High Prevalence States Research Articles

Burden of vaso-occlusive crisis, its management and impact on quality of life of Indian sickle cell disease patients.

Sickle cell disease (SCD) with vaso-occlusive pain crisis (VOC) significantly impacts patient well-being and often results in extensive healthcare resource utilization. This study assessed the VOC burden, its management and its impact on patients' quality of life (QoL). A cross-sectional observational study was conducted between November 2021 and June 2022, including 1000 SCD patients from high-prevalence states in India. Data on demographics, clinical characteristics, VOC severity, management and QoL were collected. The study revealed that 33.5% of patients reported at least one VOC episode during the study period. In the year prior to their enrolment, 836 (83.60%) patients reported at least one VOC episode, with an equal proportion of 407/487 (83.6%) adults and 429/513 (83.6%) paediatric patients, reducing their QoL across all domains compared to patients without VOC. Of these, 469/1000 patients (46.9%) experienced ≥3 VOC episodes. Additionally, 764/1000 (76.40%) patients managed their VOCs at healthcare facilities, with 501/1000 (50.1%) requiring inpatient admissions. Further, 71.80% of patients received Hydroxyurea (HU) therapy. The study depicts the severity of the Arab-Indian haplotype in Indian SCD patients visiting healthcare settings based on high VOC burden. This highlights the urgent need for better management strategies and resource allocation for these patients.

SAHELI: Study and Action on Hysterectomy: Evidence on women’s health through the life course in India. Protocol for a mixed-methods study

Hysterectomy, removal of the uterus, is a commonly performed surgery for gynaecological morbidities. Emerging evidence indicates that hysterectomy performed before age 45 (early hysterectomy), is associated with considerable risks to women’s health. While most evidence on hysterectomy is from high-income settings, national surveys from India report high prevalence of early hysterectomy in specific regions, as well as higher prevalence amongst women in rural areas and with less education. The median age at hysterectomy in India is close to ten years before the onset of natural menopause. India has recently introduced national guidelines to address early hysterectomy, but large evidence gaps on the causes and consequences remain – which in turn limits the potential effectiveness of interventions at the clinical, health system and community level. Methods SAHELI is a Team Science study that will examine: (i) individual, social and health system determinants of early hysterectomy; (ii) women’s treatment pathways to hysterectomy and for gynaecological morbidity in general; and (iii) the consequences of undergoing hysterectomy on women’s physical, mental, economic and social well-being across the life course. This mixed-methods study includes population surveys amongst women in ages 25–49 in three high-prevalence states; qualitative health systems research to trace treatment journeys with women, health care providers and other stakeholders; evidence syntheses; and knowledge translation activities to ensure findings inform co-produced strategies and interventions. The study is grounded in a feminist epidemiology approach, aiming to examine individual and structural causes of vulnerability and prioritising the views of women, particularly in knowledge translation. Conclusions SAHELI, implemented by an all-women, multi-disciplinary team, is the first study in India to examine the causes and consequences of hysterectomy in a life course approach. We aim to influence interventions, policy and future research on women’s health, particularly access to quality gynaecological care and comprehensive health services through the life course.

Cigarette smoking decline among US young adults from 2000 to 2019, in relation to state-level cigarette price and tobacco control expenditure

ObjectiveTo investigate the association of state-level cigarette price and tobacco control expenditure with the large 2000–2019 decline in cigarette smoking among US 18–24 year-olds.MethodsSmoking behaviour was assessed in the 24...

Child marriage among women in West Bengal: pervasiveness, spatial variation and socio-economic connections

ABSTRACT A human rights violation, child marriage among women, is not an uncommon practice and has continued for centuries in India. Whatever its origin, the reason for its persistence is an issue that needs to be re-looked. Therefore, the present study analyzed the spatial variation of child marriage and also identified the key drivers of this practice in the high prevalence state of West Bengal, India, using the National Family Health Survey (NFHS) dataset. Pearson’s correlation coefficient was used to measure the strength and direction of the relationship between child marriage and socioeconomic indicators. Multiple regression analysis has been used to examine the key determinants of child marriage. The result reveals that Uttar Dinajpur, Jalpaiguri, South 24 Parganas and Puruliya districts have performed well, whereas performances of Purba Medinipur, Paschim Medinipur, Murshidabad and Birbhum districts are disappointing. The study also finds that there is a significant association between child marriage and respondents' educational level, place of residence and household wealth. Findings suggest that by increasing the higher educational and employment opportunities, economic support for poor families and increasing awareness about the adverse effects of child marriage are the effective steps to mitigate the issue.

