To estimate rates of community-level influenza-like-illness (ILI) and influenza-associated ILI in... more To estimate rates of community-level influenza-like-illness (ILI) and influenza-associated ILI in rural north India. During 2011, we conducted household-based healthcare utilization surveys (HUS) for any acute medical illness (AMI) in preceding 14days among residents of 28villages of Ballabgarh, in north India. Concurrently, we conducted clinic-based surveillance (CBS) in the area for AMI episodes with illness onset ≤3days and collected nasal and throat swabs for influenza virus testing using real-time polymerase chain reaction. Retrospectively, we applied ILI case definition (measured/reported fever and cough) to HUS and CBS data. We attributed 14days of risk-time per person surveyed in HUS and estimated community ILI rate by dividing the number of ILI cases in HUS by total risk-time. We used CBS data on influenza positivity and applied it to HUS-based community ILI rates by age, month, and clinic type, to estimate the community influenza-associated ILI rates. The HUS of 69,369 res...
Illness is affected by human behaviour. However, in most developing countries the risk behaviour ... more Illness is affected by human behaviour. However, in most developing countries the risk behaviour of the general population is not assessed. We developed a surveillance system to assess the 'risk factors' at the community level using the routine healthcare system. The Comprehensive Rural Health Services Project at Ballabgarh, Haryana, provides healthcare to a population of 82,933 through 2 primary health centres and 24 health workers. Information on behavioural risk factors for communicable and non-communicable diseases was collected by health workers during the annual health census from December 2003 to February 2004. The information collected pertained to maternal and child health, and household and individual behaviour. We compared the data related to individual behaviour with that ofa survey of non-communicable diseases risk factors done in the same area. Data were collected from (i) mothers who had delivered during the preceding year (n=1625), (ii) a random sample of ind...
The feasibility of using nongovernmental organizations (NGOs) to monitor the iodine content of sa... more The feasibility of using nongovernmental organizations (NGOs) to monitor the iodine content of salt was studied in Uttar Pradesh, northern India, where iodine-deficiency disorders (IDDs) are endemic. Three NGOs already involved in health and development activities in the Gorakhpur, Varanasi, and Dehradun regions collected salt samples monthly from households and shops in selected villages over a 6-month period. A total of 4001 samples were analysed at regional laboratories by trained personnel using a standard protocol; 10% of the samples were sent to a central laboratory for external quality control. The iodine content lay in the range 0-95 mg/kg of salt; it was particularly low in the Gorakhpur and Varanasi regions, where over 80% of samples contained less than the minimum recommended level of 15 mg/kg; 37% of samples were in this category in the Dehradun region. Regular monitoring of the iodine content of salt at the consumer level is essential for the elimination of IDDs, and th...
All the women in my lifethey were someone's daughters. My Mother, who gave me all the right value... more All the women in my lifethey were someone's daughters. My Mother, who gave me all the right values and is entirely responsible for what I am today My wife Prema, for bearing with me and all my faults for twenty years and still wanting to stay with me! Finally to my two wonderful daughters Kritika and Keertana, who have made all the difference to my life by the love they brought in it and for proving that love is endless… A special remembrance for my Father, who despite having three sons, always had the softest corner for his daughter! ii aBBrEvIatIoNS ABBREVIATIONS aBaD apni Beti apna Dhan aIIMS all India Institute of Medical Sciences aNC antenatal Care aNova analysis of variance BCG Bacillus Calmette
Objective To assess the effectiveness of a multi-component school based intervention in improving... more Objective To assess the effectiveness of a multi-component school based intervention in improving knowledge and behavioral practices regarding diet, physical activity and tobacco use in middle schoolchildren of rural-Ballabgarh, North-India. Methods A total of 40 middle schools were grouped into two, based on geographic proximity and randomly assigned to the intervention or control group in a cluster randomized controlled trial. The target population consisted of 2,348 children studying in 6th and 7th grades in these schools. The intervention consisted of a school component (policies), a classroom component (activities) and a family component [Information Education & Communication (IEC) material]. The main outcome measures were knowledge and behavioral changes in physical activity, diet and tobacco which were self-reported. Results Post-intervention, a significant number of intervention schools adopted the tobacco policy (16/19), physical activity policy (6/19) and healthy food policy (14/19) as compared to the control schools (n=21). Knowledge about physical activity, diet and tobacco improved significantly in the intervention group as compared to the control group. Proportion of students attending Physical Training (PT) classes for five or more days in a week in the intervention group compared to the control group increased significantly (17.8 %; p<0.01). Proportion of students consuming fruits increased in the intervention group compared to the control group (10 %; p<0.01). Pre-post decrease in the prevalence of current smoking was significantly more in the intervention group as compared to the control group (7.7 %; p<0.01). Conclusions Healthy settings approach for schools is feasible and effective in improving knowledge and behavioral practices of non-communicable diseases (NCD) risk factors in adolescents in rural India.
