Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “INDIA”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 307 records · Page 17Linked to original sources
PubMed2006

How much attention is needed towards men who sell sex to men for HIV prevention in India?

BACKGROUND: HIV prevention in India has mostly focussed on heterosexual transmission. Data on homosexual transmission are not readily available from India. We therefore assessed the probability of acquiring and transmitting HIV for men who sell sex to men and compared this with women who sell sex in India. METHODS: Sexual behaviour characteristics of 6661 men who have sex with men and 6648 women who sell sex were obtained in the Indian state of Andhra Pradesh through confidential interviews. These, along with estimates of HIV rates among them and risk of HIV transmission per unprotected sex act from other sources, were used to calculate their annual probability of acquiring and transmitting HIV. RESULTS: Of 6661 men who have sex with men in this sample, 1776 (26.7%) had sold sex to men. For every 1000 men who sell sex to men, annually 146 (95% confidence interval [CI] 116-179) would acquire HIV and HIV would be transmitted to 55 (95% CI 42-71) men who do not sell sex or women. These estimates were higher by 6.7 (95% CI 4.9-9.2) times for acquiring HIV and 2.5 (95% CI 2.0-3.2) times for transmitting HIV to sex partners outside their group, as compared with similar estimates for women who sell sex. In this sample, the average annual probability of acquiring HIV was higher among men who have sex with men but do not sell sex as compared with women who sell sex. CONCLUSION: These data indicate that men who sell sex to men are at much higher risk of acquiring and transmitting HIV than women who sell sex. Therefore, men who sell sex to men and their clients warrant substantial attention for comprehensive HIV prevention in India.

Adolescent↗
PubMed2003

Sensitivity and specificity of rapid HIV testing of pregnant women in India.

OBJECTIVE: Efforts to prevent HIV transmission from mother to infants in settings like India may benefit from the availability of reliable methods for rapid and simple HIV screening. Data from India on the reliability of rapid HIV test kits are limited and there are no data on the use of rapid HIV tests for screening of pregnant women. METHODS: Pregnant women attending an antenatal clinic and delivery room in Pune agreed to participate in an evaluation of five rapid HIV tests, including (a) a saliva brush test (Oraquick HIV-1/2, Orasure Technologies Inc.), (b) a rapid plasma test (Oraquick HIV-1/2) and (c) three rapid finger prick tests (Oraquick HIV-1/2; HIV-1/2 Determine, Abbott; NEVA HIV-1/2 Cadila). Results of the rapid tests were compared with three commercial plasma enzyme immunoassay (EIA) tests (Innotest HIV AB EIA, Lab systems/ELISCAN HIV AB EIA, UBI HIV Ab EIA). RESULTS: Between September 2000 and October 1, 2001, 1258 pregnant women were screened for HIV using these rapid tests. Forty-four (3.49%) of the specimens were HIV-antibody-positive by at least two plasma EIA tests. All of the rapid HIV tests demonstrated excellent specificity (96-100%). The sensitivity of the rapid tests ranged from 75-94%. The combined sensitivity and specificity of a two-step algorithm for rapid HIV testing was excellent for a number of combinations of the five rapid finger stick tests. CONCLUSION: In this relatively low HIV prevalence population of pregnant women in India, the sensitivity of the rapid HIV tests varied, when compared to a dual EIA algorithm. In general, the specificity of all the rapid tests was excellent, with very few false positive HIV tests. Based upon these data, two different rapid HIV tests for screening pregnant women in India would be highly sensitive, with excellent specificity to reliably prevent inappropriate use of antiretroviral therapy for prevention of vertical HIV transmission.

Adult↗
PubMed2003

The role of non-governmental organizations for the welfare of the elderly: the case of HelpAge India.

Since there has been a gradual increase in the population aged 60 and older, a developing country like India is unable to cope with the needs and problems of its aged populations. While the government continues its efforts to introduce programs for the elderly, the non-governmental organizations (NGOs) have played a key role in bringing to the forefront the socioeconomic and health problems of older people in the society at large. This paper looks at the role of the NGOs through their various welfare activities and beneficial programs in carving out a place for the elderly in India. The work of HelpAge India is highlighted to examine how voluntary organizations have worked in the field of aging in India and made an impact on the lives of the senior citizens, especially those below the poverty line who are economically and socially deprived.

