Seroprevalence of SARS-CoV-2 in Bhubaneswar, India: findings from three rounds of community surveys.

The study aims to estimate and compare the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence, the fraction of asymptomatic or subclinical infections in the population, determine the demographic risk factors and analyse the antibody development at different time points among adults in Bhubaneswar city, India. This was a serial three-round cross-sectional, community-based study where participants were selected from the residents of Bhubaneswar city using multi-stage random sampling. Blood samples were collected during household visits along with demographic and clinical data from every participant. Total anti-SARS-CoV-2 antibody present in serum was assessed using the electro-chemiluminescence immunoassay platform. Temporal comparisons of the community seroprevalence were performed against the detected number of cumulative cases, active cases, recoveries and deaths. A total of 3693 participants were enrolled in this study with a cumulative non-response rate of 18.33% in all the three rounds. The gender-weighted seroprevalence for the city in the first round was 1.55% (95% confidence interval (CI) 0.84-2.58), second round was 5.27% (95% CI 4.13-6.59) and in the third round was 49.04% (95% CI 46.39-51.68). In the first round, the seroprevalence was found to be highest in the elderly population, whereas the seroprevalence for the second and third phases was highest in the age group of 30-39 years. Seroprevalence showed an increasing trend over the three time periods, with the highest seropositivity rates among individuals sampled between 16 and 18 September 2020. By the third round, 93.93% of those who had previously been tested positive by real-time reverse transcription polymerase chain reaction had seroconversion and 46.57% of those who had been tested negative also showed seroconversion. Infection to case ratio during first round was 27.05, for second round and third round it was 5.62 and 17.91, respectively.

Is multimorbidity associated with risk of elder abuse? Findings from the AHSETS study.

BACKGROUND: With an increasing number of older adults in low- and middle-income countries (LMIC), the burden of multimorbidity and functional dependence is on the rise. At the same time, a higher prevalence of elder abuse is observed in these populations. There is scarce evidence on the interplay between elder abuse and multimorbidity with no reports from LMIC settings yet. Present study examined the association of multimorbidity with the risk of elder abuse and its correlates in a rural elderly population of Odisha, India. METHODS: The data for this study was collected as a part of our AHSETS study comprising of 725 older adults residing in rural Odisha, India. Multimorbidity was assessed by the MAQ PC tool while Hwalek-Sengstock elder abuse screening test (HS-EAST) was used to assess the risk of elder abuse. Functional dependence was measured by the Lawton IADL questionnaire. We used ordinal logistic regression models to identify the correlates of elder abuse and test for mediation by functional dependence. RESULTS: Around 48.8 % (95 % CI:45.13-52.53 %) older adults had multimorbidity while 33.8 % (95 % CI:30.35-37.35 %) had some form of dependence. Out of 725, 56.6 % (CI 52.85-60.19 %) were found to be at low-risk elder abuse and 15.9 % (CI 13.27-18.72 %) being at high-risk. The prevalence of higher risk of elder abuse was greater among females, non-literates, widowed persons, those not currently working and those belonging to lower socio-economic strata. The risk of elder abuse was significantly associated with multimorbidity (AOR = 1.68; 95 %CI: 1.11-2.57) and functional dependence (AOR = 2.08; 95 %CI: 1.41-3.06). Additionally, we found a partial mediation mechanism of functional dependency between the pathway of multimorbidity and elder abuse. CONCLUSIONS: Elder abuse and multimorbidity are emerging as issues of significant concern among rural elderly in Odisha, India. Multimorbidity and functional dependence are associated with significantly higher odds of elder abuse among rural older adults. Further, we report the role of functional dependence as a partial mediator between multimorbidity and elder abuse. Therefore, potential interventions on reducing the economic, physical and care dependence among multimorbid patients may reduce the risk of elder abuse.

Serosurveys to detect SARS-CoV-2 antibodies among high-risk groups in six urban cities of Odisha, India.

