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PubMed | National Institute of Medical Statistics ICMR, CARE India, All India Institute of Medical Sciences and Rajendra Memorial Research Institute of Medical Sciences
Type: Journal Article | Journal: PLoS neglected tropical diseases | Year: 2016

Visceral Leishmaniasis, commonly known as kala-azar, is widely prevalent in Bihar. The National Kala-azar Control Program has applied house-to-house survey approach several times for estimating Kala-azar incidence in the past. However, this approach includes huge logistics and operational cost, as occurrence of kala-azar is clustered in nature. The present study aims to compare efficiency, cost and feasibility of snowball sampling approach to house-to-house survey approach in capturing kala-azar cases in two endemic districts of Bihar, India.A community based cross-sectional study was conducted in two highly endemic Primary Health Centre (PHC) areas, each from two endemic districts of Bihar, India. Snowball technique (used to locate potential subjects with help of key informants where subjects are hard to locate) and house-to-house survey technique were applied to detect all the new cases of Kala-azar during a defined reference period of one year i.e. June, 2010 to May, 2011. The study covered a total of 105,035 households with 537,153 populations. Out of total 561 cases and 17 deaths probably due to kala-azar, identified by the study, snowball sampling approach captured only 221 cases and 13 deaths, whereas 489 cases and 17 deaths were detected by house-to-house survey approach. Higher value of McNemars statistics (64; p<0.0001) for house-to-house survey approach than snowball sampling and relative difference (>1) indicates that most of the kala-azar cases missed by snowball sampling were captured by house-to-house approach with 13% of omission.Snowball sampling was not found sensitive enough as it captured only about 50% of VL cases. However, it captured about 77% of the deaths probably due to kala-azar and was found more cost-effective than house-to-house approach. Standardization of snowball approach with improved procedure, training and logistics may enhance the sensitivity of snowball sampling and its application in national Kala-azar elimination programme as cost-effective approach for estimation of kala-azar burden.


PubMed | National Institute of Medical Statistics ICMR and Institute of Cytology and Preventive Oncology ICMR
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2015

Cancer is one of the leading causes of mortality in Indian population with control approach of varied kind which the health system of the country needs to prioritize. The tobacco related cancer which account for major share of all the cancers could be largely controlled through primary prevention a strategy effective in terms of resources hence take priority in terms of cancer control activities. It would be worthwhile to study the cancer of sites and relative magnitude of the cancers which are tobacco related and are amenable for prevention.The age specific cancer incidence rates of cancer as available from the consolidated reports of the National Cancer Registry Program of Indian Council of Medical Research for the years 1990-96 an 2001-04 were utilized for computing proportion of tobacco related cancers which included population based cancer registries at Bangalore, Bhopal, Barshi a rural registry in Maharashtra, Chennai, Delhi and Mumbai. As defined cancer of the sites oral cavity, lip, tongue, oropharynx, hypopharnx, pharynx, oesophagus, larynx, lung, urinary bladder were considered as tobacco related cancers. The statistical evaluation of proportion of tobacco related cancers between two time periods under consideration was carried out by proportion test.There was a significant decline of proportion of tobacco related cancers from 1990-96 to 2003 for all the registries except Bhopal where around 50% of the total cancers attributed to tobacco habits for the two time periods under consideration. The Barshi also reported a decline but was not statistically significant. In females the proportion of tobacco related cancers ranged between 17% in Bangalore 10% in Delhi for the two time periods under review. All the registries showed significant decline in proportion of tobacco related cancers for the periods under consideration, except Delhi and Bhopal, while rural registry at Barshi revealed an increase of 3.3 %. The gender difference of the proportion of tobacco related cancers ranges between 19.8% to 34% during the period 1990-96, while it was 18.5% to 35% for the period 2001-03. While examining the difference between gender gap between the two time periods, the results from Mumbai registry revealed significant decline.


