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Campbell SJ, Shanmugasundaram D, Ganguly S, Sehgal R, Karmakar S, Sanga P, Stephen HN, Kaur H, Kihara J, Minnery M, Nath S, Sen S, Bundy DA, Mishra N, Batra G, Shah H, Balasubramaniam S, Dutta S, Khera A, Murhekar M. Low Prevalence of Soil-Transmitted Helminth Infections among Children in the States of Chhattisgarh and Himachal Pradesh, India, 2018. Am J Trop Med Hyg 2023; 109:820-829. [PMID: 37604473 PMCID: PMC10551095 DOI: 10.4269/ajtmh.23-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/17/2023] [Indexed: 08/23/2023] Open
Abstract
Large-scale impact assessments of soil-transmitted helminth (STH) programs are essential for determining the frequency of mass drug administration (MDA). In baseline surveys, the prevalence of STHs in the Indian States of Chhattisgarh and Himachal Pradesh was 80.2% in 2015 and 29.0% in 2016, respectively. In 2018, we estimated the prevalence and intensity of STHs after six rounds of biannual MDA in Chhattisgarh and annual MDA in Himachal Pradesh. We conducted multistage cluster sampling surveys in preschool-age children (PSAC), school-age children (SAC), and adolescent cohorts. Stool samples from 3,033 respondents (PSAC, n = 625; SAC, n = 1,363; adolescents, n = 1,045) in Chhattisgarh and 942 respondents (PSAC, n = 192; SAC, n = 388; adolescents, n = 362) in Himachal Pradesh were examined for presence of STH infection using the Kato-Katz method. The overall cluster-adjusted prevalence in Chhattisgarh was 11.6% among all age groups (95% CI, 5.6-22.4)-an 85.5% reduction in the prevalence since 2015. Prevalence was not significantly different across cohorts (PSAC, 11.0% [95% CI, 5.0-22.6]; SAC, 10.9% [95% CI, 5.2-21.6]; adolescents, 12.8% [95% CI, 6.2-24.5]). Ascaris lumbricoides was the most common helminth, with most infections of light intensity. In Himachal Pradesh, only three STH infections were detected in 2018, resulting in a cluster-adjusted prevalence of 0.3% (95% CI, 0.1-1.7)-a 99.0% reduction in prevalence since 2016. All infections were of light intensity. Both states showed substantial improvements in socioeconomic and water, sanitation, and hygiene (WASH) indicators since the baseline surveys. Extensive reductions in prevalence and intensity are linked to sustained, high deworming coverage, as well as socioeconomic WASH indicators.
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Affiliation(s)
- Suzy J. Campbell
- Deworm the World Initiative, Evidence Action, Brisbane, Australia
| | | | - Sandipan Ganguly
- Indian Council of Medical Research–National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Rakesh Sehgal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sumallya Karmakar
- Indian Council of Medical Research–National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Prerna Sanga
- Model Resource Services Private Limited, Kolkata, India
| | | | - Hargobinder Kaur
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jimmy Kihara
- Kenya Medical Research Institute, Kenya, South Africa
| | - Mark Minnery
- Deworm the World Initiative, Evidence Action, Brisbane, Australia
| | - Srabani Nath
- Deworm the World Initiative, Evidence Action, New Delhi, India
| | - Shrabanti Sen
- Deworm the World Initiative, Evidence Action, New Delhi, India
| | - Donald A. Bundy
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Neeraj Mishra
- Deworm the World Initiative, Evidence Action, New Delhi, India
| | - Gunjan Batra
- Deworm the World Initiative, Evidence Action, New Delhi, India
| | - Hemang Shah
- Children’s Investment Fund Foundation, New Delhi, India
| | | | - Shanta Dutta
- Indian Council of Medical Research–National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Ajay Khera
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Manoj Murhekar
- Indian Council of Medical Research–National Institute of Epidemiology, Chennai, India
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2
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Aruldas K, Dawson K, Saxena M, Titus A, Johnson J, Gwayi-Chore MC, Muliyil J, Kang G, Walson JL, Khera A, Ajjampur SSR, Means AR. Evaluation of opportunities to implement community-wide mass drug administration for interrupting transmission of soil-transmitted helminths infections in India. PLoS Negl Trop Dis 2023; 17:e0011176. [PMID: 36897877 PMCID: PMC10004831 DOI: 10.1371/journal.pntd.0011176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/15/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND The World Health Organization Neglected Tropical Disease (NTD) guidelines recommend control of soil transmitted helminth (STH)-associated morbidity with targeted deworming of preschool and school-aged children who are disproportionately affected by STH-associated morbidity. However, this strategy leaves many adults untreated and reinfection within communities perpetuates transmission even when mass drug administration (MDA) coverage of children is high. Evidence suggests that it may be possible to interrupt STH transmission by expanding MDA to a community-wide MDA (cMDA). METHODS This multi-methods study of organizational readiness survey, key informant interviews, and program mapping, were conducted with government stakeholders in three Indian states, Goa, Sikkim, and Odisha, to assess readiness of the states for transitioning from school-based MDA to cMDA and identify opportunities to leverage existing infrastructure from other NTD programs like lymphatic filariasis (LF) for STH cMDA. PRINCIPAL FINDINGS Overall, all three states indicated a highly favorable policy environment, effective leadership structure, adequate material resources, demonstrated technical capacity, and adequate community infrastructure needed to launch a STH cMDA program. The findings indicated a high-level of health system readiness to implement provided human resources and financial resources to deliver cMDA is strengthened. Areas with a significant overlap between LF and STH MDA platforms, particularly at the community-level, may be best primed for transitioning. Immunization, maternal child health, and non-communicable disease control programs were the other programs for possible integration of cMDA. States indicated having effective leadership structures in place at the state-level, however, engaging local leaders and community groups were considered crucial for successful implementation of cMDA. In-migration was a perceived challenge for estimating drug requirement and preventing possible stockouts. CONCLUSIONS Findings from this study are intended to proactively support government decision making, prioritization, and program planning across heterogenous implementation contexts in India to speed the translation of research findings into practice. CLINICAL TRIAL REGISTRATION NCT03014167; ClinicalTrials.gov.
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Affiliation(s)
- Kumudha Aruldas
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Kim Dawson
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Malvika Saxena
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Angelin Titus
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Jabaselvi Johnson
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Marie-Claire Gwayi-Chore
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Jayaprakash Muliyil
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Gagandeep Kang
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Judd L. Walson
- Departments of Global Health, Medicine (Infectious Disease), Pediatrics and Epidemiology, University of Washington, Seattle, Washington, United States of America
- The DeWorm3 Project, University of Washington, Seattle, Washington, United States of America
| | - Ajay Khera
- Ministry of Health and Family Welfare (former), Government of India, New Delhi, India
| | - Sitara S. R. Ajjampur
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
- * E-mail:
| | - Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- The DeWorm3 Project, University of Washington, Seattle, Washington, United States of America
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3
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Bazant E, McPhillips-Tangum C, Shrestha SD, G S P, Khera A, Nic Lochlainn L, Habtamu E, Patel VI, Muhire G, Saarlas KN. Promising practices for the collaborative planning of integrated health campaigns from a synthesis of case studies. BMJ Glob Health 2022; 7:bmjgh-2022-010321. [PMID: 36517112 PMCID: PMC9756207 DOI: 10.1136/bmjgh-2022-010321] [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: 08/02/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
A combination of public health campaigns and routine primary healthcare services are used in many countries to maximise the number of people reached with interventions to prevent, control, eliminate or eradicate diseases. Health campaigns have historically been organised within vertical (disease-specific) programmes, which are often funded, planned and implemented independently from one another and from routinely offered primary healthcare services. Global health agencies have voiced support for enhancing campaign effectiveness, including campaign efficiency and equity, through collaboration among vertical programmes. However, limited guidance is available to country-level campaign planners and implementers about how to effectively integrate campaigns. Planning is critical to the implementation of effective health campaigns, including those related to neglected tropical diseases, malaria, vitamin A supplementation and vaccine-preventable diseases, including polio, measles and meningitis. However, promising approaches to planning integrated health campaigns have not been sufficiently documented. This manuscript highlights promising practices for the collaborative planning of integrated health campaigns that emerged from the experiences of eight project teams working in three WHO regions. Adoption of the promising practices described in this paper could lead to enhanced collaboration among campaign stakeholders, increased agreement about the need for and anticipated benefits of campaign integration, and enhanced understanding of effective planning of integrated health campaigns.
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Affiliation(s)
- Eva Bazant
- Health Campaign Effectiveness Coalition, The Task Force for Global Health, Decatur, Georgia, USA
| | | | | | - Preetha G S
- International Institute of Health Management Research, Delhi, India
| | | | - Laura Nic Lochlainn
- Department of Immunization, Vaccines & Biologicals (IVB), World Health Organization, Geneve, Switzerland
| | - Esmael Habtamu
- International Centre for Eye Health (ICEH), London School of Hygiene & Tropical Medicine, London, UK
| | - Vivek I Patel
- Health Campaign Effectiveness Coalition, The Task Force for Global Health, Decatur, Georgia, USA
| | | | - Kristin N Saarlas
- Health Campaign Effectiveness Coalition, The Task Force for Global Health, Decatur, Georgia, USA
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Eason S, Khera A, Gore O, Sayers MH. Screening for familial hypercholesterolaemia; extending a role for blood programs in promoting public health. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Familial hypercholesterolaemia (FH) is a genetic disorder characterized by high levels of cholesterol with evidence of coronary arterial disease at an early age. The prevalence of FH has been recently reported as 1/200 to 1/250 in the general population and although early identification and treatment is recommended (2019 ESC/EAS Guidelines for the Management of Dyslipidaemias), the disorder is largely underdiagnosed in asymptomatic individuals.1
A number of blood programs has recognised the opportunity that blood donation provides to identify ostensibly healthy individuals who might be unaware of risks to their health. These programs have included, along with mandated serological testing, such assays as non-fasting total cholesterol (TC) and haemoglobin A1C. They have also taken steps to notify individuals whose results suggest risk for cardiovascular disease or diabetes.
Purpose
Since our blood donation program has a long history of providing donors information about their TC, we tested whether some donors with elevated TC met the criteria for FH.
Methods
We reviewed unlinked total non-fasting cholesterol results from volunteers donating between 2015 and June 2019. Cholesterols were measured on a chemistry analyzer system (Beckman Coulter AU680) on residual blood after routine testing for infectious disease markers. For volunteers donating more than once, we included only their highest TC recording. TC was classified by American Heart Association (AHA) 2020 Goal Metrics as high, if ≥240 mg/dL (6.2 mmol/L) in donors ≥20 years of age and ≥200 (5.1 mmol/L) in donors <20 years of age. 2 We applied the United States Center for Disease Control Cooperative MEDPED diagnostic criteria for FH. Using these criteria, FH is diagnosed when TC exceeds 270 mg/dL (7.0 mmol/L) in individuals less than 20, 290 mg/dL (7.5 mmol/L) in individuals 20 to 29, 340 mg/dL (8.8 mmol/L) in individuals 30 to 39, and 360 mg/dL (9.3 mmol/L) in individuals 40 years of age and older. 3
Results
There were 432,389 unique donors during the study period. The overall prevalence of high cholesterol, 11.1% and the prevalence of FH 0.24% are similar to published data for the general population. As shown in the table, the prevalence of FH was highest in blood donors 20 to 29 years of age and was lower in those over 30 years, while the prevalence of high TC was higher in older age groups.
Conclusion
There is a subset of blood donors, at all ages who can be identified as satisfying familial hypercholesterolaemia criteria that could benefit from additional evaluation and family screening. A sizeable proportion of blood donors have high cholesterol despite not having FH.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Eason
- Carter BloodCare , Dallas , United States of America
| | - A Khera
- University of Texas Southwestern Medical Center , Dallas , United States of America
| | - O Gore
- University of Colorado, Division of Cardiology , Aurora , United States of America
| | - M H Sayers
- Carter BloodCare , Dallas , United States of America
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Khera A, Lee R, Rohde E, Jayaram H, Kathiresan S, Bellinger A. An in vivo CRISPR base editing therapy to inactivate the ANGPTL3 gene: nomination of a development candidate for VERVE-201. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.3087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Lowering cumulative exposure to low-density lipoprotein cholesterol (LDL-C) is the primary treatment for patients with homozygous familial hypercholesterolemia (HoFH) and established atherosclerotic cardiovascular disease. Due to access, adherence, and healthcare infrastructure limitations, an important fraction of such patients fail to achieve adequate lowering of LDL-C. Durable inactivation in the liver of a cholesterol-raising gene with a one-time therapy offers potential to address this unmet need.
