Dengue is a systemic viral infection transmitted between humans by Aedes mosquitoes. For some patients, dengue is a life-threatening illness. There are currently no licensed vaccines or specific therapeutics, and substantial vector control efforts have not stopped its rapid emergence and global spread. The contemporary worldwide distribution of the risk of dengue virus infection and its public health burden are poorly known. Here we undertake an exhaustive assembly of known records of dengue occurrence worldwide, and use a formal modelling framework to map the global distribution of dengue risk. We then pair the resulting risk map with detailed longitudinal information from dengue cohort studies and population surfaces to infer the public health burden of dengue in 2010. We predict dengue to be ubiquitous throughout the tropics, with local spatial variations in risk influenced strongly by rainfall, temperature and the degree of urbanization. Using cartographic approaches, we estimate there to be 390 million (95% credible interval 284-528) dengue infections per year, of which 96 million (67-136) manifest apparently (any level of disease severity). This infection total is more than three times the dengue burden estimate of the World Health Organization. Stratification of our estimates by country allows comparison with national dengue reporting, after taking into account the probability of an apparent infection being formally reported. The most notable differences are discussed. These new risk maps and infection estimates provide novel insights into the global, regional and national public health burden imposed by dengue. We anticipate that they will provide a starting point for a wider discussion about the global impact of this disease and will help to guide improvements in disease control strategies using vaccine, drug and vector control methods, and in their economic evaluation.

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The global distribution and burden of dengue

Important progress has been made in the management of Helicobacter pylori infection and in this fifth edition of the Maastricht Consensus Report, key aspects related to the clinical role of H. pylori were re-evaluated in 2015. In the Maastricht V/Florence Consensus Conference, 43 experts from 24 countries examined new data related to H. pylori in five subdivided workshops: (1) Indications/Associations, (2) Diagnosis, (3) Treatment, (4) Prevention/Public Health, (5) H. pylori and the Gastric Microbiota. The results of the individual workshops were presented to a final consensus voting that included all participants. Recommendations are provided on the basis of the best available evidence and relevance to the management of H. pylori infection in the various clinical scenarios.

https://gut.bmj.com/content/gutjnl/66/1/6.full.pdf

Management of Helicobacter pylori infection—the Maastricht V/Florence Consensus Report

Management of Helicobacter pylori infection is evolving and in this 4th edition of the Maastricht consensus report aspects related to the clinical role of H pylori were looked at again in 2010. In the 4th Maastricht/Florence Consensus Conference 44 experts from 24 countries took active part and examined key clinical aspects in three subdivided workshops: (1) Indications and contraindications for diagnosis and treatment, focusing on dyspepsia, non-steroidal anti-inflammatory drugs or aspirin use, gastro-oesophageal reflux disease and extraintestinal manifestations of the infection. (2) Diagnostic tests and treatment of infection. (3) Prevention of gastric cancer and other complications. The results of the individual workshops were submitted to a final consensus voting to all participants. Recommendations are provided on the basis of the best current evidence and plausibility to guide doctors involved in the management of this infection associated with various clinical conditions.

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Management of Helicobacter pylori infection—the Maastricht IV/ Florence Consensus Report

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)61693-6.pdf

What works? Interventions for maternal and child undernutrition and survival.

OBJECTIVE: To review the evidence about the prevalence and determinants of non-psychotic common perinatal mental disorders (CPMDs) in World Bank categorized low- and lower-middle-income countries. METHODS: Major databases were searched systematically for English-language publications on the prevalence of non-psychotic CPMDs and on their risk factors and determinants. All study designs were included. FINDINGS: Thirteen papers covering 17 low- and lower-middle-income countries provided findings for pregnant women, and 34, for women who had just given birth. Data on disorders in the antenatal period were available for 9 (8%) countries, and on disorders in the postnatal period, for 17 (15%). Weighted mean prevalence was 15.6% (95% confidence interval, CI: 15.4-15.9) antenatally and 19.8% (19.5-20.0) postnatally. Risk factors were: socioeconomic disadvantage (odds ratio [OR] range: 2.1-13.2); unintended pregnancy (1.6-8.8); being younger (2.1-5.4); being unmarried (3.4-5.8); lacking intimate partner empathy and support (2.0-9.4); having hostile in-laws (2.1-4.4); experiencing intimate partner violence (2.11-6.75); having insufficient emotional and practical support (2.8-6.1); in some settings, giving birth to a female (1.8-2.6), and having a history of mental health problems (5.1-5.6). Protective factors were: having more education (relative risk: 0.5; P = 0.03); having a permanent job (OR: 0.64; 95% CI: 0.4-1.0); being of the ethnic majority (OR: 0.2; 95% CI: 0.1-0.8) and having a kind, trustworthy intimate partner (OR: 0.52; 95% CI: 0.3-0.9). CONCLUSION: CPMDs are more prevalent in low- and lower-middle-income countries, particularly among poorer women with gender-based risks or a psychiatric history.

