Venkata Raghava Mohan

Prevalence and clustering of soil‐transmitted helminth infections in a tribal area in southern India

To estimate the prevalence, spatial patterns and clustering in the distribution of soil‐transmitted helminth (STH) infections, and factors associated with hookworm infections in a tribal population in Tamil Nadu, India.

Mortality patterns and the effect of socioeconomic factors on mortality in rural Tamil Nadu, south India: a community-based cohort study

The importance of mortality data for assessing the health status of any population and for planning disease control and health promotional interventions is well established. A population-based cohort study was conducted in Kaniyambadi Block, a rural block in North Arcot District in Tamil Nadu, India, with a population of approximately 120,000 people living in 88 villages. The mortality rates, patterns and effect of socioeconomic factors on mortality were studied. The overall incidence of mortality in the study cohort was 7.3/1000 person-years, with higher rates of mortality among men than women. People with low socioeconomic status (SES) had almost two-fold higher mortality rates across all age groups compared with people with high SES. Deaths due to injuries and other external causes contributed 23.0% of all deaths, among which the low socioeconomic group had 56% excess cause-specific mortality compared with the high socioeconomic group. Standardised mortality ratios indicated that the low socioeconomic group had 25% excess mortality compared with the overall standard mortality. This study clearly shows that the low SES group had a significantly higher incidence of mortality due to all causes and among all age groups.

Risk factors for foot ulcers in patients with diabetes mellitus - a short report from vellore, South India.

Diabetes mellitus, a metabolic disease, has a population prevalence of about 10-15%. The incidence of foot ulcers range from 8 to 17% in the cohort studies, with varying lengths of follow-up, and cause severe disability and possible hospitalization to patients and considerable economic burden to families.(1–4) A variety of foot lesions are seen in people with uncontrolled diabetes mellitus namely fissures, abscess, cellulites, ulcers, claw toes and Charcots joints. There is a risk of developing gangrene and of consequent amputation of the foot especially for people from the lower socioeconomic strata and for those living in rural areas. Clinical guidelines recommend that all patients with diabetes should be screened annually to establish their risk of foot ulceration.(2) Diagnostic tests and physical signs that detect peripheral neuropathy (biothesiometry, monofilaments and absent ankle reflexes), and those that detect excessive plantar pressure (peak plantar pressure and joint deformity) were all significantly associated with future diabetic foot ulceration. However, there was a paucity of evidence from India concerning the predictive value of symptoms and signs. This study aimed to examine the risk factors for foot ulcers in patients with diabetes mellitus attending the Community Health and Development (CHAD) Hospital, Christian Medical College, Vellore, a secondary care facility.

Perception of drinking water safety and factors influencing acceptance and sustainability of a water quality intervention in rural southern India

BackgroundAcceptance and long-term sustainability of water quality interventions are pivotal to realizing continued health benefits. However, there is limited research attempting to understand the factors that influence compliance to or adoption of such interventions.MethodsEight focus group discussions with parents of young children - including compliant and not compliant households participating in an intervention study, and three key-informant interviews with village headmen were conducted between April and May 2014 to understand perceptions on the effects of unsafe water on health, household drinking water treatment practices, and the factors influencing acceptance and sustainability of an ongoing water quality intervention in a rural population of southern India.ResultsThe ability to recognize health benefits from the intervention, ease of access to water distribution centers and the willingness to pay for intervention maintenance were factors facilitating acceptance and sustainability of the water quality intervention. On the other hand, faulty perceptions on water treatment, lack of knowledge about health hazards associated with drinking unsafe water, false sense of protection from locally available water, resistance to change in taste or odor of water and a lack of support from male members of the household were important factors impeding acceptance and long term use of the intervention.ConclusionThis study highlights the need to effectively involve communities at important stages of implementation for long term success of water quality interventions. Timely research on the factors influencing uptake of water quality interventions prior to implementation will ensure greater acceptance and sustainability of such interventions in low income settings.

Changes in knowledge and practices related to taeniasis/cysticercosis after health education in a south Indian community.

A health education programme for taeniasis/cysticercosis was implemented and evaluated among schoolchildren and the general community in a rural block in southern India, an area that is endemic for cysticercosis. The baseline survey among 831 participants from three randomly selected villages showed poor knowledge regarding the spread of taeniasis and neurocysticercosis. There was also a lack of adequate hygiene and sanitation practices. Health education was given in these villages and in the schools located in these villages regarding the lifecycle of the pork tapeworm, spread of taeniasis and cysticercosis, and prevention of these conditions. The post-intervention test conducted 6 months later among 1060 participants revealed a 46% increase in the overall score of knowledge and practices. Awareness about the mode of spread of taeniasis and cysticercosis improved by almost 3 times and the reported practice of washing hands with soap and water before eating improved by 4.8 times and after using the toilet by 3.6 times. One person who reported the passage of tapeworm segments was confirmed to be a carrier of Taenia solium and was treated. The health education given on prevention of taeniasis and cysticercosis was useful in improving the knowledge and practices of the community and also in diagnosing taeniasis through self-reporting.

