Explore the vast range of titles available.

Kyasanur Forest Disease (KFD) is a highly infectious viral illness transmitted by infected ticks through contact with monkeys and other forest animals. Till date there is no definite treatment available for KFD. Hence, vaccination is considered to be an important public health intervention to control KFD. This study aimed at estimating the vaccination coverage for primary and booster doses of KFD vaccine and exploring the perceived barriers to vaccination in the affected villages of Goa, India during 2015-18. In this explanatory mixed methods study, vaccine coverage was estimated bydata obtained from the KFD vaccination registers maintained at the health centers catering to the KFD affected villages. To understand the barriers to vaccination,key informant interviews were conducted among implementing health officers, medical officers and nurses involved in vaccination. Perceptions of vaccinees and community members were studied through in-depth interviews and focus group discussions. Out of the 35,500 targeted population (6-65 years)for KFD vaccination, 32% received one dose and 13.2% received two doses. The coverage for first booster and annual booster was 4.9% and 0.5% respectively. The drop out from first to second and third doses was 57% and 85% respectively. 69% of doses were delivered during community outreach programmes and remaining at health facilities. Inadequate vaccine stock, inappropriate timing of vaccination campaign, lack of awareness and misconceptions related to indications of vaccines, travel distance for follow up doses given at community health centre and pain due to injection were perceived as reasons for poor vaccination coverage. KFD vaccination coverage was poor in the villages affected by KFD in Goa. Both left-out and drop-out phenomena were observed in KFD vaccination. Vaccine implementation plan has to consider suitable time for the local people, maintain adequate vaccine stock and encourage community-based vaccination campaigns instead of facility-based to achieve optimal vaccine coverage.

Introduction Accurate gestational age (GA) determination is essential for effective obstetric care, guiding the timing of delivery, fetal evaluations, and interventions. Conventional ultrasound (USG) markers such as biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) often lose precision in the third trimester, with discrepancies of up to three weeks. These limitations highlight the need for alternative, reliable metrics. Fetal kidney length (FKL), which increases consistently by about 1 mm per week after 24 weeks of gestation and remains unaffected by growth restrictions, presents a promising alternative. This study aimed to evaluate the diagnostic utility of mean FKL for third-trimester GA assessment. Methods A cross-sectional study was conducted from March to June 2021 at a tertiary care hospital in Tamil Nadu, India. Fifty pregnant women with singleton pregnancies between 28 and 42 weeks of gestation were enrolled. Participants were required to have confirmed last menstrual period (LMP) dates and first-trimester dating scans. Pregnancies with high-risk factors, fetal anomalies, or other complications were excluded. Biometric parameters (BPD, HC, AC, and FL) and mean FKL were measured using USG. FKL was obtained by averaging the lengths of both kidneys in the paravertebral plane. FKL-based GA (FKLGA) was compared with LMP-based GA (LMPGA) and GA derived from conventional markers. Analyses included intraclass correlation coefficients (ICC), linear regression, and Bland-Altman plots. Results The mean age of participants was 23.6 ± 1.6 years, and 54% were primigravidae. The median LMPGA was 37 weeks (interquartile range (IQR): 35-39 weeks), closely aligned with FKLGA. The mean FKL was 36.3 ± 3.2 mm. Bland-Altman plots showed that FKLGA had narrower limits of agreement (LoA) (-0.5 to 1 week) compared to conventional parameters (-2 to 6 weeks). The ICC between FKLGA and LMPGA was 0.986 (95% confidence interval (CI): 0.976-0.992), significantly higher than that of conventional markers (0.539; 95% CI: 0.31-0.739). Linear regression showed that FKL explained 97.4% of GA variability (adjusted R² = 0.974), with a 1 mm increase in FKL corresponding to a one-week GA increase (β = 0.99; p < 0.001). Conventional markers explained only 57.3% of GA variability (adjusted R² = 0.573). Discussion This study underscores the reliability of FKL for third-trimester GA estimation. The strong correlation between FKLGA and LMPGA, demonstrated by high ICC and narrow limits of agreement, supports its clinical utility. Unlike conventional biometric parameters, FKL remains unaffected by growth restrictions, making it particularly valuable for late-presentation pregnancies or uncertain LMP dates. Incorporating FKL into USG protocols can address the limitations of conventional markers and improve decision-making in high-risk pregnancies. Conclusion Mean FKL is a reliable and reproducible parameter for estimating GA in the third trimester. It outperforms conventional markers and closely aligns with LMPGA, offering a robust alternative for late-pregnancy evaluations. Further research should validate its application across diverse populations and integrate it into predictive models for enhanced clinical accuracy.

