Western Maharashtra Research Articles

Study of Outcome After One Year Follow Up of Tuberculosis Patients After the Completion of Treatment in Tertiary Care Center in Western Maharashtra

Background: Tuberculosis (TB) still remains an important public health problem in India. After completion of treatment, we hardly know that what happened to these cases once they are declared as cured and released in community. Hence the study was conducted to find out the outcomes and factors associated with them. Material and methods: It was a longitudinal observational study. Patients were followed up for up to one year after completion of the treatment for weight gain, and adverse side effects. Results: In our study 91 % of the cases were cured, 1.7 % were treatment failure and 2.18 % died. All the cases of recurrent TB were cured. HIV and TB co-infection was found in 15.7 % cases. 85% of patients tolerated the anti-tubercular therapy (ATT) well. The incidence of extra pulmonary TB was 19.2 %. Out of 229 cases 16 failed to gain weight at the end of therapy. The gain in weight was statistically significant (p value <0.001). The adverse outcome was seen in 20 cases. Conclusion: In our study, 91 % of the cases including 100% of recurrent Tb cases were cured because of newer RNTCP program. The incidence of extra pulmonary TB was higher than the national average. The majority (85%) of patients tolerated the anti-tubercular therapy (ATT) well. Out of 229 cases, only 16 patients failed to gain weight at the end of therapy. The gain in weight was significant predictor of good outcome in treating tuberculosis. The factors like weight gain, age, sex, place of stay or comorbidities were not associated as predictors of poor outcome. However, presence of co-morbidity like HIV and Diabetes may be associated with poor outcome but a higher sample size may be required to confirm it.

Undernutrition among under-five children in Western Maharashtra

Background: Undernutrition in under-five children still remains a major public health problem. Most of the under-five deaths are due to undernutrition, putting the child at more risk of catching common infections. The contributing factors for undernutrition may differ from one region to another. Aim: The aim of this study was to study undernutrition in rural under-fives. Settings and Design: A cross-sectional study was carried out. The study included 307 under-five children from a rural area of western Maharashtra. Information was collected on pretested semi-structured questionnaire after taking informed consent. The anthropological measurements were taken by standard methods. The statistical tests were performed and 5% level significance was taken for analysis. Statistical Analysis Used: Data were analyzed using software: WHO Anthro3.2.2, SPSS 26, and Epi Info v7.2.4.0. Results: More than half of the under-five children (56.3%) were found to be undernourished. The prevalence of underweight, stunting, and wasting was found to be 33.5%, 35.5%, and 12.4%, respectively. Logistic regression performed showed prelacteal feed, colostrum, BPL cardholder status, and per capita income to be significantly associated with undernutrition. Conclusions: Undernutrition still persists to be a major public health concern in rural areas. Most of the determinants of undernutrition are modifiable. The preventive and remedial measures should be an ongoing process to combat this problem.

Assessment of Meteorological Drought using Standard Precipitation Index (SPI) in Western Maharashtra, India

The crop production in rainy season in rainfed areas is dependent on vagaries of monsoon and is adversely influenced. The knowledge of different rainfall characteristics such as onset and withdrawal of monsoon, dry spell and drought would enable the optimal crop planning and implementation of protective irrigation strategies, thus mitigating the adverse impact of uncertainties of rainfall. The assessment of drought is one of the most important steps in risk management of drought analysis. The basis of drought indices is often based on measuring the deviation of precipitation values from long-term mean, during a specific period of time. The standard precipitation index (SPI) can be used for indicating the associated temporal and spatial variations. The aim of this research is the assessment of the characteristics such as intensity of meteorological drought using SPI with 12 months time scales in Western Maharashtra, India. The index has been computed in with 12 months time scales for 105 stations with 30 years record period in the study area and evaluated for the recent drought during 1983-2012. The results indicate that the rainfall pattern of Western Maharashtra exhibits non-uniform, irregular and erratic pattern of rainfall, as evidenced from SPI values. The meteorological drought shifted one step towards severity of drought condition for the time scales (month 1-12) i.e. from extremely wet to very wet; very wet to moderately wet; moderately wet to near normal; near normal to moderately dry; moderately dry to severely dry and severely dry to extremely dry condition.

Comparison of nutritional status of HIV positive children with homecare and institutional care/ orphanage - An eye opener cross sectional study.

