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Kumar G, Bhalla A, Mukherjee A, Turuk A, Talukdar A, Mukherjee S, Bhardwaj P, Menon GR, Sahu D, Misra P, Sharma LK, Mohindra R, S S, Suri V, Das H, Sarkar D, Ghosh S, Ghosh P, Dutta M, Chakraborty S, Kumar D, Gupta MK, Goel AD, Baruah TD, Kannauje PK, Shukla AK, Khambholja JR, Patel A, Shah N, Bhuniya S, Panigrahi MK, Mohapatra PR, Pathak A, Sharma A, John M, Kaur K, Nongpiur V, Pala S, Shivnitwar SK, Krishna BR, Dulhani N, Gupta B, Gupta J, Bhandari S, Agrawal A, Aggarwal HK, Jain D, Shah AD, Naik P, Panchal M, Anderpa M, Kikon N, Humtsoe CN, Sharma N, Vohra R, Patnaik L, Sahoo JP, Joshi R, Kokane A, Ray Y, Rajvansh K, Purohit HM, Shah NM, Madharia A, Dube S, Shrivastava N, Kataria S, Shameem M, Fatima N, Ghosh S, Hazra A, D H, Salgar VB, Algur S, M L KY, M PK, Panda S, Vishnu Vardhana Rao M, Bhargava B. Post COVID sequelae among COVID-19 survivors: insights from the Indian National Clinical Registry for COVID-19. BMJ Glob Health 2023; 8:e012245. [PMID: 37816536 PMCID: PMC10565174 DOI: 10.1136/bmjgh-2023-012245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/20/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities. METHODS Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020-October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting. RESULTS Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30-60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6-7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03). CONCLUSION Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality.
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Affiliation(s)
- Gunjan Kumar
- Clinical Studies & Trials Unit, Indian Council of Medical Research, New Delhi, India
| | - Ashish Bhalla
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aparna Mukherjee
- Clinical Studies & Trials Unit, Indian Council of Medical Research, New Delhi, India
| | - Alka Turuk
- Clinical Studies & Trials Unit, Indian Council of Medical Research, New Delhi, India
| | | | | | | | - Geetha R Menon
- National Institute of Medical Statistics, New Delhi, India
| | - Damodar Sahu
- National Institute of Medical Statistics, New Delhi, India
| | | | | | - Ritin Mohindra
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Samita S
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Suri
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Himadri Das
- Medical College and Hospital Kolkata, Kolkata, India
| | | | | | - Priyanka Ghosh
- College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Moumita Dutta
- College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | | | - Deepak Kumar
- All India Institute of Medical Sciences, Jodhpur, India
| | | | | | | | | | | | | | | | | | - Sourin Bhuniya
- All India Institute of Medical Sciences, Bhubaneswar, India
| | | | | | | | | | - Mary John
- Christian Medical College and Hospital, Ludhiana, India
| | | | | | | | | | | | | | | | | | | | | | - H K Aggarwal
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Deepak Jain
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Arti D Shah
- SBKS Medical Institute and Research Centre, Vadodara, India
| | - Parshwa Naik
- SBKS Medical Institute and Research Centre, Vadodara, India
| | | | | | - Nyanthung Kikon
- Department of Health and Family Welfare, Government of Nagaland, Kohima, India
| | | | - Nikita Sharma
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Rajaat Vohra
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | | | | | - Rajnish Joshi
- All India Institute of Medical Sciences, Bhopal, India
| | - Arun Kokane
- All India Institute of Medical Sciences, Bhopal, India
| | - Yogiraj Ray
- Institute of Postgraduate Medical Education and Research, Kolkata, India
| | | | | | - Nehal M Shah
- Smt NHL Municipal Medical College, Ahmedabad, India
| | | | | | | | | | | | | | - Saumitra Ghosh
- Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Avijit Hazra
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Himanshu D
- King George Medical University, Lucknow, India
| | | | - Santosh Algur
- Gulbarga Institute of Medical Sciences, Gulbarga, India
| | - Kala Yadhav M L
- Shri Atal Bihari Vajpayee Medical College and Research Institution, Bengaluru, India
| | | | - Samiran Panda
- Indian Council of Medical Research, New Delhi, India
