Intervention to Improve Diarrhea-Related Knowledge and Practices Among Informal Healthcare Providers in Slums of Kolkata.

BACKGROUND: In the densely populated slums of Kolkata, informal healthcare providers' (IHP) diarrhea-related knowledge and rationality of practices should be improved to reduce risk of adverse outcome, expenditure, and antimicrobial resistance. METHODS: A multicomponent intervention was conducted among 140 representative IHPs in the slums of 8 wards in Kolkata to assess its impact on their diarrhea-related knowledge and practice. Six intervention modules in local languages were provided (1 per month) with baseline (N = 140) and postintervention (N = 124) evaluation. RESULTS: Mean overall (61.1 to 69.3; P < .0001) and domain-specific knowledge scores for etiology/spread (5.4 to 8.1; P < .0001), management (6.4 to 7.2; P < .0001), and oral rehydration solution ([ORS] 5.7 to 6.5; P < .0001) increased significantly (at α = 0.05) after intervention and were well retained. Impact on knowledge regarding etiology/spread (adjusted odds ratio [aOR] = 5.6; P < .0001), cholera (aOR = 2.0; P = .0041), management (aOR = 3.1; P < .0001), ORS (aOR = 2.3; P = .0008), and overall (aOR = 4.3; P < .0001) were significant. Intervention worked better for IHPs who practiced for ≥10 years (aOR = 3.2; P < .0001), untrained IHPs (aOR = 4.8; P < .0001), and pharmacists (aOR = 8.3; P < .0001). Irrational practices like empirical antibiotic use for every cholera case (aOR = 0.3; P < .0001) and investigation for every diarrhea case (aOR = 0.4; P = .0003) were reduced. Rationality of testing (aOR = 4.2; P < .0001) and antibiotic use (aOR = 1.8; P = .0487) improved. CONCLUSIONS: Multicomponent educational intervention resulted in sustainable improvement in diarrhea-related knowledge and practices among IHPs in slums of Kolkata. Policy implications should be advocated along with implementation and scale-up.

Demographic and Clinical Correlates of Social Cognition in Schizophrenia: Observation from India.

PURPOSE: Although deficits in social cognition (SC) had been recognized as a hallmark of schizophrenia, quality data in Indian context were limited. The purpose of the current research was to determine the demographic and clinical correlates of SC in schizophrenia. METHODS: Between February 2014 and January 2015, a case-control study was conducted in Chhattisgarh, India, among 100 paranoid schizophrenia patients (ICD-10) from two psychiatric hospitals and 100 neighborhood-based healthy (28-item General Health Questionnaire) controls. After obtaining signed consent, SC was assessed among 20-35-year-old, high school or more educated subjects ensuring eligibility for appropriate scales. RESULTS: Patients had poorer social knowledge (adjusted-beta-coefficient [AC] = -4.89 [-6.32, -3.45]) and lower predicted mean score for internal attribution of negative event (AC: -0.72 [-1.17, -0.27]). Nonrecognition of facial expressions especially for anger (adjusted-odds-ratio [AOR] = 3.50 [1.17, 10.51]), surprise (AOR = 2.91 [1.36, 6.25]) and fear (AOR = 2.35 [1.11, 5.01]) was more common among cases. Wrong recognition of expressions was less likely among females (for surprise: AOR = 0.35 [0.13, 0.93]) and educated (for sadness: AOR = 0.11 [0.02, 0.58]) but more common among wealthy (for surprise: AOR = 4.58 [1.22, 17.19]) and urban (for fear: unadjusted odds ratios = 4.30 [1.53, 12.03]) subjects. If recognized expressions correctly, females were more likely to perceive higher intensity of anger (AOR = 4.30 [1.80, 10.29]) and happiness (AOR = 4.22 [1.66, 10.72]). Higher intensity was perceived by more educated subjects regarding anger (AOR = 2.57 [1.04, 6.34]) but not for happiness (AOR = 0.09 [0.01, 0.79]). Unmarried/divorced/separated perceived happiness (AOR = 2.86 [1.02, 7.97]) with more intensity while those in joint families perceived sadness (AOR = 2.80 [1.22, 6.41]) and fear (AOR = 2.28 [1.01, 5.16]) with more intensity. CONCLUSION: A significant impairment in SC was observed among paranoid schizophrenia cases in Chhattisgarh, India. Intervention and further research addressing identified issues of SC need to target specific subpopulations, among schizophrenia patients.

Burden of tuberculosis in Xinjiang between 2011 and 2015: A surveillance data-based study.

