Malaria outbreak in Bhojpur PHC of district Moradabad, Uttar Pradesh, India

Based on the reports of 18 fever related deaths in Bhojpur Primary Health Centre (PHC) of Moradabad District (UP), a study was undertaken during September and October, 2000 to explore the possibility of outbreak of malaria in the area and the reasons of the outbreak. The slide positivity rate (SPR) and slide falciparum rate (SFR) in active fever surveys were found to be 84.7% and 82.2% respectively. Among children the average enlarged spleen and spleen rate were 1.9 and 27.4 per cent respectively. The mortality rate of Anopheles culicifacies in DDT, Malathion and Deltamethrin was 42.5, 86.7 and cent per cent respectively. The results of the study revealed that the outbreak was of malaria with predominance of Plasmodium falciparum causing several deaths in the affected villages. The investigation revealed that there was disruption of surveillance and supervision of malaria activities.     

Geographic and ethnic distribution of beta-thalassemia mutations in Uttar Pradesh, India

We have studied the geographic and ethnic distribution of mutations in 376 subjects who were carriers of beta-thalassemia, and identified the mutations in 365 chromosomes. The majority of the beta-thalassemia carriers were of Uttar Pradesh (India) origin. Their pattern of mutations differed from the other states of India and from those families who had migrated from Pakistan. The frequency of the IVS-I-5 (G-->C) and 619 bp deletion mutations were 64.3 and 2.5%, respectively, among families originating from Uttar Pradesh, compared to a prevalence of 37.5 and 27.5%, respectively in the population of Pakistani immigrants. Of the 10 common Asian Indian mutations, only eight were observed in subjects studied from different parts of India. By use of the amplification refractory mutation system along with DNA sequencing techniques, the mutations were successfully identified in 97.1% of subjects, while 11 cases (2.9%) still remain to be characterized by single strand conformation polymorphism and sequencing analyses. The application of this knowledge has facilitated the successful implementation of the program of genetic counseling and prenatal diagnosis of beta-thalassemia, thus helping to avoid the birth of an affected child in India.     

Annual risk of tuberculous infection in rural areas of Uttar Pradesh, India.

SETTING: Rural areas in Uttar Pradesh, the most populous state in India. OBJECTIVES: 1) To estimate the average annual risk of tuberculous infection (ARI), 2) to study ARI trends with age, and 3) to compare tuberculin reactions among children with and without BCG scar. STUDY DESIGN: A cross-sectional tuberculin survey was conducted among children aged 1-9 years residing in Rae Bareli, Hardoi and Jaunpur districts, Uttar Pradesh. Tuberculin testing was performed using 1TU of PPD RT23 with Tween 80, and indurations were measured 72 hours later. Prevalence of infection was estimated in children without BCG scar based on the cut-off point identified on the frequency distribution of reaction sizes. The ARI was computed from the estimated prevalence. RESULTS: The proportion of children with BCG scar varied from 25% to 31% in the study districts. Using a cut-off of 14 mm among children without BCG scar, the ARI was estimated at 2.3% in Rae Bareli, 1.9% in Hardoi and 1.5% in Jaunpur, and was observed to increase with age. Tuberculin test results among children with BCG scar suggest that they may be included in tuberculin surveys to estimate ARI. CONCLUSION: High rates of transmission of tuberculous infection suggest that tuberculosis control measures need to be intensified.     

