Profile and Geospatial Analysis of Dog Bite Cases Attending the Antirabies Vaccine Outpatient Department at the Tertiary Level Hospital of Mumbai.

BACKGROUND: Dog bites pose a significant public health concern in India, necessitating an understanding of their epidemiological profile and spatial distribution. Adopting the One Health approach, which considers the interconnection of human, animal, and environmental health, is vital for developing effective interventions. OBJECTIVES: The study aimed to assess the epidemiological profile and geospatial trends of dog bite cases in an urban area, focusing on the age and gender distribution of victims, severity of bites, and spatial distribution of cases to inform prevention strategies. MATERIALS AND METHODS: A retrospective secondary data analysis was conducted on dog bite cases reported in 2022 at a tertiary care hospital in Mumbai. The epidemiological profile, including age, gender, and severity of bites, was examined. Quantum Geographic Information System (QGIS) was utilized for spatial distribution analysis, identifying hotspots within the urban area. RESULTS: Of the 3350 cases, 70.7% were below 40 years old, 81.6% were male, and 78.18% had Category III bites indicating severe injuries. Most cases (74%) were caused by stray dogs. QGIS analysis revealed five hotspots within the urban area. CONCLUSION: The study highlights the predominance of dog bites among younger males and the severity of injuries. Spatial analysis identified specific hotspots, underscoring the need for targeted interventions. Implementing a comprehensive surveillance system incorporating GIS technology and adopting a One Health approach can enhance the control and prevention of dog bite cases and reduce the risk of rabies outbreaks.

TB notification rates across parliamentary constituencies in India: a step towards data-driven political engagement.

OBJECTIVE: National averages obscure geographic variation in program performance. We determined Parliamentary Constituency (PC)-wise estimates of TB notification to guide political engagement. METHODS: We extracted district-level TB notification data from the 2018 annual TB report. We derived PC-level estimates by building a 'cross-walk' between districts and PCs using boundary shapefiles. We described the spatial distribution of the PC-wise estimates of Total Notification Rate and percentage of Private Sector Notification. RESULTS: The median PC-wise Total Notification Rate was 126.24/100 000 (IQR: 94.86/100 000, 162.22/100 000). The median PC-wise Percentage Private Sector Notification was 18.03% (IQR: 9.56%, 26.84%). Only 16 (2.94%) PCs met the target of 50% private sector notification. Most of high notification rates in PCs were driven by high notification in public sector. There was geographic - both interstate and within state inter-PC - variation in the estimates of these indicators. The study identified some geographic patterns of notification - high positive outlier PCs with adjoining PCs in lower deciles of notification rates, intra-state differences in PC performance, and similarities in notification rates of adjoining PCs in different states. CONCLUSION: In addition to regional inequality, the study identified geospatial patterns that can aid in the formulation of suitable interventions. These include decongestion of overburdened facilities by strengthening poorly performing units. The PCs with a high percentage Private Sector Notification can act as role models for neighbouring PCs to improve private sector engagement. MPs can play a crucial role in mobilising additional resources, creating awareness, and establishing inter-PC and inter-state collaboration to improve TB program performance.

Tuberculosis patients not covered by treatment in public health services: findings from India's National Family Health Survey 2015-16.

