Informing primi and elderly pregnant women about iron sucrose administration for moderate anemia can improve treatment compliance in public health facilities, Kancheepuram health district, Tamil Nadu, India, 2017: A cross-sectional study

Introduction: Tamil Nadu administers intravenous iron sucrose for correcting moderate anaemia among pregnant women (Haemoglobin level 7–8.9 g/dl) based on preliminary studies. We did a cross-sectional study to estimate compliance level and that of factors associated with intravenous iron sucrose treatment for moderate anaemia among pregnant women attending health facilities of Kancheepuram health district, Tamil Nadu, India, 2017. Methods: We needed five pregnant women of 20–30 weeks from 70 clusters (health subcentres) for the assumptions of 64% compliance, 7% absolute precision, 95% Confidence Interval (CI) and a design effect of two. We collected data on knowledge and experience with iron sucrose treatment and reasons for non-compliance. We abstracted haemoglobin levels and administered doses from records. We computed compliance level (%) with 95% CI and estimated adjusted odds ratio (AOR) for non-compliance through logistic regression analysis. Results: The median age of 350 women was 24 years (Range = 22 to 26). Compliance level to intravenous iron sucrose was 79% (95% CI: 73 to 84). Non-compliance was more likely among women aged 25–35 years (AOR: 2.1, 95% CI: 1.2 to 3.7), primi (AOR: 2.2’ 95% CI: 1.2 to 3.8) and not received treatment information (AOR: 3.1, 95% CI: 1.1 to 8.8). Major reasons for non-compliance were lack of information about treatment, belief that food was better than injections and that injections could harm the baby. Conclusions: The compliance to intravenous iron sucrose was insufficient. Providing clear information about intravenous iron sucrose to moderately anaemic pregnant women could increase the compliance to intravenous iron sucrose

Outbreak of acute diarrhoeal disease attributed to consumption of faecal contaminated water supplied through damaged pipelines in Thiruper, Tiruvallur district, Tamil Nadu, India, 2016

Background: On December 24, 2016, 18 Acute Diarrhoeal Disease (ADD) cases were reported in Thiruper village. We aimed to identify potential exposure and propose recommendations. Methods: We defined a case of ADD as occurrence loose stools (≥3 episodes), December 14–30, 2016. We did door-to-door case search, calculated attack rate by age and gender, drew epidemic curve and plotted cases by residence. We conducted a matched case-control study and computed Matched Odds ratio (MOR), 95% confidence interval (95% CI) and Population Attributable Risk (PAR). We collected stool and water specimens for laboratory testing. Results: We identified 38 (6%) cases among 625 residents. The attack rate of ADD was higher among aged <5 years (16.5%), and female (6.8%). The outbreak lasted between 14–27 December 2016 with multiple peaks. Cases clustered in areas receiving water from damaged pipelines crossing open-defecation area. We compared 38 ADD cases with 76 age, gender and neighbourhood matched controls for different exposures. Consuming water supplied through the damaged subterranean pipeline (MOR = 3.7; 95% CI = 1.1 to 16.4; PAR = 72%) was associated with ADD. The environmental investigation pointed out potential faecal contamination of water through damaged subterranean pipelines near open-air defaecation area of village. The collected stool specimens were negative for pathogens, and water specimens tested positive for Escherichia coli. Conclusions: We confirmed that the outbreak of ADD in Thiruper village was due to consumption of water contaminated with E. coli supplied through damaged subterranean pipelines post-cyclone. We recommended the replacement of subterranean pipelines and distribution of chlorinated water