Publications by authors named "Sonali Sarkar"

76 Publications

Reasons for refusal among patients with tuberculosis and their household contacts to participate in an observational cohort study.

Perspect Clin Res 2021 Oct-Dec;12(4):234-235. Epub 2021 Sep 20.

Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

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http://dx.doi.org/10.4103/picr.picr_377_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8525795PMC
September 2021

Prevalence and factors associated with diabetes mellitus among tuberculosis patients in South India-a cross-sectional analytical study.

BMJ Open 2021 10 22;11(10):e050542. Epub 2021 Oct 22.

Department of Preventive and Social Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, Puducherry, India.

Objective: To determine the prevalence and determinants of diabetes mellitus (DM) among tuberculosis (TB) patients and to assess the additional yield and number needed to screen (NNS) to obtain a newly diagnosed DM among TB patients.

Design: We undertook a cross-sectional analysis of the cohort data under Regional Prospective Observational Research for Tuberculosis-India consortium. Newly diagnosed TB patients recruited into the cohort between 2014 and 2018 were included. Pretested standardised questionnaires and tools were used for data collection. Prevalence of DM among TB patients was summarised as proportion with 95% CI. Type II DM was diagnosed if random blood sugar level was >200 mg/dL or if the participant had a documented history of DM. NNS by blood glucose testing to diagnose one new DM case among TB patients was also calculated.

Setting: Three districts of South India: Puducherry, Cuddalore and Villupuram SUBJECTS: Newly diagnosed sputum smear positive pulmonary TB patients aged ≥16 years RESULTS: In total, 1188 TB patients were included. Prevalence of DM among TB patients was 39% (95% CI: 36.2% to 41.8%). In unadjusted analysis, elderly TB, marital status, caste, gender, higher education level, household income and obesity had a significant association with DM. However, in adjusted analysis, only marital status (currently married aPR; 3.77 (95 CI: 2.20 to 6.49), widowed/separated/divorced aPR; 3.66 (95 CI: 1.96 to 6.83)) and body mass index category (normal weight aPR; 3.26 (95 CI: 2.55 to 4.16), overweight aPR; 3.86 (95 CI: 2.69 to 5.52), obesity aPR; 4.08 (95 CI: 2.81 to 5.94)) were found to be significant determinants. The number of TB patients needed to be screened to find a new DM case was 12.

Conclusion: We found that one in three TB patients had coexisting DM. The number of TB patients needed to be screened to obtain a newly diagnosed DM patients was also determined. The study supports and highlights the need of RNTCP's effort in bidirectional screening of TB and DM.
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http://dx.doi.org/10.1136/bmjopen-2021-050542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8543642PMC
October 2021

'People listen more to what actors say': A qualitative study of tuberculosis-related knowledge, behaviours, stigma, and potential interventions in Puducherry, India.

Glob Public Health 2021 Oct 16:1-13. Epub 2021 Oct 16.

Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.

India has made substantial advancements in reducing the burden of tuberculosis (TB), but persons living with active TB (PLWATB) still face myriad challenges in seeking and receiving care, including TB-related stigma. To meet the END TB targets, it is critical that PLWATB engage in care and are able to adhere to treatment. This qualitative study aimed to understand TB-related stigma (perceived, enacted, and internalised) and possible interventions to reduce stigma in Puducherry and Tamil Nadu, India. We conducted 47 in-depth interviews with PLWATB and household members and eight focus group discussions: two each with PLWATB, their household members, healthcare workers, and key informants. We found varying TB-related knowledge: the vast majority of interview participants reported incorrect modes of transmission, although most were also aware that TB is curable. Participants reported high levels of perceived stigma, with nearly two-thirds of PLWATB choosing to hide their disease to avoid being stigmatised in their community. Participants supported interventions including celebrity advocacy and school-based programming to increase community knowledge and reduce enacted stigma as well as support groups and counselling to reduce internalised stigma in PLWATB. This study has the potential to inform future interventions to reduce TB-related stigma in India.
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http://dx.doi.org/10.1080/17441692.2021.1990372DOI Listing
October 2021

Prevalence and risk factors associated with latent tuberculosis infection among household contacts of smear positive pulmonary tuberculosis patients in South India.

Trop Med Int Health 2021 Dec 26;26(12):1645-1651. Epub 2021 Oct 26.

Department of Preventive & Social Medicine, JIPMER, Puducherry, India.

Objective: We aimed to determine the prevalence and find the risk factors associated with latent tuberculosis infection (LTBI) among the household contacts (HHC) of pulmonary TB patients.

Methods: This cohort study was conducted from 2014 to 2019. Pretested standardised questionnaires and tools were used for data collection. The prevalence of LTBI among HHCs of TB patients was summarised as proportion with 95% confidence interval (CI). Mixed-effects generalised linear modelling function (meglm) in STATA with family Poisson and log link was performed to find the factors associated with LTBI.

Results: In total, 1523 HHC of pulmonary TB patients were included in the study. Almost all HHC shared their residence with the index case (IC) for more than a year; 25% shared the same bed with the IC. The prevalence of LTBI among the HHC of TB patients was 52.6% (95% CI: 50.1-55.1%). In an adjusted model, we found that among HHC belonging to the age group of 19-64 years (aIRR = 1.2; 95% CI: 1.1-1.3; p-value: 0.02), to the age group >65 years (aIRR = 1.4, 95% CI: 1.1-1.9, p-value: 0.02) and sharing the same bed with the IC (aIRR = 1.2, 95% CI: 1.1-1.3, p value: 0.04) were independent determinants of LTBI among the HHC.

Conclusion: One in two household contacts of TB patients have latent tuberculosis infection. This underscores the need of targeted contact screening strategies, effective contact tracing and testing using standardised methods in high TB burden settings.
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http://dx.doi.org/10.1111/tmi.13693DOI Listing
December 2021

Tuberculosis-Learning the Impact of Nutrition (TB LION): protocol for an interventional study to decrease TB risk in household contacts.

