Shantanu K. Kar

Domestic violence against women in eastern India: a population-based study on prevalence and related issues

BackgroundViolence against women is now widely recognised as an important public health problem, owing to its health consequences. Violence against women among many Indian communities on a regularly basis goes unreported. The objective of this study is to report the prevalence and other related issues of various forms of domestic violence against women from the eastern zone of India.MethodsIt is a population-based study covering both married women (n = 1718) and men (n = 1715) from three of the four states of Eastern India selected through a systematic multistage sampling strategy. Interviews were conducted using separate pre-piloted structured questionnaires for women (victimization) and men (perpetration). Women were asked whether their husband or any other family members committed violent acts against them. And men were asked whether they had ever perpetrated violent acts against their wives. Three principle domestic violence outcome variables (physical, psychological and sexual violence) were determined by response to a set of questions for each variable. In addition, data on socio-economic characteristics were collected. Descriptive statistics, bi- and multivariate analyses were done.ResultsThe overall prevalence of physical, psychological, sexual and any form of violence among women of Eastern India were 16%, 52%, 25% and 56% respectively. These rates reported by men were 22%, 59%, 17% and 59.5% respectively. Men reported higher prevalence of all forms of violence apart from sexual violence. Husbands were mostly responsible for violence in majority of cases and some women reported the involvement of husbands parents. It is found that various acts of violence were continuing among majority of women who reported violence. Some socio-economic characteristics of women have significant association with the occurrence of domestic violence. Urban residence, older age, lower education and lower family income are associated with occurrence of domestic violence. Multivariate logistic regressions revealed that the physical violence has significant association with state, residence (rural or urban), age and occupation of women, and monthly family income. Similar associations are found for psychological violence (with residence, age, education and occupation of the women and monthly family income) and sexual violence (with residence, age and educational level of women).ConclusionThe prevalence of domestic violence in Eastern India is relatively high compared to majority of information available from India and confirms that domestic violence is a universal phenomenon. The primary healthcare institutions in India should institutionalise the routine screening and treatment for violence related injuries and trauma. Also, these results provide vital information to assess the situation to develop public health interventions, and to sensitise the concerned agencies to implement the laws related to violence against women.

Coverage, compliance and some operational issues of mass drug administration during the programme to eliminate lymphatic filariasis in Orissa, India

This paper reports the coverage, compliance and other operational issues of mass drug administration (MDA) of diethylcarbamazine and albendazole under a programme to eliminate lymphatic filariasis (LF) in Orissa state of India. Both quantitative and qualitative methods were used to collect data from 90 villages and nine urban areas of four districts of Orissa, India. In Orissa, 67% of people older than 2u2003years had received the drugs during MDA and 42% had consumed them. About 25% of people had not taken the tablets although they received them. Urban areas recorded lower rates than rural areas. The paper discusses some policy/health system‐, community‐ and drug‐related issues that influenced coverage and compliance of MDA. It is essential to improve compliance in future rounds of MDA to achieve targets of control and eventual elimination of LF in a reasonable time frame.

Domestic violence in Eastern India: factors associated with victimization and perpetration.

OBJECTIVESnTo examine the factors associated with victimization and perpetration of domestic violence in Eastern India.nnnSTUDY DESIGNnPopulation-based cross-sectional study.nnnMETHODSnMarried women (n=1718) and men (n=1715) from three Eastern Indian states were included in this study. Univariate and multiple logistic regression models were used to identify the determinants of domestic violence.nnnRESULTSnAge, education, occupation, marital duration and husbands alcoholism emerged as significant predictors of victimization and perpetration of all types of domestic violence. A higher level of family income was found to be highly protective against the risk of violence. In addition, other risk and protective factors for victimization and perpetration of each type of violence were identified.nnnCONCLUSIONSnThis study contributes to the violence literature by shedding light on the risk factors of perpetration and victimization of domestic violence. These results provide vital information to develop interventions, as well as policies and programmes towards preventing violence. Also, this knowledge facilitates healthcare personnel to intervene more effectively with women at risk of violence-related health problems.

