Utilization of services under Janani Shishu Suraksha Karyakram for institutional deliveries in the public sector facilities, Sirmaur District, Himachal Pradesh, India

Background: Janani Shishu Suraksha Karyakram (JSSK) was initiated in 2011 to reduce the out of pocket expenditure for pregnant women. We estimated the proportion of mothers who received JSSK benefits and out of pocket expenditure (OOP) if any in Sirmaur, Himachal Pradesh. Materials and Methods: We did cross sectional survey in public sector facilities among 156 consecutive mothers using structured questionnaire. We computed the proportion of mother who received the benefits and the median OOP expenditure. Results: Among 156 mothers surveyed, 93 (60%) received the full benefits during hospital stay and 29 (19%) received full transport benefits. Free diagnostics and drugs were given to 149 (96%) and 134 (86%) respectively. Overall, 63 (40%) had median OOP Rs 210 during hospitalization and 127 (81%) had median OOP of Rs 420 during transport. Conclusion: JSSK benefitted the mothers utilizing the public sector facilities however drugs, consumables and transport contributed to the OOP expenditure

Measles Case Fatality Rate in Bihar, India, 2011–12

<div><p>Background</p><p>Updated estimates of measles case fatality rates (CFR) are critical for monitoring progress towards measles elimination goals. India accounted for 36% of total measles deaths occurred globally in 2011. We conducted a retrospective cohort study to estimate measles CFR and identify the risk factors for measles death in Bihar–one of the north Indian states historically known for its low vaccination coverage.</p><p>Methods</p><p>We systematically selected 16 of the 31 laboratory-confirmed measles outbreaks occurring in Bihar during 1 October 2011 to 30 April 2012. All households of the villages/urban localities affected by these outbreaks were visited to identify measles cases and deaths. We calculated CFR and used multivariate analysis to identify risk factors for measles death.</p><p>Results</p><p>The survey found 3670 measles cases and 28 deaths (CFR: 0.78, 95% confidence interval: 0.47–1.30). CFR was higher among under-five children (1.22%) and children belonging to scheduled castes/tribes (SC/ST, 1.72%). On multivariate analysis, independent risk factors associated with measles death were age <5 years, SC/ST status and non-administration of vitamin A during illness. Outbreaks with longer interval between the occurrence of first case and notification of the outbreak also had a higher rate of deaths.</p><p>Conclusions</p><p>Measles CFR in Bihar was low. To further reduce case fatality, health authorities need to ensure that SC/ST are targeted by the immunization programme and that outbreak investigations target for vitamin A treatment of cases in high risk groups such as SC/ST and young children and ensure regular visits by health-workers in affected villages to administer vitamin A to new cases.</p></div

Flowchart showing measles case ascertainment, Bihar, India, 2011–12.

<p>Flowchart showing measles case ascertainment, Bihar, India, 2011–12.</p

Measles case fatality rate by selected variables, in 16 outbreaks, Bihar, India, October 2011 to April 2012.

<p>*MCV1 status of 455 (12.4%) of children was unknown, **Vitamin A administration status of 179 (4.9%) children was unknown.</p

Laboratory confirmed measles outbreaks detected during October 2011 and April 2012 and sampling details.

<p>*One serum sample from an outbreak in Banka and another sample from an outbreak in Supaul were positive for IgM antibodies against rubella.</p

Measles case fatality rate among SC/ST and G/OBC cases stratified by age group and vitamin A administration, Bihar, India.

<p>Measles case fatality rate among SC/ST and G/OBC cases stratified by age group and vitamin A administration, Bihar, India.</p

Effectiveness of the ChAdOx1 nCoV-19 Coronavirus Vaccine (CovishieldTM) in Preventing SARS-CoV2 Infection, Chennai, Tamil Nadu, India, 2021

We estimated the effectiveness of two doses of the ChAdOx1 nCoV-19 (Covishield) vaccine against any COVID-19 infection among individuals &ge;45 years in Chennai, Tamil Nadu, India. A community-based cohort study was conducted from May to September 2021 in a selected geographic area in Chennai. The estimated sample size was 10,232. We enrolled 69,435 individuals, of which 21,793 were above 45 years. Two-dose coverage of Covishield in the 18+ and 45+ age group was 18% and 31%, respectively. Genomic analysis of 74 out of the 90 aliquots collected from the 303 COVID-19-positive individuals in the 45+ age group showed delta variants and their sub-lineages. The vaccine&rsquo;s effectiveness against COVID-19 disease in the &ge;45 age group was 61.3% (95% CI: 43.6&ndash;73.4) at least 2 weeks after receiving the second dose of Covishield. We demonstrated the effectiveness of two doses of the ChAdOx1 vaccine against the delta variant in the general population of Chennai. We recommend similar future studies considering emerging variants and newer vaccines. Two-dose vaccine coverage could be ensured to protect against COVID-19 infection