1. Children in the age group of 5 to 15 years studying in the government schools from 1st to 10th... more 1. Children in the age group of 5 to 15 years studying in the government schools from 1st to 10th standard were called along with their school teachers/parents to the pediatric outpatient department as a part of periodic school health check-up program. A sample size of 1600 students was calculated to provide sufficient statistical power (>80%) at the 5% significance level. Students were examined classand section-wise in groups of 30 on pre-decided days in arrangement with the respective class teachers.
To strengthen malaria surveillance, field-appropriate diagnostics requiring limited technical res... more To strengthen malaria surveillance, field-appropriate diagnostics requiring limited technical resources are of critical significance. Loop-mediated isothermal amplification (LAMP) based malaria diagnostic assays are potential point-of-care tests with high sensitivity and specificity and have been used in low-resource settings. Plasmodium vivax–specific consensus repeat sequence (CRS)-based and Plasmodium falciparum–specific 18S rRNA primers were designed, and a two-tube LAMP assay was developed. The diagnostic performance of a closed-tube LAMP assay and Loopamp™ Malaria Detection (Pan/Pf, Pv) kit was investigated using nested PCR confirmed mono- and co-infections of P. vivax and P. falciparum positive (n = 149) and negative (n = 67) samples. The closed-tube Pv LAMP assay showed positive amplification in 40 min (limit of detection, LOD 0.7 parasites/µL) and Pf LAMP assay in 30 min (LOD 2 parasites/µL). Pv LAMP and Pf LAMP demonstrated a sensitivity and specificity of 100% (95% CI, 95...
Background Neonatal sepsis is a major cause of death in India, which needs hospital management bu... more Background Neonatal sepsis is a major cause of death in India, which needs hospital management but many families cannot access hospitals. The World Health Organization and the Government of India developed a guideline to manage possible serious bacterial infection (PSBI) when a referral is not feasible. We implemented this guideline to achieve high coverage of treatment of PSBI with low mortality. Methodology The implementation research study was conducted in over 50 villages of Palwal district, Haryana during August 2017-March 2019 and covered a population of 199143. Policy dialogue with central, state and district health authorities was held before initiation of the study. A baseline assessment of the barriers in the implementation of the PSBI intervention was conducted. The intervention was implemented in the program setting. The research team collected data throughout and also co-participated in the implementation of the intervention for the first six months to identify bottlene...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020
Background: India has moved from single drug Antiretroviral Therapy (ART) in 2002 to triple drug ... more Background: India has moved from single drug Antiretroviral Therapy (ART) in 2002 to triple drug ART in 2013 to prevent parent to child transmission of HIV. The aim of the study was to know the effects of triple drug ART on maternal CD4+ count and prevention of HIV transmission to baby along with its adherence, side effects and pregnancy outcome.Methods: A prospective study wsas done in Safdarjung Hospital, New Delhi on 40 HIV positive pregnant women who received single dose combination of triple drug ART. CD4+ count, LFT and KFT were done before beginning of ART and repeated after 6 months of ART. The infants received nevirapine prophylaxis and HIV status was determined by DBS PCR at 6 weeks.Results: The median CD4+ count was 317 and 397 pre and post ART for 6 months respectively (p value<0.001. Low birth weight (LBW) was seen in 43.59% which was statistically significant but confounded as 76.4% of these babies were preterm. 23.08% of babies had an APGAR of < 7 at 1 minute, o...
Background: India accounts for 21% death among under-five children but the profile of the childre... more Background: India accounts for 21% death among under-five children but the profile of the children admitted in tertiary hospitals is poorly documented. We conducted secondary analysis of all hospital admissions in pediatrics wards for 1½ years to understand outcomes in different age groups. Methods: Data from October 2014 to March 2016 were retrieved and analyzed, with a focus on the age distribution at admission and death, duration of stay and outcome. Results: Almost 10% admitted children died and another 15% left the hospital before completing treatment. The analysis of 2135 deaths suggests that half of the children died within 24 h of admission. Death rate was highest among children on their 1st day of life (39%), and it reduced gradually with increase in age. Infants share 71% of all the deaths. Conclusion: Maximum death within 1st day of admission demands a further review of our referral system and health seeking behavior.
We conducted a study to find a relationship between main weather parameters with admission of pos... more We conducted a study to find a relationship between main weather parameters with admission of positive dengue cases in a tertiary hospital. Retrospective analysis was undertaken to identify epidemiological trend of dengue in 2016 from paediatric wards of a tertiary hospital in New Delhi. Data were collected on patient particulars and daily weather from January to December 2016. A total of 266 confirmed cases of dengue were considered. Relative humidity (RH) was associated with burden of positive dengue cases. On week-wise analysis, each surge of dengue admission was preceded by heavy rain 4-6 weeks earlier. Monthly averaged daily temperature range and RH were noted to have strong correlations with dengue burden, keeping an interval of 2 months in between. Weather parameters seem to influence magnitude of dengue epidemic, particularly in dengue season. There is need to have an in-depth study about developing a prediction model for dengue epidemic.
