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  • 1.
    Chandran, Salesh P.
    et al.
    Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Stockholm, Sweden.;St Johns Res Inst, Div Infect Dis, Bangalore, Karnataka, India.;RD Gardi Med Coll, Dept Microbiol, Agar Rd, Ujjain 456006, Madhya Pradesh, India..
    Sarkar, Samarpita
    St Johns Res Inst, Div Infect Dis, Bangalore, Karnataka, India..
    Diwan, Vishal
    Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Stockholm, Sweden.;RD Gardi Med Coll, Dept Publ Hlth & Environm, Ujjain, Madhya Pradesh, India..
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH). Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Stockholm, Sweden.;RD Gardi Med Coll, Dept Pediat, Ujjain, Madhya Pradesh, India..
    Shah, Harshada
    RD Gardi Med Coll, Dept Microbiol, Agar Rd, Ujjain 456006, Madhya Pradesh, India..
    Tamhankar, Ashok J.
    Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Stockholm, Sweden.;RD Gardi Med Coll, Indian Initiat Management Antibiot Resistance, Dept Environm Med, Ujjain, Madhya Pradesh, India..
    Macaden, Ragini
    St Johns Res Inst, Div Infect Dis, Bangalore, Karnataka, India..
    Stalsby-Lundborg, Cecilia
    Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Stockholm, Sweden..
    Detection of virulence genes in ESBL producing, quinolone resistant commensal Escherichia coli from rural Indian children2017Ingår i: Journal of Infection in Developing Countries, ISSN 2036-6590, E-ISSN 1972-2680, Vol. 11, nr 5, s. 387-392Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Extended-spectrum beta-lactamase producing commensal Escherichia coli are considered as a reservoir of antibiotic resistance genes that may be transmitted in the community. This study aimed to determine the genes coding for ESBLs, plasmid mediated quinolone resistance and virulence markers in commensal E. coli isolated from healthy school children. Methodology: ESBL producing E. coli isolates (n = 47) were obtained from 529 fecal samples of healthy school children from a rural area in central India. Multiplex PCR was used to detect the genes coding for cephalosporin and quinolone resistance, for virulence fluA, fluB, stx1, stx2, eae, bfp, lt, stII, virF, ipaH, daaE, aafII and phylogenetic groups. Results: Of the 47 ESBL producing E. coli, 41 were positive for CTXM-15, 23 for TEM-1, 8 for OXA-1and a single for SHV-12. For plasmid-mediated quinolone resistance, all the 47 isolates carried the aac(6')-ib-cr gene, and amongst them18 were qnrS positive. Virulence gene, fluA was detected in 32, whereas eae in 14, daaE in 7 and fluB in 1. In 10 isolates, fluA and eae and in 7, fluA and daaE co-existed. Of the 47 E. coli isolates, 18 were grouped into the phylogenetic group B2, 17 in D and 12 in A. The proportion of isolates positive for fluA gene in the phylogenetic group B2 (18/18), was significantly higher than in group A (7/12) and D (6/17). Conclusion: Commensal E. coli in healthy children in rural India may serve as reservoirs of resistance towards cephalosporins and fluoroquinolones and virulence coding genes for urinary tract and diarrheal infections.

  • 2.
    Choudhary, Anita
    et al.
    RD Gardi Med Coll, Dept Physiol, Ujjain 456006, Madhya Pradesh, India.
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH). RD Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India;Karolinska Inst, Dept Publ Hlth Sci, SE-17176 Stockholm, Sweden.
    Manickam, Ponnaiah
    Indian Council Med Res, Natl Inst Epidemiol, Chennai 600077, Tamil Nadu, India.
    Purohit, Manju
    Karolinska Inst, Dept Publ Hlth Sci, SE-17176 Stockholm, Sweden;RD Gardi Med Coll, Dept Pathol, Ujjain 456006, Madhya Pradesh, India.
    Rajasekhar, Thomas Daniel
    Indian Council Med Res, Natl Inst Epidemiol, Chennai 600077, Tamil Nadu, India.
    Dhoble, Parag
    RD Gardi Med Coll, Dept Psychiat, Ujjain 456006, Madhya Pradesh, India.
    Sharma, Ashish
    RD Gardi Med Coll, Dept Med, Ujjain 456006, Madhya Pradesh, India.
    Suliya, Juhi
    Indian Inst Publ Hlth Gandhinagar, Gandhinagar 382042, Gujarat, India.
    Apsingekar, Dhanashree
    Indian Inst Publ Hlth Gandhinagar, Gandhinagar 382042, Gujarat, India.
    Patil, Vandana
    RD Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India.
    Jaiswal, Ashish
    RD Gardi Coll Physiotherapy, Ujjain 456006, Madhya Pradesh, India.
    Gwarikar, Sudhir
    RD Gardi Med Coll, Dept Med, Ujjain 456006, Madhya Pradesh, India.
    Östh, Josefine
    Karolinska Inst, Dept Publ Hlth Sci, SE-17176 Stockholm, Sweden.
    Jirwe, Maria
    Karolinska Inst, Dept Publ Hlth Sci, SE-17176 Stockholm, Sweden;Sophiahemmet Univ, Dept Hlth Promoting Sci, SE-11486 Stockholm, Sweden.
    Diwan, Vinod Kumar
    Karolinska Inst, Dept Publ Hlth Sci, SE-17176 Stockholm, Sweden.
    Hallgren, Mats
    Karolinska Inst, Dept Publ Hlth Sci, SE-17176 Stockholm, Sweden.
    Mahadik, Vijay
    RD Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India.
    Diwan, Vishal
    Karolinska Inst, Dept Publ Hlth Sci, SE-17176 Stockholm, Sweden;RD Gardi Med Coll, Dept Publ Hlth & Environm, Ujjain 456006, Madhya Pradesh, India;Ujjain Charitable Trust Hosp, Int Ctr Hlth Res, Res Ctr, Ujjain 456006, Madhya Pradesh, India.
    Effect of Yoga versus Light Exercise to Improve Well-Being and Promote Healthy Aging among Older Adults in Central India: A Study Protocol for a Randomized Controlled Trial2019Ingår i: GERIATRICS, ISSN 2308-3417, Vol. 4, nr 4, artikel-id 64Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Aging is a natural process associated with many functional and structural changes. These changes may include impaired self-regulation, changes in tissues and organs. Aging also affects mood, physical status and social activity. There are adverse changes in cognitive behavior, perceived sensation and thinking processes. Regular physical activity can alleviate many health problems; yet, many older adults are inactive. Yoga is one of the scientific and popular lifestyle practice considered as the integration of mind, body and soul. Results of previous studies reported positive effects of yoga on multiple health outcomes in elderly. However, there is scarcity of scientific information where yoga's effect is examined on over well-being and on multiple health outcomes simultaneously in elderly. This protocol describes methods for a 12-week yoga-based intervention exploring the effects of yoga on well-being in physically inactive elderly living in community.

    Methods and analysis: This two group parallel single blind randomized controlled trial that will be conducted at a designated facility of R.D. Gardi Medical College, Ujjain, Madhya Pradesh, Central India. A 12-week 60-min yoga intervention three times weekly is designed. Comparison group participants will undergo a 60-min program comprising light exercise focusing on conventional stretching to improve mobility. After screening, 144 participants aged 60-80 years will be recruited. The primary outcome is subjective well-being. Secondary outcomes include mobility, fall risk, cognition, anxiety and depression, mood and stress, sleep quality, pain, physical activity/sedentary behavior and cardio-metabolic risk factors. Assessments will be conducted at baseline (0 week), after the intervention (12+1 week) and at follow-up (36+1 week). Intention-to-treat analyses with mixed linear modeling will be applied.

    Discussion: Through this trial, we aim to determine whether elderly people in the intervention group practicing yoga show more favorable primary (well-being) and secondary outcomes than those in the light exercise focusing on conventional stretching group. We assume that yoga may be practiced to maintain health, reduce particular symptoms commonly associated with skeletal pain, assist in pain relief and enhance well-being. We anticipate that practicing yoga will improve well-being and mental health and may lead to significant improvement in depression, pain and sleep quality.

    Ethics and dissemination: This study is approved by the Institutional Ethics Committee of R.D. Gardi Medical College, Ujjain, IEC Ref No. 09/2018. All participants would be provided with written and verbal information about the purpose of the project and would be free to withdraw from the study at any time. Refusal to participate in the study would not have any negative consequences. Confidentiality of the information of each participant would be ensured. Knowledge obtained would be disseminated to stakeholders through workshops, meetings and relevant scientific conferences.

