Improvement In Socioeconomic Conditions Research Articles

Risk factors associated with scabies infestation among primary schoolchildren in a low socio-economic area in southeast of Iran

BackgroundScabies is a neglected tropical disease caused by the mite Sarcoptes scabiei that burrows under the skin. It is a major health problem in tropical areas, largely affecting children. Scabies is common and highly contagious and in schoolchildren spreads quite rapidly, due to overcrowding and close contact within the schools. This study aimed to determine the risk factors associated with scabies infestation among primary schoolchildren in Bashagard County, one of the low socio-economic areas in southeast of Iran.MethodsTo conduct this community-based, descriptive, and cross-sectional study, four primary schools were randomly selected in the Bashagard County. All students in these schools were selected and examined for scabies. Clinical examination and sociodemographic profile of students were assessed using a pre-tested structured questionnaire. Chi-square test, and binary logistic regression were used to analyse the factors associated with scabies infestation by SPSS version 21 software.ResultsOut of 480 studied schoolchildren, 15 cases of scabies with a prevalence of 3.1 % were observed. The frequency of infestation in males was 1.6 % and it was 4.7 % in females. Independent factors associated with a high risk of scabies infestation in unadjusted analysis were being student of grade 5–6 (cOR = 13.12, 95 % CI 2.92–58.89, p = 0.0001), low educational level of father (cOR = 4.37, 95 % CI 0.97–19.59, p = 0.036), low educational level of mother (cOR = 4.14, 95 % CI 1.92–18.57, p = 0.045), joblessness of father (cOR = 14.77, 95 % CI 4.97–43.89, p = 0.0001), employment of mother (cOR = 5.28, 95 % CI 1.38–20.16, p = 0.007), large family size (cOR = 3.34, 95 % CI 1.05–10.64, p = 0.031), use of shared articles (cOR = 33.37, 95 % CI 10.82–102.90, p = 0.0001), and absence of bathroom in the house (cOR = 11.77, 95 % CI 2.16–63.94, p = 0.0001).ConclusionsResults of this study confirmed that scabies is still one of the most important health problems in the primary schools of the Bashagard County. Low socioeconomic status and personal hygiene of the schoolchildren were the most important factors influencing the prevalence of scabies. Improvement of socioeconomic conditions and implementation of appropriate educational programs and active surveillance system to quickly detect and treat scabies cases are necessary in order to reduce the prevalence of scabies in schoolchildren in this area.

A study of clinical, bacteriological and radiological profile of severe pneumonia in children

Pneumonia continues to pose a threat to health of children in developed and developing countries despite improvements in socioeconomic status, immunization and early diagnosis and treatment. Universality, vulnerability and frequency of occurrence of ALRTI in children are well recognized all over the world. Methods: This prospective clinical study of severe pneumonia conducted on n=150 children who were admitted to pediatric wards and PICU in PIMS, Nagunoor, Karimnagar. A detailed examination of each child including anthropometry was carried out. During the general physical examination, emphasis was laid on assessing general condition of the child, respiratory rate (counted over 1 minute), presence of fever and other signs such as cyanosis and pallor. Detailed systematic examination of the respiratory, cardiovascular and central nervous system was done. Any associated illness such as septicemia, meningitis and congestive cardiac failure if present was noted. Result: In this prospective study, n=150 cases of severe pneumonia were studied. In the present study, majority of cases (53%) were less than one year of age. majority of the cases were diagnosed as Bronchopneumonia (66.67%), Lobar pneumonia was diagnosed in 18.6% of cases and pneumonia and its complications in 9.3% of cases. In the present study, radiological findings were present in 80.66% of cases Bacterial pneumonia was detected in 62.67%, viral pneumonia in 14%. Culture was positive in only of cases. S. pneumonia was the most common organism isolated (6 cases) followed by S. aureus (n=5 cases) and Klebsiella (n=3 case). n the present study, antibiotics were given in all cases. Conclusion : In this study we found Bronchopneumonia is the predominant form of presentation in infants and preschool children. Among the risk factors studied, previous history of similar illness, inappropriate immunization for age, anemia, PEM grade 3 and 4, were found significant causes for severe pneumonia.