ABSTRACTBackground:Nutrition has an important bearing on the health of Human immunodeficiency virus (HIV) positive children. Ascertaining the nutritional demands correctly and provisioning the nutritional needs to HIV positive/ Acquired Immunodeficiency syndrome (AIDS) children will go a long way in maximizing the therapeutic benefits reaped through ever improving pharmaceutical initiatives, and thus, contribute to prolonging the longevity of these children who have a whole life ahead of them.Objectives:To study the nutritional status, including dietary assessment and anemia status of HIV-positive children, and compare the outcomes among children under homecare (staying with families) and orphanages/institutional care.Methodology:A cross sectional study was carried out among children between 2 and 15 years who were attending Pediatric Outpatient department (OPD) of a tertiary care hospital in western Maharashtra. Data were collected from 106 children by the interviewer himself using pretested validated questionnaire along with anthropometric measures and relevant blood tests. A 24-h recall method was used to collect the dietary intake. Institutional ethical clearance was taken, and data were collected through informed consent of the parent/guardian accompanying the children.Results:Out of the 106 subjects studied, 54 (50.9%) were living in orphanages and 52 (49.1) were living with the family. Out of the 52 subjects of children under caregivers, 48.1% of the caregivers were unskilled workers and more than half of the subjects had a monthly family income of less than Rs 3,000. About 46.1% of the subjects’ caregivers were illiterate. In the orphanage, 28 (51.8%) were males and 26 (48.2%) were females; 52 (49.1%) children were living with family of whom 30 (57.7%) were males and 22 (42.3%) were females. The prevalence of anemia (86.5%) and undernutrition (61.1%) was more among those living with family compared to the orphans living in orphanages and the same was statistically significant (P < 0.05). Among the children living in orphanages, the mean intake for most of the nutrients was more across all age groups. Within homecare, the mean nutrient intake of the females for all nutrients was more than the males across all age groups except 3–9 years, where it was more in males. Overall, all the children received less of water-soluble vitamins compared to recommended daily allowances (RDA), and the children of age group 5–15 years received less vitamin A and iron also.Conclusion:Adequate nutrition, which is best achieved through the consumption of a balanced healthy diet, is vital for health and survival for all HIV-infected children. Specific measures to be directed to children under homecare and measures directed to improve social factors need to be undertaken.

Spare the rod and spoil the child? Child disciplining practices adopted by mothers in Urban Maharashtra, India

Background: Very little is known about child disciplining practices adopted by parents in India. Few studies carried out in India have shown a high prevalence of violent disciplining practices. Aims: We carried out this study to assess the nature and severity of violent disciplinary practices (VDPs) adopted by mothers in urban Maharashtra and identify possible social and demographic factors associated with them. Materials and Methods: This descriptive cross-sectional study was carried out in a hospital attached to a medical college in Western Maharashtra, India. One hundred mothers were included in our study, and written informed consent was taken from all participants. The UNICEF/WHO Child Discipline Module questionnaire was used as the data collection tool. Ethical clearance was also obtained from the Institutional Ethical Committee before the conduct of the research. Statistical Analysis: Contingencies tables were made to find out factors associated with discipline behavior. Bivariate logistic regression was done, and factors found statistically significant were taken into multivariable logistic regression. Results: Seventy-one percent of mothers used VDP against their children. The older age of a child's mother and father and female gender significantly increased the child's risk of facing VDP. Conclusion: There is a need to sensitize parents on the ill effects of VDP on the physical and mental health of children.

Novel pyriproxyfen based treatment for Aedes breeding control through a long-lasting formulation: Laboratory and field trials in Western Maharashtra, India.

