Social network analysis of COVID-19 transmission in Karnataka, India.

We used social network analysis (SNA) to study the novel coronavirus (COVID-19) outbreak in Karnataka, India, and to assess the potential of SNA as a tool for outbreak monitoring and control. We analysed contact tracing data of 1147 COVID-19 positive cases (mean age 34.91 years, 61.99% aged 11-40, 742 males), anonymised and made public by the Karnataka government. Software tools, Cytoscape and Gephi, were used to create SNA graphics and determine network attributes of nodes (cases) and edges (directed links from source to target patients). Outdegree was 1-47 for 199 (17.35%) nodes, and betweenness, 0.5-87 for 89 (7.76%) nodes. Men had higher mean outdegree and women, higher mean betweenness. Delhi was the exogenous source of 17.44% cases. Bangalore city had the highest caseload in the state (229, 20%), but comparatively low cluster formation. Thirty-four (2.96%) 'super-spreaders' (outdegree ⩾ 5) caused 60% of the transmissions. Real-time social network visualisation can allow healthcare administrators to flag evolving hotspots and pinpoint key actors in transmission. Prioritising these areas and individuals for rigorous containment could help minimise resource outlay and potentially achieve a significant reduction in COVID-19 transmission.

Evaluation of the Performance of Anganwadi Workers in Delivering Integrated Child Development Services in the Rural Field Practice Area of a Tertiary Medical College in South India.

Background and objective To meet the overall developmental needs of children below six years, adolescent girls, and expectant and nursing mothers, the Integrated Child Development Services (ICDS) was launched on 2nd October 1975 via the network of Anganwadis. It included a range of services like supplementary nutrition, preschool education, immunization, health check-up, referral services, and nutrition and health education. The majority of Karnataka's population resides in rural areas (61.3%) and among them, children (aged zero to six years) constitute around 12.05%. The incidence of mortality and morbidity among vulnerable groups is quite high. A total of 204 ICDS project areas have been sanctioned in Karnataka till 2012, out of which 63,377 Anganwadi centers (AWCs) from 185 projects have been functional. Findings show an alarming gap of 12 million beneficiaries for the required services. Mere 44% of children between 12 and 23 months have received complete immunization. The scheme has reached a stage where enriching its contents is more crucial than concentrating on universalization. Our study has tried to recognize the hindrances in the delivery of ICDS services by evaluating the performance of Anganwadi workers (AWWs), which in turn will optimize the benefit for the beneficiaries. Materials and methods This was a community-based, cross-sectional, descriptive study conducted over a period of six months. The tertiary medical college covers a population of 16,231 in its rural catchment area, whose health needs are served by 21 AWCs. All 21 centers were included in the study through the universal sampling method. Data collection commenced after obtaining clearance from the Institutional Ethics Committee and permission from the Program Officer and Child Development Project Officer (CDPO) of the concerned ICDS block. Informed consent was taken from all the AWWs. Data to evaluate the performance of AWWs were collected using a pre-validated and pre-structured questionnaire. Performance was evaluated by allotting scores to each question. Results Among the 21 AWWs interviewed, 38.1% belonged to the age group of 41-50 years. Of them, 76.2% achieved the correct number of target home visits per day. Growth charts were plotted correctly by the workers in only 60% of centers. Only 57.1% of centers stored raw food materials safely, away from infestation. In 71.4% of centers, the health staff had immunized the children appropriately. Only 38.1% of AWWs had the knowledge of giving paracetamol tablets to the mothers in case of fever and were also giving vitamin syrup to the children. Only 19% of AWWs responded correctly regarding the importance of Village Health and Nutrition Days (VHND). In our study, 11 (52.4%) workers had "good" knowledge about delivering different services under the ICDS scheme, eight (38.1%) had "poor" knowledge while two (9.5%) workers had "satisfactory" knowledge. Conclusion The present study gives some insight into the existing situation in rural AWCs. Although the majority of AWWs had good knowledge about delivering different services under the ICDS scheme, further improvement is needed for optimizing the outcome.

A cross-sectional study of anthropometry and immunization coverage of Anganwadi children in a rural area of Karnataka.

Background: Children are a supreme asset to a nation. Beginning six years of life is pivotal for the social, emotional, cognitive, physical, motor, and psychological upbringing of the child. National Family Health Survey (NFHS) 5 data shows 41.9% of children die before the age of five years, with greater mortality in the rural areas (45.7%). The present study was conducted to assess the anthropometric profile and immunization status of children in Anganwadi centers. Materials and Methods: A community-based cross-sectional study was conducted in 21 Anganwadi centers in a rural area in South India. The anthropometry (height, weight, mid-upper arm circumference), morbidity profile, and immunization status of the enrolled and available children were assessed with the help of WHO growth charts, Salter scale, clinical examination, immunization cards, and data from Anganwadi registers. Statistical analysis: Data were compiled and analyzed using SPSS software version 20. Descriptive data were interpreted as mean and percentages and associations were tested with the Chi-square test, and Fisher's exact test. A P value of <0.05 was considered to be statistically significant. Results: Around 400 children, aged 0-6 years, participated in the study. The mean age of the study population was 42.08 ± 12.55 months. The overall prevalence of underweight, stunting, and wasting was 52%, 54%, and 47.5% respectively. The most common morbidity was upper respiratory tract infection (11.5%). A majority (97.5%) of children were found to be immunized appropriately as per age. Conclusion: The prevalence of malnutrition was alarmingly high which warrants urgent referral and follow-up. The ICDS services, although substantially beneficial, need focal strengthening with regard to the nutritional status of enrolled children.