Purpose
Both human genetic and pharmacologic studies have validated inactivation of the angiopoietin-like protein 3 gene (ANGPTL3) as an approach to lower LDL-C and triglyceride levels, particularly when ANGPTL3 reductions >80% can be achieved. Here, we outline a series of preclinical activities to optimize “VERVE-201”, a CRISPR base editing therapy targeting ANGPTL3.
Methods
Preclinical development efforts prioritized: (i) identification of a DNA site where editing of a single base pair inactivates ANGPTL3; and (ii) selection of a guide RNA and adenine base editor combination that precisely and specifically inactivates ANGPTL3; and (iii) a delivery approach suitable for all patients, including those with HoFH who lack sufficient low-density lipoprotein receptors (LDLR) needed for hepatic uptake of traditional lipid nanoparticles.
Results
Bioinformatic and in vitro screening of target sites in the ANGPTL3 gene identified a location where a single A•T to G•C DNA base pair edit leads to disruption of a splice donor and read through into a premature stop codon. To maximize editing of the ANGPTL3 gene while minimizing “off-target” editing elsewhere in the genome, >200 rationally engineered and chemically modified base editing and gRNA configurations were evaluated. Lead candidates were evaluated in primary human hepatocytes to quantify ANGPTL3 editing as well as any “off-target” editing at >600 candidate sites. In a cynomolgus monkey non-human primate model, a single dose of a drug product precursor that used a lipid nanoparticle delivery mechanism achieved potent and durable effects, with a 96% decrease from baseline in circulating ANGPTL3 616 days following administration. The non-human primate homologue to VERVE-201 (“VERVE-201cyno”) incorporates a GalNAc targeting ligand into the lipid nanoparticle, which bypasses LDLR to enable uptake via the liver-specific asialoglycoprotein receptor. VERVE-201cyno led to robust suppression of circulating ANGPTL3 in both a non-human primate model of HoFH and wild-type monkeys, with an average reduction of 89% and 88% respectively 90 days following administration.
Conclusions
These preclinical data provide the scientific foundation for nomination of a development candidate for VERVE-201, a “once-and-done” gene editing therapy intended to precisely, potently, and durably inactivate hepatic ANGPTL3 and thereby lower LDL-C and triglyceride concentrations permanently.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Verve Therapeutics
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Affiliation(s)
- A Khera
- Verve Therapeutics , Cambridge , United States of America
| | - R Lee
- Verve Therapeutics , Cambridge , United States of America
| | - E Rohde
- Verve Therapeutics , Cambridge , United States of America
| | - H Jayaram
- Verve Therapeutics , Cambridge , United States of America
| | - S Kathiresan
- Verve Therapeutics , Cambridge , United States of America
| | - A Bellinger
- Verve Therapeutics , Cambridge , United States of America
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Patrikar S, Bhatti V, Suryam V, Kotwal A, Basannar D, Khera A, Kashyap S, Sharma A. Health technology assessment of varicella vaccine in the Armed Forces. Med J Armed Forces India 2022; 78:213-220. [PMID: 35463553 PMCID: PMC9023555 DOI: 10.1016/j.mjafi.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 06/04/2021] [Indexed: 11/28/2022] Open
Abstract
Background The Indian Armed Forces, on entry, vaccinates all cadets and recruits with varicella vaccine for the prevention of varicella. This health technology assessment (HTA) report puts forth evidence for HTA of varicella vaccination in the Armed Forces in various domains namely clinical, societal, ethical, economic, and legal. Methods The policy question under each domain has been developed according to best-practice methods for HTA. The costs included were hospitalization cost due to varicella infection; training lost cost; the varicella vaccine cost; cost of the side effects of vaccine; and the outbreak investigation cost. The incremental cost-effectiveness ratio (ICER) for varicella cases averted and man-days saved, and quality-adjusted life years (QALYs) gained due to varicella vaccination strategy were calculated. Results Evidence suggests a reduction of 81% in hospitalization rates with 19392 man-days saved per 1 lakh population due to varicella vaccination strategy. The ICER for varicella cases averted is estimated to be Rs 56732/- per case averted and Rs 5687/- per man-day saved. QALYs gained due to two-dose varicella vaccination strategy is estimated to be 1152 per 1 lakh population with cost per QALY gained Rs 95735/-. Conclusion The study showed a large reduction in hospitalizations and consequently man-days lost after the introduction of the vaccination strategy. The QALYs was another aspect of importance brought out by this study. Thus, a two-dose vaccination strategy for varicella-zoster virus (VZV) for the Armed Forces trainees is a cost-effective policy.
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Affiliation(s)
- Seema Patrikar
- Senior Lecturer in Statistics, Department of Community Medicine, Armed Forces Medical College, Pune, India
- Corresponding author.
| | - V.K. Bhatti
- Brig Medical, HQ 17 Corps, C/o 99 APO, India
| | - Vani Suryam
- Col Medical (Health), O/o DGMS (Army), AG's Branch, IHQ of MoD, New Delhi, India
| | - A. Kotwal
- Executive Director, NHSRC, New Delhi, India
| | - D.R. Basannar
- Scientist 'F', Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - A. Khera
- Senior Advisor (Community Medicine) & Col Health, HQ Delhi Area, Delhi, India
| | - Surekha Kashyap
- Regional Director, Academy of Hospital Administration (WRC), India
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Abraham RA, Rana G, Agrawal PK, Johnston R, Sarna A, Ramesh S, Acharya R, Khan N, Porwal A, Kurundkar SB, Pandey A, Pullakhandam R, Nair KM, Kumar GT, Sachdev H, Kapil U, Deb S, Wagt AD, Khera A, Ramakrishnan L. The Effects of a Single Freeze-Thaw Cycle on Concentrations of Nutritional, Noncommunicable Disease, and Inflammatory Biomarkers in Serum Samples. J Lab Physicians 2021; 13:6-13. [PMID: 34054235 PMCID: PMC8154350 DOI: 10.1055/s-0041-1726575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background
The stability of biological samples is vital for reliable measurements of biomarkers in large-scale survey settings, which may be affected by freeze-thaw procedures. We examined the effect of a single freeze-thaw cycle on 13 nutritional, noncommunicable diseases (NCD), and inflammatory bioanalytes in serum samples.
Method
Blood samples were collected from 70 subjects centrifuged after 30 minutes and aliquoted immediately. After a baseline analysis of the analytes, the samples were stored at − 70°C for 1 month and reanalyzed for all the parameters. Mean percentage differences between baseline (fresh blood) and freeze-thaw concentrations were calculated using paired sample
t
-tests and evaluated according to total allowable error (TEa) limits (desirable bias).
Results
Freeze-thaw concentrations differed significantly (
p
< 0.05) from baseline concentrations for soluble transferrin receptor (sTfR) (− 5.49%), vitamin D (− 12.51%), vitamin B12 (− 3.74%), plasma glucose (1.93%), C-reactive protein (CRP) (3.45%), high-density lipoprotein (HDL) (7.98%), and cholesterol (9.76%), but they were within respective TEa limits. Low-density lipoprotein (LDL) (− 0.67%), creatinine (0.94%), albumin (0.87%), total protein (1.00%), ferritin (− 0.58%), and triglycerides (TAG) (2.82%) concentrations remained stable following the freeze-thaw cycle. In conclusion, single freeze-thaw cycle of the biomarkers in serum/plasma samples after storage at − 70°C for 1 month had minimal effect on stability of the studied analytes, and the changes in concentration were within acceptable limit for all analytes.
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Affiliation(s)
- Ransi Ann Abraham
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, Delhi, India
| | - Garima Rana
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, Delhi, India
| | | | | | | | | | | | | | | | - Sucheta Banerjee Kurundkar
- Clinical Development Services Agency, Translational Health Science & Technology Institute, Faridabad, Haryana
| | - Arvind Pandey
- National Institute of Medical Statistics, Indian Council of Medical Research, Delhi, India
| | | | | | | | - Hps Sachdev
- Paediatrics and Clinical Epidemiology, B-16 Qutab Institutional Area, New Delhi, India
| | - Umesh Kapil
- Department of Human Nutrition, All India Institute of Medical Sciences, Delhi, India
| | - Sila Deb
- Ministry of Health and Family Welfare, Delhi, India
| | | | - Ajay Khera
- Ministry of Health and Family Welfare, Delhi, India
| | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, Delhi, India
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8
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Kumar H, Bhat A, Alwadhi V, Maria A, Khanna R, Neogi SB, Khera A. An Assessment of Implementation of Family Participatory Care in Special Newborn Care Units in Three States of India. Indian Pediatr 2021; 58:349-353. [PMID: 33408278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To study special newborn care units (SNCUs) in terms of family participatory care (FPC) quality initiative as per Government of India guidelines in select public health facilities, and to document the perspectives of the doctors and mothers. DESIGN Cross-sectional. SETTINGS SNCUs with functional FPC units in the states of Odisha, Madhya Pradesh and Rajasthan. PARTICIPANTS 38 SNCUs; doctors and nurses in-charge of the unit; and two eligible mothers per unit, one inside the step-down unit and second outside the step-down unit whose newborns were admitted to special new-born care unit, having a stable baby weighing above 1500 g. INTERVENTION The states implemented FPC as per Government of India guidelines using National Health Mission funds across special newborn care units. This assessment involved onsite observation and interviews of key providers. OUTCOME Proportion of facilities providing regular counselling sessions, enabling support to mothers, recording FPC information; perspectives of health providers on improvement of breastfeeding and kangaroo mother care; proportion of eligible mothers practicing FPC, exclusively breastfeeding, and providing kangaroo mother care services. RESULTS Out of 38 SNCUs, we found that FPC sessions for mothers were happening in 36 (95%) facilities. SNCUs provided enabling support to mothers on FPC (74.2%), held regular sessions for the families (70.6%), nurses assisted mothers and family members for breastfeeding and kangaroo mother care (76.4%) and FPC information were recorded (70.6%). CONCLUSIONS The assessment of facilities where FPC was implemented showed that SNCUs were equipped to implement FPC in public health settings.
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Affiliation(s)
- Harish Kumar
- Norway India Partnership Initiative, New Delhi, India. Correspondence to: Dr Harish Kumar, Former Director, Norway-India Partnership Initiative, New Delhi, India.
| | - Ashfaq Bhat
- Norway India Partnership Initiative, New Delhi, India
| | - Varun Alwadhi
- Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India
| | - Arti Maria
- Department of Pediatrics, Ram Manohar Lohia Hospital, New Delhi, India
| | - Rajat Khanna
- Norway India Partnership Initiative, New Delhi, India
| | | | - Ajay Khera
- Child Health Division, Ministry of Health and Family Welfare, Government of India, New Delhi, India
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Kumar H, Khanna R, Alwadhi V, Bhat AA, Neogi SB, Choudhry P, Saboth PK, Khera A. Catalytic Support for Improving Clinical Care in Special Newborn Care Units (SNCU) Through Composite SNCU Quality of Care Index (SQCI). Indian Pediatr 2021; 58:338-344. [PMID: 33883309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To develop a composite index that serves as a proxy marker of quality of clinical service and pilot test its use in 11 special neonatal care units (SNCUs) across two states in India. DESIGN Secondary data from SNCU webportal. SETTING Special new-born care units in Rajasthan and Orissa. INTERVENTION We developed a composite SNCU Quality of care Index (SQCI) based on seven indices from SNCU online database. These included rational admission index, index for rational use of antibiotics, inborn birth asphyxia index, index for mortality in normal weight babies, low birth weight admission index, low birth weight survival index, and optimal bed utilization index. OUTCOME Based on the SQCI score, the performance of SNCUs was labelled as good (SQCI 0.71- 1.0), satisfactory (SQCI 0.4- 0.7) or unsatisfactory (SQCI <0.4). RESULTS The mean difference in SQCI between Jan-Mar 2016 and 2017 was 0.20 (95% CI 0.13- 0.28; P<0.001). Similar results were obtained for rational admission index, rational use of antibiotics, mortality in normal weight babies, low birth weight survival and optimal bed utilization. A significant improvement in the overall composite score was noted in Odisha (Mean difference 0.22, 95% CI 0.11-0.33, P=0.003) and Rajasthan (Mean difference 0.17, 95% CI 0.05- 0.3, P=0.002). CONCLUSIONS QI approach using SQCI tool is a useful and replicable intervention. Preliminary results show that it does lead to strengthening of implementation of the programs at SNCUs based on the comprehensive scores generated as part of routine system.