    Trial Registration: The trial is prospectively registered with the Indian Council of Medical Research Trial Registry CTRI/2018/07/015051.

  • 3.
    Dey, Sapna
    et al.
    Department of Microbiology, Madhav Science College (MVM), Vikram University, Ujjain, India.
    Rosales-Klintz, Senia
    Department of Public Health Sciences (Global Health/IHCAR), Karolinska Institutet, Stockholm, Sweden.
    Shouche, Shobha
    Department of Microbiology, Madhav Science College (MVM), Vikram University, Ujjain, India.
    Pathak, Jai Prakash Narayan
    Department of Microbiology, Madhav Science College (MVM), Vikram University, Ujjain, India.
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Prevalence and risk factors for nasal carriage of Staphylococcus aureus in children attending anganwaries (preschools) in Ujjain, India2013Ingår i: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 6, s. 265-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Children with nasal carriage of S. aureus play an important role in community spread of S. aureus and methicillin-resistant S. aureus (MRSA). Screening the nasal carriage isolates of S. aureus for antibiotic resistance patterns will provide guidelines for empiric therapy of community-acquired infections. The aim of the present study was to determine the prevalence of S. aureus and MRSA and it's in vitro antibiotic susceptibility pattern among children in anganwaries (preschools) of Ujjain city India. This work is an extension to our previous publication in BMC Pediatrics (http://www.biomedcentral.com/1471-2431/10/100).

    METHODS:

    A prospective study was done among children aged 1 to 6 years of age attending 100 anganwaries chosen purposely for the study to evenly cover the city. From each anganwari 10 children were randomly selected for nasal swabbing. Children having pyoderma were not included. Information on risk factors for nasal colonization was collected using a pre-tested questionnaire. Swabs from anterior nares were plated on 5% sheep blood agar. Antibiotic susceptibility tests were performed using Kirby-Bauer's disc diffusion method according to performance standards of Clinical and Laboratory Standard Institute guidelines.

    RESULTS:

    A total of 1002 children were included in the study. The prevalence of S. aureus nasal carriage was 35% (95% confidence interval CI 32.07 to 37.98) and that of MRSA nasal carriage was 29% (95% CI 24.28 to 33.88). The factors that were independently associated with nasal carriage of S. aureus were: "age-group" i.e. as the age increased beyond the age of 2 years the OR of nasal carriage decreased, "family size of more than 10 members" OR 2.59 (95% CI 1.53-4.37; P < 0.001), and protein energy malnutrition Grade 3 or 4 (OR 1.40, 95% CI 1.04-1.90; P = 0.026). The resistance pattern of S. aureus and MRSA showed resistance not only to single antibiotic class but co-resistance and multi-drug resistance was also common.

    CONCLUSIONS:

    The high rates of nasal carriage of S. aureus and MRSA and presence of resistance to commonly used antibiotics are disturbing. Antibiotic stewardship programmes that promote judicious use of antibiotic along with strategies to prevent community spread of S. aureus are urgently needed.

  • 4.
    Gupta, Rajesh
    et al.
    Govt Med Coll, Dept Paediat, Datia, MP, India.
    Rawat, A. K.
    Bundelkhand Med Coll, Dept Paediat, Sagar, MP, India.
    Singh, Poonam
    All India Inst Med Sci, Dept Neonatol, Rishikesh, Uttarakhand, India.
    Gupta, Jyoti
    Chirayu Med Coll, Dept Microbiol, Bhopal, MP, India.
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH). RD Gardi Med Coll, Dept Paediat, Ujjain, Madhya Pradesh, India;Karolinska Inst, Dept Publ Hlth Sci, Global Hlth IHCAR, S-17177 Stockholm, Sweden.
    Infantile tremor syndrome: current perspectives2019Ingår i: Research and Reports in Tropical Medicine, ISSN 1179-7282, Vol. 10, s. 103-108Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Infantile Tremor Syndrome (ITS) is a self-limiting clinical state characterized by tremors, anemia, pigmentary skin disease, regression of mental development, and hypotonia of muscles in a plump looking child. Tremors are coarse in character, decreased or disappeared in sleep and resolves within 4-6 weeks in its natural course. Various etiological factors as infectious, metabolic, nutritional have been hypothesized but none is conclusive. Consensus is developing on the role of Vitamin B12 deficiency in children with ITS but is still debatable. Empirical management of ITS children has been tried in the absence of exact etiology considering child as undernourished. Nutritional management includes supplementation of Iron, Calcium, Magnesium, Vitamin B12 and other multivitamins. Tremors can be managed with administration of propranolol most commonly or phenobarbitone, phenytoin, and carbamazepine.

  • 5.
    Joshi, Sudhir Chandra
    et al.
    RD Gardi Med Coll, Dept Community Med, Ujjain, Madhya Pradesh, India.
    Diwan, Vishal
    RD Gardi Med Coll, Dept Publ Hlth & Environm, Ujjain, Madhya Pradesh, India; Ujjain Charitable Trust Hosp & Res Ctr, Int Ctr Hlth Res, Ujjain, Madhya Pradesh, India; Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Stockholm, Sweden.
    Joshi, Rita
    RD Gardi Med Coll, Dept Microbiol, Ujjain, Madhya Pradesh, India.
    Sharma, Megha
    Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Stockholm, Sweden; RD Gardi Med Coll, Dept Pharmacol, Ujjain, Madhya Pradesh, India.
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH). Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Stockholm, Sweden; RD Gardi Med Coll, Dept Pediat, Ujjain, Madhya Pradesh, India.
    Shah, Harshada
    RD Gardi Med Coll, Dept Microbiol, Ujjain, Madhya Pradesh, India.
    Tamhankar, Ashok J.
    Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Stockholm, Sweden; RD Gardi Med Coll, Indian Initiat Management Antibiot Resistance, Dept Environm Med, Ujjain, Madhya Pradesh, India.
    Stålsby Lundborg, Cecilia
    Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Stockholm, Sweden.
    “How Can the Patients Remain Safe, If We Are Not Safe and Protected from the Infections”? A Qualitative Exploration among Health-Care Workers about Challenges of Maintaining Hospital Cleanliness in a Resource Limited Tertiary Setting in Rural India2018Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, nr 9, artikel-id E1942Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Health care-associated infections (HAIs) result in treatment delays as well as failures and financial losses not only to patients but also to the treating hospital and overall health-care delivery system. Due to hospital-acquired infections, there are problems of increase in morbidity and mortality, additional diagnostic and therapeutic interventions and ultimately antimicrobial resistance. Proper understanding among health-care workers about the ill effects of HAIs is very important to address this issue. The present study is a qualitative exploration aimed at understanding various aspects of hospital environmental hygiene and Infection prevention control program, by exploring the staff perception regarding the challenges, facilitators and barriers as well as feasible measures towards improvement in a rural tertiary teaching hospital in central India.

    Method: A qualitative study was conducted using 10 focus group discussions (FGDs) among five different professional groups, which included hospital administrators, doctors, nurses, environmental cleaning staff, and undergraduate medical students. The FGD guide included the following topics: (1) opinion about the status of cleanliness, (2) concepts and actual practices prevailing of hospital environmental hygiene, (3) Barriers, constraints, and problems in maintaining hospital environmental hygiene, (4) Suggestions for improvements. The data were analyzed manually using the content (thematic) analysis method.

    Results: Two themes were identified: Theme 1: “Prevailing practices and problems related to hospital surface/object contamination and hospital infection control”. Theme 2: “Measures suggested for improving hospital cleanliness within the existing constraints”. The participants emphasized the influence of resource constraints and needed inputs. They brought up the consequent prevailing practices and problems related, on one hand, to various stakeholders (service consumers, hospital personnel including the management), on the other, to specific infection prevention and control processes. They also suggested various measures for improvement.

    Conclusions: The study has revealed prevailing practices, problems, and suggested measures related to hospital environmental hygiene, particularly hospital cleanliness and HAI prevention and control processes. These insights and assertions are important for developing future behavioral and structural interventions in resource-limited settings. This study recommends a nationwide reliable HAI surveillance system and a robust infection prevention and control program in each health-care institution.

