Vol 1, Issue 3, Jul-Sep, 2011

Dengue threatens the health of populations around the world due to the expanding distribution of the virus and its mosquito vectors, co-circulation of serotypes, and the emergence of more complex and life threatening forms of the disease in new areas. The US Centers for Disease Control and Prevention (CDC) in 2009 noted that dengue is now the world’s leading arboviral disease, estimating 100 million cases of dengue fever annually, 250,000 of dengue haemorrhagic fever (DHF), and 25,000 deaths.1 Reported from >100 countries, 2.5 billion people now live in endemic areas.

Cholera is a serious public health problem, particularly in Africa, Asia, South and Central America. Similar to the neglected tropical diseases (NTD), it is common in places with unsafe water, poor sanitation and limited access to the basic health care. In the concurrent times when the world is shrinking into a Global village, the definition of NTD itself has lost significance owing to rapid transmission of such diseases. Even, the cholera non-endemic developed countries in Europe, Russia and Oceania have become vulnerable to imported cholera. The seventh pandemic of cholera is in its 51st year without any sign of abatement despite improvements in sanitation, safe drinking water supply, promotion of oral rehydration therapy and availability of alternative preventive interventions like oral cholera vaccines. Cholera is markedly under reported due to a myriad of reasons including economic ones. The under reporting is also resulted from weakening surveillance system across countries which in turn contributes to changing perceptions and attitudes on burden of the disease and deteriorating public health services. In addition to this, lack of evidence-based sector wide programmatic approach and inequitable resource allocation for prevention and control of cholera may also risk the disease to become a NTD in future. Key Words: cholera, disease burden, neglected tropical disease

The Oral Cleft Prevention Program (OCPP) is a double-blind, randomized, two-arm multi-site clinical trial designed to assess the effect of periconceptional daily folic acid supplementation (4.0 mg vs. 0.4 mg) on the recurrence of cleft lip, with or without cleft palate, among women with elevated risk. Conducted in seven sites in Brazil, the OCPP randomized 2,510 women in the trial (1,257 to the 4.0 mg group, and 1,253 to the 0.4 mg group). A Data Coordinating Center (DCC), located in the United States, is responsible for the trial’s statistical design and analysis, data collection system, data management and storage, activity coordination, data quality control, and site training. DCCs of international trials, such as the OCPP, face unique implementation challenges due to de-centralized organization. The objective of this paper is to describe these challenges and to present the innovative solutions developed to address them. Key words: International Multisite Trial; Data Coordinating Center; Oral Cleft; Folic Acid

The study was aimed at evaluating immunization coverage against Tuberculosis, Poliomyelitis, Diphtheria, Tetanus, Pertussis and Measles. The data was taken from a sufficiently large study that adopted multi stage and systematic random sampling. The current paper aims at reporting the evaluated coverage in Bellary district and discusses addressing gaps in coverage of vaccine preventable diseases. We have reported in our earlier papers that parental recall was better than immunization card for reflecting immunization coverage, and improvement in immunization coverage was due to special immunization sessions (catch up sessions) and supportive supervision. In this paper, we present the estimates of vaccine coverage under national program. We also discuss the shortfalls responsible for drop in immunization coverage. Key words: Evaluation of Immunization coverage, Parental recall, Routine Immunization.

Background: District Health Authority of Bankura in the state of West Bengal desired to estimate the coverage of childhood vaccination and vitamin A prophylaxis by an independent body. To address these issues the present study was undertaken. Objectives: To estimate immunization coverage and vitamin A supplementation in 12-23 months children. Methods: A Cross sectional observational study was conducted in the district of Bankura, West Bengal among children aged between 12-23 months with sample size 320. Study variables were sex, residence, antigen-wise immunization coverage, proportion of fully immunized children, immunization drop-out rate, Vitamin-A (first dose) supplementation etc. Coverage was estimated by proportions and Chi-square (c2) was applied as a test of significance. Results: 99.0%, 94.8% and 91.4% of studied children received BCG, DPT-3/OPV-3 and Measles vaccination respectively. 80.3% of children (80.9% male and 79.7% of female) were fully immunized. The drop out rate for highest covered antigen dose (DPT1/OPV1) to lowest covered antigen dose (measles) was 8.1%. Fully immunized children were found more in rural area (81.7%) than the urban area (62.5) of the district. Difference was statistically significant. Almost 92% children received first dose of Vitamin-A. Conclusion: Immunization coverage of Bankura district was higher than that of the state and national figures. Rural coverage is better than urban. Key words: BCG, DPT, OPV, Measles, Immunization coverage, Vitamin A supplementation

