Post Millennium Development Goals Prospect on Child Mortality in India: An Analysis Using Autoregressive Integrated Moving Averages (ARIMA) Model

Background & Objectives: Sustainable Development Goals (SDGs) are set up as a part of the Post Millennium Development Goals (MDGs). Then it becomes essential to review the achievement of the MDGs in India and lessons learned to incorporate into the SDGs. The present study reviews and predicts different components of under-five mortality rate beyond 2015 to assess the present situation and to determine the future possibilities of achieving the new targets for SDGs in India. Data and Methods: It uses available time series data on different components of U5MR from the India’s Sample Registration System (SRS). Autoregressive Integrated Moving Averages (ARIMA) model has been taken as the method of time series analysis to forecast the mortality rates beyond 2015. Results: There is a consistent pattern of faster decline in the under-five mortality compared with the neonatal mortality rate across all major states in India although neonatal mortality contributes largest share in under-five mortality. Again, share of neonatal death among under-five death is increasing steadily over the future projected years. This indicates very slow progress of reduction in neonatal mortality. Stimulating efforts with new intervention programmes will be needed to focus more on lowering neonatal mortality particularly in rural India.

Carcinogenic Helicobacter pylori in gastric pre-cancer and cancer lesions: Association with tobacco-chewing

AIM:To investigate the low gastric cancer incidence rate relative to the highly prevalent Helicobacter pylori(H.pylori)infection;data relevant to H.pylori infection during gastric carcinogenesis in Indian patients is currently lacking.METHODS:The present study examines the prevalence of H.pylori infection in DNA derived from 156endoscopic gastric biopsies of different disease groups that represent gastric pre-cancer[intestinal metaplasia(n=15),dysplasia(n=15)],cancer[diffuse adenocarcinoma(n=44),intestinal adenocarcinoma(n=21)],and symptomatic but histopathologically-normal controls(n=61).This was done by generic ureC polymerase chain reaction(PCR)and cagA-specific PCR that could specifically identify the carcinogenic H.pylori strain.RESULTS:Our analysis showed the presence of H.pylori infection in 61%of symptomatic histopathologically-normal individuals,however only 34%of control tissues were harboring the cagA+H.pylori strain.A similar proportion of H.pylori infection(52%)and cagA(26%)positivity was observed in the tumor tissue of the gastric cancer group.In comparison,H.pylori infection(90%)and cagA positivity(73%)were the highest in gastric pre-cancer lesions.In relation to tobacco and alcohol abuse,H.pylori infection showed an association with tobacco chewing,whereas we did not observe any association between tobacco smoking or alcohol abuse with prevalence of H.pylori infection in the tissue of any of the patient groups studied.CONCLUSION:High incidence of H.pylori infection and carcinogenic cagA positive strain in pre-cancer lesions during gastric carcinogenesis may be

Community effects on public health in India: A hierarchical model

The data on any aspect of public health, including that on infant mortality, has inbuilt hierarchical structure. Using traditional regression approach in data analysis, i.e., ignoring hierarchical structure, either at micro (individual) or at macro (community) level will be avoiding desired assumption related to independence of records. Accordingly, this may result into distortion in the results due to probable underestimation of standard error of the regression coefficients. To be more specific, an irrelevant co-variate may emerge as an important covariate leading to inappropriate public health implications. To overcome this problem, the objective of the present work was to deal with multilevel analysis of the data on infant mortality available under second round of National family Health Survey and notify changes in results under traditional regression analysis that ignores hierarchical structure of data. This method provides more accurate results leading to meaningful public health implications. In addition, estimation of variability at different levels and their covariance are also obtained. The results indicate that the community (e.g., state) level characteristics still have major role regarding infant mortality in India. Further, if computational facilities are available, multilevel analysis may be preferred in dealing with data involving hierarchical structure leading to accurate results having meaningful public health implications.

An Appraisal of Sexual Behaviors, STI/HIV Prevalence, and HIV Prevention Programs among Truckers in India: A Critical Literature Review

