Reproductive Group Research Articles

Prevalence of depression and anxiety among polycystic ovarian syndrome patients: a cross-sectional study

Background: Polycystic ovarian syndrome (PCOS) is one of the most common Hormonal disorder among women in reproductive age group. According to Indian fertility society prevalence of PCOS ranges from 3.7% to 22.5%. Women with PCOS have experienced adverse social, physical, emotional, and psychological consequences and they are at risk of developing depression, anxiety, sadness, and loneliness which had negative impact on their health. The problem was often overlooked and limited literature is available in this aspect. The objectives of this study was (a) to estimate the prevalence of anxiety and depression among women suffering from PCOS; (b) to assess the socio demographic factors among women with PCOS; and (c) to determine the association between depression, anxiety with clinical manifestations of PCOS. Methods: A cross-sectional study was conducted among 65 women effected with PCOS. International classification of disease-10, Hamilton depression rating scale and anxiety rating scale was used to assess the depression and anxiety. The required data was collected by semi structured, pilot tested questionnaire in local language. Data collected was analysed using MS excel 2019 and Epi-info version 7.2 software. Results: The mean age of the study population was 24.2±4.7 years. The prevalence of depression and anxiety among the study population was 66.1%, and 56.9% respectively. Menstrual irregularities 86.6% was the most common symptom. Conclusions: Higher prevalence of depression, anxiety was found among the PCOS patients, and associated with clinical manifestations. Thus, an appropriate approach towards psychological management should be implemented.

Mapping the disparities in intimate partner violence prevalence and determinants across Sub-Saharan Africa.

This study aimed to map disparities in prevalence and associated factors across countries in Sub-Saharan Africa. We used National Demographic and Health Survey (DHS) data from 26 countries in the region with 114,340 participants. Women and girls in the reproductive age group of 15 to 49 years were included in the study. To map disparities across countries and their provinces, we employed the kriging interpolation technique. We used STATA for data management. The prevalence of physical, emotional and sexual IPV in Sub-Saharan Africa was 30.58, 30.22, and 12.6% respectively, and at least one form of IPV was 42.62%. Disparities were observed across the countries and provinces in each country. Younger age, secondary-level education and above, moderate participation in decision-making, not working out of home, not afraid of the spouse, rich (wealth index), not having a child, high maternal literacy, and rural residence relatively decreased the odds of IPV. The husbands' lower education, alcohol consumption, and high controlling behavior increased the probability of IPV. The prevalence of Intimate Partner Violence in Sub-Saharan Africa is the highest in the world, a signal that the global agenda to end all forms of violence against women will be difficult to achieve. There is a large gap across countries and provinces in each country. Area-specific intervention packages that focus on modifiable factors should be strengthened.

Appraisal of Eating Disorders in Females of Reproductive Age by Using Scoff Questionnaire

Background: Unhealthy, jumbled eating habits and irregular eating behavior, often associated with body image and weight concerns, are known as abnormal eating behaviors. Anorexia nervosa, bulimia nervosa, and binge eating disorders are common disordered eating behaviors. Females are more likely than males to experience eating disorders. Objective: The research was conducted to determine the frequency of eating disorders in women of reproductive age group and identify the factors associated with it. Methods: It was a cross-sectional study carried out at Central Park Medical College, Lahore. Non-probability convenient sampling technique was used to collect data from 196 females of the reproductive age group (15-49 years) using the Scoff Questionnaire. Binary logistic regression was applied to observe the association of eating disorders with non-communicable diseases (NCDs). SPSS version 26 was used for data analysis. Results: About 82.8% of the females belonged to urban areas and out of those 44.5% had an eating disorder. Binary logistic regression analysis indicated that the odds of developing eating disorders were 85% high for obese women. Approximately 12.6% of the females agreed or strongly agreed that they overeat. Overeating was observed as a statistically significant associated factor with eating disorder (p value=0.048). Conclusion: Approximately 45.5% of the females were identified as either having anorexia nervosa or bulimia. Females living in cities and nuclear family systems had a higher percentage of eating disorders.