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Krishnan A, Kumar R, Amarchand R, Mohan A, Kant R, Agarwal A, Kulshreshtha P, Panda PK, Bhadoria AS, Agarwal N, Biswas B, Nair R, Wig N, Malhotra R, Bhatnagar S, Aggarwal R, Soni KD, Madan N, Trikha A, Tiwari P, Singh AR, Wyawahare M, Gunasekaran V, Sekar D, Misra S, Bhardwaj P, Goel AD, Dutt N, Kumar D, Nagarkar NM, Galhotra A, Jindal A, Raj U, Behera A, Siddiqui S, Kokane A, Joshi R, Pakhare A, Farooque F, Pawan S, Deshmukh P, Solanki R, Rathod B, Dutta V, Mohapatra PR, Panigrahi MK, Barik S, Guleria R. Predictors of Mortality among Patients Hospitalized with COVID-19 during the First Wave in India: A Multisite Case-Control Study. Am J Trop Med Hyg 2023; 108:727-733. [PMID: 36913920 PMCID: PMC10077017 DOI: 10.4269/ajtmh.22-0705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/12/2023] [Indexed: 03/15/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 disease (COVID-19) has caused more than 6 million deaths globally. Understanding predictors of mortality will help in prioritizing patient care and preventive approaches. This was a multicentric, unmatched, hospital-based case-control study conducted in nine teaching hospitals in India. Cases were microbiologically confirmed COVID-19 patients who died in the hospital during the period of study and controls were microbiologically confirmed COVID-19 patients who were discharged from the same hospital after recovery. Cases were recruited sequentially from March 2020 until December-March 2021. All information regarding cases and controls was extracted retrospectively from the medical records of patients by trained physicians. Univariable and multivariable logistic regression was done to assess the association between various predictor variables and deaths due to COVID-19. A total of 2,431 patients (1,137 cases and 1,294 controls) were included in the study. The mean age of patients was 52.8 years (SD: 16.5 years), and 32.1% were females. Breathlessness was the most common symptom at the time of admission (53.2%). Increasing age (adjusted odds ratio [aOR]: 46-59 years, 3.4 [95% CI: 1.5-7.7]; 60-74 years, 4.1 [95% CI: 1.7-9.5]; and ≥ 75 years, 11.0 [95% CI: 4.0-30.6]); preexisting diabetes mellitus (aOR: 1.9 [95% CI: 1.2-2.9]); malignancy (aOR: 3.1 [95% CI: 1.3-7.8]); pulmonary tuberculosis (aOR: 3.3 [95% CI: 1.2-8.8]); breathlessness at the time of admission (aOR: 2.2 [95% CI: 1.4-3.5]); high quick Sequential Organ Failure Assessment score at the time of admission (aOR: 5.6 [95% CI: 2.7-11.4]); and oxygen saturation < 94% at the time of admission (aOR: 2.5 [95% CI: 1.6-3.9]) were associated with mortality due to COVID-19. These results can be used to prioritize patients who are at increased risk of death and to rationalize therapy to reduce mortality due to COVID-19.
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Affiliation(s)
- Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ritvik Amarchand
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | | | | | | | | | | | - Neeraj Agarwal
- Department of Community & Family Medicine, AIIMS, Patna, India
| | - Bijit Biswas
- Department of Community & Family Medicine, AIIMS, Patna, India
| | | | - Naveet Wig
- Department of Medicine, AIIMS, New Delhi, India
| | - Rajesh Malhotra
- Jai Prakash Narayan Apex Trauma Center, AIIMS, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia, BRAIRCH, AIIMS, New Delhi, India
| | - Richa Aggarwal
- Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Center, AIIMS, New Delhi, India
| | - Kapil Dev Soni
- Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Center, AIIMS, New Delhi, India
| | - Nirupam Madan
- Department of Hospital Administration, AIIMS, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | | | - Mukta Wyawahare
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), India
| | | | - Dineshbabu Sekar
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), India
| | | | - Pankaj Bhardwaj
- Department of Community & Family Medicine, AIIMS, Jodhpur, India
| | | | - Naveen Dutt
- Department of Pulmonary Medicine, AIIMS, Jodhpur, India
| | | | | | | | - Atul Jindal
- Department of Paediatrics, AIIMS, Raipur, India
| | - Utsav Raj
- National Tuberculosis Elimination Program, AIIMS, Raipur, India
| | - Ajoy Behera
- Department of Pulmonary Medicine, AIIMS, Raipur, India
| | | | - Arun Kokane
- Department of Community & Family Medicine, AIIMS, Bhopal, India
| | | | - Abhijit Pakhare
- Department of Community & Family Medicine, AIIMS, Bhopal, India
| | - Farhan Farooque
- Department of Community & Family Medicine, AIIMS, Bhopal, India
| | - Sai Pawan
- Department of Medicine, AIIMS, Bhopal, India
| | | | - Ranjan Solanki
- Department of Community & Family Medicine, AIIMS, Nagpur, India