Background: A systematic review portraying the changing pattern of sexual behaviors, STI and HIV prevalence and key strategies curb HIV and STI among truckers in India is lacking. This paper therefore aims to present a chronological review of literature regarding sexual behaviors, STI/HIV prevalence, and various HIV prevention programs implemented among truckers in India. Methodology: Published and unpublished studies (1990-2011) were identified through electronic databases, and hand searching. Results: Most studies on sexual behaviors and STI/HIV prevalence among truckers focused only on drivers and ignored their helpers. Evidences suggest that consistent condom use by truckers with both paid and non-paid female partners has increased during the past decade. Many recent studies suggest that the HIV prevalence among truckers is about 2% and it has been declining slowly during the past decade. The HIV prevention programs among truckers which started with the aim of raising awareness about HIV during early 1990s, have grown multi-folds to encompass not only the standard strategies like mid-media events, interpersonal counselling and STI care for HIV prevention, but also innovations such as the use of business franchisee models, and integrated research and evidence based planning in the program. The possibilities of using new approaches such as male circumcision and the use of pre-exposure prophylaxes are underway. Conclusion: More studies are needed to explore helpers’ vulnerabilities to HIV. Very few studies have attempted to examine the impact of large-scale prevention programs among truckers. Efforts are required to examine the impact of different components of such programs to guide the HIV prevention efforts among truckers in India.

Determinants of infant mortality in rural India: A three-level model

Taking into account the hierarchical structure of the data, through two-level analysis on infant mortality available under second round of National family Health Survey, the same group of authors recently reported determinants of infant mortality while examining possible changes in results under traditional regression analysis that ignores hierarchical structure of data. They reported that the community (e.g., state) level characteristics still have a major role regarding infant mortality in India. For better epidemiological understanding, the present study is to assess determinants of infant mortality in rural India, where three level considerations were possible. The results indicate that even after consideration of these covariates, variation in infant mortality remains significant not only between States but also between Districts. Further, as an additional observation, the probability of infant mortality is still high in rural areas of districts having health facility beyond three kilometers than their counterparts.

An epidemiological study on delay in treatment initiation of cancer patients

Early diagnosis and timely initiation of treatment of cancer patients may improve survival and quality of life. Various measures of delay can be made during diagnosis and treatment initiation. Most of the studies were based on single type of cancer with different definitions and measurements of delay in diagnosis and treatment. Thus, it has been difficult to synthesize results and generalize to other types of cancer. The study proposes to measure total duration between onsets of symptom to start of treatment into three components, namely primary, secondary and tertiary delays. Primary delay is defined as onset of symptoms to contacting the first medical person, secondary delay is from first medical contact to confirmed diagnosis, and tertiary delay is from confirmed diagnosis to treatment initiation. The aim of this study is to determine factors associated with primary, secondary and tertiary delays in cancer patients. This study was planned as a cross-sectional study. Data was collected from patients admitted to the surgical wards of Department of Surgical Oncology, Institute Rotary Cancer Hospital, New Delhi during 2006-2007. Gamma regression and quantile regressions at 25th, 50th and 75th percentile of each of the delays were used to determine related factors. A total of 403 patients were included in the analysis. The median tertiary delay was found almost two folds (59;Interquartile range: 26 - 101 days) than the primary and secondary delays. Extremity cancer patients had longest primary, secondary and tertiary delays. Shortest primary, secondary and tertiary delays were observed for gastrointestinal cancer, breast and genitourinary cancer respectively. There is an urgent need and scope to reduce delay at each level primary, secondary and tertiary delay. Intervention studies are needed through information, education and communication/screening programs to reduce the diagnostic and treatment delays in cancer patients.

Does Breastfeeding Have an Effect on Infant Mortality in India? An Analysis of National Family Health Survey Data

Introduction: Sub-optimal infant and early childhood feeding practices in India contribute to the high burden of child under-nutrition and infant death. Objective: To study the effect of breast-feeding duration on the survival of infants along with other demographic, socioeconomic and service related factors and to compare the decadal changes in the association. Methods: A total of 36,754 and 26,782 births less than 3 years of age from two rounds of the National Family Health Survey (NFHS) carried out in India during 1992-1993 (NFHS-1), and 2005-2006 (NFHS-3) respectively comprised the sample. Infant mortality was examined against a set of variables and breastfeeding as a time dependent covariate using multivariate extended Cox regression model. Results: Hazard of infant death observed in NFHS-3 (2005-2006) was 18 percent less [HR = 0.82;95% CI = 0.759 - 0.879] as compared to that observed in NFHS-1 (1992-1993). After adjustment of other factors, the risk of infant death was 97% less amongst children who were breastfed [HR = 0.03;95% CI = 0.029 - 0.033] as compared to those who were not breastfed. In contrast to rural area, babies belonging to urban area had an 18 percent less hazard of death during the infancy period [HR = 0.82]. Hazard of infant death was less among births to mothers with higher maternal education levels [HR = 0.93] and in those who were in gainful occupation [HR = 0.91]. The risk of infant death was higher in babies perceived to be small at birth [HR = 1.40] and belonging to states with medium post neonatal mortality rate (PNMR) [HR = 1.23;95% CI = 1.112 - 1.371] and high PNMR [HR = 1.46;95% CI = 1.327 - 1.609] in contrast to those born to women belonging to states with low post neonatal mortality. Conclusion: Promotion and implementation of evidenced based strategies are needed in India to combat the high rates of child under-nutrition and infant and child mortality.