Herbal cure for poisons and poisonous bites from Western Uttar Pradesh,India

ObjectiveTo conduct ethnopharmacobotanical field explorations in rural areas of five districts of Uttar Pradesh, India with regard to the folk herbal formulations associated with the management of poisons and poisonous bites.MethodsLocal traditional healers known as “Vaidya” and “Hakeems” in the study area were interviewed to gather ethnopharmacobotanical information using a questionnaire attending various medical practices.ResultsInformation on 49 herbal formulations prepared from 39 plant species belonging to 28 plant families in the treatment of poisons and poisonous bites is presented in this scientific communication.ConclusionPresent communication revealed that study area is rich in its ethnopharmacobotanical knowledge. The plant species discussed here also encompasses new reports on Chenopodium album, Solanum xanthocarpum, Solanum melongena, Sesamum indicum, Calotropis procera, Coriandrum sativum, Cynodon dactylon, Brassica campestris, Triticum aestivum, Vitis vinifera, Sorgum vulgare and Nerium indicum. This study further concludes that there lies a lot of potential in the Indian herbal repository which should be explored systematically and later subjected to thorough study under the light of latest available scientific research methodologies for the drug standardization and pharmaco-toxicological studies with a view to making cheaper and safer drugs for the benefit of humanity periodically encountered with poisons and poisonous bites.     

Impact of DDT spraying on malaria transmission in Bareilly District, Uttar Pradesh, India

BACKGROUND & OBJECTIVES: Impact of indoor residual spraying of DDT on malaria transmission and vector density was evaluated in six villages of Shergarh PHC, Bareilly district, Uttar Pradesh under the operational condition of National Vector Borne Disease Control Programme (NVBDCP) from July 2001 to March 2002 (one transmission season only). METHODS: Two rounds of DDT (50% WDP) spraying @ 1 g/m2 were done both in the experimental and control villages by the state health authorities. The spraying in experimental villages was supervised by Malaria Research Centre (MRC) whereas the district health authorities supervised the operation in control villages. Mass blood surveys were made three times--before the first round, in between the first and second rounds and after the second round of spraying. The blood smears were examined by the trained microscopists of MRC, Haldwani. From the above examinations epidemiological indicators such as slide positivity rate (SPR), slide falciparum rate (SFR) and infant parasite rate (IPR) were calculated. All malaria positive cases were given radical treatment as per NVBDCP schedule. Entomological parameters such as per man hour mosquito density, parity rate, gonotrophic condition and adult susceptibility status of Anopheles culicifacies to diagnostic dosages of DDT (4%) were monitored as per the standard techniques. RESULTS: A total of 988.5 kg of DDT was consumed during two rounds of spray. The house coverage varied from 87 to 95.3%. Parasitological evaluation revealed significant reduction in malaria cases (p < 0.0005) and infant parasite rate declined from 2.9 to 0%. Entomological observations revealed considerable reduction in the density of malaria vector An. culicifacies despite of its 21.4% mortality against DDT test papers. INTERPRETATION & CONCLUSION: The overall results of the study revealed that DDT is still a viable insecticide in indoor residual spraying owing to its effectivity in well supervised spray operation and high excito-repellency factor.     

Health-related quality of life of multidrug-resistant tuberculosis patients: A study of eastern Uttar Pradesh,India

IntroductionMuch attention has been given to the microbiological aspect, drug treatment, and clinical indicators of MDR-TB, but patients' QOL has remained a neglected area. In this study, we aimed to find the quality of MDRTB on various quality of life domains during the initiation of the MDR Treatment regimen.Materials & methodsA cross-sectional study was conducted over a period of 6 months at the Drug-Resistance Tuberculosis Management Centre (DR-TB Centre), of a tertiary care centre in the eastern Uttar pradesh, India. Patients with age >18 years diagnosed with MDR-TB (Multidrug resistance TB) were included in the study. The WHO QOL-BREF scale was used to assess the health-related quality of life of patients. Data were analyzed using SPSS version 21. The institutional ethical review committee approved the study, and consent was taken before the participation of patients.ResultsA total of 157 patients were included in the study & 45.85% were dissatisfied with their condition. Social domain of WHO QOL-BREF is having the lowest mean score (28.51 ± 15.4) while psychological has high mean values (39.92 ± 6.91). There was a significant difference in the physical health domain with respect to age (p-value 0.001). Similar differences have been seen in the psychological domain regarding patient sex (p-value 0.001), smoking and alcohol within the social domain, and loss of income in the environmental domain.ConclusionThe mean value of different domains of WHO QOL-BREF is low in MDR-TB patients, with social relation domain being the most affected.     