BACKGROUND: Despite the reduction in reported incidence of tuberculosis globally, the burden of pulmonary tuberculosis (PTB) remains high in low- and middle- income countries, including China. The current study aims to evaluate the distribution and trend of PTB incidence in Xinjiang, the region with the highest PTB burden in China. METHODS: We identified all confirmed PTB case records reported to the Chinese TB Information Management System (TBIMS) between 2011 and 2015. We analyzed these records to measure the annual incidence of reported smear-positive PTB cases in Xinjiang and its trend over time. We also analyzed incidence by gender, residential area, and region. Spatial analysis was used to describe the inter-regional disparity of the disease burden during the study period. RESULTS: We identified 212,216 smear-positive PTB cases between 2011 and 2015. The reported incidence increased from 180.8 cases in 2011 to 195.8 cases in 2015 per 100,000 population. The southern region of Xinjiang had the highest disease burden (257.8/100,000 in 2011 and 312.7/100,000 in 2015). More than 60% cases occurred in persons >45 years, and 76% of cases lived in rural areas. CONCLUSION: To reach the goal of elimination and control of TB, more comprehensive STOP TB strategies should be implemented in Xinjiang. Residents in the southern region and rural areas of Xinjiang require particular attention.

Exercise and eating habits among urban adolescents: a cross-sectional study in Kolkata, India.

BACKGROUND: Unhealthy eating and lack of exercise during adolescence culminated into earlier onset and increasing burden of atherosclerotic cardiovascular diseases (CVDs) worldwide. Among urban Indian adolescents, prevalence of these risk factors of CVD seemed to be high, but data regarding their pattern and predictors was limited. To address this dearth of information, a survey was conducted among urban adolescent school-students in Kolkata, a highly populated metro city in eastern India. METHODS: During January-June, 2014, 1755 students of 9th-grade were recruited through cluster (schools) random sampling. Informed consents from parents and assents from adolescents were collected. Information on socio-demographics, CVD-related knowledge and perception along with eating and exercise patterns were collected with an internally validated structured questionnaire. Descriptive and regression analyses were performed in SAS-9.3.2. RESULTS: Among 1652 participants (response rate = 94.1%), about 44% had poor overall knowledge about CVD, 24% perceived themselves as overweight and 60% considered their general health as good. Only 18% perceived their future CVD-risk and 29% were engaged in regular moderate-to-vigorous exercise. While 55% skipped meals regularly, 90% frequently consumed street-foods and 54% demonstrated overall poor eating habits. Males were more likely to engage in moderate-to-vigorous exercise [adjusted odds ratio (AOR) = 3.40(95% confidence interval = 2.55-4.54)] while students of higher SES were less likely [AOR = 0.59(0.37-0.94)]. Males and those having good CVD-related knowledge were more likely to exercise at least 1 h/day [AOR = 7.77(4.61-13.07) and 2.90(1.46-5.78) respectively]. Those who perceived their future CVD-risk, skipped meals more [2.04(1.28-3.25)] while Males skipped them less [AOR = 0.62(0.42-0.93)]. Subjects from middle class ate street-foods less frequently [AOR = 0.45(0.24-0.85)]. Relatively older students and those belonging to higher SES were less likely to demonstrate good eating habits [AOR = 0.70(0.56-0.89) and 0.23(0.11-0.47) respectively]. A large knowledge-practice gap was evident as students with good CVD-related knowledge were less likely to have good eating habits [AOR = 0.55(0.32-0.94)]. CONCLUSIONS: CVD-related knowledge as well as eating and exercise habits were quite poor among adolescent school-students of Kolkata. Additionally, there was a large knowledge-practice gap. Multi-component educational interventions targeting behavioral betterment seemed necessary for these adolescents to improve their CVD-related knowledge, along with appropriate translation of knowledge into exercise and eating practices to minimize future risk of CVDs.

Association of Frontline Worker-Provided Services with Change in Block-Level Complementary Feeding Indicators: An Ecological Analysis from Bihar, India.

BACKGROUND: Insufficiencies in complementary feeding put infants and young children at increased risk of undernutrition. Till now, most Indian studies have looked at the individual level determinants of complementary feeding practices. We aimed to evaluate the association of frontline worker (FLW) provided nutritional counselling services, with change in community level indicators of complementary feeding practices among 9-11 month old children over time. METHODS: The study data was obtained from five rounds of 'Lot Quality Assurance Sampling' survey in eight districts of Bihar, an impoverished Indian state. The surveys were conducted as evaluation exercises for the 'Integrated Family Health Initiative (IFHI)'-a multi-faceted program aimed at improving the maternal and child health outcomes in Bihar. The main outcome indicators were-current breastfeeding, age-appropriate minimum frequency of semi-solid food, age-appropriate minimum quantity of semi-solid food, initiation of complementary feeding at the right age, and dietary diversity. Repeated measures analysis was performed to determine the association of changes in the outcome indicators with coverage of FLW-provided counselling services. RESULTS: Visits by FLW, advices on age-appropriate frequency and handwashing were significant predictors of receiving age-appropriate frequency of feeding. The determinants of receiving age-appropriate quantity were-advices on age appropriate frequency and advices on handwashing. Receiving food support from AWC and FLW visits were significantly associated with initiating complementary feeding at the right age. CONCLUSIONS: The present study identified the critical elements among the different types of FLW-provided services. The study findings, from an economically and socially underdeveloped region of India, would inform the relevant programs about the nutritional counselling services that need to be emphasized upon for reducing the burden of childhood malnutrition.

