Karl Krupp | Florida International University (original) (raw)
Papers by Karl Krupp
Midwifery, 2015
India accounts for almost a third of the global deaths among newborns on their first day of birth... more India accounts for almost a third of the global deaths among newborns on their first day of birth. In spite of making significant progress in increasing institutional births, large numbers of rural Indian women are still electing to give birth at home. The aim of this study was to identify factors associated with place of birth among women who had recently given birth in rural Mysore, India. Between January 2009 and 2011, 1675 rural pregnant women enrolled in a prospective cohort study in Mysore District completed interviewer-administered questionnaires on maternity care services. Ethical approval of the original study was obtained from the Institutional Review Boards of Vikram Hospital and Florida International University. Logistic regression analyses were conducted to identify factors associated with place of birth among the 1654 (99%) women that were successfully followed up after childbirth. The median age of the women was 20 years; the majority were educated (87%), low-income (52%), and multiparous (56%). The prevalence of home births was low (4%). Half of the women giving birth at home did not adequately plan for transportation (55%), finances (48%), or birthing with a skilled provider (55%). Multiparous women had greater odds of giving birth at home compared to public (adjusted odds ratio [AOR]=7.83, p<0.001) and private institutions (AOR=7.05, p<0.001). Women attending ≥4 antenatal consultations had greater odds of giving birth at public (AOR=2.53, p=0.036) and private institutions (AOR=3.58, p=0.010). Those with higher scores of birth preparedness also had greater odds of giving birth at public (AOR=2.53, p<0.001) and private institutions (AOR=3.00, p<0.001). As a means to reduce newborn mortality, maternal health interventions in India and similar populations should focus on increasing birth preparedness and institutional births among rural women, particularly among those from lower socio-economic status.
Culture, health & sexuality, Jan 15, 2015
Cervical cancer disproportionately affects minorities, immigrants and low-income women in the USA... more Cervical cancer disproportionately affects minorities, immigrants and low-income women in the USA, with disparities greatest among Latino immigrants. We examined barriers and facilitators to cervical cancer screening practices among a group of immigrant Latino women in Florida, USA. Between January and May 2013, six focus group discussions, involving 35 participants, were conducted among Hispanic women in Miami to explore their knowledge, beliefs about cervical cancer and facilitators and barriers to cervical cancer screening using a theoretical framework. The data showed that family support, especially from female relatives, was an important facilitator of screening and treatment. Women, however, reported prioritising family health over their own, and some expressed fatalistic beliefs about cancer. Major obstacles to receiving a Pap smear included fear that it might result in removal of the uterus, discomfort about being seen by a male doctor and concern that testing might stigmati...
![Research paper thumbnail of Doesnt the public have the right to know that male circumcision protects against HIV? [editorial]](https://attachments.academia-assets.com/43367632/thumbnails/1.jpg)
](Indian Journal of Medical Ethics, 2009
Prematurity is the cause of 85% of neonatal morbidity and mortality. Premature rupture of the mem... more Prematurity is the cause of 85% of neonatal morbidity and mortality. Premature rupture of the membranes (PROM) is associated with 30-40% of preterm deliveries. A case-control study conducted between July 2002 and 2003 examined the correlates and risk factors for PROM in Mysore, India. WBCs in vaginal fluid, leucocytes in urine, UTI and infection with E. coli, S. aureus, C. albicans and BV were significantly associated with PROM. BV, E. coli and WBCs in vaginal fluid were independent risk factors. Screening and treatment of BV and E. coli infection in pregnancy may reduce the risk of PROM.
