Background The primary objective of this study was to find the performance of the 2009 probable case definition of dengue and compare it with the definition given by the WHO-SEAR expert group in 2011. Methods A cross-sectional study was conducted in Thiruvananthapuram district of Kerala, which is hyperendemic for dengue. A consecutive series of 851 participants defined by the selection criteria were recruited from the primary, secondary, and tertiary health care settings. Sensitivity, specificity, predictive values, and likelihood ratios of the clinical case definitions were calculated using reverse transcriptasepolymerized chain reaction (RT-PCR) as gold standard in case of fever less than or equal to 5 days and serology (IgM positivity) for fever .5 days. Diagnostic odds ratio (DOR) was also calculated as a single indicator of performance of the case definition. Results The 2009 World Health Organization (WHO) case definition had a sensitivity of 76.4% (69.6-82.1) and negative predictive value of 87.5%. The 2011 WHO-SEAR expert group case definition had a higher sensitivity of 87.9% (82.2-91.9) but lower negative predictive value of 86.6%. The three independent criteria which were significantly associated with dengue were thrombocytopenia less than 150 000 (OR 2.80), leukopenia (OR 2.28), and absence of backache (OR 2.68). The performance of 2009 case definition was better (DOR 2.4) than the 2011 WHO-SEAR expert group case definition. This was further enhanced when thrombocytopenia was specified as platelet count less than 150 000 (DOR2.7). When 'no backahe' was added as an additional criteria, the performance of both definitions improved. Conclusions The 2009 WHO case definition has better discriminatory power than the 2011 WHO-SEAR expert group case definition. The performance of 2009 WHO case definition is enhanced by specifying thrombocytopenia as platelet count less than 150 000. The inclusion of 'no backache' further improves the discriminatory power. This may be more useful in primary care settings, to rule out dengue.

ObjectiveTo understand the structures and strategies that helped Kerala in fighting the COVID-19 pandemic, the challenges faced by the state and how it was tackled.DesignQualitative descriptive study using focus group discussions and in-depth interviews.SettingState of Kerala, India.Participants29 participants: four focus group discussions and eight in-depth interviews. Participants were chosen purposively based on their involvement in decision-making and implementation of COVID-19 control activities, from the department of health and family welfare, police, revenue, local self-government and community-based organisations. Districts, panchayats (local bodies) and primary health centres (PHCs) were selected based on epidemiological features of the area like the intensity of disease transmission and preventive/containment activities carried out in that particular area to capture the wide range of activities undertaken in the state.ResultsThe study identified five major themes that can inform best practices viz social capital, robust public health system, participation and volunteerism, health system preparedness, and challenges. This study was a real-time exploration of the intricacies of COVID-19 management in a low/middle-income country and the model can serve as an example for other states and nations to emulate or adjust accordingly.ConclusionThe study shows the impact of synergy of these themes towards more effective solutions; however, further research is much needed in examining the relationship between these factors and their relevance in policy decisions.

Background:The isolation from mainstream development activities, together with poverty and inaccessibility to health facilities made the tribal communities specifically vulnerable to various health problems.Objectives:This study aimed to compare the utilization of antenatal care, immunization, and supplementary nutrition services by tribal and nontribal mothers and its correlates in the selected districts.Materials and Methods:The study was a comparative cross-sectional study. The study population comprised tribal and nontribal mothers utilizing antenatal care, immunization, and supplementary nutrition services. A multi-stage cluster sampling strategy was employed for the study. The Chi-square test was used to assess the association between antenatal care services utilization, utilization of immunization services, supplementary nutrition services utilization and sociodemographic variables, and other service characteristics.Results:Effective utilization of antenatal care services was not seen in 5.6% of tribal mothers. The incidence of low-birth weight (≤2500) was significantly more among tribal mothers (31%) when compared to nontribal mothers (15%). The proportion of tribal children receiving complete immunization without delay was 74%, and among nontribal children, it was 78%. Effective immunization coverage was significantly lower among children of tribal mothers with education below high school level. Receipt of take-home ration was reported by nearly 90% of tribal and nontribal mothers. 90% of tribal mothers felt that quality of take-home ration that they received was of good quality.Conclusions:The comparison of health-care utilization restricted to the domains of antenatal care, immunization services, and supplementary nutrition suggests that the tribal mothers and children had a relatively comparable utilization pattern in most of the indicators measured.

Background: Medical students are subjected to various challenges, which are possibly etiological in the onset and persistence of depression. There is inadequate research on the longitudinal pattern and correlates of the emotional health of medical students in India. We aim to delineate the longitudinal pattern of depression among medical students and the factors predictive of depression. Methods: An 18-month follow-up design with 350 students (2012 intake) from two medical colleges in Kerala, India, was employed. A semistructured questionnaire and the Patient Health Questionnaire 9 were administered 2, 8, and 18 months into the course. Results: Depression was present in 42.80%, 36.20%, and 42.50% of the students at the three assessments. Variables significantly associated with depression on univariate analysis were the course not being of the student's choice at the first assessment; having an unemployed parent (mother) at the second assessment; alcohol use and male gender at the third assessment. On multivariate analysis, male gender (OR = 1.95[1.11-3.41]) and the presence of depression at 2 months (OR = 2.30[1.31-4.05]) and 8 months (OR = 2.48[1.39-4.44]) were predictive of depression at 18 months. Conclusions: The high rates of depression and the pattern of high rates early in the course among the medical students contrasts with that reported from other countries. Early depression and male gender were predictive of depression later in the course. The implications of this are to be taken into consideration when undergraduate intervention programs are planned.

Introduction Portable spirometers are commonly used in longitudinal epidemiological studies to measure and track the forced expiratory volume in first second (FEV1) and forced vital capacity (FVC). During the course of the study, it may be necessary to replace spirometers with a different model. This raise questions regarding the comparability of measurements from different devices. We examined the correlation, mean differences and agreement between two different spirometers, across diverse populations and different participant characteristics. Methods From June 2015 to Jan 2018, a total of 4,603 adults were enrolled from 628 communities in 18 countries and 7 regions of the world. Each participant performed concurrent measurements from the MicroGP and EasyOne spirometer. Measurements were compared by the intra-class correlation coefficient (ICC) and Bland-Altman method. Results Approximately 65% of the participants achieved clinically acceptable quality measurements. Overall correlations between paired FEV1 (ICC 0.88 [95% CI 0.87, 0.88]) and FVC (ICC 0.84 [0.83, 0.85]) were high. Mean differences between paired FEV1 (-0.038 L [-0.053, -0.023]) and FVC (0.033 L [0.012, 0.054]) were small. The 95% limits of agreement were wide but unbiased (FEV1 984, -1060; FVC 1460, -1394). Similar findings were observed across regions. The source of variation between spirometers was mainly at the participant level. Older age, higher body mass index, tobacco smoking and known COPD/asthma did not adversely impact on the inter-device variability. Furthermore, there were small and acceptable mean differences between paired FEV1 and FVC z-scores using the Global Lung Initiative normative values, suggesting minimal impact on lung function interpretation. Conclusions In this multicenter, diverse community-based cohort study, measurements from two portable spirometers provided good correlation, small and unbiased differences between measurements. These data support their interchangeable use across diverse populations to provide accurate trends in serial lung function measurements in epidemiological studies.