BackgroundCare for schizophrenia in low and middle income countries is predominantly facility based and led by specialists, with limited use of non-pharmacological treatments. Although community based psychosocial interventions are emphasised, there is little evidence about their acceptability and feasibility. Furthermore, the shortage of skilled manpower is a major barrier to improving access to these interventions. Our study aimed to develop a lay health worker delivered community based intervention in three sites in India. This paper describes how the intervention was developed systematically, following the MRC framework for the development of complex interventions.MethodsWe reviewed the lierature on the burden of schizophrenia and the treatment gap in low and middle income countries and the evidence for community based treatments, and identified intervention components. We then evaluated the acceptability and feasibility of this package of care through formative case studies with individuals with schizophrenia and their primary caregivers and piloted its delivery with 30 families.ResultsBased on the reviews, our intervention comprised five components (psycho-education; adherence management; rehabilitation; referral to community agencies; and health promotion) to be delivered by trained lay health workers supervised by specialists. The intervention underwent a number of changes as a result of formative and pilot work. While all the components were acceptable and most were feasible, experiences of stigma and discrimination were inadequately addressed; some participants feared that delivery of care at home would lead to illness disclosure; some participants and providers did not understand how the intervention related to usual care; some families were unwilling to participate; and there were delivery problems, for example, in meeting the targeted number of sessions. Participants found delivery by health workers acceptable, and expected them to have knowledge about the subject matter. Some had expectations regarding their demographic and personal characteristics, for example, preferring only females or those who are understanding/friendly. New components to address stigma were then added to the intervention, the collaborative nature of service provision was strengthened, a multi-level supervision system was developed, and delivery of components was made more flexible. Criteria were evolved for the selection and training of the health workers based on participants' expectations.ConclusionsA multi-component community based intervention, targeting multiple outcomes, and delivered by trained lay health workers, supervised by mental health specialists, is an acceptable and feasible intervention for treating schizophrenia in India.

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Studies were conducted on the effect of pruning time, host age, urediniospore release and weather parameters on the incidence and intensity of mulberry leaf rust (Peridiopsora mori). Rust severity significantly increased with increasing shoot age, irrespective of pruning time. Maximum disease severity was observed in plants pruned during the third week of October, and minimum severity in plants pruned during last week of November. Apparent infection rate was higher in younger shoots. Infection rate was higher in plants pruned during the last week of November. Urediniospore release was influenced by prevailing climatic conditions. A higher rate of spore release was noticed during sunny days. Maximum spore release was found between 12.00 h and 14.00 h. Spore release was positively correlated with temperature and negatively correlated with relative humidity. Rust severity (34.97%) was higher in January and least (1.03%) during May. Rust severity was negatively correlated with both temperature and rainfall. An exponential model was developed for the prediction of rust severity which was accurate up to 96.60%.

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Cymbilabia sourioudongii, a new species of epiphytic orchid is described and illustrated from Phou Khao Khouay National Protected Area of Laos PDR.