There is a need to evaluate novel techniques for dengue control in India. Several formulations of pyriproxyfen have been assessed for efficacy and duration of action. Pyriproxyfen is also used as a microencapsulated ready-to-use formulation against the Aedes vector. We evaluated a novel pyriproxyfen-based microencapsulated formulation. This slow-release, ready-to-use aqueous spray is a larvicidal formulation, and we assessed its efficacy and residual action through laboratory and semi-field trials against Aedes immature stages. The study was carried out as per the guidelines for laboratory and field/small-scale field testing of mosquito larvicides by the World Health Organization. The evaluation was conducted in laboratory and semi-field conditions from August to December 2018. We tested the novel formulation on three materials (plastic, ceramic, and enamel) in the laboratory for its action as an antilarval. Four containers of each kind were sprayed with the formulation and kept as replicates. Four controls were used in the laboratory trials - 120 larvae (third instar) were introduced in the replicates and the controls each. Readings were taken daily till complete adult emergence or larval and pupal mortality. In the semi-field trials, we applied this formulation to the inside of desert coolers and observed larvicidal and pupicidal activity over five months. Data is presented in numbers and percentages, along with mean and standard deviation. Adult emergence and Emergence Inhibition was calculated. There was 100% adult emergence inhibition amongst the exposed larvae in the treated containers in the laboratory trials. In the untreated controls, adult emergence ranged from 80-95% in all types of containers. In the semifield trials, Inhibition Emergence was 100% in the treated desert coolers during the five months of the study period. This advancement in insecticide formulation technology promises to make dengue control more effective and efficient.

A retrospective observational study of appearance and fusion of ossification centres in lower limb radiographs of patients reported in the tertiary health care centre

Bone ossification study is the most important part of age determination. Earlier studies were predominantly done on upper limb bones & joints; hence this bone ossification study of lower limb bones gives the opportunity to correlate earlier findings with the present study. A Retrospective cross-sectional study has been done in order to study bone ossification patterns in western Maharashtra. Lower limb radiographs of patients of the age group ranging from 1 month - 25 years reported from 1st April 2017 to 31” March 2020 at the tertiary hospital were studied for appearance and fusion of ossification centres. Out of429 patients, 236 were male and 193 females. Cases were divided joint-wise into two groups for appearance & fusion study. Age of appearance & fusions compared with Gaulstaun's chart & other studies, which are found mostly similar with some variations of 1–2 years attributed to region & sex of the individual. Complete fusion of epiphysis is a more accurate indicator of age than the stage of fusion. In general, females show appearance & fusion of ossification centres, 1 -2 years earlier although with some exceptions. We recommend more such studies be undertaken, region-wise with more sample size.

Non-communicable disease risk factors among people living with HIV/AIDS (PLHA) - A relook during the covid-19 pandemic.

Background:The Covid-19 pandemic has resulted in syndemic due to factors like overcrowding, loneliness, poor nutrition, and lack of access to health care services. With the ongoing pandemic, people with NCDs, including PLHA, are at high risk for developing severe and even fatal Covid-19 infections. Our study, which was carried out prior to the pandemic gives us an insight into the NCD risk factors profile of PLHAs so that effective interventions could be initiated to protect them from Covid-19 severity and NCDs.Materials And Methods:A prospective study was carried out among PLHA in western Maharashtra, where PLHA were selected from five ART centers by means of a systematic random sampling method. Data were collected by means of a pretested questionnaire to assess NCD risk factors and anthropometric measurements were done. Data were collected at the baseline during the time of ART initiation and then after one year. Analysis was done by means of SPSS software (version 20.0). Results: The mean age of the study participants was 41.73 years. 59% belonged to rural areas, 21% were illiterate, and 12% belonged to the lower class as per the Modified BG Prasad scale. 33% were laborers by occupation, 66% were married, and 22% were widowed. At baseline, during the start of ART, 26% of the subjects were found to be overweight or obese, 36% had tobacco or smoking habits, and 15% had alcohol consumption habits. Even after one year, despite repeated counseling, about 32% of the subjects were found to be overweight or obese, 28% had tobacco and 8% had alcohol consumption habits, pointing to the need to integrate NCD prevention measures, such as screening routinely as per the national program, even in the PLHAs. 34% had normal BMI, while 35% were underweight, 14% overweight, and 17% obese after one year. 24% of PLHA had abnormal waist circumference at the end of one year.Conclusion:These findings indicate the incorporation of early screening for NCD risk factors among PLHA and effective behavior change communication (BCC) strategies to prevent and manage the same at the earliest before it can aggravate the already compromised immune status in these subjects, particularly during this Covid 19 pandemic. It will also act as a guiding article for family physicians or primary care physicians to help them look at specific basic parameters while screening of NCDs among PLHAs.

