Prevalence and determinants of anemia due to micronutrient deficiencies among children aged 12-59 months in India-Evidence from Comprehensive National Nutrition Survey, 2016-18.

The present study aimed to estimate the prevalence of anemia, and anemia with micronutrient deficiencies (iron/ vitamin B12/ folic acid) and their determinants among children aged 12-59 months in India. Comprehensive National Nutritional Survey (2016-2018) is Asia's largest nutrition survey conducted among 0-19 years aged children in India. We used generalised linear model (modified Poisson) with adjusted prevalence ratio (aPR) to assess the socio-economic and biochemical factors associated with anemia and anemia with micronutrient deficiencies amongst children aged 12 to 59 months. Out of the total of 11,237 children included in the study, 40.5% (95%CI:38·6-42·6) were anemic, 30.0% (95%CI:27·8-32·4) had anemia with micronutrient deficiencies and 60.9% (95%CI:58·2-63·5) had micronutrient deficiencies with or without anemia. Younger age (aPR(95%CI) for one year old: 1.9(1.5-2.4), two year old: 1.8(1.5-2.2), three year old: 1.4(1.2-1.7) compared to four year old children) and lower educational status of the mother (mothers without formal schooling aPR(95%CI):1.4(1.1-1.8); 1-9 standards: 1.4(1.2-1.7)) vs mother educated with high school and above, consumption of less than 100 iron-folic acid tablets during pregnancy (aPR(95%CI):1.3(1.0-1.7) vs consumption of ≥ 180 tablets, any self-reported illness among children within two weeks preceding the interview (aPR(95%CI):1.2(1.1-1.4) vs no-illnesses, iron deficiency (aPR(95%CI):2.2(2.0-2.6)) and zinc deficiency (aPR(95%CI):1.3(1.1-1.4)) were associated with anemia in children. Among anemic, the children from scheduled tribe (aPR(95%CI):1.4(1.1-1.8)) vs other caste categories, and those following unsafe child faeces disposal practices (aPR(95%CI):1.2(1.0-1.4)) vs those who follow safe faeces disposal practices had higher chance of having micronutrient deficiency. One third of children aged 12-59 months had anemia with micronutrient deficiency (iron/ folic acid/ vitamin B12). More than half of children had micronutrient deficiencies irrespective of anemia. Micronutrient deficiencies, antenatal IFA intake, safe hygiene practices need to be strengthened to leave no stone unturned in control of anemia among under-five children in India.

Outcomes and Challenges in the Programmatic Implementation of Tuberculosis Preventive Therapy among Household Contacts of Pulmonary TB Patients: A Mixed-Methods Study from a Rural District of Karnataka, India.

The National TB Elimination Programme (NTEP) of India is implementing tuberculosis preventive treatment (TPT) for all household contacts (HHCs) of pulmonary tuberculosis patients (index patients) aged <5 years and those HHCs aged >5 years with TB infection (TBI). We conducted an explanatory mixed-methods study among index patients registered in the Kolar district, Karnataka during April-December 2022, to assess the TPT cascade and explore the early implementation challenges for TPT provision. Of the 301 index patients, contact tracing home visits were made in 247 (82.1%) instances; a major challenge was index patients' resistance to home visits fearing stigma, especially among those receiving care from the private sector. Of the 838 HHCs, 765 (91.3%) were screened for TB; the challenges included a lack of clarity on HHC definition and the non-availability of HHCs during house visits. Only 400 (57.8%) of the 692 eligible HHCs underwent an IGRA test for TBI; the challenges included a shortage of IGRA testing logistics and the perceived low risk among HHCs. As HHCs were unaware of their IGRA results, a number of HHCs actually eligible for TPT could not be determined. Among the 83 HHCs advised of the TPT, 81 (98%) initiated treatment, of whom 63 (77%) completed treatment. Though TPT initiation and completion rates are appreciable, the NTEP needs to urgently address the challenges in contact identification and IGRA testing.

Continued tobacco use among tobacco-related head and neck cancer patients seeking care in a tertiary care facility, South India.