  • 6. Joshi, Sudhir Chandra
    et al.
    Diwan, Vishal
    Tamhankar, Ashok J.
    Joshi, Rita
    Shah, Harshada
    Sharma, Megha
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Macaden, Ragini
    Lundborg, Cecilia Stalsby
    Staff Perception on Biomedical or Health Care Waste Management: A Qualitative Study in a Rural Tertiary Care Hospital in India2015Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, nr 5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Health care or biomedical waste, if not managed properly, can be of high risk to the hospital staff, the patients, the community, public health and the environment, especially in low and middle income settings where proper disposal norms are often not followed. Our aim was to explore perceptions of staff of an Indian rural tertiary care teaching hospital on hospital waste management. Method A qualitative study was conducted using 10 focus group discussions (FGDs), with different professional groups, cleaning staff, nurses, medical students, doctors and administrators. The FGD guide included the following topics: (i) role of Health Care Waste Management (HCWM) in prevention of health care associated infections, (ii) awareness of and views about HCWM-related guidelines/legislation, (iii) current HCWM practices, (iv) perception and preparedness related to improvements of the current practices, and (v) proper implementation of the available guidelines/legislation. The FGDs were recorded, transcribed verbatim, translated to English (when conducted in Hindi) and analysed using content analysis. Results Two themes were identified: Theme (A), 'Challenges in integration of HCWM in organizational practice,' with the categories (I) Awareness and views about HCWM, (II) Organizational practices regarding HCWM, and (III) Challenges in Implementation of HCWM; and Theme (B), 'Interventions to improve HCWM,' with three categories, (I) Educational and motivational interventions, (II) Organizational culture change, and (III) Policy-related interventions. Conclusion A gap between knowledge and actual practice regarding HCWM was highlighted in the perception of the hospital staff. The participants suggested organizational changes, training and monitoring to address this. The information generated is relevant not merely to the microsystem studied but to other institutions in similar settings.

  • 7.
    Khare, Shweta
    et al.
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy HSP Med Focusing A, Tomtebodavagen 18A, SE-17177 Stockholm, Sweden;RD Gardi Med Coll, Dept Publ Hlth & Environm, Ujjain 456006, Madhya Pradesh, India.
    Purohit, Manju
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy HSP Med Focusing A, Tomtebodavagen 18A, SE-17177 Stockholm, Sweden;RD Gardi Med Coll, Dept Pathol, Ujjain 456006, Madhya Pradesh, India.
    Sharma, Megha
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy HSP Med Focusing A, Tomtebodavagen 18A, SE-17177 Stockholm, Sweden;RD Gardi Med Coll, Dept Pharmacol, Ujjain 456006, Madhya Pradesh, India.
    Tamhankar, Ashok J.
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy HSP Med Focusing A, Tomtebodavagen 18A, SE-17177 Stockholm, Sweden;RD Gardi Med Coll, Indian Initiat Management Antibiot Resistance, Dept Environm Med, Ujjain 456006, Madhya Pradesh, India.
    Lundborg, Cecilia Stalsby
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy HSP Med Focusing A, Tomtebodavagen 18A, SE-17177 Stockholm, Sweden.
    Diwan, Vishal
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy HSP Med Focusing A, Tomtebodavagen 18A, SE-17177 Stockholm, Sweden;RD Gardi Med Coll, Dept Publ Hlth & Environm, Ujjain 456006, Madhya Pradesh, India;Ujjain Charitable Trust Hosp & Res Ctr, Int Ctr Hlth Res, Ujjain 456001, Madhya Pradesh, India.
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH), Internationell barnhälsa och nutrition. Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy HSP Med Focusing A, Tomtebodavagen 18A, SE-17177 Stockholm, Sweden;RD Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India.
    Antibiotic Prescribing by Informal Healthcare Providers for Common Illnesses: A Repeated Cross-Sectional Study in Rural India2019Ingår i: Antibiotics, ISSN 0066-4774, E-ISSN 2079-6382, Vol. 8, nr 3, artikel-id 139Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Informal healthcare providers (IHCPs) are predominant healthcare providers in rural India, who prescribe without formal training. Antibiotic prescription by IHCPs could provide crucial information for controlling antibiotic resistance. The aim of this study is to determine the practices and seasonal changes in antibiotic prescribing for common illnesses by IHCPs. A repeated cross-sectional study was conducted over 18 months, covering different seasons in the rural demographic surveillance site, at Ujjain, India. Prescriptions given to outpatients by 12 IHCPs were collected. In total, 15,322 prescriptions for 323 different complaint combinations were analyzed, of which 11,336 (74%) included antibiotics. The results showed that 14,620 (95%) of antibiotics prescribed were broad spectrum and the most commonly prescribed were fluoroquinolones (4771,31%), followed by penicillin with an extended spectrum (4119,27%) and third-generation cephalosporin (3069,20%). Antibiotics were prescribed more frequently in oral and dental problems (1126,88%), fever (3569,87%), and upper respiratory tract infections (3273, 81%); more during the monsoon season (2350,76%); and more frequently to children (3340,81%) than to adults (7996,71%). The study concludes that antibiotics were the more commonly prescribed drugs compared to other medications for common illnesses, most of which are broad-spectrum antibiotics, a situation that warrants further investigations followed by immediate and coordinated efforts to reduce unnecessary antibiotic prescriptions by IHCPs.

  • 8.
    Lindsjö, Cecilia
    et al.
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth IHCAR, SE-17177 Stockholm, Sweden..
    Sharma, Megha
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth IHCAR, SE-17177 Stockholm, Sweden.;Ruxmaniben Deepchand Gardi Med Coll, Dept Pharmacol, Ujjain, Madhya Pradesh, India..
    Mahadik, Vijay K.
    Ruxmaniben Deepchand Gardi Med Coll, Ujjain, Madhya Pradesh, India..
    Sharma, Shalendra
    Ruxmaniben Deepchand Gardi Med Coll, Dept Surg, Ujjain, Madhya Pradesh, India..
    Lundborg, Cecilia Stalsby
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth IHCAR, SE-17177 Stockholm, Sweden..
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH). Karolinska Inst, Dept Publ Hlth Sci, Global Hlth IHCAR, SE-17177 Stockholm, Sweden.;Ruxmaniben Deepchand Gardi Med Coll, Dept Paediat, Ujjain, Madhya Pradesh, India..
    Surgical site infections, occurrence, and risk factors, before and after an alcohol-based handrub intervention in a general surgical department in a rural hospital in Ujjain, India2015Ingår i: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 43, nr 11, s. 1184-1189Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: This study set out to determine occurrence of and risk factors for surgical site infections (SSIs) before and after implementation of an alcohol-based handrub (ABHR) intervention in general surgery wards in a rural, tertiary care hospital in India. Methods: Patients who underwent surgery between October 2010 and August 2011 (preintervention period) or September 2011 and August 2013 (intervention period) in the department of surgery were included. ABHR was introduced in September 2011. SSI was defined as per the Centers for Disease Control and Prevention guidelines. Comparison of SSI rate between the 2 periods was performed using analysis of variance. Risk factors were determined using multiple logistic regression models. Results: Incidence of SSI was 5% (36/720) and 6.5% (103/1,581) respectively, showing nonsignificant difference (P = .5735). The risk factor common for SSI in both periods was the duration of surgery (OR = 2.6 vs OR = 1.96, pre- and intervention periods, respectively). Risk factors in the intervention period were being a woman (OR = 2.18), renal disease (OR = 3.61), diabetes (OR = 4.43), smoking (OR = 2.14), preoperative hospitalization (<3 vs >15 days; OR = 3.22), and previous hospitalization (OR = 3.5). Compared with other studies, the amount of ABHR used in our study was low. Conclusion: The amount of ABHR used might not be sufficient to interrupt the chain of contamination of microorganisms; therefore, continuation of the intervention and surveillance is recommended.