Consumptive Use, Water Use Efficiency and Moisture Extraction Pattern of Summer Pearl Millet in Western Maharashtra as Influenced by Sowing Times and Irrigation Regimes

A field experiment was conducted during summer 2010 and 2011 at Water Management Project Farm, Mahatma Phule Krishi Vidyapeeth, Rahuri, Ahemadnagar, Maharashtra, India to find out appropriate sowing times and irrigation regimes for summer pearl millet. Twelve treatment combinations were investigated in this study: four with sowing times including D1 - 6th MW (5th - 11th February), D2 - 8th MW (19th - 25th February), D3 - 10th MW (5th - 11th March) and D4 - 12th MW (19th - 25th March) and the remaining three treatments were of irrigation regimes I 1 - 100 mm CPE, I 2 - 125 mm CPE and I 3 - 150 mm CPE. Irrigation water for all treatments was precisely supplied using Replouge flume. The consumptive use of water was more in 8th MW (394.2 mm) followed by 6th MW (391.0 mm) and 10th MW (382.2 mm). The consumptive use of water was more in 100 mm CPE irrigation regime (443.47 mm), followed by 125 mm (379.67 mm) and 150 mm CPE (321.0 mm) irrigation regime. Whereas, reverse trend was noticed for water use efficiency was more in 150 mm CPE (8.16 kg ha-1 mm-1) irrigation regime. The soil moisture extraction was more from middle soil moisture layer of 15-30 cm in 6th MW followed by sowing of crop in 8th, 10th and 12th MW during both the years. The soil moisture extraction from surface layer of 0-15 cm was more with 100 mm CPE irrigation regime owing to adequate moisture supply followed 125 mm CPE and 150 mm CPE irrigation regime during both the years. The sowing of summer pearl millet in 8th MW increased grain yield (30.09 q ha-1), consumptive use (394.16 mm) and net monetary returns (Rs. 25742 ha-1) while the 100 mm CPE irrigation regimes increased grain yield (29.48 q ha-1), consumptive use (443.47 mm) and net monetary returns (Rs. 23784 ha-1). Results indicated that 100 mm CPE irrigation treatment gave the highest crop yield, followed by 125 mm CPE and 150 mm CPE irrigation regimes treatments. Increasing water stress sharply decreased biomass production. Water use efficiency (WUE) was increased as inadequate water is supplied to crop (150 mm CPE irrigation regime). Results also proved that summer pearl millet sowing in 8th MW (19-25th February) and irrigating with 100 mm CPE irrigation regime treatment is a practical tool to harvest maximum crop yield, monetary benefits and water use efficiency.

Oxidative stress in sickle cell anemia can be a prognostic marker for disease severity

CONTEXT: Sickle cell anemia (SCA) or sickle cell disease (SCD) is an inherited blood disorder characterized primarily by chronic anemia and periodic episodes of pain. There are reports that increase in oxidative stress may play a significant role in the pathophysiology of SCA. AIM: The present study aims to investigate enzymatic and nonenzymatic antioxidant status in SCA patients to understand the incidence of increased oxidative stress in the populace of tribal Palghar region of Western Maharashtra. SUBJECTS AND METHODS: Patients with SCA (n = 250) and age- and sex-matched healthy persons (n = 250) as controls from the primary health center of Palghar were included in this study. Informed written consent was obtained from all the participants. RESULTS: Activities of enzymatic antioxidants such as glutathione peroxidase, glutathione-S-trasferase, catalase, and level of nonenzymatic antioxidants such as glutathione, Vitamin E and C decreased significantly in SCA participants when compared to controls. The level of lipid peroxides and activity of superoxide dismutase increased significantly above normal in SCA participants. SCA is characterized by the increased generation of reactive-oxygen species resulting in oxidative damage of various cell types, including erythrocytes and this chronically elevated oxidative stress in SCD might play a significant role in the increased autoxidation of Sickle hemoglobin (HbS), increased intravascular hemolysis, ischemia-reperfusion injury, and chronic inflammatory complications. CONCLUSION: The present study indicates that oxidative stress can be considered one of the prognostic markers to evaluate the clinical severity of the SCA participants.