Burden and Socio-Behavioral Correlates of Uncontrolled Abnormal Glucose Metabolism in an Urban Population of India.

BACKGROUND: Progressive burden of diabetes mellitus is a major concern in India. Data on the predictors of poor glycemic control among diabetics are scanty. A population-based cross-sectional study nested in an urban cohort was thus conducted in West Bengal, India to determine the burden and correlates of total and uncontrolled abnormalities in glucose metabolism (AGM) in a representative population. METHODS: From 9046 adult cohort-members, 269 randomly selected consenting subjects (non-response = 7.24%) were interviewed, examined [blood pressure (BP), anthropometry], tested for fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1C). Those having pre-diagnosed diabetes or FPG ≥126 or HbA1c≥6.5 were defined as diabetic. Among non-diabetics, subjects with FPG (mg/dl) = 100-125 or HbA1C(%) = 5.7-6.4 were defined as pre-diabetic. Pre-diagnosed cases with current FPG ≥126 were defined as uncontrolled AGM. Descriptive and regression analyses were conducted using SAS-9.3.2. RESULTS: Among participants, 28.62% [95% Confidence Interval (95%CI) = 23.19-34.06)] were overweight [body mass index(BMI) = (25-29.99)kg/meter2], 7.81% (4.58-11.03) were obese(BMI≥30kg/meter2), 20.82% (15.93-25.70) were current smokers, 12.64% (8.64-16.64) were current alcohol-drinkers and 46.32% of responders (39.16-53.47) had family history of diabetes. 17.84% (13.24-22.45) had stage-I [140≤average systolic BP (AvSBP in mm of mercury)<160 or 90≤average diastolic BP (AvDBP)<100] and 12.64% (8.64-16.64) had stage-II (AvSBP≥160 or AvDBP≥160) hypertension. Based on FPG and HbA1c, 10.41% (6.74-14.08) were diabetic and 27.88% (22.49-33.27) were pre-diabetic. Overall prevalence of diabetes was 15.61% (11.25-19.98). Among pre-diagnosed cases, 46.43% (26.74-66.12) had uncontrolled AGM. With one year increase in age [Odds Ratio(OR) = 1.05(1.03-1.07)], retired subjects [OR = 9.14(1.72-48.66)], overweight[OR = 2.78(1.37-5.64)], ex-drinkers [OR = 4.66(1.35-16.12)] and hypertensives [ORStage I = 3.75(1.42-9.94); ORStage II = 4.69(1.67-13.17)] had higher odds of diabetes. Relatively older subjects [OR = 1.06(1.02-1.10)], unemployed [OR = 19.68(18.64-20.78)], business-owners [OR = 25.53(24.91-16.18)], retired [OR = 46.53(45.38-47.72)], ex-smokers [OR = 4.75(1.09-20.78)], ex-drinkers [OR = 22.43(4.62-108.81)] and hypertensives [ORStage II = 13.17(1.29-134.03)] were more likely to have uncontrolled AGM. CONCLUSIONS: Burden of uncontrolled AGM was high among participants. Efforts to curb the diabetes epidemic in urban India should include interventions targeting appropriate diabetic control among relatively older persons, unemployed, business-owners, retired, ex-smokers, ex-drinkers and hypertensives.

Pre-exposure prophylaxis of HIV: A right way to go or a long way to go?

Antiretroviral drugs are being tried as candidates for the pre-exposure prophylaxis (PrEP) against HIV for a considerable period, due to their potential for immediate inhibition of viral replication. Discrepancies in the findings called for a critical review of the relevant efforts and their outcomes. A systematic literature search identified 143 eligible articles of which only 5 reported complete findings while another 11 were still on-going. Observed moderate efficacy and good safety profile seemed to identify PrEP as a promising step for minimizing the spread of HIV to relatively unaffected population and controlling the epidemic among high risk population groups. But the duration of this efficacy was found to depend heavily on the availability, adherence and other related issues like cost, political commitment, ethical consideration etc. To prevent potential cultural and behavioral modifications, proper pre-administration counseling also seemed critical for the success of PrEP as a cost-effective intervention with adequate coverage.

Trials and tribulations of conducting interventional studies in urban slums of a developing country: Experiences from Kolkata, India.

Experimental studies involving human subjects provide most internally valid evidences in epidemiological research due to their robust methodology. While conducting population-based interventional studies, to achieve external validity, inclusion of information from vulnerable groups like urban slum-dwellers of the developing world, in the epidemiological estimates is of paramount importance. The challenges faced while conducting 2 consecutive large-scale, community-based vaccine trials in urban slums of Kolkata, India are presented in this article. Interventions in these communities often get constrained by issues pertaining to human rights and benefits, socio-cultural factors, political environment, methodological shortcomings in addition to the challenges in ensuring community participation. While conducting these trials although we intermittently faced obstacles, by virtue of having a long term and robust surveillance system and developing a trusted relationship between the researchers, community leaders and residents we were able to come up with a commendable community participation which culminated into the success of the interventions. Bridging the gap between research and field operations by incorporating knowledge gathered from interventional studies and making strategies to improve health conditions of these informal settlers is a major unfulfilled agenda. We believe the lessons learnt during our research will help researchers while developing efficient interventions in similar setting.