  • 9.
    Lundborg, Cecilia Stalsby
    et al.
    Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Focusing Antibiot, S-17177 Stockholm, Sweden..
    Diwan, Vishal
    Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Focusing Antibiot, S-17177 Stockholm, Sweden.;RD Gardi Med Coll, Dept Publ Hlth & Environm, Ujjain, Madhya Pradesh, India.;RD Gardi Med Coll, Int Ctr Hlth Res, Ujjain, Madhya Pradesh, India..
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH). Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Focusing Antibiot, S-17177 Stockholm, Sweden.;RD Gardi Med Coll, Dept Pediat, Ujjain, Madhya Pradesh, India..
    Purohit, Manju R.
    Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Focusing Antibiot, S-17177 Stockholm, Sweden.;RD Gardi Med Coll, Dept Pathol, Ujjain, Madhya Pradesh, India.;Ujjain Charitable Trust Hosp & Res Ctr, Cent Clin Lab, Ujjain, Madhya Pradesh, India..
    Shah, Harshada
    RD Gardi Med Coll, Dept Microbiol, Ujjain, Madhya Pradesh, India..
    Sharma, Megha
    Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Focusing Antibiot, S-17177 Stockholm, Sweden.;RD Gardi Med Coll, Dept Pharmacol, Ujjain, Madhya Pradesh, India..
    Mahadik, Vijay K.
    Ujjain Charitable Trust Hosp & Res Ctr, Ujjain, Madhya Pradesh, India..
    Tamhankar, Ashok J.
    Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Focusing Antibiot, S-17177 Stockholm, Sweden.;RD Gardi Med Coll, Dept Environm Med, Indian Initiat Management Antibiot Resistance, Ujjain, Madhya Pradesh, India..
    Protocol: a 'One health' two year follow-up, mixed methods study on antibiotic resistance, focusing children under 5 and their environment in rural India2015Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, artikel-id 1321Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Antibiotic resistance has been referred to as 'the greatest malice of the 21st century' and a global action plan was adopted by the World Health Assembly in 2015. There is a wealth of independent studies regarding antibiotics and resistant bacteria in humans, animals and their environment, however, integrated studies are lacking, particularly ones that simultaneously also take into consideration the health related behaviour of participants and healthcare providers. Such, 'One health' studies are difficult to implement, because of the complex teamwork that they entail. This paper describes the protocol of a study that investigates 'One health' issues regarding antibiotic use and antibiotic resistance in children and their environment in Indian villages. Methods/Design: Both quantitative and qualitative studies are planned for a cohort of children, from 6 villages, and their surrounding environment. Repeated or continues data collection is planned over 2 years for quantitative studies. Qualitative studies will be conducted once. Studies include parents' health seeking behavior for their children (1-3 years of age at the onset), prescribing pattern of formal and informal healthcare providers, analysis of phenotypic antibiotic resistance of Escherichia coli from samples of stool from children and village animals, household drinking water, village source water and waste water, and investigation on molecular mechanisms governing resistance. Analysis of interrelationship of these with each other will also be done as basis for future interventions. Ethics approval has been obtained from the Institutional Ethics Committee R.D. Gardi Medical College, Ujjain, India (No: 2013/07/17-311). Discussion: The findings of the study presented in this protocol will add to our knowledge about the multi-factorial nature of causes governing antibiotic use and antibiotic resistance from a 'One health' perspective. Our study will be the first of its kind addressing antibiotic use and resistance issues related to children in a One-health approach, particularly for rural India.

  • 10.
    Mahadik, Kalpana V
    et al.
    Department of Obstetrics and Gynaecology, RD Gardi Medical College, Ujjain, Madhya Pradesh, India.
    Swami, M B
    Department of Obstetrics and Gynaecology, RD Gardi Medical College, Ujjain, Madhya Pradesh, India.
    Pandey, Neha
    Department of Obstetrics and Gynaecology, RD Gardi Medical College, Ujjain, Madhya Pradesh, India.
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Exsanguinated uterus after massive atonic postpartum haemorrhage2013Ingår i: BMJ case reports, ISSN 1757-790XArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    This article addresses issues related to pregnancy anaemia and late referral by a village birth attendant in resource poor setting in a central state of India. A young anaemic woman had labour onset at her village, a birth attendant tried to deliver her but failed. When she came to our hospital, had established septicaemia and absolutely non-reassurable uterine tone leading to intractable atonic postpartum haemorrhage. She died after 5 days because of coagulopathy and multiorgan failure. Huge budgets are being spent for the promotion of institutional deliveries but still the maternal mortality ratio has not reduced. The epidemiology of childbirth, social awareness for safe labour and administrative lethargy towards implementation of government programmes have not changed. The tertiary care-blood and components-multidisciplinary approach could not prevent the death of an anaemic woman. Unless there is a grassroot level change in the healthcare delivery system at the village level, the scenario might not change.

  • 11.
    Mathur, Aditya
    et al.
    RD Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India.
    Baghel, Devendra
    RD Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India.
    Jaat, Jitendra
    RD Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India.
    Diwan, Vishal
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, SE-17176 Stockholm, Sweden;RD Gardi Med Coll, Dept Publ Hlth & Environm, Ujjain 456006, Madhya Pradesh, India.
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH), Internationell barnhälsa och nutrition. RD Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India;Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, SE-17176 Stockholm, Sweden.
    Community-Based Participatory Research and Drug Utilization Research to Improve Childhood Diarrhea Case Management in Ujjain, India: A Cross-Sectional Survey2019Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, nr 9, artikel-id 1646Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Childhood diarrhea continues to be a major cause of under-five (U-5) mortality globally and in India. In this study, 1571 U-5 children residing in nine rural villages and four urban slums in Ujjain, India were included with the objective to use community participation and drug utilization research to improve diarrheal case management. The mean age was 2.08 years, with 297 (19%), children living in high diarrheal index households. Most mothers (70%) considered stale food, teething (62%), and hot weather (55%) as causes of diarrhea. Water, sanitation, and hygiene (WASH)-related characteristics revealed that most (93%) households had toilets, but only 23% of the children used them. The study identified ineffective household water treatment by filtration through cloth by most (93%) households and dumping of household waste on the streets (89%). The results revealed low community awareness of correct causes of diarrhea (poor hand hygiene, 21%; littering around the household, 15%) and of correct diarrhea treatment (oral rehydration solution (ORS) and zinc use, 29% and 11%, respectively) and a high antibiotic prescription rate by healthcare providers (83%). Based on the results of the present study, context-specific house-to-house interventions will be designed and implemented.

  • 12.
    Mathur, Aditya
    et al.
    RD Gardi Med Coll, Dept Paediat, Ujjain 456006, Madhya Pradesh, India..
    Mehra, Love
    RD Gardi Med Coll, Dept Paediat, Ujjain 456006, Madhya Pradesh, India..
    Diwan, Vishal
    RD Gardi Med Coll, Dept Publ Hlth & Environm, Ujjain 456006, Madhya Pradesh, India.;Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, SE-17176 Stockholm, Sweden..
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH). RD Gardi Med Coll, Dept Paediat, Madhya Pradesh, India.;Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, Stockholm, Sweden..
    Unintentional Childhood Injuries in Urban and Rural Ujjain, India: A Community-Based Survey2018Ingår i: Children (Basel), ISSN 2227-9067, Vol. 5, nr 2, artikel-id 23Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Injuries are a major global public health problem. There are very few community-based studies on childhood injury from India. The objective of this cross-sectional, community-based survey was to identify the incidence, type, and risk factors of unintentional childhood injuries. The study was done in seven villages and ten contiguous urban slums in Ujjain, India. World Health Organization (WHO) tested tools and definitions were used for the survey, which included 2518 households having 6308 children up to 18 years of age, with 2907 children from urban households and 3401 from rural households. The annual incidence of all injuries was 16.6%, 95% Confidence Interval 15.7-17.5%, (n = 1049). The incidence was significantly higher among boys compared to girls (20.2% versus 12.7%, respectively), was highest in age group 6-10 years of age (18.9%), and in urban locations (17.5%). The most commonly identified injury types were: physical injuries (71%), burns (16%), poisonings (10%), agriculture-related injuries (2%), near drowning (2%), and suffocations (2%). The most common place of injury was streets followed by home. The study identified incidence of different types of unintentional childhood injuries and factors associated with increased risk of unintentional injuries. The results can help in designing injury prevention strategies and awareness programs in similar settings.