Prevalence of Oral Lesions among HIV Positive Patients Attending Antiretroviral Therapy Centre in Rural Area of Western Maharashtra

Introduction: The Oral Manifestations (OM) of Human Immunodeficiency Virus (HIV) is indication of compromised immune status and disease progression. These Oral Lesions (OL) cause morbidity and affect quality of life of the patients. Aim: To evaluate the association between OM in patients with HIV infection and their level of cluster of differentiation 4 (CD4) count. Materials and Methods: The study was designed as a descriptive, cross-sectional study for a duration of two years which included a total of 565 known HIV-positive individuals visiting the regional Antiretroviral Therapy (ART) center for counseling and/or on Highly Active Antiretroviral Therapy (HAART) were selected irrespective of age and sex. The oral lesions were diagnosed using the presumptive criteria given by by the European Committee (EC) Clearinghouse, 1993. Oral and systemic manifestations were recorded and associated with CD4 counts. The data collected was subjected to statistical analysis using Statistical Package of Social Science (SPSS) 8.0 software and p-value was considered significant at a level of 0.05. Results: The male-to-female ratio was almost equal and 95.04% of the patients had reported heterosexual contact as the transmission route. The peak age of occurrence of HIV infection was during 31-40 years with the mean age of males and females 39.26 years and 34.46 years respectively. Pulmonary tuberculosis (16.11%) and herpes zoster (16.81%) were the most common systemic manifestations. The prevalence of OM reported was 86.01% and was higher in females than in males. Intraoral melanotic pigmentation (50.08%) was the most common finding, followed by periodontitis (36.46%), linear gingival erythema (14.51%), Necrotising ulcerative gingivitis (NUG) (4.42%), candidiasis (8.67%), oral ulcers, herpes zoster (5.13%), herpes simplex virus infection (1.17%) and salivary gland disease (SGD) (0.7%). There was a significant association (p=0.0110) between OL and reduced CD4 count. Conclusion: OL occur commonly in HIV infection. The decrease in CD4 count is associated with a wide range of OM. The result from this study can be used as predictive marker for oral manifestations in AIDS based on the level of immune suppression and help in improving their quality of life.

Prevalence of extended spectrum β-Lactamases Klebsiella pneumoniae in various clinical samples and characterization of the bla genes in a tertiary care hospital of Western Maharashtra

Introduction: This study was carried out to determine the presence of blaTEM, blaSHV, and blaCTX-M genes in extended-spectrum β-lactamase (ESBL) producing Klebsiella pneumoniae at a tertiary care hospital of western Maharashtra. Materials and Methods: A total of 2312 clinically significant, non-repetitive isolates of K. pneumoniae isolated from outpatient and inpatients attending the hospital were included in the study. An antibiotic susceptibility test, screening, and phenotypic confirmation for ESBLs producers were performed to check for the presence of ESBL enzymes. A polymerase chain reaction was carried out for the detection of ESBL-producing genes CTX-M-15, TEM, and SHV. Results: Non-repetitive clinical specimens processed for culture and identification in our hospital revealed 931 (40.26%) were ESBL-producing K. pneumoniae. A total of 45 bacterial isolates were subjected to molecular genotyping for the production of extended broad spectrum β-lactamases. Of the 45 samples, 40 (88.9%) were positive for blaCTX-M gene, and 44 (97.8%) were positive for blaTEM and blaSHV genes. ESBL production in these samples is largely found to be contributed by CTX-M, TEM, and SHV genes as the prevalence for these genes was higher. Conclusion: This is among the premier report describing the simultaneous occurrence of blaTEM, blaSHV, and blaCTX-M genes and their dissemination. This raises concern and emphasizes a need for more molecular studies to search for the presence of these gene pools in this locality.

Determination of sexual dimorphism of maxillary sinus using cone-beam computed tomography in a rural population of western Maharashtra – A retrospective, cross-sectional study

Context:Radiography is used in forensics for the identification of humans, especially in cases where the body is decomposed, fragmented, or burned. In the skull bones, the zygomatic bone and maxilla including the maxillary sinus tend to remain intact even if the other bones are badly disfigured. Hence, the maxillary sinus has been considered by several authors for sex identification. The cone-beam computed tomography (CBCT) is a non-invasive, recently developed technology that has seen an exponential rise in the use for visualizing dental anatomy and pathologies. The present study chose the available CBCT records of patients who show maxillary sinus and used them for determining sexual dimorphism related to the maxillary sinus.Aims:To measure the maxillary sinuses using CBCT and determine the efficacy of these measurements for sex identification.Settings and Design:Observational, cross-sectional, retrospective study.Methods and Material:A total of 60 CBCT scans (30 males, 30 females) were selected from a rural setup, and the height, length, and width of the maxillary sinus with the highest dimension for each variable were measured and recorded.Statistical Analysis:The data were analyzed by using the paired t-test. The discriminant equations were derived for both the right and left maxillary sinus.Results:Statistically significant differences were observed between the males and females for height (right and left) and length (left) of the maxillary sinus. The accuracy rate for sex identification in the present study was found to be 71.3%.Conclusion:Maxillary sinus height can be used as a reliable radiographic marker in forensic odontology for sex identification.