Conditional selection of multifactor evidence for the levels of anaemia among women of reproductive age group

The study aims at ascertaining the conditional selection of key indicators affecting severe, moderate, mild, and no anaemia levels for women of reproductive age in India. The secondary data for levels of anaemia and personal records of individuals collected for India from the 7th phase of District Health Survey program of the United States Agency for International Development data depository. The data was cleaned and summarised using frequency and percentages. Then the variables were tested for association with levels of anaemia using the Chi-square (χ2) test. The multinomial logistic regression model was employed to ascertain the key indicators through a conditional selection of reference categories. Results suggest that severe anaemia was significantly prevalent among women in the reproductive stage, especially among the 15–29 age groups. Secondary and higher education had a negative effect on the severity of severe, moderate, and mild anaemia. The poorest wealth index stratum had higher and more significant severe anaemia, and households with two adults of the opposite sex had a significant negative effect (β = −0.116, OR = 0.89, p < 0.001) on severe anaemia level while having a significant positive effect on moderate and mild anaemia. Rural households were associated negatively and significantly with moderate and mild anaemia, and nuclear household structures had a higher prevalence of severe anaemia. Therefore, these indicators across different levels of anaemia should be considered for a faster rate of reduction at the national level. Despite several initiatives by the public sector, the anaemia level has remained elevated among women of reproductive age. Education, wealth index, age, pregnancy, relationship structure, household structure, and place of residence were found to be key indicators for the level of anaemia. The significant variables will act as a crucial input to formulate cost-effective public interventions and finally encourage the faster reduction of anaemia levels.

Health-Related Quality of Life Among Women with Ovarian Cysts

Background: Ovarian cysts are a common finding in women of the reproductive age group. Aim: To evaluate the relationship between ovarian cysts and quality of life among women of reproductive age. Patients and Methods: A descriptive study was conducted at gynecological outpatient clinic and endoscopic unit in Zagazig university hospital. Sampling: A convenient sample was selected from 200 women with ovarian cysts. Data collection tools: 1) Socio-demographic Questionnaire. Quality of life was assessed with the 36-ItemShort Form Health Survey; 2) Physical and biological assessment; 3) Numeric pain scales and 4) Quality of life in women with ovarian cyst. Results: The results of the study revealed that the majority of women in the age group 17-50 years. Most of them complained of abdominal heaviness and fullness and loss of appetite, respectively. Moreover, most of them had moderate and severe pelvic pain, respectively. Also, more than half of them had severe pain that interfered with their normal physical activities. Moreover, most of women had average level regarding psychological and physical health. Conclusion: Health Related Quality of Life was significantly decreased in women with ovarian cyst. Thus, women with suspected or diagnosed ovarian cysts should seek immediate medical help because early diagnosis and treatment are beneficial in improving their quality of life.

P-540 Improper placentation due to skewed Oct4-Cdx2 expression may be a leading factor in idiopathic recurrent pregnancy loss (RPL) cases from Assam, India.