Unsupervised K-means Analysis of Tuberculosis Data in Brazil: Identifying High Prevalence States and Temporal Trends

This paper aims to demonstrate the findings obtained through the analysis and application of an unsupervised K-means algorithm on the SINAN database from 2001 to 2022 in Brazil, with the objective of understanding which states have the highest number of tuberculosis cases and identifying similarities among them that may contribute to a higher case rate relative to the local population. We will begin with a brief historical introduction, followed by an overview of the characteristics related to tuberculosis transmission. Subsequently, we will discuss the results obtained from the year-to-year analysis of the collected data.

An examination of geographic access to outpatient stroke rehabilitation services in Tennessee, a stroke belt state

BackgroundWhile over half of US stroke patients were discharged to home, estimates of geographic access to outpatient stroke rehab facilities are unavailable. The objective of our study was to assess distance and travel time to the nearest outpatient stroke rehab facility in Tennessee, a high stroke prevalence state. MethodsWe systematically scraped Google Maps with the terms “stroke”, “rehabilitation”, and “outpatient” to identify Tennessee stroke rehab facilities. We then averaged/aggregated Census block-level travel distance and travel time to determine the mean travel distance/time to a facility for each of the 95 Tennessee counties and the overall state. Comparisons of mean travel time/distance were made between rural and urban counties and between low, medium, and high stroke prevalence counties. ResultsWe found that 79% of facilities were in urban areas. Significantly higher median of mean travel times and distances (p values both <0.001) were observed in rural (22.0 miles, 31.6 min) versus urban counties (10.5 miles, 18.4 min). High (21.5 miles, 32.5 min) and medium (18.7 miles, 28.3 minutes) stroke prevalence counties, which often overlap with rural counties, had significantly higher median of mean travel times and distance than low stroke prevalence counties (7.3 miles, 14.5 min). ConclusionsRural Tennessee counties were faced with high stroke prevalence, inadequate facilities, and significantly greater travel distance and time to access care. Additional efforts to address transportation barriers and accelerate telerehabilitation implementation are crucial for improving equal access to stroke aftercare in these areas.

TO STUDY THE HEMATOLOGICAL PROFILE IN PATIENTS WITH ALCOHOLIC LIVER CIRRHOSIS IN A TERTIARY CARE HOSPITAL IN MANIPUR

Introduction: Alcoholic liver disease or alcohol-related liver disease (ALD) is damage to the liver caused by excessive alcohol consumption, resulting in serious and life-threatening complications such as cirrhosis, gastrointestinal bleeding, hepatic failure, hepatic encephalopathy and malignancy. Liver cirrhosis is defined as diffuse hepatic fibrosis with replacement of normal liver architecture by nodules. There are also lesser known sequalae including suppression of hematopoiesis due to its toxic effects, hypersplenism and nutritional deficiencies of folic acid and other vitamins. Anemia, leukocytosis, leucopenia and thrombocytopenia occurs in ALD. Most of these hematological parameters are underdiagnosed and understudied. Hence, Manipur being a high ALD prevalence state necessitates this study to evaluate the hematological profile in patients with alcoholic liver cirrhosis and to determine the association between various hematological parameters and different Model of End stage Liver Disease (MELD) scores. Methods: This cross-sectional study was conducted in Regional Institute of Medical Sciences (RIMS), Imphal, Manipur from January 2021 to October 2022.Alcoholic liver cirrhosis patients above 18 years attending Medicine OPD, Liver clinic and those admitted in Medicine ward were enrolled. Blood samples for complete Hemogram, liver function test, kidney function test, prothrombin time, INR, serology (HbsAg, Anti HCV Ab, HIV 1&amp;2) and ANA were collected. Ultrasound whole abdomen and Chest X ray were done whenever indicated. Different types of anemia, leucopenia, leukocytosis, thrombocytopenia in different groups of MELD scores were studied. Result: A total of 146 alcoholic liver cirrhosis patients were enrolled in our study. The mean ± SD age of the patients was 48.63±10.00 years with majority males (91.8%). Anemia detected in &gt;95% of the patients. Severe anemia was detected in 31.5%, moderate anemia in 49.3% and mild anemia in 15.1%. Most of them (47.9%) had leucocytosis and thrombocytopenia was seen in 78.1% patients. Prolonged PT was seen in 89.1% of the patients and elevated INR present in 69.9% of patients. Majority of patients had MELD score between 10-19 and 20-29 (34.2% each). Only 4.1% had MELD score &gt; 40. There is statistically significant association between MELD score of the patients with severity of anemia (p&lt;0.05) and leucocyte count while it is not significant with thrombocytopenia (p=0.139). Conclusion: The prevalence of anemia in the present study was found to be 94.9% with predominant normocytic normochromic anemia (71.2%). There is significant association between MELD score of the patients with severity of anemia and leukocytosis while association with thrombocytopenia was insignificant. This study can now determine the stage at which emergent intervention could help in the recovery and effectively reduce morbidity and mortality of alcoholic cirrhosis patients.

