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Bhattacharya S.K.,Society for Applied Studies | Sur D.,Indian National Institute of Cholera and Enteric Diseases | Dutta S.,Indian National Institute of Cholera and Enteric Diseases | Kanungo S.,Indian National Institute of Cholera and Enteric Diseases | And 5 more authors.
Malaria Journal | Year: 2013

Background: Falciparum malaria increases the risk for bacteraemia, whereas the relationship between vivax malaria and bacteraemia is not clear. Data from a prospective fever surveillance study in Kolkata, India were reanalysed for the potential association between Plasmodium vivax malaria and bacteraemia. Methods. Patients of all ages presenting with fever of three days or more to a project health outpost were invited to participate. A blood film and blood culture was performed on presentation. Treatment and referral were provided according to national guidelines. The case fraction and incidence of malaria, bacteraemia, and co-infection were calculated. Results: 3,371 participants were enrolled during a one-year study period, of whom 93/3,371 (2.8%) had malaria (89/93 [95.7%] Plasmodium vivax) and 256 (7.6%) bacteraemia. There were 154 malaria, 423 bacteraemia and 10 P. vivax-bacteremia coinfection episodes per 100,000/year. Among the malaria-bacteraemia co-infections, all were vivax malaria and 5/6 (83%) bacteria isolated were Gram-negative (one S. Typhi, one S. Paratyphi A, three other Gram-negative). Bacteraemia occurred in 6/89 (6.7% [95%CI: 3.1-13.9%]) of P. vivax cases versus 250/3,278 (7.6% [95% CI: 6.7-8.6%]) without Plasmodium infection (p=0.76). Conclusions: While an increased risk was not demonstrated, concomitant bacteraemia occurs frequently in vivax malaria in an area with a high background incidence of bacteraemia, and should be considered in cases of vivax malaria with severe manifestations. © 2013 Bhattacharya et al.; licensee BioMed Central Ltd.

Francis M.R.,Christian Medical College | Nagarajan G.,Christian Medical College | Sarkar R.,Christian Medical College | Mohan V.R.,Christian Medical College | And 2 more authors.
BMC Public Health | Year: 2015

Background: Acceptance 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. Methods: Eight 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. Results: The 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. Conclusion: This 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. © 2015 Francis et al.

John J.,Christian Medical College | Sarkar R.,Christian Medical College | Muliyil J.,Christian Medical College | Bhandari N.,Society for Applied Studies | And 2 more authors.
Vaccine | Year: 2014

While improvements in oral rehydration use and access to healthcare have contributed to impressive gains in child survival, diarrheal diseases remain the second most important cause of child mortality in India. Pathogen specific disease rates, while key to deciding on the utility of specific public health interventions such as vaccines, are extremely difficult to obtain in developing country settings with less than optimal health access, diagnostic services and information systems. This study combined disease burden within five cohorts of infants followed up for diarrheal morbidity with data from the nationally representative Indian Rotavirus Surveillance Network and applies rates of rotavirus related events to UNICEF birth and mortality estimates for India. These estimates, while limited by the lack of data from nationally representative population based studies, use methods consistent with those employed by the World Health Organization Child Health Epidemiology Reference Group. We estimate that 11.37 million episodes of rotavirus gastroenteritis occur each year in India, requiring 3.27 million outpatient visits and 872,000 inpatient admissions when health access is unconstrained, resulting in a need for Rs. 10.37 billion each year in direct costs. An estimated 78,000 rotavirus-associated deaths occur annually of which 59,000 occur in the first 2 years of life. Introduction of a rotavirus vaccine of similar efficacy to the Rotavac in the national immunization program would result in 686,277 fewer outpatient visits, 291,756 fewer hospitalizations and 26,985 fewer deaths each year in India, assuming no indirect effects for the vaccine. © 2014.

Basnet S.,Tribhuvan University | Shrestha P.S.,Tribhuvan University | Sharma A.,Tribhuvan University | Mathisen M.,University of Bergen | And 8 more authors.
Pediatrics | Year: 2012

BACKGROUND AND OBJECTIVE: Diarrhea and pneumonia are the leading causes of illness and death in children <5 years of age. Zinc supplementation is effective for treatment of acute diarrhea and can prevent pneumonia. In this trial, we measured the efficacy of zinc when given to children hospitalized and treated with antibiotics for severe pneumonia. METHODS: We enrolled 610 children aged 2 to 35 months who presented with severe pneumonia defined by the World Health Organization as cough and/or difficult breathing combined with lower chest indrawing. All children received standard antibiotic treatment and were randomized to receive zinc (10 mg in 2- to 11-month-olds and 20 mg in older children) or placebo daily for up to 14 days. The primary outcome was time to cessation of severe pneumonia. RESULTS: Zinc recipients recovered marginally faster, but this difference was not statistically significant (hazard ratio = 1.10, 95% CI 0.94-1.30). Similarly, the risk of treatment failure was slightly but not significantly lower in those who received zinc (risk ratio = 0.88 95% CI 0.71-1.10). CONCLUSIONS: Adjunct treatment with zinc reduced the time to cessation of severe pneumonia and the risk of treatment failure only marginally, if at all, in hospitalized children. Copyright © 2012 by the American Academy of Pediatrics.

Valentiner-Branth P.,Statens Serum Institute | Shrestha P.S.,Tribhuvan University | Chandyo R.K.,Tribhuvan University | Mathisen M.,University of Bergen | And 6 more authors.
American Journal of Clinical Nutrition | Year: 2010

Background: Pneumonia is a leading cause of illness and death in young children. Interventions to improve case management of pneumonia are needed. Objective: Our objective was to measure the effect of zinc supplementation in children with pneumonia in a population in which zinc deficiency is common. Design: In a double-blind, placebo-controlled clinical trial, children aged 2-35 mo with severe (n = 149) or nonsevere (n = 2479) pneumonia defined according to criteria established by the World Health Organization were randomly assigned to receive zinc (10 mg for children aged 2-11 mo, 20 mg for children aged ≥12 mo) or placebo daily for 14 d as an adjuvant to antibiotics. The primary outcomes were treatment failure, defined as a need for change in antibiotics or hospitalization, and time to recovery from pneumonia. Results: One of 5 children did not respond adequately to antibiotic treatment; the odds ratios between zinc and placebo groups for treatment failure were 0.95 (95% CI: 0.78, 1.2) for nonsevere pneumonia and 0.97 (95% CI: 0.42, 2.2) for severe pneumonia. There was no difference in time to recovery between zinc and placebo groups for nonsevere (median: 2 d; hazard ratio: 1.0; 95% CI: 0.96, 1.1) or severe (median: 4 d; hazard ratio: 1.1; 95% CI: 0.79, 1.5) pneumonia. Regurgitation or vomiting ≤15 min after supplementation was observed more frequently among children in the zinc group than among those in the placebo group during the supplementation period (37% compared with 13%; odds ratio: 0.25; 95% CI: 0.20, 0.30). Conclusion: Adjuvant treatment with zinc neither reduced the risk of treatment failure nor accelerated recovery in episodes of non-severe or severe pneumonia. This trial was registered at clinicaltrials. gov as NCT00148733. © 2010 American Society for Nutrition.

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