Tuberculosis burden in India and its control from 1990 to 2019: Evidence from global burden of disease study 2019

BackgroundTuberculosis is still a major public health problem in India. This study aims to assess trends in the burden of tuberculosis from 1990 to 2019 for tracking success of tuberculosis control programme in India.MethodsIn this study, the 2019 global burden of disease study data were used to measure the incidence, prevalence, mortality, and disability-adjusted life years lost (DALY)rates of Tuberculosis during 1990–2019 for India and its states. Age and gender-specific rates were also analyzed for India. All rates were age-standardized and 95% uncertainty intervals (UIs) were computed.ResultOverall incidence, prevalence, death and DALY of TB decreased in India from 1990 to 2019. Tuberculosis morbidity and mortality was higher in males as compared to females. Incidence of TB was low in children up to 14 years of age. Prevalence of TB was higher in females as compared to males till 29 years of age, whereas higher prevalence was reported in males as compared to females in adults aged 30 years and more. Death rate of TB was low in children and young adults up to 29 years of age.ConclusionThis study shows that overall incidence, prevalence, death and DALY of tuberculosis decreased from 1990 to 2019 in India. The burden of TB was higher among males as compared to females during study period. TB affects all the age groups but deaths were higher in older age groups.     

Acute hepatic failure in India: a perspective from the East

Acute hepatic failure (AHF) in India almost always presents with encephalopathy within 4 weeks of the onset of acute hepatitis. Further subclassification of AHF into hyperacute, acute and subacute forms may not be necessary in this geographical area, where the rapidity of onset of encephalopathy does not seem to influence survival. Viral hepatitis is the cause in approximately 95-100% of patients, who therefore constitute a more homogeneous population than AHF patients in the West. In India, hepatitis E (HEV) and hepatitis B (HBV) viruses are the most important causes of AHF; approximately 60% of cases are caused by to these viruses. Hepatitis B virus core mutants are very important agents in cases where hepatitis B results in AHF in this country. Half of the patients with AHF admitted to our centre are female, one-quarter of whom are pregnant. Therefore, pregnant females who contract viral hepatitis constitute a high-risk group for the development of AHF. However, the outcome of AHF in this group is similar to that in non-pregnant women and men. No association with any particular virus has been identified among sporadic cases of AHF. In our centre, approximately one-third of AHF patients survive with aggressive conservative therapy, whereas two-thirds of deaths occur within 72 h of hospitalization. Cerebral oedema and sepsis are the major fatal complications. Both fungal and gram-negative bacteria are major causes of sepsis. Among patients with AHF, despite the presence of sepsis, its overt clinical features (i.e. fever, leucocytosis) may be absent and objective documentation of the presence of sepsis in such patients is achieved by repeated culture of various body fluids. It should be possible to develop simple, clinical prognostic markers for AHF in this geographical region, in order to identify patients suitable for liver transplantation.     

低出生体质量儿肠内营养集束化护理效果

目的研究集束化护理用于极低、超低出生体质量儿肠内营养的效果。 方法选取济南军区总医院2016年6月至2017年11月收治的极低、超低出生体质量儿68例,随机分成研究组和对照组,对照组给予常规肠内营养护理,研究组在常规护理的基础上给予非营养性吸吮、口腔按摩、口腔支持、口腔喂养能力评估、腹部按摩及帮助排便等集束化护理措施。比较2组患儿平均体质量增长、恢复出生体质量日龄、体质量达2 000 g日龄及住院天数。 结果研究组患儿平均体质量增长(18.7±2.7)g/d,高于对照组(14.2±1.3)g/d;恢复出生体质量日龄(13.6±4.4)d,短于对照组(22.2±3.1)d;体质量达2 000 g日龄(31.5±3.5)d,短于对照组(43.5±2.5)d;住院天数(40.1±6.2)d,短于对照组(53.1±5.2)d,差异均有统计学意义(P均<0.05)。 结论集束化护理可以加快极低、超低出生体质量儿平均体质量增长,缩短恢复出生体质量及体质量达2 000 g日龄时间,减少住院天数,值得临床推广。     

Effects of smoking cessation with voucher‐based contingency management on birth outcomes