195 cases of acute poisoning among children (age<12 y) in a tertiary hospital were identified ... more 195 cases of acute poisoning among children (age<12 y) in a tertiary hospital were identified over a period of one year. Two-thirds (63%) of them were males and 75% were below five years of age. Poisoning by medicines was most common (17%) followed by ingestion of corrosives/detergents (16%) and kerosene (14%).
Retrospective analysis was done for 3817 children aged 5-12 years admitted in a tertiary-care, pu... more Retrospective analysis was done for 3817 children aged 5-12 years admitted in a tertiary-care, public hospital in New Delhi between January to December, 2015. Mortality rate was 5.8%. About 47.1% deaths were due to central nervous system involvement; viral meningoencephalitis being the predominant cause. Overall, infectious diseases caused >80% of deaths. Public health interventions to reduce child mortality need to review such data for effective measures.
Medical Journal of Dr. D.Y. Patil University, 2016
Transport of sick newborns is undergoing massive changes in India. Over past few years, specializ... more Transport of sick newborns is undergoing massive changes in India. Over past few years, specialized transport has been activated in most of the states although out of pocket expenditure and absence of health personnel in the ambulance are still posing hurdles. With gradual expansion of all-weather roads to the furthest corner of the country and introduction of free transport for all neonates, it brings opportunities for us to reach all the sick newborns to the nearest equipped hospital at the earliest. Telecommunication and presence of health personnel during transport and training on life support are other initiatives boosting health care of the neonates during transport. Thus, improved transport could be a solution for reduction of stagnant neonatal mortality in India.
Sir, We read with interest the article on out-of-pocket expenditure (OOPE) by Mondal et al.1 The ... more Sir, We read with interest the article on out-of-pocket expenditure (OOPE) by Mondal et al.1 The authors reiterate the need to provide fi nancial protection for ensuring universal institutional delivery at zero expense through the Janani Shishu Suraksha Karyakram (JSSK). Different variables were indicated for higher OOPE in the study. However, consideration of economic status of the benefi ciaries would have enriched the study. As pointed out previously, a higher amount during institutional delivery is incurred by economically well-off families.2,3 While it is true that the study analyzed the amount of expenditure and it might be a proxy for wealth index, but the severity of economic burden precipitated by that expenditure would remain unclear from such analysis. In fact, the greatest effect of free care would be expected among those having the least capacity to spend. As evident from literature, a signifi cant reduction in OOPE was experienced among the fi nancially weaker sections, after the introduction of the JSSK.4
Journal of clinical and diagnostic research : JCDR, 2012
Congenital Lobar Emphysema (CLE) is one of the rare cystic malformations of the lung. This malfor... more Congenital Lobar Emphysema (CLE) is one of the rare cystic malformations of the lung. This malformation is generally confused with pneumothorax of the lung and most often, the placement of an intercostal drainage tube is entertained in an emergency situation, but the non- improvement of the distress and non-expansion of the lung are eye openers for a treating paediatrician. We are describing a case of a 26 days old baby who presented with respiratory distress in the Emergency Department. On the basis of the chest X-ray (CXR), we suspected it to be a case of pneumothorax and an intercostal drainage tube was inserted. But as he did not improve, CT of the chest was done and the baby was diagnosed to have congenital lobar emphysema. In spite of the advanced diagnostic techniques, the diagnosis of CLE may present a diagnostic challenge and a high index of suspicion is needed if the diagnosis has to be made promptly.
Pediatric patients are referred for multiple reasons, either for better therapeutic services or d... more Pediatric patients are referred for multiple reasons, either for better therapeutic services or diagnostic purposes. The clinical condition of patients at the time of referral can significantly affect the outcome of such patients and there is not much data on this aspect. The overall objective of this study was to study the demographic and clinical profile, the causes for referral, and the outcome of pediatric patients being referred to a single tertiary care hospital. This was a prospective observational study done in the Department of Pediatrics of a single tertiary care hospital in North India over the course of 1 year. Patients referred from other health facilities in the age group 0 to 12 years who were admitted in the pediatric ward of the hospital were enrolled. The primary objective was to study the clinical profile and outcome (mortality) of these patients. The secondary objectives were to study the referral pattern of the referred patients, causes for referral, and the sev...