Aged↗
PubMed2001

Barriers to condom use: results from a study in Mumbai (Bombay), India.

The consistent and correct use of condoms coupled with risk reduction education strategies, continue to play an important role in the reduction and prevention of HIV/AIDS transmission. Therefore understanding and incorporating strategies to overcome barriers to condom use in such education and prevention efforts are critical. This is particularly necessary in countries such as India, where HIV/AIDS has become a serious public health crisis. The current study documents and provides preliminary data on the use of condoms, reasons for and barriers to condom use, and sources of information about safer sex practices among a sexually active adult sample of 49 women and 203 men in Mumbai, India. Despite limitations such as the use of a nonrandom sample of participants composed predominantly of young, English-speaking males, the study findings provide some insights into the importance of and the need to address issues of privacy regarding condom purchase and use in India. Most notably, the lack of privacy in stores and the social stigma associated with condom use were indicated as the most significant barriers. These and other study findings suggest the need to ease the social costs and constraints to safe behaviors through increased acceptance of condoms and promotion of their consistent use. This could serve as an important means to curb the epidemic of HIV/AIDS in India.

Adolescent↗
PubMed2001

Social cost-benefit analysis of a watershed development project in Karnataka, India.

Watershed Development Programmes (WDPs) have been initiated in India to improve and sustain productivity and the production potential of the dry and semiarid regions of the country at higher levels, through adoption of appropriate production and conservation techniques. The aim is also to meet the needs of rural communities for food, fuel, fodder, and timber and, thereby, reduce pressure on natural forests. In view of their potential for growth, for improving income, and the natural resource base of the disadvantaged regions of the country, WDPs are being accorded importance in the development plans for India and by donor agencies. This paper presents a social cost-benefit appraisal of a watershed development project in Karnataka, India. Using alternate viability measures, i.e. Net Present Value (NPV), Benefit-Cost Ratio (BCR) and Internal Rate of Return (IRR), and rigorous tests and sensitivity analyses, the results show that if expected full benefits are realized, the benefits derived from the watershed project are quite high, with the IRRs ranging from 19 to 96%. If, however, expected full benefits were to fall short by 25%, and net costs of (including the opportunity cost of grazing benefits foregone by the villagers on account of establishing community woodlots on degraded forestlands and village commons used earlier for free grazing of their cattle) the project will report losses. Even these losses can be contained if the direct benefits from some community woodlots, for which information was not available, and other indirect benefits, mostly of an environmental nature, are included. The findings of this study suggest that watershed development projects initiated to improve the economy and ecology of India's dry and semiarid regions are economically viable and socially desirable.

Agriculture↗
PubMed2004

Erroneous reports of the neotropical Echinococcus oligarthrus as a cause of echinococcosis in India.

Two cases of submandibular echinococcosis have been reported in adult residents of India (Kini et al., 1997; Sahni et al., 2000). It was stated in both publications that the cestode was E. oligarthrus, "a rare variety of E. granulosus", based on morphogical characteristics. It was also mentioned that 3 cases of E. granulosus with similar submandibular metacestode had been previously diagnosed in India. The metacestode is readily distinguishable from that of E. oligarthrus. The final hosts of E. oligarthrus are several neotropical species of wild cats and metacestode occurs in hystricognath, all of them absent in India. The larval stage of all 4 species of Echinococcus can be differentiated on the basis of the form and dimensions of rostellar hooks of protoescoleces. With the information provided in the two papers we concluded that the 2 cases of echinococcosis described in India were due to E. granulosus.

Animals↗
PubMedDate not supplied

Persistence of serum antibodies to Sarcocystis neurona in horses moved from North America to India.

BACKGROUND: The study reported here was undertaken to assess the presence of antibodies to Sarcocystis neurona in the serum of horses of North American origin that had been relocated for 1 year or more to India (ie, outside of the known endemic areas for S. neurona). HYPOTHESIS: The presence or absence of such antibodies should provide information concerning the persistence of such antibodies, or support the presence of chronic infection, or both. ANIMALS: A total of 228 Thoroughbred horses were sampled in India, of which 86 were of North American origin that had been in India between 1 and 13 years, 124 were Indian-born horses that had never been out of India, 8 were of Irish origin, 8 were of English origin, and 2 were originally from France. METHODS: Sera were tested using established western blot analysis. RESULTS: Of the Indian-born horses, 0.8% were test positive, and of the North American horses, 42% were test positive. All of the English and Irish horses were test negative, and the 2 French horses were test positive. CONCLUSIONS AND CLINICAL IMPORTANCE: These data indicate that antibodies against S. neurona can be detected for many years after horses have been removed from an endemic area and that this may be attributable to long half-life of the antibodies or to chronic infection and ongoing antibody production, or both.

