Impact of targeted interventions on heterosexual transmission of HIV in India

<p>Abstract</p> <p>Background</p> <p>Targeted interventions (TIs) have been a major strategy for HIV prevention in India. We evaluated the impact of TIs on HIV prevalence in high HIV prevalence southern states (Tamil Nadu, Karnataka, Andhra Pradesh and Maharashtra).</p> <p>Methods</p> <p>A quasi-experimental approach was used to retrospectively compare changes in HIV prevalence according to the intensity of targeted intervention implementation. Condom gap (number of condoms required minus condoms supplied by TIs) was used as an indicator of TI intensity. Annual average number of commercial sex acts per female sex worker (FSW) reported in Behavioral Surveillance Survey was multiplied by the estimated number of FSWs in each district to calculate annual requirement of condoms in the district. Data of condoms supplied by TIs from 1995 to 2008 was obtained from program records. Districts in each state were ranked into quartiles based on the TI intensity. Primary data of HIV Sentinel Surveillance was analyzed to calculate HIV prevalence reductions in each successive year taking 2001 as reference year according to the quartiles of TI intensity districts using generalized linear model with logit link and binomial distribution after adjusting for age, education, and place of residence (urban or rural).</p> <p>Results</p> <p>In the high HIV prevalence southern states, the number of TI projects for FSWs increased from 5 to 310 between 1995 and 2008. In high TI intensity quartile districts (n = 30), 186 condoms per FSW/year were distributed through TIs as compared to 45 condoms/FSW/year in the low TI intensity districts (n = 29). Behavioral surveillance indicated significant rise in condom use from 2001 to 2009. Among FSWs consistent condom use with last paying clients increased from 58.6% to 83.7% (p < 0.001), and among men of reproductive age, the condom use during sex with non-regular partner increased from 51.7% to 68.6% (p < 0.001). A significant decline in HIV and syphilis prevalence has occurred in high prevalence southern states among FSWs and young antenatal women. Among young (15-24 years) antenatal clinic attendees significant decline was observed in HIV prevalence from 2001 to 2008 (OR = 0.42, 95% CI 0.28-0.62) in high TI intensity districts whereas in low TI intensity districts the change was not significant (OR = 1.01, 95% CI 0.67-1.5).</p> <p>Conclusion</p> <p>Targeted interventions are associated with HIV prevalence decline.</p

Household, community, sub-national and country-level predictors of primary cooking fuel switching in nine countries from the PURE study

Introduction. Switchingfrom polluting (e.g. wood, crop waste, coal)to clean (e.g. gas, electricity) cooking fuels can reduce household air pollution exposures and climate-forcing emissions.While studies have evaluated specific interventions and assessed fuel-switching in repeated cross-sectional surveys, the role of different multilevel factors in household fuel switching, outside of interventions and across diverse community settings, is not well understood. Methods.We examined longitudinal survey data from 24 172 households in 177 rural communities across nine countries within the Prospective Urban and Rural Epidemiology study.We assessed household-level primary cooking fuel switching during a median of 10 years offollow up (∼2005–2015).We used hierarchical logistic regression models to examine the relative importance of household, community, sub-national and national-level factors contributing to primary fuel switching. Results. One-half of study households(12 369)reported changing their primary cookingfuels between baseline andfollow up surveys. Of these, 61% (7582) switchedfrom polluting (wood, dung, agricultural waste, charcoal, coal, kerosene)to clean (gas, electricity)fuels, 26% (3109)switched between different polluting fuels, 10% (1164)switched from clean to polluting fuels and 3% (522)switched between different clean fuels

A cross sectional study on internet usage for health information among 18- 49 years in urban Chandigarh

Background: Internet use for health information has increased over the years. However, how people use internet for health needs to be explored. Aims & Objectives: Our study aim was to determine the proportion of people who use internet for health information in the age group of 18-49 years in urban Chandigarh, to document the type of health information sought from Internet, and its association with socio-demographic variables. Material & Methods: Community based cross sectional study was carried out with multistage sampling using simple random and systematic random sampling. Data was collected using pretested semi-structured interview schedule. Results: Out of 262, 60.6 % of participants used the internet for health information. Availability of broadband connection at home and gender were significantly associated (p<0.05) with use of the internet for health information. Conclusion: Internet use for health information could have significant potential, particularly in terms of the general public decision-making and autonomy as has been reflected in the results of the present study. The Internet has become an important tool with the potential to improve information dissemination and health care delivery to consumers