OBJECTIVE: Half of the TB patients in India seek care from private providers resulting in incomplete notification, varied quality of care and out-of-pocket expenditure. The objective of this study was to describe the characteristics of TB patients who remain outside the coverage of treatment in public health services. METHODS: Cross-sectional data from National Family Health Survey-4 (2015-16) were analysed using logistic regression analysis. TB treatment was the dependent variable. Sociodemographic factors and place where households generally seek treatment were independent variables. RESULTS: Prevalence of self-reported TB was 308.17/100 000 population (95% CI: 309.44-310.55/100 000 population) and 38.8% (95% CI: 36.5-41.1%) of TB patients were outside care of public health services - 3.3% did not seek treatment and 35.3% accessed treatment from private sector. Factors associated with not seeking treatment were age <10 years [OR = 3.43; 95% CI (1.52-7.77); P = 0.00]; no/preschool education [OR = 1.82; 95% CI (1.10-3.34); P = 0.02]; poorest wealth index [OR = 1.86; 95% CI (1.01-3.34); P = 0.04] and household's general rejection of the public sector when seeking health care [OR = 1.69; 95% CI (1.69-2.26); P = 0.00]. Factors associated with seeking treatment from private providers were female sex [OR = 1.29; 95% CI (1.11-1.50); P = 0.001], younger age of the patient [OR = 2.39; 95% CI (1.62-3.53); P = 0.00], higher education [OR = 1.82; 95% CI (1.11-2.98); P = 0.02] and household's general rejection of the public sector when seeking health care [OR = 4.56; 95% CI (3.95-5.27); P = 0.00]. Patients from households reporting 'poor quality of care' as the reason for not generally preferring public health services were more likely (OR = 1.48, 95% CI = 1.19-1.65; P = 00) to access private treatment. CONCLUSION: The study provides insights for efforts to involve the private health sector for accurate surveillance and patient groups requiring targeted interventions for linking them to the national programme.

Addressing knowledge gaps and prevention for tuberculosis-infected Indian adults: a vital part of elimination.

BACKGROUND: India plans to eliminate tuberculosis (TB) by 2025, and has identified screening and prevention as key activities. Household contacts (HHCs) of index TB cases are a high-risk population that would benefit from rapid implementation of these strategies. However, best practices for TB prevention and knowledge gaps among HHCs have not been studied. We evaluated TB knowledge and understanding of prevention among tuberculin skin-test (TST) positive HHCs. While extensive information is available in other high-burden settings regarding TB knowledge gaps, identifying how Indian adult contacts view their transmission risk and prevention options may inform novel screening algorithms and education efforts that will be part of the new elimination plan. METHODS: We approached adult HHC to administer a questionnaire on TB knowledge and understanding of infection. Over 1 year, 100 HHC were enrolled at a tertiary hospital in Pune, India. RESULTS: The study population was 61% (n = 61) female, with a mean age of 36.6 years (range 18-67, SD = 12). Education levels were high, with 78 (78%) having at least a high school education, and 23 (24%) had at least some college education. Four (4%) of our participants were HIV-infected. General TB knowledge among HHC was low, with a majority of participants believing that you can get TB from sharing dishes (70%) or touching something that has been coughed on (52%). Understanding of infection was also low, with 42% believing that being skin-test positive means you have disease. To assess readiness for preventive therapy, we asked participants whether they are at a higher risk of progressing to active disease because of their LTBI status. Fifty-four (55%) felt that they are at higher risk. Only 8% had heard of preventive therapy. CONCLUSION: Our TB knowledge survey among HHCs with evidence of recent exposure found that knowledge is poor and families are confused about transmission in the household. It is imperative that the Indian program develop tools and incentives that can be used to educate TB cases and their families on what infected HHCs can do to prevent disease, including preventive therapy.

Experiences from a COVID-19 vaccination center at a tertiary care teaching hospital in Delhi, India: Challenges and solutions.

India began its nationwide coronavirus disease 2019 (COVID-19) vaccination program on January 16, 2021, in a phased manner. In this paper, we have discussed our experience at one of the COVID-19 vaccination centers in the country and have identified a few of the major challenges and their implications. The guidelines for COVID-19 vaccination in the country were changing frequently, leading to ambiguity among the beneficiaries. Co-WIN software, used for program implementation, had some glitches, which caused dissatisfaction among the service providers and beneficiaries. Vaccine hesitancy and eagerness caused low vaccine uptake initially and overcrowding at vaccination centers later. Some of the vaccination centers had the potential to become hot spots for further spread of the virus due to insufficient infrastructure. The disparity in access to vaccines for the homeless and other vulnerable groups was another hurdle for adequate vaccination coverage. These challenges could have been addressed by pretesting the information technology platform, long-term planning with a vision for handling vaccine hesitancy and eagerness, strong communication systems, removing disparities in vaccine access, and maintaining uniformity in messages for frequently updating guidelines.