Environmental predictors of diarrhoeal infection for rural and urban communities in south India in children and adults

Diarrhoeal diseases are major causes of morbidity and mortality in developing countries. This longitudinal study aimed to identify controllable environmental drivers of intestinal infections amidst a highly contaminated drinking water supply in urban slums and villages of Vellore, Tamil Nadu in southern India. Three hundred households with children (<5 years) residing in two semi-urban slums and three villages were visited weekly for 12-18 months to monitor gastrointestinal morbidity. Households were surveyed at baseline to obtain information on environmental and behavioural factors relevant to diarrhoea. There were 258 diarrhoeal episodes during the follow-up period, resulting in an overall incidence rate of 0·12 episodes/person-year. Incidence and longitudinal prevalence rates of diarrhoea were twofold higher in the slums compared to rural communities (P < 0·0002). Regardless of study site, diarrhoeal incidence was highest in infants (<1 year) at 1·07 episodes/person-year, and decreased gradually with increasing age. Increasing diarrhoeal rates were associated with presence of children (<5 years), domesticated animals and low socioeconomic status. In rural communities, open-field defecation was associated with diarrhoea in young children. This study demonstrates the contribution of site-specific environmental and behavioural factors in influencing endemic rates of urban and rural diarrhoea in a region with highly contaminated drinking water.

A current perspective on antimicrobial resistance in Southeast Asia.

Abstract Southeast Asia, a vibrant region that has recently undergone unprecedented economic development, is regarded as a global hotspot for the emergence and spread of antimicrobial resistance (AMR). Understanding AMR in Southeast Asia is crucial for assessing how to control AMR on an international scale. Here we (i) describe the current AMR situation in Southeast Asia, (ii) explore the mechanisms that make Southeast Asia a focal region for the emergence of AMR, and (iii) propose ways in which Southeast Asia could contribute to a global solution.

Prevalence of musculoskeletal disorders among brick kiln workers in rural Southern India

Background: A variety of musculoskeletal disorders and discomfort are seen among brick kiln workers, where heavy physical work is associated with awkward working postures and manual handling of materials, leading to significant morbidity. Materials and Methods: This cross-sectional study was conducted in unorganized brick kiln industries in villages of Vellore district of Tamil Nadu and included 310 brick kiln workers. Modified Nordic Questionnaire was used to survey the prevalence of musculoskeletal disorders and the intensity of pain was assessed by the body pain discomfort scale. Results: The mean age of the workers was 37 ± 13.2 years with a range of 18-85 years. 62% (n = 192) had normal body mass index, whereas 27% (n = 85) were undernourished. The commonest posture adopted at work was squatting (67%) followed by standing (14%). Majority of workers (87%, n = 269) reported to having symptoms of pain currently of which 51% (n = 158) had pain during work. Chronic low back ache (LBA) (1 year prevalence -59%) and acute LBA (1 week prevalence-33%) were the commonest followed by chronic knee pain. More than 10 years of work was significantly associated (P < 0.05) with acute LBA and acute and chronic knee pain. Severity of the pain was also significantly (t statistic 2.476, P < 0.05) associated with job dissatisfaction. Conclusion: Long-term brick kiln workers, who adopt a specific posture for prolonged periods, have severe musculoskeletal pain that interferes with activities of daily living and reduces job satisfaction. Health education on frequent postural change, implementation and monitoring of laws among unorganized industries are recommended to bring down morbidity due to musculoskeletal disorders (MSD).

Vaccine coverage and adherence to EPI schedules in eight resource poor settings in the MAL-ED cohort study

Background Launched in 1974, the Expanded Program on Immunization (EPI) is estimated to prevent two-three million deaths annually from polio, diphtheria, tuberculosis, pertussis, measles, and tetanus. Additional lives could be saved through better understanding what influences adherence to the EPI schedule in specific settings. Methods The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study followed cohorts in eight sites in South Asia, Africa, and South America and monitored vaccine receipt over the first two years of life for the children enrolled in the study. Vaccination histories were obtained monthly from vaccination cards, local clinic records and/or caregiver reports. Vaccination histories were compared against the prescribed EPI schedules for each country, and coverage rates were examined in relation to the timing of vaccination. The influence of socioeconomic factors on vaccine timing and coverage was also considered. Results Coverage rates for EPI vaccines varied between sites and by type of vaccine; overall, coverage was highest in the Nepal and Bangladesh sites and lowest in the Tanzania and Brazil sites. Bacillus Calmette-Guérin coverage was high across all sites, 87–100%, whereas measles vaccination rates ranged widely, 73–100%. Significant delays between the scheduled administration age and actual vaccination date were present in all sites, especially for measles vaccine where less than 40% were administered on schedule. A range of socioeconomic factors were significantly associated with vaccination status in study children but these results were largely site-specific. Conclusions Our findings highlight the need to improve measles vaccination rates and reduce delayed vaccination to achieve EPI targets related to the establishment of herd immunity and reduction in disease transmission.

Rotavirus Infection and Disease in a Multisite Birth Cohort: Results From the MAL-ED Study

Background In a multicountry birth cohort study, we describe rotavirus infection in the first 2 years of life in sites with and without rotavirus vaccination programs. Methods Children were recruited by 17 days of age and followed to 24 months with collection of monthly surveillance and diarrheal stools. Data on sociodemographics, feeding, and illness were collected at defined intervals. Stools were tested for rotavirus and sera for antirotavirus immunoglobulins by enzyme immunoassays. Results A total of 1737 children contributed 22646 surveillance and 7440 diarrheal specimens. Overall, rotavirus was detected in 5.5% (408/7440) of diarrheal stools, and 344 (19.8%) children ever had rotavirus gastroenteritis. Household overcrowding and a high pathogen load were consistent risk factors for infection and disease. Three prior infections conferred 74% (P < .001) protection against subsequent infection in sites not using vaccine. In Peru, incidence of rotavirus disease was relatively higher during the second year of life despite high vaccination coverage. Conclusions Rotavirus infection and disease were common, but with significant heterogeneity by site. Protection by vaccination may not be sustained in the second year of life in settings with high burdens of transmission and poor response to oral vaccines.