The number of privately treated tuberculosis cases in India: an estimation from drug sales data

Background Understanding the amount of tuberculosis managed by the private sector in India is crucial to understanding the true burden of the disease in the country, and thus globally. In the absence of quality surveillance data on privately treated patients, commercial drug sales data offer an empirical foundation for disease burden estimation. Methods We used a large, nationally representative commercial dataset on sales of 189 anti-tuberculosis products available in India to calculate the amount of anti-tuberculosis treatment in the private sector in 2013–14. We corrected estimates using validation studies that audited prescriptions against tuberculosis diagnosis, and estimated uncertainty using Monte Carlo simulation. To address implications for numbers of patients with tuberculosis, we explored varying assumptions for average duration of tuberculosis treatment and accuracy of private diagnosis. Findings There were 17·793 million patient-months (95% credible interval 16·709 million to 19·841 million) of anti-tuberculosis treatment in the private sector in 2014, twice as many as the public sector. If 40–60% of private-sector tuberculosis diagnoses are correct, and if private-sector tuberculosis treatment lasts on average 2–6 months, this implies that 1·19–5·34 million tuberculosis cases were treated in the private sector in 2014 alone. The midpoint of these ranges yields an estimate of 2·2 million cases, two to three times higher than currently assumed. Interpretation India's private sector is treating an enormous number of patients for tuberculosis, appreciably higher than has been previously recognised. Accordingly, there is a re-doubled need to address this burden and to strengthen surveillance. Tuberculosis burden estimates in India and worldwide require revision

Proximity to healthcare centres and service use: The case of Community Clinics in Bangladesh

CAUL read and publish agreement 2023fals

Mountain-Shaped Coupler for Ultra Wideband Applications

This paper demonstrates a novel mountain-shaped design for a compact 3-dB coupler operating at ultra-wideband (UWB) frequencies from 3.1GHz to 10.6 GHz. The proposed design was accomplished using multilayer technology in which the structure is formed by three layers of conductors interleaved by a layer of substrate between each conductor layer. Simulation was carried out using CST Microwave Studio; the result was then compared with results from rectangular and star-shaped couplers that implemented the same technique. The results obtained show that the proposed new coupler has better performance compared to both rectangular and star-shaped coupler designs in terms of return loss, isolation, and phase difference. The coupler was fabricated and measured; the measurement results satisfactorily agree with the simulation results

Practices and effects of menstrual hygiene management in rural Bangladesh

This study explored the existing practices on menstrual hygiene management of the girls and women in rural Bangladesh. It has also depicted the associated effects against existing practices linking with school attendance, performance, affordability of menstrual products etc. The results of the study are retrieved using both quantitative and qualitative research methods i.e. questionnaire survey, focus group discussion, key informant interviews etc. Study revalued that 91% school girls use old unhygienic cloths while 9% use improved products. Above 90% girls dispose pads un-hygienically which is not environment friendly. Among the girls, 48% miss 3 or more days causing bad performance on their results. And, 86% girls reported that improved menstrual items are not affordable for them. Improper menstrual management is identified a barrier of women empowerment. For a way forward, integrating menstrual hygiene management interventions with relevant development programmes are recommended to improve the exiting state

A multimedia data visualization based on Ad Hoc communication networks and its application to disaster management

After massive earthquakes and other large-scale disasters, existing communication infrastructure may become unavailable and, therefore, it can be quite difficult for relief organizations to fully grasp the impact of the disaster on the affected region. Consequently, this will be the cause of delays to offer the strategic assistance, and to provide water and food, etc. In order to solve the problem of re-establishing communication infrastructure to allow for information gathering, we developed an ad hoc mobile communications network for disaster-struck areas using ZigBee. As the communication speed of ZigBee is low, we propose a problem-specific image compression method for the multimedia data visualization. By using the proposed method combined with GPS information, it is possible to quickly grasp the damage situation in the region. Through our communication experiments in Tsukuba City, Japan we confirm the effectiveness of our system as a disaster information gathering and management system

Epidemiology and outcome of sepsis in adult patients with Streptococcus pneumoniae infection in a Norwegian county 1993–2011: an observational study

90-day mortality in relation to patient characteristics prior to infection. Table S1a. 90-day mortality in relation to gender. Table S2. 90-day mortality in relation to disease acquisition, severity, focus and time period. (DOCX 22 kb

Carotid intimal medial thickness in children with celiac disease

Introduction: Increasing cardiovascular risk in celiac disease (CD) may be attributed to the chronic systemic inflammation and unfavorable biochemical profile leading to accelerated atherosclerosis. Carotid intimal medial thickness (CIMT) has emerged as a direct marker of the early atherosclerosis as compared to traditional biochemical markers. Objectives: The aim of this study was to evaluate the CIMT in children with CD aged 1–16 years. Materials and Methods: A cross-sectional observational study was conducted at the department of Pediatrics and Radio Diagnosis in a tertiary care hospital of New Delhi. Thirty-six children with CD with age- and sex-matched controls were enrolled. CIMT for the anterior and posterior walls on each side was measured, and the mean CIMT was obtained for all the enrolled children. Results: The mean right-sided CIMT was significantly higher in cases (0.053±0.009 cm vs. 0.039±0.007 cm, p=0.000). The mean left-sided CIMT did not significantly differ between the groups (0.051±0.009 cm vs. 0.048±0.055 cm, p=0.702). The mean CIMT (right and left together), although higher in Celiacs, was not significantly different from controls (0.052±0.008 cm and 0.044±0.029 cm, p=0.114). However, a significant positive correlation between the age of the patients, age at the onset of symptoms, and CIMT was noted. Conclusion: Although we could not demonstrate statistically significant results, the mean CIMT and the right-sided measurements were significantly higher in cases than in controls

Epidemiology of harmful use of alcohol in Nigeria: a systematic review and meta-analysis

Background: Nigeria, the most populous country in Africa, has reported relatively high levels of alcohol misuse, yet limited resources to guide effective population-wide response. There is a need to integrate existing empirical information in order to increase the power and precision of estimating epidemiological evidence necessary for informing policies and developing prevention programs. Objectives: We aimed to estimate nationwide and zonal prevalence of harmful use of alcohol in Nigeria to inform public health policy and planning. Methods: Epidemiologic reports on alcohol use in Nigeria from 1990 through 2018 were systematically searched and abstracted. We employed random-effects meta-analysis and meta-regression model to determine the number of harmful alcohol users. Results: 35 studies (n = 37,576 Nigerians) were identified. Pooled crude prevalence of harmful use of alcohol was 34.3% (95% CI: 28.6-40.1); twice as high among men (43.9%, 31.1-56.8) compared to women (23.9%, 16.4-31.4). Harmful alcohol use was higher in rural settings (40.1%, 24.2-56.1) compared to urban settings (31.2%, 22.9-39.6). The number of harmful alcohol users aged ≥15 years increased from 24 to 34 million from 1995 to 2015. However, actual age-adjusted prevalence of harmful use of alcohol in Nigeria decreased from 38.5% to 32.6% over the twenty-year period. Conclusions: While the prevalence of the total population that drinks harmfully appears to be dropping, absolute number of individuals that would be classified as harmful drinkers is increasing. This finding highlights the complexity of identifying and advocating for substance abuse policies in rapidly changing demographic settings common in Africa, Asia, and other developing countries