STUDY OBJECTIVE The aim of this study was to compare the parental attitudes and beliefs about hum... more STUDY OBJECTIVE The aim of this study was to compare the parental attitudes and beliefs about human papillomavirus (HPV), cervical cancer, and HPV vaccine between urban and rural areas, India. DESIGN Cross-sectional. SETTING Mysore, India. PARTICIPANTS Parents of school-going adolescent girls. INTERVENTIONS Parents completed a self-administered questionnaire. MAIN OUTCOME MEASURES Attitudes and beliefs about HPV, cervical cancer, and HPV vaccine. RESULTS A total of 1609 parents from urban (n = 778) and rural (n = 831) areas participated in this study. Most of the parents had never heard about HPV (73.6%), did not know that their daughters could get an HPV infection (62.7%) or cervical cancer (64.1%) in the future, and believed that HPV vaccine was not effective (67.1%). Parents living in the urban area were more likely to believe that HPV infection (adjusted odds ratio [aOR], 2.69; 95% confidence interval [CI], 1.43-5.06) and cervical cancer (aOR, 2.68; 95% CI, 1.83-3.91) could caus...
The objective of this review was to systematically appraise the existing published literature abo... more The objective of this review was to systematically appraise the existing published literature about community-based cervical cancer screening programs that have used visual inspection methods using acetic acid (VIA) in India. All peer reviewed journal articles till December 2015 were searched per PRISMA guidelines. Articles reporting results from cervical cancer screening programs in community-based settings, conducted in India, and using VIA were included in this review. The search resulted in 20 articles to be included in the review with a total of 313,553 women at 12 unique urban and rural sites across India. Seventeen (85%) studies were cross-sectional and three studies were randomized controlled trials; most studies compared accuracy of VIA with other screening tests such as visual inspection using Lugol's Iodine (VILI), HPV DNA, and cytology. Of studies that reported test accuracy for CIN Grade 2+, the VIA sensitivity values ranged from 16.6-82.6% and specificity ranged fr...
STUDY OBJECTIVE The purpose of this study was to examine factors predicting human papillomavirus ... more STUDY OBJECTIVE The purpose of this study was to examine factors predicting human papillomavirus (HPV) vaccine acceptability among parents of adolescent girls in a rural area in Mysore district, India. DESIGN Cross-sectional. SETTING Mysore, India. PARTICIPANTS Parents of school-going adolescent girls. INTERVENTIONS Parents completed a validated self-administered questionnaire. MAIN OUTCOME MEASURES Parental willingness to vaccinate their daughters with HPV vaccine. RESULTS Of the 831 parents who participated in this study, 664 (79.9%) were willing to vaccinate their daughter with HPV vaccine sometime soon if they were invited to receive it. Higher odds of parental willingness to vaccinate their daughters with HPV vaccine was observed among those who believed that HPV vaccine is safe (adjusted odds ratio [aOR], 2.11; 95% confidence interval [CI], 1.01-4.45); their daughter might become sexually active (aOR, 1.84; 95% CI, 1.08-3.13); they have support of other family members to vacci...
BackgroundIn rural India, mobile medical clinics are useful models for delivering health promotio... more BackgroundIn rural India, mobile medical clinics are useful models for delivering health promotion, education, and care. Mobile medical clinics use fewer providers for larger catchment areas compared to traditional clinic models in resource limited settings, which is especially useful in areas with shortages of healthcare providers and a wide geographical distribution of patients.MethodsFrom 2008 to 2011, we built infrastructure to implement a mobile clinic system to educate rural communities about maternal child health, train community health workers in common safe birthing procedures, and provide comprehensive antenatal care, prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV), and testing for specific infections in a large rural catchment area of pregnant women in rural Mysore. This was done using two mobile clinics and one walk-in clinic. Women were tested for HIV, hepatitis B, syphilis, and bacterial vaginosis along with random blood sugar, ...
BACKGROUND Trichomonas vaginalis infection is the most common curable sexually transmissible infe... more BACKGROUND Trichomonas vaginalis infection is the most common curable sexually transmissible infection (STI) worldwide. The present study describes the burden and correlates of T. vaginalis infection among young reproductive age women in Mysore, India. METHODS Between November 2005 and March 2006, sexually active women aged 15-30 years were recruited from low-income peri-urban and rural neighbourhoods of Mysore, India. Participants were interviewed and offered a physical examination and testing for T. vaginalis, bacterial vaginosis, vaginal candidiasis, Neisseria gonorrheoea and herpes simplex virus type-2 antibodies. RESULTS Of the 898 participating women, 76 had a T. vaginalis infection (8.5%, 95% confidence interval [95% CI]: 6.7-10.5%). Nearly all (98%) participants were married and most reported their spouse as their main sex partner. The mean age at marriage was 16.9 years (s.d. 2.9 years) and two-thirds of the sample reported having first sexual intercourse before the age of ...
