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Nair MKC, Ahmed S, Multani KS, Mohamed Ismail PM, Kamath SS, Dalwai SH, Meenai Z, Suman P, Seth S, Srivastava L, Srinivasan R, Lewin M, Sanjay K, Lal DV, Udayakumar N, George B, Koshy B, Deshpande L, Sitaraman S, Manju GE, Unni JC, Paul AK, Chowdhury S, Arora NK, Russell PS. Consensus Statement of the IAP - Neurodevelopmental Chapter On Neurodevelopmental Disorders Habilitation Process: Strategic Plan for Prevention, Early Detection and Early Intervention. Indian Pediatr 2024; 61:10-23. [PMID: 38183246] [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: 01/07/2024]
Abstract
JUSTIFICATION Neurodevelopmental disorders, as per DSM-V, are described as a group of conditions with onset in the development period of childhood. There is a need to distinguish the process of habilitation and rehabilitation, especially in a developing country like India, and define the roles of all stakeholders to reduce the burden of neurodevelopmental disorders. PROCESS Subject experts and members of Indian Academy of Pediatrics (IAP) Chapter of Neurodevelopmental Pediatrics, who reviewed the literature on the topic, developed key questions and prepared the first draft on guidelines. The guidelines were then discussed by the whole group through online meetings, and the contentious issues were discussed until a general consensus was arrived at. Following this, the final guidelines were drafted by the writing group and approved by all contributors. OBJECTIVES These guidelines aim to provide practical clinical guidelines for pediatricians on the prevention, early diagnosis and management of neurodevelopmental disorders (NDDs) in the Indian settings. It also defines the roles of developmental pediatricians and development nurse counselor. STATEMENT There is a need for nationwide studies with representative sampling on epidemiology of babies with early NDD in the first 1000 days in India. Specific learning disability (SLD) has been documented as the most common NDD after 6 years in India, and special efforts should be made to establish the epidemiology of infants and toddlers at risk for SLD, where ever measures are available. Preconception counseling as part of focusing on first 1000 days; Promoting efforts to organize systematic training programs in Newborn Resuscitation Program (NRP); Lactation management; Developmental follow-up and Early stimulation for SNCU/ NICU graduates; Risk stratification of NICU graduates, Newborn Screening; Counseling parents; Screening for developmental delay by trained professionals using simple validated Indian screening tools at 4, 8, 12, 18 and 24 months; Holistic assessment of 10 NDDs at child developmental clinics (CDCs) / district early intervention centre (DEICs) by multidisciplinary team members; Confirmation of diagnosis by developmental pediatrician/developmental neurologist/child psychiatrist using clinical/diagnostic tools; Providing parent guided low intensity multimodal therapies before 3 years age as a center-based or home-based or community-based rehabilitation; Developmental pediatrician to seek guidance of pediatric neurologist, geneticist, child psychiatrist, physiatrist, and other specialists, when necessary; and Need to promote ongoing academic programs in clinical child development for capacity building of community based therapies, are the chief recommendations.
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Affiliation(s)
- M K C Nair
- NIMS-SPECTRUM-Child Development Research Centre (CDRC) NIMS Medicity, Thiruvananthapuram, Kerala and Emeritus Professor, Allied Health Science, NICHE, Kumarakovil, Kanyakumari District, Tamil Nadu
| | - Shabina Ahmed
- Chairperson, Neurodevelopment Chapter, Indian Academy of Pediatrics, Guwahati, Assam
| | - Kawaljit Singh Multani
- Hony Secretary, Neurodevelopment Chapter, Indian Academy of Pediatrics, Ghaziabad, Uttar Pradesh. Correspondence to: Dr. Kawaljit Singh Multani, Hony Secretary, Neurodevelopment Chapter, Indian Academy of Pediatrics, Ghaziabad, Uttar Pradesh.
| | | | - S S Kamath
- Indira Gandhi Co-op Hospital, Kochi, Kerala
| | - Samir H Dalwai
- New Horizons Child Development Centre, Mumbai, Maharashtra
| | - Zafar Meenai
- Ummeid Group of Child Development Centers, Bhopal, Madhya Pradesh
| | - Praveen Suman
- Child Development Centre, Sir Ganga Ram Hospital, New Delhi
| | | | - Leena Srivastava
- Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra
| | | | - Maria Lewin
- Unit of Hope, Child Development Centre, St John's Bengaluru, Karnataka
| | - K Sanjay
- Child Development Centre, IGICH, Bengaluru, Karnataka
| | - D V Lal
- Child Development Centre, Saveetha Medical College, Chennai, Tamil Nadu
| | - N Udayakumar
- Karthikeyan Child Development Unit, SRIHER, Chennai, Tamil Nadu
| | - Babu George
- Child Development Centre, Trivandrum, Kerala
| | - Beena Koshy
- Child Development Centre, CMC Vellore, Tamil Nadu
| | | | | | - G E Manju
- Prateeksha Child Development Centre, Pusphpagiri Institute of Medical Sciences, Thiruvalla, Kottayam District, Kerala
| | - Jeeson C Unni
- Child Development Centre, Aster Medicity, Kochi, Kerala
| | | | - Sreetama Chowdhury
- NIMS-SPECTRUM-Child Development Research Centre (CDRC) NIMS Medicity, Thiruvanthanapuram, Kerala
| | - N K Arora
- Inclen Trust International, Okhla, Delhi
| | - P S Russell
- Department of Psychiatry, CMC Vellore, Tamil Nadu
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Sinha A, Bahuguna P, Gupta SS, Kuruba YP, Poluru R, Mathur A, Raja D, Raut AV, Mahajan KS, Sudhakar R, Kulkarni B, Pandey RM, Arora NK, Prinja S. Study protocol for economic evaluation of probiotic intervention for prevention of neonatal sepsis in 0-2-month old low-birth weight infants in India: the ProSPoNS trial. BMJ Open 2023; 13:e068215. [PMID: 36990484 PMCID: PMC10069556 DOI: 10.1136/bmjopen-2022-068215] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION The ProSPoNS trial is a multicentre, double-blind, placebo-controlled trial to evaluate the role of probiotics in prevention of neonatal sepsis. The present protocol describes the data and methodology for the cost utility of the probiotic intervention alongside the controlled trial. METHODS AND ANALYSIS A societal perspective will be adopted in the economic evaluation. Direct medical and non-medical costs associated with neonatal sepsis and its treatment would be ascertained in both the intervention and the control arm. Intervention costs will be facilitated through primary data collection and programme budgetary records. Treatment cost for neonatal sepsis and associated conditions will be accessed from Indian national costing database estimating healthcare system costs. A cost-utility design will be employed with outcome as incremental cost per disability-adjusted life year averted. Considering a time-horizon of 6 months, trial estimates will be extrapolated to model the cost and consequences among high-risk neonatal population in India. A discount rate of 3% will be used. Impact of uncertainties present in analysis will be addressed through both deterministic and probabilistic sensitivity analysis. ETHICS AND DISSEMINATION Has been obtained from EC of the six participating sites (MGIMS Wardha, KEM Pune, JIPMER Puducherry, AIPH, Bhubaneswar, LHMC New Delhi, SMC Meerut) as well as from the ERC of LSTM, UK. A peer-reviewed article will be published after completion of the study. Findings will be disseminated to the community of the study sites, with academic bodies and policymakers. REGISTRATION The protocol has been approved by the regulatory authority (Central Drugs Standards Control Organisation; CDSCO) in India (CT-NOC No. CT/NOC/17/2019 dated 1 March 2019). The ProSPoNS trial is registered at the Clinical Trial Registry of India (CTRI). Registered on 16 May 2019. TRIAL REGISTRATION NUMBER CTRI/2019/05/019197; Clinical Trial Registry.
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Affiliation(s)
- Anju Sinha
- Reproductive, Child Health and Nutrition, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research School of Public Health, Chandigarh, India
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, Scotland's Western Lowlands, UK
| | | | - Yamini Priyanka Kuruba
- Reproductive, Child Health and Nutrition, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Ramesh Poluru
- Research Department, The INCLEN Trust International, New Delhi, India
| | - Apoorva Mathur
- Reproductive, Child Health and Nutrition, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Dilip Raja
- Reproductive, Child Health and Nutrition, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Abhishek V Raut
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | - Kamaleshwar S Mahajan
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | | | - Bharati Kulkarni
- Reproductive, Child Health and Nutrition, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Narendra K Arora
- Research Department, The INCLEN Trust International, New Delhi, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research School of Public Health, Chandigarh, India
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Deshmukh V, John S, Pakhare A, Dasgupta R, Joshi A, Chaturvedi S, Goswami K, Das MK, Mukhopadhyay R, Singh R, Shrivastava P, Dhingra B, Bingler S, Hill BP, Arora NK. Barriers in reaching new-borns and infants through home visits: A qualitative study using nexus planning framework. Front Public Health 2022; 10:956422. [PMID: 36249255 PMCID: PMC9558122 DOI: 10.3389/fpubh.2022.956422] [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] [Received: 05/30/2022] [Accepted: 08/19/2022] [Indexed: 01/24/2023] Open
Abstract
Background Home visitation has emerged as an effective model to provide high-quality care during pregnancy, childbirth, and post-natal period and improve the health outcomes of mother- new born dyad. This 3600 assessment documented the constraints faced by the community health workers (known as the Accredited Social Health Activists, ASHAs) to accomplish home visitation and deliver quality services in a poor-performing district and co-created the strategies to overcome these using a nexus planning approach. Methods The study was conducted in the Raisen district of Madhya Pradesh, India. The grounded theory approach was applied for data collection and analysis using in-depth interviews, and focus group discussions with stakeholders representing from health system (including the ASHAs) and the community (rural population). A key group of diverse stakeholders were convened to utilize the nexus planning five domain framework (social-cultural, educational, organizational, economic, and physical) to prioritize the challenges and co-create solutions for improving the home visitation program performance and quality. The nexus framework provides a systemic lens for evaluating the success of the ASHAs home visitation program. Results The societal (caste and economic discrimination), and personal (domestic responsibilities and cultural constraints of working in the village milieu) issues emerged as the key constraints for completing home visits. The programmatic gaps in imparting technical knowledge and skills, mentoring system, communication abilities, and unsatisfactory remuneration system were the other barriers to the credibility of the services. The nexus planning framework emphasized that each of the above factors/domains is intertwined and affects or depends on each other for home-based maternal and newborn care services delivered with quality through the ASHAs. Conclusion The home visitation program services, quality and impact can be enhanced by addressing the social-cultural, organizational, educational, economic, and physical nexus domains with concurrent efforts for skill and confidence enhancement of the ASHAs and their credibility.
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Affiliation(s)
| | - Shibu John
- School of Management and Business Studies, Jamia Hamdard, New Delhi, India
| | - Abhijit Pakhare
- Department of Community Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rajib Dasgupta
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
| | - Ankur Joshi
- Department of Community Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Sanjay Chaturvedi
- Department of Community Medicine, University College of Medical Sciences, New Delhi, India
| | - Kiran Goswami
- Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Rakesh Singh
- The INCLEN Trust International, New Delhi, India
| | | | - Bhavna Dhingra
- Department of Pediatrics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Steven Bingler
- Concordia–Architecture, Planning, Community Engagement, New Orleans, LA, United States
| | - Bobbie Provosty Hill
- Concordia–Architecture, Planning, Community Engagement, New Orleans, LA, United States
| | - Narendra K. Arora
- The INCLEN Trust International, New Delhi, India,*Correspondence: Narendra K. Arora
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Duke T, AlBuhairan FS, Agarwal K, Arora NK, Arulkumaran S, Bhutta ZA, Binka F, Castro A, Claeson M, Dao B, Darmstadt GL, English M, Jardali F, Merson M, Ferrand RA, Golden A, Golden MH, Homer C, Jehan F, Kabiru CW, Kirkwood B, Lawn JE, Li S, Patton GC, Ruel M, Sandall J, Sachdev HS, Tomlinson M, Waiswa P, Walker D, Zlotkin S. World Health Organization and knowledge translation in maternal, newborn, child and adolescent health and nutrition. Arch Dis Child 2022; 107:644-649. [PMID: 34969670 PMCID: PMC7613575 DOI: 10.1136/archdischild-2021-323102] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022]
Abstract
The World Health Organization (WHO) has a mandate to promote maternal and child health and welfare through support to governments in the form of technical assistance, standards, epidemiological and statistical services, promoting teaching and training of healthcare professionals and providing direct aid in emergencies. The Strategic and Technical Advisory Group of Experts (STAGE) for maternal, newborn, child and adolescent health and nutrition (MNCAHN) was established in 2020 to advise the Director-General of WHO on issues relating to MNCAHN. STAGE comprises individuals from multiple low-income and middle-income and high-income countries, has representatives from many professional disciplines and with diverse experience and interests.Progress in MNCAHN requires improvements in quality of services, equity of access and the evolution of services as technical guidance, community needs and epidemiology changes. Knowledge translation of WHO guidance and other guidelines is an important part of this. Countries need effective and responsive structures for adaptation and implementation of evidence-based interventions, strategies to improve guideline uptake, education and training and mechanisms to monitor quality and safety. This paper summarises STAGE's recommendations on how to improve knowledge translation in MNCAHN. They include support for national and regional technical advisory groups and subnational committees that coordinate maternal and child health; support for national plans for MNCAHN and their implementation and monitoring; the production of a small number of consolidated MNCAHN guidelines to promote integrated and holistic care; education and quality improvement strategies to support guidelines uptake; monitoring of gaps in knowledge translation and operational research in MNCAHN.
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Affiliation(s)
- Trevor Duke
- Intensive Care Unit and University of Melbourne Department of Paediatrics, Royal Children's Hospital, Parkville, Victoria, Australia
- Child Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, NCD, Papua New Guinea
| | - Fadia S AlBuhairan
- Leadership, Learning, and Development, Health Sector Transformation Program, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Koki Agarwal
- USAID Maternal Child Survival Program, Washington, District of Columbia, USA
| | | | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Fred Binka
- University of Health and Allied Sciences (UHAS), Ho, Ghana
| | - Arachu Castro
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Mariam Claeson
- Department of Global Health, Karolinska Institute, Stockholm, Sweden
| | - Blami Dao
- Western and Central Africa, Jhpiego, Ouagadougou, Burkina Faso
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Mike English
- Kemri-Wellcome Trust, Nairobi, Kenya
- Oxford University, Oxford, UK
| | | | - Michael Merson
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Rashida A Ferrand
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Alma Golden
- US Agency for International Development, Washington, District of Columbia, USA
| | | | | | - Fyezah Jehan
- Pediatrics, Aga Khan University, Karachi, Sindh, Pakistan
| | - Caroline W Kabiru
- Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Betty Kirkwood
- London School of Hygiene & Tropical Medicine, London, UK
| | - Joy E Lawn
- MARCH Centre, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Song Li
- National Health Commission of the People's Republic of China, Beijing, China
| | - George C Patton
- Adolescent Health, Murdoch Children's Research Institute and The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Ruel
- International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College, London, UK
| | - Harshpal Singh Sachdev
- Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, India
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | | | - Dilys Walker
- Department of Obstetrics, Gynecology and Reproductive Sciences, Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Stanley Zlotkin
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Majhi PK, Kothari R, Arora NK, Pandey VC, Tyagi VV. Impact of pH on Pollutional Parameters of Textile Industry Wastewater with Use of Chlorella pyrenoidosa at Lab-Scale: A Green Approach. Bull Environ Contam Toxicol 2022; 108:485-490. [PMID: 33950268 DOI: 10.1007/s00128-021-03208-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/22/2021] [Indexed: 06/12/2023]
Abstract
The current study focused on the pollution remediation of textile industry wastewater by using Chlorella pyrenoidosa in two different physical forms: free algal biomass and immobilized algal biomass. The hypothesis behind the present study was to analyze the pollution reduction efficiency of immobilized algal biomass and free algal biomass on comparative scale on the basis of the adsorption process which is directly proportional with the surface area of the adsorbate. So, in this context the immobilized form of algae could enhance the pollution reduction efficiency due to availability of more surface area. So, the textile industry wastewater was treated by both free algal biomass and immobilized algal biomass and the major wastewater contributors like nitrate, phosphate, Biochemical Oxygen Demand (BOD) and Chemical Oxygen Demand (COD) were assessed before and after the treatment process. To conclude the optimum comparative results, the pH of wastewater was maintained constant, as it can capitalize or moderate the adsorption process (initial pH of was 8.2 ± 0.1, but it was maintained to 8). The contamination remediation was found to be effective with immobilized algal biomass (46.7% of nitrate, 59.4% of phosphate, 83.1% BOD and 83.0% of COD) than free algal biomass (43.2% of nitrate, 56.7% of phosphate, 71.4% of BOD and 78.0% COD).