Abstract Study question Does the differential expression of key embryonic stem cell (ESC) markers due to upstream signaling cascade(s) deregulation influence RPL pathogenesis in the studied population? Summary answer Imbalanced Oct4-Cdx2 expression linked differential ESCs polarization due to β-catenin signaling deregulation during the peri-implantation period impacts RPL pathogenesis in the studied population. What is known already RPL affects approximately 2-5% of women globally and around 7% Indian women in reproductive age group; with 50% of case etiology being unclear. Proper placentation is indispensable for establishment, continuation, and success of a pregnancy; and it depends largely on a healthy balance between apoptosis and stem cell differentiation that aids proper trophoblast invasion. These differentiation events are tightly controlled by the interplay of oxygen tension, hormones, growth factors, other signaling molecules and most importantly by transcription factors including those deciding the stem cell lineage like Oct4, NANOG, and Cdx2, wherein, β-catenin is known to enhance Oct-4 activity in ESCs. Study design, size, duration The sample size was predicted using Raosoft software utilizing the prevalence rate of RPL. Overall 87 women with 2 or more pregnancy losses before completion of 20 weeks of gestation were enrolled as RPL cases with informed consent, whereas, for the control group, 107 women volunteers undergoing medical termination of pregnancy (MTP) were enrolled as gestation-week-matched comparative study group for experimental data analysis. Participants/materials, setting, methods Products of conception (POC) was collected from the MTP and RPL cases. POCs were collected in 2vials for every subject: (i) 4% buffered formalin for fixation and preparation of microscopic slides for immunofluorescence (IF) based protein expression of Oct4 and Cdx2; (ii) RNA later solution for site specific transcriptional analysis of Oct4, NANOG, Cdx2, and β-catenin utilizing Realtime PCR. The difference in expression was analyzed using SPSS statistical software. Main results and the role of chance IF based site specific protein expression data confirmed higher expression of OCT4 in RPL cases compared to MTP controls, whereas CDX2 expression was found to be low in RPL compared to MTP subjects. The Realtime PCR amplification of cDNA using β-actin as internal normalization control for Oct4 (25.76 ± 10.17 folds) and NANOG (18.32 ± 6.67folds) showed increased expression whereas the Cdx2 expression was downregulated (0.487 ± 0.186 folds) in RPL cases compared to MTP controls, indicating a shift towards pluripotency which is a non-favorable environment for the ongoing pregnancy since cell polarization for initiation of differentiation to different cell lineages is required at that time of gestation. The cdx2 and oct4 expression correlated inversely and significantly {Pearson’s correlation= −0.838, p = 0.009; Spearman’s rho= −0.786; p = 0.016}. The realtime PCR amplification of β-catenin, the key molecule involved in direct enhancing of Oct4 expression during gestation was found to be increased in RPL cases compared to MTP controls. Statistically, the β-catenin-Oct4 expression correlated positively significantly. Limitations, reasons for caution Being a patient based study, the present study is limited to being an associative study only; and therefore secondary validation of the data for causal association using cell lines or suitable model system futuristically may add valuable scientific inputs and aid clinical intervention modalities for controlling RPL. Wider implications of the findings As the majority of RPL pathogenesis etiology is undefined limiting the possibilities of clinical interventions therefore we presume the present data can layout possible therapeutic interventions by regulating key regulators influencing skewed ESC profile aiding proper placentation leading to successful pregnancy in a subpopulation of cases with RPL history. Trial registration number Not applicable

Prevalence and correlates of low birth weight in India: findings from national family health survey 5

BackgroundChildhood mortality and morbidity has become a major public health issue in low-middle-income countries. However, evidence suggested that Low birth weight(LBW) is one of the most important risk factors for childhood deaths and disability.This study is designed to estimate the prevalence of low birth weight (LBW) in India and to identify maternal correlates associated with LBW.MethodsData has been taken from National Family Health Survey 5 (2019–2021) for analysis. 149,279 women belonging to reproductive age group (15–49) year who had last recent most delivery preceding the NFHS-5 survey.ResultsMother's age, female child, birth interval of less than 24 months, their low educational level, low wealth index, rural residence, lack of insurance coverage, women with low BMI, anaemia, and no ANC visits during pregnancy are predictors that contribute to LBW in India. After adjusting for covariates, smoking and alcohol consupmtion is strongly correlated with LBW.ConclusionMother’s age, educational attainment and socioeconomic status of living has a highly significant with LBW in India. However, consumption of tobacco and cigarrettes are also associated with LBW.

Clinicopathologic characteristics and outcomes of late onset lupus nephritis: a single centre experience.

Systemic Lupus Erythematosus (SLE) occurs in the reproductive age group. Renal involvement occurs less frequently in late-onset SLE than in reproductive-age SLE patients. Here, we aimed to study the clinical, serological and histopathological characteristics of late-onset lupus nephritis (LN). Late-onset LN was defined as disease onset after 47years of age, corresponding to the average menopausal age. Records of biopsy proven late-onset lupus nephritis patients diagnosed between June 2000 and June 2020 were reviewed. Late-onset LN constituted 53 of 4420 patients (1.2%) biopsied during the study period. Females represented 90.65% of the cohort. Mean age of the cohort was 49.5 ± 7.05years at the time of SLE diagnosis while its renal presentation was delayed by median duration of 10months (IQR 3-48months). Renal failure was present in 28 patients (52.8%) with acute kidney injury (AKI) (28.3%, n = 15) as the most common presentation. On histopathological analysis, class IV was observed in 23 patients (43.5%), crescents were observed in one-third cases and lupus vasculopathy in 4 patients (7.5%). All patients received steroids. Majority of patients (43.3%; n = 23) received Euro lupus protocol for induction. On median follow up duration of 82months, renal flares were noted in 9 patients (17%) and 8 patients (15.1%) became dialysis dependent. Among 11 patients (21%) with infectious complications, 7 patients (13.2%) suffered from tuberculosis. Infections caused three-fourth of the deaths. Late-onset lupus nephritis is rare and presents as renal failure in majority. Renal biopsy affects the clinical decision of judicious use of immunosuppression which is imperative due to high rate of infections in this cohort.