Pandey A.,National Institute of Medical Statistics ICMR | Mishra R.M.,Population Council | Sahu D.,National Institute of Medical Statistics ICMR | Benara S.K.,National Institute of Medical Statistics ICMR | And 4 more authors.
Indian Journal of Medical Research, Supplement | Year: 2012

Background & objectives: The long distance truck drivers play an important role in the spread of HIV and sexually transmitted infections (STIs). The present study was carried out to examine association of marital status with heterosexual risk behaviour, condom use and prevalence of STI and HIV among long-distance male truck drivers in India. Methods: Using the time location cluster sampling approach, major transshipment locations covering the bulk of India's transport volume were surveyed in 2007. A total of 2,066 long-distance male truck drivers were surveyed and, after consent, interviewed about their socio-demographic characteristics, sexual behaviours, condom use practices, and tested for HIV, reactive syphilis serology, Neiserria gonorrhoeae and Chlamydia trachomatis. The key variable of this study marital status was divided in two categories: married and unmarried. Data were analyzed using multiple logistic regression methods with following four binary outcome variables (i) whether had sex with any non-regular partners in past 12 months; (ii) whether used condom consistently in past 12 months; (iii) whether tested positive for any STI; and (iv) whether tested positive for HIV. Results: Compared to married truck drivers, unmarried were significantly more likely to have sex with non-regular female partners (30.2 versus 66.9%, OR: 5.7, 95% CI 3.6-8.9), less likely to use condom consistently with non-regular female partners (50.1 versus 38.8%, OR: 0.7, 95% CI: 0.4-1.1) and more likely to have HIV (3.7 versus 3.4%, OR: 2.7, 95% CI: 1.1-6.5). Interpretation & conclusions: Unmarried truck drivers have a higher HIV risk behaviour and consequently they were more likely to have HIV than married drivers. Despite of high-risk behaviours, risk-perception remains low among both married and unmarried truck drivers. This belief coupled with inconsistent condom use put currently married long distance truck drivers as well as their wives at risk of getting infected from STI and HIV.


PubMed | National Institute of Medical Statistics ICMR, Rani Childrens Hospital and PGIMER and associated Dr Ram Manohar Lohia Hospital
Type: Journal Article | Journal: Heart Asia | Year: 2016

To compare the diagnostic yield of acute rheumatic fever (ARF) by the American Heart Association/ American College of Cardiology (AHA/ACC) 2015 revised Jones criteria with the WHO 2004 and Australian guidelines 2012.Retrospective observational study in 93 cases of suspected ARF admitted to the Division of Paediatric Cardiology between January 2012 and December 2014. WHO 2004, Australian guidelines and AHA/ACC 2015 Jones criteria were applied to assess definite and probable ARF.Of the 93 cases, 50 were diagnosed as the first episode of ARF and 43 as a recurrence of the condition. Subclinical carditis was a predominant presentation (38%) in the first episode group (p<0.01) whereas in the recurrence group carditis (88%) was the main presentation (p<0.01). Among the joint manifestations, the majority of patients in both the first episode group and the recurrence group presented with arthralgia. Of all the patients with suspected ARF (50), 34% of cases did not fulfil the standard Jones criteria 2004; however, 86% qualified as having ARF on applying the Australian and AHA/ACC 2015 criteria. Surprisingly in the recurrence group only 67% of the patients fulfilled AHA/ACC 2015 despite the modifications incorporated beyond WHO 2004; however, all the patients fulfilled the Australian guidelines either as definite (88.4%) or probable (11.6%). Inclusion of subclinical carditis, polyarthralgia and monoarthritis as major criteria influenced the diagnosis to definite ARF in 20%, 10% and 4% of patients, respectively.The clinical manifestations of ARF, comprising subclinical carditis and arthralgia, are possibly milder in the Indian population; hence, inclusion of subclinical carditis, polyarthralgia and monoarthritis as major criteria in the newer guidelines has improved the diagnostic yield of ARF. In the absence of a gold standard for the diagnosis of ARF, it is not possible to comment on sensitivity and specificity.