Role of immigration and emigration on the spread of COVID-19 in a multipatch environment: a case study of India

Human mobility has played a critical role in the spread of COVID-19. The understanding of mobility helps in getting information on the acceleration or control of the spread of disease. The COVID-19 virus has been spreading among several locations despite all the best efforts related to its isolation. To comprehend this, a multi-patch mathematical model of COVID-19 is proposed and analysed in this work, where-in limited medical resources, quarantining, and inhibitory behaviour of healthy individuals are incorporated into the model. Furthermore, as an example, the impact of mobility in a three-patch model is studied considering the three worst-hit states of India, i.e. Kerala, Maharashtra and Tamil Nadu, as three patches. Key parameters and the basic reproduction number are estimated from the available data. Through results and analyses, it is seen that Kerala has a higher effective contact rate and has the highest prevalence. Moreover, if Kerala is isolated from Maharashtra or Tamil Nadu, the number of active cases will increase in Kerala but reduce in the other two states. Our findings indicate that the number of active cases will decrease in the high prevalence state and increase in the lower prevalence states if the emigration rate is higher than the immigration rate in the high prevalence state. Overall, proper travel restrictions are to be implemented to reduce or control the spread of disease from the high-prevalence state to other states with lower prevalence rates.

Scientometric Analysis of Gastrointestinal Parasites Prevalence in Sheep and Goats of India.

In the present study, gastrointestinal parasites (GIP) prevalence in sheep and goats from India was estimated by scientometrics. The GIP prevalence studies (86) reported during 1998-2021 was obtained from online databases, and offline literatures, meta-analysis was undertaken by using "meta" package in R-Software. The pooled GIP prevalence in India was 65% (95% level CI 56-74%, PI 12-96%) in sheep, 74% (95% level CI 66-80%, PI 14-98%) in goats and 68% (95% level CI 62-73%, PI 15-96%) in sheep and goats. Period-wise analysis revealed a higher GIP prevalence during 1998-2010 than the recent periods. Among the zones, GIP prevalence was higher in the Central zone (79%) in sheep, North zone (82%) in goats, and Central zone (78%) in sheep and goats. Based on the state-wise analysis, a higher GIP prevalence was observed in Haryana for sheep, Himachal Pradesh for goats, and Uttarakhand for sheep and goats. In India, a higher prevalence was reported by nematodes than other parasite classes. Based on climatic regions, a higher GIP prevalence was observed in semi-arid Steppe type region (84%). The high prevalence zones, states, species, sample types, parasite classes, parasite species and climate regions of GIP will be useful in decision-making and resource use efficiency by policymakers and stake holders. There is an urgent need to prevent the occurrence of GIP infections in sheep and goats by adopting scientific management practices, effective therapeutic measures, and hygienic practices on farms to augment the economic benefits to sheep and goat farmers in India.

Assessment of levels and trends of HIV infections among different subgroup populations of Gujarat State - Prioritization of the districts.