Effect of Mefenamic Acid on Premenstrual Syndrome in Reproductive age Group

Background: Premenstrual syndrome is a cyclic disorder with symptoms that are severe enough to interfere with some aspect of living. The debilitating symptoms reappear with each cycle, the most common being generalized headache, breast swelling and tenderness, bloating, fatigue, depression and irritability. Aim: To determine the efficacy of mefenamic acid in treatment of premenstrual syndrome women in reproductive age groups. Methods: A quasi experimental study was donein the Department of Obstetrics and Gynecology, Federal Government Services Hospital, Islamabad between November 2020 and April2021. The study was carried out over 75 patients. Mefenamic acid for at least 3 months and followed up for a minimum of 3 months were advised. After follow up the sequel of symptoms and efficacy was noted. Results: Average age of the patients was 26.03±6.27 years. The symptoms of premenstrual syndrome nausea 84%, gastrointestinal tract disturbance 85.3% and headache 80% noted to be the leading symptoms followed by breast tenderness 77.3% and vomiting 74.7%.The efficacy of mefenamic acid in term of relieving of symptoms was observed 70.7%.Statistically significant improvement in symptoms of headache, dysmenorrhea, breast tenderness and mood irritability were noted (p ≤ 0.05). While no clinically significant distinction found among marital status, occupation, education and duration of symptoms improvement (p ≥ 0.05). Practical implication of the study is that the effect of mefenamic acid relieving the symptoms of PMS. Conclusion: The study concluded that mefenamic acid is effective in term of relieving symptoms in patients with premenstrual syndrome. Keywords: Mefenamic acid; Efficacy; Premenstrual syndrome; vomiting.

A histopathological study of ovarian lesions in a rural medical college

Ovarian lesions can present in any age of life and has a wide spectrum of presentation. They contribute to most of the pelvic masses encountered in clinical practice in reproductive age group. Histopathological examination is of prime importance in ovarian lesions as it is difficult to diagnose these lesions on basis of clinical history, radiology alone.: To analyse the spectrum of ovarian lesions and to categorize them on basis of histomorphological pattern. A total 132 cases were studied from January 2022 to December 2022. Relevant clinical details and histopathological findings were reviewed and analysed. A total of 132 cases of ovarian lesions were included in this study with age range from 20 years to 72 years. Non neoplastic cases were 71 and neoplastic cases were 61 in present study. Follicular cyst was the commonest non neoplastic lesion (48 cases) followed by haemorrhagic corpus luteal cyst (16 cases). Out of 61 neoplastic lesions, 56 were benign, 3 were borderline and 2 were malignant on histopathological examination. Mucinous cystadenoma was the commonest benign lesion and serous cystadenocarcinoma was the commonest malignant tumour in the present study. Borderline mucinous cyst adenoma was the commonest in borderline cases in our study. Unilateral presentation of ovarian lesions was found in 116 cases and bilateral in 16 cases. In present study majority of cases were of non neoplastic lesions. For accurate management of the ovarian lesions it is important to correlate clinical findings and ultrasonography findings with histopathology diagnosis.

Metformin Effects on Plasminogen Activator Inhibitor-1 in Polycystic Ovarian Women

