To control the double burden of communicable and non-communicable diseases (NCDs), in the developing world, understanding the patterns of morbidity and healthcare-seeking is critical. The objective of this cross-sectional study was to determine the distribution, predictors and inter-relationship of perceived morbidity and related healthcare-seeking behavior in a poor-resource setting. Between October 2013 and July 2014, 43999 consenting subjects were recruited from 10107 households in Malda district of West Bengal state in India, through multistage random sampling, using probability proportional-to-size. Information on socio-demographics, behaviors, recent ailments, perceived severity and healthcare-seeking were analyzed in SAS-9.3.2. Recent illnesses were reported by 55.91% (n=24600) participants. Among diagnosed ailments (n=23626), 50.92% (n=12031) were NCDs. Respiratory (17.28%,n=7605)), gastrointestinal (13.48%,n=5929) and musculoskeletal (6.25%,n=2749) problems were predominant. Non-qualified practitioners treated 53.16% (n=13074) episodes. Older children/adolescents [adjusted odds ratio for private healthcare providers(AOR_Pri)=0.76, 95% confidence interval=0.71-0.83) and for Govt. healthcare provider(AOR_Govt)=0.80(0.68-0.95)], females [AOR_Govt=0.80(0.73-0.88)], Muslims [AOR_Pri=0.85(0.69-0.76) and AOR_Govt=0.92(0.87-0.96)], backward castes [AOR_Govt=0.93(0.91-0.96)] and rural residents [AOR_Pri=0.82(0.75-0.89) and AOR_Govt=0.72(0.64-0.81)] had lower odds of visiting qualified practitioners. Apparently less severe NCDs [acid-peptic disorders: AOR_Pri=0.41(0.37-0.46) & AOR_Govt=0.41(0.37-0.46), osteoarthritis: AOR_Pri=0.72(0.59-0.68) & AOR_Govt=0.58(0.43-0.78)], gastrointestinal [AOR_Pri=0.28(0.24-0.33) & AOR_Govt=0.69(0.58-0.81)], respiratory [AOR_Pri=0.35(0.32-0.39) & AOR_Govt=0.46(0.41-0.52)] and skin infections [AOR_Pri=0.65(0.55-0.77)] were also less often treated by qualified practitioners. Better education [AOR_Pri=1.91(1.65-2.22) for ≥graduation], sanitation [AOR_Pri=1.58(1.42-1.75)] and access to safe water [AOR_Pri=1.33(1.05-1.67)] were associated with healthcare-seeking from qualified private practitioners. Longstanding NCDs [chronic obstructive pulmonary diseases: AOR_Pri=1.80(1.46-2.23), hypertension: AOR_Pri=1.94(1.60-2.36), diabetes: AOR_Pri=4.94(3.55-6.87)] and serious infections [typhoid: AOR_Pri=2.86(2.04-4.03)] were also more commonly treated by qualified private practitioners. Potential limitations included temporal ambiguity, reverse causation, generalizability issues and misclassification. In this poor-resource setting with high morbidity, ailments and their perceived severity were important predictors for healthcare-seeking. Interventions to improve awareness and healthcare-seeking among under-privileged and vulnerable population with efforts to improve the knowledge and practice of non-qualified practitioners probably required urgently.

Context: Silicosis is a progressive, irreversible and incurable respiratory morbidity and often becomes a cause for pre-mature mortality among occupationally silica dust-exposed workers in India and similar countries. It has a dual problem of associated silico-tuberculosis as a co-morbidity. The present study was done to assess the respiratory morbidity caused by silicosis in sandstone mine of Rajasthan, India. Methods: The chest X-rays of 529 subjects having history of employment in stone mines with respiratory morbidity were subjected for this study and evaluated in accordance with ILO Classification 2000. The X-rays were classified into various categories of silicosis and progressive massive fibrosis (PMF) in relation to years of work in stone mines. Results: Out of 529 chest radiographs evaluated, 275 (52%) showed radiological evidence of silicosis. Of them, 40 (7.5%) subjects showed large opacities suggestive of progressive massive fibrosis. Both silicosis and progressive massive fibrosis were associated with increasing duration of work in stone mines. Sixty-one (12.4%) subjects with silicosis also had associated pulmonary tuberculosis, termed as silico-tuberculosis. Conclusion: The present study showed a high prevalence of silicosis, progressive massive fibrosis and silico-tuberculosis among stone mine workers. It appears that that unless silicosis is controlled, elimination of tuberculosis is far from reality in the country. Hence, states and central authorities must work together towards control of both silicosis as well as silico-tuberculosis. Similarly, there is an urgent need of initiation of national silicosis control programme, similar to existing national tuberculosis control programme, considering the huge burden of silicosis in India