Geographic Distribution and Temporal Trends of Zika Virus Outbreaks in India (2016-2023): Insights From the Integrated Disease Surveillance Programme Data.

Introduction This study examines the geographic distribution and temporal trends of Zika virus (ZIKV) outbreaks in India from 2016 to 2023 using data from the Integrated Disease Surveillance Programme (IDSP). The burden of ZIKV in India has risen due to its rapid spread and significant health impacts. Existing literature highlights seasonal and geographic patterns but lacks a comprehensive, long-term analysis specific to India. This study addresses this gap by analyzing trends over seven years to inform better public health responses. Methods A secondary data analysis was conducted using publicly available data from the IDSP on reported Zika cases from January 2016 to December 2023. Descriptive statistical methods and geographic information system (GIS) mapping techniques were employed to analyze the geographic distribution and temporal trends of ZIKV outbreaks in India. The data were analyzed and visualized using R software version 4.3.2 (R Foundation for Statistical Computing, Vienna, Austria), with heat maps and choropleth maps to identify hotspots, and line diagrams to identify temporal trends. Results Zika outbreaks predominantly occurred during the post-monsoon season, accounting for 47.62% (n = 10) of the total 21 outbreaks, followed by the monsoon season with 33.33% (n = 7), and summer with 19.05% (n = 4). Two deaths were reported during a significant outbreak in Madhya Pradesh in 2018. Temporal trends indicated notable spikes in cases in 2018 (131 cases) and 2021 (234 cases), with no cases reported in 2019 and 2020. The geographic distribution maps highlighted significant concentrations of ZIKV outbreaks in specific districts within Uttar Pradesh, Madhya Pradesh, and Kerala. Discussion The study identified seasonal patterns, with most cases occurring in the post-monsoon season. The geographic spread of the ZIKV was observed in eight states from 2016 to 2023. GIS identified three hotspots in Uttar Pradesh, Madhya Pradesh, and Kerala. Conclusion The study highlights the need for heightened surveillance and targeted intervention preparedness during high-risk seasons. Enhancing testing facilities and data reporting systems could improve outbreak identification, management, and response.

Glycated Hemoglobin Trajectories and Their Association With Treatment Outcomes Among Patients With Pulmonary TB in India: A Prospective Cohort Study.

BACKGROUND: Transient hyperglycemia is seen commonly during TB treatment, yet its association with unfavorable treatment outcomes is unclear. RESEARCH QUESTION: Does an association exist between glycated hemoglobin (HbA1c) trajectories and TB treatment outcomes? STUDY DESIGN AND METHODS: Adults with pulmonary TB were evaluated prospectively for 18 months after the second HbA1c measurement. HbA1c trajectories during the initial 3 months of treatment were defined as follows: persistent euglycemia, HbA1c < 6.5% at baseline and 3-month follow-up; persistent hyperglycemia, HbA1c ≥ 6.5% at baseline and 3-month follow-up; transient hyperglycemia, HbA1c ≥ 6.5% at baseline and < 6.5% at 3-month follow-up; incident hyperglycemia, HbA1c < 6.5% at baseline and ≥ 6.5% at 3-month follow-up. Multivariable Poisson regression was used to measure the association between HbA1c trajectories and unfavorable treatment outcomes of failure, recurrence, and all-cause mortality. RESULTS: Of the 587 participants, 443 participants (76%) had persistent euglycemia, 118 participants (20%) had persistent hyperglycemia, and 26 participants (4%) had transient hyperglycemia. One participant had incident hyperglycemia and was excluded. Compared with participants with persistent euglycemia, those with transient hyperglycemia showed a twofold higher risk of experiencing an unfavorable treatment outcome (adjusted incidence rate ratio [aIRR], 2.07; 95% CI, 1.04-4.15) after adjusting for confounders including diabetes treatment, and BMI; we did not find a significant association with persistent hyperglycemia (aIRR, 1.64; 95% CI, 0.71-3.79). Diabetes treatment was associated with a significantly lower risk of unfavorable treatment outcomes (aIRR, 0.38; 95% CI, 0.15-0.95). INTERPRETATION: Transient hyperglycemia and lack of diabetes treatment was associated with a higher risk of unfavorable treatment outcomes in adults with pulmonary TB.