Objective: To investigate causes of and contributors to newborn deaths in rural Haryana using a t... more Objective: To investigate causes of and contributors to newborn deaths in rural Haryana using a three delays audit approach. Methods: The study was conducted in 28 villages under the rural field practice area of the Comprehensive Rural Health Services Project, All India Institute of Medical Sciences situated in Ballabgarh, Haryana. Data were collected through house visits and analysed using the three delays model. Results: Of the 50 newborn deaths investigated, 44% occurred within the first 24 h after birth. The leading causes of death were pre-term/low birthweight (32%), birth asphyxia (28%) and neonatal sepsis (14%). Major contributing delays to neonatal death were caretaker's delay in deciding to seek care (44%, 22/50) and delay in reaching a health care facility, i.e. the transport delay (34%, 17/50). Conclusions: Household and transport-related delays were the major contributors to newborn deaths, and efforts to improve newborn survival need to address both concurrently.
Background-India aims to reduce the infant mortality rate (IMR) to below 60 per 1000 live births ... more Background-India aims to reduce the infant mortality rate (IMR) to below 60 per 1000 live births by 2000. IMR is higher in northern India as compared with south Indian states like Kerala. Any further reduction in IMR needs identification of new strategies. The Ballabgarh project with an IMR of 36 in 1997 can help identify such strategies. Objective-To see the trend in reduction of neonatal mortality rate (NNMR) and IMR at the Ballabgarh project, compare it with Kerala and rural India's trend and look at the causes of neonatal and infant mortality. Design-The Comprehensive Rural Health Services Project, Ballabgarh, run by the All India Institute of Medical Sciences, covered an estimated population of 70 079 in 1997. The health care delivery system is on the national pattern. All the deaths are identified during the house visits by the male workers. The cause of death is ascertained by the health assistant based on the symptomatology at the time of death. Results-The trends in reduction of IMR for Ballabgarh, Kerala and rural India are roughly parallel with the IMR of Ballabgarh lying somewhere in between the two. However, the NNMR of Ballabgarh (10.6 in 1996) was comparable to Kerala's NNMR (10.9 in 1992). The proportion of infant deaths occurring during the neonatal period had fallen from 50% in the early seventies to 30% during 1996-97. In 1992-1994, 33.8% of all neonatal deaths were attributable to low birth weight and 37.3% to infective causes. Acute respiratory infection and diarrhoea continue to be the chief cause of postneonatal mortality. Conclusion-It is possible to bring down neonatal mortality before postneonatal mortality. The Kerala model, which focuses on social development, may not apply to northern India for sociocultural reasons.
International Journal of Infectious Diseases, 2013
Background: Data on influenza illness rates with population denominators are needed to quantify o... more Background: Data on influenza illness rates with population denominators are needed to quantify overall morbidity and to prioritize public health intervention strategies. Methods: The rates of influenza A(H1N1)pdm09 infection during pandemic phases were determined in a longitudinal community cohort study as part of an influenza vaccine study in a rural community of North India. Results: During the 711 731 person-weeks of surveillance, a total of 1410/7571 (19%) febrile acute respiratory illness cases were positive for influenza. Of these, 749 (53%) were influenza A(H1N1)pdm09, 643 (46%) influenza B, and 18 (1%) influenza A (H3N2). The overall incidence rate of influenza-associated febrile acute respiratory illness was 128/1000 person-years. The incidence rates of influenza A(H1N1)pdm09 were high during both the pandemic phase (179/1000 person-years; November 2009 to January 2010) and post-pandemic phase (156/1000 person-years; August to October 2010), with children <18 years of age being at the greatest risk of influenza infection in the community. Conclusions: These findings provide important information for planning clinical and public health intervention strategies to mitigate the impact of influenza epidemics.