A young clinician's perspective on deprescribing in elderly patients: A pilot study

Background: Young doctors have various barriers and hesitations towards de-prescribing. This study was planned to assess Young Clinician's perspective on deprescribing in elderly population from India. Methodology: Observation cross-sectional study done in a tertiary care hospital of Western Maharashtra. A web link consisting of 12 survey questions was shared on smart phones of postgraduates working in clinical specialties. Attitudes, knowledge, barriers and approach towards deprescribing were assessed. Results: Out of 64 doctors 30 doctors responded and completed the survey. Mean age was 32.6 years. Most common cause for deprescribing was to reduce the adverse drug reactions (76.33%), lack of definite indication (63.33%). Most common drug to be de-prescribed were multivitamins (70.66%), benzodiazepines (46.66%) and antiplatelets (43.33%). The most common barrier for de-prescribing was altering the prescription of another doctor (56.66%), lack of time and concerns on the adverse effect (36.66%). Ninety percent of the doctors were not aware of any deprescribing criteria and 70% did not have any specific approach. Conclusion: Deprescribing of drugs is a very important concept, which needs to be included in training the undergraduate medical students, postgraduate medical students and Pharmacy students.

Community-based appraisal of menopause-specific health problems and quality of life among women of rural Western Maharashtra.

Menopause is an important hormonal transition of women's lifespan which can strike as early as 30-35 years of age. Menopause-specific quality of life (MENQoL) mainly depends upon awareness, frequency, and intensity of menopausal symptoms; sociocultural, lifestyle, and dietary factors; and availability of health services specifically focusing on these issues. As life expectancy increases, women have to spend more years after menopause. So menopause specific quality of life will be a major issue of concern in the near future. The aim of this study was to assess the post-menopausal symptoms and quality of life (QoL) amongst post-menopausal women and their association with various sociodemographic factors. A community-based, descriptive, cross-sectional study was undertaken at Sakuri village among 100 postmenopausal women. Information was collected using MENQoL questionnaire. Unpaired t-test and Chi-squared test were used. The mean age of participants and menopause was 51.8 ± 4.54 years and 46.42 ± 4.13 years, respectively. The major symptoms reported were hot flushes (70%), under accomplishment (100%), bloating (100%), decrease in physical strength (95%), and change in sexual desire (78%). Statistically significant association was found between age and psychosocial domain. QoL was associated with age and educational level. More than half of the participants had poor QoL for all four domains. Awareness about post-menopausal changes and available treatment modalities can improve QoL. Accessible and affordable gynaecological and psychiatric health services through channel of primary health care are necessary to alleviate these complaints.

Water, sanitation, and hygiene (WaSH) practices among people living with HIV/AIDS (PLHA) - need to relook, in the era of COVID-19 pandemic.