BMC Infect Dis 2021 Oct 12;21(1):1058. Epub 2021 Oct 12.

Department of Medicine, Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA.

Background: Comorbidities such as undernutrition and parasitic infections are widespread in India and other tuberculosis (TB)-endemic countries. This study examines how these conditions as well as food supplementation and parasite treatment might alter immune responses to Mycobacterium tuberculosis (Mtb) infection and risk of progression to TB disease.

Methods: This is a 5-year prospective clinical trial at Jawaharlal Institute of Post Graduate Medical Education and Research in Puducherry, Tamil Nadu, India. We aim to enroll 760 household contacts (HHC) of adults with active TB in order to identify 120 who are followed prospectively for 2 years: Thirty QuantiFERON-TB Gold Plus (QFT-Plus) positive HHCs ≥ 18 years of age in four proposed groups: (1) undernourished (body mass index [BMI] < 18.5 kg/m); (2) participants with a BMI ≥ 18.5 kg/m who have a parasitic infection (3) undernourished participants with a parasitic infection and (4) controls-participants with BMI ≥ 18.5 kg/m and without parasitic infection. We assess immune response at baseline and after food supplementation (for participants with BMI < 18.5 kg/m) and parasite treatment (for participants with parasites). Detailed nutritional assessments, anthropometry, and parasite testing through polymerase chain reaction (PCR) and microscopy are performed. In addition, at serial time points, these samples will be further analyzed using flow cytometry and whole blood transcriptomics to elucidate the immune mechanisms involved in disease progression.

Conclusions: This study will help determine whether undernutrition and parasite infection are associated with gene signatures that predict risk of TB and whether providing nutritional supplementation and/or treating parasitic infections improves immune response towards this infection. This study transcends individual level care and presents the opportunity to benefit the population at large by analyzing factors that affect disease progression potentially reducing the overall burden of people who progress to TB disease. Trial registration ClinicalTrials.gov; NCT03598842; Registered on July 26, 2018; https://clinicaltrials.gov/ct2/show/NCT03598842.
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http://dx.doi.org/10.1186/s12879-021-06734-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8506078PMC
October 2021

Effect of 2 mg Versus 4 mg of Intravenous Zoledronic Acid on Bone Mineral Density at the Lumbar Spine in Indian Postmenopausal Women with Osteoporosis: A Double-blind Parallel-arm Randomized Controlled Trial.

J Res Pharm Pract 2021 Apr-Jun;10(2):71-77. Epub 2021 Aug 3.

Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Objective: The primary purpose was to compare the effect of 2 mg and 4 mg of intravenous zoledronic acid (ZA) on change in the lumbar spine (LS) bone mineral density (BMD) at the end of 1 year in postmenopausal women with osteoporosis. The secondary objectives were changes in BMD at the total hip and femoral neck, change in bone turnover markers (BTMs), and the incidence of new fractures.

Methods: This was a double-blind, parallel-arm, randomized control trial with an allocation ratio of 1:1 done in 70 postmenopausal women with osteoporosis.

Findings: The mean (±standard deviation) percentage increase in LS BMD at the end of 1 year was 4.86% ± 3.05% and 5.35% ± 3.73% in the 2 mg and 4 mg group, respectively. The dose of 2 mg ZA proved to be inferior to 4 mg with a noninferiority margin of 0.5%. There was no difference in BMD change at hip and BTMs between the two groups at the end of 1 year. Only one patient in 4 mg group developed two new vertebral fractures during a 12-month follow-up. Acute-phase reactions were the most common (43%) side-effects noted without any difference between the two groups ( = 0.63).

Conclusion: This study failed to show the noninferiority of 2 mg ZA compared to 4 mg ZA for change in LS BMD at the end of 1 year.
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http://dx.doi.org/10.4103/jrpp.JRPP_20_130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8420937PMC
August 2021

Comparison of profile and treatment outcomes between elderly and non-elderly tuberculosis patients in Puducherry and Tamil Nadu, South India.

PLoS One 2021 27;16(8):e0256773. Epub 2021 Aug 27.

Department of Preventive & Social Medicine, JIPMER, Puducherry, India.

The rising geriatric population and the increased susceptibility of this age group to tuberculosis (TB), the deadliest single infectious agent, is bothersome for India. This study tried to explore the demographic and treatment outcome differences between the elderly (aged 60 years and above) and non-elderly TB (<60 years) patients from South India. This study was part of a large ongoing cohort study under the RePORT India consortium. Newly diagnosed TB patients recruited into the cohort between 2014 and 2018 were included in this study. Pretested and standardized questionnaire and tools were used to collect data and were stored securely for the entire cohort. Required demographic, anthropometric and treatment related variables were extracted from this database and analyzed using Stata version 14.0. Prevalence of elderly TB was summarized as percentage with 95% confidence interval (CI). Generalized linear modelling was attempted to find the factors associated with elderly TB. A total of 1,259 eligible TB patients were included into this present study. Mean (SD) of the participants in the elderly and non-elderly group was 65.8 (6.2) and 40.2 (12.0) respectively. Prevalence of elderly TB was 15.6% (95%CI: 13.6%-17.6%) with nearly 71% belonging to 60-69 age category. Male sex, OBC caste, poor education, unemployment, marriage, alcohol consumption and unable to work as per Karnofsky score were found to be significantly associated with an increased prevalence of elderly TB. Unfavorable outcomes (12% vs 6.5%, p value: 0.018), including death (9.3% vs 3.4%, p value: 0.001) were significantly higher among the elderly group when compared to their non-elderly counterparts. The current TB programme should have strategies to maintain follow up with due attention to adverse effects, social support and outcomes. Additional research should focus on predictors for unfavorable outcomes among the elderly TB group and explore ways to handle the same. Rendering adequate social support from the health system side and family side would be a good start.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256773PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396735PMC
August 2021

Contraceptive knowledge, practice, and associated factors among currently married women of reproductive age group: A community-based study in Puducherry, India.

Health Care Women Int 2021 Jul 29:1-15. Epub 2021 Jul 29.

Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

In the present cross-sectional study, the researchers aimed to assess the contraceptive knowledge, practice, and associated factors among 2228 women in Puducherry, India. National Family Health Survey questionnaire was adopted for data collection and about 1924 women participated. Current use of any contraceptive was 78.6% and female sterilization was 62%. The majority (99.8%) knew female sterilization, but below average for other contraceptive methods. About 10.4% were aware of more than three contraceptive methods. Age group, homemaker, with children or one son, aware of less than three methods, residing nearby to health facility were associated with the higher practice of contraceptive methods.
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http://dx.doi.org/10.1080/07399332.2021.1953500DOI Listing
July 2021

Menstrual Hygiene Practices and Constraints in Availing Government Sanitary Pad Provision among Adolescents in Rural Puducherry: A Mixed Method Study.

Indian J Community Med 2021 Apr-Jun;46(2):288-291. Epub 2021 May 29.

Department of Preventive and Social Medicine, JIPMER, Puducherry, India.

Context: Although free and subsidized sanitary pads are provided by the government, proportion of adolescents availing this service remains low.

Aims: The aim of the study was to determine the proportion of adolescent girls availing supply of sanitary napkins from a rural health training center (RHTC) in Puducherry; to assess the level of satisfaction with government supply; and to identify reasons for not accessing the same.

Subjects And Methods: The mixed-method cross-sectional study done in July 2017 included 240 adolescent girls living in the RHTC service area of a tertiary care institute. Quantitative data were collected house to house with a pretested semi-structured questionnaire and qualitative data from a focused group discussion.

Results: Sanitary pads were used by all of the participants who achieved menarche. Of them, 87 (40.2%) used pads purchased outside and 127 (58.8%) used both government supply and private purchase. Reasons for not availing government supply were insufficient quantity and low quality, lack of information about the government provision, and accessibility issues.

Conclusions: Ensuring better quality and adequate quantity of sanitary pads supplied by the government along with increased awareness about the government provision can increase the utilization of the same by rural adolescents.
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http://dx.doi.org/10.4103/ijcm.IJCM_243_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8281880PMC
May 2021

Severe undernutrition in children affects tuberculin skin test performance in Southern India.

PLoS One 2021 16;16(7):e0250304. Epub 2021 Jul 16.

Department of Medicine, Section of Infectious Diseases, Boston University, School of Medicine, Boston, Massachusetts, United States of America.

Background: Undernutrition impairs immunity to Mycobacterium tuberculosis and is a risk factor for tuberculosis disease (TB). We aim to investigate if severe undernutrition affects the tuberculin skin test (TST) response among household contacts (HHCs) of pulmonary TB cases.

Methods: We analyzed data from HHCs (> five years) of pulmonary TB cases in Southern India. Undernutrition was defined as per World Health Organization based on body mass index (BMI) for adults (undernutrition 16-18.4 and severe undernutrition <16 kg/m2) and BMI relative to the mean for children (undernutrition 2SD-3SD and severe undernutrition < 3SDs below mean). Univariate and multivariate models of TST positivity (> five mm) were calculated using logistic regression with generalized estimating equations.

Results: Among 1189 HHCs, 342 were children (age 5-17 years) and 847 were adults. Prevalence of TST positivity in well-nourished, undernourished and severely undernourished children was 135/251 (53.8%), 32/68 (47.1%), and 7/23 (30.4%) respectively; among adults, prevalence of TST positivity was 304/708 (42.9%), 43/112 (38.4%) and 12/26 (46.2%), respectively. Severe undernutrition in children was associated with decreased odds of TST positivity (adjusted odds ratio 0.3; 95%CI 0.1-0.9).

Conclusion: Severe undernutrition in children was associated with decreased odds of TST positivity. False-negative TSTs may result from undernutrition; caution is warranted when interpreting negative results in undernourished populations.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250304PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284816PMC
October 2021

Covid-19 Pandemic: A spoiler for health research.

Natl Med J India 2020 Sep-Oct;33(5):257-259

Department of Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India.

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http://dx.doi.org/10.4103/0970-258X.317469DOI Listing
July 2021

Experiences of Volunteers and Patient Satisfaction in Home Based Palliative Care, Puducherry, South India-A Descriptive Qualitative Study.

J Palliat Care 2021 Jun 23:8258597211026400. Epub 2021 Jun 23.

Department of Anesthesiology and Critical Care, Puducherry, India.

Context: Increasing burden of non-communicable diseases and ageing population has parallely increased the need for Palliative care. Unavailable, inaccessible, and inadequate palliative care services in our setting increased the need for volunteers. In Puducherry, palliative care programme was implemented through trained volunteers in 2015.

Aims: To explore the experiences of volunteers who provide palliative care and also to get feedback on volunteering from the patients who received care.

Settings And Design: A descriptive qualitative study was carried out at two Non-Governmental Organizations (NGO) working for palliative care in and around Puducherry.

Methods And Material: Participants were selected purposively to include seven volunteers and eight patients to attain information saturation. The time period of this study was between September and October 2018.

Analysis Used: Manual thematic analysis was done to identify codes, which were grouped to form categories and themes.

Results: Factors that facilitated participants to take up the role of volunteers were witnessing the death of family members with unmet palliative care when required and experiences in organizations working for elderly and disabled children. Improvement in patients' condition and patient satisfaction motivated them to continue, despite lack of resources and social support. Their perception was of having become bolder and empathetic by working as palliative care volunteers. Patients reported satisfaction with the provision of drugs and other materialistic support like clothes and sweets during festivals; however, their basic and financial needs remained unmet.

Conclusion: The palliative care programme or the National programme for elderly should focus on components that would improve the quality of palliative care by reducing patients' dissatisfaction. Support in terms of provision of drugs, financial help and nutrition is necessary to improve both the patients' and volunteers' satisfaction in palliative care services.
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http://dx.doi.org/10.1177/08258597211026400DOI Listing
June 2021

Food for thought: addressing undernutrition to end tuberculosis.