Aims This study examined whether smoking cessation using voucher‐based contingency management (CM) improves birth outcomes. Design Data were combined from three controlled trials. Setting Each of the trials was conducted in the same research clinic devoted to smoking and pregnancy. Participants Participants (n = 166) were pregnant women who participated in trials examining the efficacy of voucher‐based CM for smoking cessation. Women were assigned to either a contingent condition, wherein they earned vouchers exchangeable for retail items by abstaining from smoking, or to a non‐contingent condition where they received vouchers independent of smoking status. Measurement Birth outcomes were determined by review of hospital delivery records. Findings Antepartum abstinence was greater in the contingent than non‐contingent condition, with late‐pregnancy abstinence being 34.1% versus 7.4% (P < 0.001). Mean birth weight of infants born to mothers treated in the contingent condition was greater than infants born to mothers treated in the non‐contingent condition (3295.6 ± 63.8 g versus 3093.6 ± 67.0 g, P = 0.03) and the percentage of low birth weight (<2500 g) deliveries was less (5.9% versus 18.5%, P = 0.02). No significant treatment effects were observed across three other outcomes investigated, although each was in the direction of improved outcomes in the contingent versus the non‐contingent condition: mean gestational age (39.1 ± 0.2 weeks versus 38.5 ± 0.3 weeks, P = 0.06), percentage of preterm deliveries (5.9 versus 13.6, P = 0.09), and percentage of admissions to the neonatal intensive care unit (4.7% versus 13.8%, P = 0.06). Conclusions These results provide evidence that smoking‐cessation treatment with voucher‐based CM may improve important birth outcomes.     

Preterm birth and later insulin resistance: effects of birth weight and postnatal growth in a population based longitudinal study from birth into adult life

Aims/hypothesis An increased risk of type 2 diabetes mellitus is associated with low birthweight after full-term gestation, including amplification of this risk by weight gain during infancy and adult body composition. Premature birth is also associated with insulin resistance, but studies conducted so far have not provided follow-up into adulthood. We studied the effects of (1) lower birthweight (as standard deviation score [SDS]) and infancy weight gain on insulin resistance in 19-year-olds born before 32 weeks of gestation, and (2) the interaction between lower birthweight SDS and infancy weight gain, as well as between lower birthweight and adult body composition, on insulin resistance. Methods This was a prospective follow-up study in 346 subjects from the Project on Preterm and Small-for-gestational-age infants cohort, in whom fasting glucose, insulin and C-peptide levels were measured at 19 years. Insulin resistance was calculated with homeostatic modelling (homeostatic model assessment for insulin resistance index [HOMA-IR]). Results Birthweight SDS was unrelated to the outcomes. Rapid infancy weight gain until 3 months post-term was weakly associated with higher insulin level (p=0.05). Adult fatness was positively associated with insulin and C-peptide levels and HOMA-IR (all p<0.001). On these parameters, there was a statistical interaction between birthweight SDS and adult fat mass (p=0.002 to 0.03). Conclusions/interpretation In subjects born very preterm, rapid infancy weight gain until 3 months predicted higher insulin levels at 19 years, but the association was weak. Adult obesity strongly predicted higher insulin and C-peptide levels as well as HOMA-IR. The effect of adult fat mass on these parameters was dependent on its interaction with birthweight SDS. For a list of participants in the Dutch POPS-19 Collaborative Study Group, see Appendix     

Effect of wealth,social inequality,Mother's BMI,and education level on child malnutrition in India

Background and aimsThe differences in prevalence of malnutrition are mostly on account of social factors. However, we did not find any published study that provided an estimate of proportion of stunting and underweight among under-5 children due to household economic conditions, social inequalities, mother's BMI and education level. Hence, study has taken to study the effect of household economic status, social inequality, mother's BMI and education on stunting and underweight among children under-5 years and its determinants.MethodsThe study used Kids file of NFHS-4 (2015–16), which comprised 259,627 children aged less than five years. This data was analysed by bivariate and Forward Logistic Regression techniques using M.S. Excel and IBM SPSS-22 version.ResultsThe prevalence of stunting and underweight children was significantly higher among those born to underweight mothers, poor households, working women, and women had a home delivery. It was also high among children of 4th or higher birth order, those from scheduled castes and tribes, born to illiterate women and those residing in rural. The odds of stunting (OR = 2.67, 95% CI: 2.54–2.81) and underweight (OR = 2.74, 95% CI: 2.60–2.88) were more than two times higher among children living in poor households than among those from rich households. Poor households account for about 40% of stunted and underweight children. Fifteen percent of stunted children and 26.9% of underweight were born to underweight mothers. Overall, 60% of stunted and 56.6% of underweight children had illiterate mothers.Conclusionschildren of illiterate and underweight mothers, socially deprived and economically poor groups are at a higher risk of being stunted and underweight. Hence, necessary health programmes are needed for improving nutritional status by giving special attention to illiterate, underweight mothers, socially deprived and economically poor groups.     