| | | | | | | | | | - Sadananda Barik
- Department of Trauma & Emergency Medicine, AIIMS, Bhubaneswar, India
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Sharma S, N SK, Kokane A, Pakhare AP, Nawaz MM, Joshi A. Quality of Life Amongst Multidrug-Resistant TB Patients: An Exploratory Study About Distributive Dimensions and Interactions. Cureus 2022; 14:e29389. [PMID: 36304356 PMCID: PMC9585424 DOI: 10.7759/cureus.29389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Multidrug-resistant (MDR)-TB has emerged as a major challenge to eliminate TB as envisioned at policy level. Distinctive traits associated with the disease such as physical, psychosocial and environmental dimensions may influence the treatment outcome in both directions. Quality of life (QoL) indicators may capture these traits distinctively. Objective: To quantify the differential effect of MDR-TB on specific QoL domains, their distributions across the strata and to check for possible interactions. Method: This community-based cross-sectional study was conducted on 98 MDR-TB patients registered in the calendar year 2017 under National Tuberculosis Elimination Programme (NTEP) in a central Indian district using the WHO-QoL BREF Scale by patients in their vicinity. The transformed domain scores were descriptively summarized, stratified and exploratory visualised. Likert mapping for each item was done. A two-way ANOVA test was applied to check differences across strata and interaction effects were calculated. Result: Participants perceived a higher QoL in the social domain (median score 69, IQR 56-75) while the psychological health domain (median 31 IQR 20.5-44) was professed as most negotiated by disease. More than 50% of participants were found to be dissatisfied with their assumed physical status in item-wise analysis. A statistically significant interaction (p=0.008) was detected with education strata to income tertile most evident in the physical domain while psychological domain alone (p=0.017) without significant interaction with treatment duration (p=0.316) was associated with the type of TB. Overall QoL scores were tilted in favour of an urban setting, male gender and towards a relatively younger population. Conclusion: The overall deficits in QoL are evident in the study, per se in the psychological and physical domains. Moreover there is an inequitable distribution of these scores as revealed in the study. Inclusion of an additional parameter of periodical QoL assessment may thus predict the outcome at individual level and may address this inequity at policy level.
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Sinha RK, Kumar P, Daniel A, Shah H, Sriswan R, Kokane A, Mohapatra A, Kashyap V, Goel AK, Kumar V, Kiran A, Arlappa N, Joshi A, Nayak RR, Sayal S, de Wagt A. Association between anthropometric criteria and body composition among children aged 6-59 months with severe acute malnutrition: a cross-sectional assessment from India. BMC Nutr 2022; 8:56. [PMID: 35739560 PMCID: PMC9219132 DOI: 10.1186/s40795-022-00551-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/14/2022] [Indexed: 12/01/2022] Open
Abstract
A multicentric study is being conducted in which children with severe acute malnutrition (SAM) aged 6–59 months are identified with only weight-for-height z-score (WHZ) < − 3 criteria. The present study aimed to assess associations of anthropometric parameters and body composition parameters, to improve treatment of SAM. We conducted a cross-section assessment using the enrolment data of children who participated in a multi-centric longitudinal controlled study from five Indian states. Fat-free mass (FFM) and fat mass (FM) were determined by bio-electrical impedance analysis (BIA). Six hundred fifty-nine children were enrolled in the study using WHZ < -3 criteria. Available data shows that WHZ, WAZ and BMIZ were significantly associated with FFMI while MUACZ was significantly associated with both FMI and FFMI. Children with both severe wasting and severe stunting had significantly lower FFMI compared to those who were only severely wasted. All forms of anthropometric deficits appear to adversely impact FFM and FM. Trial registration The study is registered with Clinical Trial Registration of India (Registration No.: CTRI/2020/09/028013 dated 24/09/2020).
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Affiliation(s)
- Rajesh Kumar Sinha
- National Centre of Excellence for Management of Children with Severe Acute Malnutrition (NCoE-SAM), Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India.