Animals↗
PubMed1992

Bluetongue virus infection in India: a review.

The history and epizootiology of bluetongue (BT) in India are reviewed. BT has become endemic in India. The first outbreak of BT in sheep and goats in the country was recorded in 1964 in Maharashtra State. Since then, several outbreaks of BT have been reported in sheep. Exotic sheep are more susceptible than indigenous and cross-bred sheep. A serological survey has indicated the presence of bluetongue virus (BTV) antibodies in cattle and buffalo in several states in India. However, clinical BT has not been observed in cattle or buffalo to date. Of the 24 known serotypes of BTV, 18 have been reported in India. Although BTV has been isolated from Culicoides midges, the particular species responsible for transmission has not yet been identified.

Animals↗
PubMed2000

Reservoir hosts of Leptospira inadai in India.

Isolation of Leptospira from the kidneys of Rattus rattus wroughtoni hinton, Rattus rattus rufescens, Bandicota bengalensis and Bandicota indica was attempted in Bangalore in southern India. In total, 296 spirochaetes were isolated from 1,348 kidney cultures (an isolation rate of 22%). A batch of fifty-six isolates from India was identified, based on serological and polymerase chain reaction analysis, of which twenty-three isolates were identified as L. inadai by the World Health Organization/Food and Agriculture Organization Collaborating Centre for Reference and Research on Leptospirosis, in Brisbane. This is the first record of isolation of L. inadai from rodents. The preponderance of L. inadai in four different species of rodents suggests that these animals could be the natural reservoir hosts of L. inadai, and raises a critical question as to the likely impact of this species of Leptospira on the renal carrier status of other Leptospira pathogenic to humans and animals in this part of India. Virulence studies conducted at the University of Trieste in Italy, revealed that isolates of L. inadai from India were moderately or totally serum resistant when subjected to a serum killing test. To establish the possible seroprevalence of this species in the population, the inclusion of L. inadai in the battery of leptospiral antigens used for sero-epidemiological studies is recommended.

Animals↗
PubMed2004

Prevalence and distribution of peste des petits ruminants virus infection in small ruminants in India.

Peste des petits ruminants (PPR) is an acute febrile viral disease of goats and sheep characterised by mucopurulent nasal and ocular discharges, necrotising and erosive stomatitis, enteritis and pneumonia. The disease is endemic in India and causes large economic losses each year due to the high rates of mortality and morbidity in infected sheep and goats. The present study reports observations from 58 laboratory confirmed outbreaks of PPR and provides details of the prevalence of antibodies to PPR virus (PPRV) in 4,407 serum samples of small ruminants. Most of the clinical specimens used for the study originated from the northern and central parts of India. Serum samples used for the detection of antibodies to PPRV were derived from a greater number of regions within the country, however, these samples may not be a true representation of the target population (unvaccinated sheep and goats over 3 months old). Indigenously developed monoclonal antibody-based diagnostic kits were used for the detection of PPRV antigen (sandwich enzyme-linked immunosorbent assay [ELISA]) and antibody (competitive ELISA). Findings suggested that the disease outbreaks were more severe in goats than sheep and that the frequency of disease outbreaks was greater between the months of March and June (51.7%) as compared to other periods of the year. Based on the screening of the 4,407 sera samples, the antibody prevalence of PPRV in small ruminants in India was 33% (95% confidence interval: 32.3% to 33.7%). The prevalence of antibodies to PPRV was noted to differ between species (i.e. sheep versus goats), age groups and geographical regions. A greater proportion of the sheep (36.3%) versus the goat (32.4%) population was infected with PPRV. The distribution and prevalence of antibodies to PPRV among various age groups of animals indicated that goats were exposed at an earlier age than the sheep, suggesting that goats may be more susceptible to infection with PPRV. A greater number of positive cases were observed in the southern and southwestern part of the country (30%-60%) as compared to northern India (10%-30%). These findings may be correlated with variations in the sheep and goat husbandry practices within different geographic regions, the topography of different states and the socio-economic status of individual Indian farmers.

