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Sehgal R, Srinivasapura Venkateshmurthy N, Khatkar R, Konkati SP, Jarhyan P, Sharma M, Ide N, Prabhakaran D, Mohan S. Awareness and Availability of Low Sodium Iodized Salt: Results from Formative Research of Promoting Uptake of Low SodiUm Iodized Salt by Rural and Urban HousehoLds in India-The PLURAL Study. Nutrients 2023; 16:130. [PMID: 38201960 PMCID: PMC10781031 DOI: 10.3390/nu16010130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Dietary sodium intake is high among adults in India. Use of low sodium iodized salt (LSIS) can help reduce sodium intake. However, contextually relevant and culturally appropriate interventions to promote LSIS uptake in India have not been developed and implemented. We carried out formative research to inform an intervention to promote uptake of LSIS among rural and urban households in north (Sonipat district) and south (Visakhapatnam and Anakapalli districts) India. Sixty-two in-depth interviews of six focus groups were held with a range of stakeholders-consumers, retailers and influencers. Participant views on availability, affordability, taste and safety of LSIS, along with views on hypertension, its risk factors and potential intervention design and delivery strategies were elicited. Thematic analysis of the data was carried out. While the awareness of hypertension and its risk factors was high among the participants, awareness of LSIS was low. There was also low demand for, and availability of, LSIS. Since cost of LSIS was higher than regular salt, participants preferred that a subsidy be provided to offset the cost. Based on these findings, an intervention to promote the uptake of LSIS was implemented by project staff using various educational materials such as posters, pamphlets and short videos.
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Affiliation(s)
- Reena Sehgal
- Public Health Foundation of India, New Delhi 110030, India; (R.S.); (R.K.); (P.J.); (D.P.); (S.M.)
| | - Nikhil Srinivasapura Venkateshmurthy
- Public Health Foundation of India, New Delhi 110030, India; (R.S.); (R.K.); (P.J.); (D.P.); (S.M.)
- Centre for Chronic Disease Control, New Delhi 110016, India;
| | - Rajesh Khatkar
- Public Health Foundation of India, New Delhi 110030, India; (R.S.); (R.K.); (P.J.); (D.P.); (S.M.)
| | | | - Prashant Jarhyan
- Public Health Foundation of India, New Delhi 110030, India; (R.S.); (R.K.); (P.J.); (D.P.); (S.M.)
| | - Manika Sharma
- Resolve to Save Lives, New York, NY 10004, USA; (M.S.); (N.I.)
| | - Nicole Ide
- Resolve to Save Lives, New York, NY 10004, USA; (M.S.); (N.I.)
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi 110030, India; (R.S.); (R.K.); (P.J.); (D.P.); (S.M.)
- Centre for Chronic Disease Control, New Delhi 110016, India;
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Sailesh Mohan
- Public Health Foundation of India, New Delhi 110030, India; (R.S.); (R.K.); (P.J.); (D.P.); (S.M.)
- Centre for Chronic Disease Control, New Delhi 110016, India;
- School of Nursing & Midwifery, Deakin University, Burwood, VIC 3125, Australia
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Ganpule A, Dubey M, Pandey H, Green R, Brown KA, Srinivasapura Venkateshmurthy N, Jarhyan P, Maddury AP, Khatkar R, Prabhakaran D, Mohan S. Dietary patterns in North and South India: a comparison with EAT-Lancet dietary recommendations. J Hum Nutr Diet 2023; 36:2170-2179. [PMID: 37555567 DOI: 10.1111/jhn.13222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Environmentally sustainable diets are represented in the EAT-Lancet recommendations developed by the Lancet Commission on Planetary Health in 2019. Very few studies have compared Indian diets with the EAT-Lancet recommendations. The present study performed such a comparison using primary dietary consumption data from adults in north and south India. METHODS Data from 8762 adults (52.4 ± 11.7 years) residing in Sonipat and Vizag India were collected on sociodemographic characteristics, wealth index (household assets) and dietary intake (food frequency questionnaire: nine food groups). The quantity consumed and energy from each food group was compared with the EAT-Lancet recommendations. We investigated the likelihood of deficit or excess in consumption compared to the EAT-Lancet recommendations by different sociodemographic factors. RESULTS Half of the participants were women and half resided in rural areas. Vegetables and fruits were consumed in lower quantity, whereas dairy and added fats were consumed in higher quantity than recommended by the EAT-Lancet recommendations. For whole grains, female gender and poorest wealth index were the factors associated with deficit or no consumption, whereas, for vegetables and fruits, it was poorest wealth index and residence in rural areas (p < 0.05, all). Rural residence and poorest wealth index were associated with excess consumption of dairy and added fats (p < 0.05, all). CONCLUSIONS The diets of the study participants were mainly plant-based, and high in dairy but lacking in nutrient-rich foods such as vegetables and fruits. Appropriate policy actions for making healthy sustainable diets and micronutrient-rich foods available and affordable to all with a particular focus on the poor and rural populations are warranted.
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Affiliation(s)
| | - Manisha Dubey
- Centre for Chronic Disease Control, New Delhi, India
| | | | - Rosemary Green
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India
- London School of Hygiene & Tropical Medicine, London, UK
- Public Health Foundation of India, New Delhi, India
| | - Sailesh Mohan
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, New Delhi, India
- Deakin University, Melbourne, Australia
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Varghese JS, Venkateshmurthy NS, Sudharsanan N, Jeemon P, Patel SA, Thirumurthy H, Roy A, Tandon N, Narayan KMV, Prabhakaran D, Ali MK. Hypertension Diagnosis, Treatment, and Control in India. JAMA Netw Open 2023; 6:e2339098. [PMID: 37870834 PMCID: PMC10594142 DOI: 10.1001/jamanetworkopen.2023.39098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/10/2023] [Indexed: 10/24/2023] Open
Abstract
Importance Hypertension is a major cause of morbidity and mortality worldwide. Previous efforts to characterize gaps in the hypertension care continuum-including diagnosis, treatment, and control-in India did not assess district-level variation. Local data are critical for planning, implementation, and monitoring efforts to curb the burden of hypertension. Objective To examine the hypertension care continuum in India among individuals aged 18 to 98 years. Design, Setting, and Participants The nationally representative Fifth National Family Health Survey study was conducted in 2 phases from June 17, 2019, to March 21, 2020, and from November 21, 2020, to April 30, 2021, among 1 895 297 individuals in 28 states, 8 union territories, and 707 districts of India. Exposures District and state of residence, urban classification, age (18-39, 40-64, and ≥65 years), sex, and household wealth quintile. Main Outcomes and Measures Hypertension was defined as a self-reported diagnosis or a newly measured blood pressure of 140/90 mm Hg or more. The proportion of individuals diagnosed (self-reported), the proportion of individuals treated among those diagnosed (self-reported medication use), and the proportion of individuals with blood pressure control among those treated (blood pressure <140/90 mm Hg [aged 18-79 years] or <150/90 mm Hg [aged ≥80 years]) were calculated based on national guidelines. Age-standardized estimates of treatment and control were also provided among the total with hypertension. To assess differences in the care continuum between or within states (ie, between districts), the variance was partitioned using generalized linear mixed models. Results Of the 1 691 036 adult respondents (52.6% women; mean [SD] age, 41.6 [16.5] years), 28.1% (95% CI, 27.9%-28.3%) had hypertension, of whom 36.9% (95% CI, 36.4%-37.3%) received a diagnosis. Among those who received a diagnosis, 44.7% (95% CI, 44.1%-45.3%) reported taking medication (corresponding to 17.7% [95% CI, 17.5%-17.9%] of the total with hypertension). Among those treated, 52.5% (95% CI, 51.7%-53.4%) had blood pressure control (corresponding to 8.5% [95% CI, 8.3%-8.6%] of the total with hypertension). There were substantial variations across districts in blood pressure diagnosis (range, 6.3%-77.5%), treatment (range, 8.7%-97.1%), and control (range, 2.7%-76.6%). Large proportions of the variation in hypertension diagnosis (94.7%), treatment (93.6%), and control (97.3%) were within states, not just between states. Conclusions and Relevance In this cross-sectional survey study of Indian adults, more than 1 in 4 people had hypertension, and of these, only 1 in 3 received a diagnosis, less than 1 in 5 were treated, and only 1 in 12 had blood pressure control. National mean values hide considerable state-level and district-level variation in the care continuum, suggesting the need for targeted, decentralized solutions to improve the hypertension care continuum in India.
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Affiliation(s)
- Jithin Sam Varghese
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Nikkil Sudharsanan
- Professorship of Behavioral Science for Disease Prevention and Health Care, Technical University of Munich, Munich, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Shivani A. Patel
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Harsha Thirumurthy
- Leonard Davis Institute of Health Economics and Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - K. M. Venkat Narayan
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi, India
- Center for Chronic Disease Control, New Delhi, India
| | - Mohammed K. Ali
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
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Singh K, Joshi A, Venkateshmurthy NS, Rahul R, Huffman MD, Tandon N, Prabhakaran D. A Delphi Study to Prioritize Evidence-Based Strategies for Cardiovascular Disease Care in India. Glob Implement Res Appl 2023; 3:1-12. [PMID: 37363377 PMCID: PMC10240122 DOI: 10.1007/s43477-023-00087-2] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/30/2023] [Indexed: 06/28/2023]
Abstract
Providing quality cardiovascular disease (CVD) care in low resource setting requires understanding of priority and effective interventions. This study aimed to identify and prioritize evidence-based quality improvement strategies for CVD care in India using a modified two-round Delphi process in which, we asked 46 experts (clinicians, researchers, program implementers and policy makers) to rate 25 proven CVD care strategies grouped into: (1) patient support, (2) information communication technology (ICT) for health, (3) group problem solving, (4) training, and (5) multicomponent strategy on a scale of 1 (highest/best)-5 (lowest/worst) on priority, relative advantage, and feasibility. Subsequently, we convened an expert consensus panel of 32 members to deliberate and achieve consensus regarding the prioritized set of strategies for CVD care. The Delphi study found that group problem solving strategies achieved the best score for priority (1.80) but fared poorly on feasibility (2.88). Compared to others, multicomponent strategies were rated favorably across all domains (priority = 1.84, relative advantage = 1.94, and feasibility = 2.40). The ICT for health strategies achieved the worst scores for priority = 2.01, relative advantage = 2.31, and feasibility = 2.85. Training and patient support strategies scored moderately across all domains. The expert panel narrowed the selection of a multicomponent strategy consisting of (1) electronic health records with clinical decision-support system, (2) non-physician health worker facilitated care, (3) patient education materials, (4) text-message based reminders for healthy lifestyle, and (5) audit and feedback report for providers. Future research will evaluate the real-world feasibility and effectiveness of the multicomponent strategy in patients with CVD in a low- and middle-income country setting. Supplementary Information The online version contains supplementary material available at 10.1007/s43477-023-00087-2.
