Ponnaiah Manickam

International open trial of uniform multi-drug therapy regimen for 6 months for all types of leprosy patients: rationale, design and preliminary results

Objective  To describe the rationale, design and preliminary results of an open trial of 6 months uniform multi‐drug therapy (U‐MDT) for all types of leprosy patients assuming a cumulative relapse rate not exceeding 5% over 5 years of follow‐up.

Programmatic and Beneficiary-related Factors for Low Vaccination Coverage in Papum Pare district, Arunachal Pradesh, India

Vaccination coverage in Papum Pare district, Arunachal Pradesh was observed to be low. We evaluated the universal immunization programme (UIP) through survey of health facilities in the district and collected data about inputs and processes for childhood vaccination, cold-chain maintenance, supervision and monitoring. Using cluster sampling methodology, we selected 697 children aged 12-23 months from 41 clusters and interviewed their mothers to collect information about vaccination status, socio-demographic factors, knowledge, attitude and practices. Only 50% health facilities in the district were conducting fixed-day immunizations. Of the children surveyed, 55% were fully vaccinated. Mothers who were informed about next due date by health workers, possessed immunization card, attended antenatal clinics, or who delivered in hospital were likely to complete the vaccination schedule of their children. In order to increase the vaccination coverage, all health facilities in the district need to be made functional for conducting immunization. Educating health workers to remind mothers about due date of vaccination will also help increasing the vaccination coverage.

High prevalence of household pesticides and their unsafe use in rural South India

ObjectiveTo estimate the prevalence of usage, unsafe practices and risk perception regarding household pesticides in a rural community of Tamil Nadu, India.Materials and MethodsIn a cross-sectional survey we used a pre-tested questionnaire and trained interviewers to collect information on household pesticide use for the past 6 months from any adult member of randomly selected households.ResultsOut of 143 households, 95% used at least one household pesticide (95% CI: 93.5–99.5) and 94% used at least one household pesticide specifically for mosquito control. The most commonly used pesticides were mosquito coils (75%), mosquito liquid vaporizers (36%), ant-killing powder (24%) and moth/naphthalene balls (18%). The major non-chemical methods of pest control were rat traps (12%) and mosquito bed nets (7.5%). Out of the mosquito coil users, 61% kept the windows and doors closed while the coil was burning. Out of the moth ball users, 88% left them in the place of use till they fully vaporized. Nearly half of the users did not know that household pesticides were harmful to their health and the health of their children.ConclusionsThe use of household pesticides was highly prevalent in this rural community. The prevalence of unsafe practices while handling them was also high. We recommend that the users of household pesticides be educated about the health hazards and about safe practices and non-chemical methods of pest control be promoted.

Seven years of the field epidemiology training programme (FETP) at Chennai, Tamil Nadu, India: an internal evaluation

BackgroundDuring 2001–2007, the National Institute of Epidemiology (NIE), Chennai, Tamil Nadu, India admitted 80 trainees in its two-year Field Epidemiology Training Programme (FETP). We evaluated the first seven years of the programme to identify strengths and weaknesses.MethodsWe identified core components of the programme and broke them down into input, process, output and outcome. We developed critical indicators to reflect the logic model. We reviewed documents including fieldwork reports, abstracts listed in proceedings and papers published in Medline-indexed journals. We conducted an anonymous online survey of the graduates to collect information on self-perceived competencies, learning activities, field assignments, supervision, curriculum, relevance to career goals, strengths and weaknesses.ResultsOf the 80 students recruited during 2001–2007, 69 (86%) acquired seven core competencies (epidemiology, surveillance, outbreaks, research, human subjects protection, communication and management) and graduated through completion of at least six field assignments. The faculty-to-student ratio ranged between 0.4 and 0.12 (expected: 0.25). The curriculum was continuously adapted with all resources available on-line. Fieldwork led to the production of 158 scientific communications presented at international meetings and to 29 manuscripts accepted in indexed, peer-reviewed journals. The online survey showed that while most graduates acquired competencies, unmet needs persisted in laboratory sciences, data analysis tools and faculty-to-student ratio.ConclusionsNIE adapted the international FETP model to India. However, further efforts are required to scale up the programme and to develop career tracks for field epidemiologists in the country.

