Therapeutic benefit of probiotic in alcohol dependence syndrome: Evidence from a tertiary care centre of India.

Probiotic adjuvant has promising effects in treating alcohol induced hepatitis, depression, and anxiety. This study aimed to assess the effectiveness of adjuvant probiotic use in improving the liver functions, anxiety, and depression among patients with alcohol dependence syndrome (ADS) in a tertiary care hospital in Andhra Pradesh, India. In this prospective observational design, ADS patients with or without probiotics were followed-up at one and three months after initiation of treatment. They were assessed for liver function test (LFT), anxiety by HAM-A and depression by HAM-D scale. A total of 120 patients complied with the treatment, 60 in each group, mean age being 35.0 years (SD 9.5 years). The baseline socio-demographic and clinical characteristics were similar in both the groups. Significant reduction was noted in the probiotic group for total bilirubin (Mean difference (MD) 0.18; 95 % CI: 0.04, 0.31), AST (MD 5.0; 95 % CI: 0.5, 9.5), and ALT (MD 8.6; 95 % CI: 1.4, 15.7) at one month after treatment. Both the groups showed a considerable change in anxiety and depression scores (HAM-A and HAM-D) till three months. At three months of treatment initiation, proportional improvement of severity grade to mild form in anxiety was more in the probiotic group (35 %) than the non-probiotic group (13.3 %) (p < 0.05). Hence, probiotic supplementation can significantly reduce the hepatic enzymes and depression severity in patients with alcohol dependence syndrome but demands additional robust evidence on the causal inference.

Prevalence of blindness and visual impairment in a coastal region of Southern India: A cross-sectional survey in Prakasam district, Andhra Pradesh.

PURPOSE: To estimate the magnitude, determinants, and causes of visual impairment (VI) and blindness among people >40 years. METHODS: In this cross-sectional survey, 2,968 people >40 years from 34 clusters were examined. A cluster random sampling method with a compact segment sampling technique was used to select the study participants. Prevalence of any VI (presenting visual acuity (PVA) <6/12 in better eye), severe VI (PVA <6/60 - 3/60), and blindness (PVA <3/60 in better eye) were expressed as percentage with 95% confidence interval. Logistic regression was performed to determine the risk factors associated with blindness. A P value of less than 0.05 was considered statistically significant. RESULTS: The mean age of the participants was 54.6 years (Standard deviation ± 11.2 years). The prevalence of mild, moderate, and severe visual impairment was 14.2% (12.95-15.49), 13.7% (12.46-14.97), and 0.7% (0.47-1.12), respectively. The prevalence of blindness was 1.3% (0.94-1.79, n = 39). The overall prevalence of VI (presenting Visual Acuity <6/12) was 12.0% (95% CI: 10.8-13.2%). The major causes of VI were cataract (78.08%), refractive error (12.07%), and optic atrophy (2.22%), and corneal opacity (2.22%) and the major cause of blindness was cataract (77.27%). Blindness was strongly associated with increasing age- OR 17.1 (95% CI: 4.9-59.8) for people >70 years, and OR 7.6 (95% CI: 2.2-26.5) for people aged between 60 and 69 years compared to those aged 41-50 years and people living near coastal regions (Within 50 km of coast) (OR: 3.9, 95% CI: 1.6-7.3). CONCLUSION: Blindness and vision impairment are of public health concern in this geographic region. Eye care services need to be augmented to address this challenge.

Structured Counselling and Regular Telephonic follow up to improve Referral flow and compliance in Nepal for Diabetic Retinopathy(SCREEN-D Study): a randomised controlled trial.

