An epidemiological study of ancylostomiasis in a rural area of Kanpur district Uttar Pradesh, India

In this epidemiological study, stool samples were collected from 256 study subjects selected from seven villages of Kanpur district, Uttar Pradesh, India. The average age of the study population was 21.6 years. The overall prevalence rate of hookworm infestation was found to be 34%. Men had significantly higher rate of infestation at all ages. Prevalence rates increased with ages as well. In addition, adult worms were collected from twelve subjects. All were identified as Ancylostoma duodenale.     

Contextual influences on reproductive health service use in Uttar Pradesh,India

This study examines the determinants of the use of four types of reproductive health-care services in Uttar Pradesh, India: contraceptive services, antenatal care, delivery in a medical institution, and services dealing with reproductive tract and sexually transmitted infections. The analysis uses a multilevel modeling strategy to assess the presence of household- and community-level variation in service use. The influence of community-level characteristics and reproductive health-care service attributes on service use is examined. The results highlight strong community-level influences on service use, although the type of community effect varies by service type. The role of some individual and household factors in determining a person's use of services is mediated by the characteristics of the community in which the individual lives. The results demonstrate the need to look beyond individual factors when examining health-care-seeking behavior, and illustrate that there is no singular "community" effect on service use.     

Mosquito records from a hot and dry climatic area experiencing frequent outbreaks of Japanese encephalitis, Bellary district, Karnataka, India

Mosquito species occurring in Bellary district, Karnataka, India were surveyed for Japanese encephalitis (JE) and West Nile virus (WNV) from 2001 to 2003. A total of 37 mosquito species in 6 genera were recovered from larval and adult habitats. Aedes, Anopheles and Culex were represented by 11 species each, Mansonia by 2 species, and Armigeres and Lutzia by a single species. A total of 68,506 mosquitoes belonging to 20 species were collected at dusk. Most (74.6%) were Cx. tritaeniorhynchus and occurred in 2 peaks of abundance in February (304 per man hour density [PMHD]) and October (465 PMHD). The mosquito fauna of Bellary district is not diverse, possibly because of the hot and dry climatic conditions in the area.     

Impact evaluation of the Urban Health Initiative in urban Uttar Pradesh,India

ObjectivesThe Urban Health Initiative (UHI) was initiated in 2009 with the goal of increasing family planning (FP) use among the poor in urban areas of Uttar Pradesh, India. The Measurement, Learning & Evaluation project (MLE) was tasked with rigorous impact evaluation of the UHI. This paper presents the impact evaluation findings of the UHI program.Study designThe MLE design includes a longitudinal sample of women and health facilities with baseline (2010) and endline (2014) data collection in six cities in Uttar Pradesh, India. At baseline, samples representative of women in each city were selected with oversampling of the poor. Eighty-four percent of women interviewed at baseline were reinterviewed 4 years later at endline. The longitudinal data support a within/fixed-effects approach to identification of program impact on changes in modern FP use.ResultsImpact evaluation results show significant effects of exposure to both demand and supply side program activities. In particular, women exposed to brochures (marginal effect: 6.96, p < .001), billboards/posters/wall hangings (marginal effect: 2.09, p < .05), and FP on the television (marginal effect: 2.46, p < .001) were significantly more likely to be using a modern method at endline. In addition, we found borderline significance for being exposed to a community health worker (marginal effect: 1.66, p < .10) and living close to an improved public and private supply environment where UHI undertook activities (marginal effects and p values: 2.48, p < .05 and 1.56, p < .10, respectively).ConclusionsUHI program activities were designed to complement the Government of India's strategies aimed at ensuring access to and provision of FP to urban poor populations. The effective demand- and supply-side strategies of the UHI program are therefore likely to be sustainable and scalable to other urban areas in India.Implications statementFindings from this study are important for designing sustainable and scalable FP strategies for urban India where increases in FP use will be relevant for meeting international FP targets.     

Ten years of negotiating rights around maternal health in Uttar Pradesh,India

Background

Preventable maternal mortality and morbidity have been globally recognized as human rights issues. Maternal mortality in India is among the highest in the world, and reflects inequity in access to healthcare: women from certain states as well as poorer women and less literate women appear to be significantly disadvantaged. The government of India has been attempting to improve maternal outcomes through a cash transfer within the National Rural Health Mission to encourage women to come to hospitals for childbirth.