Background Kerala reports one of the highest case fatality rates and high prevalence of comorbidities and risk factors among persons with tuberculosis (PwTB). We developed a comprehensive care model (CCp-K) focusing on triaging persons with tuberculosis for severe illness, uncontrolled diabetes, alcohol and nicotine dependence at diagnosis, and ensuring inpatient care and follow-up. In the pre-implementation phase, we explored the barriers, facilitators, and perceived suggestions in the design and implementation of CCp-K from various interest holders for sustainable implementation. Methods We conducted an interest holder mapping and using the Power-Interest matrix of Mendelow, we purposively selected key interest holders at the district and state level. In-depth interviews were conducted using an interview guide by trained interviewers until data saturation was achieved. The audio recordings were transcribed, translated, and analysed using a framework-guided thematic analysis approach. Results Twelve interest holders participated in the interview, which included nine men and three women. The interviews lasted for a mean duration of 74 min (SD = 22). A total of 33 codes were generated and categorized under five themes: (i) perception on TB deaths (ii) relevance of CCp-K differentiated TB care model, (iii) perceived feasibility and enablers of implementing CCp-K, (iv) perceived barriers, and (v) perceived suggestions for the model and its delivery. The interest holders perceived that while delayed diagnosis contributes to TB mortality, the CCp-K model can bridge critical gaps in post-diagnosis care, particularly through early triaging and comorbidity management to reduce TB deaths. The robust healthcare infrastructure of Kerala, local governments and community involvement, and cross-adaptation opportunities from previous successful models were perceived as facilitators. The lack of nodal treatment centres, stigma among healthcare workers, social vulnerability, and competing priorities were perceived as major barriers. Conclusions The interest holders perceived the CCp-K model to be relevant and feasible. However, Kerala should overcome the barriers of inadequate inpatient referral centers by establishing designated TB care facilities, leveraging existing collaboration with private partnerships, and strengthening the social support system.

Background and objective Dengue is a common febrile illness in tropical countries; serological detection of non-structural protein-1 (NS1) antigen or IgM is the gold standard for diagnosis. Thrombocytopenia, leukopenia, eosinopenia, and hem concentration are common hematological manifestations in dengue, and activated lymphocytes are seen in these patients. We intend to analyze the utility of a parameter called a high fluorescent cell (HFC) on Mindray BC-6000 for suspecting dengue infection in patients with febrile illness. Thrombocytopenia, when present, is taken as a warning sign and creates serious concerns for the treating physician. We studied HFC as a cost-effective tool to predict platelet recovery. Methods This is a facility-based single-gate cross-sectional comparative diagnostic accuracy study. Patients presenting with febrile illness and undergoing dengue serology testing and complete blood count (CBC) test with HFC enumeration on the same day were analyzed. Dengue-positive patients with thrombocytopenia were serially monitored for both platelet count and HFC, along with other platelet parameters. Results A total of 515 febrile patients were included. The median age of the patients was 18 (11-31) years, and 281 (54.56%) patients were males. Overall, the lab positivity rate for dengue was 33% (170 patients out of 515). The HFC in dengue-positive patients ranged from 0 to 20.1%. The sensitivity and specificity of absolute HFC count at a cut-off of 0.02 were 74% and 32%, respectively; similarly, the sensitivity and specificity of HFC percentage at a cut-off of 0.2 were 92% and 25%, respectively. Eighty-nine (out of 170) dengue-positive patients had thrombocytopenia. In 15 cases, multiple serial HFC and platelet counts were available. The falling trend in HFC was followed by platelet recovery within 24 hours in 13 (86.6%) patients. Conclusion HFC serves as a sensitive but not specific marker for dengue infection in cases with febrile illness. The role of HFC in predicting platelet recovery in dengue cases should be further explored.

Background: In India, a new care package consisting of (i) daily regimen with fixed-dose combination drugs, collected once-a-month and self-administered by the patient, (ii) 'one stop service' at antiretroviral treatment (ART) centre for both HIV and tuberculosis (TB) treatment and (iii) technology-enabled adherence support (99DOTS, which required patients to give a missed phone call after consuming drugs) was piloted for treatment of TB among HIV-infected TB patients. Conventional care included intermittent regimen (drugs consumed thrice-weekly) delivered under direct observation of treatment supporter and the patients needing to visit TB and HIV care facilities, separately for treatment. Objective: To assess the effect of new care package on TB treatment outcomes among HIV-TB patients registered during January-December 2016, as compared to conventional care and explore the implementation challenges. Methods: A mixed-methods study was conducted in four districts of Karnataka, India where new care package was piloted in few ART centres while the rest provided conventional care. Quantitative component involved a secondary cohort analysis of routine programme data. Adjusted relative risk(aRR) was calculated using Poisson regression to measure association between new care package and unsuccessful treatment outcome. We conducted in-depth interviews with healthcare providers and patients to understand the challenges. Results: Unsuccessful TB treatment outcomes (death, loss to follow-up and failure) were higher in new care package (n = 871) compared to conventional care (n = 961) (30.5% vs 23.4%; P value<0.001) and aRR was 1.3(95% CI: 1.1-1.7). Key challenges included patients' inability to give missed call, increased work load for ART staff, reduced patient-provider interaction, deficiencies in training and lack of role clarity among providers and reduced involvement of TB program staff. Conclusion: With new care package, TB treatment outcomes did not improve as expected and conversely declined compared to conventional care. TB and HIV programs need to address the operational challenges to improve the outcomes.

