Capacity and needs assessment of veterinary services in Vietnam in biosecurity, biosafety and One Health.

The Asia-Pacific region is recognised as an epicentre of emerging infectious diseases (EIDs), of which 75% are zoonotic in nature. Vietnam is recognised as a potential hotspot for zoonotic EIDs. There is a growing recognition that progress towards global health security requires greater focus on collaboration between the human health and animal health sectors to control diseases at their animal source and prevent against human health impacts. Assessment of veterinary epidemiology capacity in Vietnam is paramount to strengthening the health security of Asia-Pacific. This study aims to evaluate the national capacity and needs of veterinary services in Vietnam in biosecurity, biosafety and One Health. A cross-sectional, convergent mixed-methods study was conducted between November 2020 and April 2021. An online questionnaire was administered to government-employed field veterinarians. Descriptive analyses and logistic regression models were performed using survey responses to understand capacity in the field. Semi-structured interviews were also conducted with stakeholders in veterinary services including government, academia, research institutes, non-profit and international organisations. Coding and thematic analysis using a deductive approach was used for data collected from interviews to contextualise findings from the survey and understand institutional capacity. In total, 178 field veterinarians completed the online survey and 25 stakeholders were interviewed. The majority of participants had reported receiving training in biosecurity and biosafety, including use of personal protective equipment. Most respondents reported practicing good biosecurity measures (92%) and good biosafety measures (88%). Physical and socioeconomic barriers to practicing biosecurity were reported to be prevalent for smallholder farmers, which may suggest a gap in the capacity of veterinary services to provide cost-effective and practical biosecurity strategies. Seventy five percent of participants had never or rarely participated in One Health approaches in the field in the last 12 months and 69% reported further training as a high priority. There was a knowledge gap reported amongst district and commune-level veterinary staff about the need for, and awareness of multisectoral collaboration. Respondents that completed postgraduate qualifications in epidemiology or Field Epidemiology Training Programs (adjusted OR: 3.06; 95% CI: 1.01, 9.23, p = 0.046) and had longer job tenure between 10-12 years (OR: 10.38; 95% CI: 3.06, 35.15, p = <0.001) were more likely to have higher levels of experience in One Health. This study identified gaps in knowledge, attitudes and adoption of practices related to biosecurity, biosafety and One Health specifically in lower-level or less experienced veterinary staff without further training opportunities in epidemiology. These findings enable prioritisation of training, policy, and planning activities to further enhance the national capacity of veterinary services in Vietnam.

Cost-effectiveness of One Health interventions for rabies elimination: a systematic review.

The 'One Health' (OH) approach is the most promising idea in realising the global goal of eliminating canine-mediated human rabies by 2030. However, taking an OH approach to rabies elimination can mean many different things to different people. We conducted a systematic review scrutinizing economic evaluations (EEs) retrieved from MEDLINE OVID, Embase OVID, Global Health OVID, CINAHL EBSCO and ECONLIT EBSCO that used the OH approach with the intent of identifying cost-effective sets of interventions that can be combined to implement an optimal OH-based rabies elimination program and highlight key gaps in the knowledge base. Our review suggests that an optimal OH program to tackle rabies should incorporate mass dog vaccination and integrated bite case management in combination with efficient use of post-exposure prophylaxis along with a shift to a 1-week abbreviated intradermal rabies vaccine regimen in humans. We recommend that future EEs of OH interventions for rabies elimination should be performed alongside implementation research to ensure proposed interventions are feasible and adopt a wider societal perspective taking into account costs and outcomes across both the human health and animal welfare sectors. The systematic review has been registered with PROSPERO.

A Study on the Attitude and Perception of Bachelor of Medicine and Bachelor of Surgery (MBBS) Students Regarding Post-MBBS Compulsory Service Bond in Uttar Pradesh, India.