OBJECTIVE According to the World Health Organization, about half of all pregnant women in India s... more OBJECTIVE According to the World Health Organization, about half of all pregnant women in India suffer from some form of anemia. While poor nutrition is the most common cause, social factors, such as gender and religion, also impact anemia status. This study investigates the relationship between anemia and socioeconomic and health-related factors among pregnant women in Mysore, India. DESIGN Prospective cohort study conducted between January 2009 and 2012 SETTING: 144 rural villages ten or more kilometers outside of Mysore City received integrated antenatal care and HIV testing services provided by mobile medical clinic in their communities. PARTICIPANTS 1675 pregnant women from the villages were screened. All women and their infants were then followed up for up to a year after childbirth. METHODS women who provided informed consent underwent an interviewer-administered questionnaire, physical examination by a doctor, and antenatal laboratory investigations including blood test for ...
IntroductionIt is proven that adverse intrauterine environment results in ‘early life programming... more IntroductionIt is proven that adverse intrauterine environment results in ‘early life programming,’ alterations in metabolism and physiological development of the fetus, often termed as ‘Developmental Origins of Health and Disease’ (DOHaD) resulting in a smaller size at birth, greater non-communicable diseases (NCD) risk factors during childhood and adolescence, and cardiometabolic disorders in adulthood. Nevertheless, very few studies have examined the relationship between DOHaD programming and cognition. This study aims to examine if impaired prenatal growth indicated by birth weight is associated with cognition among adolescents in the Kisalaya cohort, a rural birth cohort in South India, thus providing newer insights into DOHaD programming for adolescent mental health in a low-income and middle-income country setting.Methods and analysisKisalaya cohort was established in 2008, to provide integrated antenatal care and HIV testing using mobile clinics to improve maternal and child...
Journal of pediatric and adolescent gynecology, 2018
The aim of this study was to compare the parental attitudes and beliefs about human papillomaviru... more The aim of this study was to compare the parental attitudes and beliefs about human papillomavirus (HPV), cervical cancer, and HPV vaccine between urban and rural areas, India. Cross-sectional. Mysore, India. Parents of school-going adolescent girls. Parents completed a self-administered questionnaire. Attitudes and beliefs about HPV, cervical cancer, and HPV vaccine. A total of 1609 parents from urban (n = 778) and rural (n = 831) areas participated in this study. Most of the parents had never heard about HPV (73.6%), did not know that their daughters could get an HPV infection (62.7%) or cervical cancer (64.1%) in the future, and believed that HPV vaccine was not effective (67.1%). Parents living in the urban area were more likely to believe that HPV infection (adjusted odds ratio [aOR], 2.69; 95% confidence interval [CI], 1.43-5.06) and cervical cancer (aOR, 2.68; 95% CI, 1.83-3.91) could cause serious health problems than those living in the rural area. The odds of agreeing that...
While breastfeeding rates have improved globally, disparities in breastfeeding practices persist ... more While breastfeeding rates have improved globally, disparities in breastfeeding practices persist particularly in rural and low resource settings. In India, only 56% of Indian mothers practice exclusive breastfeeding (EBF) for the recommended six months. As India leads the world in the number of preterm births, under 5 years of age malnutrition and neonatal mortality, understanding the factors associated with EBF can help improve the nutritional status for millions of infants. We assessed the factors associated with EBF in rural Mysore, India. This cross-sectional analysis was nested within a cohort study assessing the feasibility and uptake of mobile prenatal care and HIV counseling and testing intervention in Mysore District. Multivariable logistic regression was used to identify the factors associated with EBF for infants between birth and six months. Exclusive breastfeeding was defined as breastfeeding with no other liquids or breastfeeding substitutes given to infants exceptfor ...
