Size estimation of injecting drug users (IDU) using multiplier method in five Districts of India

The HIV epidemic in Manipur, the highest HIV prevalence state of India, is primarily driven by injecting drug use. Reliable estimate of population size of injecting drug users (IDU) is critical for aiding HIV prevention program in the state to combat drug driven HIV epidemic. The study described multiplier method, an indirect technique of estimation of IDU size in five districts of Manipur, India making use of existing records of rapid intervention and care (RIAC) programs. Number of IDUs who accessed RIAC services during the past 12 months was taken as the benchmark data for the size estimation. The benchmark data were then multiplied by the inverse of the proportion of the IDUs who reported having accessed RIAC services during the same period to derive the sizes of IDU population in each study districts. The estimated sizes of IDU population in five districts were: 7353 (95% CI: 6759-8123) in Imphal West, 5806 (95% CI: 5635-6054) in Imphal East, 3816 (95% CI: 3571-4139) in Thoubal, 2615 (95% CI: 2528-2731) in Churachandpur and 2137 (95% CI: 1979-2343) in Bishenpur district. Multiplier method seems to be a feasible indirect technique which can be applied to estimate of IDU population using existing data from intervention programs in settings like Manipur where reliable size estimation of IDU population is lacking

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

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

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

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

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