Methods

This paper reviews documents of the last ten years describing the experiences of a Non-Governmental Organisation, SAHAYOG, in working with a civil society platform, the Healthwatch Forum, to develop ‘rights based’ strategies around maternal health. The paper builds an analysis using recent frameworks on accountability and gendered rights claiming to examine these experiences and draw out lessons regarding rights claiming strategies for poor women.

Results

The examination of documents over the last ten years indicates defined phases of development in the evolution of SAHAYOG’s understanding and of the shifts in strategy among SAHAYOG and its close allies, and responses by the state. The first three stages depict the deepening of SAHAYOG’s understanding of the manner in which poor and marginalized women negotiate their access to health care; the fourth stage explores a health system intervention and the challenges of working from within civil society in alliance with poor and marginalized women.

Conclusion

The findings from SAHAYOG’s experiences with poor Dalit women in Uttar Pradesh reveal the elements of social exclusion within the health system that prevent poor and marginalized women from accessing effective lifesaving care. Creating a voice for the most marginalised and carving space for its articulation impacts upon the institutions and actors that have a duty to meet the claims being made. However, given the accountability deficit, the analysis indicates the importance of going beyond the normative to developing actor-oriented perspectives within rights based approaches, to take into account the complexity of the negotiating process that goes into claiming any kind of entitlements.

     

Availability of Safe Childbirth Supplies in 284 Facilities in Uttar Pradesh,India

Maternal and Child Health Journal - Objectives Vital to implementation of the World Health Organization (WHO) Safe Childbirth Checklist (SCC), designed to improve delivery of 28 essential birth...     

Gender Differences in Perception and Care-seeking for Illness of Newborns in Rural Uttar Pradesh, India

Although gender-based health disparities are prevalent in India, very little data are available on care-seeking patterns for newborns. In total, 255 mothers were prospectively interviewed about their perceptions and action surrounding the health of their newborns in rural Uttar Pradesh, India. Perception of illness was significantly lower in incidence (adjusted odds ratio=0.56, 95% confidence interval 0.33-0.94) among households with female versus male newborns. While the overall use of healthcare providers was similar across gender, the average expenditure for healthcare during the neonatal period was nearly four-fold higher in households with males (Rs 243.3±537.2) compared to females (Rs 65.7±100.7) (p=0.07). Households with female newborns used cheaper public care providers whereas those with males preferred to use private unqualified providers perceived to deliver more satisfactory care. These results suggest that, during the neonatal period, care-seeking for girls is neglected compared to boys, laying a foundation for programmes and further research to address gender differences in neonatal health in India.Key words: Healthcare-seeking behaviour, Equity, Gender, Health expenditure, Healthcare-use, Neonatal health, Perceptions, Rural health, India     

Seasonal prevalence of Culex vishnui subgroup,the major vectors of Japanese encephalitis virus in an endemic district of Andhra Pradesh,India

Seasonal prevalence of members of the Culex vishnui subgroup, the major vectors of Japanese encephalitis virus (JE) in an endemic district of Andhra Pradesh, was investigated. Approximately 15,500 mosquitoes belonging to 2 genera and 5 species were collected by indoor-resting collections. The predominant species were found to be from the Cx. vishnui subgroup, which comprised 42.6% of the total collection, followed by Anopheles subpictus (40.4%), An. hyrcanus (12.8%), Cx. gelidus (3.5%), and An. barbirostris (0.8%). Mosquitoes of the Cx. vishnui subgroup were collected throughout the year, and densities of females ranged from 2.3/man-hour in January 1999 to 26.0/man-hour in December 1999. Ninety-three cases of Japanese encephalitis (27 confirmed serologically) were reported, mainly during the monsoon months of November and December. A significant positive correlation between densities of mosquitoes of the Cx. vishnui subgroup and occurrence of Japanese encephalitis cases (r = 0.765, P < 0.01) was observed. The factors responsible for transmission of JE in the endemic district are discussed.     