Nested Case-control Study of Occupational Radiation Exposure and Breast and Esophagus Cancer Risk among Medical Diagnostic X Ray Workers in Jiangsu of China.

Medical diagnostic X-ray workers are one occupational group that expose to the long-term low-dose external radiation over their working lifetime, and they may under risk of different cancers. This study aims to determine the relationship between the occupational X-ray radiation exposure and cancer risk among these workers in Jiangsu, China. We conducted Nested case-control study to investigate the occupational X-ray radiation exposure and cancer risk. Data were collected through self-administered questionnaire, which includes but not limits to demographic data, personal behaviors and family history of cancer. Retrospective dose reconstruction was conducted to estimate the cumulative doses of the x-ray workers. Inferential statistics, t-test and 2 tests were used to compare the differences between each group. We used the logistic regression model to calculate the odds ratio (OR) and 95% confidence interval (CI) of cancer by adjusting the age, gender. All 34 breast cancer cases and 45 esophageal cancer cases that detected in a cohort conducted among health workers between 1950~2011 were included in this presented study, and 158 cancer-free controls were selected by frequency-matched (1:2). Our study found that the occupational radiation exposure was associated with a significantly increased cancer risk compared with the control, especially in breast cancer and esophageal cancer (adjusted OR=2.90, 95% CI: 1.19-7.04 for breast cancer; OR=4.19, 95% CI: 1.87-9.38 for esophageal cancer, and OR=3.43, 95% CI: 1.92-6.12 for total cancer, respectively). The occupational X-ray radiation exposure was associated with increasing cancer risk, which indicates that proper intervention and prevention strategies may be needed in order to bring down the occupational cancer risk.

Burden and correlates of non-communicable-diseases among rural residents: a cross-sectional study in Hebei, China.

BACKGROUND: Burden of non-communicable diseases (NCDs) is increasing rapidly in most of the developing countries including China, even in rural areas. Dearth of representative data called for an investigation to estimate the burden and identify the correlates of NCDs in rural China. METHODS: A cross-sectional study was conducted involving a representative sample of 6003 consenting randomly selected rural residents aged 15 years or more, from 36 villages of Shijiazhuang in Hebei province of China between July 2010 and June 2011. Information on demographics and behavior were collected, body mass index (BMI) and blood pressure were measured and blood samples were tested to diagnose diabetes and hyperlipidemia. RESULTS: Majority participants were aged < 30 year, married and educated up to junior/senior high school level. Mean age for the 6003 participants was 37.4 ± 14.8. About 55.7% had BMI of 18.6-24.9. In past 12 months: 19.8% smoked daily, 41.6% were exposed to passive smoking, 28.5% drank alcohol, 10.4% skipped breakfasts frequently, 82.8% did never exercise and 25.3% had psychological disturbances. 51.1% were hypertensive, 6.7% were diabetic and 9.2% had hyperlipidemia. Based on self-reports, cardiovascular diseases (4.5%), cerebrovascular diseases (2.3%), cancers (0.2%), chronic obstructive pulmonary diseases (2%), orthopedic problems (12.1%) and gastrointestinal NCDs (7.8%) were identified among the participants, while proportion of subjects with one, two and three or more NCDs were 43%, 14.4% and 5.5% respectively. Higher odds of having more NCDs were associated with higher BMI (Kg/M(2)), family history of NCDs, daily and past history of smoking and drinking, passive smoking, lack of exercise, skipping breakfast and psychological disturbances. CONCLUSION: Despite limitations associated with cross-sectional design and self-reporting, observation in this large sample of rural residents could develop important insights regarding high burden of NCDs in this population. Based on the identified correlates, targeted intervention strategies seem to be required urgently to control NCDs in rural China.

Perceived morbidity, healthcare-seeking behavior and their determinants in a poor-resource setting: observation from India.