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Affiliation(s)
- Pradeep K Majhi
- Department of Environmental Sciences, Babasaheb Bhimrao Ambedkar University, Lucknow, U.P., 226025, India
| | - Richa Kothari
- Department of Environmental Sciences, Central University of Jammu, Rahya-Suchani, Bagla, Samba, J&K, 181143, India.
| | - N K Arora
- Department of Environmental Sciences, Babasaheb Bhimrao Ambedkar University, Lucknow, U.P., 226025, India
| | - Vimal Chandra Pandey
- Department of Environmental Sciences, Babasaheb Bhimrao Ambedkar University, Lucknow, U.P., 226025, India
| | - V V Tyagi
- School of Energy Management, Shri Mata Vaishno Devi University, Katra, J&K, 182320, India
- Center of Research Excellence in Renewable Energy and Power Systems, King Abdulaziz University, Jeddah, 80200, Saudi Arabia
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Olusanya BO, Boo NY, Nair M, Samms-Vaughan ME, Hadders-Algra M, Wright SM, Breinbauer C, Almasri N, Moreno-Angarita M, Arabloo J, Arora NK, Block SS, Berman BD, Burchell G, de Camargo OK, Carr G, del Castillo-Hegyi C, Cheung VG, Halpern R, Hoekstra R, Lynch P, Mulaudzi MC, Kakooza-Mwesige A, Ogbo FA, Olusanya JO, Rojas-Osorio V, Shaheen A, Williams AN, Servili C, Gladstone M, Kuper H, Wertlieb D, Davis AC, Newton CR. Accelerating progress on early childhood development for children under 5 years with disabilities by 2030. Lancet Glob Health 2022; 10:e438-e444. [PMID: 35038406 PMCID: PMC7613579 DOI: 10.1016/s2214-109x(21)00488-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/10/2021] [Accepted: 10/13/2021] [Indexed: 12/30/2022]
Abstract
The likelihood of a newborn child dying before their fifth birthday (under-5 mortality rate) is universally acknowledged as a reflection of the social, economic, health, and environmental conditions in which children (and the rest of society) live, but little is known about the likelihood of a newborn child having a lifelong disability before their fifth birthday if he or she survives. Available data show that globally the likelihood of a child having a disability before their fifth birthday was ten times higher than the likelihood of dying (377·2 vs 38·2 per 1000 livebirths) in 2019. However, disability funding declined by 11·4% between 2007 and 2016, and only 2% of the estimated US$79·1 billion invested in early childhood development during this period was spent on disabilities. This funding pattern has not improved since 2016. This paper highlights the urgent need to prioritise early childhood development for the beneficiaries of global child survival initiatives who have lifelong disabilities, especially in low-income and middle-income countries, as envisioned by the Sustainable Development Goals agenda. This endeavour would entail disability-focused programming and monitoring approaches, economic analysis of interventions services, and substantial funding to redress the present inequalities among this cohort of children by 2030.
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Stevanovic D, Costanzo F, Fucà E, Valeri G, Vicari S, Robins DL, Samms-Vaughan M, Ozek Erkuran H, Yaylaci F, Deshpande SN, Deshmukh V, Arora NK, Albores-Gallo L, García-López C, Gatica-Bahamonde G, Gabunia M, Zirakashvili M, Machado FP, Radan M, Samadi SA, Toh TH, Gayle W, Brennan L, Zorcec T, Auza A, de Jonge M, Shoqirat N, Marini A, Knez R. Measurement invariance of the Childhood Autism Rating Scale (CARS) across six countries. Autism Res 2021; 14:2544-2554. [PMID: 34346193 DOI: 10.1002/aur.2586] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 11/07/2022]
Abstract
The Childhood Autism Rating Scale (CARS) is a simple and inexpensive tool for Autism spectrum disorder (ASD) assessments, with evidenced psychometric data from different countries. However, it is still unclear whether ASD symptoms are measured the same way across different societies and world regions with this tool, since data on its cross-cultural validity are lacking. This study evaluated the cross-cultural measurement invariance of the CARS among children with ASD from six countries, for whom data were aggregated from previous studies in India (n = 101), Jamaica (n = 139), Mexico (n = 72), Spain (n = 99), Turkey (n = 150), and the United States of America (n = 186). We analyzed the approximate measurement invariance based on Bayesian structural equation modeling. The model did not fit the data and its measurement invariance did not hold, with all items found non-invariant across the countries. Items related to social communication and interaction (i.e., relating to people, imitation, emotional response, and verbal and nonverbal communication) displayed lower levels of cross-country non-invariance compared to items about stereotyped behaviors/sensory sensitivity (i.e., body and object use, adaptation to change, or taste, smell, and touch response). This study found that the CARS may not provide cross-culturally valid ASD assessments. Thus, cross-cultural comparisons with the CARS should consider first which items operate differently across samples of interest, since its cross-cultural measurement non-invariance could be a source of cross-cultural variability in ASD presentations. Additional studies are needed before drawing valid recommendations in relation to the cultural sensitivity of particular items.
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Affiliation(s)
- Dejan Stevanovic
- Department of Psychiatry, Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Floriana Costanzo
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Elisa Fucà
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giovanni Valeri
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Diana L Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Handan Ozek Erkuran
- Child and Adolescent Psychiatry Unit, Dr Behcet Uz Children's Research and Training Hospital, Izmir, Turkey
| | - Ferhat Yaylaci
- Child Psychiatry Unit, Bursa Dortcelik Children's Hospital, Bursa, Turkey
| | - Smita N Deshpande
- Department of Psychiatry, Centre of Excellence in Mental health, Atal Bihari Vajpayee Institute of Medical Sciences; Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | | | | | - Lilia Albores-Gallo
- Research Division, Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Secretaría de Salud, Mexico City, Mexico
| | | | | | | | | | | | - Miruna Radan
- National Institute for Maternal and Child Health, Bucharest, Romania
| | - Sayyed Ali Samadi
- Institute of Nursing and Health Research, University of Ulster, Coleraine, UK
| | - Teck-Hock Toh
- Clinical Research Centre & Department of Pediatrics, Sibu Hospital, Ministry of Health Malaysia, Sibu, Malaysia
| | - Windham Gayle
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, California, USA
| | | | - Tatjana Zorcec
- Developmental Department, University Children's Hospital, Skopje, Macedonia
| | - Alejandra Auza
- Language and Cognition Laboratory, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Maretha de Jonge
- Faculty of Social Science, Education and Child Studies, Clinical Neuroscience and Developmental Disorders, Leiden University, Leiden, The Netherlands
| | | | | | - Rajna Knez
- Department of Women's and Children's Health, Skaraborgs Hospital, Skövde, Sweden.,Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Weltman RM, Edwards RD, Fleming LT, Yadav A, Weyant CL, Rooney B, Seinfeld JH, Arora NK, Bond TC, Nizkorodov SA, Smith KR. Emissions Measurements from Household Solid Fuel Use in Haryana, India: Implications for Climate and Health Co-benefits. Environ Sci Technol 2021; 55:3201-3209. [PMID: 33566595 DOI: 10.1021/acs.est.0c05143] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A large concern with estimates of climate and health co-benefits of "clean" cookstoves from controlled emissions testing is whether results represent what actually happens in real homes during normal use. A growing body of evidence indicates that in-field emissions during daily cooking activities differ substantially from values obtained in laboratories, with correspondingly different estimates of co-benefits. We report PM2.5 emission factors from uncontrolled cooking (n = 7) and minimally controlled cooking tests (n = 51) using traditional chulha and angithi stoves in village kitchens in Haryana, India. Minimally controlled cooking tests (n = 13) in a village kitchen with mixed dung and brushwood fuels were representative of uncontrolled field tests for fine particulate matter (PM2.5), organic and elemental carbon (p > 0.5), but were substantially higher than previously published water boiling tests using dung or wood. When the fraction of nonrenewable biomass harvesting, elemental, and organic particulate emissions and modeled estimates of secondary organic aerosol (SOA) are included in 100 year global warming commitments (GWC100), the chulha had a net cooling impact using mixed fuels typical of the region. Correlation between PM2.5 emission factors and GWC (R2 = 0.99) implies these stoves are climate neutral for primary PM2.5 emissions of 8.8 ± 0.7 and 9.8 ± 0.9 g PM2.5/kg dry fuel for GWC20 and GWC100, respectively, which is close to the mean for biomass stoves in global emission inventories.
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Affiliation(s)
- Robert M Weltman
- Department of Epidemiology, School of Medicine, University of California Irvine, Irvine, California 92697, United States
| | - Rufus D Edwards
- Department of Epidemiology, School of Medicine, University of California Irvine, Irvine, California 92697, United States
| | - Lauren T Fleming
- Department of Chemistry, University of California Irvine, Irvine, California 92697, United States
| | - Ankit Yadav
- INCLEN Trust International, New Delhi 110020, India
| | - Cheryl L Weyant
- Department of Civil and Environmental Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois 61820, United States
- School for Environment and Sustainability, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Brigitte Rooney
- Division of Geological and Planetary Sciences, California Institute of Technology, Pasadena, California 91125, United States
| | - John H Seinfeld
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, California 91125, United States
| | | | - Tami C Bond
- Department of Mechanical Engineering, Colorado State University, Fort Collins Colorado 80524, United States
| | - Sergey A Nizkorodov
- Department of Chemistry, University of California Irvine, Irvine, California 92697, United States
| | - Kirk R Smith
- School of Public Health, University of California, Berkeley, California 94720, United States
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9
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Olusanya BO, Wright SM, Nair M, Boo NY, Halpern R, Kuper H, Abubakar AA, Almasri NA, Arabloo J, Arora NK, Backhaus S, Berman BD, Breinbauer C, Carr G, de Vries PJ, del Castillo-Hegyi C, Eftekhari A, Gladstone MJ, Hoekstra RA, Kancherla V, Mulaudzi MC, Kakooza-Mwesige A, Ogbo FA, Olsen HE, Olusanya JO, Pandey A, Samms-Vaughan ME, Servili C, Shaheen A, Smythe T, Wertlieb D, Williams AN, Newton CR, Davis AC, Kassebaum NJ. Global Burden of Childhood Epilepsy, Intellectual Disability, and Sensory Impairments. Pediatrics 2020; 146:peds.2019-2623. [PMID: 32554521 PMCID: PMC7613313 DOI: 10.1542/peds.2019-2623] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Estimates of children and adolescents with disabilities worldwide are needed to inform global intervention under the disability-inclusive provisions of the Sustainable Development Goals. We sought to update the most widely reported estimate of 93 million children <15 years with disabilities from the Global Burden of Disease Study 2004. METHODS We analyzed Global Burden of Disease Study 2017 data on the prevalence of childhood epilepsy, intellectual disability, and vision or hearing loss and on years lived with disability (YLD) derived from systematic reviews, health surveys, hospital and claims databases, cohort studies, and disease-specific registries. Point estimates of the prevalence and YLD and the 95% uncertainty intervals (UIs) around the estimates were assessed. RESULTS Globally, 291.2 million (11.2%) of the 2.6 billion children and adolescents (95% UI: 249.9-335.4 million) were estimated to have 1 of the 4 specified disabilities in 2017. The prevalence of these disabilities increased with age from 6.1% among children aged <1 year to 13.9% among adolescents aged 15 to 19 years. A total of 275.2 million (94.5%) lived in low- and middle-income countries, predominantly in South Asia and sub-Saharan Africa. The top 10 countries accounted for 62.3% of all children and adolescents with disabilities. These disabilities accounted for 28.9 million YLD or 19.9% of the overall 145.3 million (95% UI: 106.9-189.7) YLD from all causes among children and adolescents. CONCLUSIONS The number of children and adolescents with these 4 disabilities is far higher than the 2004 estimate, increases from infancy to adolescence, and accounts for a substantial proportion of all-cause YLD.