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Affiliation(s)
| | - Rajat Khanna
- Norway India Partnership Initiative, New Delhi, India
| | - Varun Alwadhi
- Department of Pediatrics, Kalawati Saran Children's Hospital, New Delhi, India
| | - Ashfaq Ahmed Bhat
- Norway India Partnership Initiative, New Delhi, India. Correspondence to: Dr Ashfaq Ahmed Bhat, Norway India Partnership Initiative, New Delhi, India.
| | - Sutapa B Neogi
- International Institute of Health Management Research, New Delhi, India
| | | | | | - Ajay Khera
- Ministry of Health and Family Welfare, Government of India; New Delhi, India
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Kumar H, Khanna R, Alwadhi V, Bhat AA, Nagendra A, Saboth PK, Neogi SB, Khera A. Tracking Weight-for-Age of Infants Using Home Based Newborn Care Plus by ASHA Workers. Indian Pediatr 2021; 58:345-348. [PMID: 33452768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Malnutrition in all its forms remains a serious global concern, particularly affecting children, a highly vulnerable population group. Home visits during the first year of life using the community worker platform is an unexplored opportunity for making improvements in nutritional status. OBJECTIVE To analyze the nutritional status (weight for age) of a cohort of infants between 3 and 12 months of age. DESIGN Tracking weight for age of infants by ASHA workers. SETTINGS 13 districts in the states of Bihar, Madhya Pradesh, Odisha and Rajasthan. INTERVENTION Home visits under a home-based newborn care program, home-based newborn care plus (HBNC+). METHODS Norway India Partnership Initiative (NIPI) project supported implementation of HBNC+, in 13 districts across four states in India. A descriptive analysis of infants based on retrospective record based program data was done. The nutritional status (weight-for-age) of the cohort was analyzed. Categories were defined based on the z-scores of weight for age (≤-3 SD; ≤-2 SD and > -3 SD; and > -2 SD). Trend of malnutrition and proportions of children in each category at 3, 6, 9 and 12 months were assessed. RESULTS At 3 months of age, out of 3,50,986 infants provided home visits, 1,82,049 (51.97%) were underweight as per WHO definition with weight for age z-score ≤- 2 SD; this reduced to 11.1% at 12 months of age. Difference of means at 3 months and 12 months significantly different for weight for age z-score (P<0.001). There was a decline in the proportion of children in severe and moderate malnutrition categories by 15% and 26%, respectively. CONCLUSIONS Catch-up growth in terms of weight-for-age among malnourished children is possible within one year of age. Frequent contacts with the health care functionaries may result in this improvement, though it is difficult to conclude in the absence of an appropriate control.
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Affiliation(s)
| | - Rajat Khanna
- Norway India Partnership Initiative, New Delhi, India
| | - Varun Alwadhi
- Department of Pediatrics, Kalawati Saran Children's Hospital, New Delhi, India
| | - Ashfaq Ahmed Bhat
- Norway India Partnership Initiative, New Delhi, India. Correspondence to: Dr Ashfaq Ahmed Bhat, Norway India Partnership Initiative, New Delhi, India.
| | - Anil Nagendra
- Norway India Partnership Initiative, New Delhi, India
| | | | - Sutapa B Neogi
- International Institute of Health Management Research, New Delhi, India
| | - Ajay Khera
- Ministry of Health and Family Welfare, Government of India, New Delhi; India
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Kumar H, Bhat AA, Alwadhi V, Khanna R, Neogi SB, Khera A, Deb S. Situational Analysis of Management of Childhood Diarrhea and Pneumonia in 13 District Hospitals in India. Indian Pediatr 2021. [PMID: 33408280 PMCID: PMC8079854 DOI: 10.1007/s13312-021-2191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objective To generate evidence on the current situation of hospital care (emergency, inpatient and outpatient), for managing children presenting with diarrhea and pneumonia at 13 district hospitals in India. Design Facility-based assessment of district hospitals. Settings 13 district hospitals in four states of Bihar, Madhya Pradesh, Odisha and Rajasthan. Participants Staff nurses and doctors. Intervention None. Methods An assessment was done across 13 district hospitals in four states by a group or trained assessors using an adapted quality assurance tool developed by Government of India where each aspect of care was scored (maximum score 5). Emergency services and triage, case management practices, laboratory support, and record maintenance for diarrhea and pneumonia were assessed. Results Separate diarrhea treatment unit was not earmarked in any of the DHs surveyed. Overall score obtained for adequate management of diarrhea and pneumonia was 2 and 2.2 which were poor. Pediatric beds were 6.8% of the total bed strength against the recommended 8–10%. There was a 65 percent shortfall in the numbers of medical officers in position and 48 percent shortfall of nurses. There were issues with availability and utilization of drugs and equipment at appropriate places with cumulative score of 2.8. Triage for sick children was absent in all the facilities. Conclusion The standards of pediatric care for management of diarrhea and pneumonia were far from satisfactory. This calls for improvement of pediatric care units and implementation of operational guidelines for improving management of diarrhea and pneumonia.
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Madan EM, Frongillo EA, Unisa S, Dwivedi L, Johnston R, Daniel A, Agrawal PK, Deb S, Khera A, Menon P, Nguyen PH. Effect of Differences in Month and Location of Measurement in Estimating Prevalence and Trend of Wasting and Stunting in India in 2005-2006 and 2015-2016. Curr Dev Nutr 2020; 4:nzaa092. [PMID: 32582875 PMCID: PMC7299523 DOI: 10.1093/cdn/nzaa092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Child undernutrition in India remains widespread. Data from the National Family Health Survey 3 and 4 (NFHS-3 and NFHS-4) suggest that wasting prevalence has increased while stunting prevalence has declined. OBJECTIVE The objectives of this study were to do the following: 1) describe wasting and stunting by month of measurement in India in children <5 y of age in NFHS-3 and NFHS-4 surveys, and 2) test whether differences in the timing of anthropometric data collection and in states between survey years introduced bias in the comparison of estimates of wasting and stunting between NFHS-3 and NFHS-4. METHODS Data on wasting and stunting for 42,608 and 232,744 children aged >5 y in the NFHS-3 and NFHS-4 survey rounds were analyzed. Differences in the prevalence of wasting and stunting by month of year and by state of residence were examined descriptively. Regression analyses were conducted to test the sensitivity of the estimate of differences in wasting and stunting prevalence across survey years to both state differences and seasonality. RESULTS Examination of the patterns of wasting and stunting by month of measurement and by state across survey years reveal marked variability. When both state and month were adjusted, regardless of the method used to account for sample size, there was a small negative difference from 2005-2006 to 2015-2016 in the prevalence of wasting (-0.8 ± 0.6 percentage points; P = 0.2) and a negative difference in stunting prevalence (-8.3 ± 0.7 percentage points; P < 0.001), indicating a small bias for wasting but not for stunting in unadjusted analyses. CONCLUSIONS State and seasonal differences may have introduced bias to the estimated difference in prevalence of wasting between the survey years but did not do so for stunting. Future data collection should be designed to maximize consistency in coverage of both time and place.
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Affiliation(s)
- Emily M Madan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | | | - Sayeed Unisa
- International Institute for Population Sciences, Mumbai, India
| | | | | | | | | | - Sila Deb
- Ministry of Health & Family Welfare, New Delhi, India
| | - Ajay Khera
- Ministry of Health & Family Welfare, New Delhi, India
| | - Purnima Menon
- Poverty and Health Nutrition Division, International Food Policy Research Institute, Washington DC, USA
| | - Phuong H Nguyen
- Poverty and Health Nutrition Division, International Food Policy Research Institute, Washington DC, USA
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13
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Abraham RA, Agrawal PK, Johnston R, Ramesh S, Porwal A, Sarna A, Acharya R, Khan N, Sachdev HS, Kapil U, Saxena R, Janmohamed A, Wagt A, Deb S, Khera A, Ramakrishnan L. Comparison of hemoglobin concentrations measured by HemoCue and a hematology analyzer in Indian children and adolescents 1‐19 years of age. Int J Lab Hematol 2020; 42:e155-e159. [DOI: 10.1111/ijlh.13209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/26/2020] [Accepted: 03/22/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ransi Ann Abraham
- Department of Cardiac Biochemistry All India Institute of Medical Sciences New Delhi India
| | | | | | | | | | | | | | | | - Harshpal Singh Sachdev
- Paediatrics and Clinical Epidemiology Sitaram Bhartia Institute of Science and Research New Delhi India
| | - Umesh Kapil
- Department of Human Nutrition All India Institute of Medical Sciences New Delhi India
| | - Renu Saxena
- Department of Hematology All India Institute of Medical Sciences New Delhi India
| | | | | | - Sila Deb
- Ministry of Health and Family Welfare New Delhi India
| | - Ajay Khera
- Ministry of Health and Family Welfare New Delhi India
| | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry All India Institute of Medical Sciences New Delhi India
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14
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Choudhary TS, Sinha B, Khera A, Bhandari N, Chu Y, Jackson B, Walker N, Black RE, Merson M, Bhan MK. Factors associated with the decline in under-five diarrhea mortality in India: a LiST analysis. J Glob Health 2019; 9:020804. [PMID: 31673348 PMCID: PMC6816285 DOI: 10.7189/jogh.09.020804] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND India has achieved 86% reduction in the number of under-five diarrheal deaths from 1980 to 2015. Nonetheless diarrhea is still among the leading causes of under-five deaths. The aim of this analysis was to study the contribution of factors that led to decline in diarrheal deaths in the country and the effect of scaling up of intervention packages to address the remaining diarrheal deaths. METHODS We assessed the attribution of different factors and intervention packages such as direct diarrhea case management interventions, nutritional factors and WASH interventions which contributed to diarrhea specific under-five mortality reduction (DSMR) during 1980 to 2015 using the Lives Saved Tool (LiST). The potential impact of scaling up different packages of interventions to achieve universal coverage levels by year 2030 on reducing the number of remaining diarrheal deaths were estimated. RESULTS The major factors associated with DSMR reduction in under-fives during 1980 to 2015, were increase in ORS use, reduction in stunting prevalence, improved sanitation, changes in age appropriate breastfeeding practices, increase in the vitamin-A supplementation and persistent diarrhea treatment. ORS use and reduction in stunting were the two key interventions, each accounting for around 32% of the lives saved during this period. Scaling up the direct diarrhea case management interventions from the current coverage levels in 2015 to achieve universal coverage levels by 2030 can save around 82 000 additional lives. If the universal targets for nutritional factors and WASH interventions can be achieved, an additional 23 675 lives can potentially be saved. CONCLUSIONS While it is crucial to improve the coverage and equity in ORS use, an integrated approach to promote nutrition, WASH and direct diarrhea interventions is likely to yield the highest impact on reducing the remaining diarrheal deaths in under-five children.