INTRODUCTION: Personnel involved in essential services or residing in high-risk areas during the COVID-19 pandemic are at increased risk of getting infected. We evaluated the proportion of personnel infected in several high-risk groups in Odisha using seroprevalence studies. METHODOLOGY: During July to November, 2020, individuals from multiple high-risk groups in 6 urban cities (Bhubaneswar, Berhampur, Cuttack, Malkangiri, Paralakhemundi, and Rourkela) in Odisha, India, were recruited to the study after obtaining written informed consent. Blood samples collected from the study participants were tested for IgG antibodies against COVID-19 in Roche Cobas e441 (Roche Diagnostics, Rotkreuz, Switzerland). Information on socio-demographic variables, association with a confirmed or suspected case, and other details were collected using an electronic data capture tool and analysed with a statistical software. RESULTS: The overall COVID-19 seroprevalence was 34.9% (95%CI 33.6-36.2) among the 5434 individuals. The seroprevalence varied from 21.8% (95% CI, 19.6-24.1) in Rourkela to 54.9% (95% CI, 51.5-58.2) in Bhubaneswar. Seropositivity was maximum among prisoners (47.7%), followed by municipality/ sanitation staff (43.5%), and other office going staff (40.8%). Multivariate logistic regression indicated that participants aged 18-29 years, 30-44 years, residents of slums and vending zone, municipality staff, prisoners, residents of urban cities Malkangiri, Cuttack, Paralakhemundi, Bhubaneswar and those with previous history of COVID-19 were independent co-relates of seropositivity. CONCLUSIONS: The risk of COVID-19 varied among the high-risk groups of Odisha. Periodic seroprevalence studies in future are essential to protect the high-risk personnel involved in frontline activities during the pandemic.

Associations of multimorbidity on frailty and dependence among an elderly rural population: Findings from the AHSETS study.

This cross-sectional study was conducted among a rural elderly population of 725 individuals aged over 60 years from Eastern India to assess the association of multiple chronic diseases with frailty and dependence. Multimorbidity, frailty, and dependence were assessed using prevalidated tools. Regression models were used to assess the association between variables and adjust for confounders. The overall prevalence of multimorbidity was 48.8 % and that of frailty and dependence for activities of daily living was 58.6 % and 5.4 %, respectively. There was no statistically significant difference (p = 0.53) between the mean age of persons with and without multimorbidity. Frailty and dependency, however, showed a significant increasing trend with the mean age. Unadjusted bivariate analyses showed a significantly larger proportion of persons who were frail or at risk of frailty having multimorbidity as compared to those who were robust. Logistic regression models showed a significant association between risk of frailty and multimorbidity but failed to demonstrate a significant relationship between dependency and number of chronic diseases when adjusted for the interaction between frailty and chronic diseases. There was a significant association between dependence, frailty, and multimorbidity. Further research to determine the extent, direction, and nature of this complex relationship needs to be explored.

Prevalence and Patterns of Multimorbidity Among Rural Elderly: Findings of the AHSETS Study.

Introduction: In India, the proportion of older population is projected to increase from 8% in 2015 to 19% in 2050 and a third of the country's population will be older adults by end of the century. Multimorbidity is common among the elderly and the prevalence increases with age. Chronic conditions are most often present as clusters and it's critical to explore the prevalent pattern of clustering for better public health strategies. Method: A cross-sectional study was conducted among 725 rural older adults (>60 years) in Tigiria block of Odisha, India. Multimorbidity status was assessed using the prior validated MAQ-PC tool. Survey was conducted using android tablets installed with open data kit software. While Euclidean distances using K-means clustering algorithm were used to estimate the similarity or dissimilarity of observations. The optimum numbers of clusters were determined using silhouette method. Data were analyzed using multiple open source packages of R statistical programming software ver-3.6.3. Result: The overall prevalence of multimorbidity was 48.8% of which dyads (25%) were the most common form, followed by triads (15.2%). The prevalence of multimorbidity was higher in females (50.4%) than males (47.4%). The optimal number of clusters was found to be 3. While arthritis alone was a separate cluster, hypertension and acid peptic disease were in another cluster and all the rest conditions were included in the third cluster. Conclusion: The cluster analysis to measure of proximity suggested arthritis, hypertension, and acid peptic disease are the diseases that occur mostly in isolation with the other chronic conditions in the rural elderly.