BACKGROUND: To control the double burden of communicable and non-communicable diseases (NCDs), in the developing world, understanding the patterns of morbidity and healthcare-seeking is critical. The objective of this cross-sectional study was to determine the distribution, predictors and inter-relationship of perceived morbidity and related healthcare-seeking behavior in a poor-resource setting. METHODS: Between October 2013 and July 2014, 43999 consenting subjects were recruited from 10107 households in Malda district of West Bengal state in India, through multistage random sampling, using probability proportional-to-size. Information on socio-demographics, behaviors, recent ailments, perceived severity and healthcare-seeking were analyzed in SAS-9.3.2. RESULTS: Recent illnesses were reported by 55.91% (n=24,600) participants. Among diagnosed ailments (n=23,626), 50.92% (n=12,031) were NCDs. Respiratory (17.28%, n=7605)), gastrointestinal (13.48%, n=5929) and musculoskeletal (6.25%, n=2749) problems were predominant. Non-qualified practitioners treated 53.16% (n=13,074) episodes. Older children/adolescents [adjusted odds ratio for private healthcare providers (AORPri)=0.76, 95% confidence interval=0.71-0.83) and for Govt. healthcare provider (AORGovt)=0.80(0.68-0.95)], females [AORGovt=0.80(0.73-0.88)], Muslims [AORPri=0.85(0.69-0.76) and AORGovt=0.92(0.87-0.96)], backward castes [AORGovt=0.93(0.91-0.96)] and rural residents [AORPri=0.82(0.75-0.89) and AORGovt=0.72(0.64-0.81)] had lower odds of visiting qualified practitioners. Apparently less severe NCDs [acid-peptic disorders: AORPri=0.41(0.37-0.46) & AORGovt=0.41(0.37-0.46), osteoarthritis: AORPri=0.72(0.59-0.68) & AORGovt=0.58(0.43-0.78)], gastrointestinal [AORPri=0.28(0.24-0.33) & AORGovt=0.69(0.58-0.81)], respiratory [AORPri=0.35(0.32-0.39) & AORGovt=0.46(0.41-0.52)] and skin infections [AORPri=0.65(0.55-0.77)] were also less often treated by qualified practitioners. Better education [AORPri=1.91(1.65-2.22) for ≥graduation], sanitation [AORPri=1.58(1.42-1.75)] and access to safe water [AORPri=1.33(1.05-1.67)] were associated with healthcare-seeking from qualified private practitioners. Longstanding NCDs [chronic obstructive pulmonary diseases: AORPri=1.80(1.46-2.23), hypertension: AORPri=1.94(1.60-2.36), diabetes: AORPri=4.94(3.55-6.87)] and serious infections [typhoid: AORPri=2.86(2.04-4.03)] were also more commonly treated by qualified private practitioners. Potential limitations included temporal ambiguity, reverse causation, generalizability issues and misclassification. CONCLUSION: In this poor-resource setting with high morbidity, ailments and their perceived severity were important predictors for healthcare-seeking. Interventions to improve awareness and healthcare-seeking among under-privileged and vulnerable population with efforts to improve the knowledge and practice of non-qualified practitioners probably required urgently.

Predictors of rational management of diarrhea in an endemic setting: observation from India.

BACKGROUND: Decades after the establishment of clear guidelines for management, mostly due to irrational approach, diarrhea is still a major concern in the developing world, including India. The scenario is even worse in urban slums owing to poor health-seeking and socio-environmental vulnerability. Determining the distribution of rational diarrhea management by practitioners and identification of its important predictors seemed urgent to minimize the potential for antibiotic resistance, diarrhea-related mortality and morbidity in these areas. METHODS: Between May 2011 and January 2012, 264 consenting, randomly selected qualified and non-qualified practitioners (including pharmacists) were interviewed in the slums of Kolkata, a populous city in eastern India, regarding their characteristics, diarrhea-related knowledge (overall and in six separate domains: signs/symptoms, occurrence/spread, management, prevention/control, cholera and ORS), prescribed antibiotics, intravenous fluid (IVF) and laboratory investigations. Rationality was established based on standard textbooks. RESULTS: Among participants, 53.03% had no medical qualifications, 6.06% were attached to Governmental hospitals, 19.32% had best knowledge regarding diarrhea. While treating diarrhea, 7.20%, 17.80% and 20.08% respectively advised antibiotics, IVF and laboratory tests rationally. Logistic regression revealed that qualified and Governmental-sector practitioners managed diarrhea more rationally. Having best diarrhea-related knowledge regarding signs/symptoms (OR=5.49, p value=0.020), occurrence/spread (OR=3.26, p value=0.035) and overall (OR=6.82, p value=0.006) were associated with rational antibiotic prescription. Rational IVF administration was associated with best knowledge regarding diarrheal signs/symptoms (OR=3.00, p value=0.017), occurrence/spread (OR=3.57, p value=0.004), prevention/control (OR=4.89, p value=0.037), ORS (OR=2.55, p value=0.029) and overall (OR=4.57, p value<0.001). Best overall (OR=2.68, p value=0.020) and cholera-related knowledge (OR=2.34, p value=0.019) were associated with rational laboratory testing strategy. CONCLUSION: Diarrheal management practices were unsatisfactory in urban slums where practitioners' knowledge was a strong predictor for rational management. Interventions targeting non-qualified, independent practitioners to improve their diarrhea-related knowledge seemed to be required urgently to ensure efficient management of diarrhea in these endemic settings.

Cardiovascular risk reduction intervention among school-students in Kolkata, West Bengal - the CRRIS study protocol.

