Reducing Use of Injections Through Interactional Group Discussions: A Randomized Controlled Trial.

Objective: To determine whether “interactional group discussions” could reduce prescriptions of injections by physicians. Study design: Randomized controlled trial. Setting: Rural public health care facilities, North 24 Parganas district, West Bengal, India. Subjects: 72 medical officers, 36 each in intervention and control groups. Intervention: Interactional group discussions. Outcome measure: Proportion of prescriptions including at least one injection. Results: In the intervention group, 249 of 1,080 prescriptions (23%) included at least one injection compared with 79 of 1,080 prescriptions (7%) before and after the intervention, respectively. (RR: 0.32, 95% CI: 0.25-0.40). In the control group, 231 of 1,080 prescriptions (21%) included at least one injection before the intervention vs 178 of 1,080 prescriptions (16%) after the intervention (RR 0.77, 95% CI: 0.65-0.92). Conclusion: Interactional group discussions reduce prescription of injections.

An outbreak of pertussis in sarli circle of kurung-kumey district, Arunachal pradesh, India.

An outbreak of suspected pertussis occurred in Sarli circle of Kurung-kumey district of Arunachal Pradesh in 2007. We investigated this outbreak to confirm the etiology, estimate the magnitude and identify reasons for its occurrence. Twenty-six deaths were reported from the circle. We identified 72 case-patients meeting the case definition of suspected pertussis. The overall attack rate was 30%. None of the under-five children surveyed had received any vaccine in the past. It is essential to establish facilities for conducting routine immunization in Sarli and organizing special campaign in the area to vaccinate all under-fives with full course of vaccines.

An urban, water-borne outbreak of diarrhoea and shigellosis in a district town in eastern India.

Background. In September 2007, the Gayeshpur municipality reported a cluster of cases with diarrhoea. We aimed to identify the causative agent and the source of the disease. Methods. We defined a case as the occurrence of diarrhoea (>3 loose stools/day) with fever or bloody stools in a resident of Gayeshpur in September–October 2007. We asked healthcare facilities to report cases, collected stool specimens from patients, constructed an epidemic curve, drew a map and calculated the incidence by age and sex. We also conducted a matched case–control study (58 in each group), calculated matched odds ratio (MOR) and population attributable fraction (PAF), as well as assessed the environment. Results. We identified 461 cases (attack rate: 46/1000 population) and isolated Shigella flexneri (serotype 2a and 3a) from 3 of 4 stool specimens. The attack rate was higher among females (52/1000) and those in the age group of 45–59 years (71/1000). The outbreak started on 22 September, peaked multiple times and subsided on 12 October 2007. Cases were clustered distal to a leaking pipeline that crossed an open drain to intermittently supply non-chlorinated water to taps. The 58 cases and 58 controls were matched for age and sex. Drinking tap water (MOR: 10; 95% CI: 3–32; PAF: 89%), washing utensils in tap water (MOR: 3.7; 95% CI: 1.2–11.3) and bathing in tap water (MOR: 3.5; 95% CI: 1.1–11) were associated with the illness. Conclusion. This outbreak of diarrhoea and Shigella flexneri dysentery was caused by contamination of tap water and subsided following repair of the pipeline. We recommended regular chlorination of the water and maintenance of pipelines.

Prevalence of hepatitis B infection among the primitive tribes of Andaman & Nicobar Islands.

BACKGROUND & OBJECTIVES: Andaman and Nicobar Islands, is the home of six primitive tribes. No information is available on the prevalence of hepatitis B virus (HBV) infection among them. Hence a study was undertaken with the objective of assessing the sero-prevalence of HBV infection among the four accessible tribes of these islands. METHODS: A total of 1266 serum samples were collected from four tribes i.e., Nicobarese, Shompens, Onges and Great Andamanese and tested for the presence of HBsAg and anti-HBs. Information about different risk factors associated with HBV infection was also collected from the Nicobarese tribe. RESULTS: The overall seropositivity rate of HBsAg among the Nicobarese was 23.3 per cent (95% C.I. 21.0-25.9). Hepatitis B was also found to be an important health problem among the Shompens and Onges with HBsAg positivity of 37.8 and 31.0 per cent respectively. The age-wise distribution of these serological markers among Nicobarese tribe indicate that the infection is very common in all the age groups. The sero-prevalence was also found to be very high among the children. CONCLUSIONS & INTERPRETATION: The findings of the present study indicate that hepatitis B infection is hyper endemic among the primitive tribes of these islands. Though none of the risk factors studied in the Nicobarese was found to be significantly associated with HBV infection, the fact that almost 20 per cent of the women in the reproductive age group were positive for HBsAg indicates the possibility of vertical transmission among the Nicobarese. Further studies are required to find out other modes of transmission.

Risk factors in the transmission of leptospiral infection.