Background To increase the availability of doctors in the public healthcare delivery system, the state government of Uttar Pradesh, India, has implemented a two-year compulsory service bond since 2018. Students of the 2018 batch are going to complete their Bachelor of Medicine, Bachelor of Surgery (MBBS) in 2023 and are supposed to serve through this bond. There are many dilemmas in the minds of medical students regarding their compulsory service bond. Hence, there is a need to know their attitude and perceptions regarding the compulsory service bond. This study was conducted to assess the attitude and perception of undergraduate medical students toward compulsory service bonds. Methods This was a mixed-method study conducted in July-September 2022 among undergraduate medical students at Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India. For quantitative data, a structured questionnaire was developed using Google Forms (Google LLC, Mountain View, California, United States) and circulated via WhatsApp (Meta Platforms, Inc., Menlo Park, California, United States) through the random sampling method. Focused group discussions were carried out to collect the qualitative data. Result Regarding the compulsory service bond after MBBS, 100 (31.8%) medical students were found to be interested and 56 (17.8%) were disinterested. The majority (n=158; 50.4%) of participants were neutral, while 278 (88.6%) medical students perceived it as an opportunity to help poor people. Higher possibilities of social recognition and respect were some noticeable perceptions of 243 (77.4%) MBBS students. Lack of confidence to tackle serious cases without a senior doctor's supervision was perceived as an important hurdle by 286 (91%) participants. Non-availability of advanced medical facilities, issues like the safety of doctors, and the lack of availability of electricity, roads, and infrastructure were also perceived as hurdles. Conclusions and recommendations Students perceived the compulsory service bond as an opportunity if met with certain conditions like a transparent method of posting and basic facilities or an incentive for accommodation and transportation. The compulsory service bond for addressing the shortfall of doctors in the public healthcare delivery system may be more effective if these hurdles are corrected and certain opportunities are met, as mentioned in the present study. This will help the government move smoothly towards achieving Universal Health Coverage (UHC).

Field epidemiology capacity of the national veterinary services of Lao PDR: An online survey.

Introduction: Capacity in veterinary epidemiology is critical to detect, respond and control infectious diseases. Laos veterinary service is limited by having only a small number of veterinarians who graduated from overseas. Animal science graduates support the majority of the Laos veterinary services. The veterinary program was established in 2009 at the National University of Laos. We aimed to understand the national veterinary epidemiology capacity and identify gaps and training needs. Method: A cross-sectional online study was conducted in 2021 targeting central (DLF), provincial (PAFO) and district (DAFO) government animal health officers and veterinary/animal science academics (n = 332). The questionnaire addressed skills, experiences and perceived training needs in outbreak investigation, disease surveillance, data management and analysis, epidemiological surveys, One Health, leadership and communication and biosecurity. A descriptive analysis was performed and associations between demographic factors and epidemiological skills were examined. Results and discussion: In total, 205 respondents completed the questionnaire (61.8% response rate). Respondents reported low or no skills and experience in data management and analysis, epidemiological surveys and One Health. In contrast, higher but limited skills and experiences were reported in outbreak investigation, disease surveillance and biosecurity. Previous epidemiology training was primarily associated with stronger experiences in veterinary epidemiology competencies, followed by respondents that had completed a veterinary degree, highlighting the value of the currently available epidemiology training and veterinary-trained personnel in Lao PDR. This study could help inform the Laos government in its policy planning for field veterinary epidemiology capacity and future training.

Design and Evaluation of the Veterinary Epidemiology Teaching Skills (VETS) Workshop: Building Capacity in the Asia-Pacific Region.

Building workforce capacity in epidemiology skills for veterinarians in the Asia-Pacific region is crucial to health security. However, successful implementation of these programs requires a supply of trained veterinary epidemiology teachers and mentors. We sought to design and evaluate delivery of a 4-day Veterinary Epidemiology Teaching Skills (VETS) workshop as part of a larger project to strengthen field veterinary epidemiology capacity. Thirty-five veterinarians were selected to participate in the 4-day VETS workshop, consisting of nine modules delivered synchronously online. Participants were formatively assessed and given feedback from peers and facilitators on all activities. Data were collected with pre- and post-course questionnaires. Numeric values were categorized to convert into an ordinal scale with four categories. Qualitative data were analyzed using thematic analysis. Thirty-four veterinary epidemiologists from eight countries of the Asia-Pacific completed the workshop. Participants felt able to achieve most key learning outcomes through provision of succinct literature, teaching frameworks, and active participation in small groups, with multiple opportunities to give and receive feedback. Although the online workshop provided flexibility, participants felt the addition of face-to-face sessions would enrich their experience. Additionally, protected time from work duties would have improved their ability to fully engage in the workshop. The VETS workshop granted an effective online framework for veterinary epidemiologists to develop and practice skills in teaching, facilitation, assessment, feedback, case-based learning, program evaluation, and mentorship. A challenge will be ensuring provision of local teaching and mentoring opportunities to reinforce learning outcomes and build workforce capacity.