According to the World Health Organization, about half of all pregnant women in India suffer from... more According to the World Health Organization, about half of all pregnant women in India suffer from some form of anemia. While poor nutrition is the most common cause, social factors, such as gender and religion, also impact anemia status. This study investigates the relationship between anemia and socioeconomic and health-related factors among pregnant women in Mysore, India. Prospective cohort study conducted between January 2009 and 2012 SETTING: 144 rural villages ten or more kilometers outside of Mysore City received integrated antenatal care and HIV testing services provided by mobile medical clinic in their communities. 1675 pregnant women from the villages were screened. All women and their infants were then followed up for up to a year after childbirth. women who provided informed consent underwent an interviewer-administered questionnaire, physical examination by a doctor, and antenatal laboratory investigations including blood test for anemia. Women were followed through pr...
Objective According to the World Health Organization, about half of all pregnant women in India s... more Objective According to the World Health Organization, about half of all pregnant women in India suffer from some form of anemia. While poor nutrition is the most common cause, social factors, such as gender and religion, also impact anemia status. This study investigates the relationship between anemia and socioeconomic and health-related factors among pregnant women in Mysore, India. Design Prospective cohort study conducted between January 2009 and 2012 Setting 144 rural villages ten or more kilometers outside of Mysore City received integrated antenatal care and HIV testing services provided by mobile medical clinic in their communities. Participants 1675 pregnant women from the villages were screened. All women and their infants were then followed up for up to a year after delivery. Methods Women who provided informed consent underwent an interviewer-administered questionnaire, physical examination by a physician, and antenatal laboratory investigations including blood test for ...
The Journal of the Association of Nurses in AIDS Care : JANAC, Jan 4, 2017
With nearly one million HIV-infected women in India, prevention of mother-to-child transmission (... more With nearly one million HIV-infected women in India, prevention of mother-to-child transmission (PMTCT) programs serve an important role. While PMTCT programs focus on mothers living with HIV infection, offering them to uninfected pregnant women may prevent maternal HIV infections. To inform future efforts to offer PMTCT programs to uninfected women, we conducted focus groups with 24 uninfected women in the South Indian state of Karnataka who had given birth within the previous 2 years to explore their perceptions and experiences about HIV education and screening during pregnancy. Although all the participants had undergone HIV testing at a public health facility during pregnancy, they reported little knowledge about HIV transmission or prevention. Revisions are needed in existing PMTCT program curricula and instruction methods before they can be offered to uninfected women as an HIV prevention strategy.
STUDY OBJECTIVE The aim of this study was to compare the parental attitudes and beliefs about hum... more STUDY OBJECTIVE The aim of this study was to compare the parental attitudes and beliefs about human papillomavirus (HPV), cervical cancer, and HPV vaccine between urban and rural areas, India. DESIGN Cross-sectional. SETTING Mysore, India. PARTICIPANTS Parents of school-going adolescent girls. INTERVENTIONS Parents completed a self-administered questionnaire. MAIN OUTCOME MEASURES Attitudes and beliefs about HPV, cervical cancer, and HPV vaccine. RESULTS A total of 1609 parents from urban (n = 778) and rural (n = 831) areas participated in this study. Most of the parents had never heard about HPV (73.6%), did not know that their daughters could get an HPV infection (62.7%) or cervical cancer (64.1%) in the future, and believed that HPV vaccine was not effective (67.1%). Parents living in the urban area were more likely to believe that HPV infection (adjusted odds ratio [aOR], 2.69; 95% confidence interval [CI], 1.43-5.06) and cervical cancer (aOR, 2.68; 95% CI, 1.83-3.91) could caus...
The objective of this review was to systematically appraise the existing published literature abo... more The objective of this review was to systematically appraise the existing published literature about community-based cervical cancer screening programs that have used visual inspection methods using acetic acid (VIA) in India. All peer reviewed journal articles till December 2015 were searched per PRISMA guidelines. Articles reporting results from cervical cancer screening programs in community-based settings, conducted in India, and using VIA were included in this review. The search resulted in 20 articles to be included in the review with a total of 313,553 women at 12 unique urban and rural sites across India. Seventeen (85%) studies were cross-sectional and three studies were randomized controlled trials; most studies compared accuracy of VIA with other screening tests such as visual inspection using Lugol's Iodine (VILI), HPV DNA, and cytology. Of studies that reported test accuracy for CIN Grade 2+, the VIA sensitivity values ranged from 16.6-82.6% and specificity ranged fr...