Family Planning Use among Urban Poor Women from Six Cities of Uttar Pradesh, India

Family planning has widespread positive impacts for population health and well-being; contraceptive use not only decreases unintended pregnancies and reduces infant and maternal mortality and morbidity, but it is critical to the achievement of Millennium Development Goals. This study uses baseline, representative data from six cities in Uttar Pradesh, India to examine family planning use among the urban poor. Data were collected from about 3,000 currently married women in each city (Allahabad, Agra, Varanasi, Aligarh, Gorakhpur, and Moradabad) for a total sample size of 17,643 women. Participating women were asked about their fertility desires, family planning use, and reproductive health. The survey over-sampled slum residents; this permits in-depth analyses of the urban poor and their family planning use behaviors. Bivariate and multivariate analyses are used to examine the role of wealth and education on family planning use and unmet need for family planning. Across all of the cities, about 50% of women report modern method use. Women in slum areas generally report less family planning use and among those women who use, slum women are more likely to be sterilized than to use other methods, including condoms and hormonal methods. Across all cities, there is a higher unmet need for family planning to limit childbearing than for spacing births. Poorer women are more likely to have an unmet need than richer women in both the slum and non-slum samples; this effect is attenuated when education is included in the analysis. Programs seeking to target the urban poor in Uttar Pradesh and elsewhere in India may be better served to identify the less educated women and target these women with appropriate family planning messages and methods that meet their current and future fertility desire needs.     

Impact of residual spraying of bendiocarb against the malaria vector Anopheles culicifacies in selected villages of the Ghaziabad District, Uttar Pradesh, India

A longitudinal study was carried out to evaluate the bioefficacy of indoor residual spraying of bendiocarb 80% wettable powder (WP) at 0.2 and 0.4 g/m2 against Anopheles culicifacies, a principle malaria vector, and the impact of bendiocarb use on malaria incidence in selected villages of the Ghaziabad District, Uttar Pradesh, India. The control village was sprayed with malathion at 1 g/m2 in 2001. Two rounds of bendiocarb spraying were carried out in each year from 1999 to 2001. Bendiocarb applications resulted in significant reduction in densities of adult An. culicifacies and other mosquito species in villages when compared to that of the control village (P < 0.05). Bioassay tests revealed that persistence of insecticide against An. culicifacies at 100% mortality was observed for about 10, 8, and 10 wk on mud, cement, and brick wall surfaces, respectively. Epidemiological evaluation revealed that malaria cases were significantly reduced after 1 year of spraying (P < 0.05) and by 2001, no Plasmodium falciparum was recorded in either of the bendiocarb-sprayed villages. The study revealed that indoor residual spraying of bendiocarb 80% WP at 0.2 g/m2 produced effective control of resistant An. culicifacies, provided that >95% human-dwelling room coverage is achieved in both 1st and 2nd rounds of spraying at an interval of 10 wk in areas where malaria is a seasonal problem.     

Ecological studies on the mosquito vectors of Japanese encephalitis

These studies were conducted in China (Province of Taiwan) to assess the populations of known and potential mosquito vectors of Japanese encephalitis in a typical endemic area, and to evaluate a variety of sampling techniques, some of which were new. Culex annulus was found to be the predominant vector species in the study area during the epidemic season; C. tritaeniorhynchus was never abundant, and C. fuscocephalus was rare. C. annulus and C. tritaeniorhynchus were active throughout the year, although populations were at a low level during the cool season. The results show that attention must be given to C. annulus as a possible vector where it is present in JE foci. The collection of mosquitos during the early evening hours from buffalo bait tethered outdoors was found to be the most efficient and sensitive means of monitoring vector populations throughout the year. During the JE epidemic season remarkable results were obtained with a vacuum sweep-net.     

Prevalence of antibodies to Japanese encephalitis and West Nile viruses among wild birds in the Krishna-Godavari Delta,Andhra Pradesh,India

In the Krishna-Godavari Delta region of the State of Andhra Pradesh, India, 866 sera obtained from trapped birds of 13 species were tested for neutralizing antibody to Japanese encephalitis (JE) virus; two species of birds belonging to the family Ardeidae, Ardeola grayii (pond heron) and Bubulcus ibis (cattle egret), contributed 514 of these sera. Neutralizing antibody to JE virus—i.e. sera giving positive reactions—was detected in 179 sera (34·8%) from these two species; in addition, two sera (0·4%) gave equivocal reactions, presumably indicating partial protection. There were only nine positive reactors (2·6%) among the remaining 352 sera from all other bird species. Of the 181 sera from ardeid birds in which neutralizing activity was detected, 174 were tested for neutralizing antibody to West Nile (WN) virus. The results indicated that 35·6% of these 179 sera had antibody specific to JE virus only and 63·8% possessed neutralizing antibodies to JE virus or to WN virus or to both; these figures represent 12·5% and 22·5%, respectively, of the total of 514 birds of these two species which were tested for neutralizing antibody to JE virus. The findings suggest that ardeid birds may be involved in the natural cycle of JE virus and, possibly, also of WN virus in India.     

