Knowledge, Attitude and Practice of Mothers regarding Diarrhoeal Illness in Children under Five Years of Age: A Cross Sectional Study in an Urban Slum of Delhi, India

Diarrhoea is one of the lead killers of children worldwide. This study was done with an aim to determine the knowledge, attitude and practice regarding diarrhoeal illness, its prevention and management in mothers of under- five children. A descriptive cross- sectional study; 125 mothers were randomly selected from an urban slum of Delhi and were interviewed using a structured questionnaire. 96% mothers defined diarrhoea appropriately. Most common perceived causes of diarrhoea were contaminated food and drinking water (80%). Though 83% mothers believed that clean drinking water prevents diarrhoea, yet water treatment was practiced by only 36%. Most mothers believed in (90%) and practiced (88%) hand washing with soap post-defecation to prevent diarrhoea. While only 31% had knowledge on importance of use of latrine, fewer (19%) accepted that safe disposal of stool was very important and just 58% reported practicing it. Less than a third of the mothers recognized critical signs of dehydration. 79% mothers recognized importance of increased fluid requirement and 70% practiced it for management of diarrhoea. Though 76% mothers used ORS, only 26% considered it as the mainstay treatment of diarrhoea. Also, 42% mothers had incomplete knowledge regarding proper preparation of ORS. Though only 22% were aware of the role of breastfeeding in prevention of diarrhoea, a positive attitude towards (74%) and healthier practice (90%) of exclusive breast-feeding was observed. Thus, we conclude that though the community knowledge, attitude and practices on diarrhoeal illness and its prevention is marginally satisfactory, the poor knowledge regarding signs of dehydration and relevance of ORS as primary management component is a matter of concern for child survival

Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffarpur, India, 2014: a case-control study

Background Outbreaks of unexplained illness frequently remain under-investigated. In India, outbreaks of an acute neurological illness with high mortality among children occur annually in Muzaffarpur, the country’s largest litchi cultivation region. In 2014, we aimed to investigate the cause and risk factors for this illness. Methods In this hospital-based surveillance and nested age-matched case-control study, we did laboratory investigations to assess potential infectious and non-infectious causes of this acute neurological illness. Cases were children aged 15 years or younger who were admitted to two hospitals in Muzaffarpur with new-onset seizures or altered sensorium. Age-matched controls were residents of Muzaffarpur who were admitted to the same two hospitals for a non-neurologic illness within seven days of the date of admission of the case. Clinical specimens (blood, cerebrospinal fluid, and urine) and environmental specimens (litchis) were tested for evidence of infectious pathogens, pesticides, toxic metals, and other non-infectious causes, including presence of hypoglycin A or methylenecyclopropylglycine (MCPG), naturally-occurring fruit-based toxins that cause hypoglycaemia and metabolic derangement. Matched and unmatched (controlling for age) bivariate analyses were done and risk factors for illness were expressed as matched odds ratios and odds ratios (unmatched analyses). Findings Between May 26, and July 17, 2014, 390 patients meeting the case definition were admitted to the two referral hospitals in Muzaffarpur, of whom 122 (31%) died. On admission, 204 (62%) of 327 had blood glucose concentration of 70 mg/dL or less. 104 cases were compared with 104 age-matched hospital controls. Litchi consumption (matched odds ratio [mOR] 9·6 [95% CI 3·6 – 24]) and absence of an evening meal (2·2 [1·2–4·3]) in the 24 h preceding illness onset were associated with illness. The absence of an evening meal significantly modified the effect of eating litchis on illness (odds ratio [OR] 7·8 [95% CI 3·3–18·8], without evening meal; OR 3·6 [1·1–11·1] with an evening meal). Tests for infectious agents and pesticides were negative. Metabolites of hypoglycin A, MCPG, or both were detected in 48 [66%] of 73 urine specimens from case-patients and none from 15 controls; 72 (90%) of 80 case-patient specimens had abnormal plasma acylcarnitine profiles, consistent with severe disruption of fatty acid metabolism. In 36 litchi arils tested from Muzaffarpur, hypoglycin A concentrations ranged from 12·4 μg/g to 152·0 μg/g and MCPG ranged from 44·9 μg/g to 220·0 μg/g. Interpretation Our investigation suggests an outbreak of acute encephalopathy in Muzaffarpur associated with both hypoglycin A and MCPG toxicity. To prevent illness and reduce mortality in the region, we recommended minimising litchi consumption, ensuring receipt of an evening meal and implementing rapid glucose correction for suspected illness. A comprehensive investigative approach in Muzaffarpur led to timely public health recommendations, underscoring the importance of using systematic methods in other unexplained illness outbreaks

Prevalence of Soil-Transmitted Helminthic Infection in India in Current Scenario: A Systematic Review