  • 13.
    Mehta, Rishika
    et al.
    RD Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India.
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH), Internationell barnhälsa och nutrition. RD Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India;Uppsala Univ, Int Maternal & Child Hlth Unit, Dept Women & Childrens Hlth, SE-75185 Uppsala, Sweden;Karolinska Inst, Global Hlth Hlth Syst & Policy, Dept Publ Hlth Sci, SE-17176 Stockholm, Sweden;Ujjain Charitable Trust Hosp & Res Ctr, Int Ctr Hlth Res, Ujjain 456006, Madhya Pradesh, India.
    Emerging Chryseobacterium indologenes Infection in Indian Neonatal Intensive Care Units: A Case Report2018Ingår i: Antibiotics, ISSN 0066-4774, E-ISSN 2079-6382, Vol. 7, nr 4, artikel-id 109Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Antibiotic-resistant pathogens and nosocomial infections constitute common and serious problems for neonates admitted to neonatal intensive care units worldwide. Chryseobacterium indologenes is a non-lactose-fermenting, gram-negative, health care-associated pathogen (HCAP). It is ubiquitous and intrinsically resistant to several antibiotics. Despite its low virulence, C. indologenes has been widely reported to cause life-threatening infections. Patients on chronic immunosuppressant drugs, harboring invasive devices and indwelling catheters become the nidus for C. indologenes. Typically, C. indologenes causes major health care-associated infections such as pneumonia, empyema, pyelonephritis, cystitis, peritonitis, meningitis, and bacteremia in patients harboring central venous catheters. Management of C. indologenes infection in neonates is not adequately documented owing to underreporting, particularly in India. Because of its multidrug resistance and the scant availability of data from the literature, the effective empirical treatment of C. indologenes is challenging. We present an uncommon case of bacteremia caused by C. indologenes in a preterm newborn baby with moderate respiratory distress syndrome who was successfully treated. We also provide a review of infections in the neonatal age group. Henceforth, in neonates receiving treatments involving invasive equipment use and long-term antibiotic therapy, multidrug resistant C. indologenes should be considered an HCAP.

  • 14. Nerkar, Sandeep S.
    et al.
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Lundborg, Cecilia Stalsby
    Tamhankar, Ashok J.
    Can Integrated Watershed Management Contribute to Improvement of Public Health?: A Cross-Sectional Study from Hilly Tribal Villages in India2015Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 12, nr 3, s. 2653-2669Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Tribal people living in hilly areas suffer from water scarcity in many parts of the world, including India. Water scarcity adversely impacts all aspects of life, including public health. Implementation of an Integrated Watershed Management Programme (IWMP) can help solve the problems arising out of water scarcity in such areas. However, the knowledge about and views of the water scarcity sufferers on the public health implications of IWMP have not been well documented. This cross-sectional study was performed in six purposively selected tribal villages located in Maharashtra, India. In three of the villages IWMP had been implemented (IWMV), but not in the other three (NWMV). The head of each household in all villages was interviewed using a questionnaire covering various public health aspects relevant to the villages. A total of 286/313 (92%) households participated in the study. Compared to NWMV, respondents in IWMV experienced significantly lesser prolonged water scarcity (OR = 0.39), had greater number of toilets (OR = 6.95), cultivated more variety of crops (OR = 2.61), had lower migration (OR = 0.59), higher number of girls continuing education (OR = 3.04) and better utilized modern healthcare facilities in the antenatal, natal and postnatal period (OR = 3.75, 2.57, 4.88 respectively). Thus, tribal people in IWMP-implemented villages reported advantages in many aspects of public health.

  • 15.
    Pathak, Ashish
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH). RD Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India;Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, SE-17176 Stockholm, Sweden;Ujjain Charitable Trust Hosp & Res Ctr, Int Ctr Hlth Res, Ujjain 456006, Madhya Pradesh, India.
    Agrawal, Nitin
    RD Gardi Med Coll, Dept Paediat Surg, Ujjain 456006, Madhya Pradesh, India.
    Mehra, Love
    RD Gardi Med Coll, Dept Paediat Surg, Ujjain 456006, Madhya Pradesh, India.
    Mathur, Aditya
    RD Gardi Med Coll, Dept Paediat Surg, Ujjain 456006, Madhya Pradesh, India.
    Diwan, Vishal
    RD Gardi Med Coll, Dept Paediat Surg, Ujjain 456006, Madhya Pradesh, India.
    First Aid Practices and Health-Seeking Behaviors of Caregivers for Unintentional Childhood Injuries in Ujjain, India: A Community-Based Cross-Sectional Study.2018Ingår i: Children (Basel, Switzerland), ISSN 2227-9067, Vol. 5, nr 9, artikel-id 124Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Data on types of community first aid use and treatment provided post-injury from many low‒middle-income countries, including India, are lacking. This cross-sectional study was conducted among children aged one month to 18 years of age, in Ujjain, India, to understand types of first aid given and health-seeking post-injury. A total of 1087 injuries in 1049 children were identified in the past year. A total of 729 (67%) injured children received first aid and 758 (70%) sought some form of health care. Children with burns received the most (86%) first aid, and most children (84%) with road traffic accidents (RTA) sought health care. Most children (52%) sought health care from a private health care facility; most children (65%) were transported to a health care facility within the golden hour. Motorbikes were the most preferred (50%) mode of transport. Only 1% of the injured used ambulance services. Commonly reported methods or substances for first aid included the use of coconut oil on wounds from falls (38%) and burns (44%), the use of antiseptic cream on wounds from RTA (31%), the application of turmeric for wounds from falls (16%), and rubbing of metal on a bitten area (47%). For most injuries, appropriate, locally available substances were used. Potentially harmful substances applied included lime, toothpaste, clay, and mud. The findings will help design community interventions to increase the provision of appropriate first aid for childhood injuries.

  • 16.
    Pathak, Ashish
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Chandran, Salesh P
    Department of Microbiology, St Johns Research Institute, Bangalore, India.
    Mahadik, Kalpana
    Department of Obstetrics and Gynaecology, R.D. Gardi Medical College, Ujjain 456010, India.
    Macaden, Ragini
    Department of Microbiology, St Johns Research Institute, Bangalore, India.
    Lundborg, Cecilia Stålsby
    Global Health (IHCAR), Department of Public Health Sciences Karolinska Institutet, Sweden.
    Frequency and factors associated with carriage of multi-drug resistant commensal Escherichia coli among women attending antenatal clinics in Central India2013Ingår i: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 13, s. 199-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Commensal Escherichia coli are a prominent reservoir of genes coding for antibiotic resistance and also responsible for endogenous infections in pregnant women. We studied the factors in pregnant women associated with carriage of multi-drug resistant (MDR) E. coli and genetic determinants of antibiotic resistance in them.

    METHODS: Women attending to Obstetric and Gynaecology department outpatient clinics for routine antenatal check-up were administered a questionnaire. Peri-anal swabs were collected for culture isolation and identification of E.coil. Antibiotic sensitivity was done using the Kirby-Bauer disc diffusion method as recommended by the CLSI guidelines. MICs for quinolones and third generation cephalosporins were done using the agar dilution method. Genes coding for production of beta lactamses and for the quinolone resistance determinant were screened by polymerase chain reaction. Rep-PCR was done on MDR isolates for detecting possible genetic similarity. Multiple logistic regression models were used to determine the independent factors associated with carriage of MDR isolates.

    RESULTS: A total of 710 isolates of E. coli from 710 women (mean age 26 years) were included in the study. Resistance to at least one antibiotic tested was detected in 94% of the E. coli isolates. A total of 109 isolates were ESBL producing and 35 isolates were MDR. In the MDR isolates MIC50 and MIC90 for quinolones and third generation cephalosporins were high for those isolates that carried blaTEM gene (26 isolates) and blaCTX-M gene (24 isolates). Both blaTEM and blaCTX-M genes were detected in 19 isolates. The commonest Plasmid Mediated Quinolone Resistance (PMQR) gene identified was aac(6')-Ib-cr (n = 23/25). All isolates carrying the PMQR genes were also positive for blaCTX-M and blaTEM gene. Mutations in gyr A and par C genes were present in all 35 MDR isolates. The statistically significant risk factors for carriage of MDR E. coli were graduate or post-graduate education, a self-employed status, a family size of more than 10 members, antibiotic usage in last four weeks, and history of hospitalization in the last four weeks.

    CONCLUSIONS: The presence of genes coding for extended spectrum of beta lactamases and plasmid mediated quinolone resistance in commensal E. coli is disconcerting. The study provides strong basis good antibiotic stewardship.