New, recent, and questionable mosquito records from Mississippi

Enhanced mosquito surveillance in Mississippi has confirmed the presence of Mansonia titillans and Ochlerotatus trivittatus, which represent new state records for Mississippi. Recent records of Aedes albopictus, Anopheles maverlius, An. quadrimaculatus, An. smaragdinus, and Ochlerotatus hendersoni, and questionable records of Ochlerotatus dorsalis, Oc. stimulans, and Psorophora pygmaea are reviewed.     

An epidemiological study on fluorosis in an urban slum area of Nalgonda, Andhra Pradesh, India

Fluorosis is an important public health problem in certain parts of India. Nalgonda is one of the fluorosis endemic districts of Andhra Pradesh. A cross-sectional study was undertaken to assess the prevalence of dental and skeletal fluorosis in Panagal, one of the urban slum areas of Nalgonda town of Andhra Pradesh. 265 individuals residing in 92 households of five colonies of Panagal were selected by multi-stage random sampling. Fluorosis was assessed by standard clinical methods and water samples were tested for fluoride level. It was observed that mean fluoride level in ground water samples in the area was 4.01 mg/l and that of Nagarjunsagar water was 0.74 mg/l. The mean age of the study subjects in the area was 34.73 years. The overall prevalence of skeletal fluorosis was 24.9% and that of dental fluorosis was 30.6%. The prevalence increased with age. Skeletal and dental fluorosis is endemic in the study area.     

Studies on dengue in rural areas of Kurnool District, Andhra Pradesh, India

A dengue case was reported for the 1st time in a rural area of Kurnool District, Andhra Pradesh, India. Entomological and serological investigations were carried out to determine the prevalence of dengue vectors and dengue virus. Aedes aegypti was recorded for the 1st time in rural areas of Andhra Pradesh. Breeding of Ae. aegypti was observed only in containers with nonpotable water. Cement cisterns and tanks, stone tubs, and clay pots were the major breeding habitats of Ae. aegypti. Larval indices for Ae. aegypti ranged as follows: house index 28-40%, container index 13-37%, and Breteau index 32-60. A serological survey indicated that humans in Kurnool District have been exposed to dengue virus infections. The potential threat of an outbreak of dengue fever in rural areas because of the prevalence of the vector (Ae. aegypti) and dengue virus is discussed.     

New state mosquito records for Vermont including a checklist of the mosquito fauna.

Collections of mosquitoes in Vermont during 1980 and 1989 have resulted in 9 new state records, including species of Psorophora and Wyeomyia for the first time. A checklist of all species occurring in the state is also given.     

A community-based study of subclinical flavivirus infections in children in an area of Tamil Nadu, India, where Japanese encephalitis is endemic.

A characteristic feature of the epidemiology of Japanese encephalitis (JE) is the occurrence of a large number of subclinical infections. The reporting of only overt cases underestimates the total level of virus transmission, a knowledge of which is essential for the evolution of control strategies. We carried out a 3-year prospective serological study between 1989 and 1991 in a primary health centre in Tamil Nadu where JE is endemic. Each year paired specimens, taken before and after the transmission season from a cohort of schoolchildren aged 5-9 years, were tested for haemagglutination inhibition (HI) antibody titres in order to study seroconversion. The seroconversion rates in the successive years were 37.5, 42.1 and 25 percentage points, and in a third of such seroconversions it was possible to establish a specific diagnosis. Seroconversion was attributable predominantly to JE virus and minimally to West Nile virus. Relatively high dengue virus activity occurred only in 1991. There were statistically significant differences in seroconversion rates between villages and this was related to variations in the ratio cattle:humans:pigs. Very high seroconversion rates occurred among children who were negative for HI antibodies before the transmission season. HI antibodies declined to undetectable levels 6-8 months later in half the children who had seroconverted. The average net annual increase of 16.2 percentage points in seropositivity was nevertheless much higher than values reported from other areas of endemicity. The overall incidence of JE cases was 15 per 10,000 children aged 5-9 years, and the estimated ratio overt:inapparent infection was 1:270.