Water, sanitation, and hygiene (WaSH) practices always have been neglected among HIV/AIDS (Human immunodeficiency virus/ Acquired immunodeficiency syndrome) programs, even when HIV and WaSH services have robust bearing on each other. With COVID-19 pandemic on the go, it is utmost necessary for the people living with HIV/AIDS (PLHA) to ensure adequate WaSH practices. This study was carried out with an objective to assess baseline WaSH practices among PLHA and to find out if any association between nutritional status and WaSH parameters so as to identify the shortcomings and highlight the importance of WaSH practices among PLHAs and give suitable recommendations to program managers. A cross-sectional study was carried out among PLHA registered in ART centres of western Maharashtra. A sample size of 378 consented to be part of the study were included in the study, by means of systematic random sampling. Data were collected by means of pretested questionnaire prepared from guidelines and previous studies. Institutional ethical clearance was obtained and informed consent was taken from study participants before data collection. Strict confidentiality was maintained throughout the study period. When asked about the water processing method, 76% of them told they do not treat/process the water supplied to them. In contrast, only a few PLHA told they would filter (17%), boil (7%), and use aquaguard (1%). The majority (67%) had their latrines, and while 29% of them were using public latrines and its hygienic sanitation was a concern for them and 4% were still practising open-air defecation in rural areas. Almost all study participants were handwashing after toilet use and handwashing before consuming food. The majority (79%) told they used soap and water, while 20% were using only water, soil and water (1%) and ash and water (1%) which was a concern. Of all the households, 87% cooked their food twice and consumed it thrice a day, while 4% prepared thrice. 10% of them cooked only once and consumed thrice a day; 56% practised consumption of leftover food of the previous night which was a concern. A majority (54%) did not consume street food while remaining said that they used to consume street food. But majority (59%) said they did not follow the habit of checking hygiene or sanitation of hotel where they used to consume food while the remaining 41% did not check the hotel before ordering the food; 50% of them bought packaged milk while 40.9% brought from unpasteurized dairy. On analysis, hygiene and sanitation factors had no statistically significant association with the nutritional status of study participants. WaSH factors act synergistically with other factors to affect the holistic health of PLHA. Information, Education and Communication (IEC) activities (continuous and regular), that focus on improving awareness level on WaSH practices, need to be promoted and integrated into HIV program, including providing basic care packages to PLHA like household water treatment products and soap, etc., Such measures will go a long way in maintaining health of PLHA even during ongoing COVID-19 pandemic scenario.

Community Based Appraisal of Healthcare Service Utilisation and Determinants of Health Seeking Behaviour among the Elderly Population of Rural Western Maharashtra

Introduction: To mitigate an inevitable phenomenon of population ageing, which has impact on nation’s development as well as on quality of life of population, health seeking behaviour and health service utilisation need to be increased, especially in rural areas. Aim: To assess health seeking behaviour, identify hurdles and measure health services utilisation. Materials and Methods: A community based observational descriptive cross-sectional study was conducted with 210 elderly population (60 years of age and above) to assess health seeking behaviour and to measure health service utilisation for the period from October 2020 to October 2021, in rural area of Tasgaon block of Sangli district of Maharashtra by Department of Community Medicine, Government Medical College, Miraj, Maharashtra, India. A pretested, prevalidated, semi-structured proforma and interview schedule were used to collect information. Descriptive statistics along with chi-square test and Binary logistic regression were used as inferential statistical analysis. The p-value to be significant at p&lt;0.05. Results: Out of total 210 participants, 48.09% and 51.91% were males and females respectively with male to female ratio of 0.93:1. Mean ages of males and females were 63.85 and 65.23 respectively.Out of total 210 participants, 82% of participants had at least one chronic morbidity at the time of study. Musculoskeletal morbidities were most common (46.67%). Among morbid participants, 56% utilised government health facility. Health service utilisation rate was 75.86%. Lack of enough money was most common reason (76.19%) for non utilisation of health services. Gender, educational level, residential arrangements and socio-economic class showed statistically significant association with appropriate or inappropriate health seeking behaviour. About 61% participants showed appropriate health seeking behaviour. The odds of having inappropriate health seeking behaviour were 7.76 and 10.19 times greater for middle class and lower class as opposed to upper class, respectively. Illiterates had 17.53 times higher odds to seek health inappropriately. Conclusion: Quality of health seeking behaviour can be improved by narrowing gender gap, increasing literacy rate and giving social assistance to elderly persons. It is an important need of hour to pay more attention to age related issues and promote holistic approach to deal with ageing society.

Association of genetic polymorphism in Vitamin D receptor and Paraoxonase I genes with type II diabetes mellitus patients in rural South Western Maharashtra

