Seasonal variations in social contact patterns in a rural population in north India: Implications for pandemic control

Social contact mixing patterns are critical to the transmission of communicable diseases and have been employed to model disease outbreaks including COVID-19. Nonetheless, there is a paucity of studies on contact mixing in low and middle-income countries such as India. Furthermore, mathematical models of disease outbreaks do not account for the temporal nature of social contacts. We conducted a longitudinal study of social contacts in rural north India across three seasons and analysed the temporal differences in contact patterns. A contact diary survey was performed across three seasons from October 2015-16, in which participants were queried on the number, duration, and characteristics of contacts that occurred on the previous day. A total of 8,421 responses from 3,052 respondents (49% females) recorded characteristics of 180,073 contacts. Respondents reported a significantly higher number and duration of contacts in the winter, followed by the summer and the monsoon season (Nemenyi post-hoc, p<0.001). Participants aged 0-9 years and 10-19 years of age reported the highest median number of contacts (16 (IQR 12-21), 17 (IQR 13-24) respectively) and were found to have the highest node centrality in the social network of the region (pageranks = 0.20, 0.17). Employed males across all age groups were found to have a higher number of contacts than unemployed males (Negative Binomial Regression: rate ratio 1.18, 95% CI: 1.05-1.31). A large proportion (>80%) of contacts that were reported in schools or on public transport involved physical contact. To the best of our knowledge, our study is the first from India to show that contact mixing patterns vary by the time of the year and provides useful implications for pandemic control. Our results can be used to parameterize more accurate mathematical models for prediction of epidemiological trends of infections in rural India.

Lessons for addressing noncommunicable diseases within a primary health-care system from the Ballabgarh project, India

Background: Most patients with noncommunicable diseases (NCDs) can bemanaged appropriately at the primary care level, using a simplified standardprotocol supported by low-cost drugs. The primary care response to commonNCDs is often unstructured and inadequate in low- and middle-income countries.This study assessed the feasibility of integration of NCD prevention and controlwithin the primary health-care system of India.Methods: This study was done among 12 subcentres, 2 primary health centres(PHCs) and one subdistrict hospital in a block in north India. All 28 multipurposehealth workers of these subcentres underwent 3-day training for delivering thepackage of NCD interventions as a part of their routine functioning. A time–motionstudy was conducted before and after this, to assess the workload on a sample ofthe workers with and without the NCD work. Screening for risk assessment wasdone at domiciliary level as well as at health-facility level (opportunistic screening),and the cost was estimated based on standard costing procedures. Individualswho screened positive were investigated with electrocardiography and fastingblood sugar. PHCs were strengthened with provision of essential medicines andtechnologies.Results: After training, 6% of the time of workers (n = 7) was spent in the NCDrelated activities, and introduction of NCD activities did not impact the coverage ofother major national health programmes. Loss during referral of “at-risk” subjects(37.5% from home to subcentre and 33% from subcentre to PHC) resulted inscreening efficiency being lowest at domiciliary level (1.3 cases of NCDs identifiedper 1000 screened). In comparison to domiciliary screening (`21 830.6; US$ 363.8per case identified), opportunistic screening at subdistrict level (`794.6; US$ 13.2)was 27.5 times and opportunistic screening at PHC (`1457.5; US$ 24.3) was 15.0times lower. There was significant utilization of NCD services provided at PHCs,including counselling.Conclusion: Opportunistic screening appears to be feasible and a cost-effectivestrategy for risk screening. It is possible to integrate NCD prevention and controlinto primary health care in India.

Prevalence of Irritable Bowel Syndrome: A Community Based Study From Northern India

BACKGROUND/AIMS: The prevalence of irritable bowel syndrome (IBS) varies from 4% to 20% in different Asian nations. Prevalence of IBS in native North Indian community is not known. METHODS: Between November 2008 to December 2009, we estimated the prevalence of IBS in a rural community of Ballabgarh block, located in Haryana state. A structured questionnaire based on Rome III module was used to collect symptoms related to IBS from all the participants in a door to door survey. A Rome III criterion was used for diagnosis of IBS. IBS was further classified based on predominance of symptoms as constipation predominant, diarrhea predominant, mixed and unspecified based on Rome III module. RESULTS: There were 4,767 participants (mean age 34.6 +/- 10.8, males 50%). Overall, 555 (11.6%; 95% CI, 10.7-12.5) had constipation, 542 (11.4%; 95% CI, 10.5-12.3) diarrhea and 823 (17.3%; 95% CI, 16.2-18.4) abdominal pain. The overall prevalence of IBS was 4% (95% CI, 3.5-4.6). The prevalence of constipation predominant IBS was 0.3% (95% CI, 0.16-0.49), diarrhea predominant IBS 1.5% (95% CI, 1.18-1.90), mixed IBS 1.7% (95% CI, 1.35-2.11) and unsubtyped IBS 0.5% (95% CI, 0.32-0.75). The prevalence of IBS was significantly higher in females compared with males (4.8% vs 3.2%, P = 0.008). However, there was no significant difference between males and females in the prevalence of different subtypes of IBS. The prevalence increased with age. CONCLUSIONS: The prevalence of IBS in a North Indian community is 4%. IBS poses a significant burden on the rural adults.