Kerala Archives - InnoHEALTH magazine

Rising burden of non-communicable diseases

InnoHEALTH Magazine — Thu, 03 May 2018 11:13:40 +0000

The contribution of most of the major non-communicable disease groups to the total disease burden has increased all over India since 1990, including cardiovascular diseases, diabetes, chronic respiratory diseases, mental health and neurological disorders, cancers, musculoskeletal disorders and chronic kidney disease.

On the other hand, the DALY rates of stroke varied across the states without any consistent pattern in relation to the stage of epidemiological transition. This variety of trends of the different major non-communicable diseases indicates that policy and health system interventions to tackle their increasing burden have to be informed by the specific trends in each state. Increasing but variable burden of injuries among states.

The contribution of injuries to the total disease burden has increased in most states since 1990. The highest proportion of disease burden due to injuries is in young adults. Road injuries and self-harm, which includes suicides and non-fatal outcomes of self-harm, are the leading contributors to the injury burden in India. The range of disease burden or DALY rate varied 3 fold for road injuries and 6 fold for self-harm among the states of India in 2016. There was no consistent relationship between the DALY rates of road injuries or self-harm versus the stage of epidemiological transition of the states. The burden due to road injuries was much higher in males than in females. The DALY rate for self-harm for India as a whole was 1.8 times higher than the average globally for other geographies at a similar level of development in 2016.

The report says the disease burden due to child and maternal malnutrition has dropped in India substantially since 1990; this is still the single largest risk factor, responsible for 15% of the total disease burden in India in 2016.

This burden is highest in the major EAG states and Assam, and is higher in females than in males. Child and maternal malnutrition contributes to disease burden mainly through increasing the risk of neonatal disorders, nutritional deficiencies, diarrhoeal diseases, lower respiratory infections, and other common infections. As a stark contrast, the disease burden due to child and maternal malnutrition in India was 12 times higher per person than in China in 2016.

Kerala had the lowest burden due to this risk among the Indian states, but even this was 2.7 times higher per person than in China.

This situation after decades of nutritional interventions in the country must be rectified as one of the highest priorities for health improvement in India. Unsafe water and sanitation improving, but not enough yet Unsafe water and sanitation was the second leading risk responsible for disease burden in India in 1990, but dropped to the seventh leading risk in 2016, contributing 5% of the total disease burden, mainly through diarrheal diseases and other infections. The burden due to this risk is also highest in several EAG states and Assam, and higher in females than in males.

The improvement in exposure to this risk from 1990 to 2016 was least in the EAG states, indicating that higher focus is needed in these states for more rapid improvements.

Remarkably, the per person disease burden due to unsafe water and sanitation was 40 times higher in India than in China in 2016. The massive effort of the ongoing Swachh Bharat Abhiyan has the potential to improve this situation. Improvement was notice in household air pollution. Outdoor pollution worsened air pollution and remained high in India between 1990 and 2016, with levels of exposure among the highest in the world.

It causes burden through a mix of non-communicable and infectious diseases, mainly cardiovascular diseases, chronic respiratory diseases, and lower respiratory infections.

The burden of household air pollution decreased during this period due to decreasing use of solid fuels for cooking, and that of outdoor air pollution increased due to a variety of pollutants from power production, industry, vehicles, construction, and waste burning. Household air pollution was responsible for 5% of the total disease burden in India in 2016, and outdoor air pollution for 6%. The burden due to household air pollution is highest in the EAG states, where its improvement since 1990 has also been the slowest.

On the other hand, the burden due to outdoor air pollution is highest in a mix of northern states, including Haryana, Uttar Pradesh, Punjab, Rajasthan, Bihar, and West Bengal. Control of air pollution has to be ramped up through inter-sectoral collaborations based on the specific situation of each state.

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Rising risks for cardiovascular diseases & diabetes

InnoHEALTH Magazine — Thu, 03 May 2018 08:06:08 +0000

Of the total disease burden in India in 1990, a tenth was caused by a group of risks including unhealthy diet, high blood pressure, high blood sugar, high cholesterol, and overweight, which mainly contribute to ischaemic heart disease, stroke and diabetes.

The contribution of this group of risks increased massively to a quarter of the total disease burden in India in 2016. The combination of these risks was highest in Punjab, Tamil Nadu, Kerala, Andhra Pradesh, and Maharashtra in 2016, but importantly, the contribution of these risks has increased in every state of the country since 1990.

The other significant contributor to cardiovascular diseases and diabetes, as well as to cancers and some other diseases, is tobacco use, which was responsible for 6% of the total disease burden in India in 2016. All of these risks are generally higher in males than in females.

The sweeping increase of the burden due to this combination of risks in every part of the country indicates emphatically that major efforts need to be put in place to control their impact in every state before the situation gets totally out of control.

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Health of the Indian states

InnoHEALTH Magazine — Wed, 02 May 2018 11:14:35 +0000

India: Health of the Nation’s States from 9% to 12%

Infectious and associated diseases made up the majority of disease burden in most of the states in 1990, but this was less than half in all states in 2016.

However, the year when infectious and associated diseases transitioned to less than half of the total disease burden ranged from 1986 to 2010 for the various state groups in different stages of this transition.