Changing clinico-laboratory profile of encephalitis patients in the eastern Uttar Pradesh region of India

A cross-sectional study was done on 100 consecutive paediatric patients presenting with acute encephalitis syndrome. The clinico-laboratory features of all patients were recorded in a prestructured performa. Cerebrospinal fluid and serum samples were tested for: Japanese encephalitis (JE) virus; Chandipura virus; coxsackie virus; dengue virus; enterovirus 76; and West Nile virus. Twenty-two (22.0%) patients were confirmed JE cases and 17% had parasitic or bacteriological aetiology. The remaining 61 cases (61.0%) in which no viral aetiological agent was found were grouped as non-JE cases. Peripheral vascular failure, splenomegaly and hypotonia were distinguishing clinical features found in the non-JE patients. A high mortality of 26.5% was seen in patients with confirmed or presumptive viral encephalitis (22/83). A fatal outcome was independently associated with peripheral vascular failure and pallor at the time of admission. Early recognition of these signs may help clinicians to manage these cases.     

Costs of patient management of visceral leishmaniasis in Muzaffarpur, Bihar, India

OBJECTIVES: To identify and quantify the direct and indirect economic cost of treatment for visceral leishmaniasis (VL) with conventional Amphotericin B deoxycholate, currently the first-line treatment in Muzaffarpur. METHODS: Costs of patient management for VL were estimated from a societal and household perspective by means of a questionnaire designed for this study, interviews and financial reports. RESULTS: The total cost of care per episode of VL from the societal perspective was estimated at US$355, equivalent to 58% of annual household income. The largest cost category was medical costs (55%), followed by indirect costs (36%) and non-medical costs (9%). The cost from the household perspective was equivalent to US$217. The largest cost category was indirect costs (59%), followed by medical costs (27%) and non-medical costs (15%). Loss of income because of illness and hospitalization and expenses for drugs were the largest cost components. CONCLUSIONS: The economic costs related to VL are substantial, both to society and the patient. Public health authorities in Bihar should focus on policies that detect VL in the early stage and implement interventions that minimize the burden to households affected by VL.     

First case of indigenous visceral leishmaniasis from central India

Visceral leishmaniasis is endemic in the eastern states of India, but central India remains free of leishmaniais. This report describes the first indigenous case of visceral leishmaniasis in a seven-year-old girl from central India. The child presented with fever for 10 days and was diagnosed by bone marrow examination, serology using rKE16 and rK39 antigens, and a polymerase chain reaction specific for the kinesin gene. Sequencing of the immunodominant region of the kinesin gene of the parasite showed four tandem repeats, each 117 basepairs. The first tandem repeat of this strain had 97% homology with the corresponding first tandem repeat of the Leishmania donovani KE16 strain and 92% homology with the L. chagasi BA-2 strain. The second, third, and fourth tandem repeats had 97%, 98%, and 99% homology, respectively, with the L. donovani KE16 strain, and 89%, 96%, and 92% homology, respectively, with the L. chagasi BA-2 strain. This case shows that more than one genetic variant of L. donovani is circulating in various parts of India.     

Social Network and Mental Health Among Older Adults in Rural Uttar Pradesh,India: A Cross-Sectional Study

The rapid growth of the older population in India draws attention to the factors that contribute to their changing health realities. However, there has hardly been any study in India that has looked at the effects of specific social networks with children, relatives, friends and confidant on depression among older adults. The objective of the study is to investigate the association between social network and depression among the rural elderly. The study population comprised over 630 older adults (aged 60 and above) from the rural areas of Varanasi, Uttar Pradesh. We adopted Berkman's theoretical model of the impact of social relations on depression among the elderly in the Indian context. Results of the Confirmatory Factor Analysis (CFA) demonstrated that the four specific social network types: children, relatives, friends and confidant were tenable. The results showed that a better social network with 'friends/neighbours' was protective against depression among the rural elderly. This clearly points to the need for more social network centres for older adults, so that they can interact with friends within the community or between communities and participate in group activities.     