Introduction: After a commendable achievement on polio-free status for the South-East Asian Region (SEAR), WHO is now focusing towards measles elimination, which is still a major contributor of under-five mortality in SEAR. India has introduced measles and rubella (MR) vaccination throughout the country through supplementary immunization activity, followed by introducing the same in the routine vaccination. Health indicators and public health system functioning in the southern states of India are good, so India introduced the MR campaign in the southern high-performing states as phase 1 on 5 April 2017. The aim of the campaign was to vaccinate more than 95% of eligible children (aged 9 months to 15 years). At the same time, rumors and negative campaigning about this initiative started in social media. This study aimed to measure the coverage of MR vaccination among the target population in South India. Methods: Data was collected immediately after phase 1 of the MR vaccine campaign in April 2017. Data was collected based on the WHO-recommended 30/7 rapid monitoring method. Thirty villages around the Rural Health Training Centre of Pondicherry Institute of Medical Sciences were selected and seven children aged 9 months to 5 years and seven children aged 6 to 15 years from each village were included. Children were classified as 'vaccinated' or 'not vaccinated' based on the WHO 'card or history' method. Results: Among the total sample of 420 children, 380 children (90.5% (range 87.4-93.0%)) were found to be vaccinated and 40 children (9.5% (range 7.0-12.6%)) were found to be unvaccinated. Most of the people came to know about the MR vaccination through auxiliary nurses and midwives, followed by school teachers. The main reasons for not getting vaccinated was fear of an adverse event following vaccination or fear of injection. Reasons for not getting vaccinated were significantly associated with usage of smartphone by at least one of the parents (adjusted odds ratio (OR) 2.1 (1.1-4.2)), better literacy level among mothers (adjusted OR 5.2 (1.1-24.8)) and poor literacy level among fathers (adjusted OR 3.6 (1.1-11.5)). Conclusion: Despite the negative propaganda by social media, the coverage of vaccination by the public healthcare providers was near optimal in phase 1, which shows the strength of the public health system in this rural area of southern India. In accordance with the modern technology, public health policymakers should think about and plan information education and communication activities.

Introduction Five states in India are reporting sporadic outbreaks of Kyasanur Forest Disease (KFD). Goa experienced an outbreak of KFD in 2015. It remains as an important differential diagnosis for tropical fever in the endemic regions. Few studies among neighboring two states (Karnataka and Kerala) have described the epidemiological characteristics of KFD. However, there is no study which describes the same among cases in the state of Goa. Hence, we planned to understand the epidemiology (time, place, and person distribution) of the disease including seasonal pattern with forecasting using zero-inflated negative binomial regression and time series models. We also explored geo-spatial clustering of KFD cases in Goa during 2015–2018 which would help design effective intervention to curb its transmission in Goa. Results Blood samples of all suspected cases of KFD during 2015 to 2018 were tested using reverse transcriptase-polymerase chain reaction technique. Reports of these results were periodically shared with the state surveillance unit. Records of 448 confirmed cases of KFD available at the State Integrated Disease Surveillance Programme were analyzed. The mean (SD) age of the patients was 41.6 (14.9) years. Of 143 cases with documented travel history, 135 (94.4%) had history of travel to forest for cashew plucking. Two thirds of cases (66.3%) did not receive KFD vaccine prior to the disease. Case fatality rate of 0.9% was reported. Seasonal peaks were observed during January to April, and forecasting demonstrated a peak in cases in the subsequent year also during January–April persisting till May. Around 40 villages located along the Western Ghats had reported KFD, and affected villages continued to report cases in the subsequent years also. Case density-based geographic maps show clustering of cases around the index village. Conclusion Most of the confirmed cases did not receive any vaccination. KFD cases in Goa followed a specific seasonal pattern, and clustering of cases occurred in selected villages located in North Goa. Most of the patients who had suffered from the disease had visited the forest for cashew plucking. Planning for public health interventions such as health education and vaccination campaigns should consider these epidemiological features.