Introduction: The intestinal nematodes infestation in tropical and sub-tropical countries is mostly attributed to roundworms, hookworms and whipworms. India is one of the largest contributors to the global burden of soil-transmitted helminthes (STH) with a national population prevalence estimated to be 21% by Global Atlas of Helminth Infections (GAHI), as per data prior to 2007.Objective: We aimed to perform a systematic review of available studies on prevalence of soil-transmitted helminthic infections, namely Ascaris lumbricoides (AL), Ancylostoma duodenale (AD) and Trichuris trichiura (TT) in India for the period 2008 to 2015.Materials and Methods: Online databases and printed material were searched using keywords on soil-transmitted helminths.Results: 18 articles were included in the study. The overall prevalence of STH was in range 7.56 to 78.27%. The prevalence of AL, AD and TT in these studies was in range between 0.4 to 71.87%, 0.14 to 42% and 0.3 to 29.57%, respectively. Most studies 17 (94.4%) revealed polytypic infection. All except the western region states had higher prevalence. Most studies employed WHO-recommended Kato-Katz technique. Conclusion: The prevalence of STH continues to be high in this country and requires systemic implementation of STH control activities to reduce the intestinal helminthic burden

COVID-19 Pandemic: What Can We Learn for Better Air Quality and Human Health?

The COVID-19 lockdown resulted in improved air quality in many cities across the world. With the objective of what could be the new learning from the COVID-19 pandemic and subsequent lockdowns for better air quality and human health, a critical synthesis of the available evidence concerning air pollution reduction, the population at risk and natural versus anthropogenic emissions was conducted. Can the new societal norms adopted during pandemics, such as the use of face cover, awareness regarding respiratory hand hygiene, and physical distancing, help in reducing disease burden in the future? The use of masks will be more socially acceptable during the high air pollution episodes in lower and middle-income countries, which could help to reduce air pollution exposure. Although post-pandemic, some air pollution reduction strategies may be affected, such as car-pooling and the use of mass transit systems for commuting to avoid exposure to airborne infections like coronavirus. However, promoting non-motorized modes of transportation such as cycling and walking within cities as currently being enabled in Europe and other countries could overshadow such losses. This demand focus on increasing walkability in a town for all ages and populations, including for a differently-abled community. The study highlighted that for better health and sustainability there. is also a need to promote other measures such as work-from-home, technological infrastructure, the extension of smart cities, and the use of information technology

Vibrio Cholerae Outbreak in Batala Town, Punjab, India 2012

Background: On 4th October 2012, a death due to ADD was reported at Civil Hospital Batala, Punjab followed by a sudden rise in the number of cases. We sought to establish the cause and source of infection.Methods: A case was defined as a person who had three or more loose stools with or without vomiting per day between 4th October to 8th November 2012 from Gandhi Nagar Camp and adjoining colonies. To ascertain cases, a house to house survey was conducted in the affected area. Water specimens from households were tested for potability and stool culture was performed to identify the causative agent.Results: A total of 834 cases and 33 deaths were identified from a population of 24,765 {attack rate (AR): 3.4%, case fatality ratio (CFR): 4%}.The AR was significantly higher among females (n=440) compared to males (n=394; p54 years old among both sexes. The most affected area was Gandhi-Nagar (AR- 6.6%). Vibrio cholerae O1 Ogawa was identified in 8/35 stool samples. 12/23 water samples demonstrated fecal contamination.Conclusions: Identification of broken drinking water supply pipeline which resulted in fecal contamination prompted public health action to repair the water pipe and helped in controlling further occurrence of cases

Kyasanur Forest Disease Outbreak and Vaccination Strategy, Shimoga District, India, 2013–2014

We investigated a Kyasanur Forest disease outbreak in Karnataka, India during December 2013–April 2014. Surveillance and retrospective study indicated low vaccine coverage, low vaccine effectiveness, and spread of disease to areas beyond those selected for vaccination and to age groups not targeted for vaccination. To control disease, vaccination strategies need to be reviewed

Jaundice outbreak likely caused by HEV in Amritsar, Punjab, India, 2013

Abstract Background Hepatitis-E Virus (HEV) infection is endemic in Punjab, India. On 4th April 2013, public officials of Labour Colony, Amritsar reported > 20 jaundice cases occurring within several days. Methods We performed a case-control study to identify the cause and prevent additional cases of jaundice cases in Amritsar, Punjab, India in 2013. Results A total of 159 cases (attack rate 3.6%) and 1 death were identified in Labour and 5 adjoining colonies from January 1 to June 5, 2013. Persons with jaundice were more likely to report foul-smelling piped water (adjusted odds ratio [AOR], 4.0, 95% confidence interval [CI], 2.2–7.2) and used piped water for drinking (AOR, 5.1; 95% CI, 2.2–11.4) than persons without jaundice. Among 14 cases tested, all had anti-hepatitis E virus IgM, and none had anti-hepatitis A virus IgM. Additionally, 21/23 tap water samples from affected households had detectable fecal coliforms. An environmental investigation found that water pipelines were damaged during sewer construction and likely led to contamination of drinking water with hepatitis E virus. Conclusions Hepatitis E outbreaks are common in India, to curb future outbreaks of hepatitis E; measures to ensure safe drinking water are urgently needed