Kala-azar in Ballia district, Uttar Pradesh.

Door to door search during 1991 in 85 villages in Ballia district of Uttar Pradesh revealed 29 sporadic cases of Kala-azar in four villages. Epidemiological investigations indicated indigenous transmission in Phulwaria village (PHC: Dubhar) with 25 cases while the remaining three villages showed four imported cases from the endemic states. No kala-azar cases had been reported in Ballia between 1947 and the present investigation. Phlebotomus arqentipes, the known vector of kala-azar in India, was encountered in 10 PHCs including the four villages having kala-azar cases. Regular vigilance in Ballia and the neighbouring districts in Uttar Pradesh bordering Bihar is suggested in view of indigenous transmission detected in one village with multiple infection in families. The presence of high vector density, ambient environmental factors and absence of regular residual insecticidal spray warrant constant surveillance in Kala-Azar prone areas in Uttar Pradesh.     

Prevalence of human hydatidosis in Uttar Pradesh

The prevalence of human hydatidosis in eastern U.P. is higher than western U.P. Maximum infection was noticed in liver followed by lungs. The prevalence rate shows considerable variation with respect to sex and age of the patients. Comparison of the present data with previous reports suggests an increasing trend in the prevalence of this disease. Various epidemiological factors responsible for this disease have also been discussed.     

Serious underreporting of visceral leishmaniasis through passive case reporting in Bihar, India

OBJECTIVES: Visceral leishmaniasis (VL) is a major public health problem in Bihar, India. Unfortunately, accurate data on the incidence or prevalence of the disease are not available. This longitudinal study was undertaken to determine the incidence of VL in a Community Development Block area of the state of Bihar. Survey results were compared with official reports of the disease to assess the extent of underreporting by the Government health system. METHODS: Three health subcentre areas in Kanti Block, consisting of 14 villages with a total population of 26 444, were selected. Active surveillance was performed every month from January 2001 to December 2003 by house to house survey to detect cases of fever for more than 15 days. Patients clinically suspected of suffering from VL were subjected to parasitological examination for confirmation. Analysis of records of the reporting agencies in the district was undertaken to compare and assess the extent of underreporting. RESULTS: A total of 202 cases of VL were identified in 3 years giving an average annual incidence rate of 2.49/1000 population (95% CI = 2.15-2.83). As identification data of patients was not available with the official reporting agencies for 2001 and 2002, extent of underreporting could be assessed for 2003 only. In the study population, 65 cases of VL were detected during 2003 providing an annual incidence rate of 2.36/1000 population. Only eight (12.30%) cases were reported officially, resulting in underreporting by a factor of 8.13. In 2003, the official incidence rate of VL for Kanti Block was 0.31/1000 against the actual rate of 2.36/1000. As the constraints for official reporting at the block and the district levels are similar, the underreporting at district level was also assumed to be similar. This finding has significance in the preparation for elimination programme.     

The economic value of a visceral leishmaniasis vaccine in Bihar state, India

Visceral leishmaniasis (VL) is responsible for substantial morbidity and mortality and current available treatments have many limitations. The ability of VL infection to generate life-long immunity offers promise for the development of a VL vaccine. A VL vaccine candidate has recently completed phase I clinical trials. We constructed a computer simulation model to determine the potential economic value of a VL vaccine in the endemic region of Bihar state, India. Results found a potential vaccine to be cost-effective (and in many cases economically dominant, i.e., saving costs and providing health benefits) throughout a wide range of vaccination costs and vaccine efficacies, and VL risks. Overall, our study strongly supports the continued development of a VL vaccine.