Lancet Infect Dis 2021 10 23;21(10):e318-e325. Epub 2021 Mar 23.

Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston University, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston University, MA, USA.

Tuberculosis is the leading cause of deaths from an infectious disease worldwide. WHO's End TB Strategy is falling short of several 2020 targets. Undernutrition is the leading population-level risk factor for tuberculosis. Studies have consistently found that undernutrition is associated with increased tuberculosis incidence, increased severity, worse treatment outcomes, and increased mortality. Modelling studies support implementing nutritional interventions for people living with tuberculosis and those at risk of tuberculosis disease to ensure the success of the End TB Strategy. In this Personal View, we highlight nutrition-related immunocompromisation, implications of undernutrition for tuberculosis treatment and prevention, the role of nutritional supplementation, pharmacokinetics and pharmacodynamics of antimycobacterial medications in undernourished people with tuberculosis, and the role of social protection interventions in addressing undernutrition as a tuberculosis risk factor. To catalyse action on this insufficiently addressed accelerant of the global tuberculosis epidemic, research should be prioritised to understand the immunological pathways that are impaired by nutrient deficiencies, develop tools to diagnose clinical and subclinical tuberculosis in people who are undernourished, and understand how nutritional status affects the efficacy of tuberculosis vaccine and therapy. Through primary research, modelling, and implementation research, policy change should also be accelerated, particularly in countries with a high burden of tuberculosis.
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http://dx.doi.org/10.1016/S1473-3099(20)30792-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8458477PMC
October 2021

Preference on prenatal sex determination and its associated factors among currently married women of reproductive age group in Puducherry, India.

Niger Postgrad Med J 2021 Jan-Mar;28(1):51-56

Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Background: Sex determination refers to knowing the sex of foetus during prenatal period for non-medical reasons. Attitude of married women to sex determination is important to improve the sex ratio at birth.

Aim And Objectives: This study aimed to assess preference on sex determination and associated factors among currently married reproductive age group women.

Materials And Methods: This cross-sectional community-based study was done during 2016-2017 among 2228 currently married women of 18-49 years' age group in urban and rural Puducherry, India. Information on the demographic characteristics, level of awareness and preference for sex determination was obtained. Multiple logistic regression was used to identify factors influencing preference for sex determination. Unadjusted and adjusted odds ratio (AOR) as a measure of effects was used.

Results: Of 1979 respondents, all were aware that sex determination is possible. Majority of them did not prefer sex determination (95.4%, 1888). About 80 (4.0%) preferred, while 11 (0.6%) were undecided about it. Majority of them were aware that sex determination without medical indication is a crime. Common source of information was healthcare workers (76.4%). After adjusting for confounders, age group (18-24, AOR = 5.334; 25-29, AOR = 3.249; 30-34, AOR = 3.857; 35-39, AOR = 2.279), middle level education (AOR = 2.3), those with unmet need for family planning (AOR = 2.970) and urban area (AOR = 67.679) subjects were preferred more; housewife (AOR = 0.481) and those without living son (AOR = 0.406) had preferred lesser for sex determination compared to their counterparts.

Conclusion: About one in 25 currently married women preferred sex determination. It is comparatively more in urban areas. High-risk groups should be educated to develop correct awareness and attitude on prenatal sex determination.
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http://dx.doi.org/10.4103/npmj.npmj_269_20DOI Listing
March 2021

Risk factors for death during treatment in pulmonary tuberculosis patients in South India: A cohort study.

Indian J Tuberc 2021 Jan 1;68(1):32-39. Epub 2020 Oct 1.

Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India.

Objective: Identifying the risk factors for deaths during tuberculosis (TB) treatment is important for achieving the vision of India's National Strategic Plan of 'Zero Deaths' by 2025. We aimed to determine the proportion of deaths during TB treatment and its risk factors among smear positive pulmonary TB patients aged more than 15 years.

Study Design: We performed a cohort study using data collected for RePORT India Consortium (Regional Prospective Observational Research in Tuberculosis).

Setting: Revised TB Control Program (RNTCP) in three districts of South India.

Participants: The cohort consisted of newly diagnosed drug sensitive patients enrolled under the Revised National TB Control Program during 2014-2018 in three districts of southern India. Information on death was collected at homes by trained project staff.

Primary Outcome Measures: We calculated 'all-cause mortality' during TB treatment and expressed this as a proportion with 95% confidence interval (CI). Risk factors for death were assessed by calculating unadjusted and adjusted relative risks with 95% CI.

Results: The mean (SD) age was of the 1167 participants was 45 (14.5) years and 79% of them were males. Five participants (0.4%) were HIV infected. Among the males, 560 (61%) were tobacco users and 688 (75%) reported consuming alcohol. There were 47 deaths (4%; 95% CI 3.0-5.3) of which 28 deaths (60%) occurred during first two months of treatment. In a bi-variable analysis, age of more than 60 years (RR 2.27; 95%CI: 1.24-4.15), male gender (RR 3.98; 95% CI: 1.25-12.70), alcohol use in last 12 months (RR 2.03; 95%CI: 1.07-3.87), tobacco use (RR 1.87; 95%CI: 1.05-3.36) and severe anaemia (RR 3.53: 95%CI: 1.34-9.30) were associated with a higher risk of death. In adjusted analysis, participants with severe anaemia (<7gm/dl) had 2.4 times higher risk of death compared to their counterparts.

Conclusion: Though deaths during TB treatment was not very high, early recognition of risk groups and targeted interventions are required to achieve zero TB deaths.
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http://dx.doi.org/10.1016/j.ijtb.2020.09.022DOI Listing
January 2021

Prevalence and Time Trend of SARS-CoV-2 Infection in Puducherry, India, August-October 2020.

