing measure is 78% (Rho = 0.7) and 97% (Rho = 0.6). Similarly for R0 = 2.2 and 2.4, the reduction in infected numbers slightly lowers to 62% and 66% with Rho = 0.7 and 92% and 75% with Rho = 0.6, respectively. With R0 = 1.8 and Rho = 0.6, the Intensive Care Unit (ICU) bed requirement is 107,660, whereas if transmissibility is high, the ICU bed requirement would increase to 1,994,682. CONCLUSIONS: The social distancing measures seem to have been working for India in absence of treatment in sight for COVID-19. Although with the government's response strategy of social distancing, the peak of the epidemic is extended giving more months for preparedness to the country; however, the sustainability of these measures is uncertain.

Scrub typhus strikes back: Are we ready?

Scrub typhus has struck back, albeit with renewed vigour, impacting areas with previously known endemicity as also impressing newer expanses. It is not surprising, therefore, that Scrub typhus has emerged as a leading cause of public health concern globally as well as in India, but are we ready to take on the challenge? Over the last decade, there has been a global increase in the number of outbreaks of Scrub typhus, be it the military occupied areas or the civil population at large. The innumerable outbreaks of Scrub typhus, although disconcerting, have nonetheless contributed phenomenally towards better understanding of the dynamics of scrub typhus. There have been significant contributions to awareness of the disease amongst medical professionals, scrub typhus as a cause of Acute Undifferentiated Febrile Illness (AUFI) and newer clinical manifestation - Acute Encephalitis Syndrome (AES), availability and advances in diagnostics and management, man-vector-pathogen interactions, new records of Leptotrombidium species, newer vectors and Orientia species. Antigenic diversity and the varied clinical presentation of scrub typhus, absence of scrub typhus surveillance system and a lack of political will to recognize the disease as one of the important reemerging public health problem are areas seeking concerted deliberations and actions so that the challenges posed by scrub typhus can be addressed.

Is occupation the "driving force" for tobacco consumption? A cross-sectional study to assess prevalence, patterns, and attitude towards tobacco use among long-distance bus drivers and conductors in Western Maharashtra.

BACKGROUND: Tobacco use remains a major cause of preventable deaths worldwide. The recent Global Adult Tobacco Survey 2016-2017 has shown the prevalence of tobacco use among Indian population to be 28.6%. In Maharashtra, 35.5% of all adult males either smoke tobacco or use some form of smokeless tobacco. Not much data are available on tobacco use with respect to different occupations in India, though risk of tobacco use is known to be higher among individuals in certain occupations. METHODS: This cross-sectional descriptive study was conducted among 190 long-distance bus drivers and conductors of long route buses departing from one of the main bus stations of the State Transport Corporation in Pune city. Data were collected using a pretested, structured questionnaire by interview method. RESULTS: Prevalence of tobacco consumption (TC) among the respondents was 55.8% (95% confidence interval; 48.4-63). Among the tobacco users, 54% reported initiation at age <18 years "peer pressure" and "curiosity" were the main reasons for initiation while "feeling alert" and "feeling mature" were reasons for continued use. A large proportion (74.5%) of the respondents expressed their intention to quit tobacco in the near future. CONCLUSION: Long-distance bus drivers and conductors showed a high prevalence of TC which may be linked to certain occupation-related factors. Targeted tobacco cessation activities at workplaces may be considered as a strategy for better impact of tobacco control activities in India.

Sociodemographic characteristics and aggression quotient among children in conflict with the law in India: A case-control study.

BACKGROUND: The incidence of juvenile delinquency has increased in the past decade in India and juvenile crimes are increasingly being reported. This has been attributed to many biopsychosocial factors. It is essential to understand these issues in the context of India to determine the response of acts of children in conflict with the law. We aimed to assess the sociodemographic characteristics and the aggression quotient of children in conflict with the law (juvenile delinquents) in observation homes across India and compare them with those who were not. METHODS: We did a case-control study in five juvenile homes in the cities of Hyderabad, Lucknow and Pune. Ninety inmates (74 boys, 16 girls) were included in the study. Sociodemographic characteristics and aggression quotient of children in conflict with the law were evaluated using two separate questionnaires, i.e. a sociodemographic questionnaire and the modified Buss and Perry aggression questionnaire. These were compared with a control group of similar age, sex and income status. RESULTS: All the children in conflict with the law surveyed belonged to the lower socioeconomic strata, had a significantly higher chance (p<0.05) of coming from broken homes, have addictions, jailed family members and suffered physical and sexual abuse than controls. They also scored higher on all domains of the aggression questionnaire than controls. CONCLUSION: A collection of sociodemographic attributes such as broken homes, addictions and abuse seem to have an important association with juvenile delinquency. Children in conflict with the law are also more likely to be associated with a higher aggression quotient as compared to children who were not.