| | - Praveen Kumar
- Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India
| | - Abner Daniel
- UNICEF India Country Office, 73, Lodi Estate, New Delhi, 110003, India
| | - Hemang Shah
- Children's Investment Fund Foundation, The Crescent, Level 3, Lado Sarai, New Delhi, 110030, India
| | - Raja Sriswan
- ICMR-National Institute of Nutrition, Beside Tarnaka Metro Station, Osmania University, Hyderabad, PO, Telangana-500007, India
| | - Arun Kokane
- All India Institute of Medical Sciences, Bhopal Saket Nagar, AIIMS Campus, Saket Nagar, BaghSwaniya, Bhopal, Madhya Pradesh-462020, India
| | - Aditya Mohapatra
- Addl Director, Department of Health and Family Welfare, Government of Odisha Annex Building, SIHFW, Bira Maharana Ln, Nilakantha Nagar, Nayapalli, Bhubaneswar, Odisha-751012, India
| | - Vivek Kashyap
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand-834001, India
| | - Anil Kumar Goel
- All India Institute of Medical Sciences, Raipur Gate No, 1, Great Eastern Rd, opposite Gurudwara, AIIMS Campus, Tatibandh, Raipur, Chhattisgarh-492099, India
| | - Virendra Kumar
- Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India
| | - Asha Kiran
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand-834001, India
| | - N Arlappa
- ICMR-National Institute of Nutrition, Beside Tarnaka Metro Station, Osmania University, Hyderabad, PO, Telangana-500007, India
| | - Ankur Joshi
- All India Institute of Medical Sciences, Bhopal Saket Nagar, AIIMS Campus, Saket Nagar, BaghSwaniya, Bhopal, Madhya Pradesh-462020, India
| | - Rashmi Ranjan Nayak
- Joint Secretary, Department of Women and Child Development and Mission Shakti, Government of Odisha, Mission Shakti Bhawan, At-Gandamunda, PO-Baramunda, Bhubaneswar, Odisha, Pin-751030, India
| | - Shikha Sayal
- National Centre of Excellence for Management of Children with Severe Acute Malnutrition (NCoE-SAM), Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India
| | - Arjan de Wagt
- UNICEF India Country Office, 73, Lodi Estate, New Delhi, 110003, India
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Kumar P, Sinha RK, Daniel A, Shah H, Sriswan R, Kokane A, Mohapatra A, Kashyap V, Goel AK, Kumar V, Kiran A, Arlappa N, Joshi A, Nayak RR, Singh M, Salasibew M, Ghosh S, Pawar SM, Mishra P, Tiwari K, Bhattacharjee S, Saiyed F, Patel TS, Nayak PK, Sahoo SK, Prajapati M, Sinha S, de Wagt A. Effectiveness of community-based treatment programs for treatment of uncomplicated severe acute malnourished children aged 6-59 months using locally produced nutrient dense foods: protocol for a multicentric longitudinal quasi-experimental study. BMC Nutr 2021; 7:85. [PMID: 34906257 PMCID: PMC8672603 DOI: 10.1186/s40795-021-00489-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background Severe acute malnutrition (SAM) is a major underlying cause of mortality among children. Around one third of the world’s acutely malnourished children live in India. The WHO recommends community-based management of acute malnutrition (CMAM) for managing children with SAM. In India, different states are implementing community-based SAM treatment programme, hereinafter called CSAM, using varieties of locally produced nutrient dense food items with different nutrient compositions. The study will assess the effectiveness of these state specific CSAM interventions. Methods The longitudinal quasi-experimental study will be undertaken in two purposively selected blocks of one district each in the four intervention states and one comparison state. From each state, 200 SAM children identified using weight-for-length/height z-score (WHZ) < − 3 criteria will be enrolled in the study. Their anthropometric data and skinfold thickness will be taken on admission, at sixth week and at discharge by trained field investigators. Other child details, incidence of morbidity and socio-economic details will be collected on admission. To assess food consumption pattern including consumption of locally produced nutrient dense food supplements, dietary assessment, using 24-h dietary recall will be conducted on admission, at sixth week and at discharge. In addition, body composition parameters will be assessed for a sub-set of children using bio-electrical impedance analysis on admission and at discharge to analyse changes in total body water, fat-free mass, and fat mass. Post discharge, all study participants will be followed up monthly until 6 months. Atleast 10% of the sample will be checked for quality assessment. The study’s primary outcome is cure rate defined as children attaining WHZ ≥ -2. Secondary outcomes include mean weight gain, mean length of stay, body composition parameters, relapse and mortality rates. Additionally, process evaluation and cost effectiveness analysis will be conducted. Discussion There is a shortage of robust evidence regarding the effectiveness of locally produced nutrient dense food supplements provided as part of the CSAM intervention in India. This study will contribute to evidence on effective strategies to manage children with uncomplicated SAM in India. The study protocol has all necessary ethical approvals. Written informed consent will be obtained from caregivers of the children. Trial registration The study is registered with Clinical Trial Registration of India (Registration No.: CTRI/2020/09/028013) Date of registration 24/09/2020. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-021-00489-1.
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Affiliation(s)
- Praveen Kumar
- Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India.