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Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review

Objective To evaluate the effect of routine administration of intestinal anthelmintic drugs on haemoglobin.

Design Systematic review of randomised controlled trials.

Data sources Electronic databases and hand search of reviews, bibliographies of books, and abstracts and proceedings of international conferences.

Study selection Included studies were randomised or quasi-randomised controlled trials using an intestinal anthelmintic agent in the intervention group, in which haemoglobin was evaluated as an outcome measure. Trials in which treatment for schistosoma (praziquantel) was given exclusively to the intervention group were excluded.

Results The search identified 14 eligible randomised controlled trials. Data were available for 7829 subjects, of whom 4107 received an anthelmintic drug and 3722 received placebo. The pooled weighted mean difference (random effect model) of the change in haemoglobin was 1.71 (95% confidence interval 0.70 to 2.73) g/l (P<0.001; test for heterogeneity: Cochran Q=51.17, P<0.001; I2=61% (37% to 76%)). With the World Health Organization's recommended haemoglobin cut-offs of 120 g/l in adults and 110 g/l in children, the average estimated reduction in prevalence of anaemia ranged from 1.1% to 12.4% in adults and from 4.4% to 21.0% in children. The estimated reductions in the prevalence of anaemia increased with lower haemoglobin cut-offs used to define anaemia.

Conclusions Routine administration of intestinal anthelmintic agents results in a marginal increase in haemoglobin (1.71 g/l), which could translate on a public health scale into a small (5% to 10%) reduction in the prevalence of anaemia in populations with a relatively high prevalence of intestinal helminthiasis.

https://www.bmj.com/content/bmj/334/7603/1095.full.pdf

Effect of administration of intestinal anthelmintic drugs on haemoglobin: systematic review of randomised controlled trials.

Purpose: To develop a reliable and valid quality of life questionnaire for Indian patients with diabetes. Methods: A draft of 75 questions was prepared on the basis of expert opinion, focus group discussions, review of existing literature and detailed semi-structured interviews of patients with diabetes with the intention of including all aspects of diabetes-specific and quality of life considered relevant by patients and care providers to enable constrict validity. A Stage 2 questionnaire was then prepared with 13 domains and 54 items (questions) after expert panel review for obvious irrelevance and duplication of issues. It was administered to 150 participants visiting a diabetes center at New Delhi. Factor analysis was done using principal component method with varimax rotation. Reliability analysis was done by calculating Cronbach’s Alpha. For evaluating concordant validity the questionnaire was co-administered with DQL-CTQ to 30 participants. The discriminant validity of the questionnaire was tested using ‘t’ test for metabolic control, co-morbidities, insulin use and gender. Results: Using principal component method 8 domains were identified on the basis of an apriori hypothesis and the scree plot. These 8 domains explained 49.9% of the total variation. 34 items (questions) were selected to represent these domains on the basis of extraction communality, factor loading, inter-item and item-total correlations. The final questionnaire has an Overall Cronbach’s Alpha value of 0.894 (subscale- 0.55 to 0.85) showing high internal consistency. The questionnaire showed good concordance (product moment correlation 0.724; p=0.001; subscale correlation – 0.457 to 0.779) with the DQL-CTQ. The overall standardized questionnaire score showed good responsiveness to metabolic control and co-morbidities establishing discriminant validity. Conclusion: The final version of questionnaire with 8 domains and 34 items is a reliable and valid tool for assessment of quality of life of Indian patients with diabetes. Abbreviations: WHOQOL : World Health Organization Quality of Life assessment; SF-36 : Short Form- 36 questionnare; DQLCT-R : Diabetes Quality of Life Clinical Trial Revised version; ADDQoL : Audit of Diabetes Dependent Quality of Life; DQoL : Diabetes Quality of Life; PGI : Patient Generated Index; BmI : Body mass Index; CAD : Coronary Artery Disease; PDSG : Prospective Diabetes Study Group

The development of 'Quality of Life Instrument for Indian Diabetes patients (QOLID): a validation and reliability study in middle and higher income groups.