Modeling successive birth interval of women in Ethiopia: application of parametric shared frailty and accelerated failure time model

BackgroundBoth short and long birth intervals are associated with many risk factors and about 29% of births are short birth intervals in Ethiopia. The purpose of this study is to model the birth intervals of adult women aged 15–49 years using accelerated failure time and shared frailty models in order to analyze the birth intervals of Ethiopian women.MethodsThe data was obtained from the 2016 Ethiopian Demographic and Health Survey (EDHS). Accelerated failure time with different baseline and shared frailty models are used for the analysis to identify important demographic and socio-economic factors affecting the length of birth intervals and correlates of the birth intervals respectively.ResultsThe data consists of 9147 women, of which about 7842 (85.5%) are closed interval and the rest of 1323(14.5%) are open interval. Accelerated failure time (AFT) result revealed that women education level, husbands education level, age at first birth, marital status, religion and family wealth index are significant factors affecting birth interval of women in Ethiopia.ConclusionWomen with closely spaced births tend to have larger family sizes when compared with women with longer inter-birth interval. Longer successive birth interval tends to reduce the total fertility rate of women. Furthermore, improvements in socio-economic status and level of education of women associate with reduced fertility, improved maternal and child wellbeing, and longer birth interval.

Značaj političke dimenzije oružane pobune na primeru Severne Irske

At the beginning of the last century, after several unsuccessful armed uprisings against the central government, insurgents in Ireland realized that the fight with weapons was not enough and united in the political organization Sinn Fein (Irish: Sinn Fein - "We ourselves"), respecting the security grammar (Ejdus, 2017: 30), they managed to determine what was the danger they are fighting against, what was the reference object of security (what was endangered), who was the one who protected security (subject of security) and most importantly what were the means or measures to protect security. The subsequent mobilization of forces at the political level, the expansion and deepening of the conflict led to success, especially for the population in Northern Ireland who bore the brunt during the second thirty-year escalation of the conflict (armed insurgency) in the 20th century. The activities of Catholic rebels and Protestant loyalists in the second half of the twentieth century (from 1968 to 1998) confirmed the liberal view that political and economic order reduces tensions between social groups, but also the realistic view that the entire field of security is political, as well as Galula's statement that opposing an insurgency is eighty percent a political and only twenty percent a military struggle (Galula, 1966: 63). Rebel approach, motives, interests and goals, as well as the conditions (environment) were such that the repression and engagement of the army for the implementation of police tasks such are arrest, internment, maintenance of public order and peace (Alderson, 2009: 29), instead of contributing to solving conflict, in fact contributed to decades of instability. After this, the political segment of internal conflict gained importance because the military (hard) power, as a way of achieving goals (political results), did not have a decisive influence any more. The weapons that led to success at the strategic (state) level were the processes of political reconciliation, improvement of socio-economic conditions and diplomatic relations with the Republic of Ireland. At the tactical (local) level, these were investments in education, employment, housing and local government reform. So it can be concluded that the political dimension used to have and still has the biggest significance in this and similar conflicts.

Nasoorbitoethmoid fractures in a tertiary care hospital of eastern India: A prospective study.

Purpose:The purpose of this study was to report on the pattern of occurrence of nasoorbitoethmoid (NOE) fractures in Odisha and the various factors that influence their distribution.Methods:The study period was from January 1, 2016 to December 15, 2017. After approval from the Institutional Ethics Committee, all patients diagnosed with naso-orbito-ethmoid fractures reporting to the department of OMFS and Level-1 trauma centers were included in the study. Sociodemographic data along with the etiology and type of fracture were mentioned. Associated injuries to other body parts were noted. Open reduction was possible only in five cases of NOE fractures. The treatment plan including the operative approach and postoperative results was evaluated.Results:A total of 1192 patients with facial fracture were seen, of which 52 (4.36%) patients had NOE fractures. Males far outnumbered females in a ratio of 9:1. Thirty-three patients (63.46%) had unilateral NOE fracture, while the rest 19 (36.54%) had bilateral NOE fracture. Sixteen (30.76%) cases were classified as Type I, 35 (67.30%) as Type II, and 1 (1.92%) as Type III. Road traffic accidents were the most common cause of NOE fractures (69%), followed by fall (17%) and assault (10%). The most common neurological injury to be associated with NOE fractures was pneumocephalus (29%), followed by diffuse axonal injury (8%). Telecanthus (100%) was found to be the primary clinical feature in patients of NOE fracture, followed by a depressed nasal bridge (92%). Fracture of the nasal bone was invariably associated with NOE fracture. Complications observed due to untreated NOE fractures included a shortened and retruded nose, shortened palpebral fissures, telecanthus, and enophthalmos.Conclusion:Contemporary management of NOE complex fractures demands precise diagnosis and immediate surgical management with anatomic reduction and rigid fixation of the involved bone segments. With an improvement in socioeconomic status and increased awareness among maxillofacial surgeons, hopefully, a greater number of NOE fracture patients will avail the benefits of open reduction in future.