| | - Rajesh Kumar Sinha
- National Centre of Excellence for Management of Children with Severe Acute Malnutrition (NCoE-SAM), Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India
| | - Abner Daniel
- UNICEF India Country Office, 73, Lodi Estate, New Delhi, 110003, India
| | - Hemang Shah
- Children's Investment Fund Foundation, The Crescent, Level 3, Lado Sarai, New Delhi, 110030, India
| | - Raja Sriswan
- ICMR-National Institute of Nutrition, Beside Tarnaka Metro Station, Osmania University, PO, Hyderabad, Telangana, 500007, India
| | - Arun Kokane
- All India Institute of Medical Sciences, Saket Nagar, AIIMS Campus, Saket Nagar, BaghSwaniya, Bhopal, Madhya Pradesh, 462020, India
| | - Aditya Mohapatra
- Annex Building, SIHFW, BiraMaharana Ln, Nilakantha Nagar, Nayapalli, Bhubaneswar, Odisha, 751012, India
| | - Vivek Kashyap
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, 834001, India
| | - Anil Kumar Goel
- AIIMS Campus, Gate No, 1, Great Eastern Rd, opposite Gurudwara, Tatibandh, Raipur, Chhattisgarh, 492099, India
| | - Virendra Kumar
- Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India
| | - Asha Kiran
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, 834001, India
| | - N Arlappa
- ICMR-National Institute of Nutrition, Beside Tarnaka Metro Station, Osmania University, PO, Hyderabad, Telangana, 500007, India
| | - Ankur Joshi
- All India Institute of Medical Sciences, Saket Nagar, AIIMS Campus, Saket Nagar, BaghSwaniya, Bhopal, Madhya Pradesh, 462020, India
| | - Rashmi Ranjan Nayak
- Department of Women and Child Development and Mission Shakti, Government of Odisha, Mission Shakti Bhawan, At-Gandamunda, PO-Baramunda, Bhubaneswar, Odisha, Pin-751030, India
| | - Manjula Singh
- Children's Investment Fund Foundation, The Crescent, Level 3, Lado Sarai, New Delhi, 110030, India
| | - Mihretab Salasibew
- Children's Investment Fund Foundation, The Crescent, Level 3, Lado Sarai, New Delhi, 110030, India
| | - Samik Ghosh
- Children's Investment Fund Foundation, The Crescent, Level 3, Lado Sarai, New Delhi, 110030, India
| | - Sameer Manikrao Pawar
- UNICEF, Plot No.41-42, Polytechnic Colony, Shyamla Hills, Bhopal, Madhya Pradesh, 462013, India
| | - Preetu Mishra
- UNICEF, VISHWA Complex, Ground Floor, Near IICM, Kanke Road, Ranchi, Jharkhand, 834006, India
| | - Khyati Tiwari
- UNICEF, Flat No. 1104, Block B, Indis One City, KPHB, Hyderabad, Telangana, 500072, India
| | | | | | - Tarun Shrikrishna Patel
- UNICEF, Plot No.41-42, Polytechnic Colony, Shyamla Hills, Bhopal, Madhya Pradesh, 462013, India
| | - Pritish Kumar Nayak
- UNICEF, VISHWA Complex, Ground Floor, Near IICM, Kanke Road, Ranchi, Jharkhand, 834006, India
| | | | | | - Shikha Sinha
- National Centre of Excellence for Management of Children with Severe Acute Malnutrition (NCoE-SAM), Kalawati Saran Children's Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, New Delhi, 110001, India
| | - Arjan de Wagt
- UNICEF India Country Office, 73, Lodi Estate, New Delhi, 110003, India
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Gautham MS, Gururaj G, Varghese M, Benegal V, Rao GN, Kokane A, Chavan BS, Dalal PK, Ram D, Pathak K, Lenin Singh RK, Singh LK, Sharma P, Saha PK, Ramasubramanian C, Mehta RY, Shibukumar TM, Krishnatreya M, Gogoi V, Sobhana H, Sengupta S, Banerjee I, Sharma S, Giri AK, Kavishvar AB, Dave KR, Chauhan NT, Sinha VK, Goyal N, Thavody J, Anish PK, Bina T, Pakhare AP, Mittal P, Ray S, Chatterji R, Akoijam BS, Singh H, Gojendro, Kayina P, Singh LR, Das S, Puri S, Garg R, Kashyap A, Satija Y, Gaur K, Sharma D, Sathish RV, Selvi M, Krishnaraj, Singh SK, Agarwal V, Sharma E, Kar SK, Misra R, Neogi R, Sinha D, Saha S, Halder A, Aravind BA, Amudhan RS, Banandur SP, Subbakrishna DK, Marimuthu TP, Kumar BB, Jain S, Reddy YCJ, Jagadisha T, Sivakumar PT, Chand PK, Muralidharan K, Reddi S, Kumar CN, Prasad MK, Jaisoorya TS, Janardhanan CN, Sharma MP, Suman LN, Paulomi S, Kumar K, Sharma MK, Manjula M, Bhola P, Roopesh BN, Kishore MT, Veena S, Mary KAR, Anand N, Srinath S, Girimaji SC, Vijayasagar KJ, Kasi S, Muralidhar D, Pandian RD, Hamza A, Janardhana N, Raj EA, Majhi G. The National Mental Health Survey of India (2016): Prevalence, socio-demographic correlates and treatment gap of mental morbidity. Int J Soc Psychiatry 2020; 66:361-372. [PMID: 32126902 DOI: 10.1177/0020764020907941] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recognizing the need for good quality, scientific and reliable information for strengthening mental health policies and programmes, the National Mental Health Survey (NMHS) of India was implemented by National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, in the year 2015-2016. AIM To estimate the prevalence, socio-demographic correlates and treatment gap of mental morbidity in a representative population of India. METHODS NMHS was conducted across 12 Indian states where trained field investigators completed 34,802 interviews using tablet-assisted personal interviews. Eligible study subjects (18+ years) in households were selected by a multi-stage, stratified, random cluster sampling technique. Mental morbidity was assessed using MINI 6. Three-tier data monitoring system was adopted for quality assurance. Weighted and specific prevalence estimates were derived (current and lifetime) for different mental disorders. Mental morbidity was defined as those disorders as per the