Prevalence of Mycoplasma bovis Infection in Calves and Dairy Cows in Western Australia.

Mycoplasma bovis (M. bovis) can cause a multitude of diseases in cattle, with detrimental effects on the farm economy and the welfare of both adult and young cattle. The objective of this study was to determine the prevalence of M. bovis in adult cows and calves in the south-west region of Western Australia. A cross-sectional study was conducted on 29 dairy farms with 699 apparently healthy adult lactating cows and 495 young calves during 2019-2020. Nasal swabs and blood samples collected from the animals and bulk tank milk (BTM) samples were assessed for M. bovis-specific proteins and antibodies by using polymerase chain reaction (PCR) and Mycoplasma immunogenic lipase A- Enzyme-Linked Immune Sorbent Assay (MilA ELISA). A seroprevalence of 42.5% (95% CI: 38.9-46.2) and 61% (95% CI: 56.6-65.2) was found in adult lactating cows and calves, respectively. The herd-level seroprevalence of M. bovis ranged from 4% (95% CI: 07-19.5) to 92% (95% CI: 75.0-97.8) in adult lactating cows and 25% (95% CI: 10.2-49.5) to 87% (95% CI: 67.9-95.5) for calves in these farms. None of the BTM and nasal swab samples were positive for M. bovis, indicating an absence of any current active infections on the farms. The female calves and pure Holstein-Friesian animals are twice as likely to be seropositive for M. bovis compared to male calves (OR 2.4; 95% CI: 1.7-3.5) and Holstein-Friesian crossbred calves (OR 2.4; 95% CI: 1.7-3.5). The high seroprevalence in both adult and young cattle in the southwest dairy farms of Western Australia warrants more effective farm biosecurity measures and further evaluation of the current prevention and management measures practiced on the farms.

Brucellosis in India: Comparing exposure amongst veterinarians, para-veterinarians and animal handlers.

The exposure to Brucella species is an occupational hazard for veterinary personnel in India. In our previous study, paraveterinarians and animal handlers were found to be at higher risk of being seropositive. In the present study, we further investigate comparative exposure risk to brucellosis amongst the veterinary professionals, identify risk factors, and evaluate the perceptions and practices towards using adequate personal protective equipment (PPE) while attending high risk veterinary interventions. A cross-sectional study was conducted amongst veterinary personnel in the Punjab state of India. Logistic and negative binomial regression models were constructed to interpret the influence of categorical and numerical variables on prevalence of brucellosis and the adequacy of PPE use, respectively. Compared to veterinarians, animal handlers were less likely to consider veterinary practice in sheep and goats (odds ratio [OR] 0.3; 95% confidence interval [CI]: 0.2-0.7) or assisting in obstetric interventions (OR 0.3, 95% CI 0.1-0.8) as potential exposures. They were less aware of the signs and symptoms of the disease in humans (OR 0.05, 95% CI 0.02-0.14) and of the availability of vaccines for cattle (OR 0.07, 95% CI 0.01-0.3) than the veterinarians, and were least likely of the three groups to recommend vaccination of cattle against brucellosis to animal owners (OR 0.1, 95% CI 0.02-0.3). Compared to veterinarians, they were also less likely to consider zoonotic risk (OR 0.4, 95% CI 0.2-0.8) or better efficiency (OR 0.1, 95% CI 0.05-0.4) as enablers of PPE use during veterinary procedures. Of the three occupational groups, animal handlers were also less likely to use adequate PPE during high-risk veterinary exposures, although they were found to have handled the highest number of cases of abortion. The average use of adequate PPE during high-risk interventions in one month preceding this study was lowest for animal handlers. Veterinary personnel with a higher rate of PPE use during high-risk veterinary interventions were likely to obtain information on brucellosis from government sources (p = 0.06) and felt that PPE use enhanced their professional efficiency (Incidence rate ratio [IRR] 3.3, 95% CI 1.5-8.1) compared to those who were less likely to use adequate PPE. We recommend concerted efforts to increase awareness amongst veterinary personnel, particularly amongst animal handlers, regarding brucellosis and the importance of biosecurity measures in veterinary practice. Designing training courses on the importance of PPE use along with formulation of biosecurity guidelines at local levels could help reduce the prevalence of the disease in veterinary personnel.