Background: Studies have shown an association between stress and increased risk for preterm deliv... more Background: Studies have shown an association between stress and increased risk for preterm delivery. There are few measures available to quantify pregnancy-specific stressors among Indian women. A culturally-sensitive instrument was adapted to measure perceived stress among young pregnant women in rural Mysore, India. Method: In 2009, a prospective cohort study was conducted in Mysore district among 985 young pregnant women. Women were assessed for socio-demographic, economic status as well as for perceived stress using a culturally adapted A-Z Stress scale (Kazi et al, 2009). Sexual history, and clinical examination were conducted and women were followed up after delivery. Statistical analysis was conducted using SPSS v17. Results: High levels of pregnancy-specific stressors were identified. Among 985 participants, 41% had delivered low birth weight infants and 12% had experienced preterm births. About 21% of women were identified as experiencing significant stress based on stress...
The Indian Journal of Medical Research
There are sparse data on the prevalence of primary infertility in India and almost none from Sout... more There are sparse data on the prevalence of primary infertility in India and almost none from Southern India. This study describes the correlates and prevalence of primary infertility among young women in Mysore, India. The baseline data were collected between November 2005 through March 2006, among 897 sexually active women, aged 15-30 yr, for a study investigating the relationship of bacterial vaginosis and acquisition of herpes simplex virus type-2 (HSV-2) infection. A secondary data analysis of the baseline data was undertaken. Primary infertility was defined as having been married for longer than two years, not using contraception and without a child. Logistic regression was used to examine factors associated with primary infertility. The mean age of the women was 25.9 yr (range: 16-30 yr) and the prevalence of primary infertility was 12.6 per cent [95% Confidence Interval (CI): 10.5-15.0%]. The main factor associated with primary infertility was HSV-2 seropositivity (adjusted o...
The prevalence of sexual violence is increasingly being studied in India. Yet the determinants of... more The prevalence of sexual violence is increasingly being studied in India. Yet the determinants of sexual violence, irrespective of physical violence, remain largely unexplored. Here the authors identify the determinants of sexual violence, and additionally, explore how the presence of physical violence modifies these determinants. A cross-sectional analysis is conducted using baseline data from a longitudinal study involving young married women attending reproductive health clinics in Southern India. A multivariable logistic regression analysis is conducted to first identify determinants of sexual violence and then repeated after stratifying elements based on presence or absence of physical violence identified from participants' reports. 36% and 50% of the participants report experiencing sexual and physical violence, respectively. After adjusting for other covariates, women's partners' characteristics are found most significantly associated with their odds of experiencing sexual violence. These characteristics include husbands' primary education, employment as drivers, alcohol consumption, and having multiple Article at UCSF LIBRARY & CKM on March 20, 2012 jiv.sagepub.com Downloaded from 2 Journal of Interpersonal Violence XX(X)
BACKGROUND: The Government of India has recently instituted routine HIV-testing among pregnant wo... more BACKGROUND: The Government of India has recently instituted routine HIV-testing among pregnant women attending public hospitals. METHODS: A qualitative study was conducted to understand how routine HIV-testing is being implemented. Six focus group discussions were conducted among recently-delivered HIV-negative women and healthcare workers. Twelve HIV+ women who had undergone testing during antenatal care were interviewed. RESULTS: Few participants recalled being informed about the purpose of HIV-testing. Most said their doctor informed them to test if they wished to deliver at a hospital. Only three recalled signing a consent form. Most said they were given papers and told to sign. None could remember hearing they had a right to opt-out' of HIV-testing. Most said husbands/relatives were told their HIV-status before or at the time they learned. Several HIV-positive women said they were told within earshot of other patients. While most HIV+ participants reported receiving post-te...
Background: In India, approximately 49,000 women living with HIV become pregnant and deliver each... more Background: In India, approximately 49,000 women living with HIV become pregnant and deliver each year. While
Indian journal of medical ethics
The Indian journal of medical research, 2011
There are sparse data on the prevalence of primary infertility in India and almost none from Sout... more There are sparse data on the prevalence of primary infertility in India and almost none from Southern India. This study describes the correlates and prevalence of primary infertility among young women in Mysore, India. The baseline data were collected between November 2005 through March 2006, among 897 sexually active women, aged 15-30 yr, for a study investigating the relationship of bacterial vaginosis and acquisition of herpes simplex virus type-2 (HSV-2) infection. A secondary data analysis of the baseline data was undertaken. Primary infertility was defined as having been married for longer than two years, not using contraception and without a child. Logistic regression was used to examine factors associated with primary infertility. The mean age of the women was 25.9 yr (range: 16-30 yr) and the prevalence of primary infertility was 12.6 per cent [95% Confidence Interval (CI): 10.5-15.0%]. The main factor associated with primary infertility was HSV-2 seropositivity (adjusted o...