Understanding the social meaning and perceptions of a disease are the key to designing epidemiologically effective disease control programs. Tuberculosis continues to remain an important public health problem across the world, as also in India. This paper traces how the social meaning of tuberculosis has changed over the centuries under the impact of the advances in the knowledge about the disease, and how these changing perceptions have determined the societal responses to tuberculosis. The paper has been organized in two parts. Part 1 deals with the epidemiological dimensions of tuberculosis in India, a brief historiography of tuberculosis and a discussion on how social meaning of a disease is formed with a focus on tuberculosis. Part two traces the societal responses to tuberculosis in India and an analysis of the epidemiological aspects of the National Tuberculosis Program (NT P) and the Revised National Tuberculosis Program (RNTCP). Key words: Tuberculosis, RNTCP, NTP, Epidemiology, Societal

meaning determines the societal response to disease. We have already deliberated in Part 1 upon the social meaning of tuberculosis. In this second part of the paper, we shall dwell at some length upon the societal response to tuberculosis at the level of the people, that of the scientific community and the administrative response at the level of the government and the bilateral and multilateral agencies. In this context the paper deals with the formulation of the National Tuberculosis Program (NTP) and the Revised National Tuberculosis Program (RNTCP) and relative merits of these programs in dealing with the epidemiology of tuberculosis in India. Key words: Tuberculosis, RNTCP, NTP, Epidemiology, Technology

Meningococcal disease is a low endemic infection in Delhi and its outbreaks re-emerge in irregular cyclical fashion. The morbidity and mortality due to it, is not reflective of the population level disease burden as most of the data is based on reports from the different hospitals of Delhi. The reported data was analyzed for the period 2006-2010 from public and private hospitals located in Delhi. The aggregate caseload has reduced markedly over five years period since 2006 though the case fatality rate was comparatively higher in 2009 (16.8%). Maximum cases occurred in males of the agegroup 10-45 years. The Central, South and West zones of Municipal Corporation of Delhi (MCD) have been most vulnerable and affected. The usual emergence period for cases is between November and December which continues till June with a peak in the month of March every year. There is a need to take pre-emptive prevention and control measures in the preceding months; in the high risk zones of Delhi at the outset of any imminent outbreak of the disease; along with strengthening of the surveillance. Key words: Meningococcus, Neisseria meningitidis, Epidemiology, Delhi, India

Aim: This study aims to determine the relationship between Health Behavior and Health Locus of Control among 1270 adolescents (Boys N = 635 and Girls = 635) who were drawn from Bangalore rural and urban district government high schools (mean age 13.76 years). Methodology: The Global School based Health survey (WHO, 2004) and Multidimensional Health Locus of Control by Wallston and Wallston, questionnaires were used to assess health locus of control and health behavior respectively. The data obtained was subjected to statistical analysis using Pearson’s product moment correlation methods to examine the relationship between these variables. Results and Interpretation: Findings revealed that total health behavior score of adolescents is significantly correlated with ‘internal’ and ‘powerful others’ dimensions of health locus of control. Further, the ‘chance factor’ of health locus of control did not show any significant relationship with the total health behavior score. From this it can be inferred that adolescents with high inclinations towards ‘internal health locus of control’ and ‘powerful others’ have healthier dimensions of positive behaviors. Findings have also revealed that health behavior is not significantly correlated with the beliefs that ‘health is a function of chance/luck’. Key words: Health Behavior, Health Locus of Control, Adolescents, School health

Context: Healthcare in India is a complex mix of providers, facilities and payment systems with low budgetary support from the government. After decades of neglect there is realisation that health is a priority and spending should be increased. Also there is a shortage of evidence and subsequently a need to suggest direction based on this evidence. Aims: To determine the burden of illness in the study population; find out the types of healthcare facilities used during illness; study the medico-social and economic factors influencing utilization of healthcare services. Settings and Design: 10 locations, 5 villages and 5 urban areas in the field practice areas of department of Community Medicine, AMU Aligarh. Methods and Material: Cross sectional field based study on 2518 individuals using systematic random sampling. Participants interviewed and data collected on a piloted proforma. Data Collected in two parts, initial information about burden of illness and later information of treatment seeking behaviour. Statistical analysis used: Chi Square tests, Proportions. Results: Disease severity and economic reasons play a part in treatment seeking behaviour. Some kind of treatment is sought in majority of illnesses. Treatment seeking increases with the perceived severity of illness. Choice of treatment facilities depends on various factors including availability, cost and type of illness. Conclusions: There is a hidden need for healthcare in rural areas which is expected to increase with rising awareness about health. Poverty is the major reason for not seeking any treatment in urban areas reflecting an urgent need of health provision for poor. Key words: Health Services, Health Systems, Utilization, Treatment seeking behaviour, India. Key messages: Fewer illnesses are considered severe enough to warrant treatment in rural areas. The major reason in urban areas for not seeking any form of treatment is poverty. Illnesses considered severe are significantly more likely to result in visit to healthcare facility. Complimentary and alternative systems are preferred for chronic illnesses.