Satisfaction among patients seeking services at an urban health training center during the COVID-19 pandemic in South Delhi, India.

Background: The COVID-19 pandemic has posed challenges to the provision of routine health services. As we continue providing non-COVID services, it is essential that the community perceives them to be satisfactory and safe to ensure optimum uptake. The objective of the study was to determine the satisfaction and perceived safety among patients availing services at an urban health training center (UHTC) during the COVID-19 pandemic in South Delhi. Methods: UHTC, Aliganj caters to a population of over 6000, in an urbanized village of South Delhi. A pre-designed, semi-structured questionnaire incorporating the North Indian OPD Satisfaction Scale along with questions on sociodemographic details and perception of safety was used. Systematic random sampling was used to select the patients from the study population which included those above 18 years attending UHTC from November-December 2020. Exit interviews were done by a trained independent interviewer to reduce bias. Data were analyzed in SPSS using Chi-square and Fisher's Exact tests. Results: Out of 218 patients, 161 (73.7%) were satisfied, 174 (79.8%) felt safe to visit UHTC during the pandemic and 143 (65.6%) felt both satisfied and safe. Patients were dissatisfied with screening for COVID-19 (29.5%), amenities (47.1%), cleanliness (51.8%), and waiting and registration (62.9%). Conclusion: The majority of patients were satisfied and found the UHTC services safe. A large proportion of patients found location, doctor-patient interaction, and COVID-appropriate behavior at the center to be satisfactory, but there was scope to improve waiting and registration, cleanliness, and effectiveness of screening for COVID.

Adherence to antiretroviral therapy.

INTRODUCTION: The goal of HAART is to achieve maximal and durable suppression of virus replication. Adherence plays a very important role in success of antiretroviral therapy. AIMS AND OBJECTIVES: To find out the rate of adherence and factors that influence adherence to antiretroviral therapy (ART). MATERIAL AND METHODS: The present study was conducted in the Department of Medicine in a tertiary care hospital from November 2007 to September 2009. Patients attending ART centre OPD and started on ART for at least 6 months were included in the study. A pretested proforma and MMAS adherence questionnaire of every patient was used for data collection. Univariate and multivariate logistic regression analysis was done to identify factors associated with adherence. OBSERVATIONS AND RESULTS: A total of 300 patients attending ART OPD and satisfying inclusion criteria were studied. Adherence rate of >95% was reported by 290 (97%) patients. On MMAS scale 78% of the patients were found adherent to the treatment. On multivariate analysis factors such as age, addictions, difficulty in remembering treatment, finding treatment to be difficult, taking traditional medicines and having no one to remind about medicines were found to be associated with nonadherence. The most common reason for nonadherence were missing pills while travelling or being out of home. CONCLUSIONS: Adherence to antiretroviral treatment in the ART centre is high. During counseling sessions giving up addictions, avoiding traditional medicines, addressing the apprehensions about treatment, and identifying reminder systems should be emphasized. The patients should be advised to carry medications while traveling and when away from home.

Contextualization of the trends in number of beneficiaries vaccinated at a COVID-19 vaccination centre in Delhi, India.

Background and aims: India started vaccination against COVID-19 on 16th January 2021. Present study was conducted to describe the trends in the number of beneficiaries vaccinated at a tertiary care hospital in India against the dynamic background of changing contextual factors. Methods: This was a descriptive records-based study conducted at one of the COVID vaccination centre from January 2021 to June 2021. Data on dose-wise daily number of beneficiaries in various categories were collected and analyzed using Excel. The website of the Ministry of Health and Family Welfare (MoHFW), India, press releases and news reports of major media houses were reviewed. Results: The peaks observed in number of beneficiaries vaccinated were mainly due to opening up of program for new categories of beneficiaries in a phased manner, announcements made to complete the vaccination coverage within a stipulated time for some categories and publication of trial results by vaccine manufacturers. The dips could be attributed to essential requirement of certain documents, major festivals, disastrous second wave and resulting lockdown in state. Conclusion: The time-trend may not remain uniform across the course, but can be predicted in advance to some extent by analyzing past trends. Minimizing the avoidable dips and peaks and managing the unavoidable ones will help in improving the service delivery and beneficiary satisfaction.