  • 17.
    Pathak, Ashish
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH). Ruxmaniben Deepchand Gardi Med Coll, Dept Paediat, Ujjain, Madhya Pradesh, India.; Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, Stockholm, Sweden..
    Mahadik, Kalpana
    Ruxmaniben Deepchand Gardi Med Coll, Dept Obstet & Gynecol, Ujjain, Madhya Pradesh, India..
    Swami, Manmat B.
    Ruxmaniben Deepchand Gardi Med Coll, Dept Obstet & Gynecol, Ujjain, Madhya Pradesh, India..
    Roy, Pulak K.
    Ruxmaniben Deepchand Gardi Med Coll, Dept Obstet & Gynecol, Ujjain, Madhya Pradesh, India..
    Sharma, Megha
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, Stockholm, Sweden.;Ruxmaniben Deepchand Gardi Med Coll, Dept Pharmacol, Ujjain, Madhya Pradesh, India..
    Mahadik, Vijay K.
    Ruxmaniben Deepchand Gardi Med Coll, Ujjain, Madhya Pradesh, India..
    Lundborg, Cecilia Stalsby
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, Stockholm, Sweden..
    Incidence and risk factors for surgical site infections in obstetric and gynecological surgeries from a teaching hospital in rural India2017Ingår i: Antimicrobial Resistance and Infection Control, ISSN 2047-2994, E-ISSN 2047-2994, Vol. 6, artikel-id 66Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Surgical site infections (SSI) are one of the most common healthcare associated infections in the low-middle income countries. Data on incidence and risk factors for SSI following surgeries in general and Obstetric and Gynecological surgeries in particular are scare. This study set out to identify risk factors for SSI in patients undergoing Obstetric and Gynecological surgeries in an Indian rural hospital.

    Methods: Patients who underwent a surgical procedure between September 2010 to February 2013 in the 60-bedded ward of Obstetric and Gynecology department were included. Surveillance for SSI was based on the Centre for Disease Control (CDC) definition and methodology. Incidence and risk factors for SSI, including those for specific procedure, were calculated from data collected on daily ward rounds.

    Results: A total of 1173 patients underwent a surgical procedure during the study period. The incidence of SSI in the cohort was 7.84% (95% CI 6.30-9.38). Majority of SSI were superficial. Obstetric surgeries had a lower SSI incidence compared to gynecological surgeries (1.2% versus 10.3% respectively). The risk factors for SSI identified in the multivariate logistic regression model were age (OR 1.03), vaginal examination (OR 1.31); presence of vaginal discharge (OR 4.04); medical disease (OR 5.76); American Society of Anesthesia score greater than 3 (OR 12.8); concurrent surgical procedure (OR 3.26); each increase in hour of surgery, after the first hour, doubled the risk of SSI; inappropriate antibiotic prophylaxis increased the risk of SSI by nearly 5 times. Each day increase in stay in the hospital after the surgery increased the risk of contacting an SSI by 5%.

    Conclusions: Incidence and risk factors from prospective SSI surveillance can be reported simultaneously for the Obstetric and Gynecological surgeries and can be part of routine practice in resource-constrained settings. The incidence of SSI was lower for Obstetric surgeries compared to Gynecological surgeries. Multiple risk factors identified in the present study can be helpful for SSI risk stratification in low-middle income countries.

  • 18.
    Pathak, Ashish
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH). RD Gardi Med Coll, Dept Pediat, Ujjain, Madhya Pradesh, India;Uppsala Univ, Dept Women & Childrens Hlth, Int Maternal & Child Hlth Unit, SE-75185 Uppsala, Sweden.
    Mathur, Aditya
    RD Gardi Med Coll, Dept Pediat, Ujjain, Madhya Pradesh, India.
    Mehra, Love
    RD Gardi Med Coll, Dept Pediat, Ujjain, Madhya Pradesh, India.
    Unintentional Poisoning and Bites during Childhood in Ujjain, Madhya Pradesh2019Ingår i: Indian Pediatrics, ISSN 0019-6061, E-ISSN 0974-7559, Vol. 56, nr 4, s. 329-330Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    The prevalence of poisoning and bites was 0.76% (48/6308) and 1.24% (78/6308), respectively in a community-based survey in Ujjain district, Madhya Pradesh. Household cleansing agents and medicines, and-dog bite and bee-sting were the most common poisons and bites, respectively. Most parents (59%) reported lack of appropriate first-aid knowledge. Educational interventions and implementing the medicine take-back program are suggested.

  • 19.
    Pathak, Ashish
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Mårtensson, Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Gawariker, Sudhir
    Department of Medicine, R D Gardi Medical College, Surasa, Ujjain, India.
    Mandliya, Jagdish
    Department of Pediatrics, R D Gardi Medical College, Surasa, Ujjain, India.
    Sharma, Ashish
    Department of Medicine, R D Gardi Medical College, Surasa, Ujjain, India.
    Diwan, Vishal
    Department of Public Health Sciences (Global Health/IHCAR), Karolinska Institutet, Stockholm, Sweden.
    Ursing, Johan
    Malaria Research, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Characterization of drug resistance associated genetic polymorphisms among Plasmodium falciparum field isolates in Ujjain, Madhya Pradesh, India.2014Ingår i: Malaria Journal, ISSN 1475-2875, E-ISSN 1475-2875, Vol. 13, s. 182-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Since 2011, artesunate + sulphadoxine-pyrimethamine (ASP), instead of chloroquine, has been recommended for treatment of uncomplicated malaria in India. In Ujjain, central India, with an annual parasite index <0.1, the prevalence of drug-resistant Plasmodium falciparum is unknown. In other parts of India chloroquine and sulphadoxine-pyrimethamine-resistant P. falciparum is prevalent. The aim of this study was to determine the prevalence of anti-malarial drug resistance-associated genetic polymorphisms in P. falciparum collected in Ujjain in 2009 and 2010, prior to the introduction of ASP.

    METHODS: Blood samples from 87 patients with P. falciparum mono-infection verified by microscopy were collected on filter-paper at all nine major pathology laboratories in Ujjain city. Codons Pfcrt 72-76, pfmdr1 1034-1246, pfdhfr 16-185, pfdhps 436-632 and pfnhe1 ms4760 haplotypes were identified by sequencing. Pfcrt K76T and pfmdr1 N86Y were identified by restriction fragment length polymorphism, and pfmdr1 gene copy number by real-time PCR.

    RESULTS: Sulphadoxine-pyrimethamine resistance-associated pfdhfr 108 N and 59R alleles were found in 75/78 (96%) and 70/78 (90%) samples, respectively, and pfdhps 437G was found in 7/77 (9%) samples. Double mutant pfdhfr 59R + 108 N were found in 62/76 (82%) samples. Triple mutant pfdhfr 59R + 108 N and pfdhps 437G were found in 6/76 (8%) samples. Chloroquine-resistance-associated pfcrt 76 T was found in 82/87 (94%). The pfcrt 72-76 haplotypes found were: 80/84 (95%) SVMNT, 3/84 (4%) CVMNK and 1/84 (1%) CVMNT. Pfmdr1 N86 and 86Y were identified in 70/83 (84%) and 13/83 (16%) samples, respectively. Pfmdr1 S1034 + N1042 + D1246 were identified together in 70/72 (97%) of successfully sequenced samples. One pfmdr1 gene copy was found in 74/75 (99%) successfully amplified samples.

    CONCLUSION: This is the first characterization of key anti-malarial drug resistance-associated genetic markers among P. falciparum collected in Ujjain, Madhya Pradesh, India. The results indicate that the efficacy of standard dose chloroquine at the time of the study was likely to be poor, whereas ASP was likely to be efficacious, supporting the changed drug treatment policy. However, P. falciparum with reduced susceptibility to sulphadoxine-pyrimethamine is highly prevalent, highlighting the need for continuous surveillance of ASP efficacy in the study area.

  • 20.
    Pathak, Ashish
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Saliba, Erika A.
    Global Health/IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Sharma, Shailendra
    Department of Surgery, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, India.
    Mahadik, Vijay Kumar
    Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, India.
    Shah, Harshada
    Department of Microbiology, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, India.
    Lundborg, Cecilia Stalsby
    Global Health/IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Incidence and factors associated with surgical site infections in a teaching hospital in Ujjain, India2014Ingår i: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 42, nr 1, s. E11-E15Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Surgical site infections (SSI) are among the most commonly reported health care-associated infections; however, there is a paucity of data on SSI from India. This study aimed to determine the incidence of SSI and explore its associated factors at a teaching hospital in India. Methods: Direct and indirect surveillance methods, based on Centers for Disease Control and Prevention guidelines, were used to define SSI. Patients were followed up for 30 days postsurgery. Prescribing and resistance data were collected. Results: The SSI rate among the 720 patients investigated was 5%. Risk factors for SSI identified were as follows: severity of disease (P = .001), presence of drains (P = .020), history of previous hospitalization (P = .003), preoperative stay (P = .005), wound classification (P < .001), and surgical duration (P < .001). Independent risk factors identified included wound classification (odds ratio - 4.525; P <. 001) and surgical duration (odds ratio = 2.554; P = .015). Most patients (99%) were prescribed antibiotics. Metronidazole (24.5%), ciprofloxacin (11%), and amikacin (9%) were the most commonly prescribed antibiotics. Most commonly isolated bacteria were Staphylococcus aureus (n = 14), of which 34% were methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa (n = 6), which showed resistance to ceftazidime (70%), ciprofloxacin (63%), and gentamicin (57%). Conclusion: Incidence of SSI at the hospital was lower than reported in many low-and middle-income countries, although higher than reported in most high-income countries. Targeted implementation strategies to decrease incidence of preventable SSI are needed to further improve quality and safety of health care in this hospital and similar hospitals elsewhere. 