Background: Polycystic ovary syndrome (PCOS) is a widespread complex endocrine disorder of women in the reproductive age group. Plasminogen activator inhibitor-1(PAI-1) has been shown to be associated with the regulation of inflammation and ovulation. Objectives: The aim of this study was to evaluate serum PAI-1 level and to determine the effects of metformin treatment on serum PAI-1 levels in patients with PCOS. Patients and Methods: This study was conducted on sixty women with PCOS, while 30 healthy women matched for age with the PCOS patients were selected as the control group, only 30 patients of them complete the follow up study and they agree to continue on metformin treatment during three months, the duration of the follow up. Study Design: A cross sectional study is done in Salah Al-Deen general hospital/gynecology and obstetrics department in Tikrit city from 1st November 2022-30th January 2023. Patients diagnosed with PCOs depending based on the Rotterdam criteria. Participants were enrolled after all eligibility criteria were confirmed and informed consent completed. The body mass index is determined before and after therapy. Homeostatic model assessment for insulin resistance is determined according to the following formula: (fasting insulin multiplied by fasting glucose) divided by 405. Fasting serum PAI-1 was measured by Enzyme-Linked Immunosorbent Assay method. Data were analyzed using SPSS for Windows 7. Results: Compared with the control group, the levels of PAI1, fasting blood glucose (FBG), Insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) While the levels of follicle stimulating hormone (FSH) were significantly decreased (P&lt;0.05). In the PCOS group were significantly increased (P&lt;0.05). Serum levels of testosterone in PCOS group was significantly increased (P&lt;0.05). In PCOS women treated with metformin for three months, all patients showed significant in decrease in PAI1, and testosterone concentration at p-values 0.05, when compared to pre-treatment. Treatment resulted a significant decrease in in body mass index, Blood glucose, Insulin, HOMA-IR, and LH at p-values 0.05. Conclusion: Plasminogen activator inhibitor-1 level decreased significantly after 3 months of treatment with 850 mg per day with metformin in women with PCOS.

Reformed Hormonal Status in Hyperandrogenism through Ayurvedic Management with &lt;i&gt;Yoga&lt;/i&gt; and &lt;i&gt;Prānāyāma&lt;/i&gt; in a Known Case of Polycystic Ovarian Syndrome - A Case Report

Polycystic Ovarian Syndrome is the commonest endocrinological disorder of women in the reproductive age group. It is characterized by oligo/anovulation, hyperandrogenism, and raised Luteinizing Hormone: Follicle Stimulating Hormone ratio. Elevated levels of Luteinizing Hormone, contribute to hyperandrogenism and the altered ratio between Luteinizing Hormone and Follicle Stimulating Hormone. The present case report discusses the Ayurvedic management of altered Luteinizing Hormone - Follicle Stimulating Hormone ratio in a diagnosed case of Polycystic Ovarian Syndrome. The patient was diagnosed as having Ārtava Kṣaya with Mukhadūṣikā and was subjected to Ayurvedic management for 6 months commencing with Śodhana followed by Śamana. A remarkable improvement was obtained after the course of treatment.

Geostatistical analysis for spatial distribution of anemia (Hb level) among women of reproductive age and determinant factors.

The study was designed to assess the geostatistical spatial distribution of anemia and determinant factors among the women of reproductive age group (RAG) in Gilgit district, Pakistan. The Hb levels for 15-25 RAG, 26-35 RAG, and 36-45 group showed 10.22 g/dL, 10.41 g/dL, and 9.90 g/dL levels, respectively, while the Hb level showed a nugget/sill ratio of 0.21 inferring strong for the 15-25 group, weak for the 26-36, and moderate for 36-45 spatial dependence. Furthermore, 15-25 RAG showed 8% severe and 33.34% sufficient cases and 26-35 showed 12% severe and 29.33% sufficient results in their Hb level, whereas 36-45 had 9.34% severe and 29.33% sufficient.

A Study to Assess the Effect of Planned Teaching Programme on Knowledge about Breast Cancer and Breast Self Examination among the Women of Reproductive Age Group in Selected Rural Areas of Kamrup

A Study to Assess the Effect of Planned Teaching Programme on Knowledge about Breast Cancer and Breast Self Examination among the Women of Reproductive Age Group in Selected Rural Areas of Kamrup

Evaluation of Morphological Patterns of Anemia in Females of Reproductive Age Group and Correlation with Red Cell Indices

Evaluation of Morphological Patterns of Anemia in Females of Reproductive Age Group and Correlation with Red Cell Indices

A Descriptive Cross - Sectional Study on Knowledge &amp; Treatment Seeking Behavior Regarding Leucorrhoea among the Reproductive Age Group Women in Rural Area: In View to Develop an Information Booklet on Management of Leucorrhoea

A Descriptive Cross - Sectional Study on Knowledge &amp; Treatment Seeking Behavior Regarding Leucorrhoea among the Reproductive Age Group Women in Rural Area: In View to Develop an Information Booklet on Management of Leucorrhoea

Vulval Fibroadenoma Presenting as a Unilateral Vulval Mass—A Report of a Common Neoplasm Present at an Uncommon Site

ABSTRACT Vulval fibroadenoma is a rare benign tumor arising from the ectopic breast tissue or mammary-like anal glandular tissue. Although it is a common breast neoplasm, its genital location makes it notable, with less than a hundred cases being reported in the literature so far. It is commonly known to present in the reproductive age group, similar to its breast counterpart, with its histogenesis being a frequent topic of discussion. Despite being benign and largely infrequent, these vulval neoplasms continue to be important reasons for medical consultation. We present one such case of vulval fibroadenoma presenting as an enlarged lymph node in a 37-year-old female.