An epidemiological and entomological investigation of tick typhus outbreak in village, Deol District Kangra (Himachal Pradesh) was undertaken with the aim to determine the occurrence of outbreak in the area and to reinforce control measures for the continent of diseases. During the outbreak a total of 357 cases of acute febrile illness among the total 1223 population was reported. The methodology used was to review of the records of health facilities, rapid fever survey in affected and non affected village, entomological survey for collection of ticks from domestic animals/rodents serological investigation and study of eco-epidemiological feature of the study area. Based on the working case definition, clinical features, symptomatology, serological evidence in the form of IgM antibodies in patient serum, presence of vector species in good number it was concluded that an episode of Indian Typhus has occurred in the village Deol, District Kangra (H.P.) during July 2007. Details of the finding are discussed in the communication. Action taken by local health authorities and recommendations for containment of outbreak has been discussed.

While T.b rhodesiense continues to spread from its traditional focus in the South and East, cases of T.b gambiense continue to be recorded in north-western Uganda in the West Nile Region. Of particular worry is that these foci are currently separated by fewer than 150 kilometers, much of which is inhabited by tsetse flies.1 Starkly contrasting with previous ambitious unsuccessful top-down, continent-wide eradication campaigns, Human African Trypanosomiasis (HAT ) control has now shifted from governmental to the individual level. In light of this imminent threat, the centre should remain sufficiently empowered to ensure provision of adequate technical expertise, as well as monitoring and evaluation. A literature review on HAT control activities in Uganda allowed for the identification of research gaps.

The development of the female urinary and genital system is deeply linked at the embryological level. About 10% of infants are born with abnormality of the genitourinary system, and anomalies in one system are often mirrored by anomalies in another system.1 The OHVIRA syndrome is a rare set of anomalies affecting the female urogenital tract. The syndrome consists of obstructed hemivagina with ipsilateral renal agenesis with uterine anomalies. The true incidence of the OHVIRA syndrome is not precisely known, but according to the available literature it is estimated between 0.1-3.5percent of all mullerian anomalies. It is mostly reviewed in western literature under pediatric surgery, as the median age of presentation is 12.5 years (birth-25yrs), but in our setup it usually falls into the gynecologists purview as the age of presentation is in early childbearing age. A 22 year old married patient was admitted in our hospital as a referred case of abdominopelvic mass with dysmenorrhea. The patient after complete evaluation was shown to have a uterus bicollis unicornis, with obstructed hemivagina absent right kidney with unilateral right hydrosalpinx and reactive thrombocytosis. Here, we present the diagnostic modalities that helped us reach the diagnosis of this rare syndrome, its associated features and surgical management of an adult patient in a low cost setting. Key words: Hemivagina, Ipsilateral Renal Agenesis, Hematopyo-metra, Thrombocytosis.

We report here a case of keratomycosis by Paecilomyces lilacinus. 57-year-old farmer presented to us with pain, watering and defective vision in his left eye of 2 weeks duration. He gave history of injury to left eye with wooden piece. He was admitted and treated elsewhere, with no relief of symptoms. He was not a known diabetic. Other medical history was not relevant. On examination of his left eye, there was dense stromal infiltrate measuring 6 × 5 mm in the inferior cornea from 5 to 7’o clock hours, extending onto inferior pupillary margin (Figure 1). There was no lucid interval. Margins were ill defined. Cornea surrounding the ulcer was hazy due to stromal edema. Anterior chamber had 3 mm hypopyon admixed with blood with grade 4 reaction. Pupil was 3 mm reacting to light. Fundus view was hazy due to corneal infiltrate. His best-corrected visual acuity was finger counting at 3 mts. Right eye examination was within normal limits.