INTRODUCTION: Continued tobacco use in cancer patients leads to decreased treatment efficacy and safety, decreased survival, decreased quality of life, and an increased risk of cancer recurrence and primary tumours at other sites. OBJECTIVE: To determine the prevalence of continued tobacco usage during the first 6 months of diagnosis among tobacco-related head and neck cancer patients seeking care from a tertiary care centre and the factors associated with it. METHODS: A facility-based cohort study was conducted at a tertiary care centre in Puducherry, India. Newly diagnosed head and neck cancer patients aged > 18 years with a history of tobacco use were interviewed to gather information on their socio-demographic, clinical characteristics, and tobacco usage. All participants were interviewed again at the 3rd month and at the 6th month during their follow-up visit. The data were entered in EpiData v3.1 and analysed using STATA v14. Multivariable logistic regression analysis was done with continued tobacco use as the dependent variable and variables that were found significantly associated with continued tobacco use in univariate analysis. RESULTS: Out of 220 study participants at baseline, 157(71 %; 95 % CI: 65.1-77.1) were using tobacco at the time of diagnosis. Out of these 157 participants, 80(50.9 %; 95 % CI; 43.1-58.7) continued to use tobacco at the 3rd month, 63(40.1 %: 95 % CI: 32.6-47.9) continued to use tobacco at the 6th month. The characteristics significantly associated with continued tobacco use are age (less than 39 years and more than 70 years), primary school education, nuclear family, and living alone, smoking tobacco, and increased duration of tobacco use. CONCLUSION: Two-fifths of head and neck cancer patients with a history of tobacco use continued to use tobacco at the 6th month after diagnosis of cancer. Awareness of effects of tobacco use and the benefits of tobacco cessation needs to be created among cancer patients.

Prevalence of Anemia Among the Elderly in India: Evidence From a Systematic Review and Meta-Analysis of Cross-Sectional Studies.

Anemia is a leading cause of increased morbidity and mortality among the elderly population. In spite of numerous interventions and strategies rolled out to tackle the growing burden of anemia, lesser importance is being given to this age group. There is a lack of data on the national level burden of anemia among elderly persons (≥ 60 years) in India. We aimed at estimating the prevalence of anemia among elderly persons (≥ 60 years) in India by conducting a systematic review and meta-analysis. We searched PubMed, Embase, Cochrane Library, Google Scholar, and IndMed, and included cross-sectional studies reporting data on the prevalence of anemia among elderly persons in India and used random effects model to estimate pooled point prevalence with 95% confidence interval (CI), To explore the heterogeneity further, we did sub-group analyses based on zonal divisions of India (region), rural or urban, study setting, method of hemoglobin estimation and sampling strategy. Out of 22 studies, one study was of high quality of bias, 11 of moderate, and 10 were of low quality of bias. The pooled estimate of anemia was 68.3% (95%CI: 60.7 to 75.9), I2 = 99.0%, and Q=2079.2 (p-value <0.001). The pooled prevalence of anemia among the elderly in India was found to be high and necessary actions need to be taken at the policy level to achieve "active and healthy ageing".

Sequential Application and Post-Test Probability for Screening of Bladder Cancer Using Urinary Proteomic Biomarkers: A Review based Probabilistic Analysis.

BACKGROUND: Bladder cancer is one of the most common cancers in the world, with men being affected more than women. Diagnosis by cystoscopy, cytology and biopsy is invasive. Urine cytology, a non-invasive modality is not sensitive. This study is undertaken to evaluate whether non- invasive urinary proteomic profiling is more sensitive, specific for bladder cancer. OBJECTIVE: To evaluate the sensitivity and specificity of various urinary proteomic biomarkers as a screening tool for bladder cancer. METHODS: PubMed database was searched from 4th December 2011 to 30th November 2021 using Mesh terms and n = 10,364 articles were found. PRISMA guidelines were followed and Review articles, animal studies, Urinary tract infections, non-bladder cancer and other irrelevant articles were excluded. All studies who have reported mean/median (SD/IQR), sensitivity, specificity, cut off values (ROC analysis) were included (n=5). Post-test probability of various biomarkers was calculated using sequential approach. Pooled analysis was depicted using Forest plot. RESULTS: Analysis of diagnostic studies of bladder cancer showed the post-test probability of CYFRA21-1 was 36.6%. Using sequential approach, the panel of biomarkers CYFRA 21-1, CA-9, APE-1, COL13A1 has post-test probability of 95.10% to diagnose bladder cancer. Analysis of two observational studies with APOE (n= 447) showed non-significant increase of APO-E levels in bladder cancer cases (WMD: 66.41with 95% CI 52.70-185.51; p=0.27, I2 92.4%). CONCLUSION: In patients presenting with hematuria, a panel of CYFRA 21-1, CA-9, APE-1, COL13A1 markers can be considered for screening of bladder cancer.

