Case based measles surveillance in Pune: Evidence to guide current and future measles control and elimination efforts in India

Background: According to WHO estimates, 35% of global measles deaths in 2011 occurred in India. In 2013, India committed to a goal of measles elimination by 2020. Laboratory supported case based measles surveillance is an essential component of measles elimination strategies. Results from a case-based measles surveillance system in Pune district (November 2009 through December 2011) are reported here with wider implications for measles elimination efforts in India.Methods: Standard protocols were followed for case identification, investigation and classification. Suspected measles cases were confirmed through serology (IgM) or epidemiological linkage or clinical presentation. Data regarding age, sex, vaccination status were collected and annualized incidence rates for measles and rubella cases calculated.Results: Of the 1011 suspected measles cases reported to the surveillance system, 76% were confirmed measles, 6% were confirmed rubella, and 17% were non-measles, non-rubella cases. Of the confirmed measles cases, 95% were less than 15 years of age. Annual measles incidence rate was more than 250 per million persons and nearly half were associated with outbreaks. Thirty-nine per cent of the confirmed measles cases were vaccinated with one dose of measles vaccine (MCV1).Conclusion: Surveillance demonstrated high measles incidence and frequent outbreaks in Pune where MCV1 coverage in infants was above 90%. Results indicate that even high coverage with a single dose of measles vaccine was insufficient to provide population protection and prevent measles outbreaks. An effective measles and rubella surveillance system provides essential information to plan, implement and evaluate measles immunization strategies and monitor progress towards measles elimination

Determinants and perception of postpartum intrauterine contraceptive device services in Maharashtra, India

Undesired and unintended pregnancies increase unwanted births or induced abortions, consequently increasing maternal morbidity and mortality. Postpartum insertion of the Intra Uterine Contraceptive Device (PPIUCD) is an effective method for population control. The authors conducted the study to assess the determinants of PPIUCD services by identifying beneficiaries and healthcare workers' perceptions. We conducted this study in Maharashtra State, India having five geographical divisions and 36 districts. The authors visited 10 Primary Health Centers and three Community Health Centers from five districts, randomly selecting one from each division. We interviewed 45 women who had undergone insertion one day to one year prior and 17 health care workers. About one-third of women received counseling during pregnancy. The medical officers obtained the consents mostly during delivery. They inserted about 85% of devices within one hour of delivery. About 38% of women had at least one complication. Lower abdominal pain (22.22%), irregular bleeding (20.00%), the expulsion of CuT (13.33%), pain during periods (13.33%) were common. The removal rate was 6.67%. The complication rates observed in the present study are comparable to the hospital studies. Thus, the study reassures that the services in small institutions are very safe, and governments can fearlessly implement the program.Keywords: ComplicationsCounselingExpulsionHealth center Quality Removal

Comparative Study of Prevalence of Early Initiation of Breast Feeding, Its Enablers and Impeders

Background: In India the proportion of early initiation of breastfeeding is hovering around 50% and the proportion of cesarean deliveries is increasing substantially. Objectives: To compare the prevalence of early initiation of breastfeeding (EIBF) among cesarean and vaginally delivered women in hospitals in Pune District, Maharashtra State, India and to measure any association between EIBF and various socio-demographic, maternal and fetal factors. Methods: This was a multi-site study conducted in 13 selected hospitals in Pune District in 2017-18. Pune District by population is the fourth largest in India. All women delivered by cesarean section in these hospitals and an equal number of age and parity matched vaginally delivered women were enrolled. They were interviewed before discharge by obstetricians or nurses under the supervision of obstetricians, using a structured, validated tool. The data were analyzed by using Statistical Package for Social Sciences, version 25. Results: In each group, 1,556 women were enrolled. The prevalence of EIBF was 81.5% and 63.6% among vaginally and cesarean delivered women. There was a significant association between EIBF and the place of residence, mode of delivery, gestational period, parity, and presence of some disease. Residence in the rural area was the strongest enabling factor with an adjusted odds ratio of 29.6 (95% C.I.; 18.7-46.9) whereas cesarean section, preterm delivery and first para were impeding factors. Conclusions: Among institutional delivered women EIBF was about 70%. Health care workers need to strongly promote EIBF awareness, especially among women from urban areas, and undergoing cesarean section.&nbsp

Suspected measles cases by week of onset and final classification: 2009–2011.

<p>Suspected measles cases by week of onset and final classification: 2009–2011.</p

Outbreak classification protocol.

<p>Outbreak classification protocol.</p

Pune district showing blocks under case based measles surveillance.

<p>Pune district showing blocks under case based measles surveillance.</p

Suspected measles outbreaks with classification.

a<p>: 2009: From week 45; 2010 & 2011: entire year.</p>b<p>: IQR: Inter-quartile range.</p><p>Suspected measles outbreaks with classification.</p

Confirmed measles, confirmed rubella and discarded cases: Box and whiskers plot for median, inter-quartile range, minimum and maximum ages (months).

<p>Confirmed measles, confirmed rubella and discarded cases: Box and whiskers plot for median, inter-quartile range, minimum and maximum ages (months).</p

Suspected measles cases by classification and incidence rates per 100 000 persons.

a<p>: 2009: From week 45; 2010 and 2011: entire year.</p>b<p>: Annualized Incidence rate per 100,000 persons per year;</p>c<p>: 12 cases were epi-linked to a mixed outbreak of measles and rubella.</p><p>Suspected measles cases by classification and incidence rates per 100 000 persons.</p

Age distribution of confirmed measles, rubella and discarded cases, 2009–2011^a.

a<p>: Confirmed measles: Laboratory, epidemiologically or clinically confirmed measles cases; Confirmed rubella: Laboratory or epidemiologically confirmed rubella cases; Discarded: Negative laboratory results for measles or rubella.</p><p>Age distribution of confirmed measles, rubella and discarded cases, 2009–2011^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108786#nt106" target="_blank">a</a>}.</p