Trends in choosing place of delivery and assistance during delivery in Nanded district, Maharashtra, India.

Delivery in a medical institution promotes child survival and reduces the risk of maternal mortality. Many initiatives under the National Rural Health Mission (NRHM) focus on increasing the institutional deliveries. This study describes the trends in choosing place of delivery in Nanded district at the end of the first phase of the mission. Key informants were interviewed to document the initiatives under NRHM implemented in the district. A cross-sectional descriptive study was conducted in 30 villages selected using one stage cluster-sampling method. A house-to-house survey was conducted in June 2009. A set of structured open-ended questionnaire was used for interviewing all women who had delivered during January 2004-May 2009. The outcomes studied were place of delivery and assistance during delivery. Analysis was done by calculating chi-square test and odds ratio. Interventions to improve the quality of health services and healthcare-seeking behaviour were implemented successfully in the district. The proportion of institutional deliveries increased from 42% in 2004 to 69% in 2009. A significant increase was observed in the proportion of institutional deliveries [60% vs 45%; chi2 = 173.85, p < 0.05, odds ratio (OR) = 1.8 (95% confidence interval (CI) 1.65-1.97)] in the NRHM period compared to the pre-NRHM period. The deliveries in government institutions and in private institutions also showed a significant rise. The proportion of deliveries assisted by health personnel increased significantly during the NRHM period [62% vs 49%; chi2 = 149.39; p < 0.05, OR = 1.73, 95% CI 1.58-1.89]. However, less than 10% of the deliveries in the home (range 2-9%) were assisted by health personnel throughout the study period. There was a wide geographic variation in place of delivery among the study villages. The results showed a significant increase in the proportion of institutional deliveries and deliveries assisted by health personnel in the NRHM period. Since a less proportion of deliveries in the home is conducted by health personnel, the focus should be on increasing the institutional deliveries. Special and innovative interventions should be implemented in the villages with a less proportion of institutional deliveries.

Rollout of COVID-19 Vaccination in India: A SWOT Analysis.

OBJECTIVE: This study aimed to identify the strengths, weaknesses, opportunities, and threats (SWOT) in the rollout of the COVID-19 vaccination campaign in India. METHODS: The internal and external attributes affecting the vaccination rollout identifed by reviewing the scientific literature, government guidelines, and press statements, along with media reports, were categorized into the SWOT matrix. RESULTS: The existing immunization program, indigenous vaccine production, setting up of the National Expert Group on Vaccine Administration for COVID-19, updated guidelines, and training followed by dry runs were identified as strengths. The weaknesses identified in the program were knowledge gap about vaccines, apprehensions, lack of temperature loggers and vaccine vial monitors, space contraints in health care set up, demand supply gap, and digital divide. The experience of conducting the general elections, intersectoral coordination forged during the pandemic response, Information Technology platform, and vaccine eagerness present opportunities to strengthen the program. The emergence of virus variants, commercial interests, laxity in COVID-19 appropriate behavior, and receding wave of the pandemic can pose significant threats to the implementation of the vaccination campaign. CONCLUSION: The study identified factors that can aid designing effective measures and countermeasures for the COVID-19 vaccination rollout. This SWOT analysis is relevant to low- and middle-income countries planning to implement the COVID-19 vaccination in the near future.

COVID-19 vaccination in India: An ethical perspective.