International Statistical Classification of Diseases, Tenth Revision Diagnostic Criteria for Research (ICD-10 DCR). Multivariate logistic regression was conducted to examine risk for mental morbidity by different socio-demographic factors. Survey was approved by central and state-level institutional ethical committees. RESULTS The weighted lifetime prevalence of 'any mental morbidity' was estimated at 13.67% (95% confidence interval (CI) = 13.61, 13.73) and current prevalence was 10.56% (95% CI = 10.51, 10.61). Mental and behavioural problems due to psychoactive substance use (F10-F19; 22.44%), mood disorders (F30-F39; 5.61%) and neurotic and stress-related disorders (F40-F48; 3.70%) were the most commonly prevalent mental morbidity in India. The overall prevalence was estimated to be higher among males, middle-aged individuals, in urban-metros, among less educated and in households with lower income. Treatment gap for overall mental morbidity was 84.5%. CONCLUSION NMHS is the largest reported survey of mental morbidity in India. Survey estimated that nearly 150 million individuals suffer from one or the other mental morbidity in India. This information is to be used for planning, delivery and evaluating mental health programming in the country.
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Affiliation(s)
- Melur Sukumar Gautham
- Department of Epidemiology, National Institute of Mental Health and Neurosciences Bangalore, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, National Institute of Mental Health and Neurosciences Bangalore, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Girish N Rao
- Department of Epidemiology, National Institute of Mental Health and Neurosciences Bangalore, India
| | - Arun Kokane
- Department of Community Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Bir Singh Chavan
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Pronob Kumar Dalal
- Department of Psychiatry, King George's Medical University, Lucknow, India
| | - Daya Ram
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, India
| | - Kangkan Pathak
- Department of Psychiatry, Lokopriya Gopinath Bordoloi (LGB) Regional Institute of Mental Health, Tezpur, India
| | | | - Lokesh Kumar Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, India
| | - Pradeep Sharma
- Department of Psychiatry, Sawai Man Singh Medical College, Jaipur, India
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Kokane A, Pakhare A, Gururaj G, Varghese M, Benegal V, Rao GN, Arvind B, Shukla M, Mitra A, Yadav K, Chatterji R, Ray S, Singh AR. Mental Health Issues in Madhya Pradesh: Insights from National Mental Health Survey of India 2016. Healthcare (Basel) 2019; 7:healthcare7020053. [PMID: 30935112 PMCID: PMC6627290 DOI: 10.3390/healthcare7020053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/26/2019] [Accepted: 03/27/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND About 14% of the global mental health burden is contributed by India. However, there exists a disparity in mental health patterns, utilization, and prioritization among various Indian states. The state of Madhya Pradesh is a low performer among Indian states, ranking lower than the national average on the Human Development Index, Hunger Index, and Gross Domestic Product (GDP). The state also performes poorly on other health-related indicators. Objectives of Study: To estimate the prevalence and patterns of mental illnesses in the state of Madhya Pradesh, India. MATERIAL AND METHODS This study used the multistage, stratified, random cluster sampling technique, with selection probability proportionate to size at each stage. A total of 3240 individuals 18 years and older were interviewed. The mixed-method study that was employed had both quantitative and qualitative components. The Mini International Neuropsychiatric Interview along with 10 other instruments were used. RESULTS The overall weighted prevalence for any mental illness was 13.9%, with 16.7% over the lifetime. The treatment gap for all of the mental health problems is very high (91%), along with high suicidal risk and substance use in the state. CONCLUSIONS This study provides evidence of the huge burden of mental, behavioral, and substance use disorders as well as the treatment gap in Madhya Pradesh. This information is crucial for developing an effective prevention and control strategy. The high treatment gap in the state calls for coordinated efforts from all stakeholders, including policy makers, political leaders, health care professionals, and the society at large to give mental health care its due priority. These findings also highlight the need for multi-pronged interventions rooted in health policy directed at reducing the treatment gap in the short term and disease burden in the long run.
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Affiliation(s)
- Arun Kokane
- Department of Community and Family Medicine, 2nd Floor, College Building, All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bhopal 462020, Madhya Pradesh, India.
| | - Abhijit Pakhare
- Department of Community and Family Medicine, 2nd Floor, College Building, All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bhopal 462020, Madhya Pradesh, India.
| | - Gopalkrishna Gururaj
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, Karnataka, India.
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, Karnataka, India.