Age Factors↗
PubMed2005

Social class and all-cause mortality in an urban population of North India.

BACKGROUND: There is a rapid emergence of cardiovascular disease in India with economic development, leading to an increase in mortality due to these diseases. The exact causes of death in India, however, are not known. SUBJECTS AND METHODS: We studied randomly selected death records from 2222 (1385 men and 837 women) victims, aged 25-64 years, out of 3034 death records during 1999-2001 at the Municipal Corporation, Moradabad. All the families of these victims could be contacted individually to find out the causes of death, by scientists/doctors-administered pre-tested verbal autopsy questionnaires, completed with the help of spouses and local treating doctors practising in the concerned lane. Social classes were assessed by a questionnaire based on attributes of per capita income, occupation, education, housing and ownership of consumer luxury items in the household. RESULTS: Causes of mortality included infectious diseases (41.1%, n = 915) such as tuberculosis, pneumonia, chronic obstructive pulmonary disease, diarrhea/dysentery, hepatitis B, and inflammatory brain infections as the commonest causes of death in the urban population of North India. The second most common causes of death were circulatory diseases (29.1%, n = 646), including heart attacks (10.0%), strokes (7.8%), valvular heart disease (7.2%, n = 160), sudden cardiac death, and inflammatory cardiac disease (each 2.0%, n = 44). Malignant neoplasm (5.8%, n = 131), injury (14.0%, n = 313), including accidents, fire and falls, and poisonings were also quite common causes of death. Miscellaneous causes of death were noted in 9.1% (n = 202) death records, including diabetes mellitus (2.2%, n = 49), suicides (1.8%, n = 41), congenital anomalies (1.0, n = 37), dental caries infections (1.9, n = 42), and burns (1.3%, n = 33). Pregnancy and perinatal causes (0.72%, n = 15) were not commonly recorded in our study. Circulatory diseases as the cause of mortality were statistically significantly more common among higher social classes (1-3) than in lower social classes (4 and 5) whose members died more often due to infections. Heart attacks, strokes, hypertension, diabetes and obesity were statistically significantly more common among higher social classes (1-3) as compared to classes 3 and 4, but tobacco intake showed only minor differences among various classes. CONCLUSIONS: This study indicates that circulatory diseases, injury and malignant diseases have become the major causes of death in India, after infections. Members of social classes 1-3 died more often due to circulatory diseases and members in lower social classes died more often due to infections. Urbanization with rapid changes in diet and lifestyle in various social classes, and possibly aging of the population seem to be responsible for the double burden of diseases, related to under- and over-nutrition, causing death in a developing economy. Monitoring of blood pressure and heart rate around the clock for 7 days, with data analysed chronobiologically can detect abnormal circadian patterns associated with a large increase in cardiovascular disease risk, greater than hypertension itself, allowing the institution of prophylactic treatment. Such prehabilitation may be particularly useful to curb the increasing burden of cardiovascular diseases in both developed and developing countries.

Adult↗
PubMed2001

Present status of asbestos mining and related health problems in India--a survey.

At present in India more than thirty mines are in operation. It produces 2800 tones of asbestos per month (mainly chrysotile and tremolite) and in recent years substantial quantity (-70%) is imported from Canada. The quality of asbestos produced in India is very poor. The mining and milling and other related processes expose the people to cancer and related diseases. Women are more affected by their exposure in processing unit compared to male who are generally working in mines. Direct and indirect employment in asbestos related industry and mine is around 100,000 workers. Latency period (length of the time between exposure and the onset of diseases) in India is estimated to be 20-37 yr. The causes for lung and breathing problem are mainly due to obsolete technology and direct contact with the asbestos products without proper precaution, because in India asbestos are sold without statutory warning. This paper reviews health effects (such as fibrosis, sequelae, bronchogenic cancer, and malignant mesothelioma) on the Indian mine workers caused due to asbestos mining related activities with respect to their present day condition.

Asbestos, Amphibole↗
PubMed2005

Mosquitoes of the mangrove forests of India: Part 1--Bhitarkanika, Orissa.