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Affiliation(s)
- Tarun Shankar Choudhary
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Bireshwar Sinha
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ajay Khera
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Nita Bhandari
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Yue Chu
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States
| | - Bianca Jackson
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States
| | - Neff Walker
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States
| | - Robert E Black
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States
| | - Michael Merson
- Duke University, Duke Global Health Institute, Durham, North Carolina, USA
| | - Maharaj Kishan Bhan
- Indian Institute of Technology, New Delhi, India
- Knowledge Integration and Translational Platform (KnIT), Biotechnology Industry Research Assistance Council (BIRAC) New Delhi, India
- Society for Essential Health Action and Training (SEHAT), New Delhi, India
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15
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Yonzon KK, Dehingia N, Alwadhi V, Singh K, Kumar H, Bhat AA, Khanna R, Khera A. An Assessment of Home-Based Newborn Care Plus Innovation in Six districts of Rajasthan: A Cross Sectional Comparative Analysis. Indian J Community Health 2019. [DOI: 10.47203/ijch.2019.v31i03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: To improve coverage of key child health community practices, Home Based Infant Care (HBNC+) was implemented with support of Norway India Partnership Initiative (NIPI) in 4 States of Rajasthan, Madhya Pradesh, Bihar and Odisha. The innovation aimed at improving coverage of key child health interventions through home visits by community health worker, Accredited Social Health Activist (ASHA). Aims & Objective: This paper elucidates the results from the assessment of implementation in intervention versus control districts of Rajasthan. Material & Methods: A cross-sectional intervention-control design with a sample size of 3211 mothers of children in age group 0 to 23 months was adopted. Results: 85 percent of the children (aged 3-23 months) received at least one infant care home visit in the intervention districts in comparison to 32 percent in control. Significant improvements were found in terms of exclusive breastfeeding, weighing and Iron Folic Acid (IFA) consumption and availability of ORS and Iron Syrup in intervention districts. 15 percent additional children had weight plotted in growth charts and 24 percent more consumed IFA syrup bi-weekly in intervention districts. Conclusion: Home visits in infancy is a scalable model and can lead to improvement of community child health practices.
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16
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Abraham RA, Agrawal PK, Acharya R, Sarna A, Ramesh S, Johnston R, de Wagt A, Khan N, Porwal A, Kurundkar SB, Pandey A, Pullakhandam R, Nair KM, Kumar GT, Sachdev HPS, Kapil U, Saxena R, Deb S, Khera A, Ramakrishnan L. Effect of temperature and time delay in centrifugation on stability of select biomarkers of nutrition and non-communicable diseases in blood samples. Biochem Med (Zagreb) 2019; 29:020708. [PMID: 31223262 PMCID: PMC6559620 DOI: 10.11613/bm.2019.020708] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 11/29/2018] [Accepted: 03/29/2019] [Indexed: 11/01/2022] Open
Abstract
Introduction Preanalytical conditions are critical for blood sample integrity and poses challenge in surveys involving biochemical measurements. A cross sectional study was conducted to assess the stability of select biomarkers at conditions that mimic field situations in surveys. Material and methods Blood from 420 volunteers was exposed to 2 - 8 °C, room temperature (RT), 22 - 30 °C and > 30 °C for 30 min, 6 hours, 12 hours and 24 hours prior to centrifugation. After different exposures, whole blood (N = 35) was used to assess stability of haemoglobin, HbA1c and erythrocyte folate; serum (N = 35) for assessing stability of ferritin, C-reactive protein (CRP), vitamins B12, A and D, zinc, soluble transferrin receptor (sTfR), total cholesterol, high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), tryglicerides, albumin, total protein and creatinine; and plasma (N = 35) was used for glucose. The mean % deviation of the analytes was compared with the total change limit (TCL), computed from analytical and intra-individual imprecision. Values that were within the TCL were deemed to be stable. Result Creatinine (mean % deviation 14.6, TCL 5.9), haemoglobin (16.4%, TCL 4.4) and folate (33.6%, TCL 22.6) were unstable after 12 hours at 22-30°C, a temperature at which other analytes were stable. Creatinine was unstable even at RT for 12 hours (mean % deviation: 10.4). Albumin, CRP, glucose, cholesterol, LDL, triglycerides, vitamins B12 and A, sTfR and HbA1c were stable at all studied conditions. Conclusion All analytes other than creatinine, folate and haemoglobin can be reliably estimated in blood samples exposed to 22-30°C for 12 hours in community-based studies.
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Affiliation(s)
- Ransi Ann Abraham
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, Delhi, India
| | | | | | | | | | | | | | | | | | - Sucheta Banerjee Kurundkar
- Clinical Development Services Agency, Translational Health Science & Technology Institute, Faridabad, Haryana
| | - Arvind Pandey
- Ex Director, National Institute of Medical Statistics, Indian Council of Medical Research, Delhi, India
| | | | | | | | - H P S Sachdev
- Senior Consultant, Paediatrics and Clinical Epidemiology, B-16 Qutab Institutional Area, New Delhi, India
| | - Umesh Kapil
- Department of Human Nutrition, All India Institute of Medical Sciences, Delhi, India
| | - Renu Saxena
- Department of Human Nutrition, All India Institute of Medical Sciences, Delhi, India
| | - Sila Deb
- Ministry of Health and Family Welfare, Delhi, India
| | - Ajay Khera
- Ministry of Health and Family Welfare, Delhi, India
| | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, Delhi, India
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Taneja G, Sridhar VSR, Mohanty JS, Joshi A, Bhushan P, Jain M, Gupta S, Khera A, Kumar R, Gera R. India's RMNCH+A Strategy: approach, learnings and limitations. BMJ Glob Health 2019; 4:e001162. [PMID: 31139464 PMCID: PMC6509590 DOI: 10.1136/bmjgh-2018-001162] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/29/2019] [Accepted: 03/30/2019] [Indexed: 11/04/2022] Open
Abstract
Building on the gains of the National Health Mission, India’s Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) Strategy, launched in 2013, was a milestone in the country’s health planning. The strategy recognised the interdependence of RMNCH+A Interventions across the life stages and adopted a comprehensive approach to address inequitable distribution of healthcare services for the vulnerable population groups and in poor-performing geographies of the country. Based on innovative approaches and management reforms, like selection of poor-performing districts, prioritisation of high-impact RMNCH+A healthcare interventions, engagement of development partners and institutionalising a concurrent monitoring system the strategy strived to improve efficiency and effectiveness within the public healthcare delivery system of the country. 184 High Priority Districts were identified across the country on a defined set of indicators for implementation of critical RMNCH+A Interventions and a dedicated institutional framework comprising National and State RMNCH+A Units and District Level Monitors supported by the development partners was established to provide technical support to the state and district health departments. Health facilities based on case load and available services across the High Priority Districts were prioritised for strengthening and were monitored by an RMNCH+A Supportive Supervision mechanism to track progress and generate evidence to facilitate actions for strengthening ongoing interventions. The strategy helped develop an integrated systems-based approach to address public health challenges through a comprehensive framework, defined priorities and robust partnerships with the partner agencies. However, lack of a robust monitoring and evaluation framework and sub-optimal focus on social determinants of health possibly limited its overall impact and ability to sustain improvements. Guided by the learnings and limitations, the Government of India has now designed the ‘Aspirational Districts Program’ to holistically address health challenges in poor-performing districts within the overall sociocultural domain to ensure inclusive and sustained improvements.
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Affiliation(s)
- Gunjan Taneja
- USAID-VRIDDHI (Scaling up RMNCH+A Interventions Project), IPE Global, New Delhi, India
| | | | - Jaya Swarup Mohanty
- USAID-VRIDDHI (Scaling up RMNCH+A Interventions Project), IPE Global, Ranchi, India
| | - Anurag Joshi
- USAID-VRIDDHI (Scaling up RMNCH+A Interventions Project), IPE Global, Chandigarh, India
| | - Pranav Bhushan
- National Aspirational Districts PMU, Ministry of Health and Family Welfare, New Delhi, India
| | - Manish Jain
- Public Health Consultant, Lucknow, Uttar Pradesh, India
| | - Sachin Gupta
- Maternal and Child Health Division, USAID India, New Delhi, India
| | - Ajay Khera
- Child and Adolescent Health Division, India Ministry of Health and Family Welfare, New Delhi, India
| | - Rakesh Kumar
- Policy Planning & SDG Integration, United Nations Development Program India, New Delhi, India
| | - Rajeev Gera
- USAID-VRIDDHI (Scaling up RMNCH+A Interventions Project), IPE Global, New Delhi, India
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18
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Wong BKC, Fadel SA, Awasthi S, Khera A, Kumar R, Menon G, Jha P. The impact of measles immunization campaigns in India using a nationally representative sample of 27,000 child deaths. eLife 2019; 8:e43290. [PMID: 30834890 PMCID: PMC6467562 DOI: 10.7554/elife.43290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 02/15/2019] [Indexed: 11/13/2022] Open
Abstract
India comprises much of the persisting global childhood measles mortality. India implemented a mass second-dose measles immunization campaign in 2010. We used interrupted time series and multilevel regression to quantify the campaign's impact on measles mortality using the nationally representative Million Death Study (including 27,000 child deaths in 1.3 million households surveyed from 2005 to 2013). 1-59 month measles mortality rates fell more in the campaign states following launch (27%) versus non-campaign states (11%). Declines were steeper in girls than boys and were specific to measles deaths. Measles mortality risk was lower for children living in a campaign district (OR 0.6, 99% CI 0.4-0.8) or born in 2009 or later (OR 0.8, 99% CI 0.7-0.9). The campaign averted up to 41,000-56,000 deaths during 2010-13, or 39-57% of the expected deaths nationally. Elimination of measles deaths in India is feasible.
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Affiliation(s)
- Benjamin KC Wong
- Centre for Global Health Research, Dalla Lana School of Public HealthSt. Michael’s Hospital, University of TorontoOntarioCanada
| | - Shaza A Fadel
- Centre for Global Health Research, Dalla Lana School of Public HealthSt. Michael’s Hospital, University of TorontoOntarioCanada
| | - Shally Awasthi
- Department of PediatricsKing George’s Medical UniversityLucknowIndia
| | - Ajay Khera
- Ministry of Health and Family WelfareGovernment of IndiaDelhiIndia
| | - Rajesh Kumar
- School of Public Health, Post Graduate Institute of Medical Education and ResearchChandigarhIndia
| | - Geetha Menon
- Department of Health Research, National Institute of Medical StatisticsIndian Council of Medical ResearchNew DelhiIndia
| | - Prabhat Jha
- Centre for Global Health Research, Dalla Lana School of Public HealthSt. Michael’s Hospital, University of TorontoOntarioCanada
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19
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Arora NK, Swaminathan S, Mohapatra A, Gopalan HS, Katoch VM, Bhan MK, Rasaily R, Shekhar C, Thavaraj V, Roy M, Das MK, Wazny K, Kumar R, Khera A, Bhatla N, Jain V, Laxmaiah A, Nair MKC, Paul VK, Ramachandran P, Ramji S, Vaidya U, Verma IC, Shah D, Bahl R, Qazi S, Rudan I, Black RE. Research priorities in Maternal, Newborn, & Child Health & Nutrition for India: An Indian Council of Medical Research-INCLEN Initiative. Indian J Med Res 2018; 145:611-622. [PMID: 28948951 PMCID: PMC5644295 DOI: 10.4103/ijmr.ijmr_139_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In India, research prioritization in Maternal, Newborn, and Child Health and Nutrition (MNCHN) themes has traditionally involved only a handful of experts mostly from major cities. The Indian Council of Medical Research (ICMR)-INCLEN collaboration undertook a nationwide exercise engaging faculty from 256 institutions to identify top research priorities in the MNCHN themes for 2016-2025. The Child Health and Nutrition Research Initiative method of priority setting was adapted. The context of the exercise was defined by a National Steering Group (NSG) and guided by four Thematic Research Subcommittees. Research ideas were pooled from 498 experts located in different parts of India, iteratively consolidated into research options, scored by 893 experts against five pre-defined criteria (answerability, relevance, equity, investment and innovation) and weighed by a larger reference group. Ranked lists of priorities were generated for each of the four themes at national and three subnational (regional) levels [Empowered Action Group & North-Eastern States, Southern and Western States, & Northern States (including West Bengal)]. Research priorities differed between regions and from overall national priorities. Delivery domain of research which included implementation research constituted about 70 per cent of the top ten research options under all four themes. The results were endorsed in the NSG meeting. There was unanimity that the research priorities should be considered by different governmental and non-governmental agencies for investment with prioritization on implementation research and issues cutting across themes.