Thirty-five years later: Long-term effects of the Matlab maternal and child health/family planning program on older women’s well-being

Family planning programs are believed to have substantial long-term benefits for women’s health and well-being, yet few studies have established either extent or direction of long-term effects. The Matlab, Bangladesh, maternal and child health/family planning (MCH/FP) program afforded a 12-y period of well-documented differential access to services. We evaluate its impacts on women’s lifetime fertility, adult health, and economic outcomes 35 y after program initiation. We followed 1,820 women who were of reproductive age during the differential access period (born 1938–1973) from 1978 to 2012 using prospectively collected data from the Matlab Health and Demographic Surveillance System and the 1996 and 2012 Matlab Health and Socioeconomic Surveys. We estimated intent-to-treat single-difference models comparing treatment and comparison area women. MCH/FP significantly increased contraceptive use, reduced completed fertility, lengthened birth intervals, and reduced age at last birth, but had no significant positive impacts on health or economic outcomes. Treatment area women had modestly poorer overall health (+0.07 SD) and respiratory health (+0.12 SD), and those born 1950–1961 had significantly higher body mass index (BMI) in 1996 (0.76 kg/m²) and 2012 (0.57 kg/m²); fewer were underweight in 1996, but more were overweight or obese in 2012. Overall, there was a +2.5 kg/m² secular increase in BMI. We found substantial changes in lifetime contraceptive and fertility behavior but no long-term health or economic benefits of the program. We observed modest negative health impacts that likely result from an accelerated nutritional transition among treated women, a transition that would, in an earlier context, have been beneficial.

The case for global scale-up of family planning programs rests, in part, on the potential long-term benefits of family planning programs for women’s health and economic empowerment (1, 2). A counterpoint to this assumption suggests that smaller families may actually have negative consequences for women in societies where old-age support and women’s status are tied to childbearing (3). Yet, few studies have established either the extent or direction of long-term effects.Much of our existing understanding of family planning program effects comes from the Matlab maternal and child health/family planning (MCH/FP) program (4–6). The program was implemented by icddr,b (formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh) starting in 1977 in the rural Matlab area of Bangladesh. MCH/FP revolutionized the field by using a home-based delivery model, integrating family planning with mother-and-child health services, and collecting extensive data that facilitate evaluation. MCH/FP yielded immediate and enduring effects. While fertility levels were similar in treatment and comparison areas at baseline, the MCH/FP treatment area subsequently experienced increased contraceptive use, reduced fertility (6–8), and reductions in maternal and child mortality (9). By 1989, MCH/FP services were scaled up to the rest of Bangladesh, including the comparison area, creating a well-documented period of differential treatment exposure from 1977 to 1989. Using the 1996 Matlab Health and Socioeconomic Survey (MHSS1), Barham (5) assessed the medium-term effects of MCH/FP on beneficiary children in a representative sample of Matlab. Joshi and Schultz (4) found that adult women living in the treatment area compared to comparison area villages had a body mass index (BMI) more than 1 kg/m² higher and concomitant reductions in the proportion with BMI of <18 kg/m². They found no differences in self-rated health or self-reported activities of daily living (ADLs); however, the targeted women were still relatively young in 1996, and these measures of health typically show variation later in life.Relatively few other studies have demonstrated long-term effects of family planning programs, in part due to the difficulties of longitudinal follow-up, biased self-selection into treatment, and the lack of appropriate comparison groups. Family planning may affect long-term well-being through a multiplicity of mediating pathways, including via effects on age at first birth, spacing between births, age at last birth, and completed fertility (2). Canning and Schultz (1) recently highlighted similar pathways of later benefit of family planning as potentially freeing up resources and women’s time. Miller (10) showed that early access to family planning in Colombia led to delayed fertility, higher schooling, and greater labor force participation. Yet, to our knowledge, only Matlab offers the potential to apply a prospective intervention design to look at long-term health effects.This study examined the consequences of the Matlab MCH/FP on women’s lifetime fertility, adult health, and economic outcomes using the second Matlab Health and Socioeconomic Survey (MHSS2), conducted in 2012, ∼35 y after initial rollout of services. We focused on women who were of reproductive age during the period of differential treatment exposure—those born 1938–1973 (aged 40 y to 75 y in 2012). We measured impacts on three domains of health—metabolic, functional, and respiratory health—using a mix of directly observed physical tests (i.e., anthropometry, blood pressure, and grip strength) and indirectly diagnosed morbidity. The rich integrated database of the icddr,b Matlab Health and Demographic Surveillance System (HDSS) combined with MHSS1 and MHSS2 allowed us to address causal considerations related to assignment of intent-to-treat (ITT) status before program introduction, to selective attrition, and to potential confounders. We also examined take-up of modern contraception as well as underlying mechanisms related to later health, including family size, birth spacing, and BMI. In addition, we measured the effect of the program on economic outcomes such as consumption, savings, and employment.     