In this first paper of a series on mosquitoes of the mangrove forests of India, details of mosquito species recorded in Bhitarkanika, Orissa, are presented. Forty-three species of mosquitoes belonging to 21 subgenera and 13 genera, Aedes, Anopheles, Armigeres, Coquillettidia, Culex, Ficalbia, Heizmannia, Lutzia, Mansonia, Ochlerotatus, Toxorhynchites, Uranotaenia, and Verrallina, were recorded. Predominant larval habitat was the tree holes, from which 15 species were taken. Adults were mostly found resting in crab holes, tree holes, and hoof prints in the forest area and on walls in the guesthouse area. About 14 species were caught in light traps, while 19 species landed on humans for feeding. Ae. franciscoi and Oc. feegradei are 2 new country records for India. Ae. cancricomes and Cx. perplexus, known only from Andaman Islands of India, are new records for mainland India.

Aedes↗
PubMed2000

Geographic and ethnic distribution of beta-thalassemia mutations in Uttar Pradesh, India.

We have studied the geographic and ethnic distribution of mutations in 376 subjects who were carriers of beta-thalassemia, and identified the mutations in 365 chromosomes. The majority of the beta-thalassemia carriers were of Uttar Pradesh (India) origin. Their pattern of mutations differed from the other states of India and from those families who had migrated from Pakistan. The frequency of the IVS-I-5 (G-->C) and 619 bp deletion mutations were 64.3 and 2.5%, respectively, among families originating from Uttar Pradesh, compared to a prevalence of 37.5 and 27.5%, respectively in the population of Pakistani immigrants. Of the 10 common Asian Indian mutations, only eight were observed in subjects studied from different parts of India. By use of the amplification refractory mutation system along with DNA sequencing techniques, the mutations were successfully identified in 97.1% of subjects, while 11 cases (2.9%) still remain to be characterized by single strand conformation polymorphism and sequencing analyses. The application of this knowledge has facilitated the successful implementation of the program of genetic counseling and prenatal diagnosis of beta-thalassemia, thus helping to avoid the birth of an affected child in India.

DNA Mutational Analysis↗
PubMed1982

Legal control and alcohol in the United States and India.

Arrest data provide an index of public concern regarding alcohol-related activities of certain groups within a society. Any differences in these data may reflect the differences in the extent to which their conduct is viewed and reacted to as problematic behavior requiring legal control. In this paper we compare the official statistics regarding alcohol arrest data of adults and juveniles in the United States, India in general, and a "dry" Indian state, Tamil Nadu. The United States, India, and Tamil Nadu are similar in that the proportion of juveniles arrested for alcohol-related convictions compared to juveniles arrested for all offenses is about the same (i.e., 8%). But proportionately more of the young people, compared with adults, in the United States are subjected to arrest for liquor law violations, although a greater proportion of adults, compared to juveniles, are arrested for public drunkenness. In India generally, and Tamil Nadu in particular, juvenile vis-à-vis adult arrests for liquor law offenses are equal to their proportions in the population. That is, in contrast to India, alcohol law enforcement in the United States is specifically directed at regulating the drinking behavior of young people.

Adolescent↗
PubMed2006

Distribution of hepatitis B virus genotypes: phylogenetic analysis and virological characteristics of genotype C circulating among HBV carriers in Kolkata, Eastern India.

AIM: To evaluate the genotype distribution of hepatitis B virus (HBV) in Eastern India and to clarify the phylogenetic origin and virological characteristics of the recently identified genotype C in this region. METHODS: Genotype determination, T1762/A1764 mutation in the basal core promoter (BCP) and A1896 mutation in the precore region of 230 subjects were determined by restriction fragment length polymorphism method (RFLP) and the result was confirmed by direct sequencing. RESULTS: The predominant genotypes D (HBV/D) and A (HBV/A) were detected in 131/230 (57%) and 57/230 (25%) samples. In addition, genotype C (HBV/C) was detected in 42/230 (18%) isolates. Surface gene region was sequenced from 45 isolates (27 HBV/C, 9 HBV/A and 9 HBV/D). Phylogenetic analysis revealed that all of the HBV/C sequences clustered with South East Asian subgenotype (HBV/Cs). The sequence data showed remarkable similarity with a Thai strain (AF068756) (99.5% +/- 0.4% nucleotide identities) in 90% of the genotype C strains analyzed. T1762/A1764 mutation in BCP region, associated with high ALT was significantly higher in HBeAg negative isolates than HBeAg positive isolates. Frequency of A1896 mutation leading to HBeAg negativity was low. CONCLUSION: The present study reports the genotypic distribution and the characteristics of partial genome sequences of HBV/C isolates from Eastern India. Low genetic diversity and confinement of HBV/C in Eastern India possibly indicate a recent, limited, spread in this region. Genotype C with T1762/A1764 mutation has been reported to increase the risk for hepatocellular carcinoma; therefore genotype C carriers in Eastern India should be carefully monitored.