Gender and class distinction in travel behavior: evidence from India

Purpose This paper aims to examine the gender differences in various measures of travel behavior for a large-sized Indian city, taking into account the existing class differences. Design/methodology/approach Stratified random sampling technique is used to collect primary data for travel behavior. The collected data is then differentiated on the basis of socioeconomic characteristics and gender. Descriptive statistics are used for analysis. Findings The findings confirm that, women mostly walk and men use motorized vehicles. With an improvement in socioeconomic status, women switch over to public transport and men continue to ride motorized vehicles. While the number of women making everyday trips declines with a rise in socioeconomic status, the number of men rises. Research limitations/implications The study points out at the need for development of an adequate infrastructure of nonmotorized transport and public transport in the city which attends to not only the issue of environmental quality but also of women’s empowerment. Originality/value To the best of the authors’ knowledge, this is the first time a comprehensive analysis of differences in travel behavior between men and women on the basis of socioeconomic status is carried out in this region. This analysis will facilitate the policy makers in understanding the inconsistencies in transport demand between the two groups of population.

Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines.

Background Pneumonia remains a major cause of morbidity and mortality amongst South African children. More comprehensive immunisation regimens, strengthening of HIV programmes, improvement in socioeconomic conditions and new preventive strategies have impacted on the epidemiology of pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children improve aetiological diagnosis. Objectives To produce revised guidelines for pneumonia in South African children under 5 years of age. Methods The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases established seven expert subgroups to revise existing South African guidelines focusing on: (i) epidemiology; (ii) aetiology; (iii) diagnosis; (iv) antibiotic management and supportive therapy; (v) management in intensive care; (vi) prevention; and (vii) considerations in HIV-infected or HIVexposed, uninfected (HEU) children. Each subgroup reviewed the published evidence in their area; in the absence of evidence, expert opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system. Sections were synthesized into an overall guideline which underwent peer review and revision. Recommendations Recommendations include a diagnostic approach, investigations, management and preventive strategies. Specific recommendations for HIV infected and HEU children are provided. Validation The guideline is based on available published evidence supplemented by the consensus opinion of SA paediatric experts. Recommendations are consistent with those in published international guidelines.

Trends in prevalence and mortality burden attributable to smoking, Brazil and federated units, 1990 and 2017

BackgroundThe present study sought to analyze smoking prevalence and smoking-attributable mortality estimates produced by the 2017 Global Burden of Disease Study for Brazil, 26 states, and the Federal District.MethodsPrevalence of current smokers from 1990 to 2017 by sex and age was estimated using spatiotemporal Gaussian process regression. Population-attributable fractions were calculated for different risk-outcome pairs to generate estimates of smoking-attributable mortality. A cohort analysis of smoking prevalence by birth-year cohort was performed to better understand temporal age patterns in smoking. Smoking-attributable mortality rates were described and analyzed by development at state levels, using the Socio-Demographic Index (SDI). Finally, a decomposition analysis was conducted to evaluate the contribution of different factors to the changes in the number of deaths attributable to smoking between 1990 and 2017.ResultsBetween 1990 and 2017, prevalence of smoking in the population (≥ 20 years old) decreased from 35.3 to 11.3% in Brazil. This downward trend was seen for both sexes and in all states, with a marked reduction in exposure to this risk factor in younger cohorts. Smoking-attributable mortality rates decreased by 57.8% (95% UI − 61.2, − 54.1) between 1990 and 2017. Overall, larger reductions were observed in states with higher SDI (Pearson correlation 0.637; p < 0.01). In Brazil, smoking remains responsible for a considerable amount of deaths, especially due to cardiovascular diseases and neoplasms.ConclusionsBrazil has adopted a set of regulatory measures and implemented anti-tobacco policies that, along with improvements in socioeconomic conditions, have contributed to the results presented in the present study. Other regulatory measures need to be implemented to boost a reduction in smoking in order to reach the goals established in the scope of the 2030 United Nations Agenda for Sustainable Development.

Can Health Disparity Be Eliminated? The Role of Family Doctor Played in Shanghai, China.