Objective: Clinical case definitions used for influenza surveillance among hospitalized patients ... more Objective: Clinical case definitions used for influenza surveillance among hospitalized patients vary and need systematic evaluation. Design, setting and sample: During July 2009-August 2011, we collected clinical data and specimens (nasal and throat swabs) from rural patients hospitalized for acute medical illnesses. Specimens were tested by rRT-PCR for influenza viruses. Main outcome measures: Case definitions evaluated the following: influenza-like illness (ILI: measured fever plus cough or sore throat); severe acute respiratory illness (SARI: ILI with difficulty breathing in ‡5 years, Integrated Management of Childhood Illness-defined pneumonia or severe pneumonia, or physician diagnosed lower respiratory infection in <5 years); acute respiratory infection (ARI: ‡1 of cough, nasal discharge, difficulty breathing or sore throat); febrile acute respiratory illness (FARI: fever plus either cough, sore throat, runny nose, difficulty breathing, or earache). Variants that included ''reported fever'' and additional sign-symptom combinations were also evaluated. Results: We enrolled 1043 hospitalized patients, including 257 children <5 years of age (range 1 day-86 years). Seventy-four patients tested influenza virus positive (including 28 A(H1N1)pdm09). Sensitivity(95% CI) and specificity (95% CI) for influenza infection were 78% (67-87) and 60% (57-63) for ILI (measured ⁄ reported fever); 37% (26-49) and 78% (75-80) for SARI (measured ⁄ reported fever); 82% (72-90) and 57% (54-60) for FARI (measured ⁄ reported fever); 88% (78-94) and 45% (42-49) for ARI; and 74% (63-84) and 61% (58-64) for measured ⁄ reported fever plus cough. Case definitions including only measured fever had lower sensitivity. Conclusion: ILI and FARI with measured ⁄ reported fever provided good balance between sensitivity and specificity among hospitalized patients. The simpler case definition of measured ⁄ reported fever plus cough is suited for field surveillance.
Background: The current study was undertaken to estimate the delay in vaccination for National Im... more Background: The current study was undertaken to estimate the delay in vaccination for National Immunization Schedule vaccines in under-five children and explore causes for this delay. Methods: The study was carried out in Ballabgarh Health and Demographic Surveillance Site in Northern India. It is a secondary data set-based study of children born between 1991 and 2004. Causes for delay in vaccination were explored by informal discussions. Results: Total of 25 517 children were included in the analysis. Vaccination coverage at 1 year of age was high for all National immunization schedule vaccines (78.7% for measles to 97.4% for OPV-1). Children for delayed vaccination ranged from 15.9% (95% CI 15.4-16.3) for OPV booster to 83.5% (95% CI 83.1-83.9) for OPV-3. Non-availability of children was identified as important determinants of the delay. Conclusions: We conclude that focus on 'quantity' in vaccination (high vaccination coverage) needs to be supplemented with quality of vaccination (in-time vaccination).
Journal of clinical and diagnostic research : JCDR, 2014
The prevalence of osteoarthritis among elderly is high and it majorly affects the quality of life... more The prevalence of osteoarthritis among elderly is high and it majorly affects the quality of life. Knee osteoarthritis is the most common form of osteoarthritis. Timely diagnosis using clinical criteria and effective intervention is of utmost importance. To estimate the prevalence and determinants of osteoarthritis of knee joint among elderly persons residing in an urban slum of Delhi using ACR clinical criteria. We did a community-based cross-sectional study among 496 elderly (>= 60 years) persons residing in urban slum of Delhi, India from December 2009 to February 2010. The American College of Rheumatology (ACR) criteria was used to clinically diagnose osteoarthritis knee. Bivariate analysis using Chi-square test and multivariate analysis was done to identify the determinants. Sensitivity and specificity of individual factors to diagnose osteoarthritis knee was calculated. The prevalence of osteoarthritis was estimated to be 41.1% (95% C.I., 36.7-45.6). Female sex and age >...