Emerg Infect Dis 2021 02;27(2):666-669

We conducted 3 population-based cross-sectional surveys, at 1-month intervals, to estimate the prevalence and time-trend of severe acute respiratory syndrome coronavirus 2 infection in Puducherry, India. Seropositivity rate increased from 4.9% to 34.5% over 2 months and was 20-fold higher than the number of diagnosed cases of infection.
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http://dx.doi.org/10.3201/2702.204480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853553PMC
February 2021

Comparing tuberculosis gene signatures in malnourished individuals using the TBSignatureProfiler.

BMC Infect Dis 2021 Jan 22;21(1):106. Epub 2021 Jan 22.

Boston Medical Center, Boston, MA, USA.

Background: Gene expression signatures have been used as biomarkers of tuberculosis (TB) risk and outcomes. Platforms are needed to simplify access to these signatures and determine their validity in the setting of comorbidities. We developed a computational profiling platform of TB signature gene sets and characterized the diagnostic ability of existing signature gene sets to differentiate active TB from LTBI in the setting of malnutrition.

Methods: We curated 45 existing TB-related signature gene sets and developed our TBSignatureProfiler software toolkit that estimates gene set activity using multiple enrichment methods and allows visualization of single- and multi-pathway results. The TBSignatureProfiler software is available through Bioconductor and on GitHub. For evaluation in malnutrition, we used whole blood gene expression profiling from 23 severely malnourished Indian individuals with TB and 15 severely malnourished household contacts with latent TB infection (LTBI). Severe malnutrition was defined as body mass index (BMI) < 16 kg/m2 in adults and based on weight-for-height Z scores in children < 18 years. Gene expression was measured using RNA-sequencing.

Results: The comparison and visualization functions from the TBSignatureProfiler showed that TB gene sets performed well in malnourished individuals; 40 gene sets had statistically significant discriminative power for differentiating TB from LTBI, with area under the curve ranging from 0.662-0.989. Three gene sets were not significantly predictive.

Conclusion: Our TBSignatureProfiler is a highly effective and user-friendly platform for applying and comparing published TB signature gene sets. Using this platform, we found that existing gene sets for TB function effectively in the setting of malnutrition, although differences in gene set applicability exist. RNA-sequencing gene sets should consider comorbidities and potential effects on diagnostic performance.
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http://dx.doi.org/10.1186/s12879-020-05598-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7821401PMC
January 2021

Extent of contraception methods practised by unmet need couples after counselling: a cross-sectional follow-up study in Puducherry, South India.

Fam Pract 2021 07;38(4):387-394

Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

Background: Information is paucity about the extent of contraception practise among the unmet need eligible couples after counselling.

Objective: To assess the prevalence and associated factors of unmet need for family planning (FP), the extent to which they practise desired contraception methods after baseline counselling and the reasons for not practicing it.

Methods: A community-based cross-sectional analytical study was conducted between 2016 and 2019 among 2228 currently married couples with periodic follow ups of unmet need group. Baseline data on unmet need were collected based on the National Family Health Survey questionnaire. Individual and couple counselling were performed through informing choice and the support for decision making was based on the unmet need reasons with follow-ups. The data were analysed using Stata software version 12.0 (StataCorp, College Station, TX).

Results: The total study population was 1924. The prevalence of unmet need for FP was 7.1% (137) with 2.9% (55) of unmet need for spacing and 4.3% (82) of limiting births. Age groups between 18 and 24 [adjusted odds ratio (AOR) = 4.463], 25-29 (AOR = 2.339), not having a child (AOR = 0.250), having one child (AOR = 2.369) and having lower socioeconomic status (AOR = 0.155) were significantly associated with unmet need. During the follow-ups, 37.2% (29/78) received who desired limiting births, while 43.6% (34/78) changed to spacing methods. In fact, the main reason for not adopting limiting births is the fear of post-operative surgery-related health problems.

Conclusions: This study emphasizes the need for follow-up counselling for guiding contraceptive use and recorded that majority of the unmet need couples started practicing contraception methods during the follow-ups. Besides, change in desired contraception methods was observed.
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http://dx.doi.org/10.1093/fampra/cmaa133DOI Listing
July 2021

Neonatal Tetanus in a Nomadic Population in South India: A Clinicosocial Case Study.

Indian J Community Med 2020 Jul-Sep;45(3):384-385. Epub 2020 Sep 1.

Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

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http://dx.doi.org/10.4103/ijcm.IJCM_306_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745819PMC
September 2020

Alcohol use and tuberculosis clinical presentation at the time of diagnosis in Puducherry and Tamil Nadu, India.

PLoS One 2020 17;15(12):e0240595. Epub 2020 Dec 17.

Section of Infectious Diseases, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America.

Setting: Alcohol use increases the risk of tuberculosis (TB) disease and is associated with worse outcomes.

Objective: To determine whether alcohol use affects TB severity at diagnosis in a high-burden setting.

Design: Participants were smear-positive people living with TB (PLWTB) in India. Disease severity was assessed as 1) high versus low smear grade, 2) time to positivity (TTP) on liquid culture, 3) chest radiograph cavitation, and 4) percent lung affected. Alcohol use and being at-risk for alcohol use disorders (AUD) were assessed using the AUDIT-C. Univariable and multivariable analyses were conducted.

Results: Of 1166 PLWTB, 691 (59.3%) were drinkers; of those, 518/691 (75.0%) were at-risk for AUD. Drinkers had more lung affected than non-drinkers (adjusted mean difference 10.8%, p<0.0001); this was not significant for those at-risk for AUD (adjusted mean difference 3.7%, p = 0.11). High smear grade (aOR 1.0, 95%CI: 0.7-1.4), cavitation (aOR 0.8, 95%CI 0.4-1.8), and TTP (mean difference 5.2 hours, p = 0.51) did not differ between drinkers and non-drinkers, nor between those at-risk and not at-risk for AUD.

Conclusions: A large proportion of PLWTB were drinkers and were at-risk for AUD. Alcohol drinkers had more lung affected than non-drinkers. Studies are needed to explore mechanisms of this association.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240595PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746146PMC
January 2021

Evaluation of factors influencing Mycobacterium tuberculosis complex recovery and contamination rates in MGIT960.