Validity of self‐reported hypertension in India: Evidence from nationally representative survey of adult population over 45 years

Self‐reported measures of health, in the context of developed countries, are well‐researched and commonly regarded as reliable predictors of the underlying health of the population. However, the validity of these measures is under‐researched and questionable in the context of low‐ and middle‐income countries. The authors used Longitudinal Ageing Study in India (LASI) survey data from India to compare self‐reported hypertension with biometrically‐measured hypertension. The results are reported in terms of sensitivity, specificity, and kappa as a measure of agreement. Logistic regression was undertaken to examine the characteristics of those who were unaware of their hypertensive status. Our analysis showed a low sensitivity of 56% and a high specificity of 90.5%. Agreement between self‐reported data and biometric measurement of hypertension was observed to be moderate (κ = 0.48). Large variations were observed among states and sub‐groups. The odds of false negative reporting of hypertension were lower in the individuals with higher age, high education, and greater wealth status. The authors conclude that self‐reported hypertension has important limitations and may be a source of systematic bias. It is recommended that planning and policy‐making in India be based more on an objective assessment of hypertension.     

Hepatic pathology in AIDS: a pathological study from Mumbai, India

OBJECTIVES: To assess the spectrum of hepatic disorders in AIDS, liver specimens from 171 patients (155 autopsies and 16 biopsies) were reviewed. METHODS: A retrospective and prospective study of 171 autopsy and biopsy specimens was carried out at a tertiary level hospital in Mumbai, India. RESULTS: Of the patients included in the study, 127 (74%) were male and 44 (26%) were female. The heterosexual route was the predominant mode of HIV transmission, identified in 163 (95%) patients. A total of 99 of 171 patients (58%) showed significant pathological lesions, and the most common pathological processes involving the liver appeared to be secondary to infections. None of our patients showed isolated infectious diseases of the liver. The spectrum of liver diseases identified was as follows: tuberculosis in 70 patients (41%), cryptococcosis in eight (5%), cytomegalovirus infection in six (3%), hepatitis B infection in five (3%), candidiasis in one (0.5%), malaria in one (0.5%), cirrhosis in six (3%), amyloidosis in one (0.5%) and primary hepatic lymphoma in one (0.5%). CONCLUSIONS: AIDS patients were found to have a high prevalence of underlying hepatic abnormalities. The spectrum of disease among patients with AIDS in India differs from that in developed countries. Our results suggest that hepatic tuberculosis is more common in AIDS than previously recognized, and that liver specimens should be examined routinely for the presence of acid-fast bacilli.     