Most patients with noncommunicable diseases (NCDs) can be managed appropriately at the primary ca... more Most patients with noncommunicable diseases (NCDs) can be managed appropriately at the primary care level, using a simplified standard protocol supported by low-cost drugs. The primary care response to common NCDs is often unstructured and inadequate in low- and middle-income countries. This study assessed the feasibility of integration of NCD prevention and control within the primary health-care system of India. This study was done among 12 subcentres, 2 primary health centres (PHCs) and one subdistrict hospital in a block in north India. All 28 multipurpose health workers of these subcentres underwent 3-day training for delivering the package of NCD interventions as a part of their routine functioning. A time-motion study was conducted before and after this, to assess the workload on a sample of the workers with and without the NCD work. Screening for risk assessment was done at domiciliary level as well as at health-facility level (opportunistic screening), and the cost was estim...
Background: Studies in developed nations have reported an association of blindness and hearing im... more Background: Studies in developed nations have reported an association of blindness and hearing impairment with mortality in elderly persons. Objectives: To study the association of blindness and hearing impairment with mortality in a cohort of elderly persons in rural north India. Materials and Methods: This community-based prospective study was conducted in eleven randomly selected villages, in Ballabgarh block, Haryana. A cohort of 1422 participants, of age 60 years and above, was examined at baseline, for their visual and hearing status. Data on the sociodemographic factors, various comorbidities, activities of daily living, and self-rated health were recorded. Baseline data was collected for the period May 2008 to August 2008. Follow-up data collection for mortality was completed in December 2009. The median follow-up period was 518 days. Results: One hundred out of 1422 elderly (7.0%) participants died during the follow-up period. Significant hazard ratios were found after adjustment for various comorbid conditions. On adjustment for sociodemographic factors (age, sex, and literacy), neither blindness nor hearing impairment was found to be significantly associated with mortality. After adjustment for all covariates in the study, hearing impairment (Hazard Ratio = 2.13; 95% CI, 1.29-3.54) was found to be significantly associated with mortality in the age group ≥70 years. Conclusions: This study demonstrated that hearing impairment was an independent risk factor for mortality in people aged ≥70 years. Similar studies with a longer period of follow-up are required in India, to guide public health interventions.
Ethics in public health policy is given the least importance and rarely discussed. Resolving ethi... more Ethics in public health policy is given the least importance and rarely discussed. Resolving ethical issues in public health is often an arduous task as these are complicated and require careful handling. Using four case studies, we discuss issues pertaining to pertussis and brain damage, water fluoridation and dental caries, infection with the human immunodeficiency virus and the right to marriage, and the debate surrounding universal salt iodization. The core issue in all these examples pertains to the relevance of ethics in public health policy.
This study was done to estimate the prevalence of HIV infection among TB patients; and the presen... more This study was done to estimate the prevalence of HIV infection among TB patients; and the presence of HIV related risk behavior among these TB patients attending DOTS centres in Ballabgarh,
To assess the efficacy of micronutrient fortified sugar candies in improving the iron and vitamin... more To assess the efficacy of micronutrient fortified sugar candies in improving the iron and vitamin A status in children aged 3 to 6 years. Triple blind randomized controlled trial. Anganwadis and preparatory schools in rural Haryana. 410 children were randomized in four groups. One group received full dose candy (vitamin A 1000 IU and 14 mg elemental iron) daily, the second group received full dose candy for 3 days a week, the third group received half dose candy (vitamin A 500 IU and 7 mg elemental iron) daily and the fourth received placebo. The candies were provided to children under supervision of field workers. Hemoglobin, S. ferritin, S. retinol and S. retinol binding protein levels were estimated at baseline and after 13 weeks of intervention. The increase in hemoglobin was least in the placebo group (0.3 g/dL) as compared to the two full dose groups (1.15-1.18 g/dL, P < 0.001). Among anemic children, the increase in hemoglobin was about 2 g/dL in the full dose group and 0....