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Affiliation(s)
- Kavita Singh
- Public Health Foundation of India, Gurugram, Haryana 122002 India
- Centre for Chronic Disease Control, New Delhi, India
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | | | | | | | - Mark D. Huffman
- Washington University, Saint Louis, USA
- Feinberg School of Medicine, Northwestern University, Chicago, USA
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Gurugram, Haryana 122002 India
- Centre for Chronic Disease Control, New Delhi, India
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Singh S, Venkateshmurthy NS, Brown KA, Maddury AP, Khatkar R, Jarhyan P, Prabhakaran D, Mohan S. Agricultural and Socioeconomic Factors Associated with Farmer Household Dietary Diversity in India: A Comparative Study of Visakhapatnam and Sonipat. Sustainability 2023; 15:2873. [PMID: 37323772 PMCID: PMC7614637 DOI: 10.3390/su15042873] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Using primary data from 479 farmer households, this study examined the associations between agricultural and socioeconomic factors and farmer household dietary diversity in Visakhapatnam and Sonipat. Cropping intensity was positively associated with farmers' household dietary diversity score (HDDS), suggesting that higher cropping intensity may expand the gross cropped area and improve food security among subsistence farmers. Distance to food markets was also significantly associated with farmer HDDS, which suggests that market integration with rural households can improve farmer HDDS in Visakhapatnam. In Sonipat, wealth index had a positive association with farmer HDDS, targeting the income pathway by improving farmer HDDS in this region. Considering the relative contribution of these factors, distance to food markets, cropping intensity, and crop diversity were the three most important factors affecting farmer HDDS in Visakhapatnam, whereas wealth index, cropping intensity, and distance to food markets emerged as the top three important factors contributing to farmer HDDS in Sonipat. Our study concludes that the associations between agricultural and socioeconomic factors and farmer HDDS are complex but context- and location-specific; therefore, considering the site- and context-specific circumstances, different connections to HDDS in India can be found to better support policy priorities on the ground.
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Affiliation(s)
| | | | - Kerry Ann Brown
- College of Life & Environmental Sciences, University of Exeter, Exeter EX4 4PY, UK
| | | | - Rajesh Khatkar
- Public Health Foundation of India, Gurgaon 122002, India
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi 110016, India
- Public Health Foundation of India, Gurgaon 122002, India
| | - Sailesh Mohan
- Centre for Chronic Disease Control, New Delhi 110016, India
- Public Health Foundation of India, Gurgaon 122002, India
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Ganpule A, Dubey M, Pandey H, Srinivasapura Venkateshmurthy N, Green R, Ann Brown K, Maddury AP, Khatkar R, Jarhyan P, Prabhakaran D, Mohan S. Snacking Behavior and Association with Metabolic Risk Factors in Adults from North and South India. J Nutr 2023; 153:523-531. [PMID: 36894244 DOI: 10.1016/j.tjnut.2022.12.032] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Snacks are increasingly contributing to daily diets around the world. Studies from high-income countries have demonstrated the link between snack consumption and metabolic risk factors, but there are very few studies from low- and middle-income countries. OBJECTIVES The objective of this study was to assess snack behavior and its associations with metabolic risk factors in Indian adults. METHODS Adults from the UDAY study (October 2018-February 2019, n = 8762) from rural and urban Sonipat (North) and Vizag (South) India were studied for snack consumption (food frequency questionnaire), demographic factors, including age, sex, etc. and metabolic risk factors, including BMI, waist circumference, fat percentage, plasma glucose, and blood pressure. We compared snack consumption by categories of sociodemographic factors (Mann-Whitney U test, Kruskal-Wallis test) and studied the likelihood for metabolic risk (logistic regression analysis). RESULTS Half of the study participants were women and resided in rural locations. Savory snacks were the most preferred; 50% of the participants consumed them 3-5 times/wk. Participants preferred to purchase out-of-home prepared snacks and eat them at home (86.6%) while watching television (69.4%) or with family/friends (49.3%). The reasons for snacking were hunger, craving, liking, and availability. Snack consumption was higher in Vizag (56.6%) than in Sonipat (43.4%), among women (55.5%) than men (44.5%), and the wealthiest; it was similar in rural-urban locations. Frequent consumers of snacks had 2 times higher likelihood for having obesity (OR: 2.22; 95% CI: 1.51, 3.27) central obesity (OR: 2.35; 95% CI: 1.60, 3.45), and higher fat percentage (OR: 1.92; 95% CI: 1.31, 2.82) and higher fasting glucose levels (r=0.12 (0.07-0.18) than consumers who consumed snacks rarely (all P ≤ 0.05). CONCLUSIONS Snack (savory and sweet) consumption was high among adults from sexes in both urban and rural locations of north and south India. This was associated with higher risk of obesity. There is a need to improve the food environment by promoting policies for ensuring healthier food options to reduce snacking and associated metabolic risk.
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Affiliation(s)
| | - Manisha Dubey
- Centre for Chronic Disease Control, New Delhi, India
| | | | | | - Rosemary Green
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India; London School of Hygiene and Tropical Medicine, London, UK
| | - Sailesh Mohan
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India; Deakin University, Melbourne, Australia
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Ganpule A, Brown KA, Dubey M, Srinivasapura Venkateshmurthy N, Jarhyan P, Maddury AP, Khatkar R, Pandey H, Prabhakaran D, Mohan S. Food insecurity and its determinants among adults in North and South India. Nutr J 2023; 22:2. [PMID: 36624459 PMCID: PMC9827013 DOI: 10.1186/s12937-022-00831-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 12/12/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Food insecurity is a major public health problem worldwide. In India, there are limited food insecurity assessment studies using a conventionally accepted method like the Food Insecurity Experience Scale (FIES), developed by the Food and Agricultural Organization (FAO). This study aims to measure food insecurity using the FIES and explore its determinants and association with body mass index (BMI) among Indian adults. METHODS: In a cross-sectional study, we used FIES to measure food security in a sample of 9005 adults residing in North and South India. Using questionnaires, socio-demographic factors, dietary intake and food security data were collected. The dietary diversity scores (FAO-IDDS) and food insecurity scores (FAO-FIES) were calculated. Body size was measured and BMI was calculated. RESULTS: The mean age of the study participants was 52.4 years (± 11.7); half were women and half resided in rural areas. Around 10% of the participants reported having experienced (mild or moderate or severe) food insecurity between October 2018 and February 2019. Dietary diversity (measured by FAO's Individual Dietary Diversity Scores, IDDS) was low and half of the participants consumed ≤ 3 food groups/day. The mean BMI was 24.7 kg/m2. In the multivariate analysis, a lower IDDS and BMI were associated with a higher FIES. The place of residence, gender and wealth index were important determinants of FIES, with those residing in South India, women and those belonging to the poorest wealth index reporting higher food insecurity. CONCLUSION Food security is understudied in India. Our study adds important evidence to the literature. Despite having marginal food insecurity, high prevalence of low diet quality, especially among women, is disconcerting. Similar studies at the national level are warranted to determine the food insecurity situation comprehensively in India and plan appropriate policy actions to address it effectively, to attain the key Sustainable Development Goals (SDG).
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Affiliation(s)
- Anjali Ganpule
- grid.417995.70000 0004 0512 7879Centre for Chronic Disease Control, New Delhi, India
| | - Kerry Ann Brown
- grid.8391.30000 0004 1936 8024University of Exeter, Exeter, UK
| | - Manisha Dubey
- grid.417995.70000 0004 0512 7879Centre for Chronic Disease Control, New Delhi, India
| | - Nikhil Srinivasapura Venkateshmurthy
- grid.417995.70000 0004 0512 7879Centre for Chronic Disease Control, New Delhi, India ,grid.415361.40000 0004 1761 0198Public Health Foundation of India, New Delhi, India
| | - Prashant Jarhyan
- grid.415361.40000 0004 1761 0198Public Health Foundation of India, New Delhi, India
| | | | - Rajesh Khatkar
- grid.415361.40000 0004 1761 0198Public Health Foundation of India, New Delhi, India
| | - Himanshi Pandey
- grid.417995.70000 0004 0512 7879Centre for Chronic Disease Control, New Delhi, India
| | - Dorairaj Prabhakaran
- grid.417995.70000 0004 0512 7879Centre for Chronic Disease Control, New Delhi, India ,grid.415361.40000 0004 1761 0198Public Health Foundation of India, New Delhi, India ,grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK
| | - Sailesh Mohan
- Centre for Chronic Disease Control, New Delhi, India. .,Public Health Foundation of India, New Delhi, India. .,Deakin University, Melbourne, Australia.
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Shivashankar R, Singh K, Kondal D, Gupta R, Perel P, Kapoor D, Jindal D, Mohan S, Pradeepa R, Jarhyan P, Venkateshmurthy NS, Tandon N, Mohan V, Narayan KMV, Prabhakaran D, Ali MK. Correction: Cardiovascular Health in India - a Report Card from Three Urban and Rural Surveys of 22,144 Adults. Glob Heart 2022; 17:68. [PMID: 36199566 PMCID: PMC9504161 DOI: 10.5334/gh.1158] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 11/05/2022] Open
Abstract
[This corrects the article DOI: 10.5334/gh.1137.].
