Effectiveness of introducing pulse oximetry and clinical decision support algorithms for the management of sick children in primary care in India and Tanzania on hospitalisation and mortality: the TIMCI pragmatic cluster randomised controlled trial.

Background: Pulse oximetry can support better detection of hypoxaemia, an important mortality predictor, and digital clinical decision support algorithms (CDSAs) can strengthen adherence to Integrated Management of Childhood Illness (IMCI) guidelines. This study sought to address evidence gaps on the impact of providing these tools to primary care healthcare providers on under-five hospitalisations and mortality.

Methods: A pragmatic, parallel group, superiority, cluster randomised controlled trial (RCT) conducted in 172 primary care facilities in India and Tanzania (106 and 66 facilities, respectively).

Development and validation of a novel clinical risk score to predict hypoxaemia in children with pneumonia using the WHO PREPARE dataset.

Background: Hypoxaemia predicts mortality at all levels of care, and appropriate management can reduce preventable deaths. However, pulse oximetry and oxygen therapy remain inaccessible in many primary care health facilities. We aimed to develop and validate a simple risk score comprising commonly evaluated clinical features to predict hypoxaemia in 2-59-month-old children with pneumonia.

Costs of testing sick children in primary care with pulse oximetry: Evidence from four countries, both with and without electronic clinical decision support.

Introducing pulse oximeters (PO) at primary care facilities can help health workers identify severely ill children who need referral to hospital thereby allowing for improved child clinical outcomes. Adding clinical decision support algorithms (CDSA) can improve adherence to Integrated Management of Childhood Illness guidelines. The current study analyses the costs of introducing PO either with or without an electronic CDSA using an RCT in India and Tanzania and in a pre-post design with an electronic CDSA in Kenya and Senegal.

Molecular detection and serotyping of acute bacterial meningitis pathogens in Indian children.

Background: Acute bacterial meningitis (ABM) is a medical emergency that requires early diagnosis and prompt treatment. Understanding bacterial etiology and resistance patterns is critical for optimal management and reduction of mortality. Nucleic acid amplification tests, with high sensitivity and rapid results, are valuable for diagnosing ABM.

Risk factors for asthma across India: Results from global asthma network (GAN) phase I study.

Introduction: This study aimed to assess the risk factors and triggers predisposing to asthma in Indian children and adults.

Methods: The Global Asthma Network Phase I study was a multicentre, international, school, and questionnaire-based cross-sectional study conducted across the world with nine centers in India from 2017-18, the current study being analysis of the Indian data.

Results: There were 20084 children, 25887 adolescents, and 81296 adults from 9 sites across India.

"Assessment of serum homocysteine levels in congenital heart disease and with congenital rubella infection: A hospital-based case-control study in north Indian population".

Ours study examined the association of serum homocysteine (Hcy) levels with congenital heart disease (CHD) and congenital rubella infection (CRI) suggesting a potential pathogenic interaction between metabolic dysregulation and viral teratogenicity.

Clustering and visualisation of the GABRIEL network expertise in the field of infectious diseases.

Introduction: The Global Approach to Biology Research, Infectious diseases and Epidemics in Low-income countries (GABRIEL) network is an international scientific network of 21 centres coordinated by the Merieux Foundation (Lyon, France). Mapping and characterising the similarities and differences in expertise and activities across four major infectious diseases (tuberculosis, antimicrobial-resistant infections, acute respiratory infections and emerging pathogens) among these centres would help to provide a better understanding of the network's capacity. It will also highlight how the applied methodology can enhance information sharing within research networks.

Efficacy and Safety of Albendazole Versus Albendazole and Ivermectin in Reduction of Soil-Transmitted Helminth Infections in School-Age Children (DVERMIN): A Double-Blind, Randomized, Controlled Trial.

Background: Soil-transmitted helminth (STH) infections are endemic in India despite considerable improvements in hygiene conditions and regular deworming. This multicentric, double-blind, randomized controlled trial (Efficacy and Safety of Albendazole Versus AlbenDazole and IVERmectin in Reduction of Soil-Transmitted HelMINth Infections in School-Age Children (DVERMIN)) was conducted to evaluate the efficacy and safety of albendazole versus albendazole + ivermectin in the treatment of STH infections and to evaluate the prevalence of stool-positivity for STH in school-going children from 12 schools of Lucknow and Kolkata.

