Uptake of fIPV3 and implementation challenges as perceived by auxiliary nurse midwives at two primary healthcare centers in urban Bengaluru: a mixed-method study

Background: India introduced fractional-dose inactivated poliovirus vaccine (fIPV) into its routine immunization program as part of the polio eradication and endgame strategic plan. The study aimed to assess the uptake of the 3rd dose of fIPV among eligible beneficiaries and explore the implementation challenges perceived by auxiliary nurse midwives (ANMs) at two primary healthcare centers in urban Bengaluru. Methods: A mixed-method study was conducted between April and May 2023. A cross-sectional design was used for quantitative objectives, while in-depth interviews were conducted with ANMs for qualitative insights. Data were collected through vaccination registers, questionnaires, and key informant interviews. The study population included all eligible beneficiaries for the 3rd dose of fIPV from January to March 2023. Results: Out of 296 eligible beneficiaries, 139 (47%) had received the 3rd dose of fIPV. The challenges faced by ANMs in fIPV3 implementation included difficulties in recording and reporting activities, fear of managing adverse events, lack of confidence in administering intradermal injections, obtaining consent from parents, inadequate training, and concerns about vaccine wastage and increased workload. Conclusions: The uptake of fIPV3 was suboptimal, and ANMs encountered several challenges during implementation. To enhance fIPV3 integration into the vaccination schedule, the health system needs to improve awareness among the community, strengthen health worker capacity, and provide better training and support. Strengthening routine immunization programs can contribute to sustained polio eradication efforts.

Polymerase chain reaction in rapid diagnosis of neonatal sepsis.

In a prospective study a total of hundred neonates who fulfilled the American College of Obstetrics and Gynecology's (ACOG) criteria for probable sepsis admitted to NICU of tertiary care armed forces hospital were investigated for evidence of sepsis. The investigation protocol included sepsis screen, blood culture and 1 mL of venous blood for molecular analysis by polymerase chain reaction (PCR) for bacterial DNA component encoding 16 s RNA in all cases. 100 newborns with probable sepsis were studied to evaluate the molecular diagnosis of sepsis using PCR amplification of 16 S RNA in newborns with risk factors for sepsis or those who have clinical evidence of sepsis. We compared the results of PCR with blood culture and other markers of sepsis screen (total leucocyte count (TLC), absolute neutrophil count (ANC), immature/total neutrophil count ratio (I/T ratio), peripheral blood smear, micro ESR and C reactive protein (CRP). Controls consisted of 30 normal healthy newborns with no overt evidence of sepsis. Sepsis screen was positive in 24 (24%) of cases in study group with sensitivity and specificity of 100% and 83.5% respectively. Blood culture was positive in 09(9%t) with sensitivity of 69.2% and specificity of 100%. PCR was positive in 13(13%) of cases (9% are both blood culture and sepsis screen positive and 4% are positive by sepsis screen); the sensitivity of PCR was 100% and specificity was 95.6%. Blood culture is the most reliable method for diagnosis of neonatal sepsis. Polymerase chain reaction is useful and superior to blood culture for early diagnosis of sepsis in neonates.

Plasmid mediated antibiotic resistance in Klebsiella pneumoniae.

Klebsiella pneumoniae species (108) isolated from tertiary care hospitalized patients were investigated for antibiotic resistance patter. 74% isolates were from urine, 13.5% from pus, 4.5% from blood and 8% from sputum. The resistance pattern of the organisms to various antibiotics were as follows: ampicillin 93.3%, cefotaxime 70%, ceftazidime 81%, gentamicin 68.5%, amikacin 63.75%, netilmicin 74%, norfloxacin 55%, ofloxacin 53%, chloramphenicol 82%, tetracycline 85%, sulphamethoxazole 96%, trimethoprim 94%. 2-4 drug resistance was found in 34.5%, 5-8 drug resistance was in 25.1% and 9-12 drug resistance was found in 40.4% of strains. Out of 65 strains, 25 strains could be successfully conjugated. Common drugs which were transferred to transconjugants were sulphamethoxazole, trimethoprim, gentamicin, netilmicin, amikacin, chloramphenicol, tetracycline, ampicillin, cefotaxime and ceftazidime. A large plasmid of 98.7% kb could be demonstrated in these strains by alkali denaturation method and agarose gel electrophoresis.

Postal follow up of patients with epilepsy.

BACKGROUND. Epilepsy services in India are mostly located in urban areas and are often overcrowded. It is difficult, therefore, to organize long term management programmes. We report our experience at a tertiary referral centre on follow up of patients with epilepsy through regular postal review. METHODS. One hundred consecutive patients with epilepsy (63 men, 37 women, mean age 17 years) who had only seizures were followed up by post using a questionnaire, instead of reviewing them in a clinic. The safety, utility and efficiency of this system were evaluated. RESULTS. Sixty patients had generalized seizures, 30 had complex partial seizures and 10 had other types of seizures. The indication for shifting to postal review was good control of seizures in 87 cases and economic reasons in the remaining. Postal review constituted 60% of the total follow up period in 55 cases. Sixty-six patients could be maintained on postal review which was suspended or discontinued in 34 patients. Of these 34, 16 were returned to it after being seen in the clinic on a further occasion. Poor control of seizures, fresh medical or social problems, lack of confidence or a combination of these were the reasons for discontinuing the postal review. The economic benefit to a patient by way of savings in travel, incidental expenses and lost wages was estimated to be Rs 750 per annum. The work load in the epilepsy clinic was decreased by 40%. No serious medical problems or mortality were reported in the study population. CONCLUSION. Systematic postal review is a cost-effective alternative to clinic review in the long term follow up of a certain group of patients with epilepsy.

Neonatal Salmonella havana meningitis.

The clinical features, microbial characterisation and autopsy findings in a premature neonate with Salmonellas havana meningitis is presented. S. havana is a very rare pathogen in India.

Epidemiology of bancroftian filariasis in a semi-urban community of Kerala State.

A community-based longitudinal study was initiated in 1983 in a semi-urban area, endemic for bancroftian filariasis to determine the incidence and prevalence, natural history and clinical pattern of filarial infection and also to study the impact of control measures on it. The base-line filariometric indices observed during the initial clinico-parasitological survey and entomological observations made during the first 12 months of this study are highlighted in this paper. 5.5 per cent of the examined population had microfilaraemia with average infestation of 8.1 per 20 cmm. The microfilaraemia found to have significant (P less than 0.001) relationship with age, but not with sex (P greater than 0.05). The filarial disease which had the prevalence of 3.6 per cent showed a significant (P less than 0.001) relationship to both age and sex. The youngest microfilaria (mf) carrier was of 2 years and with filarial swelling was of 6 years age. A significant (P less than 0.001) relationship of educational status and family size was observed with disease while it was non-significant (P greater than 0.05) with microfilaraemia. With the increase in per capita income of the individuals, a significant decrease in number of persons with microfilaraemia (P less than 0.01) as well as with disease (P less than 0.05) was noted. Culex quinquifasciatus, the vector for this infection was prevalent throughout the period of observation with highest density in September. Vector infection and infectivity rates ranged from 0 to 4.4 per cent and 0 to 2.2 per cent respectively.