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Affiliation(s)
| | - Scott M. Wright
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - M.K.C. Nair
- NIMS Spectrum Child Development Research Centre, NIMS Medicity, Thiruvananthapuram, Kerala, India
| | - Nem-Yun Boo
- Department of Population Medicine, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | - Ricardo Halpern
- Department of Pediatrics and Adolescence, University of Health Sciences of Porto Alegre, Porto Alegrel, Brazil
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Amina A. Abubakar
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, KiIifi, Kenya
| | - Nihad A. Almasri
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Jalal Arabloo
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Sophia Backhaus
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Brad D. Berman
- Department of Pediatrics, University of California, San Francisco Benioff Children’s Hospital, San Francisco, California,Progressions: Developmental and Behavioral Pediatrics, San Francisco, California
| | | | - Gwen Carr
- Ear Institute, University College London, London, United Kingdom
| | - Petrus J. de Vries
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Christie del Castillo-Hegyi
- Department of Emergency Medicine, CHI St. Vincent, Little Rock, Arkansas,Fed Is Best Foundation, Little Rock, Arkansas
| | - Aziz Eftekhari
- Department of Pharmacology and Toxicology, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Melissa J. Gladstone
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Rosa A. Hoekstra
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Mphelekedzeni C. Mulaudzi
- Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - Angelina Kakooza-Mwesige
- department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Felix A. Ogbo
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
| | | | | | | | - Maureen E. Samms-Vaughan
- Department of Child and Adolescent Health, The University of the West Indies, Mona Campus, Kingston, Jamaica
| | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Amira Shaheen
- Division of Public Health, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Donald Wertlieb
- Eliot-Pearson Department of Child Development, Tufts University, Medford, Massachusetts
| | - Andrew N. Williams
- Virtual Academic Unit, Northampton General Hospital, Northampton, United Kingdom
| | - Charles R.J. Newton
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, KiIifi, Kenya
| | - Adrian C. Davis
- Ear Institute, University College London, London, United Kingdom
| | - Nicholas J. Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
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10
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Wahl B, Sharan A, Deloria Knoll M, Kumar R, Liu L, Chu Y, McAllister DA, Nair H, Campbell H, Rudan I, Ram U, Sauer M, Shet A, Black R, Santosham M, O'Brien KL, Arora NK. National, regional, and state-level burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in India: modelled estimates for 2000-15. Lancet Glob Health 2020; 7:e735-e747. [PMID: 31097277 PMCID: PMC6527518 DOI: 10.1016/s2214-109x(19)30081-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/21/2018] [Accepted: 01/25/2019] [Indexed: 11/17/2022]
Abstract
Background India accounts for a disproportionate burden of global childhood illnesses. To inform policies and measure progress towards achieving child health targets, we estimated the annual national and state-specific childhood mortality and morbidity attributable to Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) between 2000 and 2015. Methods In this modelling study, we used vaccine clinical trial data to estimate the proportion of pneumonia deaths attributable to pneumococcus and Hib. The proportion of meningitis deaths attributable to each pathogen was derived from pathogen-specific meningitis case fatality and bacterial meningitis case data from surveillance studies. We applied these proportions to modelled state-specific pneumonia and meningitis deaths from 2000 to 2015 prepared by the WHO Maternal and Child Epidemiology Estimation collaboration (WHO/MCEE) on the basis of verbal autopsy studies from India. The burden of clinical and severe pneumonia cases attributable to pneumococcus and Hib was ascertained with vaccine clinical trial data and state-specific all-cause pneumonia case estimates prepared by WHO/MCEE by use of risk factor prevalence data from India. Pathogen-specific meningitis cases were derived from state-level modelled pathogen-specific meningitis deaths and state-level meningitis case fatality estimates. Pneumococcal and Hib morbidity due to non-pneumonia, non-meningitis (NPNM) invasive syndromes were derived by applying the ratio of pathogen-specific NPNM cases to pathogen-specific meningitis cases to the state-level pathogen-specific meningitis cases. Mortality due to pathogen-specific NPNM was calculated with the ratio of pneumococcal and Hib meningitis case fatality to pneumococcal and Hib meningitis NPNM case fatality. Census data from India provided the population at risk. Findings Between 2000 and 2015, estimates of pneumococcal deaths in Indian children aged 1–59 months fell from 166 000 (uncertainty range [UR] 110 000–198 000) to 68 700 (44 600–86 000), while Hib deaths fell from 82 600 (52 300–112 000) to 15 600 (9800–21 500), representing a 58% (UR 22–78) decline in pneumococcal deaths and an 81% (59–91) decline in Hib deaths. In 2015, national mortality rates in children aged 1–59 months were 56 (UR 37–71) per 100 000 for pneumococcal infection and 13 (UR 8–18) per 100 000 for Hib. Uttar Pradesh (18 900 [UR 12 300–23 600]) and Bihar (8600 [5600–10 700]) had the highest numbers of pneumococcal deaths in 2015. Uttar Pradesh (9300 [UR 5900–12 700]) and Odisha (1100 [700–1500]) had the highest numbers of Hib deaths in 2015. Less conservative assumptions related to the proportion of pneumonia deaths attributable to pneumococcus indicate that as many as 118 000 (UR 69 000–140 000) total pneumococcal deaths could have occurred in 2015 in India. Interpretation Pneumococcal and Hib mortality have declined in children aged 1–59 months in India since 2000, even before nationwide implementation of conjugate vaccines. Introduction of the Hib vaccine in several states corresponded with a more rapid reduction in morbidity and mortality associated with Hib infection. Rapid scale-up and widespread use of the pneumococcal conjugate vaccine and sustained use of the Hib vaccine could help accelerate achievement of child survival targets in India. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Brian Wahl
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - Maria Deloria Knoll
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rajesh Kumar
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Li Liu
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, and Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yue Chu
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Harish Nair
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh, UK; Public Health Foundation of India, New Delhi, India
| | - Harry Campbell
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh, UK
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh, UK
| | - Usha Ram
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Molly Sauer
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anita Shet
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert Black
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mathuram Santosham
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katherine L O'Brien
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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11
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Gulati S, Saini L, Kaushik JS, Chakrabarty B, Arora NK, Pandey RM, Sagar R, Sapra S, Sharma S, Paul VK. The Development and Validation of DSM 5-Based AIIMS-Modified INDT ADHD Tool for Diagnosis of ADHD: A Diagnostic Test Evaluation Study. Neurol India 2020; 68:352-357. [PMID: 32189699 DOI: 10.4103/0028-3886.280638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The current study was planned at a tertiary centre in northern India to develop and validate a Diagnostic and Statistical Manual-5 (DSM-5)-based diagnostic tool and design a severity score for attention deficit hyperactivity disorder (ADHD) in children aged 6-18 years. An existing DSM-IV-based tool, INDT (International Clinical Epidemiology Network [INCLEN] diagnostic tool) for ADHD has been modified and named All India Institute of Medical Sciences (AIIMS)-modified INDT ADHD tool. METHOD The first phase was development of the tool and the second phase was validation of the same against the gold standard of diagnosis by the DSM-5. A severity score was developed for ADHD in concordance with the Conners rating scale. RESULTS The tool was validated in 66 children with a sensitivity and specificity of 100 per cent and 90 per cent, respectively. A cut-off score of 12 was decided for labelling severity of ADHD, which corresponded to 63 in the Conners rating scale. CONCLUSION This diagnostic tool for ADHD based on DSM-5 has acceptable psychometric properties. The severity score will be useful for prognostication, monitoring treatment response, and designing intervention trials.
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Affiliation(s)
- Sheffali Gulati
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
| | - Lokesh Saini
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
| | - Jaya Shankar Kaushik
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
| | - Biswaroop Chakrabarty
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
| | - N K Arora
- The INCLEN Trust International, 2nd Floor, F-1/5, Okhla Industrial Area, Phase-I, New Delhi, India
| | - Ravindra M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
| | - Savita Sapra
- Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
| | - Shobha Sharma
- Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
| | - Vinod K Paul
- Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
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12
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Wazny K, Arora NK, Mohapatra A, Gopalan HS, Das MK, Nair M, Bavdekar S, Rasaily R, Thavaraj V, Roy M, Shekhar C, Kumar R, Katoch VM, Rudan I, Black RE, Swaminathan S. Setting priorities in child health research in India for 2016-2025: a CHNRI exercise undertaken by the Indian Council for Medical Research and INCLEN Trust. J Glob Health 2020; 9:020701. [PMID: 31673343 PMCID: PMC6818639 DOI: 10.7189/jogh.09.020701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Millennium Development Goal 4 (MDGs) mobilised countries to reduce child mortality by two thirds the 1990 rate in 2015. While India did not reach MDG 4, it considerably reduced child mortality in the MDG-era. Efficient and targeted interventions and adequate monitoring are necessary to further progress in improvements to child health. Looking forward to the Sustainable Development Goal (SDG)-era, the Indian Council of Medical Research and The INCLEN Trust International conducted a national research priority setting exercise for maternal, child, newborn health, and maternal and child nutrition. Here, results are reported for child health. Methods The Child Health and Nutrition Research Initiative (CHNRI) method for research priority setting was employed. Research ideas were crowd-sourced from a network of child health experts from across India; these were refined and consolidated into research options (ROs) which were scored against five weighted criteria to arrive weighted Research Priority Scores (wRPS). National and regional priority lists were prepared. Results 90 experts contributed 596 ideas that were consolidated into 101 research options (ROs). These were scored by 233 experts nationwide. National wRPS for ROs ranged between 0.92 and 0.51. The majority of the top research priorities related to development of cost-effective interventions and their implementation, and impact evaluations, improving data quality; and monitoring of existing programs, or improving the management of morbidities. The research priorities varied between regions, the Economic Action Group and North-Eastern states prioritised questions relating to delivering interventions at community- or household-level, whereas the North-Eastern states and Union Territories prioritised research questions involving managing and measuring malaria, and the Southern and Western states prioritised research questions involving pharmacovigilance of vaccines, impact of newly introduced vaccines, and delivery of vaccines to hard-to-reach populations. Conclusions Research priorities varied geographically, according the stage of development of the area and mostly pertained to implementation sciences, which was expected given diversity in epidemiological profiles. Priority setting should help guide investment decisions by national and international agencies, therefore encouraging researchers to focus on priority areas. The ICMR has launched a grants programme for implementation research on maternal and child health to pursue research priorities identified by this exercise.
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Affiliation(s)
- Kerri Wazny
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK.,Joint first authors
| | - Narendra K Arora
- The INCLEN Trust International, New Delhi, India.,Joint first authors
| | | | | | - Manoj K Das
- The INCLEN Trust International, New Delhi, India
| | - Mkc Nair
- Kerala University of Health Sciences, Thrissur, Kerala, India
| | - Sandeep Bavdekar
- Department of Pediatrics, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Reeta Rasaily
- The Indian Council of Medical Research, New Delhi, India
| | | | - Malabika Roy
- The Indian Council of Medical Research, New Delhi, India
| | | | - Rakesh Kumar
- The Indian Council of Medical Research, New Delhi, India
| | | | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Robert E Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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13
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Sutcliffe CG, Shet A, Varghese R, Veeraraghavan B, Manoharan A, Wahl B, Chandy S, Sternal J, Khan R, Singh RK, Santosham M, Arora NK. Nasopharyngeal carriage of Streptococcus pneumoniae serotypes among children in India prior to the introduction of pneumococcal conjugate vaccines: a cross-sectional study. BMC Infect Dis 2019; 19:605. [PMID: 31291902 PMCID: PMC6621985 DOI: 10.1186/s12879-019-4254-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 03/11/2019] [Accepted: 07/03/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Streptococcus pneumoniae is a major cause of pneumonia, meningitis, and other serious infections among children in India. India introduced the 13-valent pneumococcal conjugate vaccine (PCV) in several states in 2017, and is expected to expand to nationwide coverage in the near future. To establish a baseline for measuring the impact of PCV in India, we assessed overall and serotype-specific nasopharyngeal carriage in two pediatric populations. METHODS A cross-sectional study was conducted in Palwal District, Haryana, from December 2016 to July 2017, prior to vaccine introduction. Children 2-59 months of age with clinical pneumonia seeking healthcare and those in the community with no clear illness were targeted for enrollment. A nasopharyngeal swab was collected and tested for pneumococcus using conventional culture and sequential multiplex PCR. Isolates were tested for antimicrobial resistance using an E test. Children were considered colonized if pneumococcus was isolated by culture or PCR. The prevalence of pneumococcal and serotype-specific colonization was compared between groups of children using log-binomial regression. RESULTS Among 601 children enrolled, 91 had clinical pneumonia and 510 were community children. The proportion colonized with S. pneumoniae was 74.7 and 54.5% among children with clinical pneumonia and community children, respectively (adjusted prevalence ratio: 1.38; 95% confidence interval: 1.19, 1.60). The prevalence of PCV13 vaccine-type colonization was similar between children with clinical pneumonia (31.9%) and community children (28.0%; p = 0.46). The most common colonizing serotypes were 6A, 6B, 14, 19A, 19F, and 23F, all of which are included in the PCV13 vaccine product. Antimicrobial resistance to at least one drug was similar between isolates from children with clinical pneumonia (66.1%) and community children (61.5%; p = 0.49); while resistance to at least two drugs was more common among isolates from children with clinical pneumonia (25.8% vs. 16.4%; p = 0.08). Resistance for all drugs was consistently higher for PCV13 vaccine-type serotypes compared to non-vaccine serotypes in both groups. CONCLUSION This study provides baseline information on the prevalence of serotype-specific pneumococcal colonization among children prior to the introduction of PCV in India. Our results suggest a role for pneumococcal vaccines in reducing pneumococcal colonization and antimicrobial resistant isolates circulating in India.
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Affiliation(s)
- Catherine G Sutcliffe
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Anita Shet
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Rosemol Varghese
- Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India
| | | | - Anand Manoharan
- The CHILDS Trust Medical Research Foundation, 12-A Nageswara Road, Nungambakkam, Chennai, 600034, India
| | - Brian Wahl
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Sara Chandy
- The CHILDS Trust Medical Research Foundation, 12-A Nageswara Road, Nungambakkam, Chennai, 600034, India
| | - Jack Sternal
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Raziuddin Khan
- The INCLEN Trust International, F-1/5, 2nd Floor, Okhla Industrial Area Phase - 1, New Delhi, 110020, India
| | - Rakesh Kumar Singh
- The INCLEN Trust International, F-1/5, 2nd Floor, Okhla Industrial Area Phase - 1, New Delhi, 110020, India
| | - Mathuram Santosham
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Narendra K Arora
- The INCLEN Trust International, F-1/5, 2nd Floor, Okhla Industrial Area Phase - 1, New Delhi, 110020, India.
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14
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Dasgupta R, Sharma S, Sharma N, Banerjee K, Haran EGP, Muliyel JP, Salunke S, Masoodi MA, Haldar P, Bahl S, Bhatnagar P, Joshi S, Arora NK. Successful switch (tOPV to bOPV) in India: Tribute to a resilient health system. Vaccine 2019; 37:2394-2400. [PMID: 30879830 DOI: 10.1016/j.vaccine.2019.02.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 11/25/2022]
Abstract
In accordance with the end game strategies for polio eradication a synchronized switch plan from tOPV to bOPV was implemented globally in 2016. The National Committee for Polio Eradication (NCCPE) validated the switch activities in India. An expert group of 104 academics conducted field visits in 25 states and 2 Union territories for independent verification (after an initial round of verification by the National Polio Surveillance Project [NPSP]). The objectives were to validate withdrawal and disposal of tOPV by screening cold chain points in public and private sector health facilities in both rural and urban areas; additionally, availability of bOPV and IPV was also documented. 34 filled tOPV and 5 empty vials were detected inside cold chain equipment and 17 outside. The disposal mechanism was found to be reasonably adequate. The key strategies -- 'throttling' of vaccine supplies well ahead of the switch date while preventing stock outs at various immunization points, simultaneously working with the regulators to delicense the tOPV on the switch date and helping manufacturers to calibrate vaccine production according to national timelines, and strong and persistent advocacy with professional associations to align with national bOPV and IPV policy facilitated successful accomplishment of the switch process. Effective implementation of the switch strategy in India also bears testimony to the resilience of the health system operating under diverse and heterogeneous governance.
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Affiliation(s)
- Rajib Dasgupta
- National Certification Committee for Polio Eradication, New Delhi, India
| | - Shweta Sharma
- National Certification Committee for Polio Eradication Secretariat, New Delhi, India
| | - Nisha Sharma
- National Certification Committee for Polio Eradication Secretariat, New Delhi, India
| | - K Banerjee
- National Certification Committee for Polio Eradication, New Delhi, India
| | - E G P Haran
- National Certification Committee for Polio Eradication, New Delhi, India
| | - J P Muliyel
- National Certification Committee for Polio Eradication, New Delhi, India
| | - Subhash Salunke
- National Certification Committee for Polio Eradication, New Delhi, India
| | | | | | | | | | - Sudhir Joshi
- National Polio Surveillance Project, New Delhi, India
| | - Narendra K Arora
- National Certification Committee for Polio Eradication, New Delhi, India.