Methods: This was a randomized controlled trial conducted from March 2022 to February 2023.

Association of Specific Dietary Fatty Acids with Asthma in Urban School Children and Adolescents: Inferences from a Cross-Sectional Multicentric Study From India.

Objective: To assess the association of dietary fatty acids with asthma in Indian school children.

Methods: Children aged 6-16 years were enrolled from randomly selected urban schools in 10 cities. The International Study on Asthma and Allergies in Childhood Phase III Questionnaire was used to assess the prevalence of asthma.

Rubella immunity among pregnant women and the burden of congenital rubella syndrome (CRS) in India, 2022.

Background: India aims to eliminate rubella and congenital rubella syndrome (CRS) by 2023. We conducted serosurveys among pregnant women to monitor the trend of rubella immunity and estimate the CRS burden in India following a nationwide measles and rubella vaccination campaign.

Methods: We surveyed pregnant women at 13 sentinel sites across India from Aug to Oct 2022 to estimate seroprevalence of rubella IgG antibodies.

Prevalence of persistent pneumonia among severe pneumonia and nutritional status as its associated risk factor: A prospective observational study among under-five children.

Background: Malnourishment is a risk factor for persistent pneumonia among under-five children with severe pneumonia. This study aims to determine the prevalence of persistent pneumonia and the association between nutritional status and pneumonia severity in children under 5 years of age.

Methodology: A prospective observational hospital-based study was conducted in the Department of Paediatrics, King George's Medical University (KGMU) from May 2019 to April 2020 among children aged 1 month to 5 years admitted with a diagnosis of severe pneumonia.

The Tools for Integrated Management of Childhood Illness (TIMCI) study protocol: a multi-country mixed-method evaluation of pulse oximetry and clinical decision support algorithms.

Effective and sustainable strategies are needed to address the burden of preventable deaths among children under-five in resource-constrained settings. The Tools for Integrated Management of Childhood Illness (TIMCI) project aims to support healthcare providers to identify and manage severe illness, whilst promoting resource stewardship, by introducing pulse oximetry and clinical decision support algorithms (CDSAs) to primary care facilities in India, Kenya, Senegal and Tanzania. Health impact is assessed through: a pragmatic parallel group, superiority cluster randomised controlled trial (RCT), with primary care facilities randomly allocated (1:1) in India to pulse oximetry or control, and (1:1:1) in Tanzania to pulse oximetry plus CDSA, pulse oximetry, or control; and through a quasi-experimental pre-post study in Kenya and Senegal.

Assessment of interleukin 1 receptor antagonist (IL-1RA) levels in children with and without community acquired pneumonia: a hospital based case-control study.

The primary objective was to compare serum interleukin-1 receptor antagonist (IL-1RA) levels in cases of community acquired pneumonia (CAP) and healthy age-gender-matched controls. The secondary objective was to compare serum IL-1RA levels in cases which were positive or negative for Streptococcus pneumoniae in the blood by real-time-polymerase chain reaction (RT-PCR). Hospitalized children with World Health Organization defined CAP, aged 2-59 months, were included as cases.

Assessment of Blood Lead Level of School Children in 10 Cities of India: A Cross-Sectional Study.

Objectives: To assess the blood lead level (BLL) of school children in 10 cities of India.

Methods: This multi-centric cross-sectional study enrolled participants from randomly selected schools. Data on demographic details, socioeconomic status (SES) and anthropometric indicators was collected.

Association of dietary intake with micronutrient deficiency in Indian school children: a cross-sectional study.

Adequate nutrition is necessary during childhood and early adolescence for adequate growth and development. Hence, the objective of the study was to assess the association between dietary intake and blood levels of minerals (calcium, iron, zinc, and selenium) and vitamins (folate, vitamin B12, vitamin A, and vitamin D) in urban school going children aged 6-16 years in India, in a multicentric cross-sectional study. Participants were enrolled from randomly selected schools in ten cities.