Background: Globally, the elimination of health disparity is a significant policy target. Primary health care has been implemented as a strategy to achieve this target in China for almost 10 years. This study examined whether family doctor (FD) policy in Shanghai contributed to eliminating health disparity as expected. Methods: System dynamics modeling was performed to construct and simulate a system of health disparity formation (business-as-usual (BAU) scenario, without any interventions), a system with FD intervention (FD scenario), and three other systems with supporting policies (Policy 1/Policy 2/Policy hybrid scenario) from 2013 to 2050. Health disparities were simulated in different scenarios, making it possible to compare the BAU results with those of FD intervention and with other policy interventions. Findings: System dynamics models showed that the FD policy would play a positive role in reducing health disparities in the initial stage, and medical price control—rather than health management—was the dominant mechanism. However, in this model, the health gap was projected to expand again around 2039. The model examined the introduction of two intervention policies, with findings showing that the policy focused on socioeconomic status improvement would be more effective in reducing health disparities, suggesting that socioeconomic status is the fundamental cause of these disparities. Conclusions: The results indicate that health disparities could be optimized, but not eliminated, as long as differences in socioeconomic status persists.

Socio-economic investigation of osteoporosis patients

Osteoporosis has become a public health problem risk factor worldwide and a deliberate disease that affects both women and men equally. The main objective of this study is to explore the socio-economic status of osteoporosis patients related to the occurrence of osteoporosis— the current study conducted at federal government hospitals in Islamabad. A quantitative research method used to collect data through a well-designed questionnaire. A stratified random sampling technique used to select a sample of 400 osteoporosis patients within 35-80 years. Mann-Whitney U Test applied for a dependent, independent variable, and frequency distribution tables used for univariate analysis. Results showed that osteoporosis patients were spending more money on their household expenditures than health. The socio-economic status of osteoporosis patients is essential for the prevention of osteoporosis and their treatment. Osteoporosis is one of the major global health issues associated with socio-economic status. The present study recommended that the improvement of socio-economic status and increasing the level of education could play a vital role in reducing the risks of osteoporosis.

Trends in Prelacteal Feeding Practices in Rural Bangladesh from 2004–2019

Abstract Objectives Our objective was to assess changes in prelacteal feeding practices in rural Bangladesh over a 15-year period, from ∼2004 to ∼2019, and to identify household, maternal, and infant characteristics associated with that trend. Methods The analysis used data from 21,804 infants enrolled in a cluster-randomized controlled trial of newborn vitamin A supplementation from 2004–2006, and from 4631 infants enrolled in a cluster-randomized controlled trial of a digital health intervention from 2018–2019. In both studies, trained field workers collected data on household socioeconomic status and maternal demographic characteristics at the time of enrollment. Upon receiving notification of an infant's birth, field workers visited the home as soon as possible, collecting detailed data on breastfeeding initiation and any foods or liquids other than breast milk provided to the infant. Prelacteal feeding was defined as giving infants any food or liquid other than breast milk within first 3 days of life. We used bivariate and multivariate logistic regression analyses to examine the association between different household, maternal, and infant characteristics and prelacteal feeding. We then applied a regression decomposition method to understand the factors associated with the changing prevalence of prelacteal feeding over time. Results The prevalence of prelacteal feeding was 88.0% during the period of 2004–2006. Among women practicing prelacteal feeding, sugar/sugar candy water was the most commonly fed prelacteal (41.2%), followed by animal milk (40.0%), honey (35.4%), and drops (11.8%). By 2018–2019, the prevalence of prelacteal feeding had declined to 24.7%. Most frequently consumed prelacteals were most commonly sugar/sugar candy water (20.0%), honey (20.0%), animal milk (19.7%), and drops (14.3%). Final analysis will include examination of the changing factors associated with this decline including rising maternal education, improvements in socioeconomic status, and exposure to media. Conclusions The prevalence of prelacteal feeding has dropped considerably in rural Bangladesh since 2004. Funding Sources The Bill and Melinda Gates Foundation; United States Agency for International Development; Sight and Life.