Indian J Tuberc 2020 Oct 19;67(4):466-471. Epub 2020 Jul 19.

Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India. Electronic address:

Background: Tuberculosis (TB) is a major public health problem worldwide. Contamination rate and poor recovery of Mycobacterium tuberculosis complex (MTBC) in MGIT960 culture may affect the early diagnosis of TB. Evidence is needed to determine the factors associated with contamination rates and MTBC recovery in MGIT960. Hence, we undertook this study to compare the factors influencing MTBC culture positivity and contamination rates in MGIT960 in patients with Pulmonary tuberculosis (PTB).

Methods: A total of 849 sputum samples from newly diagnosed smear-positive TB cases enrolled into the Regional Prospective Observational Research for Tuberculosis India cohort between May 2014 to March 2017 were analyzed. Samples were inoculated into MGIT960 and positive cultures were examined for the presence of MTBC by immunochromatographic test for detection of MPT64 antigen.

Results: Of the 849 cases, 811 (95.5%) were culture positive for MTBC, 23 (2.7%) were culture negative and 15 (1.8%) were contaminated. Salivary sputum showed significantly less culture yield compared to mucopurulent/blood stained samples (p = 0.021). Sputum from individuals <20 or ≥60 years showed lower culture yield of 93.9%, compared to those aged 20-59years (98.2%) (p = 0.002). Based on smear grading, culture isolation of MTBC by MGIT960 was 86.1%, 93.6% and 99.5% for negative, scanty and positive (1+/2+/3+) samples, respectively (p ≤ 0.0001). Sputum from HIV negative patients showed higher culture yield, compared to HIV positive patients (p ≤ 0.0001). Chest X-Ray revealed that patient with cavity showed higher culture isolation of MTBC compared to patients without cavity (p = 0.035). Contamination rates were higher in smear negatives (6.0%), compared to scanty (2.1%) and smear positives (1.1%) (p = 0.007). However, delay in transport of the specimen to the laboratory was the only independent factor significantly associated with increase in culture contamination.

Conclusion: Our results highlight that extremes of age, smear negativity, HIV infection, sputum quality and cavitation significantly influence the culture yield of MTBC, whereas transport duration and smear grading affected the contamination rates in MGIT960. Hence, addressing these factors may improve the diagnostic performance of MGIT960.
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http://dx.doi.org/10.1016/j.ijtb.2020.07.016DOI Listing
October 2020

Predictors of Loss to Follow-Up among Men with Tuberculosis in Puducherry and Tamil Nadu, India.

Am J Trop Med Hyg 2020 09;103(3):1050-1056

Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.

Identifying predictors of loss to follow-up (LTFU; treatment lapse ≥ 2 months) among people with tuberculosis (TB) may assist programmatic efforts in controlling the spread of TB. Newly diagnosed smear-positive TB patients were enrolled in the Regional Prospective Observational Research for TB study in Puducherry and Tamil Nadu, India. Treatment records were used to identify LTFU of those who were enrolled from May 2014 through December 2017. This nested case-control study evaluated male TB patients. Predictors were assessed using multivariable logistic regression. Of 425 men with TB, 82 (19%) were LTFU. In the adjusted analyses of males, divorced/separated marital status (adjusted odds ratio [aOR] 3.80; 95% CI: 1.39-10.38) and at-risk alcohol use (aOR 1.92; 95% CI: 1.12-3.27) were significant predictors for increased risk of LTFU, and diabetes was a significant predictor for decreased risk of LTFU (aOR 0.52; 95% CI: 0.29-0.92). Of 53 men with recorded date of last treatment visit, 23 (43%) and 43 (81%) had LTFU within the first 2 and first 4 months of treatment, respectively. Addressing at-risk alcohol use and providing more intensive follow-up could lead to improved treatment completion.
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http://dx.doi.org/10.4269/ajtmh.19-0415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7470548PMC
September 2020

Depression, Anxiety, and Stress among Rural South Indian Women-Prevalence and Correlates: A Community-Based Study.

J Neurosci Rural Pract 2020 Jan 3;11(1):78-83. Epub 2020 Mar 3.

Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry (JIPMER), India.

 The burden of common mental disorders (CMDs) which includes depression, anxiety, and stress-related disorders are on the rise in India. Women in rural areas form one of the high-risk groups with respect to CMDs due to their compromised status of living.  The aim of the study was to estimate the prevalence of depression, anxiety, and stress, and the predictors to depression among women in rural Puducherry.  A community-based, cross-sectional study was performed in 2016, among women aged 18 to 59 years, residing in the rural area of Puducherry. Prevalence of CMDs was determined using the Depression Anxiety Stress Scale (DASS)-21. Using a systematic random sampling method, women were interviewed in their houses. The socio-demographic characteristics along with risk factors for depression were captured using a semi-structured proforma. A multivariable logistic regression model was used to determine the predictors of depression.  A total of 301 women were surveyed and their mean age (SD) was 34.9 (10.2) years. The prevalence of depression, anxiety, and stress was found to be 15% (95% CI: 11.3-19.3), 10.6% (95% CI: 7.5-14.5), and 5% (95% CI: 3-8), respectively. Multivariable analysis identified that lesser education and living separately/divorced to be significant predictors for depression in these women.  About one in six adult women living in a rural area was found to be depressed, which is considerably high. This emphasizes the need for screening among women for common mental disorders in primary care settings, especially in rural areas so that early diagnoses happen and thus reduce the impact due to mental disability.
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http://dx.doi.org/10.1055/s-0039-1700595DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055615PMC
January 2020

Household food insecurity among patients with pulmonary tuberculosis and its associated factors in South India: a cross-sectional analysis.

BMJ Open 2020 02 28;10(2):e033798. Epub 2020 Feb 28.

Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

Objectives: Food insecurity is 'the limited or uncertain availability of nutritionally adequate, safe foods or inability to acquire foods in socially acceptable ways'. Majority of tuberculosis (TB) cases of resource-poor settings experience food insecurity, which impacts treatment adherence and outcomes. We aimed to determine level of household food insecurity (HFI) and its associated factors in patients with pulmonary TB.