BACKGROUND: Increasing burden of cardiovascular risk-factors among adolescent school-children is a major concern in India. Dearth of information regarding the burden of these factors and the efficacy of educational intervention in minimizing them among urban school-students of India called for a school-based, educational intervention involving a representative sample of these students and their caregivers. METHODOLOGY: Using a randomized-controlled design with stratified-random sampling, 1000 students (approximately 50/school) of 9th grade from 20 randomly selected schools (representing all socio-economic classes and school-types) and their caregivers (preferably mothers) will be recruited. Objectives of the study will include: estimation of the baseline burden and post-interventional change in cardiovascular risk-factors, related knowledge, perception and practice among participants in Kolkata. DATA COLLECTION: After obtaining appropriate consent (assent for adolescents), collection of the questionnaire-based data (regarding cardiovascular disease/risk-factor related knowledge, perception, practice), anthropometric measurements, stress assessment and cardiological check-up (pulse and blood pressure measurement along with auscultation for any abnormal heart sounds) will be conducted for each participating students twice at an interval of six months. In between 6 educational sessions will be administered in 10 of the 20 schools randomized to the intervention arm. After the follow-up data collection, same sessions will be conducted in the non-interventional schools. DATA ANALYSES AND DELIVERABLE: Descriptive and inferential analyses (using SAS 9.3) will be conducted to determine the distribution of the risk-factors and efficacy of the intervention in minimizing them so that policy-making can be guided appropriately to keep the adolescents healthy in their future life.

The epidemic of HIV, syphilis, chlamydia and gonorrhea and the correlates of sexual transmitted infections among men who have sex with men in Jiangsu, China, 2009.

BACKGROUND: In China, the HIV/AIDS epidemic is expanding among men who have sex with men (MSM). As independent risk factors of HIV infection, the epidemics of Chlamydia (CT) and Gonorrhea (NG) in MSM were not well studied, particular for the risk factors of these infectious. The objectives of current reported study were to understand the dynamics of HIV and other sexual transmitted infections (STIs) among MSM in Jiangsu, China, and to measure factors that correlated with STIs. METHODS: In order to gain more participants, a multisite cross-sectional study design was used in our study, by using convenience-sampling to recruit MSM in two Changzhou and Yangzhou, Jiangsu, China, between the July and October of 2009. RESULTS: In this comprehensive survey involving MSM in two cities of Jiangsu province of China, the prevalence of STIs of CT (6.54%), NG (3.63%), syphilis (20.34%) and HIV (11.62%) were measured. Overall, the STIs prevalence (CT, NG or syphilis) for the participants in our study was 26.39%, meanwhile, 3.4% (14 out of the 413) participants had at least two kinds of STIs. Meeting casual partners at parks, public restrooms or other public areas, having had anal sex with men in the past six months, having had STI symptoms in the past year were positively correlated with STIs positive, with adjusted ORs of 4.61(95%CI 1.03-20.75), 1.91(95%CI 1.14-3.21) and 2.36(95%CI 1.07,5.24). CONCLUSION: Our study findings reiterate the fact that Chinese MSM are highly susceptible to acquiring syphilis, CT, NG and HIV, and there is an urgent need for intervention targeted towards this population. Behavioral measures should constitute an important part of the targeted intervention. Furthermore, the already implemented preventive and diagnostic services for HIV should be expanded to include syphilis CT and NG, too.

Distribution and determinants of cytomegalovirus induced end organ disease/s among people living with HIV/AIDS in a poor resource setting: observation from India.

BACKGROUND: In India, despite well-established anti-retroviral treatment programs, Cytomegalovirus (CMV) infection-related end-organ diseases (EODs) still remain a major concern resulting in exacerbation of morbidity and mortality among HIV/AIDS patients. A prospective study was designed to understand the distribution and prognosis of CMV associated EODs and to determine a standardized cut-off value for serum CMV viral load associated with the development of EODs amongst HIV/AIDS subjects. METHODS: In a cohort of 400 late-diagnosed HAART naïve HIV/AIDS subjects attending anti-retroviral centers of Kolkata during 2008-2014, the median duration of follow-up was 560 days, and at least 3 visits subsequent to the baseline were mandatory for eligibility. HIV-1 and CMV viral load were estimated by performing Real-Time Polymerase Chain Reactions (PCR). RESULTS: Among subjects, 40.5% (162/400) had CMV EODs which were more common at lower CD4 counts. Poor prognosis and higher death rate were associated with a low CD4 count and increased HIV-1 and CMV viral loads. Subjects having higher CD4 count responded better to therapy [for CD4 = 60-100: Risk Ratio:RR = 1.48 (95% Confidence Interval: 95%CI = 1.18-1.82) and for CD4 = 30-59: RR = 1.64 (95%CI = 1.18-2.27)]. The cut off value of the serum CMV viral load (expressed as log10DNA/ml serum) associated with the development of EODs and disseminated CMV EODs was determined as 5.4 (p<0.0001) and 6.4 (p<0.0001) respectively. These cut offs were found to have satisfactorily high sensitivity, specificity, positive and negative predictive values. CONCLUSION: Prognosis of CMV EOD was poor as indicated by higher death rates among subjects with lower CD4 count, and specific cut-off values were found to have useful potential for identification and treatment of CMV infected HIV/AIDS patients in due time to avoid CMV EODs among HIV/AIDS subjects. Targeted intervention programs seemed to be required urgently to make these cut-offs operational in order to minimize the burden of CMV EOD in this vulnerable population.