Risk factors for non-adherence among people with HIV-associated TB in Karnataka, India: A case-control study.

SETTING: Five select districts of Karnataka, India, providing anti-tubercular and antiretroviral therapy (ATT and ART) to people with Human Immunodeficiency Virus (HIV) - associated Tuberculosis (TB) through a single window care approach at the ART centres (seven ART centres and 16 link ART centres). OBJECTIVES: To determine the factors associated with non-adherence to concurrent therapy. DESIGN: We conducted a case-control study involving primary and secondary data collection. Starting January 2019, we consecutively enrolled people on at least three months of ATT until we enrolled 125 cases (non-adherent to concurrent therapy) and 375 controls (adherent to concurrent therapy). Adherence was defined as taking >95% ART doses and >90% ATT doses, every month over the last three months. We performed multivariable logistic regression to identify factors associated with non-adherence. RESULTS: The mean age of the cases and control was similar: 39.8 (standard deviation: 8.8) years. The risk factors for non-adherence were status non-disclosure (aOR = 2.06), zidovudine-based ART (aOR = 4.87), >3 side effects (aOR = 6.45), not receiving counselling before ATT initiation (aOR = 5.25) and non-receipt of co-trimoxazole prophylaxis (aOR = 9.90). CONCLUSION: Major determinants for non-adherence were clinical and treatment related factors.

Impact of Steam Inhalation, Saline Gargling, and Povidone-Iodine Gargling on Clinical Outcome of COVID-19 Patients in Bengaluru, Karnataka: A Randomized Control Trial.

Context: In the absence of any specific treatment available for COVID-19, people started practicing traditional nonpharmacological preventive home remedies such as salt water gargling and steam inhalation. The available research evidence on some of these measures opines that steam inhalation, saline gargling, and povidone-iodine gargling does have virucidal properties and do provide symptomatic relief. Aims: The aim is to test this hypothesis, and the present trial was undertaken with an objective to assess the effect of steam inhalation, saline gargling, and povidone-iodine gargling among the COVID-19-positive patients with respect to early test negativity and clinical recovery. Methodology: Open-labeled, parallel, randomized controlled trial was conducted among asymptomatic or mild COVID-19-positive patients in Bangalore from September 2020 to February 2021. In each group of steam inhalation, saline gargling, povidone-iodine gargling, and control, twenty participants were allocated. Daily follow-up was done for 21 days to assess early test negativity and clinical recovery. Trial Registry Number: Clinical Trial Registry India/2020/09/027687. Results: Among 80 participants recruited, 65 (81.3%) were symptomatic. Early test negativity was seen in povidone-iodine gargling group of 6 days (KaplanMeier survival curve, BreslowGeneralized Wilcoxon test P = 0.7 as per the intention-to-treat and as per-protocol P = 0.8). Significant clinical recovery was seen in saline gargling group (4 days, P = 0.01). Conclusion: Povidone-iodine gargling was effective in providing early test negativity, whereas saline gargling was effective in early clinical recovery.

Tuberculosis-diabetes mellitus bidirectional screening at a tertiary care centre, South India.

SETTING: Tuberculosis (TB) and diabetes mellitus (DM) clinics at Bowring and Lady Curzon Hospital, a tertiary care centre in Bangalore, India. OBEJCTIVE: To assess the feasibility and results of TB-DM bidirectional screening. METHODS: A descriptive study conducted from 1 March to 30 September 2012, in which all TB patients were assessed for DM and vice versa. Fasting blood glucose values of ≥126 mg/dl and 110-125 mg/dl were considered as DM and pre-diabetes, respectively. RESULTS: Of 510 TB patients, 32 (6.3%) had been previously diagnosed with DM. Screening among the remaining 478 patients yielded 15 (2.9%) with pre-diabetes and 15 (2.9%) newly diagnosed cases of DM. A higher prevalence of DM was found among patients aged ≥40 years, patients with pulmonary TB and smokers. Of the 47 TB-DM patients, 45 were enrolled in DM care. Of 1670 DM patients followed up in DM clinics, 45 already had TB. Among the remaining 1625 patients screened, 152 (9%) had symptoms suggestive of TB; two of these were found to have the disease. CONCLUSION: Bidirectional screening for DM and TB is feasible and produces a high yield for DM among TB patients. The yield of TB among DM patients was low and needs future research using new, improved TB diagnostic tools.