Design: This is a cross-sectional analysis of data from an ongoing cohort study.

Setting: National Tuberculosis Programme (NTP) in three districts of South India.

Participants: All newly diagnosed pulmonary TB cases of the cohort enrolled in the NTP at the Designated Microscopy Centres (DMCs) and Primary Health Centres (PHCs) from October 2015 to October 2018.

Primary Outcome Measures: The proportion of baseline HFI assessed using a validated HFI Access Scale was summarised as percentage with 95% CI. Possible association of sociodemographic, morbidity and behavioural characteristics with HFI was assessed using χ test, and unadjusted prevalence ratios with 95% CI were calculated. The characteristics with values of p<0.2 in the univariate model were included in the multivariable generalised linear model (binomial function, log link) to derive adjusted prevalence ratios (aPRs) with 95% CI.

Result: Of a total of 765 patients, 261 had HFI and the proportion was 34.1% (95% CI 30.8% to 37.6%). Mild, moderate and severe food insecurity was found in 17 (2.2%), 67 (8.8%) and 177 (23.1%) TB cases, respectively. Patients with TB who had monthly family income less than rupees 3000 (aPR 2.0; 95% CI 1.3 to 3.0), Karnofsky Score of 60 or less (aPR 1.5; 95% CI 1.1 to 1.9) and those who were employed (aPR 1.4; 95% CI 1.0 to 2.0) were independently associated with HFI.

Conclusions: A high level of food insecurity was seen in households with TB cases. Additional food or cash assistance for this subgroup might improve food insecurity and thereby nutritional status.
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http://dx.doi.org/10.1136/bmjopen-2019-033798DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050349PMC
February 2020

Prevalence and correlates of elder abuse: A cross-sectional, community-based study from rural Puducherry.

Natl Med J India 2019 Mar-Apr;32(2):72-76

Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India.

Background: Elder abuse is a neglected problem and needs to be addressed to improve the quality of life (QoL) of the elderly. We aimed to study the correlates of elder abuse in rural Puducherry.

Methods: We conducted a cross-sectional, communitybased study among all the elderly people (60 years and above), from one of the four villages of a rural primary health centre in Puducherry. Participants were contacted at their homes. After obtaining consent, data were collected using (i) a structured, pre-tested questionnaire on sociodemographic details; (ii) elder abuse using the Hwalek-Sengstock Elder Abuse Screening Test; and (iii) QoL using WHO QoL-BREF. Multivariable logistic regression was used to identify predictors of elder abuse.

Results: Of the 243 elderly individuals studied, 63% were women. The prevalence of elder abuse was 50.2%. On multivariable analysis, elderly with higher education status were found to have lower odds for suffering from abuse (primary education odds ratio [OR] 0.39 [0.18-0.84]; middle school OR 0.35 [0.14-0.86]; high school OR 0.08 [0.01-0.4]) compared to those with no formal education and those above 80 years of age were found to have higher odds for abuse (OR 3.02 [1.1-7.9]) compared to those <80 years, after adjusting for confounders such as sex, socioeconomic status, marital status and living arrangement.

Conclusion: Half the elderly in our sample suffered from abuse. The higher age group and absence of formal education emerged as independent predictors of elder abuse.
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http://dx.doi.org/10.4103/0970-258X.275344DOI Listing
July 2020

Factors related to vaccine hesitancy during the implementation of Measles-Rubella campaign 2017 in rural Puducherry-A mixed-method study.

J Family Med Prim Care 2019 Dec 10;8(12):3962-3970. Epub 2019 Dec 10.

Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

Background: Measles is one the leading cause of morbidity, mortality, and disability among under-five children worldwide with India contributing to half of the burden. Hence, Measles-Rubella (MR) campaign was launched to vaccinate all the children between 9 months and 15 years. The current study was done to find the prevalence and factors related to vaccine hesitancy in the MR campaign 2017 in rural Puducherry.

Methods: This was a mixed-method study conducted with a quantitative part involving cross-sectional survey done among parents of children aged between 9 months and 15 years to determine the proportion of MR vaccine hesitancy and qualitative part involved in-depth interviews to explore the barriers and facilitating factors for the MR vaccine hesitancy.

Results: Among 461 participants, the prevalence of vaccine hesitancy for the MR campaign was 14.1% (95%CI: 11-17.6%). In adjusted analysis, only mother's age (aPR-2.27) was the significant predictor of vaccine hesitancy. In qualitative analysis, major facilitating factor for campaign was the role played by the doctors in spreading awareness regarding the importance of vaccine and trust by parents on doctors. Major hindering factors were inadequate knowledge regarding campaign, rumors spread about the safety of vaccine, sudden planning, and under preparedness at health system level.

Conclusion: The current study found that almost one-fifth of the parents were hesitant to give vaccination to children. Social media rumors, lack of knowledge among parents, and inadequate time in planning were major reasons for vaccine hesitancy. Hence, countries should undertake training and education of healthcare workers to empower them to address the vaccine hesitancy.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_790_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6924217PMC
December 2019

One-hour Recovery Time in Subjects Undergoing Percutaneous Liver Biopsy: A Quality Improvement and Patient Safety Project.

Cureus 2019 Sep 29;11(9):e5799. Epub 2019 Sep 29.

Gastroenterology and Hepatology, Brooke Army Medical Center, San Antonio, USA.