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Dixit S, Arora NK, Rahman A, Howard NJ, Singh RK, Vaswani M, Das MK, Ahmed F, Mathur P, Tandon N, Dasgupta R, Chaturvedi S, Jethwaney J, Dalpath S, Prashad R, Kumar R, Gupta R, Dube L, Daniel M. Establishing a Demographic, Development and Environmental Geospatial Surveillance Platform in India: Planning and Implementation. JMIR Public Health Surveill 2018; 4:e66. [PMID: 30291101 PMCID: PMC6231830 DOI: 10.2196/publichealth.9749] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/11/2018] [Accepted: 06/18/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Inadequate administrative health data, suboptimal public health infrastructure, rapid and unplanned urbanization, environmental degradation, and poor penetration of information technology make the tracking of health and well-being of populations and their social determinants in the developing countries challenging. Technology-integrated comprehensive surveillance platforms have the potential to overcome these gaps. OBJECTIVE This paper provides methodological insights into establishing a geographic information system (GIS)-integrated, comprehensive surveillance platform in rural North India, a resource-constrained setting. METHODS The International Clinical Epidemiology Network Trust International established a comprehensive SOMAARTH Demographic, Development, and Environmental Surveillance Site (DDESS) in rural Palwal, a district in Haryana, North India. The surveillance platform evolved by adopting four major steps: (1) site preparation, (2) data construction, (3) data quality assurance, and (4) data update and maintenance system. Arc GIS 10.3 and QGIS 2.14 software were employed for geospatial data construction. Surveillance data architecture was built upon the geospatial land parcel datasets. Dedicated software (SOMAARTH-1) was developed for handling high volume of longitudinal datasets. The built infrastructure data pertaining to land use, water bodies, roads, railways, community trails, landmarks, water, sanitation and food environment, weather and air quality, and demographic characteristics were constructed in a relational manner. RESULTS The comprehensive surveillance platform encompassed a population of 0.2 million individuals residing in 51 villages over a land mass of 251.7 sq km having 32,662 households and 19,260 nonresidential features (cattle shed, shops, health, education, banking, religious institutions, etc). All land parcels were assigned georeferenced location identification numbers to enable space and time monitoring. Subdivision of villages into sectors helped identify socially homogenous community clusters (418/676, 61.8%, sectors). Water and hygiene parameters of the whole area were mapped on the GIS platform and quantified. Risk of physical exposure to harmful environment (poor water and sanitation indicators) was significantly associated with the caste of individual household (P=.001), and the path was mediated through the socioeconomic status and density of waste spots (liquid and solid) of the sector in which these households were located. Ground-truthing for ascertaining the land parcel level accuracies, community involvement in mapping exercise, and identification of small habitations not recorded in the administrative data were key learnings. CONCLUSIONS The SOMAARTH DDESS experience allowed us to document and explore dynamic relationships, associations, and pathways across multiple levels of the system (ie, individual, household, neighborhood, and village) through a geospatial interface. This could be used for characterization and monitoring of a wide range of proximal and distal determinants of health.
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Affiliation(s)
- Shikha Dixit
- Research, SOMAARTH Demographic, Development and Environmental Surveillance Site, The INCLEN Trust International, New Delhi, India
| | - Narendra K Arora
- Research, Epidemiology, The INCLEN Trust International, New Delhi, India
| | - Atiqur Rahman
- Department of Geography, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi, India
| | - Natasha J Howard
- Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Rakesh K Singh
- Research, SOMAARTH Demographic, Development and Environmental Surveillance Site, The INCLEN Trust International, New Delhi, India
| | - Mayur Vaswani
- Research, SOMAARTH Demographic, Development and Environmental Surveillance Site, The INCLEN Trust International, New Delhi, India
| | - Manoja K Das
- Research, SOMAARTH Demographic, Development and Environmental Surveillance Site, The INCLEN Trust International, New Delhi, India
| | | | - Prashant Mathur
- National Cancer Registry Program, National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bangalore, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajib Dasgupta
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
| | - Sanjay Chaturvedi
- Department of Community Medicine, University College of Medical Sciences, University of Delhi, New Delhi, India
| | - Jaishri Jethwaney
- Department of Research, Indian Council for Social Science Research, New Delhi, India
| | | | - Rajendra Prashad
- Office of Chief Medical Officer, Department of Health, Palwal, India
| | - Rakesh Kumar
- Indian Council of Medical Research, New Delhi, India
| | | | - Laurette Dube
- McGill Center for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
| | - Mark Daniel
- Centre for Research and Action in Public Health, Health Research Institute, University of Canberra, Canberra, Australia.,Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, Australia
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16
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Arora NK, Nair MKC, Gulati S, Deshmukh V, Mohapatra A, Mishra D, Patel V, Pandey RM, Das BC, Divan G, Murthy GVS, Sharma TD, Sapra S, Aneja S, Juneja M, Reddy SK, Suman P, Mukherjee SB, Dasgupta R, Tudu P, Das MK, Bhutani VK, Durkin MS, Pinto-Martin J, Silberberg DH, Sagar R, Ahmed F, Babu N, Bavdekar S, Chandra V, Chaudhuri Z, Dada T, Dass R, Gourie-Devi M, Remadevi S, Gupta JC, Handa KK, Kalra V, Karande S, Konanki R, Kulkarni M, Kumar R, Maria A, Masoodi MA, Mehta M, Mohanty SK, Nair H, Natarajan P, Niswade AK, Prasad A, Rai SK, Russell PSS, Saxena R, Sharma S, Singh AK, Singh GB, Sumaraj L, Suresh S, Thakar A, Parthasarathy S, Vyas B, Panigrahi A, Saroch MK, Shukla R, Rao KVR, Silveira MP, Singh S, Vajaratkar V. Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India. PLoS Med 2018; 15:e1002615. [PMID: 30040859 PMCID: PMC6057634 DOI: 10.1371/journal.pmed.1002615] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/15/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. METHODS AND FINDINGS We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population. CONCLUSIONS The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions.
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Affiliation(s)
| | - M. K. C. Nair
- Kerala University of Health Sciences, Medical College PO, Thrissur, Kerala, India
| | - Sheffali Gulati
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Devendra Mishra
- Department of Paediatrics, Maulana Azad Medical College, New Delhi, India
| | - Vikram Patel
- Sangath, Bardez, Goa, India
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ravindra M. Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Bhagabati C. Das
- Department of Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | | | - G. V. S. Murthy
- Indian Institute of Public Health, Hyderabad, Telangana, India
| | - Thakur D. Sharma
- Himachal Foundation, Dharamshala, Kangra, Himachal Pradesh, India
| | - Savita Sapra
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Satinder Aneja
- Department of Paediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Monica Juneja
- Department of Paediatrics, Maulana Azad Medical College, New Delhi, India
| | - Sunanda K. Reddy
- Centre for Applied Research and Education on Neurodevelopmental Impairments and Disability related Health Initiatives (CARENIDHI), New Delhi, India
| | - Praveen Suman
- Department of Paediatrics, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Rajib Dasgupta
- Department of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
| | - Poma Tudu
- The INCLEN Trust International, New Delhi, India
| | | | - Vinod K. Bhutani
- Department of Paediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, California, United States of America
| | - Maureen S. Durkin
- Department of Population Health Sciences and Paediatrics, and Waisman Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Jennifer Pinto-Martin
- University of Pennsylvania School of Nursing and School of Medicine, Philadelphia, United States of America
| | - Donald H. Silberberg
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Science, New Delhi, India
| | - Faruqueuddin Ahmed
- Integral Institute of Medical Sciences & Research, Integral University, Lucknow, Uttar Pradesh, India
| | - Nandita Babu
- Department of Psychology, Delhi University, New Delhi, India
| | - Sandeep Bavdekar
- Department of Paediatrics, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Vijay Chandra
- Department of Neurology, Paras Hospital, Gurugram, Haryana, India
| | - Zia Chaudhuri
- Department of Ophthalmology, Lady Hardinge Medical College, New Delhi, India
| | - Tanuj Dada
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rashna Dass
- Department of Paediatric Disciplines, Health City Hospital, Guwahati, Assam, India
| | - M. Gourie-Devi
- Department of Neurology, Institute of Human Behaviour and Allied Sciences & Department of Neurophysiology, Sir Ganga Ram Hospital, New Delhi, India
| | - S. Remadevi
- School of Health Policy and Planning, Kerala University of Health Sciences, Thiruvananthapuram, Kerala, India
| | - Jagdish C. Gupta
- Ali Yavar Jung National Institute of Speech and Hearing Disabilities, Department of Empowerment of Persons with Disabilities, Kasturba Niketan, New Delhi, India
| | - Kumud K. Handa
- Department of ENT & Head Neck Surgery, Medanta Medicity, Gurugram, Haryana, India
| | - Veena Kalra
- Department of Paediatrics, Indraprastha Apollo Hospital, New Delhi, India
| | - Sunil Karande
- Department of Paediatrics, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Ramesh Konanki
- Department of Paediatric Neurology, Rainbow Children’s Hospital, Hyderabad, Telengana, India
| | - Madhuri Kulkarni
- Department of Paediatrics, Mumbai Port Trust Hospital, Mumbai, Maharashtra, India
| | - Rashmi Kumar
- Department of Paediatrics, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Arti Maria
- Department of Neonatology, Post Graduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, Delhi, India
| | - Muneer A. Masoodi
- Department of Community Medicine, Government Medical College, Srinagar, Kashmir, India
| | - Manju Mehta
- Department of Psychiatry, All India Institute of Medical Science, New Delhi, India
| | - Santosh Kumar Mohanty
- National Trust, Department of Empowerment of Persons with Disabilities, Ministry of Social Justice & Empowerment, Government of India, Delhi, India
| | - Harikumaran Nair
- Kerala University of Health Sciences, Medical College PO, Thrissur, Kerala, India
| | - Poonam Natarajan
- Vidya Sagar (formerly The Spastics Society of India), Chennai, Tamil Nadu, India
| | - A. K. Niswade
- Department of Paediatrics, Government Medical College, Nagpur, Maharashtra, India
| | - Atul Prasad
- Social Welfare Department, Government of Bihar, Patna, India
| | - Sanjay K. Rai
- Department of Community Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Paul S. S. Russell
- Department of Child & Adolescent Psychiatry and Facility for Children with Intellectual Disability, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rohit Saxena
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shobha Sharma
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Arun K. Singh
- Rashtriya Bal Swasthya Karyakram, Ministry of Health and Family Welfare, Nirman Bhawan, New Delhi, India
| | - Gautam B. Singh
- Department of Otorhinolaryngology and Head and Neck Surgery (ENT), Lady Hardinge Medical College, New Delhi, India
| | - Leena Sumaraj
- Child Development Centre, Medical College Campus, Thiruvananthapuram, Kerala, India
| | | | - Alok Thakar
- Department of Otolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sujatha Parthasarathy
- Department of Pediatric Neurology, The Hospital for Sick Children (SickKids), The Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Bhadresh Vyas
- Department of Paediatrics, M.P. Shah Government Medical College & G.G. Hospital, Jamnagar, Gujarat, India
| | - Ansuman Panigrahi
- Department of Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Munish K. Saroch
- Department of ENT, Dr. Rajender Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Rajan Shukla
- Indian Institute of Public Health, Hyderabad, Telangana, India
| | - K. V. Raghava Rao
- RVM Institute of Medical Sciences and Research Center, Laxmakkapally, Telangana, India
| | - Maria P. Silveira
- Department of Paediatrics, Goa Medical College, Bambolim, Goa, India
| | - Samiksha Singh
- Indian Institute of Public Health, Hyderabad, Telangana, India
| | - Vivek Vajaratkar
- Sangath, Bardez, Goa, India
- Department of Orthopedic Surgery, Goa Medical College, Bambolim, Goa, India
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Arora NK, Swaminathan S, Mohapatra A, Gopalan HS, Katoch VM, Bhan MK, Rasaily R, Shekhar C, Thavaraj V, Roy M, Das MK, Wazny K, Kumar R, Khera A, Bhatla N, Jain V, Laxmaiah A, Nair MKC, Paul VK, Ramachandran P, Ramji S, Vaidya U, Verma IC, Shah D, Bahl R, Qazi S, Rudan I, Black RE. Research priorities in Maternal, Newborn, & Child Health & Nutrition for India: An Indian Council of Medical Research-INCLEN Initiative. Indian J Med Res 2018; 145:611-622. [PMID: 28948951 PMCID: PMC5644295 DOI: 10.4103/ijmr.ijmr_139_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In India, research prioritization in Maternal, Newborn, and Child Health and Nutrition (MNCHN) themes has traditionally involved only a handful of experts mostly from major cities. The Indian Council of Medical Research (ICMR)-INCLEN collaboration undertook a nationwide exercise engaging faculty from 256 institutions to identify top research priorities in the MNCHN themes for 2016-2025. The Child Health and Nutrition Research Initiative method of priority setting was adapted. The context of the exercise was defined by a National Steering Group (NSG) and guided by four Thematic Research Subcommittees. Research ideas were pooled from 498 experts located in different parts of India, iteratively consolidated into research options, scored by 893 experts against five pre-defined criteria (answerability, relevance, equity, investment and innovation) and weighed by a larger reference group. Ranked lists of priorities were generated for each of the four themes at national and three subnational (regional) levels [Empowered Action Group & North-Eastern States, Southern and Western States, & Northern States (including West Bengal)]. Research priorities differed between regions and from overall national priorities. Delivery domain of research which included implementation research constituted about 70 per cent of the top ten research options under all four themes. The results were endorsed in the NSG meeting. There was unanimity that the research priorities should be considered by different governmental and non-governmental agencies for investment with prioritization on implementation research and issues cutting across themes.
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Affiliation(s)
- Narendra K Arora
- Executive Office, The INCLEN Trust International, New Delhi, India
| | | | | | - Hema S Gopalan
- Executive Office, The INCLEN Trust International, New Delhi, India
| | - Vishwa M Katoch
- Headquarters, Indian Council of Medical Research, New Delhi, India
| | - Maharaj K Bhan
- Centre for Health Research and Development (CHRD), Society for Applied Studies, New Delhi, India
| | - Reeta Rasaily
- Headquarters, Indian Council of Medical Research, New Delhi, India
| | - Chander Shekhar
- Headquarters, Indian Council of Medical Research, New Delhi, India
| | | | - Malabika Roy
- Headquarters, Indian Council of Medical Research, New Delhi, India
| | - Manoja K Das
- Executive Office, The INCLEN Trust International, New Delhi, India
| | - Kerri Wazny
- Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Rakesh Kumar
- Headquarters, Indian Council of Medical Research, New Delhi, India
| | - Ajay Khera
- Department of Health and Family Welfare, Ministry of Health and Family Welfare, Government of , New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vanita Jain
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Avula Laxmaiah
- Division of Community Studies, National Institute of Nutrition, Hyderabad, India
| | - M K C Nair
- Office of the Vice Chancellor, Kerala University of Health Sciences, Thrissur, India
| | - Vinod K Paul
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Siddharth Ramji
- Department of Neonatology, Maulana Azad Medical College, New Delhi, India
| | - Umesh Vaidya
- Department of Pediatrics, KEM Hospital, Pune, India
| | - I C Verma
- Editorial Office, Indian Journal of Pediatrics, New Delhi, India
| | - Dheeraj Shah
- Editorial Office, Indian Pediatrics, New Delhi, India
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Shamim Qazi
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Etchie TO, Etchie AT, Adewuyi GO, Pillarisetti A, Sivanesan S, Krishnamurthi K, Arora NK. The gains in life expectancy by ambient PM 2.5 pollution reductions in localities in Nigeria. Environ Pollut 2018; 236:146-157. [PMID: 29414335 DOI: 10.1016/j.envpol.2018.01.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 01/11/2018] [Accepted: 01/13/2018] [Indexed: 05/24/2023]
Abstract
Global burden of disease estimates reveal that people in Nigeria are living shorter lifespan than the regional or global average life expectancy. Ambient air pollution is a top risk factor responsible for the reduced longevity. But, the magnitude of the loss or the gains in longevity accruing from the pollution reductions, which are capable of driving mitigation interventions in Nigeria, remain unknown. Thus, we estimate the loss, and the gains in longevity resulting from ambient PM2.5 pollution reductions at the local sub-national level using life table approach. Surface average PM2.5 concentration datasets covering Nigeria with spatial resolution of ∼1 km were obtained from the global gridded concentration fields, and combined with ∼1 km gridded population of the world (GPWv4), and global administrative unit layers (GAUL) for territorial boundaries classification. We estimate the loss or gains in longevity using population-weighted average pollution level and baseline mortality data for cardiopulmonary disease and lung cancer in adults ≥25 years and for respiratory infection in children under 5. As at 2015, there are six "highly polluted", thirty "polluted" and one "moderately polluted" States in Nigeria. People residing in these States lose ∼3.8-4.0, 3.0-3.6 and 2.7 years of life expectancy, respectively, due to the pollution exposure. But, assuming interventions achieve global air quality guideline of 10 μg/m3, longevity would increase by 2.6-2.9, 1.9-2.5 and 1.6 years for people in the State-categories, respectively. The longevity gains are indeed high, but to achieve them, mitigation interventions should target emission sources having the highest population exposures.