Nonobstetric lower genital tract injury patients of a tertiary care center in Eastern Uttar Pradesh, India: A cross-sectional study.

Background: Injuries of lower genital tract are commonly seen in obstetrics patients during labor and delivery. Nonobstetric genital injuries are seen less commonly. Research on injuries to the lower genital tract from nonobstetric trauma is therefore scant. The purpose of this study was to document causes, treatment, and outcomes among patients of lower genital tract injuries visiting to B. R. D. Medical College and Nehru hospital, Gorakhpur, U.P. Methods: Admission and operation theater registers of the department of obstetrics and gynecology during 1 year were scrutinized for cases admitted with the diagnosis of genital trauma. Bed-head tickets of patients were scrutinized with the help of a data abstraction form, and information regarding age, cause of injury, site, size and pattern of injuries, treatment, and short-term outcome were recorded. Results: Of a total of 43 cases of traumatic genital tract injuries, 39 women received treatment. Maximum cases were seen in girls aged 6-10 years. Three women were pregnant at the time of injury. Noncoital injuries predominated over coital injuries, i.e., 59% versus 38.4%. Among the noncoital injuries, fall was the most common cause accounting for 75% of the cases. Coital injuries following consensual sex occurred more commonly in women who were sexually active, lactating, or postmenopause. The chief presenting complaint was vaginal bleeding. Vaginal wall laceration/tear was the most common injury reported. Multiple injuries were seen in 40% (17/39) of the cases. Twenty-one cases of laceration/tear (53.8%) were repaired surgically of which seven required examination and repair under anesthesia. Vulvar hematomas were managed by incision and drainage. There was no major morbidity or mortality. Conclusions: The results of this study from eastern Uttar Pradesh, India, support those from other developing nations. Noncoital injuries were found to be the most predominant cause of non-obstetric genital trauma, though, contrary to others, children were seen to be at the greatest risk. It is important to teach children about playing safely and following safety measures while on the road. We must also make them aware so that they do not become victims of rape.

Phenotypic PIA-Dependent Biofilm Production by Clinical Non-Typeable Staphylococcus aureus Is Not Associated with the Intensity of Inflammation in Mammary Gland: A Pilot Study Using Mouse Mastitis Model.

Non-typeable (NT) Staphylococcus aureus strains are associated with chronic bovine mastitis. This study investigates the impact of biofilm formation by clinical NT S. aureus on cytokine production and mammary tissue damage by using a mouse mastitis model. Mice infected with two different NT S. aureus strains with strong and weak biofilm forming potential demonstrated identical clinical symptoms (moderate), minimal inflammatory infiltrates, and tissue damage (level 1 histopathological changes) in the mammary glands. However, the S. aureus load in the mammary glands of mice and the level of pro-inflammatory cytokines (IL-1ß, IL-6, IL-12, IL-17 and IFN-γ) in serum were significantly higher (p ≤ 0.05) in those infected with the strong biofilm forming NT S. aureus strain. The level of IL-6 in sera samples of these mice was extremely high (15,479.9 ± 532 Pg/mL). Furthermore, these mice died in 24h of post infection compared to 30 h in the weak biofilm forming NT S. aureus infected group. The study demonstrates no association between the strength of PIA (polysaccharide intercellular adhesion)-dependent biofilm production by clinical NT S. aureus and mammary gland pathology in a mouse mastitis model. However, the role of biofilm in the virulence of S. aureus advancing the time of mortality in mice warrants further investigation.

