The PROMISES study: A mixed methods approach to explore the acceptability of salivary progesterone testing for preterm birth risk among pregnant women and trained frontline healthcare workers in rural India

Introduction India has an overall neonatal mortality rate of 28/1000 live births, with higher rates in rural India. Approximately 3.5 million pregnancies in India are affected by preterm birth (PTB) annually and contribute to approximately a quarter of PTBs globally. Embedded within the PROMISES study (which aims to validate a low-cost salivary progesterone test for early detection of PTB risk), we present a mixed methods explanatory sequential feasibility substudy of the salivary progesterone test. Methods A pretraining and post-training questionnaire to assess Accredited Social Health Activists (ASHAs) (n=201) knowledge and experience of PTB and salivary progesterone sampling was analysed using the McNemar test. Descriptive statistics for a cross-sectional survey of pregnant women (n=400) are presented in which the acceptability of this test for pregnant women is assessed. Structured interviews were undertaken with ASHAs (n=10) and pregnant women (n=9), and were analysed using thematic framework analysis to explore the barriers and facilitators influencing the use of this test in rural India. Results Before training, ASHAs' knowledge of PTB (including risk factors, causes, postnatal support and testing) was very limited. After the training programme, there was a significant improvement in the ASHAs' knowledge of PTB. All 400 women reported the salivary test was acceptable with the majority finding it easy but not quick or better than drawing blood. For the qualitative aspects of the study, analysis of interview data with ASHAs and women, our thematic framework comprised of three main areas: implementation of intervention; networks of influence and access to healthcare. Qualitative data were stratified and presented as barriers and facilitators. Conclusion This study suggests support for ongoing investigations validating PTB testing using salivary progesterone in rural settings

Evaluation of preventive effect of <em>Brugia malayi</em> recombinant cystatin on mBSA-induced experimental arthritis

655-660Epidemiological and experimental studies have demonstrated the therapeutic efficacy of the helminths derived immunomodulatory molecules. In this study, we investigated the preventive effect of Brugia malayi recombinant cystatin (rBmCys) in methylated bovine serum albumin (mBSA)-induced arthritis. Mastomys coucha rats were treated with 4 doses of rBmCys (intraperitoneal) in alum adjuvant (25 µg/dose/200 µL) in intervals of 15 days. Control rats received alum only. mBSA-arthritis induction was done 10 days after the last dose of rBmCys/alum. Rats were sacrificed when all the rats in mBSA group developed arthritis. Administration of rBmCys significantly (P=0.0005) protected rats from arthritis by reducing paw swelling and arthritic index. In rBmCys treated rats, histopathology of hind paw joints showed decreased synovitis, bone erosion, fibrosis and influx of inflammatory cells. This protective effect was found to be associated with significantly (P BmCys can benefit in rheumatoid arthritis prevention