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Affiliation(s)
- Tunde O Etchie
- Meteorology, Environment & Demographic Surveillance (MEDsurveillance) Ltd, Port Harcourt, Nigeria.
| | | | | | - Ajay Pillarisetti
- School of Public Health, University of California, Berkeley, CA, USA.
| | - Saravanadevi Sivanesan
- National Environmental Engineering Research Institute, Council of Scientific and Industrial Research (CSIR-NEERI), Nagpur, India.
| | - Kannan Krishnamurthi
- National Environmental Engineering Research Institute, Council of Scientific and Industrial Research (CSIR-NEERI), Nagpur, India.
| | - Narendra K Arora
- The International Clinical Epidemiology Network (INCLEN) Trust, New Delhi, India.
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Arora NK, Mohapatra A, Gopalan HS, Wazny K, Thavaraj V, Rasaily R, Das MK, Maheshwari M, Bahl R, Qazi SA, Black RE, Rudan I. Setting research priorities for maternal, newborn, child health and nutrition in India by engaging experts from 256 indigenous institutions contributing over 4000 research ideas: a CHNRI exercise by ICMR and INCLEN. J Glob Health 2018; 7:011003. [PMID: 28686749 PMCID: PMC5481897 DOI: 10.7189/jogh.07.011003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Health research in low– and middle– income countries (LMICs) is often driven by donor priorities rather than by the needs of the countries where the research takes place. This lack of alignment of donor’s priorities with local research need may be one of the reasons why countries fail to achieve set goals for population health and nutrition. India has a high burden of morbidity and mortality in women, children and infants. In order to look forward toward the Sustainable Development Goals, the Indian Council of Medical Research (ICMR) and the INCLEN Trust International (INCLEN) employed the Child Health and Nutrition Research Initiative’s (CHNRI) research priority setting method for maternal, neonatal, child health and nutrition with the timeline of 2016–2025. The exercise was the largest to–date use of the CHNRI methodology, both in terms of participants and ideas generated and also expanded on the methodology. Methods CHNRI is a crowdsourcing–based exercise that involves using the collective intelligence of a group of stakeholders, usually researchers, to generate and score research options against a set of criteria. This paper reports on a large umbrella CHNRI that was divided into four theme–specific CHNRIs (maternal, newborn, child health and nutrition). A National Steering Group oversaw the exercise and four theme–specific Research Sub–Committees technically supported finalizing the scoring criteria and refinement of research ideas for the respective thematic areas. The exercise engaged participants from 256 institutions across India – 4003 research ideas were generated from 498 experts which were consolidated into 373 research options (maternal health: 122; newborn health: 56; child health: 101; nutrition: 94); 893 experts scored these against five criteria (answerability, relevance, equity, innovation and out–of–box thinking, investment on research). Relative weights to the criteria were assigned by 79 members from the Larger Reference Group. Given India’s diversity, priorities were identified at national and three regional levels: (i) the Empowered Action Group (EAG) and North–Eastern States; (ii) States and Union territories in Northern India (including West Bengal); and (iii) States and Union territories in Southern and Western parts of India. Conclusions The exercise leveraged the inherent flexibility of the CHNRI method in multiple ways. It expanded on the CHNRI methodology enabling analyses for identification of research priorities at national and regional levels. However, prioritization of research options are only valuable if they are put to use, and we hope that donors will take advantage of this prioritized list of research options.
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Affiliation(s)
| | | | | | - Kerri Wazny
- Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | | | - Reeta Rasaily
- The Indian Council of Medical Research, New Delhi, India
| | - Manoj K Das
- The INCLEN Trust International, New Delhi, India
| | | | - Rajiv Bahl
- World Health Organization, Geneva, Switzerland
| | | | - Robert E Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
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Gulati S, Patel H, Chakrabarty B, Dubey R, Arora NK, Pandey RM, Paul VK, Ramesh K, Anand V, Meena A. Development of All India Institute of Medical Sciences-Modified International Clinical Epidemiology Network Diagnostic Instrument for Neuromotor Impairments in Children Aged 1 Month to 18 Years. Front Public Health 2017; 5:313. [PMID: 29209604 PMCID: PMC5702309 DOI: 10.3389/fpubh.2017.00313] [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] [Received: 07/28/2017] [Accepted: 11/06/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction There is shortage of specialists for the diagnosis of children with neuromotor impairments (NMIs), especially in resource limited settings. Existing International Clinical Epidemiology Network (INCLEN) instrument for diagnosing NMI have been validated for children aged 2–9 years. The current study modified the same including wider symptomatology and age group (1 month to 18 years). Methods The Modified INCLEN diagnostic tool (INDT) was developed by a team of experts by modifying the existing tool to widen the age range (1 month to 18 years) and include broader symptomatology (inclusion of milestones from the first 2 years of life and better elucidation of cerebellar and extrapyramidal features) in a tertiary care teaching hospital of North India between January and April 2015. A trained medical graduate applied the candidate tool, which was followed by gold standard evaluation by a Pediatric Neurologist (both blinded to each other). Results A total of 197 children (102 with NMI and 95 without NMI) were enrolled for the study. The sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratio of the modified NMI tool were 90.4% (82.6–95.5), 95.5% (88.7–98.7), 95.5% (88.9–98.7), 90.3% (82.4–95.5), 19.9 (12.1–32.6), and 0.13 (0.08–0.12), respectively. Conclusion The All India Institute of Medical Sciences modified INDT NMI tool is a simple and structured instrument covering a wider symptomatology in the 1 month to 18 years age group with acceptable diagnostic accuracy.
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Affiliation(s)
- Sheffali Gulati
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Harsh Patel
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Biswaroop Chakrabarty
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rachana Dubey
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod K Paul
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Vyshakh Anand
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Meena
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Etchie TO, Sivanesan S, Adewuyi GO, Krishnamurthi K, Rao PS, Etchie AT, Pillarisetti A, Arora NK, Smith KR. The health burden and economic costs averted by ambient PM 2.5 pollution reductions in Nagpur, India. Environ Int 2017; 102:145-156. [PMID: 28291535 DOI: 10.1016/j.envint.2017.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/01/2017] [Accepted: 02/16/2017] [Indexed: 05/13/2023]
Abstract
National estimates of the health and economic burdens of exposure to ambient fine particulate matter (PM2.5) in India reveal substantial impacts. This information, often lacking at the local level, can justify and drive mitigation interventions. Here, we assess the health and economic gains resulting from attainment of WHO guidelines for PM2.5 concentrations - including interim target 2 (IT-2), interim target 3 (IT-3), and the WHO air quality guideline (AQG) - in Nagpur district to inform policy decision making for mitigation. We conducted a detailed assessment of concentrations of PM2.5 in 9 areas, covering urban, peri-urban and rural environments, from February 2013 to June 2014. We used a combination of hazard and survival analyses based on the life table method to calculate attributed annual number of premature deaths and disability-adjusted life years (DALYs) for five health outcomes linked to PM2.5 exposure: acute lower respiratory infection for children <5years, ischemic heart disease, chronic obstructive pulmonary disease, stroke and lung cancer in adults ≥25years. We used GBD 2013 data on deaths and DALYs for these diseases. We calculated averted deaths, DALYs and economic loss resulting from planned reductions in average PM2.5 concentration from current level to IT-2, IT-3 and AQG by the years 2023, 2033 and 2043, respectively. The economic cost for premature mortality was estimated as the product of attributed deaths and value of statistical life for India, while morbidity was assumed to be 10% of the mortality cost. The annual average PM2.5 concentration in Nagpur district is 34±17μgm-3 and results in 3.3 (95% confidence interval [CI]: 2.6, 4.2) thousand premature deaths and 91 (95% CI: 68, 116) thousand DALYs in 2013 with economic loss of USD 2.2 (95% CI: 1.7, 2.8) billion in that year. It is estimated that interventions that achieve IT-2, IT-3 and AQG by 2023, 2033 and 2043, would avert, respectively, 15, 30 and 36%, of the attributed health and economic loss in those years, translating into an impressively large health and economic gain. To achieve this, we recommend an exposure-integrated source reduction approach.
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Affiliation(s)
- Tunde O Etchie
- The International Clinical Epidemiology Network (INCLEN) Trust, New Delhi, India
| | - Saravanadevi Sivanesan
- National Environmental Engineering Research Institute, Council of Scientific and Industrial Research (CSIR-NEERI), Nagpur, India.
| | | | - Kannan Krishnamurthi
- National Environmental Engineering Research Institute, Council of Scientific and Industrial Research (CSIR-NEERI), Nagpur, India.
| | - Padma S Rao
- National Environmental Engineering Research Institute, Council of Scientific and Industrial Research (CSIR-NEERI), Nagpur, India.
| | | | - Ajay Pillarisetti
- School of Public Health, University of California, Berkeley, California, USA
| | - Narendra K Arora
- The International Clinical Epidemiology Network (INCLEN) Trust, New Delhi, India.
| | - Kirk R Smith
- School of Public Health, University of California, Berkeley, California, USA.
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Balakrishnan K, Sambandam S, Ghosh S, Mukhopadhyay K, Vaswani M, Arora NK, Jack D, Pillariseti A, Bates MN, Smith KR. Household Air Pollution Exposures of Pregnant Women Receiving Advanced Combustion Cookstoves in India: Implications for Intervention. Ann Glob Health 2016; 81:375-85. [PMID: 26615072 PMCID: PMC4758192 DOI: 10.1016/j.aogh.2015.08.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Household air pollution (HAP) resulting from the use of solid cooking fuels is a leading contributor to the burden of disease in India. Advanced combustion cookstoves that reduce emissions from biomass fuels have been considered potential interventions to reduce this burden. Relatively little effort has been directed, however, to assessing the concentration and exposure changes associated with the introduction of such devices in households. OBJECTIVES The aim of this study was to describe HAP exposure patterns in pregnant women receiving a forced-draft advanced combustion cookstove (Philips model HD 4012) in the SOMAARTH Demographic Development & Environmental Surveillance Site (DDESS) Palwal District, Haryana, India. The monitoring was performed as part of a feasibility study to inform a potential large-scale HAP intervention (Newborn Stove trial) directed at pregnant women and newborns. METHODS This was a paired comparison exercise study with measurements of 24-hour personal exposures and kitchen area concentrations of carbon monoxide (CO) and particulate matter less than 2.5 μm in aerodynamic diameter (PM2.5), before and after the cookstove intervention. Women (N = 65) were recruited from 4 villages of SOMAARTH DDESS. Measurements were performed between December 2011 and March 2013. Ambient measurements of PM2.5 were also performed throughout the study period. FINDINGS Measurements showed modest improvements in 24-hour average concentrations and exposures for PM2.5 and CO (ranging from 16% to 57%) with the use of the new stoves. Only those for CO showed statistically significant reductions. CONCLUSION Results from the present study did not support the widespread use of this type of stove in this population as a means to reliably provide health-relevant reductions in HAP exposures for pregnant women compared with open biomass cookstoves. The feasibility assessment identified multiple factors related to user requirements and scale of adoption within communities that affect the field efficacy of advanced combustion cookstoves as well as their potential performance in HAP intervention studies.
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Affiliation(s)
- Kalpana Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra University, Porur, Chennai, India.
| | - Sankar Sambandam
- Department of Environmental Health Engineering, Sri Ramachandra University, Porur, Chennai, India
| | - Santu Ghosh
- Department of Environmental Health Engineering, Sri Ramachandra University, Porur, Chennai, India
| | - Krishnendu Mukhopadhyay
- Department of Environmental Health Engineering, Sri Ramachandra University, Porur, Chennai, India
| | - Mayur Vaswani
- The INCLEN Trust International, Okhla Industrial Area, Phase-I, New Delhi, India
| | - Narendra K Arora
- The INCLEN Trust International, Okhla Industrial Area, Phase-I, New Delhi, India
| | - Darby Jack
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Ajay Pillariseti
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA
| | - Michael N Bates
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA
| | - Kirk R Smith
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA
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Chaturvedi S, Ramji S, Arora NK, Rewal S, Dasgupta R, Deshmukh V. Time-constrained mother and expanding market: emerging model of under-nutrition in India. BMC Public Health 2016; 16:632. [PMID: 27456223 PMCID: PMC4960674 DOI: 10.1186/s12889-016-3189-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 05/30/2015] [Accepted: 06/18/2016] [Indexed: 11/10/2022] Open
Abstract
Background Persistent high levels of under-nutrition in India despite economic growth continue to challenge political leadership and policy makers at the highest level. The present inductive enquiry was conducted to map the perceptions of mothers and other key stakeholders, to identify emerging drivers of childhood under-nutrition. Methods We conducted a multi-centric qualitative investigation in six empowered action group states of India. The study sample included 509 in-depth interviews with mothers of undernourished and normal nourished children, policy makers, district level managers, implementer and facilitators. Sixty six focus group discussions and 72 non-formal interactions were conducted in two rounds with primary caretakers of undernourished children, Anganwadi Workers and Auxiliary Nurse Midwives. Results Based on the perceptions of the mothers and other key stakeholders, a model evolved inductively showing core themes as drivers of under-nutrition. The most forceful emerging themes were: multitasking, time constrained mother with dwindling family support; fragile food security or seasonal food paucity; child targeted market with wide availability and consumption of ready-to-eat market food items; rising non-food expenditure, in the context of rising food prices; inadequate and inappropriate feeding; delayed recognition of under-nutrition and delayed care seeking; and inadequate responsiveness of health care system and Integrated Child Development Services (ICDS). The study emphasized that the persistence of child malnutrition in India is also tied closely to the high workload and consequent time constraint of mothers who are increasingly pursuing income generating activities and enrolled in paid labour force, without robust institutional support for childcare. Conclusion The emerging framework needs to be further tested through mixed and multiple method research approaches to quantify the contribution of time limitation of the mother on the current burden of child under-nutrition. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3189-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Chaturvedi
- Department of Community Medicine, University College of Medical Sciences, Delhi, India
| | - S Ramji
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - N K Arora
- The INCLEN Trust International, F-1/5, Second Floor, Okhla Industrial Area, Phase-I, New Delhi, India.