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, Karnataka, India.
| | - Girish N Rao
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, Karnataka, India.
| | - Banavaram Arvind
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, Karnataka, India.
| | - Mukesh Shukla
- Department of Community and Family Medicine, 2nd Floor, College Building, All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bhopal 462020, Madhya Pradesh, India.
| | - Arun Mitra
- Department of Community and Family Medicine, 2nd Floor, College Building, All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bhopal 462020, Madhya Pradesh, India.
| | - Kriti Yadav
- Department of Community and Family Medicine, 2nd Floor, College Building, All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bhopal 462020, Madhya Pradesh, India.
| | - Rajni Chatterji
- Department of Psychiatry, Bhopal Memorial Hospital and Research Centre (BMHRC), Bhopal 462038, Madhya Pradesh, India.
| | - Sukanya Ray
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhopal 462020, Madhya Pradesh, India.
| | - Akash Ranjan Singh
- Department of Community and Family Medicine, 2nd Floor, College Building, All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bhopal 462020, Madhya Pradesh, India.
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Pradeep BS, Gururaj G, Varghese M, Benegal V, Rao GN, Sukumar GM, Amudhan S, Arvind B, Girimaji S, K. T, P. M, Vijayasagar KJ, Bhaskarapillai B, Thirthalli J, Loganathan S, Kumar N, Sudhir P, Sathyanarayana VA, Pathak K, Singh LK, Mehta RY, Ram D, T. M. S, Kokane A, R. K. LS, B. S. C, Sharma P, C. R, P. K. D, Saha PK, Deuri SP, Giri AK, Kavishvar AB, Sinha VK, Thavody J, Chatterji R, Akoijam BS, Das S, Kashyap A, R. V. S, M. S, S. K. S, Agarwal V, Misra R. National Mental Health Survey of India, 2016 - Rationale, design and methods. PLoS One 2018; 13:e0205096. [PMID: 30359382 PMCID: PMC6201882 DOI: 10.1371/journal.pone.0205096] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 09/19/2018] [Indexed: 01/10/2023] Open
Abstract
Understanding the burden and pattern of mental disorders as well as mapping the existing resources for delivery of mental health services in India, has been a felt need over decades. Recognizing this necessity, the Ministry of Health and Family Welfare, Government of India, commissioned the National Mental Health Survey (NMHS) in the year 2014–15. The NMHS aimed to estimate the prevalence and burden of mental health disorders in India and identify current treatment gaps, existing patterns of health-care seeking, service utilization patterns, along with an understanding of the impact and disability due to these disorders. This paper describes the design, steps and the methodology adopted for phase 1 of the NMHS conducted in India. The NMHS phase 1 covered a representative population of 39,532 from 12 states across 6 regions of India, namely, the states of Punjab and Uttar Pradesh (North); Tamil Nadu and Kerala (South); Jharkhand and West Bengal (East); Rajasthan and Gujarat (West); Madhya Pradesh and Chhattisgarh (Central) and Assam and Manipur (North East). The NMHS of India (2015–16) is a unique representative survey which adopted a uniform and standardized methodology which sought to overcome limitations of previous surveys. It employed a multi-stage, stratified, random cluster sampling technique, with random selection of clusters based on Probability Proportionate to Size. It was expected that the findings from the NMHS 2015–16 would reveal the burden of mental disorders, the magnitude of the treatment gap, existing challenges and prevailing barriers in the mental-health delivery systems in the country at a single point in time. It is hoped that the results of NMHS will provide the evidence to strengthen and implement mental health policies and programs in the near future and provide the rationale to enhance investment in mental health care in India. It is also hoped that the NMHS will provide a framework for conducting similar population based surveys on mental health and other public health problems in low and middle-income countries.
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Affiliation(s)
- Banandur S. Pradeep
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
- * E-mail:
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Girish N. Rao
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Gautham M. Sukumar
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Senthil Amudhan
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Banavaram Arvind
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Satish Girimaji
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Thennarasu K.
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Marimuthu P.
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Kommu John Vijayasagar
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Binukumar Bhaskarapillai
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Santosh Loganathan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Paulomi Sudhir
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Veena A. Sathyanarayana
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Kangkan Pathak
- Department of Psychiatry, LGB Regional Institute of Mental Health, Tezpur, Assam, India
| | - Lokesh Kumar Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | | | - Daya Ram
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | | | - Arun Kokane
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madya Pradesh, India
| | - Lenin Singh R. K.
- Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Chavan B. S.
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Pradeep Sharma
- Department of Psychiatry, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | | | - Dalal P. K.
- Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Pradeep Kumar Saha
- Department of Psychiatry, Institute of Psychiatry, Kolkata, West Bengal, India
| | - Sonia Pereira Deuri
- Department of Psychiatric Social Work, LGB Regional Institute of Mental Health, Tezpur, Assam, India
| | - Anjan Kumar Giri
- Department of Community Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | | | - Vinod K. Sinha
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | | | | | - Brogen Singh Akoijam
- Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Subhash Das
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Amita Kashyap
- Department of Community Medicine, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Sathish R. V.
