Anuradha Rose

Solar disinfection of water for diarrhoeal prevention in southern India

Aims: To evaluate the efficacy and acceptability of solar irradiation in the prevention of diarrhoeal morbidity in children under 5 years of age, in an urban slum in Vellore, Tamil Nadu. Methods: A total of 100 children were assigned to receive drinking water that had been subjected to solar disinfection in polyethylene terephthalate bottles. One hundred age and sex matched controls were also selected. Both groups were followed by weekly home visits for a period of six months for any diarrhoeal morbidity. At the end of the follow up period, the acceptability of the intervention was assessed by interviews, questionnaires, and focus group discussions. Results: There was significant reduction in the incidence, duration, and severity of diarrhoea in children receiving solar disinfected water, despite 86% of the children drinking water other than that treated by the intervention. The incidence of diarrhoea in the intervention group was 1.7 per child-year, and among controls 2.7 per child-year, with an incidence rate ratio of 0.64 (95% CI −0.48 to 0.86). The risk of diarrhoea was reduced by 40% by using solar disinfection. In qualitative evaluation of acceptability, most women felt that solar disinfection was a feasible and sustainable method of disinfecting water. Conclusions: Solar disinfection of water is an inexpensive, effective, and acceptable method of increasing water safety in a resource limited environment, and can significantly decrease diarrhoeal morbidity in children.

Establishment of the MAL-ED Birth Cohort Study Site in Vellore, Southern India

The Indian Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) site is in Vellore, Tamil Nadu, in south India and is coordinated by the Christian Medical College, Vellore, which has many years of experience in establishing and following cohorts. India is a diverse country, and no single area can be representative with regard to many health and socioeconomic indicators. The site in Vellore is an urban semiorganized settlement or slum. In the study site, the average family size is 5.7, adults who are gainfully employed are mostly unskilled laborers, and 51% of the population uses the field as their toilet facility. Previous studies from Vellore slums have reported stunting in well over a third of children, comparable to national estimates. The infant mortality rate is 38 per 1000 live births, with deaths due mainly to perinatal and infectious causes. Rigorous staff training, monitoring, supervision and refinement of tools have been essential to maintaining the quality of the significantly large quantity of data collected. Establishing a field clinic within the site has minimized inconvenience to participants and researchers and enabled better rapport with the community and better follow-up. These factors contribute to the wealth of information that will be generated from the MAL-ED multisite cohort, which will improve our understanding of enteric infections and its interactions with malnutrition and development of young children.

Study design and baseline results of an open-label cluster randomized community-intervention trial to assess the effectiveness of a modified mass deworming program in reducing hookworm infection in a tribal population in southern India.

Introduction Hookworm infection is a leading cause of iron deficiency anemia and malnutrition in resource-poor settings. Periodic mass deworming with anthelminthic drugs remains the cornerstone of hookworm control efforts worldwide. Reinfection following treatment occurs, reflecting the human hosts inability to acquire immunity following exposure to an untreated reservoir of infection. This cluster randomized trial will evaluate the effectiveness of a modified, population-based, mass deworming strategy in reducing hookworm infection in an endemic southern Indian population. Methods Forty five tribal villages were randomized into three groups: one received annual treatment; the second received two rounds of treatment at 1-month intervals; and the third received four rounds of treatment – two rounds 1 month apart at the beginning, followed by another two after 6 months. Stool samples collected through cross-sectional parasitological surveys pre- and post-intervention, and at 3-monthly intervals for a period of 1 year were tested for presence of hookworm ova. Long-term effectiveness of treatment will be assessed through another survey conducted 2 years after the last treatment cycle. Results From a population of 11,857 individuals, 8681 (73.2%) were found to be eligible and consented to participate, out-migration being the primary reason for non-participation. Baseline stool samples were obtained from 2082 participants, with 18.5% having hookworm infection, although majority were low intensity infections (<2000 eggs per gram of feces). Discussion This study will help identify the optimal mass deworming strategy that can achieve the greatest impact in the shortest period of time, particularly in settings where long-term program sustainability is a challenge.