In India, HIV prevalence varies by region and high-risk groups. General population rates have decreased in high prevalence states through HIV Sentinel Surveillance among pregnant women, while low-moderate prevalence states show variable trends. Gujarat, in western India, has mixed HIV prevalence according to 2017 Sentinel Surveillance data. To study the level and trend of HIV positivity among pregnant women and high-risk groups (HRGs) across different districts of the state of Gujarat from year 2012-13 to 2016-17. To review the possible determinants of the HIV epidemic across the selected districts in the state of Gujarat. Data from the National AIDS Control Organization (NACO) spanning 2012-17 was analyzed for HIV trends in Gujarat. This included combined HIV testing data from pregnant women at Integrated and Counseling Testing Centers, blood unit testing data from selected districts, and HIV testing among high-risk populations through Targeted Intervention sites. HIV cases in Kheda district declined post-2013-14 among pregnant women (0.38% to 0.21% in 2016-17), and in general ICTC clients (5.53% to 0.264% in 2017-18). MSM seropositivity dropped from 1.15% (2014-15) to 0.74% (2016-17), FSWs from 0.7% (2014-15) to 0.29% (2015-16). Contrastingly, blood donors exhibited an increasing trend, rising from 0.15% (2012-13) to 0.24% (2016-17). In Mehsana, ANC mother seropositivity rose to 0.6% (2013-14), fell to 0.32% (2015-16), and rose again to 0.48% (2016-17). General ICTC clients declined from 1.2% (2012-13) to 0.53% (2016-17). FSWs had 0.25% seropositivity (2015-16), while MSM saw a drop from 0.44% (2014-15) to 0.23% (2016-17). Blood donors' trend was inconsistent. Sabarkantha's pregnant women seropositivity dipped from 0.59% (2012-13) to 0.20% (2014-15), rising to 0.25% (2017-18). General ICTC client seropositivity decreased from 5.34% (2012-13) to 1.17% (2017-18). While declines in HIV prevalence are evident among certain groups such as pregnant women and general ICTC clients, there are fluctuations in seropositivity among high-risk populations like MSM, FSWs, and blood donors. These insights emphasize the need for targeted interventions and ongoing monitoring to effectively address the evolving HIV landscape in these districts.

A scientometric study on prevalence of gastrointestinal parasites in pigs (Sus scrofa) of India

In this study, prevalence of the gastrointestinal (GI) parasites in pigs from India was estimated by employing scientometrics. The prevalence studies on the GI parasites of pigs (n=21) were acquired from online and offline databases (timeline: 2010-2021) and meta-analysis was performed using meta package in R-software. The prevalence of GI parasites in pigs was 54% (95% level: CI 39-69%, PI 5-96% of 8,921 samples tested) in India. A higherprevalence of 81% was reported in 2010 than the recent years (2016-21). The highest prevalence in South zone (78%), and least in West zone (35%) was observed. The prevalence of GI parasites was highest in Tamil Nadu (96%) and lowest in Maharashtra (28%). The higher prevalence was observed in protozoa (30%) than other parasite classes and lower in cestodes (4%) in pigs. More number of studies have been reported on nematode parasites indicating its importance in pigs. A higher prevalence was observed in the studies conducted on samples (84%) collected from slaughterhouse than the faecal samples (46%) in pigs. Among the parasite species, coccidia (29%) were most commonly reported whereas Globocephalus urosubulatus (0.7%) was observed sporadically low. Amongst nematodes and trematodes, a higher prevalence in Ascaris spp. (27%) and Amphistomes (12%), correspondingly was observed. The high GI parasites prevalence zones, states, parasite classes, sample types and parasite species recognized will assist the stakeholders and decision makers, in control and preventive approaches. Further, this study provides the baseline information on GI parasites prevalence in pigs of India for devising effective deworming strategies which ultimately lead to beneficial piggery in India.

Exploring the challenges in the management of childhood pneumonia-qualitative findings from health care providers from two high prevalence states in India.