Background: Implementation of Multi drug Therapy (MDT) regimen has resulted in the decline of the total number of leprosy cases in the world. Though the prevalence rate has been declining, the incidence rate remains more or less constant and high in South East Asian countries particularly in India, Nepal, Bangladesh, Pakistan and Srilanka. Leprosy, particularly that of multibacillary type spreads silently before it is clinically detected. An early detection and treatment would help to prevent transmission in the community. Multiplex PCR (M-PCR) technique appears to be promising towards early detection among contacts of leprosy cases. Methods: A total of 234 paucibacillary (PB) and 205 multibacillary (MB) leprosy cases were studied in a community of an endemic area of Bankura district of West Bengal (Eastern India). They were assessed by smear examination for acid-fast bacilli (AFB) and M-PCR technique. These patients were treated with Multidrug Therapy (MDT) as prescribed by WHO following detection. A total of 110 MB and 72 PB contacts were studied by performing M-PCR in their nasal swab samples. Results: 83.4% of MB patients were observed to be positive by smear examination for AFB and 89.2% by M-PCR. While 22.2% of PB patients were found to be positive by smear examination for AFB, 80.3% of these patients were positive by M-PCR. Among leprosy contacts (using M-PCR), 10.9% were found to be positive among MB contacts and 1.3% among PB contacts. Interestingly, two contacts of M-PCR positive MB cases developed leprosy during the period of two years follow up. Conclusion: The M-PCR technique appears to be an efficient tool for early detection of leprosy cases in community based contact tracing amongst close associates of PB and MB cases. Early contact tracing using a molecular biology tool can be of great help in curbing the incidence of leprosy further.

Prevalence of both cervical cancer and Human Immunodeficiency Virus (HIV) infection are very high in India. Natural history of Human Papilloma Virus (HPV) infection is known to be altered in HIV positive women and there is an increased possibility of persistence of HPV infections in this population. Therefore, this study was conducted to understand the epidemiology and circulating genotypes of oncogenic HPV among HIV positive and negative female population in West Bengal, India.

Background & objectives: Clinically silicosis is diagnosed by chest X-ray showing specific opacities along with history of silica dust exposure. Diagnosis is invariably made at an advanced or end stage when it is irreversible. Moreover, silicosis patients are susceptible to develop tuberculosis. Therefore, a suitable biomarker for early detection of silicosis is needed. This study evaluated the suitability of club cell protein (CC16) as a biomarker for early detection of silicosis. Methods: This pilot study included 121 individuals from X-ray-confirmed/advanced silicosis, moderate silica dust-exposed workers and healthy controls from western India. CC16 levels were quantified in serum samples through ELISA. Sensitivity and specificity of CC16 values at different cut-off points were calculated in both non-smokers and smokers. Results: Serum CC16 level was significantly (P<0.01) decreased in X-ray confirmed advanced silicosis patients (4.7±3.07 ng/ml) followed by moderately exposed workers (10.2±1.77 ng/ml) as compared to healthy non-exposed individuals (16.7±3.81 ng/ml). Tobacco smoking also caused a significant decrease of serum CC16 concentration in both healthy (10.2±1.12 ng/ml) and advanced silicosis workers (2.6±2.28 ng/ml) compared to non-smokers. Sensitivity and specificity of CC16 values were also found to be ≥83 per cent for screening all categories of individuals. Interpretation & conclusions: Because of high sensitivity and specificity, serum CC16 could be used as predictive biomarker for suspicion and early detection of silicosis, which would help in reducing/delaying premature deaths caused by silicosis. It would also control silicotuberculosis additionally.