Are Truckers Being over Stigmatized as HIV Carriers in India? Evidences from Behavioral and Biological Cross-Sectional Surveys among Clients of Female Sex Workers

This paper examines whether truckers have been over-stigmatized as HIV carriers in the country. Data were taken from cross-sectional surveys of clients of female sex workers conducted in 2006-2007 in 12 districts of the country. A total 4822 clients of female sex workers were covered in the survey. Low-income skilled/semi-skilled men, including non-agricultural/casual labor, and petty businessmen/small shop owners, have the largest share in the clients’ population. There was no significant difference between truckers and other sub-group of clients’ population in terms of consistent condom use with female sex workers and prevalence of HIV or STI. These evidences suggest that the contribution of truckers in HIV epidemic in India might to similar to other sub-groups of clients’ population. Thus, truckers might have been over-stigmatized as HIV carriers in the country. However, there is no doubt that truckers constitute an extremely important target group for the HIV prevention programs and these efforts must be continued to prevent new HIV infections in the country.

Causes of Death among HIV-Infected Adults Registered in Selected Anti-Retroviral Therapy Centers in North-Eastern India

Background: Causes of death related studies in HIV infected population are necessary to devise disease specific preventive interventions at both state and national level HIV programs. This study examines the causes of death among HIV-infected individuals registered at selected Anti-Retroviral Therapy (ART) centers in the era of treatment in north-eastern India. Data and Methods: A retrospective chart review of causes of death was undertaken among HIV-infected patients who were treated between January 2006 and November 2012 at three selected ART centers in Assam, a north-eastern state of India. Reported causes of death were coded as per the guidelines of the International Classification of Diseases (ICD-10) to determine the deaths to standard definitions. Results: Among 5612 HIV-infected patients registered over a period of 71 months, 370 deaths have occurred. Tuberculosis (28%) was the leading cause of death followed by death due to AIDS related complex (11%), wasting syndrome and multiple infections (9% each). Deaths due to selected causes were significantly associated with patient’s use of alcohol, WHO clinical stage, CD4 count at the time of diagnosis, presence of opportunistic infections during treatment and ART adherence. Median survival duration was shortest among patients who had CD4 count <50 at the start of ART (2.9 months) and patients who had multiple opportunistic infections during treatment (2.5 months). Discussion: Majority (67%) of deaths in our study were due to AIDS-related causes. Tuberculosis has remained the leading cause of death among the HIV patients on ART. Strengthening the linkages and referral between the HIV and TB program will be crucial to reduce the AIDS-related deaths attributed to tuberculosis.

Towards Developing Communication Strategies for HIV/AIDS Control among the Scheduled Tribes and Scheduled Castes Women in Three Northeastern States of India

HIV/AIDS spread has opened a Pandora of medical and health problems apart from creating serious socio-psychological trauma for the victims and their families. Despite the governmental effort to curve the growing infection, very little success has been achieved. The northeastern region of India presents a very peculiar situation due to recurrent insurgency in all its states for long time and thus it became instrumental in paralyzing the social and health machineries to an extent, which still deteriorated the futile national effort to check the deadly infection. The study tried to understand the level of awareness and correct knowledge among the underprivileged scheduled tribes and scheduled castes women in the age group 15 -44 by exploring data from district level of Rapid Household Reproductive and Child Health Project Phase I (1998) and Phase II (1999) for Assam, Manipur and Nagaland and suggested a strategy to control the infection in the region. It is found that HIV/AIDS awareness was 59% among the women in all the three states with very few among them who had correct understanding of its prevention. A pronounced difference in the level of awareness was observed with respect to age, economy and residential status of the respondents.