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Affiliation(s)
- Narendra K Arora
- Executive Office, The INCLEN Trust International, New Delhi, India
| | | | | | - Hema S Gopalan
- Executive Office, The INCLEN Trust International, New Delhi, India
| | - Vishwa M Katoch
- Headquarters, Indian Council of Medical Research, New Delhi, India
| | - Maharaj K Bhan
- Centre for Health Research and Development (CHRD), Society for Applied Studies, New Delhi, India
| | - Reeta Rasaily
- Headquarters, Indian Council of Medical Research, New Delhi, India
| | - Chander Shekhar
- Headquarters, Indian Council of Medical Research, New Delhi, India
| | | | - Malabika Roy
- Headquarters, Indian Council of Medical Research, New Delhi, India
| | - Manoja K Das
- Executive Office, The INCLEN Trust International, New Delhi, India
| | - Kerri Wazny
- Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Rakesh Kumar
- Headquarters, Indian Council of Medical Research, New Delhi, India
| | - Ajay Khera
- Department of Health and Family Welfare, Ministry of Health and Family Welfare, Government of , New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vanita Jain
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Avula Laxmaiah
- Division of Community Studies, National Institute of Nutrition, Hyderabad, India
| | - M K C Nair
- Office of the Vice Chancellor, Kerala University of Health Sciences, Thrissur, India
| | - Vinod K Paul
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Siddharth Ramji
- Department of Neonatology, Maulana Azad Medical College, New Delhi, India
| | - Umesh Vaidya
- Department of Pediatrics, KEM Hospital, Pune, India
| | - I C Verma
- Editorial Office, Indian Journal of Pediatrics, New Delhi, India
| | - Dheeraj Shah
- Editorial Office, Indian Pediatrics, New Delhi, India
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Shamim Qazi
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Goel K, Naithani S, Bhatt D, Khera A, Sharapov UM, Kriss JL, Goodson JL, Laserson KF, Goel P, Kumar RM, Chauhan LS. The World Health Organization Measles Programmatic Risk Assessment Tool-Pilot Testing in India, 2014. Risk Anal 2017; 37:1063-1071. [PMID: 27088758 DOI: 10.1111/risa.12615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 02/05/2016] [Accepted: 02/10/2016] [Indexed: 06/05/2023]
Abstract
Measles is a leading cause of child mortality, and reduction of child mortality is a key Millennium Development Goal. In 2014, the World Health Organization and the U.S. Centers for Disease Control and Prevention developed a measles programmatic risk assessment tool to support country measles elimination efforts. The tool was pilot tested in the State of Uttarakhand in August 2014 to assess its utility in India. The tool assessed measles risk for the 13 districts of Uttarakhand as a function of indicator scores in four categories: population immunity, surveillance quality, program delivery performance, and threat. The highest potential overall score was 100. Scores from each category were totaled to assign an overall risk score for each district. From this risk score, districts were categorized as low, medium, high, or very high risk. Of the 13 districts in Uttarakhand in 2014, the tool classified one district (Haridwar) as very high risk and three districts (Almora, Champawat, and Pauri Garhwal) as high risk. The measles risk in these four districts was largely due to low population immunity from high MCV1-MCV2 drop-out rates, low MCV1 and MCV2 coverage, and the lack of a supplementary immunization activity (SIA) within the past three years. This tool can be used to support measles elimination in India by identifying districts that might be at risk for measles outbreaks, and to guide risk mitigation efforts, including strengthening routine immunization services and implementing SIAs.
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Affiliation(s)
- Kapil Goel
- India Epidemic Intelligence Service, India Centers for Disease Control and Prevention, Delhi, India
| | | | | | - Ajay Khera
- Ministry of Health & Family Welfare, Immunization & Child Health, Delhi, India
| | - Umid M Sharapov
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Global Immunization Division, Atlanta, GA, USA
| | - Jennifer L Kriss
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Global Immunization Division, Atlanta, GA, USA
| | - James L Goodson
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Global Immunization Division, Atlanta, GA, USA
| | - Kayla F Laserson
- India Centers for Disease Control and Prevention, Division of Global Health Protection, Delhi, India
| | - Parul Goel
- India Epidemic Intelligence Service, India Centers for Disease Control and Prevention, Delhi, India
| | - R Mohan Kumar
- India Epidemic Intelligence Service, India Centers for Disease Control and Prevention, Delhi, India
| | - L S Chauhan
- National Center for Disease Control, Delhi, India
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Gupta SS, Bharati K, Sur D, Khera A, Ganguly NK, Nair GB. Why is the oral cholera vaccine not considered an option for prevention of cholera in India? Analysis of possible reasons. Indian J Med Res 2017; 143:545-51. [PMID: 27487997 PMCID: PMC4989827 DOI: 10.4103/0971-5916.187102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sanjukta Sen Gupta
- Translational Health Science & Technology Institute, Faridabad 121 001, Haryana, India
| | - Kaushik Bharati
- Translational Health Science & Technology Institute, Faridabad 121 001, Haryana, India
| | - Dipika Sur
- Translational Health Science & Technology Institute, Faridabad 121 001, Haryana, India
| | - Ajay Khera
- Ministry of Health & Family Welfare, Government of India, New Delhi 110 011, India
| | - N K Ganguly
- Translational Health Science & Technology Institute, Faridabad 121 001, Haryana, India
| | - G Balakrish Nair
- Translational Health Science & Technology Institute, Faridabad 121 001, Haryana, India
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Neogi SB, Khanna R, Chauhan M, Sharma J, Gupta G, Srivastava R, Prabhakar PK, Khera A, Kumar R, Zodpey S, Paul VK. Inpatient care of small and sick newborns in healthcare facilities. J Perinatol 2016; 36:S18-S23. [PMID: 27924106 PMCID: PMC5144116 DOI: 10.1038/jp.2016.186] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Neonatal units in teaching and non-teaching hospitals both in public and private hospitals have been increasing in number in the country since the sixties. In 1994, a District Newborn Care Programme was introduced as a part of the Child Survival and Safe Motherhood Programme (CSSM) in 26 districts. Inpatient care of small and sick newborns in the public health system got a boost under National Rural Health Mission with the launch of the national programme on facility-based newborn care (FBNC). This has led to a nationwide creation of Newborn Care Corners (NBCC) at every point of child birth, newborn stabilization units (NBSUs) at First Referral Units (FRUs) and special newborn care units (SNCUs) at district hospitals. Guidelines and toolkits for standardized infrastructure, human resources and services at each level have been developed and a system of reporting data on FBNC created. Till March 2015, there were 565 SNCUs, 1904 NBSUs and 14 163 NBCCs operating in the country. There has been considerable progress in operationalizing SNCUs at the district hospitals; however establishing a network of SNCUs, NBSUs and NBCCs as a composite functional unit of newborn care continuum at the district level has lagged behind. NBSUs, the first point of referral for the sick newborn, have not received the desired attention and have remained a weak link in most districts. Other challenges include shortage of physicians, and hospital beds and absence of mechanisms for timely repair of equipment. With admission protocols not being adequately followed and a weak NBSU system, SNCUs are faced with the problem of admission overload and poor quality of care. Applying best practices of care at SNCUs, creating more NBSU linkages and strengthening NBCCs are important steps toward improving quality of FBNC. This can be further improved with regular monitoring and mentoring from experienced pediatricians, and nurses drawn from medical colleges and the private sector. In addition there is a need to further increase such units to address the unmet need of facility-based care.
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Affiliation(s)
- S B Neogi
- Indian Institute of Public Health (Delhi), Public Health Foundation of India, Delhi, India
| | - R Khanna
- Saving Newborn Lives, Save the Children, India
| | - M Chauhan
- Indian Institute of Public Health (Delhi), Public Health Foundation of India, Delhi, India
| | - J Sharma
- Indian Institute of Public Health (Delhi), Public Health Foundation of India, Delhi, India
| | - G Gupta
- UNICEF, Country Office, New Delhi, India
| | - R Srivastava
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - P K Prabhakar
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - A Khera
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - R Kumar
- Ministry of Health and Family Welfare, Government of India, New Delhi, India,Ministry of Health and Family Welfare, Govt of India, Nirman Bhawan, New Delhi 110011, India. E-mail:
| | - S Zodpey
- Indian Institute of Public Health (Delhi), Public Health Foundation of India, Delhi, India
| | - V K Paul
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Abstract
About 0.75 million neonates die every year in India, the highest for any country in the world. The neonatal mortality rate (NMR) declined from 52 per 1000 live births in 1990 to 28 per 1000 live births in 2013, but the rate of decline has been slow and lags behind that of infant and under-five child mortality rates. The slower decline has led to increasing contribution of neonatal mortality to infant and under-five mortality. Among neonatal deaths, the rate of decline in early neonatal mortality rate (ENMR) is much lower than that of late NMR. The high level and slow decline in early NMR are also reflected in a high and stagnant perinatal mortality rate. The rate of decline in NMR, and to an extent ENMR, has accelerated with the introduction of National Rural Health Mission in mid-2005. Almost all states have witnessed this phenomenon, but there is still a huge disparity in NMR between and even within the states. The disparity is further compounded by rural-urban, poor-rich and gender differentials. There is an interplay of different demographic, educational, socioeconomic, biological and care-seeking factors, which are responsible for the differentials and the high burden of neonatal mortality. Addressing inequity in India is an important cross-cutting action that will reduce newborn mortality.
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Affiliation(s)
- M J Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - S B Neogi
- Indian Institute of Public Health (Delhi), Public Health Foundation of India, Delhi, India
| | - J Sharma
- Indian Institute of Public Health (Delhi), Public Health Foundation of India, Delhi, India
| | - M Chauhan
- Indian Institute of Public Health (Delhi), Public Health Foundation of India, Delhi, India
| | - R Srivastava
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - P K Prabhakar
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - A Khera
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - R Kumar
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - S Zodpey
- Indian Institute of Public Health (Delhi), Public Health Foundation of India, Delhi, India
| | - V K Paul
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Gilbert C, Shukla R, Kumar R, Khera A, Murthy GV. Services for the Detection and Treatment of Retinopathy of Prematurity in Major Indian Cities: The 11-City 9-State Study. Indian Pediatr 2016; 53 Suppl 2:S112-S117. [PMID: 27915318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Control of visual loss from retinopathy of prematurity requires high quality neonatal care, and timely screening and treatment of sight-threatening disease. We assessed services for retinopathy of prematurity provided by ophthalmic training institutions in major Indian cities. METHODS Eleven cities were purposefully selected and eye-care facilities were evaluated using predefined criteria. Field teams visited these facilities to collect data by interview and observation using structured questionnaires. RESULTS 30 training institutions were visited (18 public; 12 not-for-profit); 24 (24/30, 80%) provided a service for retinopathy of prematurity in 58 neonatal units (30 public, 28 private). 15/24 (63%) screened in one unit; six (25%) in 2-3 units and three (12%) in >3 units. Not-for-profit facilities (n=9) screened in more units than public facilities (n=15)(mean (range) 4.5 [1-12] vs 1.1 [1-2] units). Indirect ophthalmoscopy by ophthalmologists was the commonest screening modality but only half of these visited the units weekly. Laser was the commonest treatment, but only half treated babies in the neonatal unit. Annual treatments ranged from 1-200 (mean 39). CONCLUSION Eye-care services for retinopathy of prematurity need to expand, particularly in the government sector.
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Affiliation(s)
- Clare Gilbert
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK; #Indian Institute of Public Health, Hyderabad, Public Health Foundation of India; and $Ministry of Health and Family Welfare, Government of India. Correspondence to: Dr Clare Gilbert, International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Frøen JF, Friberg IK, Lawn JE, Bhutta ZA, Pattinson RC, Allanson ER, Flenady V, McClure EM, Franco L, Goldenberg RL, Kinney MV, Leisher SH, Pitt C, Islam M, Khera A, Dhaliwal L, Aggarwal N, Raina N, Temmerman M. Stillbirths: progress and unfinished business. Lancet 2016; 387:574-586. [PMID: 26794077 DOI: 10.1016/s0140-6736(15)00818-1] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [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] [Indexed: 11/19/2022]
Abstract
This first paper of the Lancet Series on ending preventable stillbirths reviews progress in essential areas, identified in the 2011 call to action for stillbirth prevention, to inform the integrated post-2015 agenda for maternal and newborn health. Worldwide attention to babies who die in stillbirth is rapidly increasing, from integration within the new Global Strategy for Women's, Children's and Adolescents' Health, to country policies inspired by the Every Newborn Action Plan. Supportive new guidance and metrics including stillbirth as a core health indicator and measure of quality of care are emerging. Prenatal health is a crucial biological foundation to life-long health. A key priority is to integrate action for prenatal health within the continuum of care for maternal and newborn health. Still, specific actions for stillbirths are needed for advocacy, policy formulation, monitoring, and research, including improvement in the dearth of data for effective coverage of proven interventions for prenatal survival. Strong leadership is needed worldwide and in countries. Institutions with a mandate to lead global efforts for mothers and their babies must assert their leadership to reduce stillbirths by promoting healthy and safe pregnancies.