  • 21.
    Pathak, Ashish
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH). Karolinska Inst, Dept Publ Hlth Sci, Global Hlth IHCAR, S-17177 Stockholm, Sweden.;Ruxmaniben Deepchand Gardi Med Coll, Dept Paediat, Ujjain, Madhya Pradesh, India..
    Sharma, Shailendra
    Ruxmaniben Deepchand Gardi Med Coll, Dept Surg, Ujjain, Madhya Pradesh, India..
    Sharma, Megha
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth IHCAR, S-17177 Stockholm, Sweden.;Ruxmaniben Deepchand Gardi Med Coll, Dept Pharmacol, Ujjain, Madhya Pradesh, India..
    Mahadik, Vijay K.
    Ruxmaniben Deepchand Gardi Med Coll, Ujjain, Madhya Pradesh, India..
    Lundborg, Cecilia Stalsby
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth IHCAR, S-17177 Stockholm, Sweden..
    Feasibility of a Mobile Phone-Based Surveillance for Surgical Site Infections in Rural India2015Ingår i: Telemedicine journal and e-health, ISSN 1530-5627, E-ISSN 1556-3669, Vol. 21, nr 11, s. 946-949Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To assess the feasibility of using mobile communication technology in completing a 30-day follow-up of surgical site infection (SSI). Subjects and Methods: SSIs are infections occurring up to 30 days after an operative procedure. This prospective exploratory study was conducted in a cohort of patients who were admitted and operated on in the general surgery wards of a rural hospital in India from October 2010 to June 2011. At the time of discharge, all patients were requested to follow-up in the surgical outpatient clinic at 30 days after surgery. If this was not done, a mobile phone-based surveillance was done to complete the follow-up. Results: The mean age of the 536 operated-on patients was 40 years (95% confidence interval [CI], 38-41 years). The mean duration of hospital stay was 10.7 days (95% CI, 9.9-11.6 days). Most (81%) operated-on patients were from rural areas, and 397 (75%) were male. Among the operated-on patients the ownership of mobile phones was 75% (95% CI, 73-78%). The remaining 25% of patients (n = 133) used a shared mobile phone. For 380 patients (74.5%) the follow-up was completed by mobile phones. The SSI rate at follow-up was 6.3% (n=34). In 10 patients, an SSI was detected over the mobile phone. Conclusions: Mobile communication technology is feasible to be used in rural settings to complete case follow-up for SSIs.

  • 22.
    Pathak, Ashish
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Singh, Poonam
    Department of Pediatrics, RD Gardi Medical College, Ujjain, Madhya Pradesh, India.
    Gehlot, Prateek
    Department of Radiodiagnosis, RD Gardi Medical College, Ujjain, Madhya Pradesh, India.
    Dhaneria, Mamta
    Department of Pediatrics, RD Gardi Medical College, Ujjain, Madhya Pradesh, India.
    Spinal epidural abscess treated with antibiotics alone2013Ingår i: BMJ case reports, ISSN 1757-790X, Vol. 2013Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Spinal epidural abscess (SEA) is a rare clinical condition among children. Most patients do not present with classical signs. A 13-year-old boy without any predisposing factors presented with paraparesis, bladder and bowel involvement. MRI spine demonstrated an SEA at the C7 and D1 levels on both sides of the midline with cord oedema at the C2-3 to C6 level with minimal marrow oedema in the C6 vertebral body. We treated the patient with antibiotics (ceftriaxone and vancomycin) alone. The patient showed excellent response with only minimal residual gait disturbance at the end of 6 weeks of antibiotic therapy. This is the first paediatric report of complete recovery of a patient at clinical stage 4 following antibiotic treatment alone from India. However, caution should be exercised to closely monitor the patient's recovery as any progression in the neurological state warrants surgery.

  • 23.
    Pathak, Ashish
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Singh, Poonam
    Department of Pediatrics, RD Gardi Medical College, Ujjain, Madhya Pradesh, India.
    Yadav, Yogendra
    Department of Pediatrics, RD Gardi Medical College, Ujjain, Madhya Pradesh, India.
    Dhaneria, Mamta
    Department of Pediatrics, RD Gardi Medical College, Ujjain, Madhya Pradesh, India.
    Ecthyma gangrenosum in a neonate: not always pseudomonas2013Ingår i: BMJ case reports, ISSN 1757-790XArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    Ecthyma gangrenosum (EG) is a cutaneous manifestation of invasive infection usually caused by pseudomonas, but can be caused by many bacteria, fungal and viral infections. We present the first reported case of EG caused by invasive Escherichia coli in a neonate. A neonate presented with evidence of sepsis and a rapidly evolving 3×3.5 cm2 well-circumscribed haemorrhagic and necrotic ulcer on the left groin. There was evidence of decreased perfusion of the lower limb owing to pressure effect of the ulcer. The child responded well to anticoagulation and antibiotic therapy. It is crucial to clinically suspect EG and promptly start empiric antibiotic therapy covering pseudomonas to decrease the morbidity and mortality. However, other viruses, fungus and bacteria including E coli should also be considered in the differential diagnosis of EG in a neonate.

  • 24.
    Rathi, Manju
    et al.
    Department of Obstetrics and Gynecology, RD Gardi Medical College, Ujjain, Madhya Pradesh, India.
    Rathi, Sunil Kumar
    Department of Peadiatrics, RD Gardi Medical College, Ujjain, Madhya Pradesh, India.
    Purohit, Manju
    Department of Pathology, RD Gardi Medical College, Ujjain, Madhya Pradesh, India.
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Couvelaire uterus2014Ingår i: BMJ case reports, ISSN 1757-790XArtikel i tidskrift (Refereegranskat)
  • 25.
    Sahoo, Krushna Chandra
    et al.
    Department of Public Health Sciences (Global health/IHCAR), Karolinska Institutet, Stockholm, Sweden.
    Sahoo, Soumyakanta
    Department of Microbiology, Kalinga Institute of Medical Sciences (KIMS), Super Religare Laboratories Limited, Bhubaneswar, India.
    Marrone, Gaetano
    Department of Public Health Sciences (Global health/IHCAR), Karolinska Institutet, Stockholm, Sweden.
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Lundborg, Cecilia Stålsby
    Department of Public Health Sciences (Global health/IHCAR), Karolinska Institutet, Stockholm, Sweden.
    Tamhankar, Ashok J
    Department of Public Health Sciences (Global health/IHCAR), Karolinska Institutet, Stockholm, Sweden.
    Climatic Factors and Community - Associated Methicillin-Resistant Staphylococcus aureus Skin and Soft-Tissue Infections: A Time-Series Analysis Study2014Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 11, nr 9, s. 8996-9007Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Skin and soft tissue infections caused by Staphylococcus aureus (SA-SSTIs) including methicillin-resistant Staphylococcus aureus (MRSA) have experienced a significant surge all over the world. Changing climatic factors are affecting the global burden of dermatological infections and there is a lack of information on the association between climatic factors and MRSA infections. Therefore, association of temperature and relative humidity (RH) with occurrence of SA-SSTIs (n = 387) and also MRSA (n = 251) was monitored for 18 months in the outpatient clinic at a tertiary care hospital located in Bhubaneswar, Odisha, India. The Kirby-Bauer disk diffusion method was used for antibiotic susceptibility testing. Time-series analysis was used to investigate the potential association of climatic factors (weekly averages of maximum temperature, minimum temperature and RH) with weekly incidence of SA-SSTIs and MRSA infections. The analysis showed that a combination of weekly average maximum temperature above 33 °C coinciding with weekly average RH ranging between 55% and 78%, is most favorable for the occurrence of SA-SSTIs and MRSA and within these parameters, each unit increase in occurrence of MRSA was associated with increase in weekly average maximum temperature of 1.7 °C (p = 0.044) and weekly average RH increase of 10% (p = 0.097).