PubMed | National Institute of Medical Statistics ICMR and National Health Research Institute
Type: Journal Article | Journal: The Indian journal of medical research | Year: 2016

Despite various efforts by the Government of India, utilization of antenatal care (ANC) services continues to be low among women from rural areas particularly those belonging to the Scheduled Tribes. The present study was undertaken to examine the factors associated with the utilization of ANC services among women in four States including Rajasthan, Odisha, Chhattisgarh and Madhya Pradesh which constitute a good share of tribal population of the country.Data from third round of District Level Household and Facility Survey, 2007-08 (DLHS-3) have been used. Bivariate and multivariate analyses (logistic regression model) were used to study the association between the utilization of ANC services and the independent variables at individual, household and village levels along with the motivational factors (motivation by health workers and family members).The utilization of ANC services among Scheduled Tribes women varied from about 4 per cent in Madhya Pradesh and Rajasthan to 10-14 per cent in Chhattisgarh and Odisha. Utilization was highest among those women with level of education 9th class and above (15-28%) and those women who visited health facility for pregnancy confirmation test (9-27%). Across the States, women who visited health facility for pregnancy testing (adjusted odds ratio, AOR = 1.5-2.5; P<0.001) except in Madhya Pradesh; registration of pregnancy (AOR = 2.1-4.5; P<0.01) and sought treatment of pregnancy related problems (AOR = 1.5-1.8; P<0.06) except in Rajasthan, were more likely to avail complete ANC services than their counterparts.The utilization of antenatal care among Scheduled Tribe women across four States was very poor. The reasons behind non-utilisation include both socio-economic and health system factors. For improving ANC utilization among tribes, these factors need to be addressed with special emphasis on womans educational attainment of high school and above. In addition, the study highlighted the need to create awareness among both pregnant tribal women as well as her family members on the importance of early ANC care.


Kumar G.,National Bureau of Fish Genetic Resources | Sharma P.,National JALMA Institute for Leprosy and Other Mycobacterial Diseases ICMR | Rathore G.,National Bureau of Fish Genetic Resources | Bisht D.,National JALMA Institute for Leprosy and Other Mycobacterial Diseases ICMR | Sengupta U.,National Institute of Medical Statistics ICMR
Journal of Applied Microbiology | Year: 2010

Aims: The purpose of this study was to identify outer membrane proteins (OMPs) of Edwardsiella tarda. Methods and Results: The OMPs from a virulent strain of E. tarda (ET-7) was extracted using lauroyl sarcosine method. The OMPs were analysed by two-dimensional polyacrylamide gel electrophoresis (2D-PAGE), and protein spots were identified using matrix assisted laser desorption/ionization-time-of-flight mass spectrometry. A total of 21 proteins were identified from 24 protein spots observed on the 2D-PAGE gel. These proteins were identified as GroEL, antigenic proteins, ABC transporters, elongation factors, OmpA, PTSINtr with GAF domain, catalase C, glycolytic enzymes, DnaJ, transcriptional regulator, proteins mraZ and ccdA. Subcellular localizations, β-barrel OMPs and lipoproteins of identified proteins were predicted using PSORTb, PRED-TMBB and LipoP1.0 programme. Conclusions: Identification, localization and possible functions of OMPs of E. tarda were studied. Significance and Impact of the Study: These proteins could be used for development of novel drug targets, diagnostics or vaccine against edwardsiellosis. © 2009 The Society for Applied Microbiology.