Correction Equation for Hemoglobin Values Obtained Using Point of Care Tests-A Step towards Realistic Anemia Burden Estimates.

Digital hemoglobinometers have been used as point-of-care tests (POCT) to estimate the burden of anemia in community-based studies and national-level surveys in India. As the accuracy of hemoglobin estimated in POCT varies, there is a need for adjustments to the POCT-hemoglobin to ensure they are closer to reality and are comparable. We used data (collected between 2016 and 2020) (N = 1145) from four studies from India: three among pregnant women and 6-59-month-old children from Haryana and the fourth from a national nutritional survey among 1-19-year-old children. We compared the same individuals' POCT-hemoglobin (capillary blood) and automated hematology analyzers (AHA) hemoglobin (venous blood) and developed a predictive linear regression model to obtain the correction equation for POCT-hemoglobin. We analyzed paired data from 1145 participants. The correction equation for obtaining the true hemoglobin value = 3.35 + 0.71 × POCT-hemoglobin using capillary blood (adjusted R2-64.4% and mean squared error -0.841 g/dL). In comparison with the AHA-hemoglobin, the mean difference of POCT-hemoglobin was 0.2 g/dL, while with the predicted Hb obtained from the correction equation it was 0.01 g/dL. The correction equation was the first attempt at deriving the true hemoglobin values from the POCTs. There is a need for multi-country collaborative studies to improve the correction equation by adjusting for factors affecting hemoglobin estimation.

Feasibility of Real-Time Monitoring for Anemia Using Mobile Application Linked With Point-of-Care Testing Device.

Background Anemia testing using digital hemoglobinometers (DH) enabled with real-time data visibility improves delivery outcomes, reduces the manual process of keeping records, and strengthens follow-up. In this study, testing of anemia was done by HealthTrender, an innovative mobile-based cloud-connected application, with HemoCue 301 device (HemoCue AB, Ängelholm, Sweden). Aim The objective of the study was to assess the feasibility, acceptability and coverage of anemia testing by the HealthTrender mobile application by the end users - Auxiliary Nursing Midwives (ANMs). Material and methods An exploratory mixed-method study was conducted for three months, i.e., from 1st January 2020 to 31st March 2020. The study was done at the antenatal clinics (ANCs) of two Primary Health Centres (PHCs) and their subcentres in the Ballabgarh block of Haryana, India. Qualitative data on the feasibility of the HealthTrender application was collected from 13 ANMs involved in the testing of anemia using in-depth interviews. Quantitative data of 1057 pregnant women attending the ANC clinics was also analysed. For data capturing, a Bluetooth dongle connected with HemoCue 301 transferred the hemoglobin (Hb) values to the HealthTrender mobile application and was uploaded to the cloud, displaying it on a webpage in real time. Result Among 1057 pregnant women enrolled, the mean (SD) hemoglobin was 10.9 gm/dl (1.5) and the prevalence of anemia was 47%. ANMs reported that the mobile application was easy to use, and half of them were very satisfied with its speed, easy uploading and quickness in reflecting Hb values on the mobile screen. Challenges related to internet connectivity, loss of Bluetooth dongle connection and less manpower with extra work required were expressed by the ANMs. Completion of records was significantly higher for the mobile application (100%) as compared to manual register-based records (81%). Conclusion Web-based application HealthTrender used by ANMs for screening pregnant women for anemia was feasible and had high acceptance. Using digital technology increases the reporting and coverage of hemoglobin testing. Information technology use may be highly beneficial for the serial recording of hemoglobin and subsequent management and follow-ups.

Effect of iron-fortified rice on the hemoglobin level of the individuals aged more than six months: A meta-analysis of controlled trials.