The feasibility and acceptability of various bovine brucellosis control strategies in India.

Bovine brucellosis is a neglected zoonotic disease prevalent in several developing countries including India. It has been successfully controlled in many developed countries by using vaccination in conjunction with extensive surveillance and test-and-cull approaches, but some of these approaches do not suit Indian culture and norms. This study was conducted to investigate the feasibility and social acceptability of various bovine brucellosis control strategies in India. Focus group discussions and key-informant interviews were conducted with veterinarians, para-veterinarians, veterinary academics, farmers and other stakeholders. Vaccination with the Brucella strain 19 vaccine was considered feasible, but the participants were concerned about the risk of self-inoculation, the inability to vaccinate pregnant and male animals, the difficulty to differentiate vaccinated from diseased animals and the challenges of maintaining the vaccine cold chain in India. As expected, the test-and-cull approach was not considered feasible as cattle are considered sacred by Hindus and their slaughter is banned in most states. Although the test-and-segregation approach appears reasonable in theory, it would have low acceptability, if implemented without providing any compensation to farmers. Negligible biosecurity was implemented by farmers: almost no biosecurity procedures were performed for visitors entering a farm, and testing of animals was rarely undertaken before introducing them to a farm. However, the participants considered that improving biosecurity would be more acceptable and feasible than both the test-and-cull and the test-and-segregation approaches. Similarly, inadequate personal protection was used by veterinary personnel for handling parturition, retention of placenta and abortion cases; this was considered as another area of possible improvement. Farmers and veterinarians expressed serious concerns about stray cattle as many of them could potentially be infected with brucellosis, and thus could spread the infection between farms. This study recommends using vaccination and biosecurity along with some ancillary strategies to control brucellosis in India. Information from the study could be used to develop an evidence-based disease control program for the disease in the country.

Using Dairy Value Chains to Identify Production Constraints and Biosecurity Risks.

The dairy industry plays an important role in the economy and food security of India. A study of the dairy value chains was conducted in Punjab, India, to identify production constraints and biosecurity risks. Focus group discussions and key informant interviews were conducted during 2018-2019 with a total of 119 participants comprising veterinarians (41), paraveterinarians (15), veterinary academics (12), dairy farmers (46) and key informants (5). Input and output value chains were created, and potential risk nodes were identified that could facilitate the transmission of pathogens between animals, farms and villages. The majority of the participants were male (93%), middle-aged (68%) or worked in rural areas (75%). Most of the farmers self-cultivated their green fodder (82%), used the wheat straw from their own fields (60%) but purchased commercial feed (63%). Artificial insemination was used by 85% of farmers for cattle, but only 68% for buffaloes. Most of the farmers (76%) reported getting their animals vaccinated against foot-and-mouth disease and hemorrhagic septicemia. Animals were sold and purchased without any health certification and testing in most cases. Adoption of biosecurity measures by farmers and the use of personal protective equipment by veterinary personnel were very low. We recommend conducting epidemiological studies to further characterize the identified risk nodes, training of veterinary practitioners and farmers to ensure adequate biosecurity practices and the appropriate use of personal protective equipment.

A study on effectiveness of video assisted counselling in establishing and sustaining appropriate breast feeding practices.

BACKGROUND AND AIMS: Breast milk is the only food for the neonate with vast benefits. Although breastfeeding process is natural but extensive research has revealed that mother requires active support for establishing and sustaining appropriate breast feeding practices. Due to high patient load, effective counselling of all pregnant ladies becomes a huge task. Video-assisted counselling has been tried for establishing and sustaining breastfeeding practices as it helps mothers to understand the procedure and process better as the video image is animated with a narrative voice. The objective is to study the effectiveness of video assisted breast feeding counselling in establishing and sustaining breast feeding practices. MATERIALS AND METHODS: A Quasi experimental study was done in Obstetrics and Gynaecology department of BRD Medical College Gorakhpur from September 2019 to February 2020. Study subjects were pregnant ladies admitted in labour room for delivery. A total of 60 study subjects were allocated in Video-assisted breast feeding counselling group and same number in routine counselling group. Video-assisted counselling group breast feeding counselling was done with use of two videos (Video 1 is of 5 minute and 34 seconds duration and Video 2 is of 2 minutes and 50 seconds duration) demonstrations in labour room and post natal ward. Routine breast feeding counselling group received routine counselling as done by resident or consultants during their care. After the delivery the study participants were interviewed regarding their profile and breast feeding knowledge, motivation and behaviour and a scoring was done with Min. -0 to Max. 20 score. RESULT: Higher proportion of early initiation of breast feeding was observed in the video assisted counselling group as compared with the routine counselling group. The mean knowledge score of the subjects' video-assisted counselling group the mean knowledge score was significantly higher. Motivation of mother for breast feeding and improvement in their behaviour and skill in video-assisted counselling group was higher in comparison to routine counselling group. CONCLUSION: Video-assisted counselling was found effective in successful initiation and establishment of breast feeding.