Cervical Fibroids: A Surgical Challenge

ABSTRACT Leiomyomas are the most common benign tumors affecting the female reproductive tract and constitute around 18–20% of all the uterine pathologies that are seen in women of reproductive age group. Based on their location in the uterus, fibroids can be uterine, cervical, and ligamentary, of which the cervical fibroids are the rarest and make up only around 2–2.5% of the total incidence of fibroids. Large cervical fibroids generally give a typical appearance of “Lantern on St. Paul’s dome,” where the small size uterus sits on top of the cervical fibroid mimicking the lantern on the dome of the famous St. Paul’s Cathedral of Russia. We report here a case series of cervical fibroids who reported to the gynecology OPD of our institute. The first patient was a 41-year-old lady who presented with complaints of heavy menstrual bleeding for the last 2 years. Clinical findings as well as imaging confirmed a 24-week size large cervical fibroid along with surprise element in form of double ureters on right side on intravenous urogram(IVU). Our second patient was a peri-menopausal lady with heavy menstrual bleeding(HMB)for 2 months and cervical fibroid of 16-week size gravid uterus on examination. The third patient was a 37-year-old lady with heavy menstrual bleeding with pressure symptoms in the form of retention of urine. Clinically, a 16-week size cervical fibroid was present which after surgery revealed STUMP on histopathology. All patients were managed surgically with uneventful postoperative recovery.

Nutritional status of reproductive age group women: A community-based study.

Anemia continues to be a major public health problem worldwide, particularly among females of reproductive age in developing country settings. The prevalence of anemia in South Asia is among the highest in the world, mirroring overall high rates of malnutrition. 1) To estimate the prevalence of anemia and undernutrition among reproductive age group females. 2) To study factors associated with anemia and undernutrition among reproductive age group females. This was cross-sectional study, which was carried out from June 2011 to December 2012 at Nanded City in Maharashtra state among nonpregnant ever-married women of 15-49 years age with a sample size of 750 selected using probability proportional to size sampling technique. Percentage, Chi-square test, analysis of variance (ANOVA) test, and Student's t test were used for analyzing the data. The prevalence of anemia among reproductive age group women was 554 (73.9%). 20.8% of women were undernourished and 4.1% were obese. There was a significant difference in the hemoglobin percentage of study subjects in relation to their age at marriage, weight, and body mass index (BMI). Mean BMI increases significantly as the age of women and duration of marriage increases. Nutritional status has a significant effect on the grade of anemia. Women of reproductive age groups are affected by anemia irrespective of age and parity.

Aftermath of Chlamydia Trachomatis - The Tip of an Iceberg in Female Reproductive Health.

The magnitude of infertile couples worldwide was found to be 60-80 million. Genital infection due to Chlamydia trachomatis (C. trachomatis) is one of the most prevalent sexually transmitted infections (STIs) which may present as PID, leading to ectopic pregnancy, infertility or other adverse health outcomes. This study was done to assess the prevalence of C. trachomatis infections among female patients with infertility using real time PCR (RT-PCR) and to compare the findings of molecular testing with hysterosalpingography (HSG) and ultrasonography (USG). 50 endocervical swabs were collected from women of reproductive age group attending infertility clinic and stored at -80 ºC. DNA extraction was done with Helini bacterial mini spin kit and tested for C. trachomatis DNA by RT-PCR kit. Of the 50 patients, 43 (86%) had primary infertility, and 7 (14%) had secondary infertility. Three (6%) were positive for C. trachomatis by RT-PCR. Two had primary infertility and one had secondary infertility. Routine screening of C. trachomatis even in high-risk populations is not available in developing countries like India. The World Health Organization recommends syndromic approach for case management. Hence, a cost-effective, highly sensitive and specific test is the pressing priority in resource poor settings.