Factors associated with loss-to-follow-up during behavioral interventions and HIV testing cohort among men who have sex with men in Nanjing, China.

BACKGROUND: Behavioral interventions (BIs) remained the cornerstone of HIV prevention in resource-limited settings. One of the major concerns for such efforts is the loss-to-follow-up (LTFU) that threatens almost every HIV control program involving high-risk population groups. METHODS: To evaluate the factors associated with LTFU during BIs and HIV testing among men who have sex with men (MSM), 410 HIV sero-negatives MSM were recruited using respondent driven sampling (RDS) in Nanjing, China during 2008, they were further followed for 18 months. At baseline and each follow-up visits, each participant was counseled about various HIV risk-reductions BIs at a designated sexually transmitted infection (STI) clinic. RESULTS: Among 410 participants recruited at baseline, altogether 221 (53.9%) were LTFU at the 18-month follow-up visit. Overall, 46 participants were found to be positive for syphilis infection at baseline while 13 participants were HIV sero-converted during the follow-up period. Increasing age was less (Adjusted Odds Ratio(aOR) of 0.90, 95% confidence Interval (CI) 0.86-0.94) and official residency of provinces other than Nanjing (AOR of 2.49, 95%CI 1.32-4.71), lower level of education (AOR of 2.01, 95%CI 1.10-3.66) and small social network size (AOR of 1.75, 95%CI 1.09-2.80) were more likely to be associated with higher odds of LTFU. CONCLUSION: To improve retention in the programs for HIV control, counseling and testing among MSM in Nanjing, focused intensified intervention targeting those who were more likely to be LTFU, especially the young, less educated, unofficial residents of Nanjing who had smaller social network size, might be helpful.

Sociobehavioral correlates of HIV risk among men who have sex with men in Chhattisgarh, India: analysis of sentinel surveillance data.

Men who have sex with men (MSM) in India are mostly hidden due to stigma and discrimination and are at a higher risk of acquiring human immunodeficiency virus (HIV). HIV Sentinel Surveillance (HSS) reported an increased HIV burden in Chhattisgarh, an important state in central India. This state has the distinction of having the highest HIV prevalence among MSM in India; therefore, it warrants special attention; hence, we focused on the role of MSM in the HIV epidemic in this state. Cross-sectional analysis of the most recent latest (2010-2011) HSS data of 227 MSM in Chhattisgarh revealed a HIV seropositivity of 14.98%. Older age, unemployment, and receiving money for sex with a man were associated with a higher HIV risk. Participants were mostly young (mean age, approximately 26 years), school-level educated (51.98%), urban residents (99.56%), in service (46.26%), not involved in heterosexual activity (97.36%), or paid sex (68.72%). None of the participants reported injection drug use, and almost all of them (98.68%) were kothis. Some of the observed associations lacked statistical power due to sparse data obtained during this initial surveillance among MSM in Chhattisgarh. Therefore, further studies involving a larger population are needed to understand the role of MSM in the dynamics of the HIV epidemic in this state to facilitate the planning of appropriate interventions, as the epidemic is likely to be concentrated among MSM in Chhattisgarh.

Burden and correlates of geriatric depression in the Uyghur elderly population, observation from Xinjiang, China.

BACKGROUND: With the gradual aging of the population, geriatric depression has become a major public health issue in China owing to its overall upward trend and associated negative socio-economic impact. Dearth of information regarding the burden and correlates of geriatric depression among Uyghur minority population in Xinjiang Autonomous Region, called for a comprehensive survey involving representative sample for designing efficient targeted intervention to control this disabling disease. METHODS: A cross-sectional study was conducted among 1329 consenting Uyghur elderly in 2011 in six randomly selected communities/villages in Xinjiang. Information about socio-demographics, behavior, negative life-events, satisfaction regarding income/quality of life and other chronic diseases were collected while assessment of geriatric depression was done using Geriatric Mental State Schedule (GMS). RESULTS: Among these participants, majority were currently married, had attended elementary school or less, had an average annual family income of less than 3000 Yuan/person, had strong religious beliefs while 10.61% (2.77% in urban and 23.60% in rural area) had geriatric depression (5.91% among male and 14.58% among females). 61.83% were suffering from other chronic diseases, 96.16% could take care of themselves and 39.28% had experienced negative events during last two years. Religious belief (AOR = 3.92, 95% CI 1.18-13.03), satisfaction regarding quality of life (AOR = 0.53, 95% CI 0.37-0.84) and income (AOR = 0.75, 95% CI 0.35-1.60), suffering from more chronic diseases (AOR = 1.70, 95% CI 1.42-2.04), experiencing three or more negative events (AOR = 1.72, 95% CI 0.92-3.22) and lack of ability to take self-care (AOR = 2.20, 95% CI 1.09-4.48) were all associated with having geriatric depression with or without adjustment for gender, education and occupation. CONCLUSION: High prevalence of geriatric depression among Uyghur elderly in Xinjiang seemed to call for urgent interventions, specifically targeting rural residents, who experienced more negative life-events, were suffering from chronic diseases and were dissatisfied with their income and quality of life.