Fortification of staple food items with iron is a potential strategy to address anemia for a larger population. We reviewed studies to assess the impact of iron-fortified rice (IFR) on hemoglobin levels of individuals more than six months of age. We included studies assessing the effectiveness of IFR (with or without other micronutrients) conducted in any part of the world available in PubMed, Embase, Web of Science, Cochrane Library, Google Scholar, clinicaltrials.gov, International database of prospectively registered systematic reviews in health and social care (PROSPERO), unicef.org, and who.int databases and published from January 1, 1990 to April 1, 2019 (PROSPERO registration number: RD42020139895). We extracted the changes in hemoglobin, serum ferritin, and serum transferrin levels among the participants. Finally, data from 15 trials and their 21 subsets were analyzed. Mean difference in hemoglobin was 0.53 g/dl (95% CI: 0.26, 0.80, P < 0.001, I2 = 84%) in the IFR group compared to the control group. In the subgroup analysis after removing studies with small sample size and high risk for bias, a mean difference of 0.44 g/dl (95% CI: 0.20, 0.69, P < 0.001, I2 = 82%) was observed. No significant effect on serum ferritin or transferrin levels was observed. From this review it can be concluded that fortification of rice with iron can be adopted as an intervention to improve hemoglobin levels, especially in countries where rice is the major part food of staple diet. Research is needed on an optimal iron compound for fortification and the acceptance of IFR.

Compliance with iron folic acid (IFA) tablets and associated factors among pregnant women attending ante-natal care clinic at Sub District Hospital, Ballabgarh.

INTRODUCTION: Anemia is a common public health problem among children, adolescent girls, women in reproductive age groups, pregnant and lactating women, with an estimated prevalence of 50.3% among pregnant women according to National Family Health Survey (NFHS) 4. Iron deficiency is regarded as the most common cause of anemia among pregnant women globally and in India. This study was aimed to estimate the prevalence of compliance to iron folic acid (IFA) tablets among pregnant mothers attending ante-natal care (ANC) clinic in a Sub-district hospital (SDH) situated in north India and the various factors associated with non-compliance to IFA tablets. METHODOLOGY: A cross-sectional facility-based study was conducted among pregnant women attending the ANC clinic at SDH, Ballabgarh. A pretested, semi-structured interview schedule was used to obtain socio-demographic data, information related to IFA therapy that they receive, their compliance and the factors that are related to missing of the doses. Data were entered using Epicollect 5 software and Stata version 13.0 was used for statistical analysis. RESULTS: A total of 484 pregnant women were enrolled in our study. More than 3/4th (77.1%) of the pregnant women were compliant to IFA tablet supplement given to them. The compliance was more in the study participants belonging to older age groups, lower socio-economic status and those with hemoglobin levels >11 gm/dl. The most common reason for non-compliance was found to be "forgetfulness" (63.0%) followed by "side effects" (49.5%). CONCLUSION: Compliance with IFA tablets was better among pregnant women who were non anemic and those with good compliance to IFA tablets had better hemoglobin levels.

Effect of cooking food in iron-containing cookware on increase in blood hemoglobin level and iron content of the food: A systematic review.

In developing countries there is a need for simple and cost-effective strategies to reduce the prevalence of iron deficiency anemia. The objective of the current systematic review is to summarize how cooking food in iron pots or iron ingots can increase the blood hemoglobin level and iron content of the food. Literature search was conducted using databases namely PubMed, Google Scholar, Medline-Ovid, IndMed, Cochrane library, World Health Organization bulletin and by cross-referencing articles. Thirteen researches were found to be suitable for inclusion in this systematic review. Four studies reported significant increase in blood hemoglobin levels while others reported only a minor increase. Significant improvement in amount of iron in food and iron bioavailability was also observed when food was cooked using iron pot or ingots. This can be used as a strategy for reduction of iron deficiency anemia. However, more research is required to understand the efficacy of this approach.

'I was scared I will end up in another abortion': a mixed-methods study assessing the impact of COVID-19 pandemic and lockdown on the antenatal care of pregnant women in Puducherry, South India.