India ranks among the top five countries in the world in child deaths due to pneumonia. Apart from poor public awareness, inadequate health infrastructure and treatment services have compromised effective management. This qualitative study guided by components of the Andersen-Newman's health care utilization framework explored contextual and community challenges faced by health care providers (HCPs) in the delivery of care services for children with pneumonia in select districts of Uttar Pradesh (UP) and Madhya Pradesh (MP). Semi structured interviews (SSIs) and focus groups discussions (FGDs) were carried out with a purposive sample of HCPs selected from three districts in each state. The HCPs included doctors and community health workers (CHWs). All SSIs and FGDs were audio- recorded, with consent, transcribed verbatim, entered into NVivo and analysed using thematic analysis. A total of 15 SSIs were conducted with doctors and eight FGDs were carried out with CHWs. Two themes that best explained the data were:, 1. Health systems: barriers faced in delivery of care services and 2. Evaluated Need: perceptions on community awareness and practices. According to the HCPs inadequacies in government health infrastructure both manpower and equipment, and skill deficits of paramedical staff and CHWs contributed to poor quality of care services for management of childhood pneumonia. This combined with inadequate understanding of pneumonia in the community, dependence on unqualified care providers and distrust of government hospitals acted as barriers to seeking appropriate medical care. Additionally, poor compliance with exclusive breast feeding practices, nutrition and hygiene had contributed to the high prevalence of the disease in these states. Strengthening public health facilities, instilling trust and confidence in people about the availability and the quality of these services and enhancing health literacy around childhood pneumonia would be critical towards protecting children from this disease.

CKD Prevalence Among Patients With and Without Type 2 Diabetes: Regional Differences in the United States

Rationale & ObjectiveRegional variation in chronic kidney disease (CKD) prevalence in patients with or without type 2 diabetes mellitus (T2DM) has not been well characterized.Study DesignSpatial and temporal comparative analysis.Setting & ParticipantsMarketScan databases were used to identify patients with CKD overall and subgroups of patients with CKD with and without T2DM in the United States.OutcomesSpatial patterns in CKD prevalence based on year, regional clusters of CKD between years, and characteristics of patients in high-prevalence states.Analytical ApproachGeomapping was used to visualize the state-level data of CKD prevalence generated from 2013 to 2018. We used univariate local indicators of spatial association (LISA) to evaluate geographic differences in prevalence, differential LISA for changes in CKD prevalence over time, and the χ2 test to identify patient characteristics in the top-20th percentile states for the prevalence of CKD.ResultsIn univariate LISA, low-low clusters, in which a state has a low CKD prevalence and the surrounding states have a below-average CKD prevalence, were observed in the northwest region throughout the study period, regardless of the T2DM status, indicating a consistently low prevalence of CKD clustered in these areas. High-high clusters were observed, regardless of the T2DM status, in the southeast region in more recent years, suggesting an increased CKD prevalence in this region.LimitationsHealth care insurance enrollment might not have been representative of the United States; the estimates were based on claims data that likely underestimated the true prevalence.ConclusionsGeographic disparities in CKD prevalence appear increasingly magnified, with an increase in the southeastern region of the United States. This increase is especially problematic because patients with CKD in high-prevalence states experience a greater likelihood of chronic conditions than those in the rest of the United States.

Understanding issues around use of oral pre exposure prophylaxis among female sex workers in India

BackgroundEmpowering female sex workers (FSWs) through women controlled HIV prevention option has been in focus globally. FSWs are important target for oral pre exposure prophylaxis (PrEP). A multi-centric qualitative study was conducted to explore the FSWs’ willingness to use oral PrEP in India.MethodsSeventy three interviews and 02 focus group discussions were conducted at 3 high HIV prevalent states in India during 2013–14. Study explored issues around willingness to use oral PrEP. The study was approved by the respective institutional ethics committee of the study sites. Thematic analysis using grounded theory approach was used to analyze the data in N-VIVO version 8.0.ResultsThematic analysis showed events of forced condom-less sex. FSWs believed that oral PrEP could provide independence, financial gains, and privacy and therefore hoped to use it as an alternative to male condom. However, any impact on physical/ aesthetic attributes and reproductive system were not acceptable and could become a barrier. Provider initiated oral PrEP was not preferred. Providers voiced safety monitoring concerns. Adherence emerged as a challenge because of: (1) alcohol use; (2) taking PrEP tablet each day being boring; (3) Stigma because Oral PrEP is ARV based. Alcohol use and dread of repetitive dose brings forth the need for long acting oral PrEP.ConclusionOral PrEP is acceptable among FSWs; it should be rolled out alongside strong messages on STI protection and PrEP as compliment to condoms. PrEP roll out requires educating communities about HIV treatment versus prevention. Long-acting oral PrEP could address both ‘boredom’ and alcoholism and sustain adherence.