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Affiliation(s)
- Roopa Shivashankar
- Indian Council of Medical Research (ICMR), New Delhi, IN
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
| | - Kalpana Singh
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Hamad Medical Corporation, Doha, QA
| | - Dimple Kondal
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
| | - Ruby Gupta
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine (LSHTM), London, GB
| | - Deksha Kapoor
- All India Institute of Medical Sciences (AIIMS), New Delhi, IN
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Edinburgh, GB
| | - Devraj Jindal
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
| | - Sailesh Mohan
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
- Deakin University, Melbourne, AU
| | | | | | | | - Nikhil Tandon
- All India Institute of Medical Sciences (AIIMS), New Delhi, IN
| | | | - K. M. Venkat Narayan
- Rollins School of Public Health & Emory Global Diabetes Research Center, Emory University, Atlanta, US
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
- Rollins School of Public Health, Emory University, Atlanta, US
| | - Mohammed K. Ali
- Rollins School of Public Health & Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, US
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Shivashankar R, Singh K, Kondal D, Gupta R, Perel P, Kapoor D, Jindal D, Mohan S, Pradeepa R, Jarhyan P, Srinivasapura Venkateshmurthy N, Tandon N, Mohan V, Venkat Narayan KM, Prabhakaran D, Ali MK. Cardiovascular Health in India - a Report Card from Three Urban and Rural Surveys of 22,144 Adults. Glob Heart 2022; 17:52. [PMID: 36051326 PMCID: PMC9354560 DOI: 10.5334/gh.1137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 02/08/2022] [Accepted: 07/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background Markers of ideal cardiovascular health (CVH) predict cardiovascular events. We estimated the prevalence of ideal CVH markers in two levels of cities and villages in India. Methods We did pooled analysis of individual-level data from three cross sectional surveys of adults ≥ 30 years over 2010-14 (CARRS: Centre for cArdiometabolic Risk Reduction in South Asia; UDAY and Solan Surveillance Study) representing metropolitan cities; smaller cities and rural areas in diverse locations of India. We defined ideal CVH using modified American Heart Association recommendations: not smoking, ≥ 5 servings of fruits and vegetables (F&V), high physical activity (PA), body mass index (BMI) <25 Kg/m2, blood pressure (BP) <120/80 mm Hg, fasting plasma glucose (FPG) <100 mg/dl, and total cholesterol (TC) <200 mg/dL. We estimated (1) age-and sex-standardized prevalence of ideal CVH and (2) prevalence of good (≥6 markers), moderate (4-5), and poor CVH (≤3) adjusted for age, sex, education, and stratified by setting and asset tertiles. Results Of the total 22,144 participants, the prevalence of ideal CVH markers were: not smoking (76.7% [95% CI 76.1, 77.2]), consumed ≥5 F&V (4.2% [3.9, 4.5]), high PA (67.5% [66.8, 68.2]), optimum BMI (59.6% [58.9, 60.3]), ideal BP (34.5% [33.9, 35.2]), FPG (65.8% [65.1, 66.5]) and TC (65.4% [64.7, 66.1]). The mean number of ideal CVH metrics was 3.7(95% CI: 3.7, 3.8). Adjusted prevalence of good, moderate, and poor CVH, varied across settings: metropolitan (3.9%, 41.0%, and 55.1%), smaller cities (7.8%, 49.2%, and 43%), and rural (10.4%, 60.9%, and 28.7%) and across asset tertiles: Low (11.0%, 55.9%, 33.1%), Middle (6.3%, 52.2%, 41.5%), and High (5.0%, 46.4%, 48.7%), respectively. Conclusion Achievement of ideal CVH varied, with higher prevalence in rural and lower asset tertiles. Multi-sectoral and targeted policy and program actions are needed to improve CVH in diverse contexts in India.
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Affiliation(s)
- Roopa Shivashankar
- Indian Council of Medical Research (ICMR), New Delhi, IN
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
| | - Kalpana Singh
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Hamad Medical Corporation, Doha, QA
| | - Dimple Kondal
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
| | - Ruby Gupta
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Deksha Kapoor
- All India Institute of Medical Sciences (AIIMS), New Delhi, IN
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Edinburgh, UK
| | - Devraj Jindal
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
| | - Sailesh Mohan
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
- Deakin University, Melbourne, AUS
| | | | | | | | - Nikhil Tandon
- All India Institute of Medical Sciences (AIIMS), New Delhi, IN
| | | | - K. M. Venkat Narayan
- Rollins School of Public Health & Emory Global Diabetes Research Center, Emory University, Atlanta, US
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control (CCDC), New Delhi, IN
- Public Health Foundation of India (PHFI), New Delhi, IN
- Rollins School of Public Health, Emory University, Atlanta, US
| | - Mohammed K. Ali
- Rollins School of Public Health & Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, US
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10
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Jindal D, Sharma H, Gupta Y, Ajay VS, Roy A, Sharma R, Ali M, Jarhyan P, Gupta P, Srinivasapura Venkateshmurthy N, Ali MK, Narayan KMV, Prabhakaran D, Weber MB, Mohan S, Patel SA, Tandon N. Improving care for hypertension and diabetes in india by addition of clinical decision support system and task shifting in the national NCD program: I-TREC model of care. BMC Health Serv Res 2022; 22:688. [PMID: 35606762 PMCID: PMC9125907 DOI: 10.1186/s12913-022-08025-y] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background The growing burden of hypertension and diabetes is one of the major public health challenges being faced by the health system in India. Clinical Decision Support Systems (CDSS) that assist with tailoring evidence-based management approaches combined with task-shifting from more specialized to less specialized providers may together enhance the impact of a program. We sought to integrate a technology “CDSS” and a strategy “Task-shifting” within the Government of India’s (GoI) Non-Communicable Diseases (NCD) System under the Comprehensive Primary Health Care (CPHC) initiative to enhance the program’s impact to address the growing burden of hypertension and diabetes in India. Methods We developed a model of care “I-TREC” entirely calibrated for implementation within the current health system across all facility types (Primary Health Centre, Community Health Centre, and District Hospital) in a block in Shaheed Bhagat Singh (SBS) Nagar district of Punjab, India. We undertook an academic-community partnership to incorporate the combination of a CDSS with task-shifting into the GoI CPHC-NCD system, a platform that assists healthcare providers to record patient information for routine NCD care. Academic partners developed clinical algorithms, a revised clinic workflow, and provider training modules with iterative collaboration and consultation with government and technology partners to incorporate CDSS within the existing system. Discussion The CDSS-enabled GoI CPHC-NCD system provides evidence-based recommendations for hypertension and diabetes; threshold-based prompts to assure referral mechanism across health facilities; integrated patient database, and care coordination through workflow management and dashboard alerts. To enable efficient implementation, modifications were made in the patient workflow and the fulcrum of the use of technology shifted from physician to nurse. Conclusion Designed to be applicable nationwide, the I-TREC model of care is being piloted in a block in the state of Punjab, India. Learnings from I-TREC will provide a roadmap to other public health experts to integrate and adapt their interventions at the national level. Trial registration CTRI/2020/01/022723. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08025-y.
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Affiliation(s)
- Devraj Jindal
- Centre for Chronic Disease Control, New Delhi, India.
| | - Hanspria Sharma
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Yashdeep Gupta
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Vamadevan S Ajay
- Faculty of Healthcare Management & Center for Excellence in Sustainable Development, Goa Institute of Management (GIM), Goa, India
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakshit Sharma
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Mumtaj Ali
- Centre for Chronic Disease Control, New Delhi, India
| | | | - Priti Gupta
- Centre for Chronic Disease Control, New Delhi, India
| | | | - Mohammed K Ali
- Hubert Department of Global Health, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA
| | - K M Venkat Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India.,Public Health Foundation of India, Gurgaon, India
| | - Mary Beth Weber
- Hubert Department of Global Health, Emory University, Atlana, GA, USA
| | - Sailesh Mohan
- Centre for Chronic Disease Control, New Delhi, India.,Public Health Foundation of India, Gurgaon, India
| | - Shivani A Patel
- Hubert Department of Global Health, Emory University, Atlana, GA, USA
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
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11
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Brown KA, Venkateshmurthy NS, Potubariki G, Sharma P, Cardwell JM, Prabhakaran D, Knai C, Mohan S. The role of dairy in healthy and sustainable food systems: community voices from India. BMC Public Health 2022; 22:806. [PMID: 35459172 PMCID: PMC9026048 DOI: 10.1186/s12889-022-13194-w] [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: 07/16/2021] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background Managing the role of dairy foods in healthy and sustainable food systems is challenging. Milk production is associated with greenhouse gas emissions and milk-based processed foods can be high in fat, sugar and salt; yet, milk production provides income generating opportunities for farmers and dairy foods provide essential nutrients to young children, with a cultural significance in many communities. This is particularly relevant to India, the world’s largest producer of milk. The aim of this study was to use Photovoice, a participatory research method, to explore the experiences and perceptions of communities in India on the role of dairy products in local sustainable and healthy food systems. Methods Purposive sampling recruited two women’s self-help groups in Visakhapatnam, Andhra Pradesh: one in a rural area and one in an urban area. A total of 31 participants (10–17 urban group and 12–14 rural group), produced photographs with captions to represent their views on how dairy was produced, sold, and consumed in their community. A discussion workshop was held in each area, with prompts to consider health and the environment. Workshop transcripts, photographs and captions were analysed qualitatively using thematic analysis. Results A range of experiences and perceptions were discussed by the two women’s self help groups. Participants had an awareness of their local food system and how stages of dairy food supply chains were non-linear and inherently interconnected. Three main themes were identified: 1) Quality and value matters to producers and consumers; 2) The need to adapt to sustain dairy farmer livelihoods in water scarce areas; 3) It’s not only about health. Conclusions Moderate milk-producing states such as Andhra Pradesh will continue to develop their dairy industry through policy actions. Including communities in policy discussions through innovative methods like Photovoice can help to maximise the positive and minimise the negative role of dairy in evolving local food systems.