BACKGROUND: Diabetic Retinopathy (DR) is an emerging public health issue, leading to severe visual impairment or blindness. Early identification and prompt treatment play a key role in achieving good visual outcomes. The objective of the study was to estimate the effectiveness of SCREEN package on improving referral compliance from peripheral centres to a tertiary eye centre in Nepal. METHODS: In this facility-based cluster-randomized trial, ten out of 19 referring centres of the tertiary eye care centre in Lumbini zone, Nepal were randomized into intervention and control groups. A SCREEN packagewereprovided as intervention for DR patients who require advanced treatment in the tertiary centres and was compared with the current practice of the control arm, where structured counselling and follow-up mechanism are absent. Compliance was estimated by a weekly follow-up between the referring centre and the referred hospital. RESULTS: We recruited 302 participantsof whom 153 were in the intervention arm. The mean age of the participants was 57.8 years (Standard deviation [SD]±11.7 years). With implementation of SCREEN package71.2% (n=109) in the intervention group and 42.9% (n=64) in the control group were compliant till three months of follow-up (Difference 28.3%, 95% CI: 17.6- 39.0, p<0.05). Compliance was 43% (n=66) with counselling alone, and 66% (n=103) with first telephonic follow-up in the intervention arm. The mean duration to reach the referral centre was 14.7 days (SD± 9.4 days) and 18.2 days (SD± 9.1 days) in the intervention and the control arm, respectively (Difference 3.5 days, 95% CI: 0.7 to 6.4 days). CONCLUSIONS: Counselling& follow-up to patients is the key factor to improve the utilization of the health services by patients with DR. Health systems must be strengthened by optimizing the existing referral structure in Nepal. TRIAL REGISTRATION: ClinicalTrials.gov Protocol Registration and Results System, ClinicalTrials.gov Identifier: NCT04834648 , 08/04/2021.

Prospective cohort study of surgical site infections following single dose antibiotic prophylaxis in caesarean section at a tertiary care teaching hospital in Medchal, India.

BACKGROUND: Caesarean section (CS) is considered to be a life-saving operative intervention for women and new-borns in certain antepartum and intrapartum conditions. Caesarean delivery may be accompanied by several complications including surgical site infections (SSI). However, there is a significant lack of uniformity in the administration of antibiotics for preventing surgical site infections (SSI) following caesarean deliveries. The present study was conducted to determine the incidence of post CS SSI following the adoption of single-dose antibiotic prophylaxis as recommended by WHO at a tertiary care teaching hospital in Medchal, India. Also, to identify the risk factors of SSI and reported the bacteriological profiles and the antimicrobial susceptibility pattern of the culture positive isolates. MAIN OBJECTIVES: To estimate the incidence of surgical site infections (SSI's) according to CDC criteria following WHO-recommended single-dose antibiotic prophylaxis for caesarean section at a tertiary care teaching hospital in Medchal, India. METHODS: A prospective hospital-based study was conducted between June 2017 and December 2019, in which women who underwent caesarean delivery were followed up for 30 days post-delivery. Clinical details were collected using a structured questionnaire, and participants were followed up weekly after discharge to document any signs and symptoms of SSI. Symptomatic patients were requested to come to the hospital for further investigation and treatment. Standard microbiological tests were conducted to detect microorganisms and their antibiotic sensitivity. RESULTS: The study included 2,015 participants with a mean age of 24.1 years. The majority were multigravida (n = 1,274, 63.2%) and underwent emergency caesarean delivery (n = 1,232, 61.1%). Ninety two participants (4.6%, 95% CI: 3.7% to 5.6%) developed surgical site infections, with 91 (98.9%) having superficial and 1 (1.1%) having a deep infection. Among those who developed an SSI, 84 (91.3%) did so during their hospital stay, while 8 (8.7%) developed an SSI at home. The adjusted relative risk (a RR) for developing an SSI was 2.5 (95% CI: 1.4 to 4.6; power 99.9%) among obese women and 2.3 (95% CI: 1.1 to 4.7; power 100%) among women aged 25 years or younger. Microbial growth in culture was observed from 55 (75.8%) out of total 66 samples. The most common organisms identified were Staphylococcus aureus (n = 7(12.3%)23, 46.0%), Klebsiella sp. (n = 13, 26.0%), and Escherichia coli (n = 12, 24.0%). CONCLUSION: The rate of SSI following caesarean deliveries subjected to single dose antibiotic prophylaxis was low. Young women and obese women were at high risk of developing SSI.