A randomized clinical trial to compare the efficacy of three treatment regimens along with footcare in the morbidity management of filarial lymphoedema

The progression of lymphoedema to elephantiasis associated with increased incidence of episodic adeno‐lymphangitis (ADL) is of great concern, as it causes physical suffering, permanent disability and economic loss to lymphatic filariasis patients. This randomized clinical trial aimed to assess the efficacy in terms of reduction of oedema and ADL frequency of three treatment regimens among lymphoedema patients from Orissa, India. The regimens were: (I) oral penicillin – one tablet of 800u2003000u2003U penicillin G potassium twice daily for 12u2003days‐repeated every 3u2003months for 1u2003year; (II) diethylcarbamazine – 6u2003mg/kg bodyweight for 12u2003days‐repeated every 3u2003months for 1u2003year; and (III) topical antiseptic, i.e. betadine ointment. Foot care was part of all regimens. All three drug regimens are efficacious in reducing oedema and frequency of ADL episodes. Although the efficacy was slightly higher in regimen I, the difference was not significant. About half of all patients had reduced oedema after the 90u2003days of treatment, with oedema reduction of 75–100% in 20%. A major proportion of the remaining patients had oedema reduced by less than 25%. The proportion of people whose oedema reduced was slightly but not significantly lower in regimen II. anova revealed that lymphoedema reduction varied according to grade; being greatest at grade 1 lymphoedema, followed by grade 2. All three regimens significantly reduced ADL frequency after 1u2003year of treatment. This may be because of foot care as well as use of antibiotics. The estimated costs of treatment per patient for a period of 3u2003months are US

Endothelial Nitric Oxide Synthase Gene Polymorphisms and Plasmodium falciparum Infection in Indian Adults

2.4, 1.5 and 4.0 respectively for regimen I, II and III. Thus affordable treatments with simple antibiotics and foot care can give substantial relief to the patients and reverse early lymphoedema.

Genetic variation in neuronal nitric oxide synthase (nNOS) gene and susceptibility to cerebral malaria in Indian adults

ABSTRACT To explore the hypothesis that susceptibility to cerebral malaria is influenced by genetic variation in endothelial nitric oxide synthase (eNOS), we genotyped three commonly defined polymorphic loci of eNOS, Glu298→Asp, intron 4 variable number of tandem repeat region, and T-786→C, in 244 patients (mean age, 36.2 years) with mild malaria and 194 patients (mean age, 35.6 years) with severe malaria belonging to same ethnic group in Orissa, an eastern Indian state. We found that there was an association of the Glu298→Asp substitution (P = 0.0037; odds ratio, 1.95; 95% confidence interval, 1.2 to 3.0) and a single unique haplotype defined by “C-b-Asp” (Pcorrected = 0.0024) for protection against cerebral malaria. Further, the median plasma level of nitrite-nitrate was found to be increased in individuals with the Glu298→Asp substitution and was significantly higher in the mild malaria group (P ≤ 0.0001), but the increase was not significant in the severe malaria group (P = 0.0528). These findings suggest that the Glu298→Asp substitution and the “C-b-Asp” haplotype may enhance eNOS expression and NO production, which leads to protection against cerebral malaria. These findings may increase our understanding of the pathogenesis of malaria.