To estimate rates of community-level influenza-like-illness (ILI) and influenza-associated ILI in... more To estimate rates of community-level influenza-like-illness (ILI) and influenza-associated ILI in rural north India. During 2011, we conducted household-based healthcare utilization surveys (HUS) for any acute medical illness (AMI) in preceding 14days among residents of 28villages of Ballabgarh, in north India. Concurrently, we conducted clinic-based surveillance (CBS) in the area for AMI episodes with illness onset ≤3days and collected nasal and throat swabs for influenza virus testing using real-time polymerase chain reaction. Retrospectively, we applied ILI case definition (measured/reported fever and cough) to HUS and CBS data. We attributed 14days of risk-time per person surveyed in HUS and estimated community ILI rate by dividing the number of ILI cases in HUS by total risk-time. We used CBS data on influenza positivity and applied it to HUS-based community ILI rates by age, month, and clinic type, to estimate the community influenza-associated ILI rates. The HUS of 69,369 res...
Illness is affected by human behaviour. However, in most developing countries the risk behaviour ... more Illness is affected by human behaviour. However, in most developing countries the risk behaviour of the general population is not assessed. We developed a surveillance system to assess the 'risk factors' at the community level using the routine healthcare system. The Comprehensive Rural Health Services Project at Ballabgarh, Haryana, provides healthcare to a population of 82,933 through 2 primary health centres and 24 health workers. Information on behavioural risk factors for communicable and non-communicable diseases was collected by health workers during the annual health census from December 2003 to February 2004. The information collected pertained to maternal and child health, and household and individual behaviour. We compared the data related to individual behaviour with that ofa survey of non-communicable diseases risk factors done in the same area. Data were collected from (i) mothers who had delivered during the preceding year (n=1625), (ii) a random sample of ind...
The feasibility of using nongovernmental organizations (NGOs) to monitor the iodine content of sa... more The feasibility of using nongovernmental organizations (NGOs) to monitor the iodine content of salt was studied in Uttar Pradesh, northern India, where iodine-deficiency disorders (IDDs) are endemic. Three NGOs already involved in health and development activities in the Gorakhpur, Varanasi, and Dehradun regions collected salt samples monthly from households and shops in selected villages over a 6-month period. A total of 4001 samples were analysed at regional laboratories by trained personnel using a standard protocol; 10% of the samples were sent to a central laboratory for external quality control. The iodine content lay in the range 0-95 mg/kg of salt; it was particularly low in the Gorakhpur and Varanasi regions, where over 80% of samples contained less than the minimum recommended level of 15 mg/kg; 37% of samples were in this category in the Dehradun region. Regular monitoring of the iodine content of salt at the consumer level is essential for the elimination of IDDs, and th...
All the women in my lifethey were someone's daughters. My Mother, who gave me all the right value... more All the women in my lifethey were someone's daughters. My Mother, who gave me all the right values and is entirely responsible for what I am today My wife Prema, for bearing with me and all my faults for twenty years and still wanting to stay with me! Finally to my two wonderful daughters Kritika and Keertana, who have made all the difference to my life by the love they brought in it and for proving that love is endless… A special remembrance for my Father, who despite having three sons, always had the softest corner for his daughter! ii aBBrEvIatIoNS ABBREVIATIONS aBaD apni Beti apna Dhan aIIMS all India Institute of Medical Sciences aNC antenatal Care aNova analysis of variance BCG Bacillus Calmette
Objective To assess the effectiveness of a multi-component school based intervention in improving... more Objective To assess the effectiveness of a multi-component school based intervention in improving knowledge and behavioral practices regarding diet, physical activity and tobacco use in middle schoolchildren of rural-Ballabgarh, North-India. Methods A total of 40 middle schools were grouped into two, based on geographic proximity and randomly assigned to the intervention or control group in a cluster randomized controlled trial. The target population consisted of 2,348 children studying in 6th and 7th grades in these schools. The intervention consisted of a school component (policies), a classroom component (activities) and a family component [Information Education & Communication (IEC) material]. The main outcome measures were knowledge and behavioral changes in physical activity, diet and tobacco which were self-reported. Results Post-intervention, a significant number of intervention schools adopted the tobacco policy (16/19), physical activity policy (6/19) and healthy food policy (14/19) as compared to the control schools (n=21). Knowledge about physical activity, diet and tobacco improved significantly in the intervention group as compared to the control group. Proportion of students attending Physical Training (PT) classes for five or more days in a week in the intervention group compared to the control group increased significantly (17.8 %; p<0.01). Proportion of students consuming fruits increased in the intervention group compared to the control group (10 %; p<0.01). Pre-post decrease in the prevalence of current smoking was significantly more in the intervention group as compared to the control group (7.7 %; p<0.01). Conclusions Healthy settings approach for schools is feasible and effective in improving knowledge and behavioral practices of non-communicable diseases (NCD) risk factors in adolescents in rural India.