Asia-Pacific journal of public health / Asia-Pacific Academic Consortium for Public Health, 2014
Few studies have examined intimate partner physical violence (IPPV) in south India. This article ... more Few studies have examined intimate partner physical violence (IPPV) in south India. This article examines the frequency and correlates of IPPV among 898 young married women from urban, rural, and periurban areas of Mysore, India. Most (69.2%) of the participants were Hindus and 28.7% were Muslims. Overall, 50% of participants reported some type of IPPV. Factors that were independently associated with IPPV included being younger than 18 years at the time of marriage, contributing some household income, having anal sex, reporting sexual violence, and having a sex partner who drinks alcohol and smokes cigarettes. Women with skilled occupation were at reduced odds of experiencing IPPV compared with women who did not work. These findings suggest that IPPV is highly prevalent in this setting and that additional interventions are needed to reduce morbidity particularly among young women. These data also suggest that more studies are needed among men who perpetrate IPPV in south India.
Sexually Transmitted Infections, 2011
ABSTRACT Background There is currently limited information on the acceptability of medical male c... more ABSTRACT Background There is currently limited information on the acceptability of medical male circumcision (MMC) in India. This study investigated the acceptability of MMC as a HIV prevention strategy among attendees of an HIV voluntary counselling and testing center (VCT) in Mysore, India. Methods A cross-sectional survey was conducted among a consecutive sample of 300 men attending the VCT in Mysore, India, between April and August 2009. After obtaining the informed consent in Kannada, an interviewer administered survey collected demographic, sexual risk behaviour, perceived risk and acceptability of MMC information. Results Most participants were Hindus (98.2%); 1.5% were Muslims, and 0.3% belonged to other religions. Fifty-three per cent of respondents had less than 7 years of schooling, 27.5% had 8–10 years, 3.0 % had attended high school and 16.0% had more than 12 years. Of participants, 71% were married and 45% made less than 4000 INR per month. About 244(73.9%) said that they had heard of MMC. On being informed about the risks and benefits of male circumcision, 97.9% said that other men should consider MMC to reduce the risk of contracting HIV/STDs. When asked if they would consider being circumcised safely in a hospital or clinic with little/no pain and at low/no cost, only a third (32.1%) said they would consider circumcision. The most important barriers to MMC reported by participants included MMC not being their cultural tradition (90%), fear of stigma and rejection by friends and family (74.8%) and pain (76.7%). Conclusions While MMC has been shown to be protective against heterosexual acquisition of HIV, little is known about whether it could be implemented in this primarily non-circumcising country. While this study found relatively low acceptability for MMC among VCT clinic attendees, more research on MMC acceptability among other populations, particularly those at high risk for HIV, is warranted.