Acute respiratory infections (ARIs) are the leading cause of death among children less than 5 years in India. Emergence of newer pathogenic organisms, reemergence of disease previously controlled, wide spread antibiotic resistance, and suboptimal immunization coverage even after many innovative efforts are major factors responsible for high incidence of ARI. Drastic reduction in the burden of ARI by low-cost interventions such as hand washing, breast feeding, availability of rapid and feasible array of diagnostics, and introduction of pentavalent vaccine under National Immunization Schedule which are ongoing are necessary for reduction of ARI.

COVID-associated rhino-orbito-cerebral Mucormycosis (CA-ROCM), henceforth referred to as Covid-Associated Mucormycosis (CAM), is a serious and fatal condition unless treated promptly and completely. The main treatment of the CAM is complete surgical debridement and administration of systemic antifungals. The first line antifungal recommended for CAM is Amphotericin-B. Since Amphotericin-B has systemic side effects mainly on the renal system, a timely decision to start and end Amphotericin-B therapy is very essential. Besides the Computed Tomography (CT) scan, serum levels of C-reactive protein (CRP) levels are a good indicator of CAM-associated inflammation levels in the patient's body. By monitoring the CRP levels, we can titrate amphotericin treatment to cause minimal harm to the kidneys. Our study was done to analyze the kinetics of C-reactive protein in patients of CAM admitted in a tertiary-care hospital and compare it with the CRP levels in COVID-associated non-Mucormycosis Sinusitis patients. Aim and objective To study the kinetics of serum C-reactive protein (CRP) levels among patients undergoing in-patient care for COVID-associated rhino-orbito-cerebral mucormycosis and compare with serum CRP levels in COVID-19 patients suffering from sinusitis without rhino-orbito-cerebral mucormycosis.  Materials and methods This was a retrospective cohort study. The source of data was post-COVID sinusitis patients who were admitted during 2nd wave of COVID-19 in India in our hospital whose medical records were accessed by the Medical Records Department. The subjects were recruited into the two study groups namely the Mucormycosis group and the non-Mucormycosis group based on the histopathological report of the nasal biopsy specimen. The medical records of each member of the two groups were studied for the levels of serum C-reactive protein measured at the time of admission and every 5(+1) days thereafter till the time of discharge. The kinetics of serum C-reactive protein levels, which is a marker of inflammation is studied in each of the two groups and compared using statistical methods. Results There was a significant difference between Mucormycosis and Non-Mucormycosis groups in CRP-level kinetics. However, there was no significant trend of decrease or increase over time in Mucormycosis as well as non-Mucormycosis cases. Conclusion CRP is an important biomarker in assessing the septic response to COVID-associated rhino-orbito-cerebral mucormycosis. Detection of raised CRP levels helps in prompt early initiation of anti-fungal treatment. Also, monitoring the levels of serum CRP will guide in deciding the time to stop the antifungals at an appropriate time. CRP monitoring is commonly available and affordable. Hence, we recommend CRP monitoring of in-patients of CAM.

Background: A child receiving an acceptable diet is expected to reach the optimal anthropometric measures. More than 60% of dietary requirement has to be met through complimentary diet. Objectives: This aimed to estimate the prevalence of dietary diversity and to assess factors associated with it from caregivers' perceptions by quantitative and qualitative participatory techniques. Methods: A mixed-method study comprising community-based cross-sectional quantitative and participatory rural appraisal qualitative components was conducted in 25 villages from the field practice area of medical institute in South India during 2017. Caregivers of eligible children 6-23 months from villages were interviewed regarding various food groups consumed in the last 24 h using a validated checklist. Association of demographic-, child, and mother-related characteristics with inappropriate dietary diversity was identified using multivariate negative log-binomial model. Results: Of the 603 eligible children, 75.1% had inappropriate dietary diversity. Although inappropriate dietary diversity prevailed across all categories, mothers with less than primary education (adjusted prevalence ratio [PR]: 1.26) children <1 year (adjusted PR: 1.29) and not on current breastfeeding (adjusted PR: 1.15) had significantly more inappropriate diversity. Restraining and motivating forces for dietary diversity were initially recorded from free listing and subjected to force-field analysis. Ignorance, lack of literacy, affordability issues, nuclear family pattern, and influence of junk foods are restraining forces. Conclusion: Inappropriate dietary diversity among 6-23 months children in the rural block of Tamil Nadu, South India, is extensive (75%). Current Child development programs should focus to address these issues based on these identified contextual factors.