Correlates of treatment outcomes and drug resistance among pulmonary tuberculosis patients attending tertiary care hospitals of Kolkata, India.

BACKGROUND: Worldwide highest number of new pulmonary tuberculosis (PTB) cases, was reported from India in 2012. Adverse treatment outcomes and emergence of drug resistance further complicated the prevailing scenario owing to increased duration, cost and toxicity associated with the treatment of drug-resistant cases. Hence to reinforce India's fight against TB, identification of the correlates of adverse treatment outcomes and drug resistance, seemed critical. METHODS: To estimate the associations between diagnostic findings, patient types (based on treatment outcomes), drug resistance and socio-demographic characteristics of PTB patients, a cross-sectional study was conducted in two tertiary-care hospitals in Kolkata between April 2010 and March 2013. Altogether, 350 consenting Mycobacterium tuberculosis sputum-culture positive PTB patients were interviewed about their socio-demographic background, evaluated regarding their X-ray findings (minimal/moderately advanced/far advanced/cavities), sputum-smear positivity, and treatment history/outcomes (new/defaulter/relapse/treatment-failure cases). Multiple-allele-specific polymerase chain reaction (MAS-PCR) was conducted to diagnose drug resistance. RESULTS: Among all participants, 31.43% were newly diagnosed, while 44%, 15.43% and 9.14% patients fell into the categories of relapsed, defaulters and treatment-failures, respectively. 12.29% were multi-drug-resistant (MDR: resistant to at least isoniazid and rifampicin), 57.71% had non-MDR two-drug resistance and 12% had single-drug resistance. Subjects with higher BMI had lower odds of being a relapse/defaulter/treatment failure case while females were more likely to be defaulters and older age-groups had more relapse. Elderly, females, unmarried, those with low BMI and higher grade of sputum-smear positivity were more likely to have advanced X-ray features. Higher grade of sputum-smear positivity and advanced chest X-ray findings were associated with relapse/treatment-failures. Elderly, unmarried, relapse/defaulter/treatment-failure cases had higher odds and those with higher BMI and moderately/far advanced X-ray findings had lower odds of having MDR/non-MDR two-drug resistant PTB. CONCLUSION: Targeted intervention and appropriate counseling are needed urgently to prevent adverse treatment outcomes and development of drug resistance among PTB patients in Kolkata.

Distribution and determinants of non communicable diseases among elderly Uyghur ethnic group in Xinjiang, China.

BACKGROUND: Non-communicable diseases (NCDs) are showing an increasing trend globally as well as in China. Elderly population are more prone to these NCDs. Situation in China is worse owing to the higher proportion of geriatric population. Burden of NCDs and the role of their socio-demographic and behavioral predictors among these elderly and more so among the ethnic minority groups among them, need to be investigated specifically, owing to their distinct genetic background, lifestyles and behavior. METHODS: A cross-sectional study was conducted among 1329 randomly selected persons of Uyghur ethnicity, aged 60 years or more in Xinjiang, the largest administrative division in China to measure the burden of NCDs, understand the distribution of socio-demographic, behavioral and life event-related potential correlates of them and to estimate the association of the NCDs with these correlates. RESULTS: Among these participants 54.2% were female, 86.8% were married and more than half had only attended elementary school or less. 41.46% was suffering from at least one NCD. 20.22% had one NCD, 12.11% had two and 8.58% had three or more. 27.3% had hypertension, 4.06% had diabetes, 6.02% had hyperlipidemia, 7.37% had angina, 14.52% had cardiovascular diseases, 11.59% had any kind of cancers and 9.78% had chronic obstructive pulmonary diseases. Rural residents (OR = 1.45, 95% CI: 1.17-1.80, AOR = 2.00, 95% CI: 1.53-2.61) and current smokers had higher odds of having more NCDs (AOR = 1.53, 95% CI: 1.00-2.34). Additionally not being satisfied with current life, not being able to take care of self in daily life, currently not being involved in farm work, less intake of fresh vegetables, fruits and garlic, too less or too much salt intake, not having hobbies were found to be positively associated with having more NCDs. CONCLUSION: Implementation of effective intervention strategies to promote healthy life styles among the Uyghur elderly population of China seems urgent.