Sexually Transmitted Infections, 2011
ABSTRACT Background Bacterial vaginosis (BV) is a common infection and has been associated with a... more ABSTRACT Background Bacterial vaginosis (BV) is a common infection and has been associated with adverse health outcomes including preterm birth, pelvic inflammatory disease and acquisition of HIV and other sexually transmitted diseases. There are limited data on persistent BV in Indian women. This study examined the risk factors for persistent bacterial vaginosis in young reproductive women in India. Study Design Between November 2005 and January 2007, a prospective cohort study was carried out to examine the relationship of BV and HSV-2 acquisition among women in Mysore. Quarterly, data were collected on sociodemographics, risk behaviour, partner characteristics, followed by a physical examination to diagnose and treat reproductive tract infections. BV was defined using Nugent scoring of gram stained vaginal smears. Persistent BV was calculated using generalised estimating equation methods. Women gave informed consent prior to enrolment in the study. Results Of the 420 women for which there were data available for all three visits, 114 (27%) had two or more BV episodes. Women with a history of 2 or more BV episodes were more likely to be infected with Trichomonas vaginalis [OR 72.93, 95% CI 9.69 to 548.4] and be diagnosed with HSV-2 infection [OR 2.58, 95% CI 1.44 to 4.63] compared to women with no BV history. Women with a history of BV were also more likely to report no education, tubal ligation, being a non-Muslim, and having a sex partner who had other sex partners. Conclusions Young reproductive age women in India have a high persistence of BV. Although the association between BV and Trichomonas vaginalis is unclear, it seems prudent to recommend that women with BV or TV be screened for both infections.
Asian Pacific journal of cancer prevention : APJCP, 2014
Increasing uptake of human papillomavirus (HPV) vaccine should be a priority in developing countr... more Increasing uptake of human papillomavirus (HPV) vaccine should be a priority in developing countries since they suffer 88% of the world's cervical cancer burden. In many countries studies show that age at vaccination is an important determinate of parental acceptability. This study explores parental preferences on age-to-vaccinate for adolescent school-going girls. The sample was selected using a two-stage probability proportional to size cluster sampling methodology. Questionnaires were sent home with a random sample of 800 adolescent girls attending 12 schools in Mysore to be completed by parents. Descriptive statistics including frequencies, percentages and proportions were generated for independent variables and bivariate analyses (Chi square test) were used to assess the relationship between independent and appropriate age-to-vaccinate. HPV vaccination acceptability was high at 71%. While 5.3% of parents felt girls should be vaccinated by 10 years or younger; 38.3% said 11-...
Discernment analyses in survey data are being developed to help researchers better understand int... more Discernment analyses in survey data are being developed to help researchers better understand intentions of surveyed subjects. These models can aid in successful decision-making by allowing calculation of the likelihood of a particular outcome based on subject's known characteristics. There are many modern discernment analyses which have been used to develop predictive models in many different scientific disciplines areas. Predictive models are used in a variety of public health and medical domains. These models are constructed from observed cases, which are typically collected from various studies. The data can be preprocessed and serve as data to build statistical and machine learning models.
Sexually Transmitted Infections, 2013
Sexually Transmitted Infections, 2011
ABSTRACT Background Bacterial vaginosis (BV) remains the most common cause of abnormal vaginal di... more ABSTRACT Background Bacterial vaginosis (BV) remains the most common cause of abnormal vaginal discharge in Indian women of reproductive age and is associated with increased susceptibility to HIV/STI and preterm delivery. Diagnosis of BV in resource-poor settings is often overlooked; there is a need for cheap, rapid, objective point-of-care diagnostic test. Methods Vaginal swabs were collected from women attending a women's health clinic. Women over the age of 18 with a pH of over 4.5 were invited to participate in the study. BV was diagnosed on the basis of the Nugent score, the Amsel clinical criteria, and results of OSOM BVBlue test independently by study clinician and laboratory personnel who were blinded to the results of the other tests. Results From August 2009 to May 2010, 313 participants were enrolled. BV prevalence was 45.1% (95% CI 41.5% to 52.8%) according to Nugent score. When compared with the Nugent score, the sensitivity, specificity, positive predictive value, negative predictive value for Amsel clinical criteria was 61.9%, 88.3%, 81.5%, 73.7%; and for BVBlue it was 38.1%, 92.7%, 82.1%, 63.9% respectively. The performance of BVBlue can be increased if it is combined with “Whiff test where the sensitivity increases to 64.4%, sensitivity 85.6%, PPV 79.3% and NPV 73.8%”. Conclusions These results highlight the importance of systematic evaluation of rapid test kits as a low-cost alternative to laboratory diagnosis in resource-constrained settings. The BVBlue test is a simple, rapid, and objective test for the diagnosis of BV and has the potential to facilitate prompt diagnosis and appropriate treatment of BV in the absence of microscopy.