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Affiliation(s)
- Kerry Ann Brown
- College of Life & Environmental Sciences, University of Exeter, Exeter, UK. .,Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | - Piyu Sharma
- Centre for Chronic Disease Control, New Delhi, India
| | - Jacqueline M Cardwell
- Department of Pathobiology & Population Sciences, Royal Veterinary College, London, UK
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India.,Public Health Foundation of India, Gurugram, India.,Department of Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Cecile Knai
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sailesh Mohan
- Centre for Chronic Disease Control, New Delhi, India.,Public Health Foundation of India, Gurugram, India.,Faculty of Health, Deakin University, Burwood, Melbourne, Australia
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12
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Jaacks LM, Serupally R, Dabholkar S, Venkateshmurthy NS, Mohan S, Roy A, Prabhakaran P, Smith B, Gathorne-Hardy A, Veluguri D, Eddleston M. Impact of large-scale, government legislated and funded organic farming training on pesticide use in Andhra Pradesh, India: a cross-sectional study. Lancet Planet Health 2022; 6:e310-e319. [PMID: 35397219 DOI: 10.1016/s2542-5196(22)00062-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 02/10/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The use of pesticides in agriculture has been associated with the destruction of biodiversity and damage to human health. A marked reduction in pesticide use is urgently required globally, but whether this can be achieved rapidly and at scale is unclear. We aimed to assess whether government-legislated and funded organic farming training in Andhra Pradesh, India, reduced pesticide use by farmers and sales of pesticides by pesticide retailers. METHODS We did a cross-sectional survey between Aug 11 and Nov 26, 2020, among farmers and pesticide retailers in Kurnool District of Andhra Pradesh (India). We assessed the impact of the Andhra Pradesh Community Managed Natural Farming (APCNF) programme, which aims to transition 100% of the agricultural land of Andhra Pradesh (population approximately 49 million, 6 million of whom are farmers) to organic farming practices by 2030. We did cross-sectional phone interview surveys of farmers and face-to-face surveys of pesticide retailers. We used multivariable Poisson regression models to estimate relative risks (RRs) and logistic regression models to estimate odds ratios (ORs). FINDINGS 962 farmers were invited to participate, of whom 894 (93%) consented (709 conventional farmers and 149 APCNF farmers). 47 pesticide retailers were invited to participate, of whom 38 (81%) consented. APCNF farmers had practised APCNF for a median of 2 years (IQR 1-3). APCNF farmers were less likely to use pesticides than conventional farmers (adjusted RR 0·65 [95% CI 0·57-0·75]), although pesticide use remained high among both APCNF and conventional farmers (73 [49%] of 148 APCNF farmers vs 695 [99%] of 700 conventional farmers; p<0·0001). APCNF farmers had lower pesticide expenditures than conventional farmers (median US$0 [IQR 0-170] for APCNF farmers vs $175 [91-281] for conventional farmers; p=0·0001). Increased frequency of meeting with agricultural extension workers was associated with reduced pesticide use among ACPNF farmers. Seven (18%) of 38 retailers reported a decrease in sales of pesticides in the past 4 years; no difference in the odds of reporting a decrease in pesticide sales in the past 4 years was identified between APCNF retailers and conventional retailers (OR 0·95 [95% CI 0·58-1·57]). INTERPRETATION Despite a major government drive for organic agriculture, about half of APCNF farmers continued to use pesticides and no impact on pesticide sales at local retailers was observed. A combination of policy instruments (eg, bans on highly hazardous pesticides), not solely training for farmers, might be needed to eliminate pesticide use in agriculture. FUNDING Scottish Funding Council and UK Research and Innovation.
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Affiliation(s)
- Lindsay M Jaacks
- Global Academy of Agriculture and Food Security, University of Edinburgh, Edinburgh, UK; Public Health Foundation of India, New Delhi, India; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | | | - Shweta Dabholkar
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
| | - Nikhil Srinivasapura Venkateshmurthy
- Public Health Foundation of India, New Delhi, India; Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA; Centre for Chronic Disease Control, New Delhi, India
| | - Sailesh Mohan
- Public Health Foundation of India, New Delhi, India; Centre for Chronic Disease Control, New Delhi, India
| | - Aditi Roy
- Public Health Foundation of India, New Delhi, India
| | - Poornima Prabhakaran
- Public Health Foundation of India, New Delhi, India; Centre for Chronic Disease Control, New Delhi, India
| | - Barbara Smith
- Centre for Agroecology, Water and Resilience, Coventry University, Coventry, UK
| | - Alfred Gathorne-Hardy
- Global Academy of Agriculture and Food Security, University of Edinburgh, Edinburgh, UK
| | - Divya Veluguri
- Global Academy of Agriculture and Food Security, University of Edinburgh, Edinburgh, UK
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
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13
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Davids R, Scheelbeek P, Sobratee N, Green R, Häesler B, Mabhaudhi T, Chatterjee S, Venkateshmurthy NS, Mace G, Dangour A, Slotow R. Towards the Three Dimensions of Sustainability for International Research Team Collaboration: Learnings from the Sustainable and Healthy Food Systems Research Programme. Sustainability 2021; 13:12427. [PMID: 37692052 PMCID: PMC7615057 DOI: 10.3390/su132212427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
This paper highlights the potential for learning and virtual collaboration in international research teams to contribute towards sustainability goals. Previous research confirmed the environmental benefits of carbon savings from international virtual conferences. This paper adds the social and economic dimensions by using a combination of qualitative and quantitative methods to measure the constraints and benefits for personal development, economic costs, efficiency and team learning of holding international virtual conferences (VCs). Using the Sustainable and Healthy Food Systems (SHEFS) research programme as a case study, we analysed VC participant survey data to identify strengths, weaknesses, opportunities, and threats of VCs. We estimated 'saved' GHG emissions, costs, and time, of using VCs as an alternative for a planned in-person meeting in Chennai, India. Hosting VCs reduced North-South, gender, and researcher inclusivity concerns, financial and travelling time costs, and substantially reduced emissions. For one international meeting with 107 participants, changing to a virtual format reduced the per capita GHG emissions to half the annual global average, and avoided 60% of travel costs. The benefits of VCs outweighed weaknesses. The main strengths were inclusivity and access, with 20% more early/mid-career researchers attending. This study identified opportunities for international research partnerships to mitigate their carbon footprint (environmental benefit) and enhance inclusivity of early/mid-career, women and Global South participants (social benefit), whilst continuing to deliver effective collaborative research meetings (economic benefit). In doing so, we present a holistic view of sustainability opportunities for virtual collaboration.
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Affiliation(s)
- Rashieda Davids
- Centre for Transformative Agricultural and Food Systems, School of Agriculture, Earth and Environmental Sciences, University of KwaZulu-Natal, Pietermaritzburg 3201, KwaZulu-Natal, South Africa
| | - Pauline Scheelbeek
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Nafiisa Sobratee
- Centre for Transformative Agricultural and Food Systems, School of Agriculture, Earth and Environmental Sciences, University of KwaZulu-Natal, Pietermaritzburg 3201, KwaZulu-Natal, South Africa
| | - Rosemary Green
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Barbara Häesler
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London E16 2PX, UK
| | - Tafadzwanashe Mabhaudhi
- Centre for Transformative Agricultural and Food Systems, School of Agriculture, Earth and Environmental Sciences, University of KwaZulu-Natal, Pietermaritzburg 3201, KwaZulu-Natal, South Africa
| | - Suparna Chatterjee
- Ashoka Trust for Research in Ecology and the Environment Royal Enclave, Sriramapura, Jakkur Post, Bangalore 560064, India
| | | | - Georgina Mace
- Department of Genetics, Evolution and Environment, University College London, London WC1E 6BT, UK
| | - Alan Dangour
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Rob Slotow
- Department of Genetics, Evolution and Environment, University College London, London WC1E 6BT, UK
- School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg 3201, KwaZulu-Natal, South Africa
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Venkateshmurthy NS, Potubariki G, Brown KA, Sharma P, Ganpule AR, Prabhakaran D, Mohan S, Knai C. A Photovoice Study to Reveal Community Perceptions of Highly Processed Packaged Foods in India. Ecol Food Nutr 2021; 60:810-825. [PMID: 34632907 PMCID: PMC8642275 DOI: 10.1080/03670244.2021.1968853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
India is experiencing a nutrition transition, with sales of packaged and processed foods rapidly increasing in recent years. This study sought to understand the views and experiences of self-help groups about highly processed, packaged food in Visakhapatnam, India, using the Photovoice method. Participants were able to record, reflect on and critique their environments through participatory analysis, identifying key themes, and offering a critical lens on their food environment and experiences. On an average eight and 14 members participated in the Photovoice workshops held in urban and rural Visakhapatnam respectively. The key themes emerging from the photos and text data are that participants experienced highly processed packaged foods as being: 1) democratic (easily available and consumed by all, affordable and accessible; 2) convenient (easy to prepare) and 3) unhealthy (for human consumption and for environmental sustainability). These data demonstrate the challenges facing public health nutritionists in wishing to shift dietary behaviors to healthy habits: on the surface participants acknowledged their unhealthy characteristics, however these products may now be embedded in dietary culture. Traditional methods for changing dietary habits may not be able to capture the complexity and systems approach is required to explore the most effective entry points for affecting change.
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Affiliation(s)
| | | | - Kerry Ann Brown
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Piyu Sharma
- Centre for Chronic Disease Control, New Delhi, India
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, Gurgaon, India
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sailesh Mohan
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, Gurgaon, India
| | - Cécile Knai
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
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15
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Patel SA, Vashist K, Jarhyan P, Sharma H, Gupta P, Jindal D, Venkateshmurthy NS, Pfadenhauer L, Mohan S, Tandon N. A model for national assessment of barriers for implementing digital technology interventions to improve hypertension management in the public health care system in India. BMC Health Serv Res 2021; 21:1101. [PMID: 34654431 PMCID: PMC8517936 DOI: 10.1186/s12913-021-06999-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 01/30/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is substantial interest in leveraging digital health technology to support hypertension management in low- and middle-income countries such as India. The potential for healthcare infrastructure and broader context to support such initiatives in India has not been examined. We evaluated existing healthcare infrastructure to support digital health interventions and examined epidemiologic, socioeconomic, and geographical contextual correlates of healthcare infrastructure in 544 districts covering 29 states and union territories across India. METHODS The study was a cross-sectional analysis of India's Fourth District Level Household and Facility Survey (DLHS-4; 2012-2014), the most up-to-date nationally representative district-level healthcare infrastructure data. Facilities were the unit of analysis, and analyses accounted for clustering within states. The main outcome was healthcare system infrastructural context to implement hypertension management programs. Domains included diagnostics (functional BP instrument), medications (anti-hypertensive medication in stock), essential clinical staff (e.g., staff nurse, medical officer, pharmacist), and IT specific infrastructure (regular power supply, internet connection, computer availability). Descriptive analysis was conducted for infrastructure indicators based on the Indian Public Health Standards, and logistic regression was conducted to estimate the association between epidemiologic and geographical context (exposures) and the composite measure of healthcare system. RESULTS Data from 32,215 government facilities were analyzed. Among lowest-tier subcenters, 30% had some IT infrastructure, while at the highest-tier district hospitals, 92% possessed IT infrastructure. At mid-tier primary health centres and community health centres, IT infrastructure availability was 28 and 51%, respectively. For all but sub-centres, the availability of essential staff was lower than the availability of IT infrastructure. For all but district hospitals, higher levels of blood pressure, body mass index, and urban residents were correlated with more favorable infrastructure. By region, districts in Western India tended towards having the best prepared health facilities. CONCLUSIONS IT infrastructure to support digital health interventions is more frequently lacking at lower and mid-tier healthcare facilities compared with apex facilities in India. Gaps were generally larger for staffing than physical infrastructure, suggesting that beyond IT infrastructure, shortages in essential staff impose significant constraints to the adoption of digital health interventions. These data provide early benchmarks for state- and district-level planning.
