Seasonal Variation and Dengue Burden in Paediatric Patients in New Delhi.

OBJECTIVE: We conducted a study to find a relationship between main weather parameters with admission of positive dengue cases in a tertiary hospital. METHODS: Retrospective analysis was undertaken to identify epidemiological trend of dengue in 2016 from paediatric wards of a tertiary hospital in New Delhi. Data were collected on patient particulars and daily weather from January to December 2016. RESULTS: A total of 266 confirmed cases of dengue were considered. Relative humidity (RH) was associated with burden of positive dengue cases. On week-wise analysis, each surge of dengue admission was preceded by heavy rain 4-6 weeks earlier. Monthly averaged daily temperature range and RH were noted to have strong correlations with dengue burden, keeping an interval of 2 months in between. CONCLUSIONS: Weather parameters seem to influence magnitude of dengue epidemic, particularly in dengue season. There is need to have an in-depth study about developing a prediction model for dengue epidemic.

Lessons from implementation research on community management of Possible Serious Bacterial Infection (PSBI) in young infants (0-59 days), when the referral is not feasible in Palwal district of Haryana, India.

BACKGROUND: Neonatal sepsis is a major cause of death in India, which needs hospital management but many families cannot access hospitals. The World Health Organization and the Government of India developed a guideline to manage possible serious bacterial infection (PSBI) when a referral is not feasible. We implemented this guideline to achieve high coverage of treatment of PSBI with low mortality. METHODOLOGY: The implementation research study was conducted in over 50 villages of Palwal district, Haryana during August 2017-March 2019 and covered a population of 199143. Policy dialogue with central, state and district health authorities was held before initiation of the study. A baseline assessment of the barriers in the implementation of the PSBI intervention was conducted. The intervention was implemented in the program setting. The research team collected data throughout and also co-participated in the implementation of the intervention for the first six months to identify bottlenecks in the health system and at the community level. RE-AIM framework was utilized to document implementation strategies of PSBI management guideline. Implementation strategies by the district technical support unit (TSU) included: (i) empower mothers and families through social mobilization to improve care-seeking of sick young infants 0-59 days of age, (ii) build capacity through training and build confidence through technical support of health staff at primary health centers (PHC), community health centers (CHC) and sub-centers to manage young infants with PSBI signs and (iii) improve performance of accredited social health activists (ASHAs). FINDINGS: A total of 370 young infants with signs of PSBI were identified and managed in 5270 live births. Treatment coverage was 70% assuming that 10% of live births would have PSBI within the first two months of life. Mothers identified 87.6% (324/370) of PSBI cases. PHCs and CHCs became functional and managed 150 (40%) sick young infants with PSBI. Twenty four young infants (7-59days) who had only fast breathing were treated with oral amoxicillin without a referral. Referral to a hospital was refused by 126 (84%); 119 had clinical severe infection (CSI), one 0-6 days old had fast breathing and six had critical illness (CI). Of 119 CSI cases managed on outpatient injection gentamicin and oral amoxicillin, 116 (96.7%) recovered, 55 (45.8%) received all seven gentamicin injections and only one died. All 7-59 day old infants with fast breathing recovered, 23 on outpatient oral amoxicillin treatment; and 19 (79%) received all doses. Of 65 infants managed at either district or tertiary hospital, two (3.1%) died, rest recovered. Private providers managed 155 (41.9%) PSBI cases, all except one recovered, but sub-classification and treatment were unknown. Sub-centers could not be activated to manage PSBI. CONCLUSION: The study demonstrated resolution of implementation bottlenecks with existing resources, activated PHCs and CHCs to manage CSI and fast breathers (7-59 day old) on an outpatient basis with low mortality when a referral was not feasible. TSU was instrumental in these achievements. We established the effectiveness of oral amoxicillin alone in 7-59 days old fast breathers and recommend a review of the current national policy.

Profile of Children Hospitalized with Acute Poisoning in New Delhi.

195 cases of acute poisoning among children (age<12 y) in a tertiary hospital were identified over a period of one year. Two-thirds (63%) of them were males and 75% were below five years of age. Poisoning by medicines was most common (17%) followed by ingestion of corrosives/detergents (16%) and kerosene (14%).

Causes of Death among Children Aged >5 Years in a Public Hospital in New Delhi.

Retrospective analysis was done for 3817 children aged 5-12 years admitted in a tertiary-care, public hospital in New Delhi between January to December, 2015. Mortality rate was 5.8%. About 47.1% deaths were due to central nervous system involvement; viral meningoencephalitis being the predominant cause. Overall, infectious diseases caused >80% of deaths. Public health interventions to reduce child mortality need to review such data for effective measures.

Pattern of Pediatric Bacterial Infection and Antibiotic Resistance in New Delhi.

The retrospective study analyzed 1025 bacterial isolates from blood cultures collected from pediatric patients admitted in a tertiary-care hospital in New Delhi to find out drug sensitivity patterns. Staphylococcus was isolated from approximate 70% of the cultures, with 63.7% of them being methicillin-resistant. Meropenem resistance among acinetobacter was 38.6%.