| | - S Rewal
- Child Nutrition, New Delhi, India
| | - R Dasgupta
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
| | - V Deshmukh
- The INCLEN Trust International, F-1/5, Second Floor, Okhla Industrial Area, Phase-I, New Delhi, India
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Deshmukh V, Lahariya C, Krishnamurthy S, Das MK, Pandey RM, Arora NK. Taken to Health Care Provider or Not, Under-Five Children Die of Preventable Causes: Findings from Cross-Sectional Survey and Social Autopsy in Rural India. Indian J Community Med 2016; 41:108-19. [PMID: 27051085 PMCID: PMC4799633 DOI: 10.4103/0970-0218.177527] [Citation(s) in RCA: 14] [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] [Indexed: 12/03/2022] Open
Abstract
Background: Under-five children in India continue to die from causes that can either be treated or prevented. The data regarding causes of death, community care-seeking practices, and events prior to death are needed to guide and refine health policies for achieving national goals and targets. Materials and Methods: A cross-sectional survey covering rural areas of 16 districts from eight states across India was conducted to understand the causes of deaths and the health-seeking patterns of caregivers prior to the death of such children. Mothers of the deceased children were interviewed. The physician review process was used to assign cause of death. The qualitative data were analyzed as per standard methods, while STATA version 10 was used for analysis of quantitative data. Findings: A total of 1,488 death histories were captured through verbal autopsy. Neonatal etiologies, acute respiratory infection (ARI), and diarrhea accounted for approximately 63.1% of all deaths in the under-five age group. The causes of death in neonates showed that birth asphyxia, prematurity, and neonatal infections contributed to more than 67.5% of all neonatal deaths, while in children aged 29 days to 59 months, ARI and diarrhea accounted for 54.3% of deaths. Care providers of 52.6% of the neonates and 21.7% of infants and under-five children did not seek any medical care before the death of the child. Substantial delays in seeking care occurred at home and during transit. For those who received medical care, there was an apparent amongst in their caregivers toward private health providers. Conclusion: The deaths of neonates and postneonates taken to any health facilities highlight the need for providing equitable and high-quality health services in India. The findings could be used for policy planning and program refinement in India.
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Affiliation(s)
| | - Chandrakant Lahariya
- Formerly, The INCLEN Trust International, New Delhi, India; Formerly, Department of Community Medicine, GR Medical College, Gwalior, India
| | - Sriram Krishnamurthy
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Manoj K Das
- The INCLEN Trust International, New Delhi, India
| | - Ravindra M Pandey
- Department of Biostatistics, All India Institutes of Medical Sciences, New Delhi, India
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Pillai R, Dasgupta R, Mathur P, Arora NK. Can Competitive Advantages of Markets be Leveraged for Addressing Childhood Obesity in India?? Indian J Community Med 2015; 40:145-8. [PMID: 26170535 PMCID: PMC4478652 DOI: 10.4103/0970-0218.158839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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26
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Juneja M, Mishra D, Russell PSS, Gulati S, Deshmukh V, Tudu P, Sagar R, Silberberg D, Bhutani VK, Pinto JM, Durkin M, Pandey RM, Nair MKC, Arora NK. INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD): development and validation. Indian Pediatr 2015; 51:359-65. [PMID: 24953575 DOI: 10.1007/s13312-014-0417-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To develop and validate INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD). DESIGN Diagnostic test evaluation by cross sectional design. SETTING Four tertiary pediatric neurology centers in Delhi and Thiruvanthapuram, India. METHODS Children aged 2-9 years were enrolled in the study. INDT-ASD and Childhood Autism Rating Scale (CARS) were administered in a randomly decided sequence by trained psychologist, followed by an expert evaluation by DSM-IV TR diagnostic criteria (gold standard). MAIN OUTCOME MEASURES Psychometric parameters of diagnostic accuracy, validity (construct, criterion and convergent) and internal consistency. RESULTS 154 children (110 boys, mean age 64.2 mo) were enrolled. The overall diagnostic accuracy (AUC=0.97, 95% CI 0.93, 0.99; P<0.001) and validity (sensitivity 98%, specificity 95%, positive predictive value 91%, negative predictive value 99%) of INDT-ASD for Autism spectrum disorder were high, taking expert diagnosis using DSM-IV-TR as gold standard. The concordance rate between the INDT-ASD and expert diagnosis for 'ASD group' was 82.52% [Cohen's k=0.89; 95% CI (0.82, 0.97); P=0.001]. The internal consistency of INDT-ASD was 0.96. The convergent validity with CARS (r = 0.73, P= 0.001) and divergent validity with Binet-Kamat Test of intelligence (r = -0.37; P=0.004) were significantly high. INDT-ASD has a 4-factor structure explaining 85.3% of the variance. CONCLUSIONS INDT-ASD has high diagnostic accuracy, adequate content validity, good internal consistency high criterion validity and high to moderate convergent validity and 4-factor construct validity for diagnosis of Autistm spectrum disorder.
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Affiliation(s)
- Monica Juneja
- INCLEN Trust International, New Delhi, India. Correspondence to: Dr Narendra K Arora, Executive Director, The INCLEN TRUST International, F1/5, Okhla Industrial Area, Phase-1, New Delhi, India.
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Dasgupta R, Pillai R, Kumar R, Arora NK. Sugar, salt, fat, and chronic disease epidemic in India: is there need for policy interventions? Indian J Community Med 2015; 40:71-4. [PMID: 25861165 PMCID: PMC4389505 DOI: 10.4103/0970-0218.153858] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rajib Dasgupta
- CSMCH (Centre for Social Medicine and Community Health), Jawaharlal Nehru University, New Delhi, India
| | - Rakesh Pillai
- IIGH (INCLEN Institute for Global Health), The INCLEN Trust International, New Delhi, India. E-mail:
| | - Rakesh Kumar
- Department of Reproductive and Child Health (RCH), MoHFW (Ministry of Health and Family Welfare), Government of India, New Delhi, India
| | - Narendra K Arora
- IIGH (INCLEN Institute for Global Health), The INCLEN Trust International, New Delhi, India. E-mail:
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28
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Dubé L, Webb P, Arora NK, Pingali P. Agriculture, health, and wealth convergence: bridging traditional food systems and modern agribusiness solutions. Ann N Y Acad Sci 2015; 1331:1-14. [PMID: 25514864 DOI: 10.1111/nyas.12602] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The causes of many vexing challenges facing 21st-century society are at the nexus of systems involved in agriculture, health and wealth production, consumption, and distribution. Using food as a test bed, and on the basis of emerging roadmaps that set achievable objectives over a 1- to 3-year horizon, we introduce this special feature with convergence thinking and practice at its core. Specifically, we discuss academic papers structured around four themes: (1) evidence for a need for convergence and underlying mechanisms at the individual and societal levels; (2) strategy for mainstreaming convergence as a driver of business engagement and innovation; (3) convergence in policy and governance; (4) convergence in metrics and methods. Academic papers under each theme are accompanied by a roadmap paper reporting on the current status of concrete transformative convergence-building projects associated with that theme. We believe that the insights provided by these papers have the potential to enable all actors throughout society to singly and collectively work to build supply and demand for nutritious food, in both traditional and modern food systems, while placing the burdens of malnutrition and ill health on their core strategic agendas.
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Affiliation(s)
- Laurette Dubé
- Desautels Faculty of Management.,McGill Centre for the Convergence of Health and Economics (MMCHE), McGill University, Montréal, Québec, Canada
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Narendra K Arora
- Clinical Epidemiology, The INCLEN Trust International, New Delhi, India
| | - Prabhu Pingali
- Charles H. Dyson School of Applied Economics and Management, Cornell University, Ithaca, New York
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Pillarisetti A, Vaswani M, Jack D, Balakrishnan K, Bates MN, Arora NK, Smith KR. Patterns of stove usage after introduction of an advanced cookstove: the long-term application of household sensors. Environ Sci Technol 2014; 48:14525-33. [PMID: 25390366 PMCID: PMC4270394 DOI: 10.1021/es504624c] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 05/21/2023]
Abstract
Household air pollution generated from solid fuel use for cooking is one of the leading risk factors for ill-health globally. Deployment of advanced cookstoves to reduce emissions has been a major focus of intervention efforts. However, household usage of these stoves and resulting changes in usage of traditional polluting stoves is not well characterized. In Palwal District, Haryana, India, we carried out an intervention utilizing the Philips HD4012 fan-assisted stove, one of the cleanest biomass stoves available. We placed small, unobtrusive data-logging iButton thermometers on both the traditional and Philips stoves to collect continuous data on use patterns in 200 homes over 60 weeks. Intervention stove usage declined steadily over time and stabilized after approximately 200 days; use of the traditional stove remained relatively constant. We additionally evaluated how well short-duration usage measures predicted long-term use. Measuring usage over time of both traditional and intervention stoves provides better understanding of cooking behaviors and can lead to more precise quantification of potential exposure reductions and consequent health benefits attributable to interventions.
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Affiliation(s)
- Ajay Pillarisetti
- Division
of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California 94720, United States
- Phone: +1 (318) 229 9909; e-mail:
| | - Mayur Vaswani
- The
INCLEN Trust International, Okhla Industrial Area, Phase-I, New Delhi-110020, India
| | - Darby Jack
- Department
of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York 10032, United States
| | - Kalpana Balakrishnan
- Department
of Environmental Health Engineering, Sri
Ramachandra University, Chennai-600116, India
| | - Michael N. Bates
- Division
of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California 94720, United States
| | - Narendra K. Arora
- The
INCLEN Trust International, Okhla Industrial Area, Phase-I, New Delhi-110020, India
| | - Kirk R. Smith
- Division
of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California 94720, United States
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Shepard DS, Halasa YA, Tyagi BK, Adhish SV, Nandan D, Karthiga KS, Chellaswamy V, Gaba M, Arora NK. Economic and disease burden of dengue illness in India. Am J Trop Med Hyg 2014; 91:1235-1242. [PMID: 25294616 PMCID: PMC4257651 DOI: 10.4269/ajtmh.14-0002] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 08/18/2014] [Indexed: 01/10/2023] Open
Abstract
Between 2006 and 2012 India reported an annual average of 20,474 dengue cases. Although dengue has been notifiable since 1996, regional comparisons suggest that reported numbers substantially underrepresent the full impact of the disease. Adjustment for underreporting from a case study in Madurai district and an expert Delphi panel yielded an annual average of 5,778,406 clinically diagnosed dengue cases between 2006 and 2012, or 282 times the reported number per year. The total direct annual medical cost was US$548 million. Ambulatory settings treated 67% of cases representing 18% of costs, whereas 33% of cases were hospitalized, comprising 82% of costs. Eighty percent of expenditures went to private facilities. Including non-medical and indirect costs based on other dengue-endemic countries raises the economic cost to $1.11 billion, or $0.88 per capita. The economic and disease burden of dengue in India is substantially more than captured by officially reported cases, and increased control measures merit serious consideration.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Narendra K. Arora
- Brandeis University, Waltham, Massachusetts; Centre for Research in Medical Entomology, Madurai, India; National Institute of Health and Family Welfare, New Delhi, India; INCLEN Trust International, New Delhi, India
| | - the INCLEN Study Group
- Brandeis University, Waltham, Massachusetts; Centre for Research in Medical Entomology, Madurai, India; National Institute of Health and Family Welfare, New Delhi, India; INCLEN Trust International, New Delhi, India
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Arora NK, Pillai R, Dasgupta R, Garg PR. Whole-of-society monitoring framework for sugar, salt, and fat consumption and noncommunicable diseases in India. Ann N Y Acad Sci 2014; 1331:157-173. [PMID: 25335459 DOI: 10.1111/nyas.12555] [Citation(s) in RCA: 18] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
India has experienced a rising prevalence of cardiometabolic risk factors in the past 15 years: the prevalence of diabetes has increased from 5.9% to 9.1%, hypertension from 17.2% to 29.2%, and obesity from 4% to 15%. The increase is among all socioeconomic groups and in urban and rural populations, though the quantum of change varies. A concomitant increase in per capita consumption of sugar from 22 to 55.3 g/day and total fat from 21.2 to 54 g/day was observed, with significant differences between states of high and low human development index (HDI). Per capita consumption of sugar, salt, and fat is consistently and significantly associated with overweight and obesity but variably associated with the occurrence of hypertension and diabetes. Market research shows that approximately 50-60% of total salt, sugar, and fat in Indian markets is procured by bulk purchasers, generally for manufacturing processed food items. This sector of the Indian economy is among the fastest growing, with several policy incentives. It is not clear from most of the data sets whether available information on per capita sugar, salt, and fat consumption has considered the contribution of processed and ready-to-eat food items. The unprecedented changes of rapid urbanization, mechanization, and globalization demand close monitoring of social, developmental, and economic determinants. This paper provides pieces of evidence to justify a whole-of-society (WoS) framework for monitoring the inputs, processes, and behavioral components of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS) in India.
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Affiliation(s)
- Narendra K Arora
- Clinical Epidemiology, The INCLEN Trust International, New Delhi, India
| | - Rakesh Pillai
- Clinical Epidemiology, The INCLEN Trust International, New Delhi, India
| | - Rajib Dasgupta
- Centre of Social Medicine & Community Health, Jawaharlal Nehru University, New Delhi, India
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Konanki R, Mishra D, Gulati S, Aneja S, Deshmukh V, Silberberg D, Pinto JM, Durkin M, Pandey RM, Nair MKC, Arora NK. INCLEN diagnostic tool for epilepsy (INDT-EPI) for primary care physicians: Development and validation. Indian Pediatr 2014; 51:539-43. [DOI: 10.1007/s13312-014-0443-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Champa WAH, Gill MIS, Mahajan BVC, Arora NK. Preharvest salicylic acid treatments to improve quality and postharvest life of table grapes (Vitis vinifera L.) cv. Flame Seedless. J Food Sci Technol 2014; 52:3607-16. [PMID: 26028743 DOI: 10.1007/s13197-014-1422-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 05/21/2014] [Accepted: 05/26/2014] [Indexed: 11/26/2022]
Abstract
Significance of preharvest salicylic acid (SA) treatments on maturity, quality and postharvest life of grape cv. Flame Seedless were studied during two years. The experiment was performed on 12-year old own rooted, grapevines planted at 3 m × 3 m spacing trained on overhead system. Vines were treated with aqueous solutions of SA (0.0, 1.0, 1.5 and 2.0 mM) at pea stage and at veraison. After harvesting, clusters were divided into two lots in which one was subjected to initial quality evaluation, while the other was stored in cold room (3-4 °C, 90-95 % RH) for evaluation of postharvest quality. SA at the dose of 1.5 and 2.0 mM hastened berry maturity by 3 to 5 days, produced less compact bunches alongside larger berries in contrast to control and the lowest dose. The same doses effectively maintained peel colour, higher firmness, lower pectin methyl esterase activity and electrolyte leakage alongside suppressing degradation of TSS and TA during cold storage. These two doses also exhibited higher efficacy on maintaining anthocyanins, phenols and organoleptic properties while reducing weight loss, rachis browning and decay incidence. Correlation analysis demonstrated that many quality parameters are interdependent. In conclusion, preharvest spray of 1.5 mM SA proved to be an effective means of improving quality and extending postharvest life of grape cv. Flame Seedless.