2009 SUMMARY Background Several randomized-controlled trials (RCTs) have sought to determine the efficacy of bovine lactoferrin in Helicobacter pylori eradication with equivocal results. Aim To evaluate the effect of bovine lactoferrin supplementation in H. pylori eradication. Methods Electronic databases, reviews, bibliographies, abstracts and conference proceedings were searched. Included trials had to be randomized or quasi-randomized and controlled, using bovine lactoferrin in the intervention group, treating Helicobacter-infected subjects and evaluating eradication of H. pylori as an outcome. Results The search identified five eligible RCTs (of 169). Data were available for 682 subjects (bovine lactoferrin group-n = 316; control group-n = 366). The pooled odds ratio (five studies) for eradication by intention-to-treat analysis was 2.22 (95% CI 1.44‐3.44; P = 0.0003) using the fixed effects model (FEM) and 2.24 (95% CI 1.15‐4.35; P = 0.0003) using the random effects model (REM) (Cochran’s Q = 6.83; P = 0.145). The pooled risk difference was 0.11 (95% CI 0.05‐0.16; P = 0.0001) by FEM (Cochran’s Q = 6.67; P = 0.154) and 0.10 (95% CI 0.04‐0.17; P = 0.0023) by REM. There was no significant difference in incidence of adverse effects.

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Meta-analysis: efficacy of bovine lactoferrin in Helicobacter pylori eradication.

Given the postulated advantages of mother generated index (MGI) in incorporating the patients' viewpoint and in the absence of a validated India specific postpartum quality of life assessment tool we proposed to evaluate the utility of an adapted Mother-Generated-Index in assessing postpartum quality of life (PQOL) in India. The study was integrated into a community survey conducted in one district of Delhi by two-stage cluster randomized sampling to recruit women who delivered in the last 6 months. PQOL was assessed using MGI. Physical morbidity and Edinburgh- postnatal-depression-scale (EPDS) were also recorded for validation purposes. All subjects (249 of 282 eligible) participating in the survey were approached for the MGI evaluation which could be administered to 195 subjects due to inadequate comprehension or refusal of consent. A trend towards lower scores in lower socioeconomic stratum was observed (Primary index score-2.9, 3.7 and 4.0 in lower, middle and higher strata; Secondary Index Score-2.6, 3.2 and 3.0 in lower, middle and higher strata). 59.4% mothers had scores suggestive of possible depression (EPDS; n = 172). Primary index score had a good correlation with validator scores like EPDS (p = 0.024) and number of physical problems (p = 0.022) while the secondary index score was only associated with EPDS score (p = 0.020). The study documents that the MGI, with its inherent advantages, is a potentially useful tool for postpartum quality of life evaluation in India especially in the absence of an alternative pre-validated tool.

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An exploratory study to evaluate the utility of an adapted Mother Generated Index (MGI) in assessment of postpartum quality of life in India

The study was conducted to estimate the direct maternity-care expense for women who recently delivered in South Delhi and to explore its sociodemographic associations. A survey was conducted using the two-stage cluster-randomized sampling technique. Two colonies each from high-, middle- and low-income ar­eas were selected by simple random sampling, followed by a house-to-house survey in each selected colony. Information was collected by recall of healthcare expenses for mother and child. In total, 249 subjects (of 282 eligible) were recruited. The mean expense for a normal vaginal delivery (n=182) was US$ 370.7, being much higher in a private hospital (US$ 1,035) compared to a government hospital (US$ 61.1) or a delivery in the home (US$ 55.3). Expenses for a caesarean delivery (n=67) were higher (US$ 1,331.1). Expenses for the lowest-income groups were ~10% of their annual family income at government facilities and ~26% at private hospitals. The direct maternity expense is high for large subsections of the population. Key words: Community survey; Healthcare cost; Health expenditure; Maternal health services; Maternity care; India doi: 10.3329/jhpn.v27i3.3379 J Health Popul Nutr 2009 Jun;27(3):368-378

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Jitender Nagpal

Papers

Effect of administration of intestinal anthelmintic drugs on haemoglobin: systematic review of randomised controlled trials.

The development of 'Quality of Life Instrument for Indian Diabetes patients (QOLID): a validation and reliability study in middle and higher income groups.

Meta-analysis: efficacy of bovine lactoferrin in Helicobacter pylori eradication.

An exploratory study to evaluate the utility of an adapted Mother Generated Index (MGI) in assessment of postpartum quality of life in India

Direct Cost of Maternity-care Services in South Delhi: A Community Survey