Background: Type II diabetes mellitus (T2DM) is increasing at an alarming rate in urban as well as rural parts of India. Change in life-style, dietary habits, aging, environmental factors contribute to developing this disorder, T2DM is a polygenic disorder which involves large number of genes interacting with each other and the environment to manifest itself phenotypically. Aims and Objectives: In the present study, we investigated the association of Vitamin D receptor (VDR) and Paraoxonase I (PON I) gene polymorphisms with T2DM patients among rural population in South western Maharashtra. Materials and Methods: The study groups included healthy non-diabetic control group (n = 120), non-obese diabetic group (n = 120), obese diabetic group (n = 120) from the same geographical region. The single nucleotide polymorphisms (SNPs) amongst these groups were studied using Polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP) for VDR and PON I genes. Results and Conclusion: Amongst the studied genes VDR SNP rs1544410 [OR 0.24 (0.1-0.63); P 0.005] and Paraoxonase I SNP rs854560 (OR 0.47 (0.26-0.84); P 0.015) had a protective effect against T2DM for non-obese individuals. Whereas only VDR SNP rs1544410 [OR 0.025 (0.003-0.91); P 0.001] had a protective effect in case of obese individuals. The findings suggest greater gene-gene interaction and gene-environment interactions influence the phenotypic outcomes of genetic polymorphisms.

Visual impairment and blindness among children from schools for the blind in Maharashtra state, India: Changing trends over the last decade.

Purpose:To determine the causes of severe visual impairment and blindness in children in schools for the blind in Maharashtra, India.Methods:Children aged <16 years, enrolled in the schools for the blind in Maharashtra state, India were examined between October 2018 and December 2019. The anatomical sites and etiology for blindness were recorded using the World Health Organization’s standard reporting form. Causes of blindness were compared among different regions of the state and also by different age groups.Results:Of the 1,969 students examined from 39 schools for the blind, 188 children (9.5%) had severe visual impairment and 1,666 children (84.6%) were blind. Whole globe anomalies (794, 42.8%) were the most common anatomical site of vision loss in children, followed by corneal (289, 15.6%) and retinal abnormalities (280, 15.2%). Corneal causes were second most common in the poorer districts of Vidarbha (15.3%) and Marathwada (14.6%), whereas retinal causes were second most common in the wealthier regions of western Maharashtra (18.3%) and Khandesh (24.1%). Nearly one-third (593, 32%) of children were blind from potentially avoidable causes. Preventable blindness consisting of corneal causes and retinopathy of prematurity was seen in 281 (15.2%) cases, whereas treatable causes comprising of lens-related causes, glaucomas, refractive errors, amblyopia, and uveitis accounted for another 311 (16.8%). Among the younger children (≤10 years), the proportion of corneal blindness was lower (83/623, 13.3% vs. 206/1232, 16.7%) and that of retinal blindness was higher (119/623, 19% vs. 163/1232, 13.2%) than the older children.Conclusion:Whole globe anomalies constitute a major cause of SVI and blindness in Maharashtra. There seems to be an increase in the proportion of retinal blindness, especially retinopathy of prematurity, suggesting a need for increased screening coverage.

Use of contact tracing as a pivotal tool to curb the COVID-19 transmission in the urban part of Western Maharashtra

Introduction: Contact tracing is an essential public health response to infectious disease outbreaks, principally in the early stages of an outbreak when specific treatments are limited. Importation of novel coronavirus (SARS CoV-2) from Hubei province China and elsewhere into the world highlights the need to recognize the power of contact tracing as a preventive measure. This study was performed to estimate the SARS CoV-2 transmission among the contacts of confirmed cases of coronavirus disease-19 (COVID-19). Methods: The present study included data from contact tracing performed on confirmed COVID-19 cases admitted in the tertiary care hospital of western Maharashtra. Contacts were categorized into high-risk and low-risk contacts. Contacts were quarantined in home or institute, and reverse transcription–polymerase chain reaction (RT-PCR) was done as per the COVID-19 testing strategy. Contacts were admitted once they were RT-PCR-confirmed COVID-19 positive. Results: Out of 471 COVID-19 cases, 104 (22.08%) were females and 367 (77.92%) were males. A total of 2617 contacts were traced with the mean (standard deviation) of 5.56 (8.52). Of these 2617 contacts, 289 (11.04%) contacts became RT-PCR-confirmed positive COVID-19 cases. Out of 471 COVID-19 cases, 271 (46.7) were the contacts of RT-PCR-confirmed COVID-19 cases, and from them, 92 (42.4%) were asymptomatic at the time of admission. Conclusion: The contact tracing strategy in India helped to identify a sufficient proportion of infected individuals, and due to that, subsequent spread of the disease could be prevented. However, the complete achievement will depend on the rapid detection of cases and isolation of contacts. With the increasingly large number of cases globally once in between the null period, this strategy can be effectively utilized to contain the spread of disease.