The impact of HIV/AIDS on the control of tuberculosis in India.

Epidemics of HIV/AIDS have increased the tuberculosis (TB) case-load by five or more times in East Africa and southern Africa. As HIV continues to spread, warnings have been issued of disastrous AIDS and TB epidemics in "new-wave" countries, including India, which accounts for 20% of all new TB cases arising in the world each year. Here we investigate whether, in the face of the HIV epidemic, India's Revised National TB Control Program (RNTCP) could halve TB prevalence and death rates in the period 1990-2015, as specified by the United Nations Millennium Development Goals. Using a mathematical model to capture the spatial and temporal variation in TB and HIV in India, we predict that, without the RNTCP, HIV would increase TB prevalence (by 1%), incidence (by 12%), and mortality rates (by 33%) between 1990 and 2015. With the RNTCP, however, we expect substantial reductions in prevalence (by 68%), incidence (by 41%), and mortality (by 39%) between 1990 and 2015. In India, 29% of adults but 72% of HIV-positive adults live in four large states in the south where, even with the RNTCP, mortality is expected to fall by only 15% between 1990 and 2015. Nationally, the RNTCP should be able to reverse the increases in TB burden due to HIV but, to ensure that TB mortality is reduced by 50% or more by 2015, HIV-infected TB patients should be provided with antiretroviral therapy in addition to the recommended treatment for TB.

Progress towards elimination of leprosy as a public health problem in India and role of modified leprosy elimination campaign.

India (population 943 million) has seen a highly significant decrease in the prevalence of leprosy since the introduction of multi-drug therapy (MDT) in 1981. From a prevalence rate of 57/10,000 of the population in March 1981, the figure has declined to 5.2/10,000 in March 1999. This was possible due to the creation of a completely vertical (specialized) infrastructure for leprosy control in the 218 endemic districts of the country and skeleton vertical staff in the remaining districts, coupled with the recruitment of additional staff on contract basis to provide MDT through vertical staff in endemic districts and mobile treatment units in the moderate and low endemic districts. Despite all efforts, however, new case detection has not shown a decline over the last 14 years due to the presence of hidden (and undiagnosed) cases. Therefore, in order to intensify and hasten progress towards elimination (less than 1 case per 10,000 of the population) in the whole country, it was decided to implement a massive leprosy elimination campaign (LEC) in all the States/Union Territories (UTs). The reports of 22 States/UTs indicate that 415 out of the total of 490 districts in the country were covered by modified LEC (MLEC), with 85% coverage of the population. The campaign used in India was modified from the pattern previously described by the World Health Organization. The detection of hidden or suspected cases took place within a short, intensive period of 6-7 days and relied heavily on house-to-house searches by General Health Care staff trained in leprosy detection and confirmation was made by appropriately trained staff. This MLEC received widespread Government and public support, resulting in the detection of 454,290 hidden cases of leprosy, whilst providing training to a large number of General Health Care staff and volunteers and creating widespread awareness about leprosy and the availability of treatment free of charge for all cases. This programme proved to be one of the most successful health care interventions undertaken in India in recent years, particularly in the states of Bihar and Orissa. Although a few states in India are unlikely to reach the current WHO goal of elimination before end of the year 2000, the results of the MLEC strongly support the possibility that elimination levels will be achieved in the majority of states by the end of the year 2000 and at national level by the end of the year 2002.

A survey on proportion of multibacillary cases of leprosy in Himachal Pradesh.

The present village survey indicates that though the percentage of Multi-bacillary cases remains high (50%) even after deducting the cases fit for discharge yet there is no evidence of high proportion of MB cases among newly detected cases. The percentage of MB cases among newly detected Leprosy cases is 16.7, but when old and new cases are put together and cases fit for discharge are deducted-the percentage of MB cases increases to 50. This high percentage of MB case is due to prolonged irregular treatment of old cases that are still clinically active, even after 10-30 years of treatment. The State level, district level/Leprosy Control Unit level data also indicated high percentage of MB cases which was mainly due to underdetection of cases particularly of Pauci-bacillary type, non-discharge of Multi-bacillary cases fit for discharge, prolonged irregular treatment of remaining MB cases that are active and due to various other contributory factors.

Laboratory study on the mosquito larvicidal properties of leaf and seed extract of the plant Agave americana.

Experiments on the leaf extract tested against three mosquito species led to 100% mortality of stage 4 Anopheles, Aedes and Culex larvae at a concentration of 0.08% within 24-48 h, whereas 100% mortality of stage 1 larvae occurred at lower concentrations: 0.0032% for Aedes aegypti, 0.016% for Culex quinquefasciatus and 0.08% for Anopheles stephensi, and was more rapid. At the end of 24 h, the highest dilution of the seed extract studied (1:200) produces a larval mortality of 100% for Anopheles and Aedes and 56% for Culex spp., when 4th instar larvae were exposed at room temperature. The comparative mortality in the control group was negligible. One hundred per cent mortality of Anopheles larvae took place by the end of 10 h, and of Aedes larvae by 17 h, at a dilution of 1:200 with water.