Prevalence of goitre and iodine deficiency among school children (6-12 years) in rural areas of North Karnataka, India: A cross-sectional survey, 2016-19.

Introduction: Iodine deficiency disorders (IDD) have remained an unresolved public health problem in India. In this survey, we have estimated the prevalence of IDD among 6-12 years of school children in rural areas of north Karnataka, India and estimated the prevalence of low iodine content (<15 ppm) in salt at the household level and urine iodine excretion in this population. Material and Methods: In this cross-sectional survey, we recruited 16,827 children between 6 and 12 years of age through multistage sampling from six districts. Goitre was examined clinically for all children. Household-level salt iodine estimation and urinary iodine estimation were carried out among a subset of the participants. Results: Overall prevalence of goitre was 17.1% (95% CI: 16.5, 17.7). Out of this, 76.7% (n = 2116) had Grade-1 goitre, and 23.7% (n = 656) had Grade-2 goitre. The prevalence of goitre was higher among females (17.9%, vs. male 16.4%, P < 0.05). The prevalence of low iodine content (<15 ppm) in salt was 48.5% (95%CI: 46.7, 50.3). The overall median iodine excretion in urine was 85 µg/L (IQR: 60-150 µg/L). In total, 37.2% (n = 601) had mild iodine deficiency, 5.2% (n = 84) had moderate deficiency, and 10.1% (n = 163) had severe deficiency. All parameters showed high inter- and intradistrict variations. Conclusion: North Karnataka has a high goitre prevalence. Low use of iodized salt can be a major reason for the high prevalence of the condition. Ensuring the availability of iodized salt in this region and periodic surveillance to measure the impact of the programme should be the priority in this region.

Infertility Management in India: Issues and Potential Solutions.

Infertility is a significant global issue affecting numerous couples, with India experiencing a considerable prevalence. Limited access to assisted reproductive technology centers and social stigmas result in underreporting and low service utilization. The financial burden of infertility treatment is substantial due to high costs and lack of insurance coverage. The absence of national guidelines and monitoring raises concerns about unethical practices. Standardizing ART practice and infertility management guidelines, integrating care into primary healthcare, and raising awareness to reduce social stigma can enhance the quality and accessibility of infertility treatment.

The epidemiological and mycological profile of superficial mycoses in india from 2015 to 2021: A systematic review.

Background: The epidemiological and mycological patterns of superficial mycoses across various geographic regions of India across the last few years are changing. Objective: This study was performed to evaluate the epidemiological and mycological profile of superficial mycoses in India between 2015 and 2021. Methods: In this systematic review, the PubMed database was searched for all observational studies published between January 1, 2015, and December 31, 2021, which had evaluated the clinico-mycological profile of superficial mycoses among outpatients from various parts of India. Descriptive statistics was used to represent the results. Results: Forty studies (21 from the north, three from the northeast, five from the east, seven from the south, one from the west, and three from multiple regions of India) were included. Male patients and those of the age group of 21-40 years were most commonly affected. The proportion of dermatophytes as causative organisms was consistently high across all regions and throughout the study period (23.6%-100%). Among dermatophytes, the proportion of Trichophyton mentagrophyte (14.0%-97.2%) and Trichophyton rubrum (0%-69.1%) was consistently high across all regions. The prevalence of T. mentagrophyte showed a rising trend, while that T. rubrum showed a declining trend from 2015 to 2021. Conclusions: The epidemiological and mycological pattern of superficial mycoses showed a fairly similar trend across various regions of India from 2015 to 2021. Dermatophytes were the main causative agents of superficial mycoses; the most common species were T. mentagrophyte and T. rubrum. A rising trend of T. Mentagrophyte infection was found.

Medication adherence and environmental barriers to self-care practice among people with diabetes: A cross-sectional study in a lifestyle clinic in eastern India.