Evaluation of Undiagnosed HIV Estimates Computed from the CD4 Depletion Model in a Rural, Medium-low HIV Prevalence State.

The CD4 depletion model estimates diagnosis delays by approximating infection date from CD4 T-cell count at diagnosis, and back-calculation can compute the proportion of undiagnosed PLWHA. The model assumes the immigration of PLWHA to the U.S. is negligible and counts as a transmission event, which may be impractical outside high prevalence states. Duration of U.S. residency among foreign-born PLWHA and diagnosis delays were compared. The impact on estimates of undiagnosed PLWHA was tested through simulation with different proportions of foreign-born people assumed to have acquired HIV abroad. In 67% of foreign-born people, the mean (SD) years of delay (9.9 (6.3)) exceeded the duration of U.S. residency (2.0 (1.9)). Additionally, inaccuracies in the estimates for proportions of undiagnosed PLWHA were pronounced when foreign-born people who acquired HIV abroad comprised 30% of diagnoses. The CD4 model inadvertently misclassified some diagnoses as in-state transmission events. Consequently, simulated results demonstrated inaccuracies and unstable calculations.

Familiarity and screening practices for adverse childhood experiences: Contemporary considerations from providers in a high prevalence state

Objective: The purpose of this exploratory study was to examine adverse childhood experiences (ACEs), knowledge, and screening practices. Methods: A convenience sample of pediatric primary care providers in a health-care system within a high-prevalence state were invited to participate. The original 12-item survey addressed familiarity, tools, barriers, and prevalence regarding ACEs. Results: Study participants reported familiarity with ACEs; however, only 23% reported the use of any screening tool(s). Primary barriers included time and lack of staff and/or knowledge/training. About 77% of respondents have encountered at least eight of the 10 major types of ACEs. Most frequently encountered ACEs included parental separation or divorce, substance abuse in the household, and mental illness in the household. About 73% expressed interest in continuing medical education. Conclusions: Provider knowledge/familiarity with ACEs does not imply systematic screening. An efficient and evidence-based standardization for screening merits consideration. Continued education and training may address barriers to both provider understanding and screening of ACEs.

Raising the legal age for purchase and use of tobacco to 21 years: A step towards tobacco endgame in India

BackgroundGlobally, policies to counter targeting of young people by the tobacco industry have proven to be effective and a key determinant of reducing the magnitude of tobacco epidemic. This paper presents a case for increasing the minimum legal age to access tobacco to 21 years in India. MethodWe analysed the two rounds of nationally representative Global Adult Tobacco Survey (GATS) data: GATS-1 (2009–10) and GATS-2 (2016–17). We segregated data for two categories of tobacco consumption (smokers and smokeless tobacco users) at the age of initiation (<18, 18–21 and >21 years) and analysed for their consumption patterns found during the time of the survey (current daily, current less than daily, former and ever users) from GATS-2 (2016–17). Further, we compared the projections from the sub-national level analysis for youth initiating tobacco use before 21 years and change in the prevalence of overall underage tobacco users between the two survey rounds. ResultNearly 77% of smokers and 75% smokeless tobacco users in India initiate tobacco use before or until the age of 21 years. Many large, most populous and high tobacco prevalence states had higher than national mean (14.1%) of youth initiating into tobacco use before 21 years. Overall, as compared to GATS-1, there is a perceptible increase in the prevalence of underage tobacco use in most states. ConclusionGlobal best practices and the significant number of young tobacco users in India call for increasing the age of access to tobacco from the current 18 years to 21 years. This will help in reducing the overall adult tobacco use prevalence in the longer run in India.

Understanding the Relationship Between Nursing Home Experience With Human Immunodeficiency Virus and Patient Outcomes.