An unmatched case control study was conducted to study the various risk factors for acquiring leptospiral infection in Diglipur tehsil of North Andaman. A random sample of 1014 persons residing in various villages of Diglipur was inducted into the study. Serum samples were collected from them and tested for anti-leptospiral antibodies using microscopic agglutination test (MAT) using Leptospira grippotyphosa, L. australis, L. canicola and L. icterohaemorrhagiae antigens. Persons with a titre of 1:50 or more were considered as the cases (550) and the seronegatives as controls (464). Information about 30 variables relating to household characteristics, occupation, contact with animals and behavioural factors was collected by interviewing the subjects. The prevalences of these variables in both the groups were calculated and the odds ratio with 95 per cent confidence intervals were computed. The seroprevalence rate was found to increase linearly with age and it was significantly higher in males. None of the risk factors studied had any association with seropositivity to serovar L. icterohaemorrhagiae. For the other serovars, some form of recent exposure to outdoor environment had significant association. Other factors which had association with infection with specific serovars included use of well or stream water and presence of dogs in the house for infection with L. grippotyphosa, farming families and presence of cattle in the houses for infection with L. australis and the habit of bathing in ponds for infection with L. canicola. These observed associations can be taken as clues of the transmission cycles and would help in guiding further investigations for understanding the epidemiology of leptospirosis in these islands.

Intestinal parasitic infestation among different population groups of Andaman and Nicobar islands.

A survey was carried out among the rural and urban settlers and two tribal groups viz. Nicobarese and Onges, of Andaman and Nicobar islands. The survey covered preschool school aged children and adults. Out of the total 1,384 stool samples examined, 652 (47.1%) showed ova or cysts of one or more intestinal parasites. Among the preschool children, Nicobarese showed the highest overall prevalence rate (80.5%) followed by urban (46.7%) and rural (38.6%) preschool children. Ascaris lumbricoides was the commonest form of parasite encountered in all the groups of preschool children, followed by Trichuris trichura. While ascariasis and trichuriasis were more common among the urban children than in rural children, giardiasis was more common among the rural preschool children. The school age children among rural settlers showed an overall prevalence rate of 61.1% which was significantly higher than that among the rural preschool children. Among the school age children also, ascariasis was the commonest form of parasitosis followed by trichuriasis. The Nicobarese and Onge adults showed significantly higher overall prevalence rates (72.2%) and 71.1% vs 48.6%) compared to rural adults. In all the groups studied ascariasis was the commonest form of parasitosis except in Onges among whom trichuriasis and giardiasis were more common than ascariasis. Change in prevalence rates over age was studied among the rural settlers. While ascariasis and trichuriasis showed peak prevalence rates in school age children prevalence of giardiasis declined with increase in age from a peak in the preschool age group and prevalence rates of hook worm infestation continued increasing beyond school age.

Little Andaman Island, a new focus of infection with nocturnally periodic Wuchereria bancrofti.

A filariasis survey was carried out for the first time in the Little Andaman island, covering a population of 12,247 in 12 of the 13 villages. Infection due to Wuchereria bancrofti was found only in 3 villages with microfilaria (mf) rate ranging from 1.02 to 6.45 per cent. Observations on the appearance of mf in peripheral blood showed that the parasite is nocturnally periodic form with a peak at 2000 h. The infection was prevalent only among the settlers from Bihar and Bangladesh and none of the local tribal population was affected. Carriers included 18 males and 4 females. Their age ranged from 6 to 50 yr. Only one of 2788 individuals examined was found to have clinical manifestation. A total of 442 female mosquitoes belonging to eight species were collected and dissected. Natural infection was found only in Culex quinquefasciatus (0.24%). Epidemiological investigations and vector studies indicates local transmission. Thus, this island appears as a new focus of infection.

Outbreak of leptospirosis with pulmonary involvement in north Andaman.

An outbreak of acute febrile illness with haemorrhagic manifestations and pulmonary involvement occurred in Diglipur of North Andaman during October-November 1993. Investigations were carried out to see whether leptospires were responsible for this outbreak. Serum samples were collected from suspected cases and tested for presence of antibodies to leptospires by microscopic agglutination test (MAT) using a battery of 19 antigens representing 16 serogroups. 66.7 per cent of the specimens showed significant titres of antibodies against leptospires, 18 of 23 paired sera (78.3%) showed sero-conversion or four-fold rise in antibody titres. The commonest serovar involved was Leptospira grippotyphosa followed by L. canicola and L. JEZ bratislava. In 7 patients L. grippotyphosa was the sole serovar against which antibodies were detected. Clinical and epidemiological observations of this outbreak were similar with that of earlier seasonal outbreaks of acute febrile illness with haemorrhagic manifestations occurring in the same area, indicating that the past outbreaks may also have been due to leptospires. This is the first report of pulmonary leptospirosis from India.