Midwifery, 2015
India accounts for almost a third of the global deaths among newborns on their first day of birth... more India accounts for almost a third of the global deaths among newborns on their first day of birth. In spite of making significant progress in increasing institutional births, large numbers of rural Indian women are still electing to give birth at home. The aim of this study was to identify factors associated with place of birth among women who had recently given birth in rural Mysore, India. Between January 2009 and 2011, 1675 rural pregnant women enrolled in a prospective cohort study in Mysore District completed interviewer-administered questionnaires on maternity care services. Ethical approval of the original study was obtained from the Institutional Review Boards of Vikram Hospital and Florida International University. Logistic regression analyses were conducted to identify factors associated with place of birth among the 1654 (99%) women that were successfully followed up after childbirth. The median age of the women was 20 years; the majority were educated (87%), low-income (52%), and multiparous (56%). The prevalence of home births was low (4%). Half of the women giving birth at home did not adequately plan for transportation (55%), finances (48%), or birthing with a skilled provider (55%). Multiparous women had greater odds of giving birth at home compared to public (adjusted odds ratio [AOR]=7.83, p<0.001) and private institutions (AOR=7.05, p<0.001). Women attending ≥4 antenatal consultations had greater odds of giving birth at public (AOR=2.53, p=0.036) and private institutions (AOR=3.58, p=0.010). Those with higher scores of birth preparedness also had greater odds of giving birth at public (AOR=2.53, p<0.001) and private institutions (AOR=3.00, p<0.001). As a means to reduce newborn mortality, maternal health interventions in India and similar populations should focus on increasing birth preparedness and institutional births among rural women, particularly among those from lower socio-economic status.
Culture, health & sexuality, Jan 15, 2015
Cervical cancer disproportionately affects minorities, immigrants and low-income women in the USA... more Cervical cancer disproportionately affects minorities, immigrants and low-income women in the USA, with disparities greatest among Latino immigrants. We examined barriers and facilitators to cervical cancer screening practices among a group of immigrant Latino women in Florida, USA. Between January and May 2013, six focus group discussions, involving 35 participants, were conducted among Hispanic women in Miami to explore their knowledge, beliefs about cervical cancer and facilitators and barriers to cervical cancer screening using a theoretical framework. The data showed that family support, especially from female relatives, was an important facilitator of screening and treatment. Women, however, reported prioritising family health over their own, and some expressed fatalistic beliefs about cancer. Major obstacles to receiving a Pap smear included fear that it might result in removal of the uterus, discomfort about being seen by a male doctor and concern that testing might stigmati...
Indian Journal of Medical Ethics, 2009
Prematurity is the cause of 85% of neonatal morbidity and mortality. Premature rupture of the mem... more Prematurity is the cause of 85% of neonatal morbidity and mortality. Premature rupture of the membranes (PROM) is associated with 30-40% of preterm deliveries. A case-control study conducted between July 2002 and 2003 examined the correlates and risk factors for PROM in Mysore, India. WBCs in vaginal fluid, leucocytes in urine, UTI and infection with E. coli, S. aureus, C. albicans and BV were significantly associated with PROM. BV, E. coli and WBCs in vaginal fluid were independent risk factors. Screening and treatment of BV and E. coli infection in pregnancy may reduce the risk of PROM.
Background: Studies have shown an association between stress and increased risk for preterm deliv... more Background: Studies have shown an association between stress and increased risk for preterm delivery. There are few measures available to quantify pregnancy-specific stressors among Indian women. A culturally-sensitive instrument was adapted to measure perceived stress among young pregnant women in rural Mysore, India. Method: In 2009, a prospective cohort study was conducted in Mysore district among 985 young pregnant women. Women were assessed for socio-demographic, economic status as well as for perceived stress using a culturally adapted A-Z Stress scale (Kazi et al, 2009). Sexual history, and clinical examination were conducted and women were followed up after delivery. Statistical analysis was conducted using SPSS v17. Results: High levels of pregnancy-specific stressors were identified. Among 985 participants, 41% had delivered low birth weight infants and 12% had experienced preterm births. About 21% of women were identified as experiencing significant stress based on stress...