Syndromic surveillance in religiious festival involving circumambulation in India

Objective To study operation feasibility and prepadness of a a tablet-based participatory syndromic surveillance among pilgrims during annual ritual circumbulation (Panchkroshi Yatra) coveirng 15 miles daily in Ujjain, Madhya Pradesh India Introduction Panchkroshi yatra is an annual ritual of circumambulation ( yatra ) of temples ( Mahadevs ) and 100,000 devotees walk for around 15 miles per day for six days and cover a total of 73 miles to worship important Mahadevs . The festival is held every year at the city of Ujjain, Madhya Pradesh, Central India. The yatra attracts large number of pilgrims especially from rural areas and usually women outnumber men. During the yatra, the pilgrims halt at several places and prepare their food in outdoors. We described the public health preparedness, implemented a tablet-based participatory syndromic surveillance among pilgrims of the yatra and reviewed satisfaction of the pilgrims regarding implementation of public health measures, Ujjain during 21-26, April, 2017. Methods We described preparedness and arrangements done for the Yatra . We designed tablet-based android to collect information from pilgrims on socio-demographic-economic details, location and self-reported health problems (syndromes). Trained investigators collected data from consenting pilgrims at strategically located halting places. We interviewed a convenient sample of consenting participants to assess satisfaction regarding the public health measures such as sanitation, water, safety, food and cleanliness. Results The district team organized round-the-clock medical camps in strategic locations (mainly at temple or halting place) of the route of the Yatra with few camps having admission facility for emergency conditions. There were no mobile medical units. Ambulance services were on standby at all medical camps. Our satisfactory survey of 360 participants indicated that 79% were satisfied with these medical facilities (79%). District administration alongwith local village administration ( panchayat ) had set up outlets selling provisions necessary meeting cooking needs. Eighty percent pilgrims were satisfied with food and refreshment arrangements. Permanent and temporary toilets were set-up at the halt-locations but not on the route. Snitation measures such as chlorination and solid waste management were in place. Pilgrims’ satisfaction for urinals (53%) and toilets (60%) was less as compared to cleanliness (74%). Electrical supply and lighting were arranged properly. Volunteers were available to provide assistance to pilgrims. Provision of safe drinking water and potable water were arranged by the authorities and the village-residents made water available through well, pots etc. The survey suggested that only 5% of them were not satisfied with water related arrangements. Security arrangements such as deployment of police, crowd management, and traffic control and fire safety were well-arranged by the authorities and majority of the respondents expressed satisfaction on these arrangements (79-84%). We interviewed 6435 pilgrims for any self-reported symptoms. More than half (56%) of the responders were female and majority (64%) aged 15- 59 years. Around 44% were from Ujjain district. Every second person (around 47%) reported illness with one or other symptoms. Most of them complained of injury with blister (11%). Other common complaints include stomach ache (8%), redness in eyes (7%), fever (7%), cough (6%), vomiting (4%), diarrhea (4%) and throat pain (3%) (Figure) Conclusions The participants’ response indicates that all the public health and safety measures were satisfactory except the need for setting up urinals along the fixed route of circumambulation. Table-based surveillance during the yatra indicated that injury was the most commonly self-reported health problem. Implementation of such surveillance helps in tracking health events and therefore, may facilitate preparedness and response. We recommend implementation of such tablet-based surveillance during such mass gathering events. References 1. Qanta A Ahmed, Yaseen M Arabi, Ziad A Memish, Health risks at the Hajj, Lancet 2006; 367: 1008–15 2. Tam JS, Barbeschi M, Shapovalova N, Briand S, Memish ZA & Kieny MP. Research agenda for mass gatherings: a call to action. The Lancet infectious diseases, 2012;12,3, 231-239 3. Henning KJ, Overview of syndromic surveillance. What is syndromic surveillance? MMWR Morb Mortal Wkly Rep 53 (Suppl): 5-11 (2004). 4. Chandrasekhar, CP, Ghosh J Information and communication technologies and health in low income countries: the potential and the constraints. Bulletin of the World Health Organization, 2001, 79: 850–855

