Study of Pap smear and other feasible tests among self reported symptomatic married women in reproductive age group (15-49 yrs) regarding reproductive tract infections in a rural community of Maharashtra

Background: Reproductive tract infections (RTIs) represent a major public health problem in developing countries. Integrating RTIs/STIs management and early detection of cervical dysplasia in broader reproductive health services can improve women’s health. The objectives of the study were 1. To study the association of socio-demographic & reproductive factors among self-reported symptomatic women for reproductive tract infections. 2. To carry out clinical examination & feasible tests like PH, gram staining, VDRL for reproductive tract infections.  3. To study Pap smear among study subjects.Methods: A cross sectional study community based study was carried out in villages under ‘Parol’ Primary Health Centre of Thane district, Maharashtra, India. A total of 415 married women in reproductive age group were interviewed and examined. Pre-structured, pre-designed questionnaire was used. Clinical examination & feasible laboratory tests were done. Results were analyzed with the help of Microsoft Excel & SPSS 15.  Results: A total of 415 women were interviewed, of them 263(63.4%) had one or more symptoms of reproductive tract infections. On examination, 69(35%) had cervicitis and 30(15.2%) pelvic inflammatory disease, 39(19.8%) bacterial vaginosis and candidiasis in 61(31%). Cervical erosion was present in 147(74.6%) women. On Pap smear, 20(10.2%) women had ASCUS (Atypical squamous cells of undetermined significance). Only 2(1%) women found HIV positive. No woman was found VDRL reactive.Conclusion: Routine RTI/STI screening and periodic surveys to detect the infection patterns which will helps to control HIV infections in the community is needed in the remote tribal area as the current study shows high prevalence of reproductive tract infection.

Study on awareness and knowledge regarding Janani Suraksha Yojana (JSY) among ANC registered women in a primary health centre of tribal area of Thane District of Maharashtra

Background: In an attempt to make primary health care services available, especially, to the poorest and most vulnerable segments of rural & tribal society, JSY forms a crucial component of the NRHM. JSY is a safe motherhood intervention initiated to reduce maternal and neo-natal mortality and increasing institutional deliveries in them. Objective: 1) To assess awareness about Janani Suraksha Yojana (JSY) among ANC registered women. 2) To establish association of socio-demographic factors with awareness about Janani Suraksha Yojana (JSY).Methods: A cross sectional study was conducted in Primary Health Centre, Khardi of Thane district of Maharashtra during the period of Oct. 2010. A total of 110 ANC registered women were interviewed using pre-designed questionnaire. Results were analyzed by using SPSS version-15. Chi-square test was applied and p < 0.05 was considered as statistically significant. Results: More than half of the women (52.7%) were aware about this governmental scheme & only 17.24% of them were able to answer the correct name of the scheme. They obtained this knowledge mainly from the ANMs (58.6%), AWWs (22.4%) and ASHAs (17.2%). About 54.5% women had the knowledge about the components of JSY. Poor socioeconomic class, backward caste (SC/ST) & skilled/unskilled type of occupation were found to be significantly associated with the presence of knowledge about JSY. Conclusion: As the awareness and knowledge in our study group was less compared to other studies, there is a need to intensify the efforts to increase awareness and knowledge about JSY.

Frequency of fokI and taqI polymorphism of vitamin D receptor gene in Indian population and its association with 25-hydroxyvitamin D levels

Background: The VDR protein is at the centre of the vitamin D endocrine system, a complex physiological system with substantial feedback regulatory mechanisms involved in maintaining serum calcium and 1, 25 dihydroxy vitamin D3. Variations in VDR gene are shown to have implications in several diseases and have also been implicated as an important genetic factor affecting bone mass. Aim: To determine the frequency of Fok I and Taq I variants in healthy Indian individuals and its association with 25-OH-Vitamin D levels. Settings and Design: Blood samples were collected from 143 unrelated normal individuals (Male-84 and Female-59) and their genotypes determined. Materials and Methods: After amplification by polymerase chain reaction, each polymorphism was genotyped by restriction fragment length polymorphism. For 100 normal healthy individuals 25-hydroxyvitamin D estimation was done using DiaSorin kit method. Statistical Analysis: Graph pad software was used to calculate the P values from the Chi-square. Results: Out of 143 samples analyzed for FokI and TaqI polymorphisms the following genotypic frequency was obtained FF 59%, Ff 36%, ff 5% and TT 49%, Tt 43%, tt 8% respectively. Conclusions: Results indicate that the distribution of the polymorphic loci Fok I and Taq I vary considerably not only in different populations, but also within India. Furthermore, when the genotypes were analyzed with respect to 25-OH-Vitamin D levels, a significant association was seen for the Taq 1 SNP but not with the Fok I

Experiences of stigma and discrimination faced by family caregivers of people with schizophrenia in India.