SEROPREVALENCE AND ASSOCIATED FACTORS OF HELICOBACTER PYLORI AMONG MYANMAR CHILDREN FROM THE PERI-URBAN COMMUNITY OF YANGON

Helicobacter pylori infects 50% of children aged 5 years in developing countries. The infection is associated with socio-economic background and family composition. The aim of this study was to determine the seroprevalence and associated factors of Helicobacter pylori infection among Myanmar children in Insein Township, which is a peri-urban community situated in the northern region of Yangon. A cross-sectional study was carried out in Insein Township on 193 children, aged 2 to 13 years, who were tested for H. pylori antibody by enzyme-linked immunosorbent assay (ELISA) test. Parents were interviewed using a questionnaire. Statistical analyses were done using chi-square test and two-sample t-test. The prevalence of H. pylori infections was 67.36%. The mean age of the participants was 7.6 +/- 3.85 years. Those positive for H. pylori antibody were significantly older (8.18+/-3.8) than those with negative results (6.41+/-3.7). There is no gender preponderance. The sero- positive rate was higher among low socio-economic group. The children who tested positive for H. pylori antibody had a mean family member of 5.97+/-2.22 and those who tested negative had 6.06+/-2.17. Thus, there was no association between H. pylori infection and number of family members. There was no association between H. pylori infection and overcrowding, type of drinking water, type of latrine used and type of housing.Our findings suggest that the prevalence of H. pylori infection among Myanmar children is common, as it is in other developing countries, and also highlight its association with socioeconomic status. Over time, the prevalence of H. pylori infections in children is expected to decline worldwide in parallel with the improvement in socioeconomic status of the nations. There is a need to intensify efforts of improving sanitation and living conditions in order to protect children against H. pylori infection.

Socio-Economic Status and Burden of Malaria in Kolkata Municipal Corporation (KMC) Area, West Bengal

Background: Among vector-borne diseases, malaria induces a significant socio-economic burden mainly on poor households directly or indirectly. So in a country like India where BPL population is about 21.9%, (Census of India, 2011), malaria continues to be a persistent public health concern. The present paper is a modest attempt towards the assessment of the effect of socio-economic status on disease burden in KMC Area which is a high burden area of West Bengal.Methods: The data was collected from 396 randomly selected households across the randomly selected 12 wards of Kolkata Municipal Corporation (KMC) Area. The household expenditure incurred on preventive measures and total expenses on the treatment of malaria were calculated. Socio-economic status (SES) of the households is examined against the prevalence of the diseases as well as against the preventive and curative expenditure incurred due to malaria.Result: Malaria is the most commonly found disease in the study area, having a prevalence rate of 5.02%. More males are affected than females and the working-age group is the worst affected category. The population had to spend about 0.06% to 1.79% of their annual income on the treatment of the disease.Conclusion: The economic burden of the disease seems to be higher in those wards, which are having a larger population of low SES. The improvement in SES of the household’s status and fruitful developments in the slums would help alleviate the disease prevalence and consequently would lessen the economic burden on the residents. How to cite this article:Khatoon S, Khan MMA. Socio-Economic Status and Burden of Malaria in Kolkata Municipal Corporation (KMC) Area, West Bengal. J Commun Dis 2020; 52(1): 72-77. DOI: https://doi.org/10.24321/0019.5138.202009

Clinical profile of children aged 2 months to 60 months presenting with wheeze in a tertiary medical centre

Background: Wheezing is common throughout infancy and childhood except in the neonatal period where it is relatively rare. By 10 years of age, about 19% of children experience wheezing with an average onset at 3 years of age. This study was aimed to identify the diverse factors associated with wheezing in children aged 2 months to 60 months and to study clinical profile along with short term outcome of the same.Methods: It was a hospital based cross-sectional study carried out in the Department of Paediatrics, Regional Institute of Medical Sciences Hospital (RIMS), Imphal, Manipur. The Study population consisted of randomly selected 131 children aged 2 months to 60 months who were admitted in Paediatrics ward with the symptom of wheezing.Results: Authors found that age below 12 months, male sex, low socioeconomic conditions and artificial breastfeeding practices were important risk factors for wheeze.Conclusions: Wheezing is accountable for a high demand of medical consultations and emergency care services with relatively high rates of hospitalization. Along with ARI, it plays an important role in infant mortality. In Manipur, it is being observed that increasing number of children with wheezing are attended by paediatricians in ED, OPD and ward, thereby proving an added burden to the younger age group. Therefore proper health education and counselling of parents, promotion of exclusive breast feeding and improvement of socioeconomic status can play a vital role in preventing occurrence of wheeze among the children.

Cardiac arrhythmias in low- and middle-income countries.