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Affiliation(s)
- W A Harindra Champa
- Department of Fruit Science, Punjab Agricultural University, Ludhiana, 141 004 Punjab India ; Research and Development Centre, Institute of Postharvest Technology, Jayanthi Mawatha, Anuradhapura, 50000 Sri Lanka
| | - M I S Gill
- Department of Fruit Science, Punjab Agricultural University, Ludhiana, 141 004 Punjab India
| | - B V C Mahajan
- Punjab Horticultural Post Harvest Technology Centre, Punjab Agricultural University, Ludhiana, Punjab, 141 004 India
| | - N K Arora
- Department of Fruit Science, Punjab Agricultural University, Ludhiana, 141 004 Punjab India
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Arora NK, Lal AA, Hombach JM, Santos JI, Bhutta ZA, Sow SO, Greenwood B. The need for targeted implementation research to improve coverage of basic vaccines and introduction of new vaccines. Vaccine 2014; 31 Suppl 2:B129-36. [PMID: 23598474 DOI: 10.1016/j.vaccine.2013.01.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 01/22/2013] [Accepted: 01/25/2013] [Indexed: 01/01/2023]
Abstract
The Decade of Vaccines Collaboration (DoVC) Research and Development (R&D) Working Group identified implementation research as an important step toward achieving high vaccine coverage and the uptake of desirable new vaccines. The R&D Working Group noted that implementation research is highly complex and requires participation of stakeholders from diverse backgrounds to ensure effective planning, execution, interpretation, and adoption of research outcomes. Unlike other scientific disciplines, implementation research is highly contextual and depends on social, cultural, geographic, and economic factors to make the findings useful for local, national, and regional applications. This paper presents the broad framework for implementation research in support of immunization and sets out a series of research questions developed through a Delphi process (during a DoVC-supported workshop in Sitges, Spain) and a literature review.
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Dhillon PK, Jeemon P, Arora NK, Mathur P, Maskey M, Sukirna RD, Prabhakaran D. Authors' response to: Mortality estimates for South East Asia, and INDEPTH mortality surveillance: necessary, but not sufficient. Int J Epidemiol 2013; 42:1200-1. [PMID: 24062303 DOI: 10.1093/ije/dyt031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Preet K Dhillon
- South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India, Centre for Chronic Disease Control, New Delhi, India, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK, Public Health Foundation of India, New Delhi, India, International Clinical Epidemiology Network, New Delhi, India, Division of Non-Communicable Diseases, Indian Council for Medical Research, New Delhi, India, Nepal Public Health Foundation, Kathmandu, Nepal, Department of Epidemiology, Faculty of Public Health, University of Indonesia, Depok, Indonesia and Centre for cArdiometabolic Risk Reduction Strategies (CARRS), Centre of Excellence (COE), New Delhi, India
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Bhatia V, Dhawan A, Arora NK, Mathur P, Das MK, Irshad M. Urinary potassium loss in children with acute liver failure and acute viral hepatitis. J Pediatr Gastroenterol Nutr 2013; 57:102-8. [PMID: 23471182 DOI: 10.1097/mpg.0b013e31828fc8ea] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aim of the present study was to determine urinary potassium (K⁺) loss (as measured by fractional excretion of K⁺ [FEK] and transtubular K⁺ gradient [TTKG]) in children with acute liver failure (ALF) and acute viral hepatitis (AVH) at the time of presentation to the hospital and day 45 of follow-up. METHODS Twenty-five patients with ALF and 84 patients with AVH were worked up for clinical features, liver function tests, and hepatitis viral infections and monitored for outcome. All of the patients with ALF were hospitalized. FEK and TTKG were estimated on the day patients were first seen in the hospital or hospitalized and later on day 45 of follow-up. RESULTS Sixty percent (15/25) of patients with ALF were hypokalemic (serum K⁺ <3.5 mEq/L) as compared with only 12% (10/84) in the AVH group (P = 0.000) at the time of presentation in the hospital. Inappropriate kaliuresis was present in 80% to 100% of hypokalemic children compared with 0% to 30% of normokalemic individuals at the time of first contact in either the ALF or AVH group. Inappropriate urinary K⁺ loss and serum K⁺ levels in the hypokalemic individuals improved as the hepatic functions recovered by day 45 of follow-up (P = 0.014-0.000). No significant change in kaliuresis was observed among normokalemic subjects between first contact and later on day 45 of follow-up (P = 0.991-0.228). Despite different physiologic mechanisms, appropriateness of kaliuresis measured by FEK and TTKG showed results in the same direction. CONCLUSIONS Hypokalemia and inappropriate kaliuresis observed during the acute phase of ALF and AVH reversed with clinical and biochemical recovery. In the absence of major gastrointestinal losses and renal abnormalities, there is need to investigate the contributory role of factors like hyperaldosteronism and food intake, which may have therapeutic implications.
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Affiliation(s)
- Vidyut Bhatia
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Kiranmala N, Das MK, Arora NK. Determinants of childhood obesity: need for a trans-sectoral convergent approach. Indian J Pediatr 2013; 80 Suppl 1:S38-47. [PMID: 23404696 DOI: 10.1007/s12098-013-0985-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 01/23/2013] [Indexed: 11/29/2022]
Abstract
The emerging burden of non communicable diseases is likely to erode the "Demographic-Dividend" of India and compromise the national growth and development. Increasing rates of childhood obesity globally and in India is a cause for serious public health concern. It is becoming increasingly apparent that obesity is result of complex interplay between multiple genes, environmental factors and human behavior. Clear comprehension of this interaction and pathway is still not clear, making the prevention and management of obesity especially challenging. Globalization and rapid economic growth has led to dramatic changes in the life style of the population including food intake, physical activity, market, environmental factors and social structures. A growing economy, urbanization and motorized transport have increased physical inactivity. A systematic multi-sectoral approach with population health as the center of discourse and attention is the only key to tackle this problem.
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Affiliation(s)
- Naorem Kiranmala
- The INCLEN Trust International & CHNRI, INCLEN Executive Office, F-1/5, 2nd Floor, Okhla Industrial Area, Phase1, New Delhi, 110020, India
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Epstein MB, Bates MN, Arora NK, Balakrishnan K, Jack DW, Smith KR. Household fuels, low birth weight, and neonatal death in India: the separate impacts of biomass, kerosene, and coal. Int J Hyg Environ Health 2013; 216:523-32. [PMID: 23347967 DOI: 10.1016/j.ijheh.2012.12.006] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
Abstract
We examined the impact of maternal use of different household cooking fuels in India on low birth weight (LBW<2500g), and neonatal mortality (death within 28 days of birth). Using cross-sectional data from India's National Family Health Survey (NFHS-3), we separately analyzed the prevalence of these two outcomes in households utilizing three types of high-pollution fuels for cooking - biomass, coal, and kerosene - using low-pollution fuels (gas and biogas) as the comparison "control" group. Taking socioeconomic and child-specific factors into account, we employed logistic regression to examine the impact of fuel use on fetal and infant health. The results indicate that household use of high-pollution fuels is significantly associated with increased odds of LBW and neonatal death. Compared to households using cleaner fuels (in which the mean birth weight is 2901g), the primary use of coal, kerosene, and biomass fuels is associated with significant decreases in mean birth weight (of -110g for coal, -107g for kerosene, and -78g for biomass). Kerosene and biomass fuel use are also associated with increased risk of LBW (p<0.05). Results suggest that increased risk of neonatal death is strongly associated with household use of coal (OR 18.54; 95% CI: 6.31-54.45), and perhaps with kerosene (OR 2.30; 95% CI: 0.95-5.55). Biomass is associated with increased risk of neonatal death among infants born to women with no more than primary education (OR 7.56; 95% CI: 2.40-23.80). These results are consistent with a growing literature showing health impacts of household air pollution from these fuels.
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Affiliation(s)
- M B Epstein
- School of Public Health, University of California, Berkeley, CA, USA
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Dhillon PK, Jeemon P, Arora NK, Mathur P, Maskey M, Sukirna RD, Prabhakaran D. Status of epidemiology in the WHO South-East Asia region: burden of disease, determinants of health and epidemiological research, workforce and training capacity. Int J Epidemiol 2012; 41:847-60. [PMID: 22617689 PMCID: PMC3396314 DOI: 10.1093/ije/dys046] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [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] [Accepted: 03/05/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The South-East Asia region (SEAR) accounts for one-quarter of the world's population, 40% of the global poor and ∼30% of the global disease burden, with a disproportionately large share of tuberculosis (35%), injuries (30%), maternal (33%) and <5-year-old mortality (30%). In this article, we describe the disease burden and status of epidemiological research and capacity in the SEAR to understand, analyse and develop capacity in response to the diverse burdens of diseases in the region. METHODS Data on morbidity, mortality, risk factors, social determinants, research capacity, health education, workforce and systems in the SEAR were obtained using global data on burden of disease, peer-reviewed journals, World Health Organization (WHO) technical and advisory reports, and where available, validated country reports and key informants from the region. RESULTS SEAR countries are afflicted with a triple burden of disease-infectious diseases, non-communicable diseases and injuries. Of the seven WHO regions, SEAR countries account for the highest proportion of global mortality (26%) and due to relatively younger ages at death, the second highest percentage of total years of life lost (30%). The SEAR exceeds the global average annual mortality rate for all three broad cause groupings-communicable, maternal, perinatal and nutritional conditions (334 vs 230 per 100 000); non-communicable diseases (676 vs 573 per 100 000); and injuries (101 vs 78 per 100 000). Poverty, education and other social determinants of health are strongly linked to inequities in health among SEAR countries and within socio-economic subgroups. India, Thailand and Bangladesh produce two-thirds of epidemiology publications in the region. Significant efforts to increase health workforce capacity, research and training have been undertaken in the region, yet considerable heterogeneity in resources and capacity remains. CONCLUSIONS Health systems, statistics and surveillance programmes must respond to the demographic, economic and epidemiological transitions that define the current disease burden and risk profile of SEAR populations. Inequities in health must be critically analysed, documented and addressed through multi-sectoral approaches. There is a critical need to improve public health intelligence by building epidemiological capacity in the region.
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Affiliation(s)
- Preet K Dhillon
- South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India, Centre for Chronic Disease Control, New Delhi, India, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK, Public Health Foundation of India, New Delhi, India, International Clinical Epidemiology Network, New Delhi, India, Division of Non-Communicable Diseases, Indian Council for Medical Research, New Delhi, India, Nepal Public Health Foundation, Kathmandu, Nepal, Department of Epidemiology, Faculty of Public Health, University of Indonesia, Depok, Indonesia and Centre for cArdiometabolic Risk Reduction Strategies (CARRS), Centre of Excellence (COE), New Delhi, India
| | - Panniyammakal Jeemon
- South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India, Centre for Chronic Disease Control, New Delhi, India, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK, Public Health Foundation of India, New Delhi, India, International Clinical Epidemiology Network, New Delhi, India, Division of Non-Communicable Diseases, Indian Council for Medical Research, New Delhi, India, Nepal Public Health Foundation, Kathmandu, Nepal, Department of Epidemiology, Faculty of Public Health, University of Indonesia, Depok, Indonesia and Centre for cArdiometabolic Risk Reduction Strategies (CARRS), Centre of Excellence (COE), New Delhi, India
| | - Narendra K Arora
- South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India, Centre for Chronic Disease Control, New Delhi, India, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK, Public Health Foundation of India, New Delhi, India, International Clinical Epidemiology Network, New Delhi, India, Division of Non-Communicable Diseases, Indian Council for Medical Research, New Delhi, India, Nepal Public Health Foundation, Kathmandu, Nepal, Department of Epidemiology, Faculty of Public Health, University of Indonesia, Depok, Indonesia and Centre for cArdiometabolic Risk Reduction Strategies (CARRS), Centre of Excellence (COE), New Delhi, India
| | - Prashant Mathur
- South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India, Centre for Chronic Disease Control, New Delhi, India, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK, Public Health Foundation of India, New Delhi, India, International Clinical Epidemiology Network, New Delhi, India, Division of Non-Communicable Diseases, Indian Council for Medical Research, New Delhi, India, Nepal Public Health Foundation, Kathmandu, Nepal, Department of Epidemiology, Faculty of Public Health, University of Indonesia, Depok, Indonesia and Centre for cArdiometabolic Risk Reduction Strategies (CARRS), Centre of Excellence (COE), New Delhi, India
| | - Mahesh Maskey
- South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India, Centre for Chronic Disease Control, New Delhi, India, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK, Public Health Foundation of India, New Delhi, India, International Clinical Epidemiology Network, New Delhi, India, Division of Non-Communicable Diseases, Indian Council for Medical Research, New Delhi, India, Nepal Public Health Foundation, Kathmandu, Nepal, Department of Epidemiology, Faculty of Public Health, University of Indonesia, Depok, Indonesia and Centre for cArdiometabolic Risk Reduction Strategies (CARRS), Centre of Excellence (COE), New Delhi, India
| | - Ratna Djuwita Sukirna
- South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India, Centre for Chronic Disease Control, New Delhi, India, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK, Public Health Foundation of India, New Delhi, India, International Clinical Epidemiology Network, New Delhi, India, Division of Non-Communicable Diseases, Indian Council for Medical Research, New Delhi, India, Nepal Public Health Foundation, Kathmandu, Nepal, Department of Epidemiology, Faculty of Public Health, University of Indonesia, Depok, Indonesia and Centre for cArdiometabolic Risk Reduction Strategies (CARRS), Centre of Excellence (COE), New Delhi, India
| | - Dorairaj Prabhakaran
- South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India, Centre for Chronic Disease Control, New Delhi, India, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK, Public Health Foundation of India, New Delhi, India, International Clinical Epidemiology Network, New Delhi, India, Division of Non-Communicable Diseases, Indian Council for Medical Research, New Delhi, India, Nepal Public Health Foundation, Kathmandu, Nepal, Department of Epidemiology, Faculty of Public Health, University of Indonesia, Depok, Indonesia and Centre for cArdiometabolic Risk Reduction Strategies (CARRS), Centre of Excellence (COE), New Delhi, India
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Lahariya C, Dhawan J, Pandey RM, Chaturvedi S, Deshmukh V, Dasgupta R, Suresh K, Ramji S, Adhish V, Goswami K, Rewal S, Choudhury P, Das MK, Arora NK. Interdistrict variations in child health status and health services utilization: lessons for health sector priority setting and planning from a cross-sectional survey in rural India. Natl Med J India 2012; 25:137-141. [PMID: 22963289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND There are limited data on interdistrict variations in child health status and health services utilization within the states of India. We conducted this study to identify and understand district-wise variations in child morbidity, mortality, healthcare seeking, and the status of health facilities in India. METHODS A cross-sectional population-based cluster survey was conducted from April to July 2007 in 16 districts of eight states in India. Two districts with similar demographic profile and health criteria were selected from each study state. RESULTS A total of 216 794 households and 24 812 under-5 children were surveyed. There were wide interdistrict variations in the health status of children within the same state and between different states across India. Interdistrict difference of >5 points/1000 live-births was found for infant mortality rate and under-5 mortality rate in all eight study states, while in six out of eight states this difference was >10 points/1000 live-births. Four states had a difference of >10 points/1000 live-births between respective districts for neonatal mortality rate. The interdistrict differences were also noted in childhood morbidity and health-seeking behaviour. Analysis of proportion of health facilities conforming to Indian public health standards revealed that the difference was m10% for availability of vaccines in five states, emergency services in three, laboratory services and logistics in four each, and referral facility in three of the eight study states. CONCLUSION This study underscores an important information gap in the country where planners seem to rely heavily on a few selected national-level databases that may not be adequate at the micro level. The current process of sporadic health surveys also appears inadequate and inappropriate. There is a need for district-specific data for planning, improving quality of service and generating demand for health service utilization to improve child survival in India. The findings of this study may prove useful for child health programme planning in India.