Introduction Liver biopsy is the gold standard in diagnosing, staging and guiding clinical management in liver disease. There are currently no standard guidelines for liver biopsy recovery time. The aims of this project are to study the safety of a one-hour recovery time after percutaneous liver biopsies and to measure the rate of complications and identify risk factors. Methods A total of 500 consecutive subjects who underwent a percutaneous liver biopsy at a single-center teaching institution (Brooke Army Medical Center) were enrolled between December 2016 and October 2018. Biopsies were performed using a 14-gauge Bard® Monopty® core biopsy needle using bedside ultrasound. Complications were defined as: Pain level > 5 out of 10, hospitalizations, emergency department visits, or other. Major complications were defined as: hospitalizations and emergency department visits. Results The only complication that required hospitalization was identified during the first hour of recovery. Liver biopsies of subjects with body mass index (BMI) ≥35 kg/m were not associated with more complications when compared to patients less than 30 kg/m. Using a spinal needle (3.5'') to anesthetize the liver capsule in subjects with excess subcutaneous tissue did not result in more complications when compared to the standard 1.5'' needle. Only 3% of the patients who received lidocaine alone for the biopsy required post-procedure medications. Conclusion Ultrasound-guided percutaneous liver biopsies, using a 14-gauge needle, were overall found to be safe. A one-hour post recovery period is adequate to identify all immediate major complications.
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http://dx.doi.org/10.7759/cureus.5799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827865PMC
September 2019

Effectiveness of different methods of health education on knowledge and attitude regarding palliative care among college students in urban Puducherry: a pre-post intervention study.

Int J Adolesc Med Health 2019 Sep 20. Epub 2019 Sep 20.

Sanjeevan Palliative Care Project, Puducherry, India.

Background The World Health Organization estimates that around 6 million people need palliative care in India but not even 1% of the patients have access to it. Objective To find the prevalence of knowledge on palliative care and compare the effectiveness of different methods of health education on attitude regarding palliative care among urban college students in southern India. Subjects A pre-post intervention study was conducted in three different arts, science and commerce colleges in urban Pondicherry in August 2017. Methods Data regarding attitude change towards palliative care by three different modes of intervention in the three colleges: health talk (Group A), health talk with video (Group B) and health talk and interaction with a patient's caregiver (Group C) - before and after intervention - were collected using a predesigned pretested structured questionnaire. Results Among the 65, 75 and 67 participants in Groups A, B and C, respectively - the majority belonged to urban nuclear families; the mean age was 19.5 (0.9) years and Group C had only female students. The prevalence of knowledge about palliative care was found to be 9.2%. There was a difference in attitude scores among the three groups (p = 0.02) with Group C having the highest change of a score with a median of 2 (-1,5). Conclusion Awareness about palliative care is very low among non-medical undergraduate college students of urban Pondicherry. The best method of health education in changing the attitude towards palliative care was interaction with patient's caregiver.
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http://dx.doi.org/10.1515/ijamh-2019-0058DOI Listing
September 2019

Caregivers' perspectives on disclosure, care, and treatment among pediatric HIV/AIDS patients in South India: A qualitative study.

Ind Psychiatry J 2018 Jul-Dec;27(2):219-225

Department of Community Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

Background: Rollout of antiretroviral therapy (ART) has helped to achieve the increased life span among pediatric HIV patients. The psychosocial aspects of parents or caregivers can affect the treatment adherence in children and the disease outcome.

Aims And Objectives: This study aims at understanding the perspectives on disclosure of HIV status, stigma, antiretroviral treatment, and compliance among caregivers of children attending ART clinic in South India and to explore the barriers to treatment-seeking behavior.

Materials And Methods: This facility-based qualitative study was carried out among caregivers of pediatric HIV patients <15 years of age. In-depth interview was conducted on caregivers after informed consent in the absence of the child, focusing on stigma, disclosure of HIV status to children, adherence, and coping strategies followed by the parents. The complete interviews were transcribed in English, and content analysis was done to identify the emergence of codes. Interview was conducted among mothers of affected child. The disease status of the children was known only to the parents and not to the children themselves (excepting one) or siblings. Parents intended to keep it confidential for the affected children as long as possible. Nevertheless, to maintain adherence and to prevent disclosure of HIV status, mothers traveled to this ART center from very far places, medical records were hidden, and tablets were removed from the strips and said to be medicines for energy and protection.

Conclusion: Mothers of HIV-positive children faced many difficulties to prevent the disclosure of the diagnosis from the affected children and others, which is not very conducive to adherence to the ART regimen. Effective disclosure strategies to manage this emotionally vulnerable group are an urgent need.
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http://dx.doi.org/10.4103/ipj.ipj_54_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592199PMC
July 2019

Interaction of nutritional status and diabetes on active and latent tuberculosis: a cross-sectional analysis.

BMC Infect Dis 2019 Jul 16;19(1):627. Epub 2019 Jul 16.

Department of Epidemiology, Boston University School of Public Health, Boston, USA.

Background: Malnutrition and diabetes are risk factors for active tuberculosis (TB), possible risk factors for latent TB infection (LTBI), and may interact to alter their effect on these outcomes. Studies to date have not investigated this interaction.

Methods: We enrolled 919 newly diagnosed active TB patients and 1113 household contacts at Primary Health Centres in Puducherry and Tamil Nadu, India from 2014 to 2018. In cross-sectional analyses, we used generalized estimating equations to measure additive and multiplicative interaction of body mass index (BMI) and diabetes on two outcomes, active TB and LTBI.

Results: Among overweight or obese adults, active TB prevalence was 12-times higher in diabetic compared to non-diabetic participants, 2.5-times higher among normal weight adults, and no different among underweight adults (P for interaction < 0.0001). Diabetes was associated with 50 additional active TB cases per 100 overweight or obese participants, 56 per 100 normal weight participants, and 17 per 100 underweight participants (P for interaction < 0.0001). Across BMI categories, screening 2.3-3.8 active TB patients yielded one hyperglycemic patient. LTBI prevalence did not differ by diabetes and BMI*diabetes interaction was not significant.

Conclusions: BMI and diabetes are associated with newly diagnosed active TB, but not LTBI. Diabetes conferred the greatest risk of active TB in overweight and obese adults whereas the burden of active TB associated with diabetes was similar for normal and overweight or obese adults. Hyperglycemia was common among all active TB patients. These findings highlight the importance of bi-directional diabetes-active TB screening in India.
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http://dx.doi.org/10.1186/s12879-019-4244-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636094PMC
July 2019
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