PW 2288 Prevalence and risk factors of unintentional injuries among children aged 1–5 years in urban slums of vellore, south india

Unintentional injuries (UI) are a major cause of mortality and morbidity among children, contributing to over 8 75 000 deaths worldwide every year. In India, injury specific mortality rate was 2.9 per 1000 live births contributing to 5.9% of the total mortality in the under five children. This study was designed to estimate the prevalence and understand the risk factors of unintentional injuries in the urban slums of Vellore, South India. This was a cross-sectional study conducted in eight urban slums of Vellore, Tamil Nadu. Mothers of children aged 1–5 years residing in the area for more than three months were interviewed with a questionnaire after an informed consent. The details of injuries sustained in the past three months were obtained. An indigenously developed environmental hazard observation form was used to assess the risk of injuries in places the children frequently visit. Logistic and Poisson regression analysis were used to assess significant risk factors for experiencing injuries and repeated injuries respectively. Prevalence of unintentional injuries in children between 1–5 years during the three months recall period was 39.1% (95% CI 35.4%–42.9%). Children of working mothers had a higher risk of injury compared to children of stay-at-home mothers (OR 1.48, 95% CI (1.01–2.18). Children from overcrowded family were at higher risk of injury (OR 1.66, 95% CI 1.14–2.41). Boys had a higher risk of multiple injuries compared to girls (RR 1.335, 95% CI 1.07–1.66). Children with environmental hazard score greater than 66th percentile were more prone to have an injury and a severe injury (RR=0.39 95% CI 0.31–0.48). Prevalence of unintentional injuries in children between 1–5 years was high in the study population. Overcrowding, working mothers and high environmental hazard score were significant risk factors. The environmental hazard score can be further validated and used as a tool.

476 Incidence, impact, medical consequences of unintentional childhood injuries in a rural block in South India

Background Unintentional childhood injury is a major cause of mortality and morbidity among children (upto 18 years) across the globe and contributes to over 875,000 deaths annually worldwide. Global Childhood Unintentional Injury Surveillance estimates that nearly 50% of children under 12 years suffered severe unintentional injuries leading to some form of disability. Unintentional childhood injury is an under-reported public health problem in India. This study was undertaken to estimate the incidence and assess economic impact and medical consequences of unintentional childhood injuries among children between 0–14 years. Methods This is a non-concurrent cohort study, conducted in 13 clusters of a rural block in Vellore. Double stage cluster sampling method was used to screen 1600 children with injury. Information regarding the impact and consequences of injury was obtained. Results Childhood injury related morbidity was 292.5/1000/year. Children between 10–14 years (4.6%) and boys (4.5%) had a higher rate of injury. Majority of injuries occurred at home (44.8%) and most commonly on the lower extremity (51.7%). Falls (43.1%) was the most common cause of injury followed by RTIs (27.6%). The direct medical and non medical cost of treatment ranged from

651 Perception of unintentional childhood injuries among rural mothers in South India

US0.14 to

Unintentional injuries among children aged 1–5 years: understanding the burden, risk factors and severity in urban slums of southern India

US74. The wages lost by the primary caregiver ranged from

Perception of unintentional childhood injuries among mothers in rural South India

US1.4 to

Incidence and Impact of Unintentional Childhood Injuries: A Community Based Study in Rural South India

US90 and absenteeism from work ranged from 1–60 days. Sick absenteeism ranged from 0–45 days with a mean of 5.17 days. 50% of children missed school after an injury. The days spent with temporary disability ranged from 1–60 days with a mean of 4.08 days and 7.73% had permanent disability. Conclusion Unintentional childhood injuries is an emerging public health problem which leads to significant injury related sickness absenteeism and disability. Boys and older children are the most common victims of injury. Prospective trials on the economic impact and medical consequences will help to gain a clear understanding of DALY and loss of productivity.