STUDY OBJECTIVE The purpose of this study was to examine factors predicting human papillomavirus ... more STUDY OBJECTIVE The purpose of this study was to examine factors predicting human papillomavirus (HPV) vaccine acceptability among parents of adolescent girls in a rural area in Mysore district, India. DESIGN Cross-sectional. SETTING Mysore, India. PARTICIPANTS Parents of school-going adolescent girls. INTERVENTIONS Parents completed a validated self-administered questionnaire. MAIN OUTCOME MEASURES Parental willingness to vaccinate their daughters with HPV vaccine. RESULTS Of the 831 parents who participated in this study, 664 (79.9%) were willing to vaccinate their daughter with HPV vaccine sometime soon if they were invited to receive it. Higher odds of parental willingness to vaccinate their daughters with HPV vaccine was observed among those who believed that HPV vaccine is safe (adjusted odds ratio [aOR], 2.11; 95% confidence interval [CI], 1.01-4.45); their daughter might become sexually active (aOR, 1.84; 95% CI, 1.08-3.13); they have support of other family members to vacci...
BackgroundIn rural India, mobile medical clinics are useful models for delivering health promotio... more BackgroundIn rural India, mobile medical clinics are useful models for delivering health promotion, education, and care. Mobile medical clinics use fewer providers for larger catchment areas compared to traditional clinic models in resource limited settings, which is especially useful in areas with shortages of healthcare providers and a wide geographical distribution of patients.MethodsFrom 2008 to 2011, we built infrastructure to implement a mobile clinic system to educate rural communities about maternal child health, train community health workers in common safe birthing procedures, and provide comprehensive antenatal care, prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV), and testing for specific infections in a large rural catchment area of pregnant women in rural Mysore. This was done using two mobile clinics and one walk-in clinic. Women were tested for HIV, hepatitis B, syphilis, and bacterial vaginosis along with random blood sugar, ...
BACKGROUND Trichomonas vaginalis infection is the most common curable sexually transmissible infe... more BACKGROUND Trichomonas vaginalis infection is the most common curable sexually transmissible infection (STI) worldwide. The present study describes the burden and correlates of T. vaginalis infection among young reproductive age women in Mysore, India. METHODS Between November 2005 and March 2006, sexually active women aged 15-30 years were recruited from low-income peri-urban and rural neighbourhoods of Mysore, India. Participants were interviewed and offered a physical examination and testing for T. vaginalis, bacterial vaginosis, vaginal candidiasis, Neisseria gonorrheoea and herpes simplex virus type-2 antibodies. RESULTS Of the 898 participating women, 76 had a T. vaginalis infection (8.5%, 95% confidence interval [95% CI]: 6.7-10.5%). Nearly all (98%) participants were married and most reported their spouse as their main sex partner. The mean age at marriage was 16.9 years (s.d. 2.9 years) and two-thirds of the sample reported having first sexual intercourse before the age of ...
OBJECTIVE According to the World Health Organization, about half of all pregnant women in India s... more OBJECTIVE According to the World Health Organization, about half of all pregnant women in India suffer from some form of anemia. While poor nutrition is the most common cause, social factors, such as gender and religion, also impact anemia status. This study investigates the relationship between anemia and socioeconomic and health-related factors among pregnant women in Mysore, India. DESIGN Prospective cohort study conducted between January 2009 and 2012 SETTING: 144 rural villages ten or more kilometers outside of Mysore City received integrated antenatal care and HIV testing services provided by mobile medical clinic in their communities. PARTICIPANTS 1675 pregnant women from the villages were screened. All women and their infants were then followed up for up to a year after childbirth. METHODS women who provided informed consent underwent an interviewer-administered questionnaire, physical examination by a doctor, and antenatal laboratory investigations including blood test for ...
IntroductionIt is proven that adverse intrauterine environment results in ‘early life programming... more IntroductionIt is proven that adverse intrauterine environment results in ‘early life programming,’ alterations in metabolism and physiological development of the fetus, often termed as ‘Developmental Origins of Health and Disease’ (DOHaD) resulting in a smaller size at birth, greater non-communicable diseases (NCD) risk factors during childhood and adolescence, and cardiometabolic disorders in adulthood. Nevertheless, very few studies have examined the relationship between DOHaD programming and cognition. This study aims to examine if impaired prenatal growth indicated by birth weight is associated with cognition among adolescents in the Kisalaya cohort, a rural birth cohort in South India, thus providing newer insights into DOHaD programming for adolescent mental health in a low-income and middle-income country setting.Methods and analysisKisalaya cohort was established in 2008, to provide integrated antenatal care and HIV testing using mobile clinics to improve maternal and child...