Adolescent↗
PubMed1999

Progress towards elimination of leprosy as a public health problem in India and role of modified leprosy elimination campaign.

India (population 943 million) has seen a highly significant decrease in the prevalence of leprosy since the introduction of multi-drug therapy (MDT) in 1981. From a prevalence rate of 57/10,000 of the population in March 1981, the figure has declined to 5.2/10,000 in March 1999. This was possible due to the creation of a completely vertical (specialized) infrastructure for leprosy control in the 218 endemic districts of the country and skeleton vertical staff in the remaining districts, coupled with the recruitment of additional staff on contract basis to provide MDT through vertical staff in endemic districts and mobile treatment units in the moderate and low endemic districts. Despite all efforts, however, new case detection has not shown a decline over the last 14 years due to the presence of hidden (and undiagnosed) cases. Therefore, in order to intensify and hasten progress towards elimination (less than 1 case per 10,000 of the population) in the whole country, it was decided to implement a massive leprosy elimination campaign (LEC) in all the States/Union Territories (UTs). The reports of 22 States/UTs indicate that 415 out of the total of 490 districts in the country were covered by modified LEC (MLEC), with 85% coverage of the population. The campaign used in India was modified from the pattern previously described by the World Health Organization. The detection of hidden or suspected cases took place within a short, intensive period of 6-7 days and relied heavily on house-to-house searches by General Health Care staff trained in leprosy detection and confirmation was made by appropriately trained staff. This MLEC received widespread Government and public support, resulting in the detection of 454,290 hidden cases of leprosy, whilst providing training to a large number of General Health Care staff and volunteers and creating widespread awareness about leprosy and the availability of treatment free of charge for all cases. This programme proved to be one of the most successful health care interventions undertaken in India in recent years, particularly in the states of Bihar and Orissa. Although a few states in India are unlikely to reach the current WHO goal of elimination before end of the year 2000, the results of the MLEC strongly support the possibility that elimination levels will be achieved in the majority of states by the end of the year 2000 and at national level by the end of the year 2002.

Health Promotion↗
PubMed1999

Pace of leprosy elimination and support teams in Bihar state, India.

Despite the extensive implementation of multiple drug therapy (MDT) in most leprosy-endemic countries world-wide since 1982, bringing about a remarkable reduction in prevalence, there are still regions at the sub-national level where the implementation of MDT remains difficult. The state of Bihar (population 86.3 million) in India is a good example of such a region. Previously rated as one of the most highly endemic states, it still contributes about 21% of the total caseload in India and about 12% of the global caseload. For various reasons, case-finding and drug treatment have lagged behind the progress made in most other states in the country and in 1996, the Damien Foundation India Trust (DFIT) volunteered technical support to increase the pace of elimination. Sixteen out of the 39 districts in the state were allocated, with a population of 41.8 million. Support teams, including a Medical Advisor and a Non-Medical Supervisor, both with over 10 years experience of leprosy work and control programmes, were provided to assist and work alongside government staff in case detection, treatment delivery, case-holding and discharge in their respective areas of operation. New case detection by intensive survey increased by 394% and total new case detection by 226% during the year 1996-1997, with similar trends in the following year. Striking improvements were also observed in MDT coverage, treatment regularity, monitoring and discharge of patients and in the training of local staff. This collaboration between a non-government agency (DFIT) and the staff of the National Leprosy Eradication Programme in 16 out of 39 districts in the State of Bihar has clearly been extremely successful. Similar approaches in the remaining districts of Bihar, and in other parts of India, where the infrastructure is available but inadequate, may contribute significantly to achieving the elimination goal at national and sub-national levels.

Drug Therapy, Combination↗