The Indian Journal of Medical Research
There are sparse data on the prevalence of primary infertility in India and almost none from Sout... more There are sparse data on the prevalence of primary infertility in India and almost none from Southern India. This study describes the correlates and prevalence of primary infertility among young women in Mysore, India. The baseline data were collected between November 2005 through March 2006, among 897 sexually active women, aged 15-30 yr, for a study investigating the relationship of bacterial vaginosis and acquisition of herpes simplex virus type-2 (HSV-2) infection. A secondary data analysis of the baseline data was undertaken. Primary infertility was defined as having been married for longer than two years, not using contraception and without a child. Logistic regression was used to examine factors associated with primary infertility. The mean age of the women was 25.9 yr (range: 16-30 yr) and the prevalence of primary infertility was 12.6 per cent [95% Confidence Interval (CI): 10.5-15.0%]. The main factor associated with primary infertility was HSV-2 seropositivity (adjusted o...
The prevalence of sexual violence is increasingly being studied in India. Yet the determinants of... more The prevalence of sexual violence is increasingly being studied in India. Yet the determinants of sexual violence, irrespective of physical violence, remain largely unexplored. Here the authors identify the determinants of sexual violence, and additionally, explore how the presence of physical violence modifies these determinants. A cross-sectional analysis is conducted using baseline data from a longitudinal study involving young married women attending reproductive health clinics in Southern India. A multivariable logistic regression analysis is conducted to first identify determinants of sexual violence and then repeated after stratifying elements based on presence or absence of physical violence identified from participants' reports. 36% and 50% of the participants report experiencing sexual and physical violence, respectively. After adjusting for other covariates, women's partners' characteristics are found most significantly associated with their odds of experiencing sexual violence. These characteristics include husbands' primary education, employment as drivers, alcohol consumption, and having multiple Article at UCSF LIBRARY & CKM on March 20, 2012 jiv.sagepub.com Downloaded from 2 Journal of Interpersonal Violence XX(X)
BACKGROUND: The Government of India has recently instituted routine HIV-testing among pregnant wo... more BACKGROUND: The Government of India has recently instituted routine HIV-testing among pregnant women attending public hospitals. METHODS: A qualitative study was conducted to understand how routine HIV-testing is being implemented. Six focus group discussions were conducted among recently-delivered HIV-negative women and healthcare workers. Twelve HIV+ women who had undergone testing during antenatal care were interviewed. RESULTS: Few participants recalled being informed about the purpose of HIV-testing. Most said their doctor informed them to test if they wished to deliver at a hospital. Only three recalled signing a consent form. Most said they were given papers and told to sign. None could remember hearing they had a right to opt-out' of HIV-testing. Most said husbands/relatives were told their HIV-status before or at the time they learned. Several HIV-positive women said they were told within earshot of other patients. While most HIV+ participants reported receiving post-te...
Background: In India, approximately 49,000 women living with HIV become pregnant and deliver each... more Background: In India, approximately 49,000 women living with HIV become pregnant and deliver each year. While
Indian journal of medical ethics
The Indian journal of medical research, 2011
There are sparse data on the prevalence of primary infertility in India and almost none from Sout... more There are sparse data on the prevalence of primary infertility in India and almost none from Southern India. This study describes the correlates and prevalence of primary infertility among young women in Mysore, India. The baseline data were collected between November 2005 through March 2006, among 897 sexually active women, aged 15-30 yr, for a study investigating the relationship of bacterial vaginosis and acquisition of herpes simplex virus type-2 (HSV-2) infection. A secondary data analysis of the baseline data was undertaken. Primary infertility was defined as having been married for longer than two years, not using contraception and without a child. Logistic regression was used to examine factors associated with primary infertility. The mean age of the women was 25.9 yr (range: 16-30 yr) and the prevalence of primary infertility was 12.6 per cent [95% Confidence Interval (CI): 10.5-15.0%]. The main factor associated with primary infertility was HSV-2 seropositivity (adjusted o...