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Rai SK, Dasgupta R, Das MK, Singh S, Devi R, Arora NK. Determinants of utilization of services under MMJSSA scheme in Jharkhand 'Client Perspective': a qualitative study in a low performing state of India. Indian J Public Health 2012; 55:252-9. [PMID: 22298133 DOI: 10.4103/0019-557x.92400] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Preventing maternal death associated with pregnancy and child birth is one of the greatest challenges for India. Approximately 55,000 women die in India due to pregnancy- and childbirth- related conditions each year. Increasing the coverage of maternal and newborn interventions is essential if Millennium Development Goals (MDG) 4 and 5 are to be reached. With a view to accelerate the reduction in maternal and neonatal mortality through institutional deliveries, Government of India initiated a scheme in 2005 called Janani Suraksha Yojna (JSY) under its National Rural Health Mission (NRHM). In Jharkhand the scheme is called the Mukhya Mantri Janani Shishu Swasthya Abhiyan (MMJSSA). This paper focuses on community perspectives, for indentifying key areas that require improvement for proper implementation of the MMJSSA in Jharkhand. Qualitative research method was used to collect data through in-depth interviews (IDIs) and focus group discussions (FGDs) in six districts of Jharkhand- Gumla, West Singhbhum, Koderma, Deoghar, Garhwa, and Ranchi. Total 300 IDIs (24 IDIs each from mother given birth at home and institution respectively; two IDIs each with members of Village Health and Sanitation Committees (VHSC) / Rogi Kalyan Samitis (RKS) from each district) and 24 FGDs (four FGDs were conducted from pools of husbands, mothers-in-law and fathers-in-law in each district) were conducted. Although people indicated willingness for institutional deliveries (generally perceived to be safe deliveries), several barriers emerged as critical obstacles. These included poor infrastructure, lack of quality of care, difficulties while availing incentives, corruption in disbursement of incentives, behavior of the healthcare personnel and lack of information about MMJSSA. Poor (and expensive) transport facilities and difficult terrain made geographical access difficult. The level of utilization of maternal healthcare among women in Jharkhand is low. There was an overwhelming demand for energizing sub-centers (including for deliveries) in order to increase access to maternal and child health services. Having second ANMs will go a long way in achieving this end. The MMJSSA scheme will thus have to re-invent itself within the overall framework of the NRHM.
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Affiliation(s)
- Sanjay K Rai
- Center for Community Medicine, all Indiana Institute of Medical Science, New Delhi, India
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Hesse BW, Arora NK, Khoury MJ. Implications of Internet availability of genomic information for public health practice. Public Health Genomics 2012; 15:201-8. [PMID: 22488463 DOI: 10.1159/000335892] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Tensions in the field have emerged over how best to communicate to the public about genomic discoveries in an era of direct-to-consumer (DTC) DNA testing services available through the Internet. Concerns over what the psychological and behavioral response might be to a nuanced, multiplex risk message have spurred some to offer caution in communicating to the public about personalized risk until the necessary research has been completed on how to communicate effectively. The popularization of DTC testing services, along with a spreading Internet culture on transparency for personal data, may make 'waiting to communicate' a moot point. To steer communication efforts in the midst of increasing access to personal genomic information, a self-regulation framework is presented. The framework emphasizes the importance of presenting a coherent message in all communiqués about public health genomics. Coherence should be based on an evidence-based model of how the public processes information about health conditions and an emphasis on risk-to-action links. Recommendations from the President's Council of Advisors for Science and Technology are reviewed as a way of identifying targets of opportunity for structured communications both within the healthcare system and in the broader external ecosystem of publicly available health information technologies.
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Affiliation(s)
- B W Hesse
- National Cancer Institute, National Institutes of Health, 6130 Executive Boulevard, Bethesda, MD 20892-7365, USA.
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Ananthakrishnan N, Arora NK, Chandy G, Gitanjali B, Sood R, Supe A, Nagarajan S. Is there need for a transformational change to overcome the current problems with postgraduate medical education in India? Natl Med J India 2012; 25:101-108. [PMID: 22686720] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In spite of the existence of a dual system of postgraduation, one under the Medical Council of India (MCI) and the other on a parallel track under the National Board of Examinations, postgraduate medical education in India is beset with several problems. For example, the curriculum has not been revised comprehensively for several decades. The diploma course under the MCI has become unpopular and is largely a temporary refuge for those who do not get admission to degree courses. The level of skills of the outgoing graduate is falling and the increase in the number of seats is taking place in a haphazard manner, without reference to the needs. In spite of increase in seats, there is a shortage of specialists at the secondary and tertiary care levels, especially in medical colleges, to share teaching responsibilities. Further, the distribution of specialists is skewed, with some states having far more than others. To remedy these ills and fulfil the requirements of the country over the next two decades, a working group appointed by the erstwhile governors of the MCI was asked to suggest suitable modifications to the existing postgraduate system. After an extensive review of the lacunae in the present system, the needs at various levels and the pattern of postgraduate education in other countries, it was felt that a competency-based model of a 2-year postgraduate course across all specialties, the use of offsite facilities for training and a criterion-based evaluation system entailing continuous monitoring would go a long way to correct some of the deficiencies of the existing system. The details of the proposal and its merits are outlined for wider discussion and to serve as a feedback to the regulatory agencies engaged in the task of improving the medical education system in India. We feel that the adoption of the proposed system would go a long way in improving career options, increasing the availability of teachers and dissemination of specialists to the secondary and primary levels, and improving the quality of outgoing postgraduates.
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Affiliation(s)
- N Ananthakrishnan
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India.
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Abstract
BACKGROUND About 16 billion injections are administered each year worldwide, and at least half of them are unsafe. India contributes 25% to 30% of the global injection load. A majority of curative injections are unnecessary. The present study was undertaken to assess the burden of injections and prevalent injection practices in India. METHODS A nationwide population-based cluster survey (1200 clusters; 24 021 subjects) at household level; along with observations, interview of prescribers (2402), and exit interview of the patients (12 012) at health facility level in the selected clusters was carried out -using probability proportionate to size (PPS) technique. Observations at health facility included generic observation (3592), observation of injection process (17 844), and observation of prescriber-client interaction (24 030). RESULTS The frequency of injections was 2.9 (95%CI: 2.8-3.2) per person/year. Of the total injections, 62.9% (95%CI: 60.7-65.0) were unsafe. Injections administered for curative purpose constituted 82.5% and a large majorly of these were prescribed for common symptoms like fever/cough/diarrhoea. Use of glass syringes was consistently associated with potential risk of blood-borne viral transmission. Satisfactory disposal of injection waste was observed at 61.3% (95%CI: 58.2-64.3) of the health facilities, and at 50.9% (95%CI: 46.7-55.2) of the immunization clinics. Significant differences were observed in the injection prescription pattern in public and private facilities, and in rural and urban areas. CONCLUSIONS Three billion injections were estimated to be administered annually in India; of them 1.89 billion were unsafe. Evidence suggests that the micro-level leadership for reducing injection overuse and making injections safer lies with the prescriber.
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Affiliation(s)
- Narendra K Arora
- The INCLEN Trust International, F-1/5, 2nd Floor, Okhla Industrial Area, Phase-I, New Delhi 110020, India
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Saikia KK, Bewal R, Bansal D, Kapil A, Sood S, Arora NK, Das BK. Multi locus sequence type comparison of invasive and commensal Haemophilus influenzae isolates from Delhi. Indian J Med Microbiol 2011; 29:158-60. [PMID: 21654111 DOI: 10.4103/0255-0857.81800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Haemophilus influenzae is a major public health concern in the developing world. The most virulent strain is H. influenzae Type b (Hib). Hib also constitutes a major portion of nasopharyngeal commensal flora in otherwise healthy individuals. Through dendogram based on composite gene sequences of seven multi locus sequence type genes, it was observed that invasive and commensal isolates made two completely separate clusters which are indicative of independent evolution of these two groups of H. influenzae in the Indian subcontinent.
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Affiliation(s)
- K K Saikia
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 100 029, India
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Arora NK, Chaturvedi S, Dasgupta R. Global lessons from India's poliomyelitis elimination campaign. Bull World Health Organ 2010; 88:232-4. [PMID: 20428393 DOI: 10.2471/blt.09.072058] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 12/12/2009] [Accepted: 12/15/2009] [Indexed: 11/27/2022] Open
Affiliation(s)
- Narendra K Arora
- The INCLEN Trust International, 2nd floor, F - 1/5, Okhla Industrial Area, Phase I, New Delhi - 110020, India.
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Arora NK, Arora S, Ahuja A, Mathur P, Maheshwari M, Das MK, Bhatia V, Kabra M, Kumar R, Anand M, Kumar A, Gupta SD, Vivekanandan S. Alpha 1 antitrypsin deficiency in children with chronic liver disease in North India. Indian Pediatr 2009; 47:1015-23. [PMID: 20453271 DOI: 10.1007/s13312-010-0174-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Accepted: 06/02/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We attempted to determine the role of alpha-1-antitrypsin (AAT) deficient variants as an etiologic factor for chronic liver disease in North Indian children. DESIGN This study investigated 1700 children (682 retrospectively and 1018 prospectively) (840 CLD, 410 neonatal cholestasis and 450 without liver disease) for AAT deficiency. SETTING Tertiary referral center, All India Institute of Medical Sciences, New Delhi. PATIENTS Of 1250 liver disease patients, 98 (7.8%) were suspected to be AAT deficient on the basis of screening tests (low serum AAT levels and/or absent/faint alpha-1-globulin band on serum agarose electrophoresis and/or diastase resistant PAS positive granules on liver biopsy). MAIN OUTCOME MEASURES AAT deficient Z or S allele in suspected patients. RESULTS Z or S allele was not observed on phenotyping (1700 subjects), or with PCR-RFLP, SSCP and sequencing done in 50 of 98 suspected AAT deficient patients. A novel mutation G-to-A at position 333 in exon V was found in two siblings having positive immunohistochemistry for AAT on liver biopsy, both of whom had significant liver disease with portal hypertension. CONCLUSION In conclusion, AAT deficiency as an etiologic factor for chronic liver disease in childhood appeared to be uncommon in North India.
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Affiliation(s)
- Narendra K Arora
- International Clinical Epidemiology Network (INCLEN), Division of Pediatric Gastroenterology, Hepatology and Nutrition, All India Institute of Medical Sciences, New Delhi 110 020, India.
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Chaturvedi S, Dasgupta R, Adhish V, Ganguly KK, Rai S, Sushant L, Srabasti S, Arora NK. Deconstructing social resistance to pulse polio campaign in two North Indian districts. Indian Pediatr 2009; 46:963-974. [PMID: 19736365] [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] [Received: 12/31/2008] [Accepted: 04/28/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To gain an insight into the phenomenon of social resistance and rumors against pulse polio campaign. DESIGN Qualitative, community-based investigation, mapping perceptions of various stakeholders through in-depth interviews (IDIs), focus group discussions (FGDs), non-formal interactions and observations. SETTING Moradabad and JP Nagar districts of Uttar Pradesh. SUBJECTS IDIs (providers 33, mothers 33, community leaders 10); FGDs (providers 4, mothers 8) and non-formal interactions (156) with community leaders, parents, businessmen, journalists (Hindi and Urdu media), mobilizers, vaccinators and supervisors. RESULTS A distinct machination of social resistance and rumors against oral polio vaccine during supplementary immunization activities (SIA) was observed in some minority dominated areas. The pattern can be understood through a model that emerged through qualitative evidence. Inspite of all this, most parents in minority areas supported the SIAs. Only a few clusters from extremely marginalized sections continued to evade SIAs, with an endemic pattern. Through social osmosis, these rumors reached majority community as well and some parents were affected. However, in such cases, the resistance was sporadic and transient. CONCLUSION While the programs focus was on microbiological issues, the obstacles to polio eradication lie in the endemicity of social (and/or cultural) resistance in some pockets, leading to clustering of perpetually unimmunized children - inspite of good coverage of SIAs at macro level. This may sustain low levels of wild poliovirus transmission, and there can be exceptions to the robustness of the pulse approach. A micro level involvement of volunteers from marginalized pockets of minorities might be able to minimize or eliminate this resistance.
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Gisselquist D, Potterat JJ, St Lawrence JS, Hogan M, Arora NK, Correa M, Dinsmore WW, Mehta G, Millogo J, Muth SQ, Okinyi M, Ounga T. How to contain generalized HIV epidemics? A plea for better evidence to displace speculation. Int J STD AIDS 2009; 20:443-6. [PMID: 19541883 DOI: 10.1258/ijsa.2009.009003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In the worst generalized HIV epidemics in East and Southern Africa, from one-quarter to three-quarters of women aged 15 years can expect to be living with HIV or to have died with AIDS by age 40 years. This disaster continues in the face of massive HIV prevention programmes based on current inexact knowledge of HIV transmission pathways and risks. To stop this disaster, both the public and public health experts need better information about the specific factors that allow HIV to propagate so extensively in countries with generalized epidemics. This knowledge could be acquired by tracing HIV infections to their source - especially tracing HIV infections in women of all ages, and tracing unexplained HIV infections in children with HIV-negative mothers.
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Mathur P, Arora NK. Epidemiological transition of hepatitis A in India: issues for vaccination in developing countries. Indian J Med Res 2008; 128:699-704. [PMID: 19246792] [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: 05/27/2023] Open
Abstract
With improvement in economic and living conditions of the communities, the age of acquiring hepatitis A virus (HAV) infection is shifting from early childhood to adolescence and young adulthood. Such epidemiological shift leads to an increased incidence of symptomatic HAV infection, including heightened risk of liver failure. Data from India indicate that the population is no longer homogeneous for its HAV exposure profile. Occasional outbreaks of HAV and higher proportions of symptomatic cases are reported amongst older children and adults from different regions of the country. However, the heterogeneous exposure to HAV defies widespread use of the vaccine. The challenge is to recognize the susceptible pockets and take pre-emptive steps. In regions with rapid improvement in living standards and environmental hygiene, there is a need for regular surveillance through structured protocols that are able to identify early signs of epidemiological shift. This review discusses relevant issues and concerns to influence decision making for HAV vaccination in such transition societies.
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Affiliation(s)
- P Mathur
- Indian Council of Medical Research, New Delhi, India
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