Stigma associated with schizophrenia significantly affects family caregivers, yet few studies have examined the nature and determinants of family stigma and its relationship to their knowledge about the condition. This paper describes the experiences and determinants of stigma reported by the primary caregivers of people living with schizophrenia (PLS) in India. The study used mixed methods and was nested in a randomised controlled trial of community care for people with schizophrenia. Between November 2009 and October 2010, data on caregiver stigma and functional outcomes were collected from a sample of 282 PLS-caregiver dyads. In addition, 36 in-depth-interviews were conducted with caregivers. Quantitative findings indicate that 'high caregiver stigma' was reported by a significant minority of caregivers (21%) and that many felt uncomfortable to disclose their family member's condition (45%). Caregiver stigma was independently associated with higher levels of positive symptoms of schizophrenia, higher levels of disability, younger PLS age, household education at secondary school level and research site. Knowledge about schizophrenia was not associated with caregiver stigma. Qualitative data illustrate the various ways in which stigma affected the lives of family caregivers and reveal relevant links between caregiver-stigma related themes ('others finding out', 'negative reactions' and 'negative feelings and views about the self') and other themes in the data. Findings highlight the need for interventions that address both the needs of PLS and their family caregivers. Qualitative data also illustrate the complexities surrounding the relationship between knowledge and stigma and suggest that providing 'knowledge about schizophrenia' may influence the process of stigmatisation in both positive and negative ways. We posit that educational interventions need to consider context-specific factors when choosing anti-stigma-messages to be conveyed. Our findings suggest that messages such as 'recovery is possible' and 'no-one is to blame' may be more helpful than focusing on bio-medical knowledge alone

Experiences of stigma and discrimination of people with schizophrenia in India.

Stigma contributes greatly to the burden of schizophrenia and is a major obstacle to recovery, yet, little is known about the subjective experiences of those directly affected in low and middle income countries. This paper aims to describe the experiences of stigma and discrimination of people living with schizophrenia (PLS) in three sites in India and to identify factors influencing negative discrimination. The study used mixed methods and was nested in a randomised controlled trial of community care for schizophrenia. Between November 2009 and October 2010, data on four aspects of stigma experienced by PLS and several clinical variables were collected from 282 PLS and 282 caregivers and analysed using multivariate regression. In addition, in-depth-interviews with PLS and caregivers (36 each) were carried out and analysed using thematic analysis. Quantitative findings indicate that experiences of negative discrimination were reported less commonly (42%) than more internalised forms of stigma experience such as a sense of alienation (79%) and significantly less often than in studies carried out elsewhere. Experiences of negative discrimination were independently predicted by higher levels of positive symptoms of schizophrenia, lower levels of negative symptoms of schizophrenia, higher caregiver knowledge about symptomatology, lower PLS age and not having a source of drinking water in the home. Qualitative findings illustrate the major impact of stigma on 'what matters most' in the lives of PLS and highlight three key domains influencing the themes of 'negative reactions' and 'negative views and feelings about the self', i.e., 'others finding out', 'behaviours and manifestations of the illness' and 'reduced ability to meet role expectations'. Findings have implications for conceptualising and measuring stigma and add to the rationale for enhancing psycho-social interventions to support those facing discrimination. Findings also highlight the importance of addressing public stigma and achieving higher level social and political structural change

Challenges with the use of Xpert HPV as a screening tool for oral HPV among people living with HIV (PLHIV): experiences from Pune, India

Abstract Background People living with HIV (PLHIV) are at higher risk for human papillomavirus (HPV)-related oropharyngeal cancers compared to the general population. Xpert HPV test is a polymerase chain reaction (PCR) assay capable of rapid HPV detection. Performing the assay requires minimal intervention by laboratory personnel. Its use could improve oropharyngeal cancer screening among PLHIV living in low-and middle-income countries (LMICs) with limited diagnostic capacities. However, Xpert HPV performance for oral samples has not been evaluated. Here, we describe our experience with Xpert HPV and compare its results with traditional PCR, for oral samples. Methods Oral samples from 429 PLHIV receiving care at a tertiary care hospital affiliated antiretroviral therapy center in Pune, India were used. Samples were collected either after a 30s oral rinse and gargle (n = 335) or in combination with cytobrush scraping of the oral mucosa (n = 91). Unsuccessful tests were those that generated an invalid or error result on Xpert HPV. Successful tests were those that generated a positive or negative result. Kappa statistic was used to compare concordance between Xpert HPV and traditional real-time PCR results. Results There were 29.8% (n = 127) unsuccessful tests, of which 78.7% (n = 100) were invalid and 21.3% (n = 27) were error results. Adding cytobrush scraping to oral rinse as a collection procedure did not significantly reduce the proportion of unsuccessful tests (p = 0.9). For successful tests, HPV positivity on Xpert was 0.3% (n = 1/299). Kappa statistic was 0.11, indicating poor agreement between Xpert HPV and traditional PCR results. Conclusions Presently, Xpert HPV appears to have limited use for oral HPV detection among PLHIV using oral samples. More research to improve the diagnostic capabilities of Xpert HPV for oral samples among PLHIV is needed