BACKGROUND AND AIMS: COVID-19 had put world to a standstill with enormous morbidity and mortality. Vaccines' development against this provided a beacon of hope. India approved different vaccines under emergency use authorization but distribution of vaccines and vaccination of huge population was a challenging task. We attempted to review the vaccination program from an ethics perspective. METHODS: The core ethical principles of healthcare and other tenets put forth in discussion papers on addressing ethical issues in pandemic influenza planning, ethical considerations in developing a public health response to pandemic influenza and World Health Organization (WHO) Scientific Advisory Group for Emergencies values framework for the allocation and prioritization of COVID-19 vaccination were used to identify the ethical concerns in the vaccination program of the country. Relevant ministry guidelines, documents, websites etc., were accessed. RESULTS: The program tried addressing many of the ethical principles laid out in various international documents. Approving indigenously produced vaccines upheld the principle of utility while prioritizing health care workers for vaccination was an example of reciprocity. However, vaccine approval without availability of trial results in public domain raised apprehensions and lacked transparency. Lack of well-defined mechanism to facilitate vaccination for socially disadvantaged groups compromises equity. CONCLUSION: Overall, the program fared well on most aspects of ethical principles, but there were few gaps which still exist. These should be taken care of as the country advances further into vaccination program to garner enhanced public trust in the scientific, regulatory and administrative authorities.

COVID Appropriate Behavior Compliance and Vaccine Hesitancy: Findings From a COVID-19 Health Education Campaign in a Government Tertiary Care Hospital in Delhi, India.

Public health measures remain the best available approach to tackle the coronavirus disease 2019 (COVID-19) pandemic. However, little is currently known about the compliance and acceptance of these measures by people in India. The Department of Community Medicine at Vardhman Mahavir Medical College (VMMC), and Safdarjung Hospital, a tertiary care hospital in New Delhi, organized a health education campaign for raising awareness on COVID-19 in the hospital premises over a period of 15 d in May 2021. Educational and interactive sessions were conducted by medical residents, interns, and staff. Data on compliance to public health measures were collected and analyzed using SPSS 21. All quantitative variables were descriptively analyzed while qualitative data were narratively analyzed. A total of 84 (12.57%) of those observed were wearing their mask incorrectly. Social distancing was inadequate at 16 sites. Sixty-nine (10.33%) reported to have received single or both doses of vaccine. Common reasons for not getting vaccinated included doubts about vaccine efficacy, eligibility, adverse events, availability, and accessibility. Mask use was universal, but directives on correct protocol of wearing masks needs to be widely circulated. Credible information about vaccine safety, efficacy, availability, and accessibility needs to be available to the community to build confidence in COVID-19 vaccination.

Survival analysis and risk factors for death in tuberculosis patients on directly observed treatment-short course.

BACKGROUND: Tuberculosis is a disease with a high case fatality of 4.65%. OBJECTIVES: To describe the survival pattern of patients on Directly Observed Treatment-Short course (DOTS) according to categories, age and sex of patients. SETTINGS: Tuberculosis unit (TU) at District Tuberculosis Centre (DTC), Yavatmal, India. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Data of patients registered for DOTS in the year 2004 were collected from the tuberculosis register. STATISTICAL ANALYSIS: Kaplan Meier plots and log rank tests to assess the survival pattern. Cox proportional hazards model for multivariate analysis. RESULTS: A total of 716 patients were registered at the TU. The survival rates by the end of the intensive phase were 96%, 93% and 99% in categories I, II and III of DOTS, respectively. The cumulative survival rates were 93%, 88% and 96% in the three DOTS categories, respectively. There was a significant difference in the survival curves amongst the three DOTS categories (log rank statistic= 7.26, d.f..= 2, P=0 0.02) and amongst the different age groups [log rank statistic= 8.78, d.f.= 3, P= 0.012). There was no difference in the survival curves of male and female patients (log rank statistic= 0.05, d.f.= 1, P= 0.80) and according to type of disease (log rank statistic= 5.63, d.f.= 2, P= 0.05). On Cox proportional hazard analysis, age groups of 40 to 60 years [adjusted hazard ratio= 7.81 (1.002-60.87)] and above 60 years [adjusted hazard ratio= 21.54 (2.57-180.32)] were identified as significant risk factors for death. CONCLUSIONS: Age above 40 years is a significant risk factor for death in patients of tuberculosis. There was a significant difference in survival curves of the three DOTS categories and age groups.

Non - DOTS regimens under RNTCP: reasons for initiation and treatment outcome.