1. Children in the age group of 5 to 15 years studying in the government schools from 1st to 10th... more 1. Children in the age group of 5 to 15 years studying in the government schools from 1st to 10th standard were called along with their school teachers/parents to the pediatric outpatient department as a part of periodic school health check-up program. A sample size of 1600 students was calculated to provide sufficient statistical power (>80%) at the 5% significance level. Students were examined classand section-wise in groups of 30 on pre-decided days in arrangement with the respective class teachers.
To strengthen malaria surveillance, field-appropriate diagnostics requiring limited technical res... more To strengthen malaria surveillance, field-appropriate diagnostics requiring limited technical resources are of critical significance. Loop-mediated isothermal amplification (LAMP) based malaria diagnostic assays are potential point-of-care tests with high sensitivity and specificity and have been used in low-resource settings. Plasmodium vivax–specific consensus repeat sequence (CRS)-based and Plasmodium falciparum–specific 18S rRNA primers were designed, and a two-tube LAMP assay was developed. The diagnostic performance of a closed-tube LAMP assay and Loopamp™ Malaria Detection (Pan/Pf, Pv) kit was investigated using nested PCR confirmed mono- and co-infections of P. vivax and P. falciparum positive (n = 149) and negative (n = 67) samples. The closed-tube Pv LAMP assay showed positive amplification in 40 min (limit of detection, LOD 0.7 parasites/µL) and Pf LAMP assay in 30 min (LOD 2 parasites/µL). Pv LAMP and Pf LAMP demonstrated a sensitivity and specificity of 100% (95% CI, 95...
Background Neonatal sepsis is a major cause of death in India, which needs hospital management bu... more Background Neonatal sepsis is a major cause of death in India, which needs hospital management but many families cannot access hospitals. The World Health Organization and the Government of India developed a guideline to manage possible serious bacterial infection (PSBI) when a referral is not feasible. We implemented this guideline to achieve high coverage of treatment of PSBI with low mortality. Methodology The implementation research study was conducted in over 50 villages of Palwal district, Haryana during August 2017-March 2019 and covered a population of 199143. Policy dialogue with central, state and district health authorities was held before initiation of the study. A baseline assessment of the barriers in the implementation of the PSBI intervention was conducted. The intervention was implemented in the program setting. The research team collected data throughout and also co-participated in the implementation of the intervention for the first six months to identify bottlene...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020
Background: India has moved from single drug Antiretroviral Therapy (ART) in 2002 to triple drug ... more Background: India has moved from single drug Antiretroviral Therapy (ART) in 2002 to triple drug ART in 2013 to prevent parent to child transmission of HIV. The aim of the study was to know the effects of triple drug ART on maternal CD4+ count and prevention of HIV transmission to baby along with its adherence, side effects and pregnancy outcome.Methods: A prospective study wsas done in Safdarjung Hospital, New Delhi on 40 HIV positive pregnant women who received single dose combination of triple drug ART. CD4+ count, LFT and KFT were done before beginning of ART and repeated after 6 months of ART. The infants received nevirapine prophylaxis and HIV status was determined by DBS PCR at 6 weeks.Results: The median CD4+ count was 317 and 397 pre and post ART for 6 months respectively (p value<0.001. Low birth weight (LBW) was seen in 43.59% which was statistically significant but confounded as 76.4% of these babies were preterm. 23.08% of babies had an APGAR of < 7 at 1 minute, o...
Background: India accounts for 21% death among under-five children but the profile of the childre... more Background: India accounts for 21% death among under-five children but the profile of the children admitted in tertiary hospitals is poorly documented. We conducted secondary analysis of all hospital admissions in pediatrics wards for 1½ years to understand outcomes in different age groups. Methods: Data from October 2014 to March 2016 were retrieved and analyzed, with a focus on the age distribution at admission and death, duration of stay and outcome. Results: Almost 10% admitted children died and another 15% left the hospital before completing treatment. The analysis of 2135 deaths suggests that half of the children died within 24 h of admission. Death rate was highest among children on their 1st day of life (39%), and it reduced gradually with increase in age. Infants share 71% of all the deaths. Conclusion: Maximum death within 1st day of admission demands a further review of our referral system and health seeking behavior.
We conducted a study to find a relationship between main weather parameters with admission of pos... more We conducted a study to find a relationship between main weather parameters with admission of positive dengue cases in a tertiary hospital. Retrospective analysis was undertaken to identify epidemiological trend of dengue in 2016 from paediatric wards of a tertiary hospital in New Delhi. Data were collected on patient particulars and daily weather from January to December 2016. A total of 266 confirmed cases of dengue were considered. Relative humidity (RH) was associated with burden of positive dengue cases. On week-wise analysis, each surge of dengue admission was preceded by heavy rain 4-6 weeks earlier. Monthly averaged daily temperature range and RH were noted to have strong correlations with dengue burden, keeping an interval of 2 months in between. Weather parameters seem to influence magnitude of dengue epidemic, particularly in dengue season. There is need to have an in-depth study about developing a prediction model for dengue epidemic.