Objective: To investigate causes of and contributors to newborn deaths in rural Haryana using a t... more Objective: To investigate causes of and contributors to newborn deaths in rural Haryana using a three delays audit approach. Methods: The study was conducted in 28 villages under the rural field practice area of the Comprehensive Rural Health Services Project, All India Institute of Medical Sciences situated in Ballabgarh, Haryana. Data were collected through house visits and analysed using the three delays model. Results: Of the 50 newborn deaths investigated, 44% occurred within the first 24 h after birth. The leading causes of death were pre-term/low birthweight (32%), birth asphyxia (28%) and neonatal sepsis (14%). Major contributing delays to neonatal death were caretaker's delay in deciding to seek care (44%, 22/50) and delay in reaching a health care facility, i.e. the transport delay (34%, 17/50). Conclusions: Household and transport-related delays were the major contributors to newborn deaths, and efforts to improve newborn survival need to address both concurrently.
Background-India aims to reduce the infant mortality rate (IMR) to below 60 per 1000 live births ... more Background-India aims to reduce the infant mortality rate (IMR) to below 60 per 1000 live births by 2000. IMR is higher in northern India as compared with south Indian states like Kerala. Any further reduction in IMR needs identification of new strategies. The Ballabgarh project with an IMR of 36 in 1997 can help identify such strategies. Objective-To see the trend in reduction of neonatal mortality rate (NNMR) and IMR at the Ballabgarh project, compare it with Kerala and rural India's trend and look at the causes of neonatal and infant mortality. Design-The Comprehensive Rural Health Services Project, Ballabgarh, run by the All India Institute of Medical Sciences, covered an estimated population of 70 079 in 1997. The health care delivery system is on the national pattern. All the deaths are identified during the house visits by the male workers. The cause of death is ascertained by the health assistant based on the symptomatology at the time of death. Results-The trends in reduction of IMR for Ballabgarh, Kerala and rural India are roughly parallel with the IMR of Ballabgarh lying somewhere in between the two. However, the NNMR of Ballabgarh (10.6 in 1996) was comparable to Kerala's NNMR (10.9 in 1992). The proportion of infant deaths occurring during the neonatal period had fallen from 50% in the early seventies to 30% during 1996-97. In 1992-1994, 33.8% of all neonatal deaths were attributable to low birth weight and 37.3% to infective causes. Acute respiratory infection and diarrhoea continue to be the chief cause of postneonatal mortality. Conclusion-It is possible to bring down neonatal mortality before postneonatal mortality. The Kerala model, which focuses on social development, may not apply to northern India for sociocultural reasons.
International Journal of Infectious Diseases, 2013
Background: Data on influenza illness rates with population denominators are needed to quantify o... more Background: Data on influenza illness rates with population denominators are needed to quantify overall morbidity and to prioritize public health intervention strategies. Methods: The rates of influenza A(H1N1)pdm09 infection during pandemic phases were determined in a longitudinal community cohort study as part of an influenza vaccine study in a rural community of North India. Results: During the 711 731 person-weeks of surveillance, a total of 1410/7571 (19%) febrile acute respiratory illness cases were positive for influenza. Of these, 749 (53%) were influenza A(H1N1)pdm09, 643 (46%) influenza B, and 18 (1%) influenza A (H3N2). The overall incidence rate of influenza-associated febrile acute respiratory illness was 128/1000 person-years. The incidence rates of influenza A(H1N1)pdm09 were high during both the pandemic phase (179/1000 person-years; November 2009 to January 2010) and post-pandemic phase (156/1000 person-years; August to October 2010), with children <18 years of age being at the greatest risk of influenza infection in the community. Conclusions: These findings provide important information for planning clinical and public health intervention strategies to mitigate the impact of influenza epidemics.