Nearly 1% of the patients registered under RNTCP are put on non-DOTS regimens. Understanding the reasons for initiation of non- DOTS and its treatment outcome is one of the priority areas on the research agenda of RNTCP. In phase I the data of patients put on non DOTS at two TUs under Yavatmal DTC from April 2005 to March 2007 was collected from TB registers and treatment cards. In Phase II the reasons for initiating non DOTS was assessed in a sub sample by conducting two Focus group discussions with the staff at one of the TUs. In Phase III a comparison of the treatment outcome was done between patients on DOTS and Non DOTS by matched pair analysis using McNemar's chi square test. A total of 40 (1.28%) patients were put on non-DOTS. Nearly 27% of the patients on non DOTS belonged to the paediatric age group. Only one new smear positive patient and 11% of patients on retreatment after default were initiated on non-DOTS. The reasons for initiation of non DOTS was discussed for 27 patients registered at one TU in the FGDs. The main reasons for initiation of non-DOTS in new patients were drug intolerance, drug toxicity, liver disease, immunocompromised patient on ART and migration. The reasons in retreatment cases were persistent default and chronic smear positivity. The risk of un favourable outcome was significantly more in patients on non- DOTS. Many of the reasons for initiation of non-DOTS in new cases i.e. drug toxicity, intolerance; liver disease will continue to be indications for non DOTS in RNTCP areas. In some special circumstances interventions like DOTS plus and availability of ART compatible with Rifampicin will be better options for management of Tuberculosis. Default is a problem at all levels of treatment and concerted and coordinated efforts from various levels are needed to prevent it. Community DOTS providers can be involved in the programme in case of migration, some cases of persistent default and paediatric cases. The availability of Paediatric patient wise boxes will make it easier for dispensing DOTs in Paediatric Tuberculosis.

Changing Scenario in Indian Contraceptive Methods: A Glimpse Through a Tertiary Hospital Statistics.

BACKGROUND: The patient scenario of a tertiary hospital changes with the implementation of various national programmes in any country. These programmes are conceived after understanding the felt need of the society. Though IUCD was available as an interval method of contraception in the past also and was meant to be effective for 10 years, the prerequisite to come again to the medical facility after 6 weeks of childbirth for insertion resulted in almost all patients to dropout and only the highly motivated would come on their own. Post-partum insertion of IUCD at the time of childbirth or within 48 h has addressed the need of contraception in the post-partum period as well as omitted the need for second visit to a health set-up. Earlier, after achieving the desired family goal of children, tubectomy was the preferred choice, irrespective of age of children but PPIUCD seems to have come up as a long-term reversible method of contraception. OBJECTIVE: The present study was conceived to study the shift of method of long-term contraception from tubal sterilization and vasectomy to PPIUCD over a period of 8 years from 2010 to 2017. METHOD: This study was a retrospective analytical study conducted at the Department of Obstetrics and Gynaecology in Safdarjung Hospital between the years 2010 and 2017. The number of IUCDs inserted post-placental (i.e. within 10 min of delivery of placenta) and within 48 h (of vaginal childbirth) and intra-caesarean (intrauterine insertion while performing caesarean) were recorded and analysed. Also, sterilizations (tubectomy) and interval IUCD insertions done during this time period were compared. RESULTS: With the introduction of PPIUCD in national family programme, more women are inclining towards long-term spacing method and not resorting to sterilizations. PPIUCD is preferred over interval IUCD. CONCLUSIONS: PPIUCD is there to stay as a method of long-term contraception.

Epidemiological profile of tuberculosis patients in Delhi, India: A retrospective data analysis from the directly observed treatment short-course (DOTS) center.