International open trial of uniform multidrug therapy regimen for leprosy patients: Findings & implications for national leprosy programmes

Background & objectives: Uniform therapy for all leprosy patients will simplify leprosy treatment. In this context, we evaluated six-month multidrug therapy (MDT) currently recommended for multibacillary (MB) patients as uniform MDT (U-MDT) in a single-arm open trial under programme conditions. Primary objective was to determine efficacy to prevent five-year cumulative five per cent relapse. Secondary objectives were to assess acceptability, safety and compliance. Methods: Newly detected, treatment-naive leprosy patients were enrolled in India (six sites) and P. R. China (two sites). Primary outcome was clinically confirmed relapse of occurrence of one or more new skin patches consistent with leprosy, without evidence of reactions post-treatment. Event rates per 100 person years as well as five-year cumulative risk of relapse, were calculated. Results: A total of 2091 paucibacillary (PB) and 1298 MB leprosy patients were recruited from the 3437 patients screened. Among PB, two relapsed (rate=0.023; risk=0.11%), eight had suspected adverse drug reactions (ADRs) (rate=0.79) and rate of new lesions due toreactions was 0.24 (n=23). Rates of neuritis, type 1 and type 2 reactions were 0.39 (n=37), 0.54 (n=51) and 0.03 (n=3), respectively. Among MB, four relapsed (rate=0.07; risk=0.37%) and 16 had suspected ADR (rate=2.64). Rate of new lesions due to reactions among MB was 1.34 (n=76) and rates of neuritis, type 1 and type 2 reactions were 1.37 (n=78), 2.01 (n=114) and 0.49 (n=28), respectively. Compliance to U-MDT was 99 per cent. Skin pigmentation due to clofazimine was of short duration and acceptable. Interpretation & conclusions: We observed low relapse, minimal ADR and other adverse clinical events. Clofazimine-related pigmentation was acceptable. Evidence supports introduction of U-MDT in national leprosy programmes. [CTRI No: 2012/ 05/ 002696]

Behavioural Determinants Associated with CHIKV Outbreak in Gouriepet, Avadi, Chennai, South India

Introduction: Frequent outbreaks of CHIKV infection implicate not only vectors but also risk behaviours of communities. While ample literature is available on vector biodynamics, studies on behavioural determinants are limited. We conducted a study to: (i) identify behavioural risk factors associated with CHIKV outbreak in Gouripet, Avadi, Chennai, South India and (ii) describe the association between vector indices and CHIKV infections. Methods: Adopting a case control design, we defined households with at least one case of CHIKV as case-households and those without any case of CHIKV as control households. Using interview techniques, we collected data on behavioural risk factors at individual and household levels. By observation we ascertained information on backyard cleanliness in households. We calculated Odds Ratios, Adjusted Odds Ratios and 95% Confidence Intervals. House, Breteau and Container Indices were compared for case and control households. We used chi-square test, mid P exact test and conditional Poisson test to test the differences of these indices between case and control households. Results: We included 279 case households and 378 control households. Not wearing clothes that fully cover the body (AOR: 4.7, 95% CI: 1.95 – 11.11), storing water (AOR: 4.6, 95% CI: 2.64 – 7.88), storing water in cement barrels/ plastic containers (AOR: 2.6, 95% CI: 1.90 – 3.78), infrequent changing of stored water ( AOR: 2.6, 95% CI: 1.66 – 3.99), poor backyard cleanliness (AOR: 1.6, 95% CI: 1.10 – 2.27) were all significantly associated with risk of CHIKV infections. Vector indices in case households were double compared to control households. Conclusion: Our study has proved that risk behaviour impacts adversely on vector indices to cause CHIKV outbreaks. We strongly advocate efficient vector control measures combined with Behavior Change Communication programmes to effectively prevent future outbreaks.