Asia-Pacific journal of public health / Asia-Pacific Academic Consortium for Public Health, 2014
Few studies have examined intimate partner physical violence (IPPV) in south India. This article ... more Few studies have examined intimate partner physical violence (IPPV) in south India. This article examines the frequency and correlates of IPPV among 898 young married women from urban, rural, and periurban areas of Mysore, India. Most (69.2%) of the participants were Hindus and 28.7% were Muslims. Overall, 50% of participants reported some type of IPPV. Factors that were independently associated with IPPV included being younger than 18 years at the time of marriage, contributing some household income, having anal sex, reporting sexual violence, and having a sex partner who drinks alcohol and smokes cigarettes. Women with skilled occupation were at reduced odds of experiencing IPPV compared with women who did not work. These findings suggest that IPPV is highly prevalent in this setting and that additional interventions are needed to reduce morbidity particularly among young women. These data also suggest that more studies are needed among men who perpetrate IPPV in south India.
Sexually Transmitted Infections, 2011
ABSTRACT Background There is currently limited information on the acceptability of medical male c... more ABSTRACT Background There is currently limited information on the acceptability of medical male circumcision (MMC) in India. This study investigated the acceptability of MMC as a HIV prevention strategy among attendees of an HIV voluntary counselling and testing center (VCT) in Mysore, India. Methods A cross-sectional survey was conducted among a consecutive sample of 300 men attending the VCT in Mysore, India, between April and August 2009. After obtaining the informed consent in Kannada, an interviewer administered survey collected demographic, sexual risk behaviour, perceived risk and acceptability of MMC information. Results Most participants were Hindus (98.2%); 1.5% were Muslims, and 0.3% belonged to other religions. Fifty-three per cent of respondents had less than 7 years of schooling, 27.5% had 8–10 years, 3.0 % had attended high school and 16.0% had more than 12 years. Of participants, 71% were married and 45% made less than 4000 INR per month. About 244(73.9%) said that they had heard of MMC. On being informed about the risks and benefits of male circumcision, 97.9% said that other men should consider MMC to reduce the risk of contracting HIV/STDs. When asked if they would consider being circumcised safely in a hospital or clinic with little/no pain and at low/no cost, only a third (32.1%) said they would consider circumcision. The most important barriers to MMC reported by participants included MMC not being their cultural tradition (90%), fear of stigma and rejection by friends and family (74.8%) and pain (76.7%). Conclusions While MMC has been shown to be protective against heterosexual acquisition of HIV, little is known about whether it could be implemented in this primarily non-circumcising country. While this study found relatively low acceptability for MMC among VCT clinic attendees, more research on MMC acceptability among other populations, particularly those at high risk for HIV, is warranted.
Sexually Transmitted Infections, 2011
ABSTRACT Background Bacterial vaginosis (BV) is a common infection and has been associated with a... more ABSTRACT Background Bacterial vaginosis (BV) is a common infection and has been associated with adverse health outcomes including preterm birth, pelvic inflammatory disease and acquisition of HIV and other sexually transmitted diseases. There are limited data on persistent BV in Indian women. This study examined the risk factors for persistent bacterial vaginosis in young reproductive women in India. Study Design Between November 2005 and January 2007, a prospective cohort study was carried out to examine the relationship of BV and HSV-2 acquisition among women in Mysore. Quarterly, data were collected on sociodemographics, risk behaviour, partner characteristics, followed by a physical examination to diagnose and treat reproductive tract infections. BV was defined using Nugent scoring of gram stained vaginal smears. Persistent BV was calculated using generalised estimating equation methods. Women gave informed consent prior to enrolment in the study. Results Of the 420 women for which there were data available for all three visits, 114 (27%) had two or more BV episodes. Women with a history of 2 or more BV episodes were more likely to be infected with Trichomonas vaginalis [OR 72.93, 95% CI 9.69 to 548.4] and be diagnosed with HSV-2 infection [OR 2.58, 95% CI 1.44 to 4.63] compared to women with no BV history. Women with a history of BV were also more likely to report no education, tubal ligation, being a non-Muslim, and having a sex partner who had other sex partners. Conclusions Young reproductive age women in India have a high persistence of BV. Although the association between BV and Trichomonas vaginalis is unclear, it seems prudent to recommend that women with BV or TV be screened for both infections.