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Affiliation(s)
- Shivani A Patel
- Department of Global Health and Epidemiology, Emory University, Atlanta, USA.
| | - Kushagra Vashist
- Department of Global Health and Epidemiology, Emory University, Atlanta, USA
| | - Prashant Jarhyan
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, Gurgaon, India
| | | | - Priti Gupta
- Centre for Chronic Disease Control, New Delhi, India
| | - Devraj Jindal
- Centre for Chronic Disease Control, New Delhi, India
| | | | - Lisa Pfadenhauer
- Department of Global Health and Epidemiology, Emory University, Atlanta, USA
| | - Sailesh Mohan
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, Gurgaon, India
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
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16
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Hamilton SA, Jarhyan P, Fecht D, Venkateshmurthy NS, Pearce N, Venkat Narayan KM, Ali MK, Mohan V, Tandon N, Prabhakaran D, Mohan S. Environmental risk factors for reduced kidney function due to undetermined cause in India: an environmental epidemiologic analysis. Environ Epidemiol 2021; 5:e170. [PMID: 34934891 PMCID: PMC8683143 DOI: 10.1097/ee9.0000000000000170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/10/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND An epidemic of chronic kidney disease is occurring in rural communities in low-income and middle-income countries that do not share common kidney disease risk factors such as diabetes and hypertension. This chronic kidney disease of unknown etiology occurs primarily in agricultural communities in Central America and South Asia. Consequently, environmental risk factors including heat stress, heavy metals exposure, and low altitude have been hypothesized as risk factors. We conducted an environmental epidemiological analysis investigating these exposures in India which reports the disease. METHODS We used a random sample population in rural and urban sites in Northern and Southern India in 2010, 2011, and 2014 (n = 11,119). We investigated associations of the heat index, altitude, and vicinity to cropland with estimated glomerular filtration rate (eGFR) using satellite-derived data assigned to residential coordinates. We modeled these exposures with eGFR using logistic regression to estimate the risk of low eGFR, and linear mixed models (LMMs) to analyze site-specific eGFR-environment associations. RESULTS Being over 55 years of age, male, and living in proximity to cropland was associated with increased risk of low eGFR [odds ratio (OR) (95% confidence interval (CI) = 2.24 (1.43, 3.56), 2.32 (1.39, 3.88), and 1.47 (1.16, 2.36)], respectively. In LMMs, vicinity to cropland was associated with low eGFR [-0.80 (-0.44, -0.14)]. No associations were observed with temperature or altitude. CONCLUSIONS Older age, being male, and living in proximity to cropland were negatively associated with eGFR. These analyses are important in identifying subcommunities at higher risk and can help direct future environmental investigations.
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Affiliation(s)
- Sophie A. Hamilton
- Department of Epidemiology and Biostatistics, MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
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Singh K, Kaushik A, Johnson L, Jaganathan S, Jarhyan P, Deepa M, Kong S, Venkateshmurthy NS, Kondal D, Mohan S, Anjana RM, Ali MK, Tandon N, Narayan KMV, Mohan V, Eggleston K, Prabhakaran D. Patient experiences and perceptions of chronic disease care during the COVID-19 pandemic in India: a qualitative study. BMJ Open 2021; 11:e048926. [PMID: 34145019 PMCID: PMC8214993 DOI: 10.1136/bmjopen-2021-048926] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE People with chronic conditions are known to be vulnerable to the COVID-19 pandemic. This study aims to describe patients' lived experiences, challenges faced by people with chronic conditions, their coping strategies, and the social and economic impacts of the COVID-19 pandemic. DESIGN, SETTING AND PARTICIPANTS We conducted a qualitative study using a syndemic framework to understand the patients' experiences of chronic disease care, challenges faced during the lockdown, their coping strategies and mitigators during the COVID-19 pandemic in the context of socioecological and biological factors. A diverse sample of 41 participants with chronic conditions (hypertension, diabetes, stroke and cardiovascular diseases) from four sites (Delhi, Haryana, Vizag and Chennai) in India participated in semistructured interviews. All interviews were audio recorded, transcribed, translated, anonymised and coded using MAXQDA software. We used the framework method to qualitatively analyse the COVID-19 pandemic impacts on health, social and economic well-being. RESULTS Participant experiences during the COVID-19 pandemic were categorised into four themes: challenges faced during the lockdown, experiences of the participants diagnosed with COVID-19, preventive measures taken and lessons learnt during the COVID-19 pandemic. A subgroup of participants faced difficulties in accessing healthcare while a few reported using teleconsultations. Most participants reported adverse economic impact of the pandemic which led to higher reporting of anxiety and stress. Participants who tested COVID-19 positive reported experiencing discrimination and stigma from neighbours. All participants reported taking essential preventive measures. CONCLUSION People with chronic conditions experienced a confluence (reciprocal effect) of COVID-19 pandemic and chronic diseases in the context of difficulty in accessing healthcare, sedentary lifestyle and increased stress and anxiety. Patients' lived experiences during the pandemic provide important insights to inform effective transition to a mixed realm of online consultations and 'distanced' physical clinic visits.
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Affiliation(s)
- Kavita Singh
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
- Clinical Research, Centre for Chronic Disease Control, New Delhi, India
| | - Aprajita Kaushik
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
- Clinical Research, Centre for Chronic Disease Control, New Delhi, India
| | - Leslie Johnson
- School of Medicine, Emory University, Atlanta, Georgia, USA
| | | | - Prashant Jarhyan
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - Mohan Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Sandra Kong
- Shorenstein Asia-Pacific Research Center, Stanford University, Stanford, California, USA
| | - Nikhil Srinivasapura Venkateshmurthy
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
- Clinical Research, Centre for Chronic Disease Control, New Delhi, India
| | - Dimple Kondal
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
- Clinical Research, Centre for Chronic Disease Control, New Delhi, India
| | - Sailesh Mohan
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
- Clinical Research, Centre for Chronic Disease Control, New Delhi, India
| | - Ranjit Mohan Anjana
- Department of Epidemiology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Mohammed K Ali
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Nikhil Tandon
- Departement of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - K M Venkat Narayan
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Viswanathan Mohan
- Department of Epidemiology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Karen Eggleston
- Shorenstein Asia-Pacific Research Center, Stanford University, Stanford, California, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
- Clinical Research, Centre for Chronic Disease Control, New Delhi, India
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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18
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Law C, Brown KA, Green R, Venkateshmurthy NS, Mohan S, Scheelbeek PF, Shankar B, Dangour AD, Cornelsen L. Changes in take-home aerated soft drink purchases in urban India after the implementation of Goods and Services Tax (GST): An interrupted time series analysis. SSM Popul Health 2021; 14:100794. [PMID: 33997244 PMCID: PMC8102159 DOI: 10.1016/j.ssmph.2021.100794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Taxes on sugar-sweetened beverages (SSB) are increasingly being implemented as public health interventions to limit the consumption of sugar and reduce associated health risks. In July 2017, India imposed a new tax rate on aerated (carbonated) drinks as part of the Goods and Services Tax (GST) reform. This study investigates the post-GST changes in the purchase of aerated drinks in urban India. METHODS An interrupted time series analysis was conducted on state-level monthly take-home purchases of aerated drinks in urban India from January 2013 to June 2018. We assessed changes in the year-on-year growth rate (i.e. percentage change) in aerated drink purchases with controls for contextual variables. RESULTS We found no evidence of a reduction in state-level monthly take-home aerated drink purchases in urban India following the implementation of GST. Further analysis showed that the year-on-year growth rate in aerated drink purchases increased slightly (0.1 percentage point per month, 95%CI = 0.018, 0.181) after the implementation of GST; however, this trend was temporary and decreased over time (0.008 percentage point per month, 95%CI = -0.015, -0.001). CONCLUSIONS In India, a country currently with low aerated drink consumption, the implementation of GST was not associated with a reduction in aerated drink purchase in urban settings. Due to the lack of accurate and sufficiently detailed price data, it is not possible to say whether this finding is driven by prices not changing sufficiently. Furthermore, the impact of GST reform on industry practice (reformulation, marketing) and individual behaviour choices (substitution) is unknown and warrants further investigation to understand how such taxes could be implemented to deliver public health benefits.