Objective: The study was conducted to estimate the prevalence of non-adherence to medications among patients with type 2 diabetes attending a lifestyle clinic in a tertiary care hospital in West Bengal, India; to identify the environmental barriers to self-care practices, including diet, exercise, glucose testing and medication; and to identify the socio-demographic and environmental determinants of medication non-adherence. Methods: A cross-sectional study was performed among the patients with type 2 diabetes taking oral hypoglycemic drugs and attending a lifestyle clinic of a teaching hospital in 2021. The participants were interviewed in clinical settings via a structured questionnaire in the local language. Medication adherence was assessed with Morisky Medication Adherence Scale-8 (MMAS), and environmental barriers were assessed with the Environmental Barrier Assessment Scale (EBAS). Results: Among 178 participants, a high level of adherence (MMAS score 8.0) was found among 3 (1.7%) participants, and moderate adherence (MMAS score 6.0 to 7.75) was found among 67 (37.6%; 95% CI 30.3%, 44.9%) participants. The prevalence of non-adherence was 60.7% (95% CI: 53.4%, 68.0%). The overall mean barrier score was 134 (SD 13). All environmental barrier components were distributed equally among the predictor variables except the diet score, which was lower among men (mean difference 1.3; 95% CI: 0.04, 2.5) and people with higher education (mean difference 1.8; 95% CI: 0.6, 3.1). Conclusion: The study indicated poor adherence to OHA in this population. Barriers to self-care practice and medication adherence were observed acrross all socio-economic strata. Poor medication adherence poses a major challenge to clinicians and public health experts in achieving treatment goals.

Infertility Burden Across Indian States: Insights from a Nationally Representative Survey Conducted During 2019-21.

Background: Infertility is an escalating global concern, impacting approximately one-sixth of the reproductive age population worldwide. Employing data from the National Family Health Survey-5 (NFHS-5, 2019-21), this study assessed the prevalence of primary infertility at both national and state levels in India. Methods: The data of the study was extracted from the National Family Health Survey and Individual file (women file) of the fifth round of NFHS encompassing a sample of 491,484 currently married women in the age group of 15-49 years. Results: The findings showed that the prevalence of infertility is 18.7 per 1,000 women among those married for at least five years and currently in union. This prevalence increases as the duration of marriage decreases. On a state-level analysis, regions such as Goa, Lakshadweep, and Chhattisgarh exhibit the highest burdens. Conclusion: These findings underscore the growing challenge posed by primary infertility in India, calling for targeted interventions and policy measures. The establishment of a national infertility surveillance system is of pivotal importance in addressing this pressing public health issue.

Clinical, laboratory and high-resolution computed tomography (HRCT) thorax profile of reverse transcription polymerase chain reaction (RT-PCR) negative COVID-19 suspects with moderate to severe disease.

BACKGROUND: Diagnostic dilemma arises when patients with clinical suspicion of COVID-19 disease having moderate-to-severe respiratory symptoms yield negative result for COVID-19 in reverse transcription polymerase chain reaction (RT-PCR). This study evaluated the clinical, laboratory and HRCT thorax findings among RT-PCR-negative COVID-19 suspects with moderate-to-severe disease. MATERIALS AND METHODS: A hospital-based retrospective observational study was conducted between July 2021 to December 2021, among 60 moderate and severe symptomatic COVID-19 suspects admitted in the severe acute respiratory illness (SARI) ward and intensive care unit (ICU), who were negative for COVID-19 in RT-PCR. Data were abstracted from the medical records section of the hospital using a predesigned data abstraction form and presented by descriptive statistics. RESULTS: Mean age of study participants was 55.5 years (SD 14.1 years), and majority were males (n = 43, 71.7%). Common presenting symptoms were fever (n = 60, 100%), dyspnea (n = 57, 95%), and cough (n = 54, 90%). The common laboratory findings were rise of C-reactive protein (n = 60, 100%), NLR (n = 49, 81.7%), d-dimer (n = 47, 78.3%), ferritin (n = 46, 76.7%), and LDH (n = 40, 66.7%). HRCT scan of thorax revealed ground glass opacities with or without consolidations located bilaterally with diffuse or peripheral distribution, interlobar septal thickening (n = 43, 74.1%), vascular thickening (n = 35, ≥58.3%), and sub-pleural lines (n = 32, 53.3%). Median CT-SS value was 15 (IQR 11-19), and majority (n = 56, 93.3%) belonged to CO-RADS ≥4. CONCLUSION: Diagnosis of COVID-19 can be presumed in RT-PCR-negative suspected COVID-19 patients with moderate-to-severe disease, with marked rise of inflammatory markers and HRCT revealing typical findings of COVID-19 pneumonia.