BACKGROUND: As a mitigation measure for COVID-19 pandemic, lockdown was implemented in India for a period of 2 months (24 March-31 May 2020). Disruption in antenatal care (ANC) provisions during lockdown is expected due to diversion of public health facilities on pandemic. OBJECTIVE: To assess the proportion of pregnant women who had not completed the ideal number of antenatal visits, availability of iron-folic acid (IFA) supplements and challenges in availing health services during the period of lockdown. METHODS: A concurrent mixed-methods study was conducted among pregnant women in Puducherry, India. Information on obstetric characteristics and details regarding antenatal visits were collected through telephonic interviews. In-depth interviews were conducted to understand the perceived challenges in availing health services during the lockdown period. RESULTS: Out of 150 pregnant women, 62 [41.3%; 95% confidence interval (CI) 33.6-49.3] did not complete the ideal number of visits and 61 (40.7%, 95% CI 32.7-49.0) developed health problems. Out of 44 women who received medical care for health problems, 11 (25%) used teleconsultation. Of all the women, 13 (8.7%, 95% CI 4.9-14.0) had not taken the IFA supplements as prescribed by the health provider. Economic hardship, restricted mobility, lack of information about the health system changes and psychological stress due to the fear of COVID were the challenges in accessing care. CONCLUSIONS: Two out of five pregnant women did not complete the ideal number of visits and developed health problems during the lockdown period.

Point-of-Care Testing Using Invasive and Non-Invasive Hemoglobinometers: Reliable and Valid Method for Estimation of Hemoglobin among Children 6-59 Months.

INTRODUCTION: Globally around 47.4% of children and in India, 58% of children aged 6-59 months are anemic. Diagnosis of anemia in children using accurate technologies and providing adequate treatment is essential to reduce the burden of anemia. Point-of-care testing (POCT) devices is a potential option for estimation of hemoglobin in peripheral and field settings were the hematology analyzer and laboratory services are not available. OBJECTIVES: To access the validity of the POCTs (invasive and non-invasive devices) for estimation of hemoglobin among children aged 6-59 months compared with hematology analyzer. METHODS: The study participants were enrolled from the pediatric outpatient department in Haryana, India, from November 2019 to January 2020. Hemoglobin levels of the study participants were estimated in Sahli's hemoglobinometer and invasive digital hemoglobinometers (DHs) using capillary blood samples. Hemoglobin levels in non-invasive DH were assessed from the finger/toe of the children. Hemoglobin levels measured in POCTs were compared against the venous blood hemoglobin estimated in the hematology analyzer. RESULTS: A total of 120 children were enrolled. The mean (SD) of hemoglobin (g/dl) estimated in auto-analyzer was 9.4 (1.8), Sahli's hemoglobinometer was 9.2 (1.9), invasive DH was 9.7 (1.9), and non-invasive DH was 11.9 (1.5). Sahli's hemoglobinometer (95.5%) and invasive DH (92.2%) had high sensitivity for the diagnosis of anemia compared with non-invasive DH (24.4%). In contrast, non-invasive DH had higher specificity (96.7%) compared with invasive DH (83.3%) and Sahli's hemoglobinometer (70%). Invasive DH took the least time (2-3 min) for estimation of hemoglobin per participant, followed by Sahli's (4-5 min) and non-invasive DH (5-7 min). CONCLUSION: All three POCT devices used in this study are reasonable and feasible for estimating hemoglobin in under-5 children. Invasive DHs are potential POCT devices for diagnosis of anemia among under-5 children, while Sahli's can be considered as a possible option, where trained and skilled technicians are available. Further research and development are required in non-invasive DH to improve accuracy. Lay summaryIn India, anemia is a serious public health problem, where 58% of the children aged 6-59 months are anemic. Point-of-care testing (POCT) using digital hemoglobinometers (DHs) has been recommended as one of the key interventions by the Anemia Mukt Bharat program since 2018 in India. These POCT devices are easy to use, less invasive, can be carried to field, require minimal training and results are available immediately. Therefore this study assessed the validity of POCT devices-invasive DH, non-invasive DH and Sahli's hemoglobinometer among 6-59 months children in facility setting compared with the gold standard hematology analyzer. A total of 120 children under 6-59 months of age were enrolled from the pediatric outpatient department in Haryana, India, from November 2019 to January 2020. The (mean hemoglobin in g/dl) invasive (9.7) and non-invasive DH (11.9) overestimated hemoglobin value, while Sahli's (9.2) underestimated hemoglobin compared with hematology analyzer (9.4). Invasive DH (92.2%) and Sahli's hemoglobinometer (95.5%) reported high ability to correctly identify those with anemia compared with non-invasive DH (24.4%). In contrast, non-invasive DH (96.73%) had higher ability to correctly identify those without the anemia compared with invasive DH (83.3%) and Sahli's (70%).