Journal of pediatric and adolescent gynecology, 2018
The aim of this study was to compare the parental attitudes and beliefs about human papillomaviru... more The aim of this study was to compare the parental attitudes and beliefs about human papillomavirus (HPV), cervical cancer, and HPV vaccine between urban and rural areas, India. Cross-sectional. Mysore, India. Parents of school-going adolescent girls. Parents completed a self-administered questionnaire. Attitudes and beliefs about HPV, cervical cancer, and HPV vaccine. A total of 1609 parents from urban (n = 778) and rural (n = 831) areas participated in this study. Most of the parents had never heard about HPV (73.6%), did not know that their daughters could get an HPV infection (62.7%) or cervical cancer (64.1%) in the future, and believed that HPV vaccine was not effective (67.1%). Parents living in the urban area were more likely to believe that HPV infection (adjusted odds ratio [aOR], 2.69; 95% confidence interval [CI], 1.43-5.06) and cervical cancer (aOR, 2.68; 95% CI, 1.83-3.91) could cause serious health problems than those living in the rural area. The odds of agreeing that...
While breastfeeding rates have improved globally, disparities in breastfeeding practices persist ... more While breastfeeding rates have improved globally, disparities in breastfeeding practices persist particularly in rural and low resource settings. In India, only 56% of Indian mothers practice exclusive breastfeeding (EBF) for the recommended six months. As India leads the world in the number of preterm births, under 5 years of age malnutrition and neonatal mortality, understanding the factors associated with EBF can help improve the nutritional status for millions of infants. We assessed the factors associated with EBF in rural Mysore, India. This cross-sectional analysis was nested within a cohort study assessing the feasibility and uptake of mobile prenatal care and HIV counseling and testing intervention in Mysore District. Multivariable logistic regression was used to identify the factors associated with EBF for infants between birth and six months. Exclusive breastfeeding was defined as breastfeeding with no other liquids or breastfeeding substitutes given to infants exceptfor ...
According to the World Health Organization, about half of all pregnant women in India suffer from... more According to the World Health Organization, about half of all pregnant women in India suffer from some form of anemia. While poor nutrition is the most common cause, social factors, such as gender and religion, also impact anemia status. This study investigates the relationship between anemia and socioeconomic and health-related factors among pregnant women in Mysore, India. Prospective cohort study conducted between January 2009 and 2012 SETTING: 144 rural villages ten or more kilometers outside of Mysore City received integrated antenatal care and HIV testing services provided by mobile medical clinic in their communities. 1675 pregnant women from the villages were screened. All women and their infants were then followed up for up to a year after childbirth. women who provided informed consent underwent an interviewer-administered questionnaire, physical examination by a doctor, and antenatal laboratory investigations including blood test for anemia. Women were followed through pr...
Objective According to the World Health Organization, about half of all pregnant women in India s... more Objective According to the World Health Organization, about half of all pregnant women in India suffer from some form of anemia. While poor nutrition is the most common cause, social factors, such as gender and religion, also impact anemia status. This study investigates the relationship between anemia and socioeconomic and health-related factors among pregnant women in Mysore, India. Design Prospective cohort study conducted between January 2009 and 2012 Setting 144 rural villages ten or more kilometers outside of Mysore City received integrated antenatal care and HIV testing services provided by mobile medical clinic in their communities. Participants 1675 pregnant women from the villages were screened. All women and their infants were then followed up for up to a year after delivery. Methods Women who provided informed consent underwent an interviewer-administered questionnaire, physical examination by a physician, and antenatal laboratory investigations including blood test for ...
The Journal of the Association of Nurses in AIDS Care : JANAC, Jan 4, 2017
With nearly one million HIV-infected women in India, prevention of mother-to-child transmission (... more With nearly one million HIV-infected women in India, prevention of mother-to-child transmission (PMTCT) programs serve an important role. While PMTCT programs focus on mothers living with HIV infection, offering them to uninfected pregnant women may prevent maternal HIV infections. To inform future efforts to offer PMTCT programs to uninfected women, we conducted focus groups with 24 uninfected women in the South Indian state of Karnataka who had given birth within the previous 2 years to explore their perceptions and experiences about HIV education and screening during pregnancy. Although all the participants had undergone HIV testing at a public health facility during pregnancy, they reported little knowledge about HIV transmission or prevention. Revisions are needed in existing PMTCT program curricula and instruction methods before they can be offered to uninfected women as an HIV prevention strategy.
Uploads
Papers by Anjali Arun