Author Correction: Demographic characteristics of free-roaming dogs (FRD) in rural and urban India following a photographic sight-resight survey.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Training and mentorship of medical officers to improve MCH care in public health facilities: Lessons learned from eastern Uttar Pradesh.

INTRODUCTION: To improve the quality of MCH services in high priority districts of eastern Uttar Pradesh, Regional Resource Training Center (RRTC) has been established in BRD Medical College Gorakhpur. Medical College faculties empanelled at RRTC Gorakhpur carried out the training and mentoring of medical officers of public health facilities. AIMS AND OBJECTIVES: To study the role of training and mentoring of medical officers in terms of quality improvements of MCH services at public health facilities. MATERIALS AND METHODS: The present study was carried out in women hospitals of seven districts and one of their respective CHCs of eastern Uttar Pradesh from December 2017 to October 2018. Data was collected by direct observation and review of records of OPD/IPD, labor room, operation theaters, blood bank, and blood storage facilities by mentoring team. Findings of these observations were recorded in predesigned 50 point quality assurance, and facility score was calculated. Technical score was calculated from data collected during one-to-one interaction of mentor and mentees in a predesigned and tested proforma. RESULT: Technical scores of medical officers showed marked improvement after mentoring visits in majority of facilities. Mentoring visits build the confidence of medical officers to deal with the complications like severe anemia, eclampsia, and postpartum hemorrhage as per latest guidelines and protocol. It also helped in the initiation and augmentation of LSCS at certain facilities. Technical scores at few facilities showed little improvement (DWH Sant Kabir Nagar, CHC Colonelganj). Mentoring visit also helped in overall facility improvement at these centers. CONCLUSIONS: The whole training and mentorship program was found effective to improve the knowledge and skills of the medical officer with few exceptions of opposition/resistance. It was found useful in overall facility improvement up to some extent.

Demographic characteristics of free-roaming dogs (FRD) in rural and urban India following a photographic sight-resight survey.

An understanding of the core demographic characteristics of the sub-populations of FRD is essential to effectively implement both rabies control interventions through mass vaccination of FRD, and dog population control programmes. This study compares the data obtained following photographic sight-resight surveys in rural (Shirsuphal village in west India) and urban (Municipal Corporation Panchkula in north India) locations . A total of 263 and 1408  FRD were seen at least once through 617 and 3465 sightings in the rural and urban sites, respectively. The rural location had a lower proportion of females (OR 0.5, 95% CI 0.4-0.7) and a higher proportion of poor and fair conditioned dogs (OR 1.8, 95% CI 1.3-2.3) compared to the urban setting. The rural site also had fewer active FRD (OR 0.6, 95% CI 0.5-0.7) and FRD were less likely to be sighted within 20 m of garbage points (OR 0.3, 95% CI 0.2-0.3) compared to the urban site. The demographic composition of the FRD population was found to vary within the urban location, with the odds of sighting a de-sexed dog being significantly higher in residential areas compared to other areas. The study underlines the importance of knowing the demographic composition of FRD for implementation of effective interventions against rabies. Fewer female dogs in the rural location indicate that spaying could be an effective tool for dog population management in this setting, while presence of dogs within 20 m of garbage points in urban settings highlights that an improved garbage management may reduce the carrying capacity of the urban locality resulting in smaller FRD population. It is concluded that quick and low cost surveys can generate useful demographic data for FRD in urban and rural settings which can be useful to understand the epidemiology of rabies and its control.