High Prevalence of Prehypertension and its Association with Modifiable Risk Factors: Findings of Household STEPS Survey from Urban Puducherry, South India.

BACKGROUND: Prehypertension increases the likelihood of hypertension, cardiovascular diseases, and renal failure, and it is amenable to control if it is detected early. The burden of prehypertension prevalent in the community is not much explored. This study aimed to estimate the prevalence and to identify the socio-behavioral and dietary factors related to prehypertension in South India. METHODS: A community-based cross-sectional study was carried out where data related to socio-demographic status, substance use, dietary patterns, physical activity, and associated comorbidities were assessed using the WHO STEPwise survey tool. Adults aged >=18 years who were not previously diagnosed and treated for hypertension were assessed for prehypertension. Prevalence of prehypertension is reported as percentage with 95% CI. Association was reported as adjusted prevalence ratio obtained through multivariable log binomial regression adjusted for potential confounders. RESULTS: Among 2399 participants, 2213 underwent screening. Among 2213 adults, 810 (36.6%, 95% CI: 34.6-38.6%) were in the prehypertension range. The adjusted prevalence for prehypertension was 36.2% among males and 37.2% among females, respectively. Being in the age group of 45-54 years aPR-1.36, body mass index (BMI) >23 Kg/m2 aPR-1.25, consumption of more than 6 grams of salt per day aPR-1.15 times were more likely to be associated with prehypertension. The comorbid conditions such as diabetes are less likely to be associated with prehypertension aPR-0.54 (0.41-0.72). CONCLUSIONS: This community-based surveillance showed 36% of prehypertension among adults which would have been missed if we were to follow the routine cares such as opportunistic and high-risk-based screening. Since prehypertension increases the risk for various end organ failures, there is an impending need to focus on screening and promote healthy lifestyles.

Comparison of different doses of daily iron supplementation for anemia prophylaxis in pregnancy: A systematic review.

Different doses of iron are used for oral supplementation during pregnancy throughout the world. This objective of this review is to describe the effectiveness and side effect profile of different doses of oral iron supplementation for prophylaxis of anemia among pregnant women. Published literature was searched using keywords "iron," "pregnancy," and "supplementation" and related terms. Gray literature was searched in medical libraries including National Medical Library, Dr. B. B. Dikshit library, and library of ICMR. Intervention studies comparing different doses of oral iron given as prophylaxis for anemia during pregnancy, published till December 2017, were retrieved. Studies done only among anemic patients, and studies comparing oral iron with placebo were excluded. In total, 1588 studies were obtained and 11 of them met the objectives. In global studies, prophylactic dose of 30 mg and above is shown to maintain normal hemoglobin. Among the studies from India, prophylactic dose of 120 mg showed consistent results and 60 mg showed inconsistent results in increasing both hemoglobin and ferritin levels. No significant difference in side effects was reported up to 80 mg iron in global studies and the side effects were comparable with 60 to 240 mg doses in Indian studies. It was evident from the review that a state of clinical equipoise exists for the ideal dose of iron supplementation for the prevention of anemia in pregnancy in terms of efficacy and side effect profile. Robust clinical trial as well as technical consultation is required, especially in Indian setting to explore this question further.

Understanding barriers in implementation and scaling up WIFS from providers perspective: A mixed-method study, Rishikesh, India.