HIV care policy in India: A review of social security schemes.

Social protection schemes are available in India to mitigate the various challenges faced by people living with human immunodeficiency virus (PLWH) infection. The availability of the schemes should be uniform across the country and based on the rights of these people. We reviewed the schemes available in the high PLWH-burdened states of the country for the year 2019. We identified 83 social protection schemes for the PLWH in 13 representative states from different zones of India. The number of schemes was as low as two in the states of Mizoram and Telangana and 12 schemes in Rajasthan. Most of the schemes belong to the 'health' category (n = 26, 31.3%), nutrition (n = 14, 16.9%), financial aid (n = 12, 14.5%), insurance (n = 11, 13.5%), employment generation (n = 3, 3.6%), housing (n = 3, 3.6%), and legal support (n = 5, 6.0%). While health-related schemes are present in all the states, the distribution of the other social schemes varies widely across the states. The schemes commonly address the social safety of the children affected by human immunodeficiency virus (HIV), nutritional supplementation, direct financial assistance or subsidized services, and employment generation but vary considerably regarding the type and the number of services. We strongly recommend for evidence-based policy decision to provide uniform social schemes for PLWH.

Effectiveness of BBV152/Covaxin and AZD1222/Covishield vaccines against severe COVID-19 and B.1.617.2/Delta variant in India, 2021: a multi-centric hospital-based case-control study.

OBJECTIVES: India introduced BBV152/Covaxin and AZD1222/Covishield vaccines in January 2021. We estimated the effectiveness of these vaccines against severe COVID-19 among individuals aged ≥45 years. METHODS: We did a multi-centric, hospital-based, case-control study between May and July 2021. Cases were severe COVID-19 patients, and controls were COVID-19 negative individuals from 11 hospitals. Vaccine effectiveness (VE) was estimated for complete (2 doses ≥ 14 days) and partial (1 dose ≥ 21 days) vaccination; interval between two vaccine doses and vaccination against the Delta variant. We used the random effects logistic regression model to calculate the adjusted odds ratios (aOR) with a 95% confidence interval (CI) after adjusting for relevant known confounders. RESULTS: We enrolled 1143 cases and 2541 control patients. The VE of complete vaccination was 85% (95% CI: 79-89%) with AZD1222/Covishield and 71% (95% CI: 57-81%) with BBV152/Covaxin. The VE was highest for 6-8 weeks between two doses of AZD1222/Covishield (94%, 95% CI: 86-97%) and BBV152/Covaxin (93%, 95% CI: 34-99%). The VE estimates were similar against the Delta strain and sub-lineages. CONCLUSION: BBV152/Covaxin and AZD1222/Covishield were effective against severe COVID-19 among the Indian population during the period of dominance of the highly transmissible Delta variant in the second wave of the pandemic. An escalation of two-dose coverage with COVID-19 vaccines is critical to reduce severe COVID-19 and further mitigate the pandemic in the country.

"Design and implementation challenges of massive open online course on research methods for Indian medical postgraduates and teachers -descriptive analysis of inaugural cycle".