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Affiliation(s)
- J Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway; Center for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway.
| | - Ingrid K Friberg
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Zulfiqar A Bhutta
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Robert C Pattinson
- South African Medical Research Council, Maternal and Infant Health Care Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Emma R Allanson
- School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, Australia; UNDP/UN Population fund/UNICEF/WHO/World Bank Special Programme of Research, WHO, Geneva, Switzerland
| | - Vicki Flenady
- Mater Research Institute, University of Queensland, Brisbane, Australia; International Stillbirth Alliance, Millburn, NJ, USA
| | | | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Mary V Kinney
- Save the Children, Saving Newborn Lives, Edgemead, South Africa
| | - Susannah Hopkins Leisher
- Mater Research Institute, University of Queensland, Brisbane, Australia; International Stillbirth Alliance, Millburn, NJ, USA
| | - Catherine Pitt
- Department of Global Healthand Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ajay Khera
- Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Lakhbir Dhaliwal
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Aggarwal
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neena Raina
- Department of Child and Adolescent Health, WHO Regional Office for South-East Asia, Delhi, India
| | - Marleen Temmerman
- Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
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Debnath J, Ravikumar R, Sharma V, Senger KPS, Maurya V, Singh G, Sharma P, Khera A, Singh A. 'Empty sella' on routine MRI studies: An incidental finding or otherwise? Med J Armed Forces India 2015; 72:33-7. [PMID: 26900220 DOI: 10.1016/j.mjafi.2015.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/22/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Empty sella (ES) has been regarded as an incidental finding. Recently, there have been studies documenting association of ES with hormonal and non-hormonal abnormalities. To detect the prevalence of empty sella in routine MRI brain study and to find associations with other diseases. METHODS A retrospective study was carried out for patients undergoing MRI brain studies in the radiology department of a teaching institution. Patients with ES formed the study group. The rest formed the baseline population. Presence of nine select variables, viz. hormonal disturbances, headache, sensorineural hearing loss, seizures, vertigo, psychiatric disorders, visual disturbances, ataxia and raised intracranial tension, was analyzed amongst the study group, as well as the baseline population. Association of ES and the select variables was analyzed by determining means and proportions and using Chi-square test. RESULTS During the study period, a total of 12,414 patients underwent MRI brain studies at our centre. ES was found in 241 (1.94%) patients. The proportion of patients in the ES and non-empty sella groups for each of the variables were as follows: hormonal disturbances (3.31% vs 0.56%, P = .000), headache (8.3% vs 7.4%, P = .596), SNHL (3.7% vs 1.3%, P = .0010), seizure (6.2% vs 13%, P = .002), vertigo (4.6% vs 1.6%, P = .000), psychiatric disorders (4.6% vs 1.3%, P = .000), visual disturbances (2% vs 1.1%, P = .166), ataxia (1.7% vs 1.2%, P = .519) and raised ICT (2% vs 0.5%, P = .002). CONCLUSION Hormonal disturbances, psychiatric disorders, raised ICT and SNHL have been found to be more often associated with ES as compared to general population.
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Affiliation(s)
- Jyotindu Debnath
- Professor, Department of Radiodiagnosis, Armed Forces Medical College, Pune 411040, India
| | - R Ravikumar
- Professor & Head, Department of Radiodiagnosis, Armed Forces Medical College, Pune 40, India
| | - Vivek Sharma
- Commandant, 155 Base Hospital, C/O 99 APO, India
| | - K P S Senger
- Resident, Department of Radiodiagnosis, Armed Forces Medical College, Pune 40, India
| | - Vinay Maurya
- Associate Professor, Department of Radiodiagnosis, Armed Forces Medical College, Pune 40, India
| | - Giriraj Singh
- Senior Adviser (Radiology), Command Hospital (Southern Command), Pune 40, India
| | - Pankaj Sharma
- Associate Professor, Department of Radiodiagnosis, Armed Forces Medical College, Pune 40, India
| | - A Khera
- Assistant Professor, Department of Community Medicine, Armed Forces Medical College, Pune 40, India
| | - Ankita Singh
- Former Research Associate, Intra Health International, BMGF Funded Project, India
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Singh AK, Kumar R, Mishra CK, Khera A, Srivastava A. Moving from Survival to Healthy Survival through Child Health Screening and Early Intervention Services Under Rashtriya Bal Swasthya Karyakram (RBSK). Indian J Pediatr 2015. [PMID: 26199076 DOI: 10.1007/s12098-015-1823-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
For negating the impact of early adversities on the development and ensuring a healthy, dynamic future for all children, Ministry of Health and Family Welfare in 2013 launched a programme for child health screening and early intervention services as Rashtriya Bal Swasthya Karyakram (RBSK) which aims to improve the quality of life with special focus on improving cognition and survival outcomes for "at risk" children. It has a systemic approach of prevention, early identification and management of 30 health conditions distributed under 4Ds: Defects at birth, Diseases, Deficiencies and Developmental delays including Disabilities spread over birth to 18 y of age in a holistic manner. There is a dedicated 4 member Mobile Health team for community screening and a dedicated 14 member team at District Early Intervention Center (DEIC) for comprehensive management. Existing health infrastructure and personnel are also integrated and utilized in this endeavor. Defects at birth are screened at Delivery points, home visits by accredited social health activist (ASHA), Anganwadi centers and at schools. Developmental delays are evaluated at DEIC through a multidisciplinary team with interdisciplinary approach. Five thousand four hundred eighteen dedicated Mobile Health teams have screened a total of 12.19 crore children till Dec.14. From April to Dec. 2014, 4.20 crore children were screened, of which birth to 6-y-old children were 2.13 crore while 2.07 crore were from 6 to 18 y. 17.7 lakh children were referred to tertiary centers and 6.2 lakh availed tertiary care. 50.7 lakhs were found positive for 4Ds; 1.35 lakhs were birth defects. RBSK is a step towards universal health care for free assured services.
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Affiliation(s)
- Arun K Singh
- Rashtriya Bal Swasthya Karyakram (RBSK), Ministry of Health & Family Welfare, Government of India, New Delhi, India.
| | - Rakesh Kumar
- Reproductive, Maternal, New-Born, Child, and Adolescent Health (RMNCH+A), Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - C K Mishra
- National Health Mission-Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Ajay Khera
- Child Health, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Anubhav Srivastava
- Rashtriya Bal Swasthya Karyakram (RBSK), Ministry of Health & Family Welfare, Government of India, New Delhi, India
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Abstract
Rotavirus vaccines are being introduced in several low- and middle-income countries across the world with and without support from the GAVI Alliance. India has the highest disease burden of rotavirus based on morbidity and mortality estimates and several indigenous vaccine manufacturers are developing rotavirus vaccines. One candidate has undergone phase III testing and others have completed evaluation in phase II. Global data on licensed vaccine performance in terms of impact on disease, strain diversity, safety and cost-effectiveness has been reviewed to provide a framework for decision making in India.
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Affiliation(s)
- T S Rao
- Department of Biotechnology, Ministry of Science and Technology, Government of India, CGO Complex, New Delhi, India
| | - Rashmi Arora
- Division of Epidemiology and Communicable Diseases, Indian Council for Medical Research, Ansari Nagar, New Delhi, India
| | - Ajay Khera
- Child Health and Immunization, Ministry of Health and Family Welfare, Nirman Bhawan, New Delhi, India
| | - Jacqueline E Tate
- Viral Gastroenteritis Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Umesh Parashar
- Viral Gastroenteritis Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore 632004, Tamil Nadu, India.
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Megiddo I, Colson AR, Nandi A, Chatterjee S, Prinja S, Khera A, Laxminarayan R. Analysis of the Universal Immunization Programme and introduction of a rotavirus vaccine in India with IndiaSim. Vaccine 2015; 32 Suppl 1:A151-61. [PMID: 25091670 DOI: 10.1016/j.vaccine.2014.04.080] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES India has the highest under-five death toll globally, approximately 20% of which is attributed to vaccine-preventable diseases. India's Universal Immunization Programme (UIP) is working both to increase immunization coverage and to introduce new vaccines. Here, we analyze the disease and financial burden alleviated across India's population (by wealth quintile, rural or urban area, and state) through increasing vaccination rates and introducing a rotavirus vaccine. METHODS We use IndiaSim, a simulated agent-based model (ABM) of the Indian population (including socio-economic characteristics and immunization status) and the health system to model three interventions. In the first intervention, a rotavirus vaccine is introduced at the current DPT3 immunization coverage level in India. In the second intervention, coverage of three doses of rotavirus and DPT and one dose of the measles vaccine are increased to 90% randomly across the population. In the third, we evaluate an increase in immunization coverage to 90% through targeted increases in rural and urban regions (across all states) that are below that level at baseline. For each intervention, we evaluate the disease and financial burden alleviated, costs incurred, and the cost per disability-adjusted life-year (DALY) averted. RESULTS Baseline immunization coverage is low and has a large variance across population segments and regions. Targeting specific regions can approximately equate the rural and urban immunization rates. Introducing a rotavirus vaccine at the current DPT3 level (intervention one) averts 34.7 (95% uncertainty range [UR], 31.7-37.7) deaths and $215,569 (95% UR, $207,846-$223,292) out-of-pocket (OOP) expenditure per 100,000 under-five children. Increasing all immunization rates to 90% (intervention two) averts an additional 22.1 (95% UR, 18.6-25.7) deaths and $45,914 (95% UR, $37,909-$53,920) OOP expenditure. Scaling up immunization by targeting regions with low coverage (intervention three) averts a slightly higher number of deaths and OOP expenditure. The reduced burden of rotavirus diarrhea is the primary driver of the estimated health and economic benefits in all intervention scenarios. All three interventions are cost saving. CONCLUSION Improving immunization coverage and the introduction of a rotavirus vaccine significantly alleviates disease and financial burden in Indian households. Population subgroups or regions with low existing immunization coverage benefit the most from the intervention. Increasing coverage by targeting those subgroups alleviates the burden more than simply increasing coverage in the population at large.
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Affiliation(s)
- Itamar Megiddo
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA
| | - Abigail R Colson
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA; Princeton Environmental Institute, Princeton University, Princeton, NJ, USA
| | - Arindam Nandi
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA
| | | | - Shankar Prinja
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Khera
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA; Princeton Environmental Institute, Princeton University, Princeton, NJ, USA; Public Health Foundation of India, New Delhi, India.
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Yang LS, Khera A, Kamm MA. Outcome of behavioural treatment for idiopathic chronic constipation. Intern Med J 2014; 44:858-64. [DOI: 10.1111/imj.12490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/25/2014] [Indexed: 02/06/2023]
Affiliation(s)
- L. S. Yang
- Departments of Medicine and Gastroenterology; University of Melbourne and St Vincent's Hospital; Melbourne Victoria Australia
| | - A. Khera
- Central Melbourne Gastroenterology; Melbourne Victoria Australia
| | - M. A. Kamm
- Departments of Medicine and Gastroenterology; University of Melbourne and St Vincent's Hospital; Melbourne Victoria Australia
- Central Melbourne Gastroenterology; Melbourne Victoria Australia
- Imperial College; London UK
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Abstract
Diphtheritic polyneuropathy is a vaccine-preventable illness caused by exotoxin-producing strains of Corynebacterium diphtheriae. We present a retrospective convenience case series of 15 children (6 girls) <15 years of age (mean age 5.2 years, case-fatality rate 53%, and 1 additional case-patient who was ventilator dependent at the time of last follow-up; median follow-up period 60 days) with signs and symptoms suggestive of diphtheritic polyneuropathy. All cases were identified through national acute flaccid paralysis surveillance, which was designed to detect poliomyelitis in India during 2002–2008. We also report data on detection of diphtheritic polyneuropathy compared with other causes of acute flaccid paralysis identified by this surveillance system.