An Assessment of Comprehensive Knowledge of HIV/AIDS among Slum and Non-Slum Populations in Delhi, India

In order to design appropriate HIV prevention programs, it is important to examine the perception and knowledge of HIV/AIDS and methods of preventive. This article explores comprehensive knowledge of HIV/AIDS prevention methods among women and men in slum and non-slum areas in the National Capital Territory of Delhi, India. Data were drawn from the National Family Health Survey, 2005-06 (NFHS-3). The sample included 3096 women aged 15 - 49 years and 1321 men aged 15 - 54 years. Pearson Chi-square test and logistic regression analyses were conducted to examine the association between the study variables and the background characteristics of the slum and non-slum populations. Comprehensive knowledge of HIV/AIDS prevention methods was significantly lower among women and men in slum areas as compared with non-slum areas. Compared to men, women had less comprehensive knowledge of HIV/AIDS prevention methods in slum and non-slum areas, even after controlling for various demographic and socio-economic and exposure variables. Findings indicate that comprehensive knowledge of HIV prevention methods is low among women in slum areas. Interventions are needed to build knowledge of HIV transmission and prevention methods in this vulnerable group. Strategies to build awareness of HIV/AIDS could include mass media campaigns HIV/AIDS, and information, education and communication programs (IEC) on HIV/AIDS in slum areas.

Multiple Sexual Partners and Vulnerability to HIV: A Study of Patterns of Sexual Behaviour in the Slum Population of India

Globally, research indicates that monogamous married women living in slums are at heightened risk of HIV men’s risky sexual behaviour. Hence, to reduce the risk of HIV transmission, there is need to understand the number, nature and variation in transition of sexual partners of men in living in slums. This paper uses India’s National Family Health Survey-3 data to estimate the variation in the type of sexual partners among sexually active men age 15 - 54 with more than one sexual partner in last 12 months prior to the survey in eight slums?of India. Among sexually active men, 1.3 percent reported having more than one sexual partner in the last 12 months prior to the survey. Men who are more likely to have two or more partners are those who are young, especially below age 25 years, never married, educated up to 5 years, and from middle class. There is a higher increase in the probability of sex with spouse from second last to the last sexual partner in non-slum areas than slum areas. However, in case of transition from other friends/relatives and female sex workers to spousal partners, there is a major decline in probability among non-slum men than slum men. These transitions are extremely important from the perspective of curbing the spread of HIV epidemic, especially in situations where women lack control over their own sexuality and seldom use condom in marital sex. Therefore, strategies focused in slums should either consider reducing men’s risky sexual behaviour or build capacities of women to negotiate safe sex in marital relationships or consider a combination of both.

Characterization of Electrical Behavior of Ba₅HoTi₃V₇O₃₀Ceramic Using Impedance Analysis

Polycrystalline sample of Ba5HoTi3V7O30 was prepared using solid-state reaction technique. X-ray structural analysis indicated a single-phase formation with orthorhombic structure. Microstructural study by SEM showed non-uniform distribution of grains over the surface of the sample. Impedance and modulus spectroscopy studies were carried out, as functions of frequency (42 Hz - 5 MHz) and temperature (RT-773K). The Nyquist plots clearly showed the presence of both bulk and grain boundary effect in the compound. Electrical phenomena in the material can appropriately be modeled in terms of an equivalent circuit with R, C and CPE in parallel. The fitting procedure used here allows us to determine the value of R and C with good precision. Here R2 and R3 correspond to the resistance contributed from the grain boundary and bulk, respectively. C1 and C2 correspond to the capacitance contributed from the grain boundary and bulk, respectively. The real part of electrical modulus shows that the material is highly capacitive. The asymmetric peak of the imaginary part of electric modulus M″, predicts a non Debye type relaxation. The activation energy of the compound (calculated both from impedance and modulus spectrum) is same, and hence the relaxation process may be attributed to the same type of charge carriers.

Role of Al and Ti doping in modulating electrical properties of BIVOX system

The doubly-doped bismuth vanadate with Al and Ti having formula unit, Bi2V1–xAlx/2Tix/2O5.5–δ(0.10 ≤ x ≤ 0.25) was synthesized. The specimens were characterized by scanning electron microscopy(SEM), X-ray diffraction(XRD), Fourier transform infrared(FT-IR), differential scanning calorimetric(DSC), UV–Vis, and electrochemical impedance spectroscopy(EIS) for their structural, thermal, optical, and electrical studies. Influence of both dopant cations(Al and Ti) was observed in the gradual stabilization of the tetragonal phase of Bi2VO5.5–δ with dopant amount. A non-uniform grain growth phenomenon was observed up to x = 0.175, with dopant addition. UV–Vis study revealed the comparatively higher order of oxide ion vacancies for the composition x = 0.175. Impedance spectroscopy measurements indicate a significant decrease of both the grain(Rg) and grain boundary resistances(Rgb) with the rise in temperature and the overall resistance is found to be dominated by the grain interior contribution. Enhancement of ionic conductivity was found in all the compositions in the intermediate temperature range as compared to the parent compound, and the single Al-doped system and the highest value were obtained for x = 0.175.