Estimating mortality using data from civil registration: a cross-sectional study in India

Objective To analyse the design and operational status of India’s civil registration and vital statistics system and facilitate the system’s development into an accurate and reliable source of mortality data. Methods We assessed the national civil registration and vital statistics system’s legal framework, administrative structure and design through document review. We did a cross-sectional study for the year 2013 at national level and in Punjab state to assess the quality of the system’s mortality data through analyses of life tables and investigation of the completeness of death registration and the proportion of deaths assigned ill-defined causes. We interviewed registrars, medical officers and coders in Punjab state to assess their knowledge and practice. Findings Although we found the legal framework and system design to be appropriate, data collection was based on complex intersectoral collaborations at state and local level and the collected data were found to be of poor quality. The registration data were inadequate for a robust estimate of mortality at national level. A medically certified cause of death was only recorded for 965 992 (16.8%) of the 5 735 082 deaths registered. Conclusion The data recorded by India’s civil registration and vital statistics system in 2011 were incomplete. If improved, the system could be used to reliably estimate mortality. We recommend improving political support and intersectoral coordination, capacity building, computerization and state-level initiatives to ensure that every death is registered and that reliable causes of death are recorded – at least within an adequate sample of registration units within each state

Association between Social Capital and Self-rated Health of Older People in Chandigarh, India

Background: Social capital reflect the degree of social cohesion in communities. Although studies have shown that social capital influences health, there is limited understanding about the role of social capital on physical and mental health of older people in India.  Aims & Objectives: To assess the association between social capital and self-rated health among older people. Material &Methods: A cross-sectional study was conducted among 211 older people selected from 1563 households in urban and rural Chandigarh District. Standardized tools were used to measure social capital (Global Social Capital Survey) and self-rated health (SF-36). The association between social capital and physical and mental health dimensions of self-rated health was analyzed using multiple linear regression. Results: Participants’ mean age was 68.1 years (SD 7.6); about half were women. The mean total social capital score was 45.5 (SD 11.9). The mean physical and mental health dimensions of self-rated health scores were 1027.7 (SD 252.5) and 1416.9 (SD 487.7), respectively. Social capital was found to be a significant predictor of mental health dimension of self-rated health. Age and gender were found to be significant predictors of physical health dimension of self-rated health. Conclusion: Social capital influences mental health of older people. Interventions to improve social capital, in terms of strengthening relationships with family members and other social networks, can contribute to improving mental health of older people

Association between Social Capital and Self-rated Health of Older People in Chandigarh, India

Background: Social capital reflect the degree of social cohesion in communities. Although studies have shown that social capital influences health, there is limited understanding about the role of social capital on physical and mental health of older people in India. &nbsp;Aims &amp; Objectives: To assess the association between social capital and self-rated health among older people.&nbsp;Material &amp;Methods: A cross-sectional study was conducted among 211 older people selected from 1563 households in urban and rural Chandigarh District. Standardized tools were used to measure social capital (Global Social Capital Survey) and self-rated health (SF-36). The association between social capital and physical and mental health dimensions of self-rated health was analyzed using multiple linear regression.&nbsp;Results: Participants’ mean age was 68.1 years (SD 7.6); about half were women. The mean total social capital score was 45.5 (SD 11.9). The mean physical and mental health dimensions of self-rated health scores were 1027.7 (SD 252.5) and 1416.9 (SD 487.7), respectively. Social capital was found to be a significant predictor of mental health dimension of self-rated health. Age and gender were found to be significant predictors of physical health dimension of self-rated health.&nbsp;Conclusion: Social capital influences mental health of older people. Interventions to improve social capital, in terms of strengthening relationships with family members and other social networks, can contribute to improving mental health of older people