CONTEXT: Since the implementation of Weekly Iron and Folic acid Supplementation (WIFS) program in India in 2013, little effort has been made to comprehensively evaluate the program. AIMS: This study was carried out to assess the coverage of WIFS among adolescent girls, explore implementation barriers, and suggest solutions to improve WIFS through public schools in Rishikesh, India (2018-19). METHODS AND MATERIALS: This was a sequential explanatory mixed-methods study. Quantitative component was a community-based cross-sectional survey to determine the prevalence of anemia and coverage of WIFS. Qualitative component added an explanation to understand WIFS implementation through document review and nonparticipant observation of WIFS session. We invited stakeholders for nominal group discussion on barriers and solutions. STATISTICAL ANALYSIS USED: Variables were described as proportion and mean. Group discussion transcript was analyzed using content analysis. RESULTS: Of 400 adolescent girls, 16% (95% CI: 12.4, 19.6) received weekly and 45% ever received iron tablets over the last 3 months and 79% were anemic. From ten schools, one school never implemented WIFS. There was iron-folic acid (IFA) stock out for 10 months last year. Major barriers identified were nonavailability of IFA, and irregularity in submitting IFA consumption report. Suggested solutions were ensuring IFA stock, strengthening supervision, ownership, training, and regular meetings of stakeholders. CONCLUSIONS: To conclude, in a setting with high anemia prevalence, WIFS was poorly implemented. Ownership and strengthening supervision is essential for the success of the program.

Validation of Point of Care Hemoglobin Estimation Among Pregnant Women Using Digital Hemoglobinometers (HemoCue 301 and HemoCue 201+) as Compared with Auto-Analyzer.

Accurate and reliable point of care tests (POCTs) for hemoglobin estimation is essential for early diagnosis and management of anemia. This study was aimed to assess the reliability and validity of two versions of digital hemoglobinometer (HemoCue 201+ and HemoCue 301) compared to the gold standard Sysmex autoanalyzer for hemoglobin estimation. Pregnant women attending antenatal clinics of Primary Health Centre and a Sub Divisional Hospital in Haryana, India, were recruited. After obtaining consent, capillary blood samples were collected and tested for hemoglobin levels with digital hemoglobinometers (HemoCue 201+ and HemoCue 301). Among same pregnant women venous blood was collected and hemoglobin levels were estimated using autoanalyzer. Validity and reliability of POCTs compared to Sysmex autoanalyzer were reported. Of the 102 pregnant women included in the study, 44 (43%) were primigravida, with mean (SD) age of 23.3 (3.4) years. The mean (SD) of difference in hemoglobin levels using HemoCue 201+ was - 0.53 (1.01) and using HemoCue 301 was - 0.25 (0.85) g/dL as compared to auto-analyzer. Lin's concordance coefficient was 0.80 for HemoCue 201+ and 0.85 for HemoCue 301. Weighted Cohen's Kappa indicated moderate degree of agreement with the gold standard. Sensitivity (HemoCue 201+: 93%; HemoCue 301: 90%) and specificity (HemoCue 201: 76% HemoCue 301: 80%) for detecting anemia was similar for both the POCT devices. The digital hemoglobinometers used in the study had moderate degree of agreement and concordance with the autoanalyzer for hemoglobin estimation. HemoCue 301 had higher validity as compared to HemoCue 201+.

High Levels of Treatment Success and Zero Relapse in Multidrug-Resistant Tuberculosis Patients Receiving a Levofloxacin-Based Shorter Treatment Regimen in Vietnam.

Vietnam has been using a levofloxacin-based shorter treatment regimen (STR) for rifampicin resistant/multidrug-resistant tuberculosis (RR/MDR-TB) patients since 2016 on a pilot basis. This regimen lasts for 9-11 months and is provided to RR/MDR-TB patients without second-line drug resistance. We report the treatment outcomes and factors associated with unsuccessful outcomes. We conducted a cohort study involving secondary analysis of data extracted from electronic patient records maintained by the national TB program (NTP). Of the 302 patients enrolled from April 2016 to June 2018, 259 (85.8%) patients were successfully treated (246 cured and 13 'treatment completed'). Unsuccessful outcomes included: treatment failure (16, 5.3%), loss to follow-up (14, 4.6%) and death (13, 4.3%). HIV-positive TB patients, those aged ≥65 years and patients culture-positive at baseline had a higher risk of unsuccessful outcomes. In a sub-group of patients enrolled in 2016 (n = 99) and assessed at 12 months after treatment completion, no cases of relapse were identified. These findings vindicate the decision of the Vietnam NTP to use a levofloxacin-based STR in RR/MDR-TB patients without second-line drug resistance. This regimen may be considered for nationwide scale-up after a detailed assessment of adverse drug events.

An Innovative Public-Private Mix Model for Improving Tuberculosis Care in Vietnam: How Well are We Doing?