Objective: Clinical case definitions used for influenza surveillance among hospitalized patients ... more Objective: Clinical case definitions used for influenza surveillance among hospitalized patients vary and need systematic evaluation. Design, setting and sample: During July 2009-August 2011, we collected clinical data and specimens (nasal and throat swabs) from rural patients hospitalized for acute medical illnesses. Specimens were tested by rRT-PCR for influenza viruses. Main outcome measures: Case definitions evaluated the following: influenza-like illness (ILI: measured fever plus cough or sore throat); severe acute respiratory illness (SARI: ILI with difficulty breathing in ‡5 years, Integrated Management of Childhood Illness-defined pneumonia or severe pneumonia, or physician diagnosed lower respiratory infection in <5 years); acute respiratory infection (ARI: ‡1 of cough, nasal discharge, difficulty breathing or sore throat); febrile acute respiratory illness (FARI: fever plus either cough, sore throat, runny nose, difficulty breathing, or earache). Variants that included ''reported fever'' and additional sign-symptom combinations were also evaluated. Results: We enrolled 1043 hospitalized patients, including 257 children <5 years of age (range 1 day-86 years). Seventy-four patients tested influenza virus positive (including 28 A(H1N1)pdm09). Sensitivity(95% CI) and specificity (95% CI) for influenza infection were 78% (67-87) and 60% (57-63) for ILI (measured ⁄ reported fever); 37% (26-49) and 78% (75-80) for SARI (measured ⁄ reported fever); 82% (72-90) and 57% (54-60) for FARI (measured ⁄ reported fever); 88% (78-94) and 45% (42-49) for ARI; and 74% (63-84) and 61% (58-64) for measured ⁄ reported fever plus cough. Case definitions including only measured fever had lower sensitivity. Conclusion: ILI and FARI with measured ⁄ reported fever provided good balance between sensitivity and specificity among hospitalized patients. The simpler case definition of measured ⁄ reported fever plus cough is suited for field surveillance.
Background: The current study was undertaken to estimate the delay in vaccination for National Im... more Background: The current study was undertaken to estimate the delay in vaccination for National Immunization Schedule vaccines in under-five children and explore causes for this delay. Methods: The study was carried out in Ballabgarh Health and Demographic Surveillance Site in Northern India. It is a secondary data set-based study of children born between 1991 and 2004. Causes for delay in vaccination were explored by informal discussions. Results: Total of 25 517 children were included in the analysis. Vaccination coverage at 1 year of age was high for all National immunization schedule vaccines (78.7% for measles to 97.4% for OPV-1). Children for delayed vaccination ranged from 15.9% (95% CI 15.4-16.3) for OPV booster to 83.5% (95% CI 83.1-83.9) for OPV-3. Non-availability of children was identified as important determinants of the delay. Conclusions: We conclude that focus on 'quantity' in vaccination (high vaccination coverage) needs to be supplemented with quality of vaccination (in-time vaccination).
Journal of clinical and diagnostic research : JCDR, 2014
The prevalence of osteoarthritis among elderly is high and it majorly affects the quality of life... more The prevalence of osteoarthritis among elderly is high and it majorly affects the quality of life. Knee osteoarthritis is the most common form of osteoarthritis. Timely diagnosis using clinical criteria and effective intervention is of utmost importance. To estimate the prevalence and determinants of osteoarthritis of knee joint among elderly persons residing in an urban slum of Delhi using ACR clinical criteria. We did a community-based cross-sectional study among 496 elderly (>= 60 years) persons residing in urban slum of Delhi, India from December 2009 to February 2010. The American College of Rheumatology (ACR) criteria was used to clinically diagnose osteoarthritis knee. Bivariate analysis using Chi-square test and multivariate analysis was done to identify the determinants. Sensitivity and specificity of individual factors to diagnose osteoarthritis knee was calculated. The prevalence of osteoarthritis was estimated to be 41.1% (95% C.I., 36.7-45.6). Female sex and age >...