Many low- and middle-income countries (LMICs) are undergoing an epidemiological transition. With an improvement in socioeconomic conditions and an aging population, cardiovascular diseases (CVDs), like cardiac arrhythmias, are expected to increase in these countries. However, there are limited studies on the epidemiology and management of cardiac arrhythmias in LMICs. This review will highlight the unique challenges and opportunities that these countries face when managing cardiac arrhythmias.

Industrial livestock production: A review on advantages and disadvantages

Development of livestock production in many parts of the world has shown to be growing more towards an industrialised type of farm animal rearing operations. These involve raising farm animals in densely populated environment, commonly termed as a factory livestock farming. Such an operation is actually aimed at yielding a very large scale of farm animal products by means of intensification in animal rearing systems. This is becoming a global trend in practicing farm animal productions nowadays. The transformation of livestock production from a family small scale animal husbandry to a large scale of corporate business has been mainly driven by three major interrelated factors, these are i) a prediction on a rapid world‘s human population growth, ii) demographic factors, particularly age structure and urbanization, and iii) socio-economic status improvement. The total world‘s population has been estimated to reach 9.1 billion in 2050, where 70 percent of rural inhabitants are going to shift mostly living in urban areas and with their better incomes than previously earned and are also predicted to increase by 2 percent annually. Indications in changing urban lifestyle has then been shown affecting on shifted food consumption patterns more to semi-processed and/or pre-prepared-ready to eat foods of which their main component deriving from livestock product origin. As the trend has been commonly shown in many urban areas, where their working hours are becoming longer than there used to be. In an actual fact, that has been happening for the last two decades, particularly in regions used to be identified as developing countries, such as in Southeast Asia, Sub Saharan Africa, West Asia and North Africa. Consequently, an increase rate in meat consumption has been estimated at over 4 percent per annum. Moreover, that change has become a sequential driving factor for the rapid growth in the meat production sector. As higher consumer preference in chicken meat than that in other types, global broiler production is holding supremacy over the other meat complex. A special highlight on Brunei Darussalam poultry industry development will also be addressed here, particularly to focusing on an industry dynamic based on data posted in country‘s agricultural statistics for the year of 2013 [1]. At that time when the country was reported to fulfil its self-sufficiency in chicken meat with a consumption per capita per year reached 58.5 kg. The figure was accounted as being the second highest chicken meat consumption per capita per year in the world after Hong Kong. In line with the global trend in livestock production, continuous growing demands for the products had also led to intensification in livestock farming in the Southeast Asia region. As far as the factory livestock farming as has gone more common operations up to now, and yet there might have been more and more questionable arguments over negative impacts arising, particularly in regards to animal welfare, human health and environmental degradations will be seemingly left hard to answer as most vast scientific empirical assessments required, nonetheless the matter may only open for discussions.

Vitamin D evaluation based on demographics and calcium supplement intake in children suffering from acute febrile illness admitted in as tertiary care center

Background: Vitamin D or sunshine vitamin is a vital steroid group of vitamins with its deficiency being common, especially among children. The literature establishing the correlation of dietary habits with Vitamin D levels in Indian population is scarce. Objective: This study aims to evaluate serum 25-hydroxyvitamin D (25(OH)D) level in the hospitalized children suffering from acute febrile illness (AFI) and find its correlation with calcium intake and demographic characters. Materials and Methods: The study was conducted at the pediatric department of a tertiary hospital of Maharashtra, over a period of 6 months in the children between the age groups of 1 month and 12 years, admitted with AFI and with or without clinical or biochemical evidence of rickets. After detailed history, evaluation of Vitamin D status was done in all children within 48 h of admission to the hospital using early morning sample of 2 ml of serum using chemiluminescent immunoassay method. We correlated Vitamin D levels with socioeconomic status (SES) along with various other parameters like serum calcium (S. calcium). Results: It was observed that with the improvement of SES, the Vitamin D deficiency (VDD) did not improve. The biochemical parameters such as S. calcium and alkaline phosphatase revealed a significant correlation with Vitamin D status. S. calcium level was significantly low in children with VDD. Radiological evidence of rickets was seen only in 40.5% of cases of VDD and 14.3% of cases of Vitamin D insufficiency and thus was not a diagnostic hallmark for rickets. Conclusion: The data suggested that VDD is very common among children aged 1 month–12 years and it is not correlated with SES and calcium intake. Efforts need to be made to improve the Vitamin D status by creating awareness among people.