To improve tuberculosis (TB) care among individuals attending a private tertiary care hospital in Vietnam, an innovative private sector engagement model was implemented from June to December 2018. This included: (i) Active facility-based screening of all adults for TB symptoms (and chest x-ray (CXR) for those with symptoms) by trained and incentivized providers, with on-site diagnostic testing or transport of sputum samples, (ii) a mobile application to reduce dropout in the care cascade and (iii) enhanced follow-up care by community health workers. We conducted a cohort study using project and routine surveillance data for evaluation. Among 52,078 attendees, 368 (0.7%) had symptoms suggestive of TB and abnormalities on CXR. Among them, 299 (81%) were tested and 103 (34.4%) were diagnosed with TB. In addition, 195 individuals with normal CXR were indicated for TB testing by attending clinicians, of whom, seven were diagnosed with TB. Of the 110 TB patients diagnosed, 104 (95%) were initiated on treatment and 97 (93%) had a successful treatment outcome. Given the success of this model, the National TB Programme is considering to scale it up nationwide after undertaking a detailed cost-effectiveness analysis.

Prevalence and determinants of sleep disorders in a community in rural southern India.

Background: . We assessed the prevalence of sleep disorders among people above 15 years of age from a rural area of Puducherry, south India. Methods: . We did a community-based cross-sectional study among people residing in four service area villages of a rural primary health centre in Puducherry, India. Probability sampling techniques were used to select participants. The Pittsburgh Sleep Quality Index was administered to detect sleep disorders among the participants. The data were entered and analysed using EpiData entry 3.1 and Stata 12 software, respectively. Association between various individual factors and sleep disorders was assessed using generalized linear models adjusting for clustering at the household level and expressed as prevalence ratio with 95% confidence interval (CI). Results: . The mean (SD) age of the 501 participants was 38.3 (15.4) years. Poor quality of sleep was present in 36.3% (95% CI 32.2%-40.6%). In multivariate generalized linear model, age >60 years (adjusted prevalence rate ratio [aPRR] 1.68; 95% CI 1.11-2.53), female sex (aPRR 1.57; 95% CI 1.18-2.08), living in a broken family (aPRR 1.47; 95% CI 1.06-2.02) and having a television in their sleeping room (aPRR 1.40; 95% CI 1.40-1.79) were independently associated with poor quality of sleep. Conclusions: . A high prevalence suggests that sleep disorders are a problem in the rural community too. Capacity building among the existing health workforce to identify and treat sleep disorders and health education activities focusing on sleep hygiene among the general public are needed to tackle sleep disorders in the community.

Digital Hemoglobinometers as Point-of-Care Testing Devices for Hemoglobin Estimation: A Validation Study from India.

INTRODUCTION: India has launched Anemia Mukt Bharat (AMB) strategy in 2018, to deal with the high burden of anemia in the country. Point-of-care testing (POCT) of anemia using digital hemoglobinometers and treatment is one of the primary interventions under AMB. This study aimed to determine the diagnostic validity of digital hemoglobinometers (TrueHb and HemoCue 301) for screening of anemia compared to hematology analyzer. METHODOLOGY: A hospital-based, cross-sectional study was conducted among pregnant women attending antenatal clinics of a selected primary health center and subdivisional hospital of Haryana, India, during January 2019. Hemoglobin (Hb) levels of the pregnant women were estimated in digital hemoglobinometers using capillary blood samples and hematology analyzer using venous blood samples. Bias, limits of agreement (LOA), and validity of digital hemoglobinometers were assessed against a hematology analyzer. RESULTS: A total of 110 pregnant women were included. Bias (LOA) in Hb values estimated using digital hemoglobinometers was -0.09 g/dL (-1.97 to 1.80 ) for HemoCue301 and -0.04 g/dL (-1.69 to 1.60) for TrueHb compared to the hematology analyzer. HemoCue® 301 (sensitivity: 86% and specificity: 83%) had relatively higher sensitivity and specificity compared to TrueHb (sensitivity: 78.9% and specificity: 81%). CONCLUSIONS: Digital hemoglobinometers have high sensitivity and specificity. Thus, these can be a potential POCTs for screening of anemia in peripheral health facilities. Further studies are required to establish the validity of the digital hemoglobinometers at community settings.