  • 26.
    Shakya, Pragya
    et al.
    Department of Microbiology, R.D. Gardi Medical College, Ujjain, India.
    Barrett, Peter
    Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Diwan, Vishal
    Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Marothi, Yogyata
    Department of Microbiology, R.D. Gardi Medical College, Ujjain, India.
    Shah, Harshada
    Department of Microbiology, R.D. Gardi Medical College, Ujjain, India.
    Chhari, Neeraj
    Department of Community Medicine, R.D. Gardi Medical College, Ujjain, India.
    Tamhankar, Ashok J.
    Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Lundborg, Cecilia Stalsby
    Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Antibiotic resistance among Escherichia coli isolates from stool samples of children aged 3 to 14 years from Ujjain, India2013Ingår i: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 13, s. 477-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Antibiotic resistance is a major global public health concern, particularly in settings where few treatment options are available. Limited research has been done on antibiotic resistance in Escherichia coli of Indian children at community level. Therefore we studied antibiotic resistance patterns in E. coli isolates from stool samples of children aged 3-14 years from Ujjain, Central India, to investigate associations of resistance with demographic variables. Methods: Children, 3-14 years of age, were included from 30 randomly selected villages of Palwa demographic surveillance site, Ujjain, India. Parents were interviewed using a questionnaire, and stool samples were collected from participating children. E. coli were isolated from stool samples (n = 529), and susceptibility testing to 18 different antibiotics was done using standard methods. Results: The proportions of isolates resistant to various antibiotics were, nalidixic acid, (45%), tetracycline (37%), ampicillin (37%), sulfamethoxazole/trimethoprim (29%) and amoxicillin/clavulanic acid (29%). No isolates were resistant to imipenem. Overall, 72% of isolates were resistant to at least one antibiotic and 33% were multi-drug resistant. High rates of cross-resistance were seen for 15 (83%) of the antibiotics studied. E. coli isolates from children with literate mothers were more resistant to penicillins and fluoroquinolones. ESBL-producers comprised 9% of the isolates. Conclusion: Antibiotic resistance and cross-resistance were common in E. coli from stools of children. Resistance rates were associated with maternal literacy.

  • 27.
    Sharma, Megha
    et al.
    Ruxmaniben Deepchand Gardi Med Coll, Dept Pharmacol, Ujjain, Madhya Pradesh, India.;Karolinska Inst, Global Hlth Hlth Syst & Policy HSP Med Focusing A, Dept Publ Hlth Sci, S-17177 Stockholm, Sweden..
    Damlin, Anna
    Karolinska Inst, Global Hlth Hlth Syst & Policy HSP Med Focusing A, Dept Publ Hlth Sci, S-17177 Stockholm, Sweden..
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH). Karolinska Inst, Global Hlth Hlth Syst & Policy HSP Med Focusing A, Dept Publ Hlth Sci, S-17177 Stockholm, Sweden.;Ruxmaniben Deepchand Gardi Med Coll, Dept Pediat, Ujjain, Madhya Pradesh, India..
    Lundborg, Cecilia Stalsby
    Karolinska Inst, Global Hlth Hlth Syst & Policy HSP Med Focusing A, Dept Publ Hlth Sci, S-17177 Stockholm, Sweden..
    Antibiotic Prescribing among Pediatric Inpatients with Potential Infections in Two Private Sector Hospitals in Central India2015Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, nr 11, artikel-id e0142317Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction Infectious diseases are one of the major causes of child mortality in India. Pediatric patients are commonly prescribed antibiotics for non-bacterial infections. Monitoring of local antibiotic prescribing with respect to the diagnosis is necessary to improve the prescribing practices. The aim of the study was to describe antibiotic prescribing for potential infections among patients admitted in pediatric departments in two private sector hospitals; one teaching (TH) and one non-teaching (NTH) in Central India. Methods Data from all patients admitted at the pediatric departments of both study hospitals was collected manually, for 3 years (2008-2011) using a customized form. Data from inpatients aged 0-18 years, diagnosed with; acute gastroenteritis (AGE), respiratory tract infections, enteric fever, viral fever or unspecified fever were focused for analysis. Antibiotic prescriptions were analysed using the WHO Anatomical Therapeutic Chemical (ATC) classification system and defined daily doses (DDDs). Adherence to the Indian Academy of Pediatrics list of essential medicines (IAP-LEM) was investigated. P-values <0.05 were considered significant. Results Oftotal6, 825 inpatients admitted at two pediatric departments, 510 patients from the TH and 2,479from the NTH were selected based on the assigned potential infectious diagnoses. Of these, 224 patients (44%) at the TH and 2,088 (84%) at the NTH were prescribed at least one antibiotic during hospital stay (odds ratio-0.69, 95% confidence interval-0.52 to 0.93; p<0.001). Patients with AGE, viral-and enteric fever were frequently prescribed antibiotics at both hospitals, yet higher proportion were prescribed antibiotics at the NTH compared to the TH. Broad-spectrum antibiotics were the most commonly prescribed antibiotic class in both hospitals, namely third generation cephalosporins, J01DD (69%) at the TH, and new fixed dose combinations of antibiotics J01R (FDCs, 42%) at the NTH. At the TH, 37% of the antibiotic prescriptions were comprised of antibiotics listed in the IAP-LEM, compared to 24% at the NTH (p<0.05). Conclusions Broad-spectrum antibiotics were prescribed frequently in both hospitals also for the un-indicated conditions such as viral fever and enteric fever. At the NTH, new FDCs were more frequently prescribed and adherence to the IAP-LEM was substantially lower at the NTH compared to the TH. The results demonstrate need to develop diagnosis-specific prescribing guidelines to facilitate rational use of antibiotics and implement antibiotic stewardship program.

  • 28. Shrivastava, Shreya
    et al.
    Patil, Vandana
    Shelke, Madhavi
    Anvikar, Madhura
    Mathur, Aditya
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH), Internationell barnhälsa och nutrition.
    Assessment of school readiness of children and factors associated with risk of inadequate school readiness in Ujjain, India: an observational study2019Ingår i: BMJ paediatrics open, ISSN 2399-9772, Vol. 3, nr 1, artikel-id e000509Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: School readiness is a condition or state indicating that the child is ready to learn in a formal educational set-up. The objective of this study was to estimate the prevalence of and factors associated with school readiness in urban schoolchildren in Ujjain, India.

    Methods: This cross-sectional study was conducted from February 2016 to March 2017. Two English-medium schools were conveniently selected. All children aged 5-7 years were eligible to participate. A subscale of Differential Ability Scales-Second Edition, namely 'school readiness scale', was used to assess school readiness in three major domains-early number concept, matching letter-like forms and phonological processing. Data on factors associated with school readiness were collected through parent interview. Quantile regression analysis was used to explore school readiness scores.

    Results: This study included 203 school-going children (105 boys and 98 girls) having a mean (SD) age of 67.7 (±0.51) months. The phonological processing and matching letter-like forms had 31.5% and 30.5% children, respectively, in lower quantiles (≤25th). The higher quantile (≥75th) scores were achieved for phonological processing and early number concept (47.7% and 44.8% children, respectively). The results of quantile regression showed negative association of school readiness scores with age of children, lower socioeconomic status and hospitalisation status, especially in the lower quantiles (≤25th). The 10th, 50th and 75th quantile scores were positively correlated with the increasing education status of the mother. Birth weight was positively associated with the median and higher quantile scores (≥75th).

    Conclusions: School readiness in a middle-class urban setting in India was negatively associated with lower age of the child, lower socioeconomic status, hospitalisation and positively correlated with increasing birth weight and maternal education. Lower quantile scores were achieved in matching letter-like forms, which measures complex visual-spatial processing, and phonological ability, which correlates with acquired verbal concepts. Focused interventions are needed to improve these skills.

  • 29.
    Singh, Poonam
    et al.
    Department of Pediatrics, RD Gardi Medical College, Ujjain, Madhya Pradesh, India.
    Eske, Gunvant Singh
    Department of Pediatrics, RD Gardi Medical College, Ujjain, Madhya Pradesh, India.
    Dhaneria, Mamta
    Department of Pediatrics, RD Gardi Medical College, Ujjain, Madhya Pradesh, India.
    Pathak, Ashish
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Rickets in the tropics: not always nutritional2013Ingår i: BMJ case reports, ISSN 1757-790XArtikel i tidskrift (Refereegranskat)
1 - 29 av 29
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