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Affiliation(s)
- Cherry Law
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
- (Honorary) College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
| | - Kerry Ann Brown
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Rosemary Green
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Nikhil Srinivasapura Venkateshmurthy
- Centre for Chronic Disease Control, C1/52, 2nd Floor, Safdarjung Development Area, New Delhi, 110016, India
- Public Health Foundation of India, Plot 47, Sector 44, Institutional Area Gurugram, 122002, India
| | - Sailesh Mohan
- Centre for Chronic Disease Control, C1/52, 2nd Floor, Safdarjung Development Area, New Delhi, 110016, India
- Public Health Foundation of India, Plot 47, Sector 44, Institutional Area Gurugram, 122002, India
- Centre for Chronic Conditions and Injuries (CCCI), Plot 47, Sector 44, NCR, Gurgaon, Haryana, 122002, India
| | - Pauline F.D. Scheelbeek
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Bhavani Shankar
- Institute for Sustainable Food and Department of Geography, University of Sheffield, Winter St, Sheffield, S3 7ND, UK
| | - Alan D. Dangour
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Laura Cornelsen
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
- (Honorary) College of Medicine and Health, University of Exeter, Exeter, EX1 2LU, UK
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Singh K, Bawa VS, Venkateshmurthy NS, Gandral M, Sharma S, Lodhi S, Wafford QE, Patel SA, Tandon N, Narayan KMV, Prabhakaran D, Huffman MD. Assessment of Studies of Quality Improvement Strategies to Enhance Outcomes in Patients With Cardiovascular Disease. JAMA Netw Open 2021; 4:e2113375. [PMID: 34125220 PMCID: PMC8204210 DOI: 10.1001/jamanetworkopen.2021.13375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Clinical care quality improvement (QI) strategies are critical to prevent and control cardiovascular disease (CVD). However, there is limited evidence regarding which components of the health system-, clinician-, and patient-based QI strategies contribute to their impact on CVD. OBJECTIVES To identify, map, and organize evidence on the effectiveness and implementation of cardiovascular QI strategies that seek to improve outcomes in patients with CVD. EVIDENCE REVIEW Eight electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library, ProQuest, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform) were searched for studies published between January 1, 2009, and October 25, 2019. Eligible study designs included randomized trials and preintervention and postintervention evaluations. Descriptive findings of included studies were reported using several frameworks to map the intervention components stratified by target population, setting, outcomes, and overall results. FINDINGS From 8066 screened titles and abstracts, 456 unique studies with 150 148 unique patients (38.1% women and 61.9% men; mean [SD] age, 64.6 [7.1] years) were identified, including 427 randomized trials, 21 quasi-randomized studies, and 8 preintervention and postintervention studies. Of 336 studies from 45 countries that were classified, 255 (75.9%) were from high-income countries; 68 (20.2%), upper-middle-income countries; 13 (3.9%), lower-middle-income countries; and 0, low-income countries, with diverse clinical settings and target patient populations (post-myocardial infarction, stroke, heart failure). Patient support (311 studies), information communication technology (ICT) for health (78 studies), community support (18 studies), supervision (15 studies), and high-intensity training (14 studies) were the most commonly evaluated QI strategies. Other strategies were group problem-solving (7 studies), printed information (5 studies), strengthening infrastructure (4 studies), and financial incentives (3 studies). Patient support, ICT for health, training, and community support were strategies that had been evaluated the most for clinical end points and showed modest associations with several clinical outcomes. The other strategies did not have outcome-driven evaluations reported. Group problem-solving was associated with improved patient self-care and quality of life. Strengthening infrastructure was associated with improved treatment satisfaction. Printed information and financial incentives showed no meaningful effect. CONCLUSIONS AND RELEVANCE This systematic review found that substantial variations exist in the types, effectiveness, and implementation of QI strategies for patients with CVD. A comprehensive map of QI strategies created by this study would be useful for researchers to identify where new knowledge is needed to improve cardiovascular outcomes. Outcome-driven evaluations and long-term studies are needed, particularly in low-income settings, to better understand the effects of QI strategies on prevention and control of CVD.
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Affiliation(s)
- Kavita Singh
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Vidit Singh Bawa
- Indian Institute of Public Health, Delhi, Public Health Foundation of India, Gurugram, India
| | - Nikhil Srinivasapura Venkateshmurthy
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Mareesha Gandral
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India
| | - Shuchita Sharma
- Indian Institute of Public Health, Delhi, Public Health Foundation of India, Gurugram, India
| | - Sugandha Lodhi
- Indian Institute of Public Health, Delhi, Public Health Foundation of India, Gurugram, India
| | - Q. Eileen Wafford
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Shivani A. Patel
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Mark D. Huffman
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- The George Institute for Global Health, University of New South Wales, Kensington, Sydney, Australia
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20
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Singh K, Kondal D, Mohan S, Jaganathan S, Deepa M, Venkateshmurthy NS, Jarhyan P, Anjana RM, Narayan KMV, Mohan V, Tandon N, Ali MK, Prabhakaran D, Eggleston K. Health, psychosocial, and economic impacts of the COVID-19 pandemic on people with chronic conditions in India: a mixed methods study. BMC Public Health 2021; 21:685. [PMID: 33832478 PMCID: PMC8027966 DOI: 10.1186/s12889-021-10708-w] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [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: 12/07/2020] [Accepted: 03/24/2021] [Indexed: 02/07/2023] Open
Abstract
Background People with chronic conditions are disproportionately prone to be affected by the COVID-19 pandemic but there are limited data documenting this. We aimed to assess the health, psychosocial and economic impacts of the COVID-19 pandemic on people with chronic conditions in India. Methods Between July 29, to September 12, 2020, we telephonically surveyed adults (n = 2335) with chronic conditions across four sites in India. Data on participants’ demographic, socio-economic status, comorbidities, access to health care, treatment satisfaction, self-care behaviors, employment, and income were collected using pre-tested questionnaires. We performed multivariable logistic regression analysis to examine the factors associated with difficulty in accessing medicines and worsening of diabetes or hypertension symptoms. Further, a diverse sample of 40 participants completed qualitative interviews that focused on eliciting patient’s experiences during the COVID-19 lockdowns and data analyzed using thematic analysis. Results One thousand seven hundred thirty-four individuals completed the survey (response rate = 74%). The mean (SD) age of respondents was 57.8 years (11.3) and 50% were men. During the COVID-19 lockdowns in India, 83% of participants reported difficulty in accessing healthcare, 17% faced difficulties in accessing medicines, 59% reported loss of income, 38% lost jobs, and 28% reduced fruit and vegetable consumption. In the final-adjusted regression model, rural residence (OR, 95%CI: 4.01,2.90–5.53), having diabetes (2.42, 1.81–3.25) and hypertension (1.70,1.27–2.27), and loss of income (2.30,1.62–3.26) were significantly associated with difficulty in accessing medicines. Further, difficulties in accessing medicines (3.67,2.52–5.35), and job loss (1.90,1.25–2.89) were associated with worsening of diabetes or hypertension symptoms. Qualitative data suggest most participants experienced psychosocial distress due to loss of job or income and had difficulties in accessing in-patient services. Conclusion People with chronic conditions, particularly among poor, rural, and marginalized populations, have experienced difficulties in accessing healthcare and been severely affected both socially and financially by the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10708-w.
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Affiliation(s)
- Kavita Singh
- Public Health Foundation of India, Plot number 47, Sector 44, Gurugram, New Delhi, Haryana, 122002, India. .,Centre for Chronic Disease Control, New Delhi, India.
| | - Dimple Kondal
- Public Health Foundation of India, Plot number 47, Sector 44, Gurugram, New Delhi, Haryana, 122002, India
| | - Sailesh Mohan
- Public Health Foundation of India, Plot number 47, Sector 44, Gurugram, New Delhi, Haryana, 122002, India.,Centre for Chronic Disease Control, New Delhi, India.,Deakin University, Melbourne, Australia
| | | | - Mohan Deepa
- Madras Diabetes Research Foundation, Chennai, India
| | - Nikhil Srinivasapura Venkateshmurthy
- Public Health Foundation of India, Plot number 47, Sector 44, Gurugram, New Delhi, Haryana, 122002, India.,Centre for Chronic Disease Control, New Delhi, India
| | - Prashant Jarhyan
- Public Health Foundation of India, Plot number 47, Sector 44, Gurugram, New Delhi, Haryana, 122002, India
| | | | | | | | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Dorairaj Prabhakaran
- Public Health Foundation of India, Plot number 47, Sector 44, Gurugram, New Delhi, Haryana, 122002, India.,Centre for Chronic Disease Control, New Delhi, India.,London School of Hygiene and Tropical Medicine, London, UK
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21
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Abstract
In recent decades low- and middle-income countries (LMICs) have been witnessing a significant shift toward raised blood pressure; yet in LMICs, only 1 in 3 are aware of their hypertension status, and ≈8% have their blood pressure controlled. This rising burden widens the inequality gap, contributes to massive economic hardships of patients and carers, and increases costs to the health system, facing challenges such as low physician-to-patient ratios and lack of access to medicines. Established risk factors include unhealthy diet (high salt and low fruit and vegetable intake), physical inactivity, tobacco and alcohol use, and obesity. Emerging risk factors include pollution (air, water, noise, and light), urbanization, and a loss of green space. Risk factors that require further in-depth research are low birth weight and social and commercial determinants of health. Global actions include the HEARTS technical package and the push for universal health care. Promising research efforts highlight that successful interventions are feasible in LMICs. These include creation of health-promoting environments by introducing salt-reduction policies and sugar and alcohol tax; implementing cost-effective screening and simplified treatment protocols to mitigate treatment inertia; pooled procurement of low-cost single-pill combination therapy to improve adherence; increasing access to telehealth and mHealth (mobile health); and training health care staff, including community health workers, to strengthen team-based care. As the blood pressure trajectory continues creeping upward in LMICs, contextual research on effective, safe, and cost-effective interventions is urgent. New emergent risk factors require novel solutions. Lowering blood pressure in LMICs requires urgent global political and scientific priority and action.
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Affiliation(s)
- Aletta E Schutte
- School of Population Health, University of New South Wales, Sydney, Australia (A.E.S.).,George Institute for Global Health, Sydney, NSW, Australia (A.E.S.).,Hypertension in Africa Research Team, MRC Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S.)
| | - Nikhil Srinivasapura Venkateshmurthy
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon (N.S.V., S.M., D.P.).,Centre for Chronic Disease Control, New Delhi, India (N.S.V., S.M., D.P.).,School of Exercise and Nutrition Sciences (N.S.V.), Deakin University, Burwood, VIC, Australia
| | - Sailesh Mohan
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon (N.S.V., S.M., D.P.).,Centre for Chronic Disease Control, New Delhi, India (N.S.V., S.M., D.P.).,Faculty of Health (S.M.), Deakin University, Burwood, VIC, Australia
| | - Dorairaj Prabhakaran
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon (N.S.V., S.M., D.P.).,Centre for Chronic Disease Control, New Delhi, India (N.S.V., S.M., D.P.).,Department of Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom (D.P.)