Utilising Group-Size and Home-Range Characteristics of Free-Roaming Dogs (FRD) to Guide Mass Vaccination Campaigns against Rabies in India.

Adequate vaccination coverage of free roaming dogs (FRD) against canine rabies is not achieved primarily due to difficulties in administering parenteral vaccinations to this population. One factor associated with this difficulty is the tendency of FRD to form groups, which increases their aggressive behavior, resulting in a significant risk of dog-bites for the vaccinators. This study investigated factors that influenced FRD forming groups and their home-ranges, using data obtained from photographic capture-recapture/sight-resight surveys conducted in rural Shirsuphal (584 sightings) and urban Panchkula (3208 sightings), India. In the rural site, older dogs (OR 0.5, 95% CI 0.2-0.9, p = 0.03) and FRD sighted within 20 m of garbage sites (OR 0.6, 95% CI 0.4-0.9, p = 0.02) were less likely to be in groups. The number of dogs sighted with an FRD decreased with increased resight-probability of that dog (ß= -1.0, p < 0.001). The rural FRD with smaller home-ranges were more likely to be sighted alone (OR 2.3, 95% CI 1.0-95, p = 0.04) than those with larger home-ranges. In the urban site, females (OR 1.3, 95% CI 1.1-1.5, p = 0.002) and older dogs (OR 1.5, 95% CI 1.1-2.1, p = 0.07) were more likely to be found in groups, and groups of dogs were more likely to be seen within 20 meters of garbage sites (OR 1.7, 95% CI 1.5-2.0, p < 0.001). The distribution of urban FRD sighted alone, in pairs, triads, and in packs of ≥4 dogs were not random in the administrative (p = 0.02), and the two industrial (p = 0.03 & 0.01) survey tracks of the urban site, implying stable groups. The resighting probability of a dog (ß = 0.3, p < 0.0001) and presence of garbage within 20 m (ß = 0.2, p < 0.0001) in the urban site increased the likelihood of sighting a FRD with other dogs. It is concluded that data on the resighting probability, presence of garbage points, and home-ranges can be utilised to guide the selection of parenteral or oral rabies vaccination to achieve a population vaccination coverage of 70% to break the transmission cycle of rabies virus in FRD in India.

Spectrum and Immediate Outcome of Acute Kidney Injury in a Pediatric Intensive Care Unit: A Snapshot Study from Indian Subcontinent.

BACKGROUND AND AIMS: Acute kidney injury (AKI) became an important cause of mortality and morbidity in critically ill children, despite advancement in its management. In developing countries etiology of AKI are different from that of developed countries. MATERIALS AND METHODS: This observational study was carried out in pediatric intensive care unit (PICU) in 2 months to18 years of critically ill children. Kidney injury was defined and categorized by the pRIFLE criteria. RESULTS: Out of 361children, 86 children (23.8%) developed AKI at some point during admission, 275 children (age and sex matched) who did not develop kidney injury during hospitalization served as non-AKI children. Maximum cases of AKI were seen in 1-5 years of age. Maximum children of AKI were of viral encephalitis (n = 43, 50.0%) followed by scrub typhus (n = 14, 16.3%). Risk factors for the development of AKI were shock, PRISM score and longer hospital stay. In our study the mortality in AKI children (n = 30, 34.8%) was significantly higher (p = 0.005) as compared to non-AKI children (n = 56, 20.3%)). Duration on mechanical ventilation, PICU stay and hospital stay were also significantly (p = 0.001) higher in AKI children. CONCLUSION: AKI is common in critically ill children and associated with high mortality and morbidity. HOW TO CITE THIS ARTICLE: Bharat A, Mehta A, Tiwari HC, Sharma B, Singh A, Singh V. Spectrum and Immediate Outcome of Acute Kidney Injury in a Pediatric Intensive Care Unit: A Snapshot Study from Indian Subcontinent. Indian J Crit Care Med 2019;23(8):352-355.

Validation of Application SuperDuplicates (AS) Enumeration Tool for Free-Roaming Dogs (FRD) in Urban Settings of Panchkula Municipal Corporation in North India.