BACKGROUND: Tuberculosis (TB) has been a public health menace for decades. India harbors its highest burden globally. The present study was conducted to study the epidemiological profile of patients taking treatment from a directly observed treatment short-course (DOTS) center in Delhi, India. METHOD: Retrospective analysis of past 1-year treatment records of a total of 227 patients undergoing treatment in DOTS since June 2014-2015 was undertaken. Socio-demographic information, data related to disease status, and HIV testing were collected and analyzed. RESULTS: The majority of cases were new (77.1%) and pulmonary TB (69.2%). The highest disease burden was found in the 20-60 year age group (72.2%) and males (58.6%). Genitourinary TB was present only among females. None of the patients was HIV positive. A significant association was found between the age group of 20-60 years and relapse and loss to follow-up cases (P < 0.05). CONCLUSIONS: A higher proportion of adult males aged 20-60 years constituted the majority of patients treated in the DOTS center. Focussed interventions can be designed for this age group in future public health policies to reduce disease burden in the total population. Further research is required to be undertaken in exploring reasons for higher prevalence among males and productive age group and role of age, gender in disease causation.

High risk for latent tuberculosis infection among medical residents and nursing students in India.

Defining occupational latent tuberculosis infection (LTBI) risk among healthcare workers is needed to support implementation of prevention guidelines. Prospective cohort study of 200 medical residents and nursing students in India was conducted May 2016-December 2017. Tuberculin skin test (TST) and QuantiFERON TB Gold Test-in-tube (QFT-GIT) were performed at study entry and 12 months. Primary outcome was incident LTBI (≥10mm TST induration and/or ≥0.35IU/mL QFT-GIT) at 12 months; secondary outcomes included baseline LTBI prevalence and risk factors for incident and prevalent LTBI using Poisson regression. Among 200, [90 nursing students and 110 medical residents], LTBI prevalence was 30% (95% CI, 24-37); LTBI incidence was 26.8 (95% CI, 18.6-37.2) cases per 100 person-years and differed by testing method (28.7 [95% CI, 20.6-38.9] vs 17.4 [95% CI, 11.5-25.4] cases per 100 person-years using TST and QFT-GIT, respectively). Medical residents had two-fold greater risk of incident LTBI than nursing students (Relative Risk, 2.16; 95% CI, 1.05-4.42). During study period 6 (3%) HCWs were diagnosed with active TB disease. Overall, median number of self-reported TB exposures was 5 (Interquartile Range, 1-15). Of 60 participants with prevalent and incident LTBI who were offered free isoniazid preventive therapy (IPT), only 2 participants initiated and completed IPT. High risk for LTBI was noted among medical residents compared to nursing students. Self-reported TB exposure is underreported, and uptake of LTBI prevention therapy remains low. New approaches are needed to identify HCWs at highest risk for LTBI.

Cross-sectional study of psychiatric morbidity in patients with melasma.

CONTEXT: Patients with dermatological problems have higher prevalence of psychiatric illnesses than the general population. Melasma, hyperpigmentation of skin over sun-exposed areas, has bidirectional cause-effect relationship with depression and stress through psycho-neuro-endocrine pathways. AIMS: The aim of this study is to study the psychiatric morbidity and perceived stress in patients with melasma and statistically compare objective study parameters with those without melasma. SETTINGS AND DESIGN: This cross-sectional descriptive study was carried out in Tertiary hospital in urban setting, jointly by psychiatrist and dermatologist. METHODS AND MATERIALS: The study involved 50 consecutive patients with melasma and 30 relatives of patients coming to dermatology clinic not having any skin disorder. Cases were assessed by psychiatrist as per the International Classification of Diseases-10 Diagnostic Criteria for Research, Cohen's 4 item perceived stress scale, Disability Assessment Scale 2.0 by WHO and Hospital Anxiety Depression Scale (HADS) and Dermatologist calculated melasma area severity index score (MASI). RESULTS: Majority patients were females (88%) in the reproductive age group. The most common psychiatric morbidity seen in 42% cases was major depressive disorder. Adjustment disorder (26%) was the second most common diagnosis. Nonparametric analysis using Mann-Whitney U test revealed significantly more perceived stress (P = 0.001), more disability (P = 0.000) and anxiety-depression on HADS (P = 0.0 16) in cases than in their relatives. LIMITATIONS: This was a hospital-based study and thus melasma patients in the community are not represented. Small sample size, less number of controls, lack of structured diagnostic interview are other limitations of this study. CONCLUSIONS: There is high psychiatric comorbidity (76%) of depressive and stress disorders, higher functional disability and perceived stress in patients with melasma compared to controls.