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22
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Venkateshmurthy NS, Mohan S, Singh K, Prabhakran D, Huffman MD. Implementation Research to Improve Cardiovascular Disease Management in India's Heterogeneous Primary Healthcare System. Natl Med J India 2021; 33:65-68. [PMID: 33753632 DOI: 10.4103/0970-258x.310986] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Sailesh Mohan
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, Gurgaon, India; Deakin University, Burwood, Victoria, Australia
| | - Kavita Singh
- Centre for Chronic Disease Control, New Delhi, India
| | - Dorairaj Prabhakran
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, Gurgaon, India; Department of Epidemiology London School of Hygiene and Tropical Medicine, UK
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA; Food Policy Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
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23
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Brown KA, Srinivasapura Venkateshmurthy N, Law C, Harris F, Kadiyala S, Shankar B, Mohan S, Prabhakaran D, Knai C. Moving towards sustainable food systems: A review of Indian food policy budgets. Glob Food Sec 2021; 28:100462. [PMID: 33738184 PMCID: PMC7941605 DOI: 10.1016/j.gfs.2020.100462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/25/2020] [Accepted: 11/15/2020] [Indexed: 11/23/2022]
Abstract
Moving towards sustainable food systems is a complex problem, which requires high level co-ordination, coherence, and integration of national food policy. The aim of this study is to explore where environmental sustainability is integrated into national food policy in India. A scoping review of food policies was conducted, and findings mapped to ministerial responsibility, estimated budget allocation, and relevant Sustainable Development Goals. Fifty-two policies were identified, under the responsibility of 10 ministries, and with relevance to six Sustainable Development Goals. Content analysis identified references to environmental sustainability were concentrated in policies with the smallest budgetary allocation. Resources together with political will are required to integrate environmental sustainability into food policies and avoid conflicts with more well-established health, societal, and economic priorities.
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Affiliation(s)
- Kerry Ann Brown
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Cherry Law
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Francesca Harris
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical, London, UK
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Bhavani Shankar
- Institute for Sustainable Food, University of Sheffield, Sheffield, UK
| | - Sailesh Mohan
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, Gurgaon, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, Gurgaon, India
| | - Cécile Knai
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
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24
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Shankar S. U, Kumar AMV, Venkateshmurthy NS, Nair D, Kingsbury R, R. P, Velu M, P. S, Gupta J, Ahmed J, G. P, Hiremath S, Jaiswal RK, Kokkad RJ, N. S. Implementation of the new integrated algorithm for diagnosis of drug-resistant tuberculosis in Karnataka State, India: How well are we doing? PLoS One 2021; 16:e0244785. [PMID: 33406153 PMCID: PMC7787455 DOI: 10.1371/journal.pone.0244785] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/16/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As per national policy, all diagnosed tuberculosis patients in India are to be tested using Xpert® MTB/RIF assay at the district level to diagnose rifampicin resistance. Regardless of the result, samples are transported to the reference laboratories for further testing: first-line Line Probe Assay (FL-LPA) for rifampicin-sensitive samples and second-line LPA(SL-LPA) for rifampicin-resistant samples. Based on the results, samples undergo culture and phenotypic drug susceptibility testing. We assessed among patients diagnosed with tuberculosis at 13 selected Xpert laboratories of Karnataka state, India, i) the proportion whose samples reached the reference laboratories and among them, proportion who completed the diagnostic algorithm ii) factors associated with non-reaching and non-completion and iii) the delays involved. METHODS This was a cohort study involving review of programme records. For each TB patient diagnosed between 1st July and 31st August 2018 at the Xpert laboratory, we tracked the laboratory register at the linked reference laboratory until 30th September (censor date) using Nikshay ID (a unique patient identifier), phone number, name, age and sex. RESULTS Of 1660 TB patients, 1208(73%) samples reached the reference laboratories and among those reached, 1124(93%) completed the algorithm. Of 1590 rifampicin-sensitive samples, 1170(74%) reached and 1104(94%) completed the algorithm. Of 64 rifampicin-resistant samples, only 35(55%) reached and 17(49%) completed the algorithm. Samples from rifampicin-resistant TB, extra-pulmonary TB and two districts were less likely to reach the reference laboratory. Non-completion was more likely among rifampicin-resistant TB and sputum-negative samples. The median time for conducting and reporting results of Xpert® MTB/RIF was one day, of FL-LPA 5 days and of SL-LPA16 days. CONCLUSION These findings are encouraging given the complexity of the algorithm. High non-reaching and non-completion rates in rifampicin-resistant patients is a major concern. Future research should focus on understanding the reasons for the gaps identified using qualitative research methods.
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Affiliation(s)
- Uma Shankar S.
- National Tuberculosis Institute, Bangalore, India
- * E-mail: ,
| | - Ajay M. V. Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India
| | | | - Divya Nair
- The INCLEN Trust International, New Delhi, India
| | | | - Padmesha R.
- National Tuberculosis Institute, Bangalore, India
| | - Magesh Velu
- National Tuberculosis Institute, Bangalore, India
| | - Suganthi P.
- National Tuberculosis Institute, Bangalore, India
| | - Joydev Gupta
- National Tuberculosis Institute, Bangalore, India
| | - Jameel Ahmed
- National Tuberculosis Institute, Bangalore, India
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25
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Bradshaw C, Kondal D, Montez-Rath ME, Han J, Zheng Y, Shivashankar R, Gupta R, Srinivasapura Venkateshmurthy N, Jarhyan P, Mohan S, Mohan V, Ali MK, Patel S, Narayan KMV, Tandon N, Prabhakaran D, Anand S. Early detection of chronic kidney disease in low-income and middle-income countries: development and validation of a point-of-care screening strategy for India. BMJ Glob Health 2019; 4:e001644. [PMID: 31544000 PMCID: PMC6730594 DOI: 10.1136/bmjgh-2019-001644] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/12/2019] [Accepted: 07/29/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Although deaths due to chronic kidney disease (CKD) have doubled over the past two decades, few data exist to inform screening strategies for early detection of CKD in low-income and middle-income countries. METHODS Using data from three population-based surveys in India, we developed a prediction model to identify a target population that could benefit from further CKD testing, after an initial screening implemented during home health visits. Using data from one urban survey (n=8698), we applied stepwise logistic regression to test three models: one comprised of demographics, self-reported medical history, anthropometry and point-of-care (urine dipstick or capillary glucose) tests; one with demographics and self-reported medical history and one with anthropometry and point-of-care tests. The 'gold-standard' definition of CKD was an estimated glomerular filtration rate <60 mL/min/1.73 m2 or urine albumin-to-creatinine ratio ≥30 mg/g. Models were internally validated via bootstrap. The most parsimonious model with comparable performance was externally validated on distinct urban (n=5365) and rural (n=6173) Indian cohorts. RESULTS A model with age, sex, waist circumference, body mass index and urine dipstick had a c-statistic of 0.76 (95% CI 0.75 to 0.78) for predicting need for further CKD testing, with external validation c-statistics of 0.74 and 0.70 in the urban and rural cohorts, respectively. At a probability cut-point of 0.09, sensitivity was 71% (95% CI 68% to 74%) and specificity was 70% (95% CI 69% to 71%). The model captured 71% of persons with CKD and 90% of persons at highest risk of complications from untreated CKD (ie, CKD stage 3A2 and above). CONCLUSION A point-of-care CKD screening strategy using three simple measures can accurately identify high-risk persons who require confirmatory kidney function testing.
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Affiliation(s)
- Christina Bradshaw
- Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA
| | - Dimple Kondal
- Public Health Foundation of India, New Delhi, Delhi, India
- Centre for Chronic Disease Control, Gurgaon, Haryana, India
| | - Maria E Montez-Rath
- Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA
| | - Jialin Han
- Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA
| | - Yuanchao Zheng
- Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA
| | | | - Ruby Gupta
- Public Health Foundation of India, New Delhi, Delhi, India
| | | | | | - Sailesh Mohan
- Public Health Foundation of India, New Delhi, Delhi, India
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Mohammed K Ali
- Department of Global Health, Emory University School of Public Health, Atlanta, Georgia, USA
| | - Shivani Patel
- Department of Global Health, Emory University School of Public Health, Atlanta, Georgia, USA
| | - K M Venkat Narayan
- Department of Global Health, Emory University School of Public Health, Atlanta, Georgia, USA
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi, Delhi, India
- Centre for Chronic Disease Control, Gurgaon, Haryana, India
| | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA
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Srinivasapura Venkateshmurthy N, Mc Namara K, Koorts H, Mohan S, S Ajay V, Jindal D, Malipeddi BR, Roy A, Tandon N, Prabhakaran D, Worsley T, Maddison R, O’Reilly S. Process evaluation protocol for a cluster randomised trial of a complex, nurse-led intervention to improve hypertension management in India. BMJ Open 2019; 9:e027841. [PMID: 31110103 PMCID: PMC6530308 DOI: 10.1136/bmjopen-2018-027841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION India has high prevalence of hypertension but low awareness, treatment and control rate. A cluster randomised trial entitled 'm-Power Heart Project' is being implemented to test the effectiveness of a nurse care coordinator (NCC) led complex intervention to address uncontrolled hypertension in the community health centres (CHCs). The trial's process evaluation will assess the fidelity and quality of implementation, clarify the causal mechanisms and identify the contextual factors associated with variation in the outcomes. The trial will use a theory-based mixed-methods process evaluation, guided by the Consolidated Framework for Implementation Research. METHODS AND ANALYSIS The process evaluation will be conducted in the CHCs of Visakhapatnam (southern India). The key stakeholders involved in the intervention development and implementation will be included as participants. In-depth interviews will be conducted with intervention developers, doctors, NCCs and health department officials and focus groups with patients and their caregivers. NCC training will be evaluated using Kirkpatrick's model for training evaluation. Key process evaluation indicators (number of patients recruited and retained; concordance between the treatment plans generated by the electronic decision support system and treatment prescribed by the doctor and so on) will be assessed. Fidelity will be assessed using Borrelli et al's framework. Qualitative data will be analysed using the template analysis technique. Quantitative data will be summarised as medians (IQR), means (SD) and proportions as appropriate. Mixed-methods analysis will be conducted to assess if the variation in the mean reduction of systolic blood pressure between the intervention CHCs is influenced by patient satisfaction, training outcome, attitude of doctors, patients and NCCs about the intervention, process indicators etc. ETHICS AND DISSEMINATION: Ethical approval for this study was obtained from the ethics committees at Public Health Foundation of India and Deakin University. Findings will be disseminated via peer-reviewed publications, national and international conference presentations. TRIAL REGISTRATION NUMBER NCT03164317; Pre-results.