As the population with human immunodeficiency virus (HIV) continues to age, the need for nursing home (NH) care is increasing. To assess whether NH's experience in treating HIV is related to outcomes. We used claims and assessment data to identify individuals with and without HIV who were admitted to NHs in 9 high HIV prevalent states. We classified NHs into HIV experience categories and estimate the effects of NH HIV experience on patient's outcomes. We applied an instrumental variable using distances between each individual's residence and NHs with different HIV experience. In all, 5,929,376 admissions for those without HIV and 53,476 admissions for residents with HIV. Our primary outcomes were 30-day hospital readmissions, likelihood of becoming a long stay resident, and 180-day mortality posthospital discharge. Residents with HIV tended to have poorer outcomes than residents without HIV, regardless of the NH they were admitted to. Residents with HIV admitted to high HIV experience NHs were more likely to be readmitted to the hospital than those admitted to NHs with lower HIV experience (19.6% in 0% HIV NHs, 18.7% in 05% HIV NHs and 22.9% in 5%-50% HIV NHs). Residents with HIV experience worse outcomes in NHs than residents without HIV. Increased HIV experience was not related to improved outcomes.

Obstetrical Unit Response to the COVID-19 Pandemic: OUR Study.

This study aimed to describe the response of labor and delivery (L&D) units in the United States to the novel coronavirus disease 2019 (COVID-19) pandemic and determine how institutional characteristics and regional disease prevalence affect viral testing and personal protective equipment (PPE). A cross-sectional survey was distributed electronically through the Society for Maternal-Fetal Medicine e-mail database (n = 584 distinct practices) and social media between April 14 and 23, 2020. Participants were recruited through "snowballing." A single representative was asked to respond on behalf of each L&D unit. Data were analyzed using Chi-square and Fisher's exact tests. Multivariable regression was performed to explore characteristics associated with universal testing and PPE usage. A total of 301 surveys (estimated 51.5% response rate) was analyzed representing 48 states and two territories. Obstetrical units included academic (31%), community teaching (45%) and nonteaching hospitals (24%). Sixteen percent of respondents were from states with high prevalence, defined as higher "deaths per million" rates compared with the national average. Universal laboratory testing for admissions was reported for 40% (119/297) of units. After adjusting for covariates, universal testing was more common in academic institutions (adjusted odds ratio [aOR] = 1.73, 95% confidence interval [CI]: 1.23-2.42) and high prevalence states (aOR = 2.68, 95% CI: 1.37-5.28). When delivering asymptomatic patients, full PPE (including N95 mask) was recommended for vaginal deliveries in 33% and for cesarean delivery in 38% of responding institutions. N95 mask use during asymptomatic vaginal deliveries remained more likely in high prevalence states (aOR = 2.56, 95% CI: 1.29-5.09) and less likely in hospitals with universal testing (aOR = 0.42, 95% CI: 0.24-0.73). Universal laboratory testing for COVID-19 is more common at academic institutions and in states with high disease prevalence. Centers with universal testing were less likely to recommend N95 masks for asymptomatic vaginal deliveries, suggesting that viral testing can play a role in guiding efficient PPE use. · Heterogeneity is seen in institutional recommendations for viral testing and PPE.. · Universal laboratory testing for COVID-19 is more common at academic centers.. · N95 mask use during vaginal deliveries is less likely in places with universal testing..

Prevalence and risk factors of anemia among children 6–59 months in India: A multilevel analysis

BackgroundEarly detection of anemia and subsequent measures to prevent anemia can help children grow healthily. There is considerable attention given to the impact of individual-level factors on Anaemia, but less is known about how community characteristics affect Anaemia among children. The present study was focused at estimating the prevalence and associated risk factors at individual and community level in India among children aged 6–59 months in India. MethodsDescriptive statistics and the chi-square test were applied using fourth round of National Family Health Survey dataset. Later, to explore the association of child anemia and some potential risk factors regarding hierarchy (individual and community level) of data, a multilevel logistic regression model was conducted using STATA-SE 14 software. ResultsThe results indicate that some aspects of the community influence the anemia risks of children. For instance, a 1% increase in the proportion of mother education in the community decreased the likelihood of anemia by 9% among children. Northeast region was the only region at lesser risk of anemia. Higher community level ethnic and religious homogeneity is associated with decreased odds of anemia among children. Children aged 12–35 months, girl child, children having diarrhoea, mothers of age group 15–24, high parity and low exposure to mass-media were the high risk individual factors of anemia among children. ConclusionsOverall, the present study indicated the requirement to include community-level factors beyond the individual level factors by policymakers to eradicate the burden of anemia in the country and the high prevalence states.