BACKGROUND: In view of the growing popularity, reach and access for Massive Open Online Courses (MOOCs), India's apex body for medical education, the National Medical Commission (NMC) mandated uniform foundational course on research methods for the medical post graduates (PGs) and faculty members of the medical institutions under NMC as MOOC. This course is a pioneering effort in the field of India's PG medical education. NMC entrusted Indian Council of Medical Research (ICMR)-National Institute of Epidemiology (NIE) to design and offer the MOOC, named as Basic Course in Biomedical Research (BCBR). We describe the experience of designing and that of implementation challenges in the inaugural cycle of the course. METHODS: The course objective was to inculcate the fundamental concepts in research methods covering epidemiology and biostatistics in the form of video lectures, resource materials, discussion forum, assignments, feedback and a final proctored examination. The course was delivered over 16 weeks through MOOCs platform under the Indian Ministry of Education. We reviewed records, documents and faculty notes and described the course conceptualization, development, design and implementation process. We abstracted information from course portal on enrolment profile of the participants, self-reported course feedback (structured and open-ended on format, lectures and quality of contents), examination registration form, scores obtained in the assignments/examination and that of the participant queries. We described quantitative data using descriptive statistics. We presented the thematic analysis of qualitative data from open-ended questions in the feedback system and that of email interactions. RESULTS: The inaugural cycle (September-December 2019) was taken by 24,385 participants. Majority, 15,879 (65%) were from medical background. 13,242 (54%) were medical postgraduates and 2637 (11%) were medical teachers. Among the enrolled, 14,720 (60%) cleared the assignments. A total of 11,392 (47%), 8,205 (62%) medical PGs and 896 (34%) faculty members successfully completed the course. Feedback from 1305 (5%) participants had mean score of 4.5/5 (±0.7) for quality of teaching. We faced challenges in customizing the course for medical participants, unawareness among target group, digital illiteracy and the ongoing pandemic. CONCLUSIONS: During the inaugural cycle of the online Basic Course in Biomedical Research course, nearly half of the enrolled participants successfully completed and received the certificate. India's MOOC for enhancing research capabilities of future medical researchers encountered successes and challenges. Lessons learnt from the inaugural cycle will guide future directions and to address larger issues in terms of sustainability and replication by stakeholders in medical education in India or elsewhere.

Electronic versus paper-based data collection for conducting health-care research: A cost-comparison analysis.

Background: Containing expenditure and efficient resource use is essential to limit the increasing costs of health research. Electronic data collection (EDC) is thought to reduce the costs compared to paper-based data collection (PDC). Objectives: As economic evidence in this area is scanty, especially in low- and middle-income countries, the objectives of the study are to perform an economic evaluation and compare the cost between EDC and PDC. Methods: A cost-comparison study was conducted to compare between EDC and PDC from the institutional perspective for the year 2018, based on a community-based survey. Step-down cost accounting was adopted with a bottom-up approach for cost estimation. Total and unit costs were estimated with the base case comparison between EDC and PDC while using SPSS software (e-SPSS and p-SPSS, respectively). We conducted scenario analyses based on the usage of different software, R and STATA for both EDC and PDC (e-R, p-R, e-STATA, and p-STATA, respectively). One-way and probabilistic sensitivity analysis (PSA) was performed to examine the robustness of the observed results. Results: In the base-case analysis, total costs of EDC and PDC were ₹72,617 ($1060.9) and 87,717 ($1281.5), respectively, with estimated cost reduction of ₹15,100 ($220.6). In other scenarios, the estimated cost reduction for e-R, e-STATA, p-R, p-STATA was ₹-274 ($4.0), 98 ($1.4), 14826 ($216.6), and 15,002 ($219.2), respectively, when compared to EDC-SPSS. On one-way and PSA, the results of the cost-comparison analysis were robust. Conclusion: EDC minimizes institutional cost for conducting health research. This finding will help researchers in efficiently planning for the budget for their research.

Development of a community orientation program (COP) as a community-based medical education method for undergraduate medical students: an experience from India.