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Affiliation(s)
- Nikhil Srinivasapura Venkateshmurthy
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Kevin Mc Namara
- School of Medicine, Deakin University, Burwood, Victoria, Australia
| | - Harriet Koorts
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Sailesh Mohan
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
| | | | - Devraj Jindal
- Centre for Chronic Disease Control, New Delhi, Delhi, India
| | | | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Tony Worsley
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Ralph Maddison
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Sharleen O’Reilly
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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Venkateshmurthy NS, Geldsetzer P, Jaacks LM, Prabhakaran D. Implications of the New American College of Cardiology Guidelines for Hypertension Prevalence in India. JAMA Intern Med 2018; 178:1416-1418. [PMID: 30083722 PMCID: PMC6233754 DOI: 10.1001/jamainternmed.2018.3511] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Indexed: 12/28/2022]
Abstract
This study analyzes whether the lowered blood pressure threshold for hypertension in the 2017 American College of Cardiology/American Heart Association guidelines vs the JNC7 guidelines are associated with diagnosis prevalence of hypertension among adults in India.
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Affiliation(s)
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Srinivasapura Venkateshmurthy N, Soundappan K, Gummidi B, Bhaskara Rao M, Tandon N, Reddy KS, Prabhakaran D, Mohan S. Are people at high risk for diabetes visiting health facility for confirmation of diagnosis? A population-based study from rural India. Glob Health Action 2018; 11:1416744. [PMID: 29334333 PMCID: PMC5769807 DOI: 10.1080/16549716.2017.1416744] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: India is witnessing a rising burden of type 2 diabetes mellitus. India’s National Programme for Prevention and Control of Diabetes, Cancer, Cardiovascular diseases and Stroke recommends population-based screening and referral to primary health centre for diagnosis confirmation and treatment initiation. However, little is known about uptake of confirmatory tests among screen positives. Objective: To estimate the uptake of confirmatory tests and identify the reasons for not undergoing confirmation by those at high risk for developing diabetes. Methods: We analysed data collected under project UDAY, a comprehensive diabetes and hypertension prevention and management programme, being implemented in rural Andhra Pradesh, India. Under UDAY, population-based screening for diabetes was carried out by project health workers using a diabetes risk score and capillary blood glucose test. Participants at high risk for diabetes were asked to undergo confirmatory tests. On follow-up visit, health workers assessed if the participant had undergone confirmation and ask for reasons if not so. Results: Of the 35,475 eligible adults screened between April 2015 and August 2016, 10,960 (31%) were determined to be at high risk. Among those at high risk, 9670 (88%) were followed up, and of those, only 616 (6%) underwent confirmation. Of those who underwent confirmation, ‘lack of symptoms of diabetes warranting visit to health facility’ (52%) and ‘being at high risk was not necessary enough to visit’ (41%) were the most commonly reported reasons for non-confirmation. Inconvenient facility time (4.4%), no nearby facility (3.2%), un-affordability (2.2%) and long waiting time (1.6%) were the common health system-related factors that affected the uptake of the confirmatory test. Conclusion: Confirmation of diabetes was abysmally low in the study population. Low uptake of the confirmatory test might be due to low ‘risk perception’. The uptake can be increased by improving the population risk perception through individual and/or community-focused risk communication interventions.
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Affiliation(s)
| | - Kathirvel Soundappan
- b Department of Community Medicine, School of Public Health , Post Graduate Institute for Medical Education and Research , Chandigarh , India
| | | | | | - Nikhil Tandon
- d Department of Endocrinology and Metabolism , All India Institute of Medical Sciences , New Delhi , India
| | | | - Dorairaj Prabhakaran
- a Public Health Foundation of India , Gurgaon , India.,e Centre for Chronic Disease Control , Gurgaon , India
| | - Sailesh Mohan
- a Public Health Foundation of India , Gurgaon , India
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Srinivasapura Venkateshmurthy N, Ajay VS, Mohan S, Jindal D, Anand S, Kondal D, Tandon N, Rao MB, Prabhakaran D. m-Power Heart Project - a nurse care coordinator led, mHealth enabled intervention to improve the management of hypertension in India: study protocol for a cluster randomized trial. Trials 2018; 19:429. [PMID: 30086778 PMCID: PMC6081824 DOI: 10.1186/s13063-018-2813-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 08/03/2017] [Accepted: 07/18/2018] [Indexed: 12/21/2022] Open
Abstract
Background The proportion of patients with controlled hypertension (< 140/90 mmHg) is very low in India. Thus, there is a need to improve blood pressure management among patients with uncontrolled hypertension through innovative strategies directed at health system strengthening. Methods We designed an intervention consisting of two important components – an electronic decision support system (EDSS) used by a trained nurse care coordinator (NCC). Based on preliminary data, we hypothesized that this intervention will be able to reduce mean systolic blood pressure by 6.5 mmHg among those with uncontrolled blood pressure in the intervention arm compared to the standard treatment arm (paper-based hypertension treatment guidelines). The study will adopt a cluster randomized trial design with the community health center (CHC) as the unit of randomization. The trial will be conducted in Visakhapatnam district (southern India). A total of 1876 participants aged ≥30 years with high blood pressure – systolic blood pressure (SBP) ≥ 160 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg will be enrolled from 12 CHCs. The intervention consists of trained NCCs equipped with an evidence-based hypertension treatment algorithm in the form of the EDSS with regular SMSs to patients with hypertension to promote hypertension treatment and blood pressure control for 12 months. The primary outcome will be difference in the mean change of SBP, from baseline to 12 months, between the intervention and the standard treatment arm. The secondary outcomes are the difference in mean change of DBP; difference in the proportion of patients with controlled blood pressure (< 140/90 mmHg); difference in mean change of fasting blood sugar, HbA1C, eGFR, and albumin to creatinine ratio; difference in the proportion of patients visiting the CHC regularly (number of actual visits to the CHC/number of visits suggested by the EDSS > 80%); difference in proportion of patients compliant to anti-hypertensive medication/s; cost-effectiveness of intervention versus enhanced care. All the outcomes will be assessed at 12 months. Discussion The study is expected to provide evidence on the effectiveness of NCC-led, EDSS-based hypertension management in India and can likely offer an exemplar for improving cardiovascular disease (CVD) management in India within the resource-constrained public healthcare system. Trial registration ClinicalTrials.gov, ID: NCT03164317). Registered retrospectively on 23 May 2017 (first patient enrolled on 6 April 2017) because the authors did not receive a response to their original registration submission (5 January 2017) to the Clinical Trial Registry – India (CTRI). Electronic supplementary material The online version of this article (10.1186/s13063-018-2813-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Vamadevan S Ajay
- Center for Chronic Disease Control, C-1/52, 2nd Floor, Safdarjung Development Area, New Delhi, India
| | - Sailesh Mohan
- Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, India
| | - Devraj Jindal
- Center for Chronic Disease Control, C-1/52, 2nd Floor, Safdarjung Development Area, New Delhi, India
| | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Dimple Kondal
- Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | | | - Dorairaj Prabhakaran
- Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, India. .,Center for Chronic Disease Control, C-1/52, 2nd Floor, Safdarjung Development Area, New Delhi, India.
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Mohan S, Jarhyan P, Ghosh S, Venkateshmurthy NS, Gupta R, Rana R, Malhotra C, Rao MB, Kalra S, Tandon N, Srinath Reddy K, Prabhakaran D. UDAY: A comprehensive diabetes and hypertension prevention and management program in India. BMJ Open 2018; 8:e015919. [PMID: 29991625 PMCID: PMC6082491 DOI: 10.1136/bmjopen-2017-015919] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Diabetes and hypertension are two leading non-communicable conditions, which are suboptimally managed in India. Thus, innovative comprehensive approaches that can concomitantly improve their detection, prevention and control are warranted. METHODS AND ANALYSIS UDAY, a 5-year initiative, aims to reduce the risk of diabetes and hypertension and improve management by implementing a comprehensive intervention programme in the two selected study sites, Sonipat and Visakhapatnam (Vizag). It has a pre-post evaluation design with representative cross-sectional surveys before and after intervention. Within these two sites, urban and rural subsites each with a total population of approximately 100 000 people each were selected and a baseline and postintervention assessment was conducted deploying five surveys [among general population (including body measurements or biosamples), patients, healthcare providers including physicians and pharmacists, health facilities], which will determine the knowledge levels about diabetes and hypertension, the proportion treated and controlled; the patient knowledge and self-management skills; healthcare providers' management practices; the level of access and barriers to obtaining care.The interventions will include: tailored health promotion for improving public knowledge; screening of adults aged ≥ 30 years for identifying those at high risk of diabetes and/or hypertension for linkage to the healthcare system; patient education using technology enabled community health workers, geographic information system (GIS) based mapping of the communities, healthcare provider training on management guidelines, community based diabetes registry and; advocacy to improve access to healthcare. The baseline surveys have been completed, the study areas mapped using GIS and the interventions are being implemented. UDAY is expected to increase over baseline the levels of: public knowledge about diabetes and hypertension; those treated and controlled; patient self-management skills; the use of guideline based management by providers and; access to healthcare, leading to improved health outcomes and inform development of a India relevant chronic care model. ETHICS AND DISSEMINATION Ethical clearance for conduct of the study was obtained from the Institutional Ethics Committee (IEC) of the Public Health Foundation of India. The findings will be targeted primarily at public health policymakers and advocates, but will be disseminated widely through other mechanisms including conference presentations and peer-reviewed publications, as well as to the participating communities.
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Affiliation(s)
- Sailesh Mohan
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Prashant Jarhyan
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Shreeparna Ghosh
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
| | | | - Ruby Gupta
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Ritu Rana
- Population Services International, New Delhi, Delhi, India
| | | | | | | | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - K Srinath Reddy
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
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