Lower respiratory infections mortality among Brazilians under-five before and after national pneumococcal conjugate vaccine implementation

BackgroundStudies on the impact of pneumococcal conjugate vaccines (PCV) on mortality, especially among preschoolers are scarce. We aimed to assess time trend mortality from lower respiratory infections (LRI), taken as a proxy of pneumonia, from 1990 to 2017. MethodsThis ecological study assessed the mortality rate among Brazilians under-five before and after the national PCV-10 implementation in 2010. Pneumococcal meningitis (PM) and diarrheal diseases (DD) were included as a “positive and negative controls”, respectively. Trend analysis was performed through Global Burden of Disease estimates. Joinpoint regression modeling was used to describe trends in mortality and to identify time points of its statistically significant decreases throughout the study period. ResultsThere was a sustainable reduction in mortality rates for these three diseases, with no relevant changes in the secular trends for LRI and PM after the PCV-10 implementation. For LRI, PM, and DD the higher and statistically significant (p < 0.05) annual percent change reduction occurred between 2000 and 2003, (−8.3%), 1997–2000 (−11.9%), and 1990–1994.(−13.8%), respectively, i.e., several years before the nationwide implementation of PCV-10. Moreover, for LRI the annual percent change (from −5.9 to −8.8) verified from 1990 to 2009, i.e., 20 years before countrywide vaccination, was comparable to that observed during the PCV era, that is, from minus 5.8 to minus 7.8, between 2010 and 2017. ConclusionMortality from LRI, PM, and DD decreased over time, irrespective of national PCV-10 implementation in Brazil. Other factors such as healthcare delivery, socioeconomic status improvement, and health interventions may have impacted this secular trend.

Declining trends in Hepatitis A seroprevalence over the past two decades, 1998–2017, in Pune, Western India

Reduction in seroprevalence of Hepatitis A virus (HAV) is known to be associated with improvements in socioeconomic conditions of the community. National Institute of Virology, Pune has been studying seroprevalence of hepatitis viruses in Pune region over the past four decades. In total, 1438 samples were collected from urban general (UGEN), urban lower socioeconomic stratum (ULSES) and rural (RURAL) populations of the Pune district. Based on estimates in previous studies, subjects were enrolled from age groups '6-10', '15-25' and '40 + ' years. HAV seroprevalence in younger population showed a significant decline. A significant decline in HAV seroprevalence in '15-25' years age group in UGEN (from 85.9% to 73.9%; OR = 0.46, 95% CI: 0.25-0.86) and RURAL (from 98.6% to 91.4%; OR = 0.15, 95% CI: 0.05-0.45) populations suggested that the trend probably started more than a decade ago. Seroprevalence of HAV among ULSES '6-10' children was found to be significantly higher (70.4%) than that among the RURAL children (44.2%; OR = 3.0, 95%CI: 1.7-5.2) and UGEN children (40.4%; OR = 3.5, 95%CI: 1.8-6.7). In view of increasing rates of urbanisation in India, ULSES population needs special consideration while designing future studies and viral hepatitis vaccination/elimination strategies. Our findings call for robust population-based studies that consider heterogeneity within populations and dynamics of socio-economic parameters in various regions of a country.

Trend of social iniquities in reports of sexual violence in Brazil between 2010 and 2014.

Sexual violence has emerged in the health field with changes in the epidemiological profiles of populations. An ecological study with 5,565 Brazilian municipalities between 2010 and 2014. A descriptive analysis of the variables (Population rate of sexual violence reporting, household income per capita and HDI) and their stratification by quintile was performed. In order to explore the factors associated with changes in social inequalities regarding the rate of reporting of sexual violence, the Slope Index of Inequality and Relative Index of Inequality were adopted. An Equiplot was constructed for the outcome on each independent variable. The mean rate of reports of sexual violence in Brazil was 4.38 reports/100,000 inhabitants for the period. There was an increase in the rate of sexual violence and improvement in socioeconomic conditions. There was a higher rate of reporting in the quintile with better living conditions. An increase in the inequality of the rate of sexual violence as a function of household income and the HDI was observed. Several factors seem to influence the increase of reports of sexual violence in the country, among them the improvement in the living conditions of the population and greater moral sensitivity to violence. However, there is still a disparity in reporting among municipalities according to their socioeconomic status. The lack of public policies on social equity in health has interfered with reports of sexual violence in the country and has widened health inequities.