Khatuja R.,University of Delhi | Jain G.,University of Delhi | Mehta S.,University of Delhi | Arora N.,University of Delhi | And 2 more authors.
Minimally Invasive Surgery | Year: 2014

Aim. To find out the changing trends in indications for use of laparoscopy for diagnostic or operative procedures in gynaecology. Methods. This was a clinical audit of 417 women who underwent laparoscopic procedures over a period of 8 years from January 2005 to December 2012 in the Department of Obstetrics and Gynaecology at a tertiary care centre in Delhi. Results. A total of 417 diagnostic and operative laparoscopic procedures were performed during the period from January 2005 to December 2012. Out of 417 women, 13 women were excluded from the study due to inadequate data. 208 (51.4%) women had only diagnostic laparoscopy whereas 196 (48.6%) patients had operative laparoscopy after the initial diagnostic procedure. Change in trend of diagnostic versus operative procedures was observed from 2005 to 2012. There was increase in operative procedures from 10 (37.03%) women in 2005 as compared to 51 (73.91%) in 2012.The main indication for laparoscopy was infertility throughout the study period (61.38%), followed by chronic pelvic pain (CPP) (11.38%) and abnormal uterine bleeding (AUB) (9.4%). Conclusion. Over the years, there has been a rise in the rate of operative laparoscopy.Though the indications for laparoscopy have remained almost similar during the years, laparoscopy for diagnosis and treatment of CPP and AUB has now increased. Copyright © 2014 Ritu Khatuja et al.


Aggarwal A.,National Institute of Medical statistics ICMR | Pandey A.,National Institute of Medical statistics ICMR
Indian Journal of Medical Research | Year: 2010

Background & objective: Estimation of disease burden due to leprosy by conventional sampling procedure is difficult due to large sample size requirement. In such situation, inverse sampling procedure could be a choice. A pilot study was undertaken to study the feasibility of adopting inverse sampling procedure over conventional sampling in an endemic area of Uttar Pradesh, India. Method: Two community development blocks one with high endemic, namely, Fatehganj, and other low endemic, Ramnagar, in Bareilly district of Uttar Pradesh, India, were selected. The Inverse sampling was adopted in Fatehganj and conventional cluster sampling was used in Ramnagar. As per the design of inverse sampling, 25 new cases of leprosy were to be detected from a population that could provide the cases. Under conventional sampling, a sample of 44,000 subjects (population) was targeted for the survey. Results: In Fatehganj, 25 new cases of leprosy were detected from a sample of 14734 individuals. In Ramnagar, a total of 63 new cases of leprosy were found after covering a sample of 44686 individuals. Both the techniques provided similar estimates. The precision obtained under inverse sampling was though less than that under conventional sampling but found to be more feasible and suitable for estimation of leprosy due to less population to be covered, time and cost. Interpretation & conclusion: Our findings showed reveals that inverse sampling was advantageous over conventional sampling and could be adopted for the large scale survey at national level.


Juneja A.,National Institute of Medical Statistics ICMR | Aggarwal A.R.,National Institute of Medical Statistics ICMR | Adhikari T.,National Institute of Medical Statistics ICMR | Pandey A.,National Institute of Medical Statistics ICMR
Journal of Clinical and Diagnostic Research | Year: 2016

Establishing the appropriate hypothesis is one of the important steps for carrying out the statistical tests/analysis. Its understanding is important for interpreting the results of statistical analysis. The current communication attempts to provide the concept of testing of hypothesis in non inferiority and equivalence trials, where the null hypothesis is just reverse of what is set up for conventional superiority trials. It is similarly looked for rejection for establishing the fact the researcher is intending to prove. It is important to mention that equivalence or non inferiority cannot be proved by accepting the null hypothesis of no difference. Hence, establishing the appropriate statistical hypothesis is extremely important to arrive at meaningful conclusion for the set objectives in research. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved.


PubMed | National Institute of Medical Statistics ICMR
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2016

Establishing the appropriate hypothesis is one of the important steps for carrying out the statistical tests/analysis. Its understanding is important for interpreting the results of statistical analysis. The current communication attempts to provide the concept of testing of hypothesis in non inferiority and equivalence trials, where the null hypothesis is just reverse of what is set up for conventional superiority trials. It is similarly looked for rejection for establishing the fact the researcher is intending to prove. It is important to mention that equivalence or non inferiority cannot be proved by accepting the null hypothesis of no difference. Hence, establishing the appropriate statistical hypothesis is extremely important to arrive at meaningful conclusion for the set objectives in research.

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