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Morris SK, Awasthi S, Kumar R, Shet A, Khera A, Nakhaee F, Ram U, Brandao JRM, Jha P. Measles mortality in high and low burden districts of India: estimates from a nationally representative study of over 12,000 child deaths. Vaccine 2013; 31:4655-61. [PMID: 23876496 DOI: 10.1016/j.vaccine.2013.07.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/22/2013] [Accepted: 07/02/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Direct estimates of measles mortality in India are unavailable. Our objective is, to use a nationally-representative study of mortality to estimate the number and distribution of, measles deaths in India with a focus on 264 high burden districts. METHODS We used physician coded verbal autopsy data from the Million Death Study which surveyed, over 12,000 deaths in children aged 1 month to under 15 years from 1.1 million nationally, representative households in 2001-2003. RESULTS We estimate there were 92,000 (99% CI 63,000-137,000) measles deaths in children 1-59, months of age in India in 2005, representing a mortality rate of 3.3 (99% CI 2.3-5.0) per 1000 live, births and about 6% of all 1-59 month deaths. In children under 15 years of age, there were 107,000, (99% CI 74,000-158,000) measles deaths. The measles mortality rate was nearly 70% greater in girls, than in boys, and 60% of the deaths were in three populous states Uttar Pradesh, Bihar, and Madhya, Pradesh. The 1-59 month measles mortality rate in high burden districts was 4.48 (99% CI 3.94-5.02) compared to 2.40 (99% CI 2.28-2.52) per 1000 live births in other districts. CONCLUSION Measles killed over 100,000 children in India in 2005 and girls were at higher risk than boys. The majority of measles deaths occurred in a few states and high burden districts. The results of this study highlight the importance of focusing measles supplementary immunization activities in high burden districts.
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Affiliation(s)
- Shaun K Morris
- Centre for Global Heath Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada; Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada and Department of Pediatrics, University of Toronto, 555 University Avenue, Toronto, Ontario, M5G1X8, Canada.
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Khera A, Vanderlelie J, Perkins A. Selenium supplementation protects trophoblast cells from mitochondrial oxidative stress. Placenta 2013; 34:594-8. [DOI: 10.1016/j.placenta.2013.04.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/15/2013] [Accepted: 04/17/2013] [Indexed: 11/26/2022]
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Morris SK, Awasthi S, Khera A, Bassani DG, Kang G, Parashar UD, Kumar R, Shet A, Glass RI, Jha P. Rotavirus mortality in India: estimates based on a nationally representative survey of diarrhoeal deaths. Bull World Health Organ 2012; 90:720-7. [PMID: 23109739 DOI: 10.2471/blt.12.101873] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 04/04/2012] [Accepted: 04/10/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To estimate the number of rotavirus-associated deaths among Indian children younger than five years. METHODS We surveyed more than 23 000 child deaths from a nationally representative survey of 1.1 million Indian households during 2001-2003. Diarrhoeal deaths were characterized by region, age and sex and were combined with the proportion of deaths attributable to rotavirus, as determined by hospital microbiologic data collected by the Indian Rotavirus Strain Surveillance Network from December 2005 to November 2007. Rotavirus vaccine efficacy data from clinical trials in developing countries were used to estimate the number of deaths preventable by a national vaccination programme. Data were analysed using Stata SE version 10. FINDINGS Rotavirus caused an estimated 113 000 deaths (99% confidence interval, CI: 86 000-155 000); 50% (54 700) and 75% (85 400) occurred before one and two years of age, respectively. One child in 242 died from rotavirus infection before five years of age. Rotavirus-associated mortality rates overall, among girls and among boys were 4.14 (99% CI: 3.14-5.68), 4.89 (99% CI: 3.75-6.79) and 3.45 (99% CI: 2.58-4.66) deaths per 1000 live births, respectively. Rates were highest in Bihar, Uttar Pradesh and Madhya Pradesh, which together accounted for > 50% of deaths (64 400) nationally. Rotavirus vaccine could prevent 41 000-48 000 deaths among children aged 3-59 months. CONCLUSION The burden of rotavirus-associated mortality is high among Indian children, highlighting the potential benefits of rotavirus vaccination.
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Affiliation(s)
- Shaun K Morris
- Division of Infectious Diseases, Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON M5G1X8, Canada
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Morris S, Khera A, Jha P. Geographic, gender, and age distribution of measles deaths in India: estimates from a nationally representative study of over 12000 child deaths. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
BACKGROUND The aim of Avahan, the India AIDS Initiative, was to reduce HIV transmission in the general population through large-scale prevention interventions focused on high-risk groups. It was launched in 2003 in six states with a total population of 300 million and a high HIV burden. We assessed the population-level effect of the first phase of Avahan (2003-08). METHODS Population prevalence was estimated by use of adjustment factors from the national HIV sentinel surveillance data obtained annually from antenatal clinics. A mixed-effects multilevel regression model was developed to estimate the association between intervention intensity and population HIV prevalence trends, taking into account differences in the underlying epidemic trends in states and other potential confounders, and to estimate the number of HIV infections averted with Avahan. FINDINGS 80 (61%) of 131 districts in the six Avahan states received funding from Avahan for HIV prevention, as the only or shared source. Greater intensity of Avahan, measured as amount of grant per HIV population (medians US$24-432 in the six states), was significantly associated with lower HIV prevalence in Andhra Pradesh (p=0·004), Karnataka (p=0·004), and Maharashtra (p=0·008) states; this association was not significant in Tamil Nadu (p=0·06), Manipur (p=0·62), and Nagaland (p=0·67). Overall, we estimated that 100,178 HIV infections (95% CI 25,897-207,713) were averted at the population level from 2003 up to 2008 as a result of Avahan. INTERPRETATION The results of our analysis suggest that Avahan had a beneficial effect in reducing HIV prevalence at the population level over 5 years of programme implementation in some of the states. With stagnating funding for HIV prevention globally, our findings support investment in well planned and managed HIV prevention programmes in low-income and middle-income countries. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Marie Ng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA
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Turer AT, Khera A, Ayers CR, Turer CB, Grundy SM, Vega GL, Scherer PE. Adipose tissue mass and location affect circulating adiponectin levels. Diabetologia 2011; 54:2515-24. [PMID: 21779869 PMCID: PMC4090928 DOI: 10.1007/s00125-011-2252-z] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 06/14/2011] [Indexed: 01/04/2023]
Abstract
AIMS/HYPOTHESIS Plasma levels of adiponectin are inversely associated with body mass. We hypothesised that adipose tissue distribution and body composition influences adiponectin levels. METHODS We assessed plasma adiponectin concentrations and dual-energy X-ray absorptiometry (DEXA) measurements of body composition among 2,820 participants from the Dallas Heart Study. RESULTS Among both women and men, adiponectin levels were higher in whites than in either Hispanics or African-Americans (for women: median 9.99 μg/ml [25th,75th percentile 7.11, 13.77] vs 7.56 μg/ml [5.05, 9.98] vs 6.39 μg/ml [4.37, 9.41], respectively, p < 0.0001; for men: 6.43 μg/ml [4.66, 9.19] vs 5.55 μg/ml [3.64, 7.50] vs 5.03 μg/ml [3.39, 7.28], p < 0.0001). In univariate analysis, each individual component of body mass was inversely associated with adiponectin. After multivariate analysis, adiponectin levels were found to be positively associated with lower extremity fat, whether expressed in absolute mass (for women: β = 0.055, p < 0.0001; for men: β = 0.061, p < 0.0001), or as a relative proportion (for women: β = 0.035, p < 0.0001; for men: β = 0.034, p < 0.0001). This association was consistent across ethnicities. Conversely, adiponectin was negatively correlated with truncal fat, both in absolute (for women: β = -0.039, p < 0.0001; for men: β = -0.044, p < 0.0001) and relative terms (for women: β = -0.027, p < 0.0001; for men β = -0.033, p < 0.0001). At the extreme of body mass, higher degrees of lower extremity and truncal adiposity were associated with higher levels of adiponectin. CONCLUSIONS/INTERPRETATION These data suggest that the location of adipose depots differentially influences circulating adiponectin concentrations-a finding observed across ethnicity and sex. Gross measures of body mass alone do not adequately account for adiponectin levels. This supports a role of adiponectin as a mediator of the positive effects of lower extremity adiposity on improvements in insulin sensitivity.
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Affiliation(s)
- A T Turer
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8521, USA.
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Jha P, Kumar R, Khera A, Bhattacharya M, Arora P, Gajalakshmi V, Bhatia P, Kam D, Bassani D, Sullivan A, Suraweera W, McLaughlin C, Dhingra N, Nagelkerke N. O6-4.2 HIV mortality and infection in India: estimates from nationally representative mortality survey of 1.1 million homes. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976b.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gaffey MF, Venkatesh S, Dhingra N, Khera A, Kumar R, Arora P, Nagelkerke N, Jha P. Male use of female sex work in India: a nationally representative behavioural survey. PLoS One 2011; 6:e22704. [PMID: 21829486 PMCID: PMC3146473 DOI: 10.1371/journal.pone.0022704] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 07/05/2011] [Indexed: 11/29/2022] Open
Abstract
Heterosexual transmission of HIV in India is driven by the male use of female sex workers (FSW), but few studies have examined the factors associated with using FSW. This nationally representative study examined the prevalence and correlates of FSW use among 31,040 men aged 15–49 years in India in 2006. Nationally, about 4% of men used FSW in the previous year, representing about 8.5 million FSW clients. Unmarried men were far more likely than married men to use FSW overall (PR = 8.0), but less likely than married men to use FSW among those reporting at least one non-regular partner (PR = 0.8). More than half of all FSW clients were married. FSW use was higher among men in the high-HIV states than in the low-HIV states (PR = 2.7), and half of all FSW clients lived in the high-HIV states. The risk of FSW use rose sharply with increasing number of non-regular partners in the past year. Given the large number of men using FSW, interventions for the much smaller number of FSW remains the most efficient strategy for curbing heterosexual HIV transmission in India.
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Affiliation(s)
- Michelle F. Gaffey
- Centre for Global Health Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Ajay Khera
- Ministry of Health and Family Welfare, New Delhi, India
| | - Rajesh Kumar
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Paul Arora
- Centre for Global Health Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nico Nagelkerke
- Centre for Global Health Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Prabhat Jha
- Centre for Global Health Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Kumar R, Virdi NK, Lakshmi PVM, Garg R, Bhattacharya M, Khera A. Utility of Prevention of Parent-to-Child Transmission (PPTCT). Programme data for HIV surveillance in general population. Indian J Med Res 2010; 132:256-259. [PMID: 20847370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND & OBJECTIVES HIV sentinel surveillance (HSS) among antenatal clinic (ANC) attendees is used to monitor HIV trends in general population. Recently, information on HIV infection has also become available from prevention of parent-to-child transmission (PPTCT) programmes. Systematic appraisal of routinely collected programme data is needed for choosing a scientific, cost-effective, and ethical surveillance strategy. In this study HIV prevalence estimates obtained from PPTCT programme and HSS were compared to find out the utility of PPTCT programme data for HIV surveillance. METHODS The data of HSS and PPTCT programme were obtained from National AIDS Control Organization, New Delhi. A list of PPTCT programme sites where ANC HSS was also conducted during 2005 to 2007 was prepared. HIV prevalence and 95 per cent confidence interval (CI) were estimated from antenatal attendees in PPTCT and HSS. Correlation coefficient of HIV prevalence in PPTCT and HSS was also examined according to the level of HIV test acceptance in PPTCT programme. Pregnant women presenting directly for labour in PPTCT centers were not included in the analyses. RESULTS In 2007, HIV test acceptance ranged from 8 to 100 per cent (average 76%) in 372 sites where both PPTCT and HSS were carried out. HIV prevalence was similar in the PPTCT (0.68%, 95% CI 0.66%, 0.70%) as compared to the HSS (0.61%, 95% CI 0.58%, 0.66%). Overall the correlation of HIV prevalence between PPTCT and HSS was quite high at state level (r = 0.9) but low at district or site level (r = 0.6). INTERPRETATION & CONCLUSIONS HIV prevalence estimates among pregnant women in PPTCT program were similar to that of ANC HSS. Routinely collected PPTCT program data therefore has potential for providing reliable HIV time trends in various states of India.