Offspring birth weight,gestational age and maternal characteristics in relation to glucose status at age 53 years: evidence from a national birth cohort

Aims We investigated pathways linking offspring birth weight to maternal diabetes risk in later life by taking into account a range of prospective early-life and adult maternal factors. Methods In a national birth cohort study, we examined the relationship between offspring birth weight and maternal glycated haemoglobin (HbA_1c) at age 53 years in 581 mothers who had a first birth between age 19 and 25 years, and had data on potential confounders or mediators. Results Mean age at first birth was 21.5 years. After adjustment for maternal body mass index (BMI), mean percentage change in maternal HbA_1c per kilogram increase in offspring birth weight was −1.8%[95% confidence interval (CI) −3.5, −0.1; P = 0.03]. This relationship was mostly accounted for by gestational age that was inversely related to maternal HbA_1c (−0.9%; 95% CI −1.5, −0.4; P = 0.001). Other risk factors for high HbA_1c were smoking and high BMI at 53 years. There was a significant interaction between offspring birth weight and maternal childhood social class (P = 0.01). Mothers from a manual background with higher birth weight offspring had lower HbA_1c (BMI adjusted: −3.1%; 95% CI −5.0, −1.1); this was not observed for mothers from a non-manual background (BMI adjusted: 1.9%; 95% CI −1.3, 5.0). Conclusions Short gestational age and low offspring birth weight may be part of a pathway linking impaired early maternal growth to diabetes risk in later life. A second possible pathway linking higher offspring birth weight to later maternal glucose status was also identified. These potential pathways require further investigation in cohorts with a wider maternal age range so that the early targeting of public health initiatives can be assessed.     

Cost of antihypertensive treatment: A point of view from India

Summary In India, expenditure on the treatment of all patients with mild hypertension is not cost effective. Nonpharmacologic treatment is encouraged.     

Effect of electrode size and spacing on electrograms: Optimized electrode configuration for near-field electrogram characterization

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Illustrative effects of social capital on health and quality of life among older adult in India: Results from WHO-SAGE India

BackgroundLacuna in contemporary Indian academic research highlights the need to investigate the component of social capital and health outcome among elderly individuals in Indian context. Study endeavors to investigate prevalence of health indicators: self-rated good health(SRH), functional limitation, depression and quality of life(QoL) and the illustrative effects of social capital on elderly health outcome and QoL.MethodsNationally representative cross-sectional data from WHO Study on global AGEing and adults health (SAGE) India 2007 is used. Individuals aged 50+ are included where logistic regression is used to estimate the effect of social capital along with other co-founders on SRH, functional limitation, and depression. Linear regression model is used to analyse evaluates the impact of social capital with other co-founders on QoL among elderly.ResultsThe multivariate analysis shows that SRH is associated with age, female, those having education, higher social-action with strong trust, safety and higher psychological resources. Depression among elderly is significantly related to age, gender, education level, higher wealth, strong sociability. QoL is inversaly related to age, gender, being muslim. A positive association of QoL is observed with higher education, having wealth, and strong social capital component like currently married, civic engagement, social-action, trust solidarity,and strong psychological resources.ConclusionThe paper presents evidence that social capital significantly associated with SRH, lower depression, better functional health and higher quality of life. Hench forth policy makers should construct social policy where elderly feel safe and trusty surrounding, that can involved them into main stream as a productive resource of society.     

Role and importance of high fiber in diabetes management in India

Background & aimsIndia is facing a triple burden of pre-diabetes, diabetes, and obesity. Unhealthy eating habits and physical inactivity have been linked to the onset and progression of type 2 diabetes mellitus (T2DM). Despite dietary recommendations, individuals consume inadequate amounts or unsuitable type of dietary fiber (DF) which needs correction. An Expert group attempted to review and report on the role and importance of high DF in the management of T2DM and offer practical guidance on high fiber use in daily diet.MethodologyTwelve diabetologists and two expert dietitians from India were chosen to ensure diversity of the members both in professional interest and cultural background. The authors convened virtually for one group meeting and actively participated in a detailed discussion. Multiple reviews of the draft document followed by focused teleconference calls & email helped to reach consensus on final recommendations between Aug 2021 and Dec 2021.ResultsEvidence has shown that medical nutrition therapy (MNT) is a valuable approach and an essential component of T2DM prevention and management. Studies have shown that fiber rich diabetes nutrition (FDN) has multi-systemic health benefits, including, improvement in glycemic control, reduction in glucose spikes, decrease in hyperinsulinemia, improvement in plasma lipid concentrations and weight management in T2DM patients.ConclusionA high fiber diet is vital for people with diabetes and associated conditions. Increasing fiber intake, preferably through food or through dietary supplement, may help. Fiber rich diabetes nutrition (FDN) is recommended in order to prevent and manage T2DM.