Primary Healthcare Services Among a Migrant Indigenous Population Living in an Eastern Indian City

The role of nitric oxide (NO) in the pathogenesis of cerebral malaria is controversial. Of the three isoforms of nitric oxide synthases (NOS), though iNOS expression is the major source of NO level in vivo, nNOS is the main isoform constitutively expressed in the neural tissues. However, there has been no investigation of the role of polymorphisms of the nNOS gene in the etiology of cerebral malaria. We have analyzed two single nucleotide polymorphisms (SNPs) of nNOS gene (-84G-->A and 276C-->T), responsible for decreased basal transcriptional activity, in 200 patients with mild Plasmodium falciparum malaria and 170 patients with cerebral malaria. Our results showed a significant association of AG genotype (OR=1.83, 95%CI=1.19-2.78, P=0.007) and AA genotype (OR=3.86, 95%CI=1.42-10.5, P=0.007) of nNOS -84G-->A substitution with cerebral malaria. Interestingly, when the nNOS variant genotypes were combined together for analysis, a significantly increased risk of cerebral malaria was associated with -84(AG+AA)/276(CT+TT) genotype (OR=2.59, 95%CI=1.46-4.60, P=0.0016) and -84(AG+AA)/276(CC) genotype (OR=1.89, 95%CI=1.08-3.32, P=0.0334). The -84A seems to be a putative risk allele on the susceptibility to cerebral malaria and low nitric oxide production might have contributed to the development of cerebral malaria.

Use of an inclusive-partnership strategy in urban areas of Orissa, India, to increase compliance in a mass drug administration for the control of lymphatic filariasis

This paper reports the accessibility and utilization of the healthcare services among a migrant indigenous community inhabiting slums of an eastern Indian city. It is based on data collected through semi-structured interviews conducted with heads of the households. The results indicated that the services of health personnel by visiting households are rare and the service provision was very poor. For curative services, the people heavily depend on private practitioners, including unqualified practitioners, by spending large proportions of their earnings. Due to migration, this community becomes more vulnerable to low utilization of healthcare services. This study warrants evolving a system of healthcare to cater the needs of vulnerable migrant groups in urban areas of India.

High CR1 level and related polymorphic variants are associated with cerebral malaria in eastern-India

Abstract In India, the programme to eliminate lymphatic filariasis, which is largely based on mass administrations of diethylcarbamazine, has, in terms of coverage and compliance, been generally much less successful in urban areas than in rural communities. An innovative strategy to make the programme more effective in urban settings, largely based on an inclusive partnership and community participation, has recently been developed. An evaluation of the strategys implementation in Orissa, which employed both quantitative and qualitative methods of data collection, revealed significantly higher coverage and compliance in an urban area where the strategy had been implemented than in a similar urban area where there had been no such intervention. Application of this strategy in other urban settings in general, and in small towns in particular, is recommended in India.

Sequence analysis of coding DNA fragments of pfcrt and pfmdr-1 genes in Plasmodium falciparum isolates from Odisha, India

The complement receptor 1 (CR1/CD35) protein acts as the major rosetting receptor in Plasmodium falciparum infection and several genetic variants of CR1 gene have been shown to be associated with quantitative expression of erythrocyte CR1 (E-CR1) level. However, CR1 level and gene polymorphisms exhibit differences in clinical manifestation of malaria in regions of varying disease endemicity. The result of the present study which analyzed three SNPs (intron 27 HindIIIA>T, exon 22 3650 A>G, and exon 33 5507 C>G) of the CR1 gene in Orissa, a hyperendemic state in eastern-India showed that a significantly increased risk for cerebral malaria (CM) was associated with AA genotype of both intron 27 and exon 22 when compared with mild, severe malaria anemia (SMA) and CM+SMA group respectively. Further, the overall haplotype analysis for all the three loci showed predominantly two major haplotypes AAC coding for higher expression of CR1 and TGG haplotype coding for low expression of CR1 level with the former haplotype being significantly associated with CM (P value<0.00619 after Bonferroni correction) compared to mild malaria. The TGG haplotype was proportionately more in SMA cases compared to mild malaria though statistically not significant. These findings suggest that the mild malaria group had an intermediate level of E-CR1 and extremely low or high levels of CR1 can cause severity in malaria. Further large scale studies in different endemic regions are needed to explain the epidemiological differences between E-CR1 expression and clinical manifestation of malaria which may contribute to the understanding of malaria pathogenesis.