A cost-effective estimation of the number of free-roaming dogs is an essential prerequisite for the control of rabies in countries where the disease is endemic, as vaccination of at least 70% of the population is recommended to effectively control the disease. Although estimating the population size through sight-resight based maximum likelihood methodology generates an estimate closest to the actual size, it requires at least five survey efforts to achieve this. In a rural setting in India, a reliable estimate of at least 70% of the likely true population of free-roaming dogs was obtained with the Application SuperDuplicates shinyapp online tool using a photographic sight-resight technique through just two surveys. We tested the wider applicability of this method by validating its use in urban settings in India. Sight-resight surveys of free-roaming dogs were conducted in 15 sectors of the Panchkula Municipal Corporation in north India during September- October 2016. A total of 1,408 unique dogs were identified through 3,465 sightings on 14 survey tracks. The estimates obtained by the Application SuperDuplicates shinyapp online tool after two surveys were compared with the maximum likelihood estimates and it was found that the former, after two surveys, provided an estimate that was at least 70% of that obtained by the latter after 5-6 surveys. Thus, the Application SuperDuplicates shinyapp online tool provides an efficient means for estimating the minimum number of free-roaming dogs to vaccinate with a considerably lower effort than the traditional mark-resight based methods. We recommend use of this tool for estimating the vaccination target of free-roaming dogs prior to undertaking mass vaccination efforts against rabies.

Knowledge, attitudes and practices (KAP) towards rabies and free roaming dogs (FRD) in Panchkula district of north India: A cross-sectional study of urban residents.

Canine rabies is endemic in urban India. A questionnaire was administered to 204 residents of the urbanised municipality of Panchkula in north India to assess the influence of gender, age, family size, social status and dog ownership, over the knowledge, attitudes and practices (KAP) towards rabies control and free-roaming dogs (FRD) in their locality. Bivariate analyses revealed significant knowledge gaps regarding crucial information on the control and transmission of rabies. Multivariable logistic regression models found that the respondents with a high/middle socio-economic status were likely to be more knowledgeable than those from low socio-economic levels (OR 3.03, 95%CI 1.5-6.0, p = 0.001). Households with children ≤14 years of age were likely to be lacking in knowledge about rabies compared to households with older or no children (OR 0.5, 95%CI 0.3-0.9, p = 0.04). The attitudes and practices of the respondents towards rabies control was positive in households with a high/middle socio-economic status (OR 3.4, 95%CI 1.7-7.2, p = 0.0008) but poor in older (≥ 35 years) participants (OR 0.4, 95%CI 0.2-0.7, p = 0.001). It is concluded that rabies awareness campaigns should be developed and conducted to target sectors of the urban community such as those belonging to lower socio-economic sections and schools to improve the residents' knowledge and practices towards rabies. Educating dog owners about sterilising their pets is also recommended to alter the attitudes of the residents towards FRD population control.

Knowledge, attitudes and practices (KAP) towards rabies and free-roaming dogs (FRD) in Shirsuphal village in western India: A community based cross-sectional study.

The lack of awareness about dog-bite related rabies in the rural population of developing countries, including India, is a major impediment to controlling the incidence of disease in humans. A survey of 127 rural residents was undertaken in Shirsuphal village in western India using a structured questionnaire to assess the influence of demographic and pet/livestock owning characteristics on the knowledge, attitudes and practices of the respondents towards rabies and free roaming dogs (FRD). Multivariable logistic regression models were constructed and the knowledge of the rural residents of Shirsuphal village was found to be significantly influenced by family size (OR 2.1, 95%CI 1.0-4.6, p = 0.04) and poultry ownership (OR 2.3, 95%CI 1.1-4.9, p = 0.03), while their attitudes towards FRD was significantly influenced by age of the respondents (OR 2.6, 95% CI 1.2-5.8) and ownership of cattle/buffalo (OR 2.2, 95% CI 1.1-5.5). Although the knowledge score about rabies was high, a comprehensive understanding of the disease was lacking. Concerted efforts to widen the knowledge about rabies and promote healthier practices towards FRD are recommended.