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Affiliation(s)
- Rajesh Kumar
- Postgraduate Institute of Medical Education & Research, School of Public Health, Chandigarh, India
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Jha P, Kumar R, Khera A, Bhattacharya M, Arora P, Gajalakshmi V, Bhatia P, Kam D, Bassani DG, Sullivan A, Suraweera W, McLaughlin C, Dhingra N, Nagelkerke N. HIV mortality and infection in India: estimates from nationally representative mortality survey of 1.1 million homes. BMJ 2010; 340:c621. [PMID: 20179131 PMCID: PMC2827715 DOI: 10.1136/bmj.c621] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [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: 11/15/2022]
Abstract
OBJECTIVE To determine the rates of death and infection from HIV in India. DESIGN Nationally representative survey of deaths. SETTING 1.1 million homes in India. Population 123,000 deaths at all ages from 2001 to 2003. MAIN OUTCOME MEASURES HIV mortality and infection. RESULTS HIV accounted for 8.1% (99% confidence interval 5.0% to 11.2%) of all deaths among adults aged 25-34 years. In this age group, about 40% of deaths from HIV were due to AIDS, 26% were due to tuberculosis, and the rest were attributable to other causes. Nationally, HIV infection accounted for about 100,000 (59,000 to 140,000) deaths or 3.2% (1.9% to 4.6%) of all deaths among people aged 15-59 years. Deaths from HIV were concentrated in the states and districts with higher HIV prevalence and in men. The mortality results imply an HIV prevalence at age 15-49 years of 0.26% (0.13% to 0.39%) in 2004, comparable to results from a 2005/6 household survey that tested for HIV (0.28%). Collectively, these data suggest that India had about 1.4-1.6 million HIV infected adults aged 15-49 years in 2004-6, about 40% lower than the official estimate of 2.3 million for 2006. All cause mortality increased in men aged 25-34 years between 1997 and 2002 in the states with higher HIV prevalence but declined after that. HIV prevalence in young pregnant women, a proxy measure of incidence in the general population, fell between 2000 and 2007. Thus, HIV mortality and prevalence may have fallen further since our study. CONCLUSION HIV attributable death and infection in India is substantial, although it is lower than previously estimated.
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Affiliation(s)
- Prabhat Jha
- Centre for Global Health Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada M5C1N8.
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Dewan PK, Gupta D, Williams BG, Thakur R, Bachani D, Khera A, Wares DF, Sahu S, Reddy DCS, Raizada N, Chauhan LS. National estimate of HIV seroprevalence among tuberculosis patients in India. Int J Tuberc Lung Dis 2010; 14:247-249. [PMID: 20074420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
The national estimate for human immunodeficiency virus (HIV) prevalence among tuberculosis (TB) patients in India has previously been estimated indirectly from global data. To derive an improved national estimate from local data, we correlated district-level HIV surveillance data from antenatal clinics and TB diagnostic centres, and applied this correlation to state-level HIV prevalence estimates for the antenatal population. We estimate that among the 1.96 million incident TB cases in 2007, 4.85% (95%CI 4.12-5.73) or 95 240 (95%CI 80 730-112 478) were HIV-infected. With these estimates from local data, the national programme can better plan TB-HIV collaborative activities and monitor efforts to detect HIV infection in this large population.
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Affiliation(s)
- P K Dewan
- Office of the World Health Organization Representative to India, New Delhi, India.
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Pandey A, Reddy DCS, Ghys PD, Thomas M, Sahu D, Bhattacharya M, Maiti KD, Arnold F, Kant S, Khera A, Garg R. Improved estimates of India's HIV burden in 2006. Indian J Med Res 2009; 129:50-58. [PMID: 19287057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND & OBJECTIVE HIV estimates in India were based on HIV sentinel surveillance (HSS) data and several assumptions. Expansion of sentinel surveillance to all districts and community based HIV prevalence measured by National Family Health Survey-3 (NFHS-3) in 2006 provided opportunity to replace many of the assumptions with evidence based information and improve the HIV estimate closer to reality. This article presents a detailed account of the methodology used for the 2006 HIV burden estimates for India. METHODS State-wise adult HIV prevalence among different risk groups observed from HSS 2006 was adjusted for site level variations using a random effects model and for the previous four years the same was back calculated using trend equations derived from a mixed effects logistic regression model based on consistent sites prevalence. The adjusted HIV prevalence among the general population was calibrated to the estimates from NFHS-3. Overall point estimates of adult HIV prevalence in each State for 2002-2006 were derived from the UNAIDS Workbook and projected for the period 1985-2010. The results were put into Spectrum to derive estimates of the number of people living with HIV in all ages and other epidemic impacts. RESULTS National adult HIV prevalence was 0.36 per cent (range 0.29-0.46%) and the estimated number of people living with HIV was 2.47 million (range 2.0-3.1 million) in 2006. The national adult HIV prevalence remains stable around 0.4 per cent between 2002 and 2006. The States with the highest estimated prevalence were Manipur, Nagaland and Andhra Pradesh. The States with the highest burden were Andhra Pradesh, Maharashtra, Karnataka and Tamil Nadu. INTERPRETATION & CONCLUSION The improvement in the 2006 estimates of the HIV burden in India is attributable to the expanded sentinel surveillance and representative data from the population-based survey in 2006, combined with an improved analysis. Despite the downward revision, India continues to face a formidable challenge to provide prevention, treatment and care to those in need.
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Affiliation(s)
- Arvind Pandey
- National Institute of Medical Statistics, ICMR, New Delhi, India.
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Raizada N, Chauhan LS, Khera A, Sokhey J, Wares DF, Sahu S, Thakur R, Dewan PK. HIV seroprevalence among tuberculosis patients in India, 2006-2007. PLoS One 2008; 3:e2970. [PMID: 18714335 PMCID: PMC2495033 DOI: 10.1371/journal.pone.0002970] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Accepted: 07/09/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little information exists regarding the burden of HIV among tuberculosis patients in India, and no population-based surveys have been previously reported. A community-based HIV prevalence survey was conducted among tuberculosis patients treated by the national tuberculosis control programme to evaluate the HIV prevalence among tuberculosis patients in India. METHODOLOGY/PRINCIPAL FINDINGS Fifteen districts (total population: 40.2 million) across 8 states were stratified by HIV prevalence in antenatal clinic HIV surveillance sites and randomly selected. From December 2006 to May 2007, remnant serum was collected from patients' clinical specimens taken after 2 months of anti-tuberculosis treatment and subjected to anonymous, unlinked HIV testing. Specimens were obtained and successfully tested for 5,995 (73%) of 8,217 tuberculosis patients eligible for the survey. HIV prevalence ranged widely among the 15 surveyed districts, from 1% in Koch Bihar, West Bengal, to 13.8% in Guntur, Andhra Pradesh. HIV infection was 1.3 times more likely among male TB patients than among female patients. Relative to smear-positive tuberculosis, HIV infection was 1.4 times more likely among smear-negative patients and 1.3 times more likely among extrapulmonary patients. In 4 higher-HIV prevalence districts, which had been previously surveyed in 2005-2006, no significant change in HIV prevalence was detected. CONCLUSIONS The burden of HIV among tuberculosis patients varies widely in India. Programme efforts to implement comprehensive TB-HIV services should be targeted to areas with the highest HIV burden. Surveillance through routine reporting or special surveys is necessary to detect areas requiring intensification of TB-HIV collaborative activities.
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Affiliation(s)
- Neeraj Raizada
- Office of the WHO Representative to India, New Delhi, India
| | - Lakbir Singh Chauhan
- Central Tuberculosis Division, Directorate General of Health Services, New Delhi, India
| | - Ajay Khera
- Ministry of Health and Family Welfare, National AIDS Control Organization, Ministry of Health and Family Welfare, New Delhi, India
| | - Jotna Sokhey
- Ministry of Health and Family Welfare, National AIDS Control Organization, Ministry of Health and Family Welfare, New Delhi, India
| | | | - Suvanand Sahu
- Office of the WHO Representative to India, New Delhi, India
| | - Rahul Thakur
- Office of the WHO Representative to India, New Delhi, India
| | - Puneet Kumar Dewan
- World Health Organization, Southeast Asia Regional Office, New Delhi, India
- * E-mail:
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Rao V, Dhar N, Shakila H, Singh R, Khera A, Jain R, Naseema M, Paramasivan CN, Narayanan PR, Ramanathan VD, Tyagi AK. Increased expression of Mycobacterium tuberculosis 19 kDa lipoprotein obliterates the protective efficacy of BCG by polarizing host immune responses to the Th2 subtype. Scand J Immunol 2005; 61:410-7. [PMID: 15882432 DOI: 10.1111/j.1365-3083.2005.01569.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Mycobacterium tuberculosis can not only neutralize immune effector functions, but also has the ability to modulate host-signalling cascades involved in the development of these responses. The 19 kDa antigen (Rv3763), a lipoprotein of M. tuberculosis, elicits high levels of interleukin (IL)-12 from macrophages in addition to its powerful immunomodulatory properties, leading to suppression of antigen-presentation signalling cascades. The present study was aimed at analysing the effect of overexpression of this antigen on the immunostimulatory properties of M. bovis Bacille Calmette-Guerin (BCG). We have constructed a recombinant BCG strain (rBCG19N) producing higher levels of the 19 kDa antigen in both the cytoplasmic (approximately eightfold) and extracellular (approximately fivefold) fractions as compared to the wildtype BCG. Immunization of mice with rBCG19N elicited high levels of interferon-gamma (IFN-gamma) and relatively low levels of IL-10 against the purified 19 kDa antigen. However, in response to total BCG sonicate, mice immunized with rBCG19N produced significantly high levels of IL-10 with relatively very low levels of IFN-gamma. This polarization of the host immune responses towards T-helper 2 subtype resulted in complete abrogation of the protective efficacy of BCG, when rBCG19N was used as a live vaccine against M. tuberculosis challenge in guinea pigs.
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Affiliation(s)
- V Rao
- Department of Biochemistry, University of Delhi South Campus, New Delhi, India
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Upasani CD, Khera A, Balaraman R. Effect of lead with vitamin E, C, or Spirulina on malondialdehyde, conjugated dienes and hydroperoxides in rats. Indian J Exp Biol 2001; 39:70-4. [PMID: 11349530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Lead (100 ppm) was given in doubly deionised water for 30 days to one group of rats. The other groups received lead along with exogenous antioxidants like vitamin E (50 IU/kg), vitamin C (800 mg/kg) or Spirulina (1500 mg/kg) in food for a similar period. Levels of lipid peroxidation products such as malondialdehyde, conjugated diene and hydroperoxide were measured in liver, lung and kidney of treated rats. In lead treated animals there was a significant increase in the levels of these lipid peroxidative products. Administration of exogenous antioxidants in the lead treated animals reduced the levels of malondialdehyde, conjugated diene and hydroperoxide. It indicated that vitamin E, vitamin C and Spirulina had significant (P < 0.001) antioxidant activity thereby protecting the animals from lead induced toxicity.
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Affiliation(s)
- C D Upasani
- Pharmacy Department, Faculty of Technology & Engineering, M S University of Baroda, Kalabhavan, Baroda 390 001, India
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Maubon AJ, Thurmond AS, Nikolchev J, Khera A, Machan LS, Rouanet JP. Endoscopic transvaginal approach to the rabbit uterine cervix: improvement in the technique of selective tubal catheterization. Acad Radiol 1997; 4:270-4. [PMID: 9110024 DOI: 10.1016/s1076-6332(97)80028-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
RATIONALE AND OBJECTIVES The authors compared two methods of selective fallopian tube catheterization in female rabbits. METHODS Technical success rates and procedure times in two groups of animals were compared. Group 1 consisted of 20 female rabbits catheterized with a fluoroscopic technique. Group 2 consisted of 55 rabbits catheterized with a combination of endoscopic and fluoroscopic guidance. RESULTS The technique used in group 2 allowed a statistically significant reduction in the time required for cervical catheterization and the total procedural time (P < .01). There was a parallel statistically significant reduction in fluoroscopy time (P < .01). Technical success rates and adverse effects were similar for the two techniques. CONCLUSION The combined endoscopic-fluoroscopic technique requires a shorter time than the established fluoroscopic technique and should be considered for future selective tubal catheterization experiments in rabbits.
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Affiliation(s)
- A J Maubon
- Department of Radiology, Centre Medico-chirurgical Beausoleil, Montpellier, France
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