An outbreak investigation of typhoid fever in Pondicherry, South India, 2013

Background: Preliminary investigation at Pediatric ward of Indira Gandhi Medical College revealed admission of a cluster of typhoid cases who were residents of one particular street in a nearby locality. Objectives: This study was undertaken to estimate the magnitude of the outbreak, identify the source of infection, and, thereby, institute control measures. Materials and Methods: An investigation team including 10 MBBS students carried out a sanitary survey, house-to-house survey, data collection using epidemiological case sheets, and spot mapping. Typhoid diagnosis was confirmed as per the IDSP guidelines, i.e., either a blood culture growth positive for Salmonella typhi or a fourfold rise in antibody titer. An age- and gender-matched case–control study was conducted to find the association of occurrence of typhoid with various possible sources of infection. Water samples were collected from the affected households and public taps for investigation. Results: Rapid survey of all the 6 streets of Thilaspet covered 1106 people living in 283 households. All nine confirmed cases were residents of one particular street. The attack rate calculated was 3.4% in this street. A significant association of occurrence of typhoid was found only with consumption of raw drinking water (OR = 12.6, P = 0.01). Water samples only from the affected street tested positive for the presence of coliforms. The sanitary survey documented water pipeline breakage at the junction of this street. Further spread of disease was stopped by advocating drinking of boiled water and repair of pipeline. Conclusion: Strengthening of disease surveillance for early identification of localized outbreaks and instituting control measures can effectively control disease spread

Effect of mobile reminders on screening yield during opportunistic screening for type 2 diabetes mellitus in a primary health care setting: A randomized trial

AbstractObjective. We wanted to study whether mobile reminders increased follow-up for definitive tests resulting in higher screening yield during opportunistic screening for diabetes. Methods. This was a facility-based parallel randomized controlled trial during routine outpatient department hours in a primary health care setting in Puducherry, India (2014). We offered random blood glucose testing to non-pregnant non-diabetes adults with age >30years (667 total, 390 consented); eligible outpatients (random blood glucose ≥6.1mmol/l, n=268) were requested to follow-up for definitive tests (fasting and postprandial blood glucose). Eligible outpatients either received (intervention arm, n=133) or did not receive mobile reminder (control arm, n=135) to follow-up for definitive tests. We measured capillary blood glucose using a glucometer to make epidemiological diagnosis of diabetes. The trial was registered with Clinical Trial Registry of India (CTRI/2014/10/005138). Results. 85.7% of outpatients in intervention arm returned for definitive test when compared to 53.3% in control arm [Relative Risk=1.61, (0.95 Confidence Interval — 1.35, 1.91)]. Screening yield in intervention and control arm was 18.6% and 10.2% respectively. Etiologic fraction was 45.2% and number needed to screen was 11.9. Conclusion. In countries like India, which is emerging as the diabetes capital of the world, considering the wide prevalent use of mobile phones, and real life resource limited settings in which this study was carried out, mobile reminders during opportunistic screening in primary health care setting improve screening yield of diabetes

Unmet need for contraception among married women in an urban area of Puducherry, India

Background & objectives: Unmet need for contraception remains a national problem. The study was conducted in an urban area of Puducherry, India, among the eligible couples to assess the unmet need for contraception and to determine the awareness and pattern of use of contraceptives along with the socio-demographic factors associated with the unmet needs for contraception. Methods: This cross-sectional study included eligible couples with married women in age group of 15-45 yr as the study population (n=267). Probability proportional to size sampling followed by systematic random sampling was used. A pre-tested questionnaire was administered to collect data from the respondents. Double data entry and validation of data was done. Results: Unmet need for contraception was 27.3 per cent (95% CI: 22.3-33); unmet need for spacing and limiting was 4.9 and 22.5 per cent, respectively. Among those with unmet need (n=73), 50 per cent reported client related factors (lack of knowledge, shyness, etc.); and 37 per cent reported contraception related factors (availability, accessibility, affordability, side effects) as a cause for unmet need. Interpretation & conclusions: Our study showed a high unmet need for contraception in the study area indicating towards a necessity to address user perspective to meet the contraception needs