Asian Pacific journal of cancer prevention : APJCP, 2014
Increasing uptake of human papillomavirus (HPV) vaccine should be a priority in developing countr... more Increasing uptake of human papillomavirus (HPV) vaccine should be a priority in developing countries since they suffer 88% of the world's cervical cancer burden. In many countries studies show that age at vaccination is an important determinate of parental acceptability. This study explores parental preferences on age-to-vaccinate for adolescent school-going girls. The sample was selected using a two-stage probability proportional to size cluster sampling methodology. Questionnaires were sent home with a random sample of 800 adolescent girls attending 12 schools in Mysore to be completed by parents. Descriptive statistics including frequencies, percentages and proportions were generated for independent variables and bivariate analyses (Chi square test) were used to assess the relationship between independent and appropriate age-to-vaccinate. HPV vaccination acceptability was high at 71%. While 5.3% of parents felt girls should be vaccinated by 10 years or younger; 38.3% said 11-...
Discernment analyses in survey data are being developed to help researchers better understand int... more Discernment analyses in survey data are being developed to help researchers better understand intentions of surveyed subjects. These models can aid in successful decision-making by allowing calculation of the likelihood of a particular outcome based on subject's known characteristics. There are many modern discernment analyses which have been used to develop predictive models in many different scientific disciplines areas. Predictive models are used in a variety of public health and medical domains. These models are constructed from observed cases, which are typically collected from various studies. The data can be preprocessed and serve as data to build statistical and machine learning models.
Sexually Transmitted Infections, 2013
Sexually Transmitted Infections, 2011
ABSTRACT Background Bacterial vaginosis (BV) remains the most common cause of abnormal vaginal di... more ABSTRACT Background Bacterial vaginosis (BV) remains the most common cause of abnormal vaginal discharge in Indian women of reproductive age and is associated with increased susceptibility to HIV/STI and preterm delivery. Diagnosis of BV in resource-poor settings is often overlooked; there is a need for cheap, rapid, objective point-of-care diagnostic test. Methods Vaginal swabs were collected from women attending a women's health clinic. Women over the age of 18 with a pH of over 4.5 were invited to participate in the study. BV was diagnosed on the basis of the Nugent score, the Amsel clinical criteria, and results of OSOM BVBlue test independently by study clinician and laboratory personnel who were blinded to the results of the other tests. Results From August 2009 to May 2010, 313 participants were enrolled. BV prevalence was 45.1% (95% CI 41.5% to 52.8%) according to Nugent score. When compared with the Nugent score, the sensitivity, specificity, positive predictive value, negative predictive value for Amsel clinical criteria was 61.9%, 88.3%, 81.5%, 73.7%; and for BVBlue it was 38.1%, 92.7%, 82.1%, 63.9% respectively. The performance of BVBlue can be increased if it is combined with “Whiff test where the sensitivity increases to 64.4%, sensitivity 85.6%, PPV 79.3% and NPV 73.8%”. Conclusions These results highlight the importance of systematic evaluation of rapid test kits as a low-cost alternative to laboratory diagnosis in resource-constrained settings. The BVBlue test is a simple, rapid, and objective test for the diagnosis of BV and has the potential to facilitate prompt diagnosis and appropriate treatment of BV in the absence of microscopy.