Most patients with noncommunicable diseases (NCDs) can be managed appropriately at the primary ca... more Most patients with noncommunicable diseases (NCDs) can be managed appropriately at the primary care level, using a simplified standard protocol supported by low-cost drugs. The primary care response to common NCDs is often unstructured and inadequate in low- and middle-income countries. This study assessed the feasibility of integration of NCD prevention and control within the primary health-care system of India. This study was done among 12 subcentres, 2 primary health centres (PHCs) and one subdistrict hospital in a block in north India. All 28 multipurpose health workers of these subcentres underwent 3-day training for delivering the package of NCD interventions as a part of their routine functioning. A time-motion study was conducted before and after this, to assess the workload on a sample of the workers with and without the NCD work. Screening for risk assessment was done at domiciliary level as well as at health-facility level (opportunistic screening), and the cost was estim...
Background: Studies in developed nations have reported an association of blindness and hearing im... more Background: Studies in developed nations have reported an association of blindness and hearing impairment with mortality in elderly persons. Objectives: To study the association of blindness and hearing impairment with mortality in a cohort of elderly persons in rural north India. Materials and Methods: This community-based prospective study was conducted in eleven randomly selected villages, in Ballabgarh block, Haryana. A cohort of 1422 participants, of age 60 years and above, was examined at baseline, for their visual and hearing status. Data on the sociodemographic factors, various comorbidities, activities of daily living, and self-rated health were recorded. Baseline data was collected for the period May 2008 to August 2008. Follow-up data collection for mortality was completed in December 2009. The median follow-up period was 518 days. Results: One hundred out of 1422 elderly (7.0%) participants died during the follow-up period. Significant hazard ratios were found after adjustment for various comorbid conditions. On adjustment for sociodemographic factors (age, sex, and literacy), neither blindness nor hearing impairment was found to be significantly associated with mortality. After adjustment for all covariates in the study, hearing impairment (Hazard Ratio = 2.13; 95% CI, 1.29-3.54) was found to be significantly associated with mortality in the age group ≥70 years. Conclusions: This study demonstrated that hearing impairment was an independent risk factor for mortality in people aged ≥70 years. Similar studies with a longer period of follow-up are required in India, to guide public health interventions.
Ethics in public health policy is given the least importance and rarely discussed. Resolving ethi... more Ethics in public health policy is given the least importance and rarely discussed. Resolving ethical issues in public health is often an arduous task as these are complicated and require careful handling. Using four case studies, we discuss issues pertaining to pertussis and brain damage, water fluoridation and dental caries, infection with the human immunodeficiency virus and the right to marriage, and the debate surrounding universal salt iodization. The core issue in all these examples pertains to the relevance of ethics in public health policy.
This study was done to estimate the prevalence of HIV infection among TB patients; and the presen... more This study was done to estimate the prevalence of HIV infection among TB patients; and the presence of HIV related risk behavior among these TB patients attending DOTS centres in Ballabgarh,
To assess the efficacy of micronutrient fortified sugar candies in improving the iron and vitamin... more To assess the efficacy of micronutrient fortified sugar candies in improving the iron and vitamin A status in children aged 3 to 6 years. Triple blind randomized controlled trial. Anganwadis and preparatory schools in rural Haryana. 410 children were randomized in four groups. One group received full dose candy (vitamin A 1000 IU and 14 mg elemental iron) daily, the second group received full dose candy for 3 days a week, the third group received half dose candy (vitamin A 500 IU and 7 mg elemental iron) daily and the fourth received placebo. The candies were provided to children under supervision of field workers. Hemoglobin, S. ferritin, S. retinol and S. retinol binding protein levels were estimated at baseline and after 13 weeks of intervention. The increase in hemoglobin was least in the placebo group (0.3 g/dL) as compared to the two full dose groups (1.15-1.18 g/dL, P < 0.001). Among anemic children, the increase in hemoglobin was about 2 g/dL in the full dose group and 0....
Uploads
Papers by Anand Krishnan