Developing Standard Treatment Workflows-way to universal healthcare in India.

Primary healthcare caters to nearly 70% of the population in India and provides treatment for approximately 80-90% of common conditions. To achieve universal health coverage (UHC), the Indian healthcare system is gearing up by initiating several schemes such as National Health Protection Scheme, Ayushman Bharat, Nutrition Supplementation Schemes, and Inderdhanush Schemes. The healthcare delivery system is facing challenges such as irrational use of medicines, over- and under-diagnosis, high out-of-pocket expenditure, lack of targeted attention to preventive and promotive health services, and poor referral mechanisms.

Profile of cardiac lesions among laboratory confirmed congenital rubella syndrome (CRS) infants: a nationwide sentinel surveillance, India, 2016-22.

Background: The phenotypical profile of cardiovascular malformations in patients with congenital rubella syndrome (CRS) is varied. We aimed to describe the profile of cardiac defects among CRS patients detected in the sentinel CRS surveillance in India during 2016-22.

Methods: Sentinel sites enrolled infants with suspected CRS based on presence of cardiac defects, hearing impairment, eye signs, or maternal history of febrile rash illness.

Cost of treating sick young infants (0-59 days) with Possible Serious Bacterial Infection in resource-constrained outpatient primary care facilities: An insight from implementation research in two districts of Haryana and Uttar Pradesh (India).

Background: Information on the average and incremental costs of implementing alternative strategies for treating young infants 0-59 days old in primary health facilities with signs of possible serious bacterial infection (PSBI) when a referral is not feasible is limited but valuable for policymakers.

Methods: Direct activity costs were calculated for outpatient treatment of PSBI and pneumonia in two districts of India: Palwal, Haryana and Lucknow, Uttar Pradesh. These included costs of staff time and consumables for initial assessment, classification, and referrals; recommended treatment of fast breathing (oral amoxicillin for seven days) and PSBI (injection gentamicin and oral amoxicillin for seven days); and daily assessments.

Care-Seeking Behavior of Families of North Indian Children Suffering From WHO-Defined Severe Community-Acquired Pneumonia: A Hospital-Based Prospective Study.

Background Community-acquired pneumonia (CAP) is one of the leading causes of death in children under five. In developing countries, delayed treatment seeking has been associated with mortality and morbidity. There are only a few studies in India evaluating care-seeking behavior, particularly in children with CAP.

Association of Interleukin-1 Receptor Antagonist ( ) Gene Polymorphism with Community-Acquired Pneumonia in North Indian Children: A Case-Control Study.

 Community-acquired pneumonia (CAP) is the leading cause of death in children < 5 years of age. The primary objective of the study was to assess the association of gene polymorphism in children aged 2 to 59 months with CAP and the secondary objective was to assess the association of gene polymorphism with mortality among hospitalized CAP cases.  This case-control study was conducted in a tertiary teaching institute in Northern India.

Congenital rubella syndrome surveillance in India, 2016-21: Analysis of five years surveillance data.

Background: In India, facility-based surveillance for congenital rubella syndrome (CRS) was initiated in 2016 to estimate the burden and monitor the progress made in rubella control. We analyzed the surveillance data for 2016-2021 from 14 sentinel sites to describe the epidemiology of CRS.

Method: We analyzed the surveillance data to describe the distribution of suspected and laboratory confirmed CRS patients by time, place and person characteristics.

Childhood Pneumonia: What's Unchanged, and What's New?

Childhood pneumonia is still a significant clinical and public health problem. India contributes the highest number of deaths due to pneumonia, accounts for about 20% of global mortality among under five children. Various etiologic agents including bacteria, viruses and atypical organism are responsible for childhood pneumonia.

Identifying risk of death in children hospitalized with community-acquired pneumonia.

Objective: To externally validate a tool developed by the Pneumonia Research Partnership to Assess WHO Recommendations study group for identification of the risk of death in children hospitalized with community-acquired pneumonia, the PREPARE tool.

Methods: We did a secondary analysis of data collected during hospital-based surveillance of children with community-acquired pneumonia in northern India from January 2015 to February 2022. We included children aged 2-59 months with pulse oximetry assessment.