195 cases of acute poisoning among children (age<12 y) in a tertiary hospital were identified ... more 195 cases of acute poisoning among children (age<12 y) in a tertiary hospital were identified over a period of one year. Two-thirds (63%) of them were males and 75% were below five years of age. Poisoning by medicines was most common (17%) followed by ingestion of corrosives/detergents (16%) and kerosene (14%).
Retrospective analysis was done for 3817 children aged 5-12 years admitted in a tertiary-care, pu... more Retrospective analysis was done for 3817 children aged 5-12 years admitted in a tertiary-care, public hospital in New Delhi between January to December, 2015. Mortality rate was 5.8%. About 47.1% deaths were due to central nervous system involvement; viral meningoencephalitis being the predominant cause. Overall, infectious diseases caused >80% of deaths. Public health interventions to reduce child mortality need to review such data for effective measures.
Medical Journal of Dr. D.Y. Patil University, 2016
Transport of sick newborns is undergoing massive changes in India. Over past few years, specializ... more Transport of sick newborns is undergoing massive changes in India. Over past few years, specialized transport has been activated in most of the states although out of pocket expenditure and absence of health personnel in the ambulance are still posing hurdles. With gradual expansion of all-weather roads to the furthest corner of the country and introduction of free transport for all neonates, it brings opportunities for us to reach all the sick newborns to the nearest equipped hospital at the earliest. Telecommunication and presence of health personnel during transport and training on life support are other initiatives boosting health care of the neonates during transport. Thus, improved transport could be a solution for reduction of stagnant neonatal mortality in India.
Sir, We read with interest the article on out-of-pocket expenditure (OOPE) by Mondal et al.1 The ... more Sir, We read with interest the article on out-of-pocket expenditure (OOPE) by Mondal et al.1 The authors reiterate the need to provide fi nancial protection for ensuring universal institutional delivery at zero expense through the Janani Shishu Suraksha Karyakram (JSSK). Different variables were indicated for higher OOPE in the study. However, consideration of economic status of the benefi ciaries would have enriched the study. As pointed out previously, a higher amount during institutional delivery is incurred by economically well-off families.2,3 While it is true that the study analyzed the amount of expenditure and it might be a proxy for wealth index, but the severity of economic burden precipitated by that expenditure would remain unclear from such analysis. In fact, the greatest effect of free care would be expected among those having the least capacity to spend. As evident from literature, a signifi cant reduction in OOPE was experienced among the fi nancially weaker sections, after the introduction of the JSSK.4
Journal of clinical and diagnostic research : JCDR, 2012
Congenital Lobar Emphysema (CLE) is one of the rare cystic malformations of the lung. This malfor... more Congenital Lobar Emphysema (CLE) is one of the rare cystic malformations of the lung. This malformation is generally confused with pneumothorax of the lung and most often, the placement of an intercostal drainage tube is entertained in an emergency situation, but the non- improvement of the distress and non-expansion of the lung are eye openers for a treating paediatrician. We are describing a case of a 26 days old baby who presented with respiratory distress in the Emergency Department. On the basis of the chest X-ray (CXR), we suspected it to be a case of pneumothorax and an intercostal drainage tube was inserted. But as he did not improve, CT of the chest was done and the baby was diagnosed to have congenital lobar emphysema. In spite of the advanced diagnostic techniques, the diagnosis of CLE may present a diagnostic challenge and a high index of suspicion is needed if the diagnosis has to be made promptly.
Pediatric patients are referred for multiple reasons, either for better therapeutic services or d... more Pediatric patients are referred for multiple reasons, either for better therapeutic services or diagnostic purposes. The clinical condition of patients at the time of referral can significantly affect the outcome of such patients and there is not much data on this aspect. The overall objective of this study was to study the demographic and clinical profile, the causes for referral, and the outcome of pediatric patients being referred to a single tertiary care hospital. This was a prospective observational study done in the Department of Pediatrics of a single tertiary care hospital in North India over the course of 1 year. Patients referred from other health facilities in the age group 0 to 12 years who were admitted in the pediatric ward of the hospital were enrolled. The primary objective was to study the clinical profile and outcome (mortality) of these patients. The secondary objectives were to study the referral pattern of the referred patients, causes for referral, and the sev...
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