BACKGROUND: Intra-regional cultural and linguistic differences are common in low- and middle-income countries. To sensitise undergraduate medical students to the social and contextual determinants of health to achieve the 'health for all' goal, these countries must focus on innovative teaching methods. The early introduction of a Community Orientation Program (COP) as a Community-based Medical Education (CBME) method could be a game changing strategy. In this paper the methods, evaluation, and implication of the COP in an Indian setting are described. METHODS: The curriculum of the COP was developed based on the analysis, design, development, implementation, and evaluation (ADDIE) model for educational intervention. In this learner-centric and supervised educational program, the key aim was to focus on developing students' communication skills, observation power and enhancing their motivation for learning through collaborative learning. To meet the objectives of the COP, a situated learning model under the constructivism theory was adopted. RESULTS: Between 2016 and 2019, 557 students were trained through the COP by visiting more than 1300 households in ten villages. To supplement the students' observations in the community, more than 150 small group discussions, a health education programme for the community and summary presentations were conducted. The students' feedback indicated the need to improve the clinical examinations demonstration quality and increase the number of instruments for clinical examinations. More than 80% of students felt that the program would assist them to improve their communication skills, their understanding of the various socio-demographic factors associated with the common diseases, and it will enable them to respect the local culture during their clinical practice. CONCLUSIONS: Early initiation of the COP as a CBME method in the undergraduate medical curriculum in an Indian setting has shown promising results. Further evidence is required to adopt such a program routinely for under-graduate medical teaching in the low- and middle- income settings.

Epidemiology of hospital-based COVID- 19 cluster in a tertiary care cancer hospital, Chennai, India 2020.

OBJECTIVES: To identify risk factors associated with Coronavirus disease 2019 (COVID-19) in a Tertiary care cancer hospital-based cluster and recommend control measures. METHODS: We conducted tracing and confirmation among hospital and community contacts. We telephonically interviewed and abstracted information from hospital records and registers. We described the cluster by time, place and person. We conducted unmatched case-control study to compare risk factors and computed Odds Ratio (OR) and 95% confidence interval. RESULTS: We confirmed COVID-19 in 21 of 1478 tested (1.4%). Secondary attack (%) of COVID-19 among 824 contacts was higher among in-patients of block A (18), household contacts (3.4), housekeeping staff (3.3) and nurses (1.7). The cluster started on April 22 with two successive peaks five days apart and lasted until May 8. Being male, patients aged >33 years [OR = 30·7; 95% CI = 3·6 to 264], having hypertension [OR = 4·3; 95% CI = 1·1 to 16·7] or diabetes [OR = 3·8; 95% CI = 1·0 to 14·1] were associated with COVID-19. Mask compliance was poor (20%) among hospital workers. DISCUSSION: We recommended screening of all patients for diabetes and hypertension and isolation/testing of anyone with influenza-like illness for preventing COVID-19 clusters in hospital settings.

Water quality, sanitation, and hygiene among the tribal community residing in Jawadhi hills, Tamilnadu: An observational study from Southern India.

OBJECTIVES: To assess the water, sanitation, and hygiene (WASH) practice among the tribal population of Tamil Nadu, India and to determine the physiochemical and bacteriological quality of drinking water at the principal source and at the households along with the household-level determinants of WASH practices. METHODS: A door-to-door survey was conducted in 150 households, distributed across six villages of Jawadhi hills, a tribal area in the state of Tamil Nadu, India. Water samples were collected from the principal sources and a subset of households for assessing water quality. A composite scoring was formulated to determine the overall WASH practices. RESULTS: Overall, a poor WASH score (≤4) was found in 103 (68.7%; 95% CI: 60.7, 75.6) households. The majority (96.7%) of the household water samples showed the presence of fecal coliforms. Poor WASH score was uniformly distributed across the villages. Low per capita income (≤1000 INR) was strongly associated with the poor WASH score (Adjusted OR 2.4; 95% CI: 1.04, 5.7). The per capita income had a strong negative association with the high fecal coliform count (Adjusted OR 5.07; 95% CI: 1.08, 23.74). CONCLUSIONS: We conclude that WASH-related practices among the tribal population of Tamil Nadu is not acceptable. The lack of administrative function and poor economic conditions are the likely causes attributed to the poor WASH conditions and drinking water quality. Urgent action from the stakeholders is the need of the hour to improve the water quality and living standards of such marginalized populations.

Utilization of Janani Shishu Suraksha Karyakram and estimation of out of pocket expenditure: A prospective follow-up study among mothers and newborns in Chittoor.