- Tamil Nadu Health Systems Project, Tamil Nadu, India
| | - Selvi M.
- Clinical Psychologist, M.S. Chellamuthu Trust, Tamil Nadu, India
| | - Singh S. K.
- Department of Community Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Vivek Agarwal
- Department of Child Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Raghunath Misra
- Department of Community Medicine, IPGME&R, Kolkata, West Bengal, India
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Jhaj R, Sharma S, Sabir M, Kokane A. A pilot study to determine the occurrence of concomitant diseases and drug intake in patients on antituberculosis therapy. J Family Med Prim Care 2018; 7:414-419. [PMID: 30090786 PMCID: PMC6060940 DOI: 10.4103/jfmpc.jfmpc_103_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction: Altered pharmacokinetics of antituberculosis (anti-TB) drugs due to interaction with non-TB medications or concomitant diseases may lead to suboptimal plasma levels of the affected drugs and hence contribute to the emergence of drug resistance in mycobacteria. Yet, few studies have investigated the prevalence of concomitant drug intake or concurrent diseases in patients on anti-TB therapy (ATT). The objective of this study is to study the prevalence of concomitant diseases and intake of non-TB drugs in patients on ATT. Methods: Adult patients who were undergoing treatment for TB at a directly observed treatment short-course (DOTS) center were interviewed to find out any concomitant drug intake and ailments they were suffering from. Data were also collected from the patients’ treatment cards. Results: A total of 105 patients were interviewed for the study over a period of 1 month. Among these, 66 (62.9%) patients reported having taken a non-ATT drug in the last 3 months, 61 (58.1%) of which were drugs that may affect the ATT. A comparable number of patients (61 [58.1%]) reported suffering from one or the other concurrent illnesses or symptoms while on DOTS, including one patient with AIDS and eight with diabetes mellitus. Fluoroquinolones had been prescribed to four patients while on DOTS. Conclusion: A large proportion of the patients with TB were found to be on non-TB concomitant medications including drugs with potential for interactions that are capable of affecting ATT outcomes. It is, therefore, important that the patients and prescribing physicians be aware of any possible drug interactions.
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Affiliation(s)
- Ratinder Jhaj
- Department of Pharmacology and Toxicology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Shweta Sharma
- Department of Pharmacology and Toxicology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Mohammed Sabir
- Department of Medical Student, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Arun Kokane
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Pakhare A, Sabde Y, Joshi A, Jain R, Kokane A, Joshi R. A study of spatial and meteorological determinants of dengue outbreak in Bhopal City in 2014. J Vector Borne Dis 2016; 53:225-233. [PMID: 27681545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND & OBJECTIVES Dengue epidemics have been linked to various climatic and environmental factors. Dengue cases are often found in clusters; identification of these clusters in early phase of epidemic can help in efficient control by implementing suitable public health interventions. In year 2014, Bhopal City in Madhya Pradesh, India witnessed an outbreak of dengue with 729 recorded cases. This study reports spatial and meteorological determinants and, demographic and clinical characteristics of the dengue outbreak in Bhopal City. METHODS A cross-sectional survey of all confirmed cases reported to District Unit of Integrated Disease Surveillance Programme (IDSP), Bhopal was carried out during June to December 2014. Data pertaining to clinical manifestations, health seeking and expenditure were collected by visiting patient's residence. Geographic locations were recorded through GPS enabled mobile phones. Meteorological data was obtained from Indian Meteorological Department website. Multiple linear regression analysis was used to test influence of meteorological variables on number of cases. Clustering was investigated using average nearest neighbour tool and hot-spot analysis or Getis- Ord Gi* statistic was calculated using ArcMap 10. RESULTS The incidence of confirmed dengue as per IDSP reporting was 38/100,000 population (95% CI, 35.2- 40.7), with at least one case reported from 73 (86%) of the total 85 wards. Diurnal temperature variation, relative humidity and rainfall were found to be statistically significant predictors of number of dengue cases on multiple linear regressions. Statistically significant hot-spots and cold-spots among wards were identified according to dengue case density. INTERPRETATION & CONCLUSION Seasonal meteorological changes and sustained vector breeding contributed to the dengue epidemic in the post-monsoon period. Cases were found in geographic clusters, and therefore, findings of this study reiterate the importance of spatial analysis for understanding the pace of outbreak and identification of hot-spots.
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Affiliation(s)
- Abhijit Pakhare
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Yogesh Sabde
- National Institute of Research in Environmental Health, Bhopal, India
| | - Ankur Joshi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Rashmi Jain
- District Epidemiologist, IDSP District Surveillance Unit, Bhopal, India
| | - Arun Kokane
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Rajnish Joshi
- Department of General Medicine, All India Institute of Medical Sciences, Bhopal, India
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