INTRODUCTION: Janani Sishu Suraksha Karyakram (JSSK) is a flagship program of India to reduce out of pocket expenditure (OOPE) of the families during childbirth and neonatal sicknesses. OBJECTIVES: To assess the utilization of JSSK while availing services for childbirth and newborn care in a secondary care hospital in Southern India; estimate the OOPE in services covered by JSSK and identify the associated factors with OOPE. METHODS: 228 mothers who delivered in the previous 2 days, were recruited from a secondary-level government hospital in Chittoor. Expenditure incurred under various components of JSSK was asked during the recruitment and subsequently through telephonic interviews. RESULTS: All components of JJSK, except transport, were fully utilized by the families. 138 mothers (60.5%, 95% CI: 54.0, 67.0), and all sick children (n = 138, 100%) who visited government hospital, incurred OOPE in the form of transport cost. The median expenditure of transport (from home to hospital and hospital to home) of the mothers was 250 INR (IQR: 100-513 INR). Transport expenditure was greater for the rural families (300 INR) than the urban families (100 INR) (p < 0.05). In multiple logistic regression, nuclear families were associated with high OOPE (AOR- 2.0, 95% CI: 1.1- 3.7). Though education of the mother showed high association (AOR- 2.7, 95% CI: 1.0- 7.8), it was not statistically significant (p = 0.05). CONCLUSION: The families utilize most of the components of JSSK, except transport. Family-centric counselling of the beneficiaries during antenatal check-ups and home visits by the healthcare workers can reduce transport-related OOPE.

​Primary closure versus delayed or no closure for traumatic wounds due to mammalian bite.

BACKGROUND: Mammalian bites are a common presentation in emergency and primary healthcare facilities across the world. The World Health Organization recommends postponing the suturing of a bite wound but this has not been evaluated through a systematic review. OBJECTIVES: To assess the effects of primary closure compared with delayed closure or no closure for mammalian bite wounds. SEARCH METHODS: In July 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We included randomised controlled trials which compared primary closure with delayed or no closure for traumatic wounds due to mammalian bite. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles, abstracts and full-text publications, applied the inclusion criteria, and extracted data. We pooled data using a random-effects model, as appropriate. We used the Cochrane 'Risk of bias' tool and assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We found three trials (878 participants) that compared primary closure with no closure for dog bites and one trial (120 participants) that compared primary closure with delayed closure. No other mammalian bite studies were identified. The trials were from the UK (one trial), Greece (one trial) and China (two trials). Overall, participants from both sexes and all age groups were represented. We are uncertain whether primary closure improves the proportion of wounds which are infection-free compared with no closure, as the certainty of evidence for this outcome was judged to be very low (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.97 to 1.05; 2 studies, 782 participants; I2 = 0%). We downgraded the evidence by one level for high risk of bias and two levels for imprecision. There is no clinically important difference in cosmesis (acceptable physical/cosmetic appearance) of dog bite wounds when primary closure is compared with no closure (mean difference (MD) -1.31, 95% CI -2.03 to -0.59; 1 study, 182 participants). The certainty of evidence for this outcome was judged to be moderate (we downgraded our assessment by one level for imprecision). We are uncertain whether primary closure improves the proportion of dog bite wounds that are infection-free compared with delayed closure, as the evidence for this outcome was judged to be very low (RR 0.98, 95% CI 0.90 to 1.07; 1 study, 120 participants; I2 = 0%). We downgraded the evidence by one level for high risk of bias and two levels for imprecision. None of the four trials reported any adverse outcomes such as death or rabies but they were, in any case, unlikely to have been large enough to have satisfactory power to provide precise estimates for these. Important outcomes like time to complete wound healing, proportion of wounds healed, and length of hospital stay were not evaluated. AUTHORS' CONCLUSIONS: All the studies we identified concerned dog bites. There is no high-certainty evidence to support or refute existing recommendations concerning primary closure for dog bites. The potential benefits and harms of primary closure compared with delayed or no closure for mammalian bites remain uncertain and more robust trials are needed.