The wide variations between the states in this epidemiological transition are reflected in the range of the contribution of major disease groups to the total disease burden in 2016: 48% to 75% for non-communicable diseases, 14% to 43% for infectious and associated diseases, and 9% to 14% for injuries. Kerala, Goa, and Tamil Nadu have the largest dominance of non-communicable diseases and injuries over infectious and associated diseases, whereas this dominance is present but relatively the lowest in Bihar, Jharkhand, Uttar Pradesh, and Rajasthan. Infectious and associated diseases are reducing, but still high in many states.

The burden of most infectious and associated diseases reduced in India from 1990 to 2016, but five of the ten individual leading causes of disease burden in India in 2016 still belonged to this group: diarrheal diseases, lower respiratory infections, iron-deficiency anemia, preterm birth complications, and tuberculosis.

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The burden caused by these conditions generally continues to be much higher in the Empowered Action Group (EAG) and North-East state groups than in the other states, but there were notable variations between the states within these groups as well.

The range of disease burden or DALY rate among the states of India was nine fold for diarrheal disease, seven fold for lower respiratory infections, and nine fold for tuberculosis in 2016, highlighting the need for targeted efforts based on the specific trends in each state.

The burden also differed between the sexes, with diarrheal disease, iron-deficiency anemia, and lower respiratory infections higher among females, and tuberculosis higher among males.

The proportion of total disease burden caused by infectious and associated diseases was highest among children, which contributed to the disproportionately higher overall disease burden suffered by the under-5 year’s age group.

The report said for India as whole, the disease burden or DALY rate for diarrheal diseases, iron-deficiency anemia, and tuberculosis was 2.5 to 3.5 times higher than the average globally for other geographies at a similar level of development, indicating that this burden can be brought down substantially.

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Lifestyle diseases: A threat to backward states

InnoHEALTH Magazine — Wed, 02 May 2018 08:13:02 +0000

Lifestyle diseases like chronic respiratory and heart diseases are killing more people in India than communicable ailments like Tuberculosis (TB) or Diarrhea in every states, including most backward belts, says the India State-Level Disease Burden Initiative’s Report.

Among the leading non-communicable diseases, the largest disease burden or Disability-Adjusted Life Year (DALY) rate increase from the period of 1990 to 2016 was observed for diabetes at 80 per cent, and ischaemic heart disease at 34 per cent.

In 2016, three of the five leading individual causes of disease burden in India were non-communicable, with ischaemic heart disease and chronic obstructive pulmonary disease as the top two causes and stroke as the fifth leading cause. The range of disease burden or DALY rate among the states in 2016 was nine-fold for ischaemic heart disease, four-fold for chronic obstructive pulmonary disease, and six-fold for stroke, and fourfold for diabetes across the country.

The key metric used in the study is DALYs, which is the sum of the number of years of life lost due to premature death and a weighted measure of the years lived with disability due to a disease or injury. The use of DALYs to track disease burden is recommended by India’s National Health Policy of 2017.

While ischaemic heart disease and diabetes generally had higher DALY rates in states that are at a more advanced epidemiological transition stage toward non-communicable diseases, the DALY rates of chronic obstructive pulmonary disease were generally higher in the Empowered Action Group (EAG) states that are at a relatively less advanced epidemiological transition stage.

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The report shows that communicable diseases constitute almost two-thirds of the disease burden in India from a little over a third in 1990. Despite the transition, which is associated with development, malnutrition remains the single top risk for health loss.

All states have thus made what’s called the ‘epidemiological transition’ there remain wide variations in their disease profiles with some having made that transition as early as 1986, and others as recently as 2010.

The first group to make the transition in 1986 included Kerala, Tamil Nadu, Goa, Himachal Pradesh and Punjab. The last group to do so, accounting for the highest number of people (588 million), made the transition almost a quarter of a century later, in 2010. This group included Bihar, Uttar Pradesh, Madhya Pradesh, Chhattisgarh, Jharkhand, Rajasthan and Odisha. India as a country made the transition in 2003.

The Report’s executive summary says with almost one-fifth of the world’s population living in India, the health status and the drivers of health loss are expected to vary between different parts of the country and between the states.

Accordingly, effective efforts to improve population health in each state require systematic knowledge of the local health status and trends. While state-level trends for some important health indicators have been available in India, a comprehensive assessment of the diseases causing the most premature deaths and disability in each state, the risk factors responsible for this burden, and their time trends have not been available in a single standardised framework.

The Report finds that the Health status improving, but major inequalities between states Life expectancy at birth improved in India from 59.7 years in 1990 to 70.3 years in 2016 for females, and from 58.3 years to 66.9 years for males.

There were, however, continuing inequalities between states, with a range of 66.8 years in Uttar Pradesh to 78.7 years in Kerala for females, and from 63.6 years in Assam to 73.8 years in Kerala for males in 2016.

The per person disease burden measured as DALYs rate dropped by 36% from 1990 to 2016 in India, after adjusting for the changes in the population age structure during this period. But there was an almost two-fold difference in this disease burden rate between the states in 2016, with Assam, Uttar Pradesh, and Chhattisgarh having the highest rates, and Kerala and Goa the lowest rates.

While the disease burden rate in India has improved since 1990, it was 72% higher per person than in Sri Lanka or China in 2016. The under-5 mortality rate has reduced substantially from 1990 in all states, but there was a four-fold difference in this rate between the highest in Assam and Uttar Pradesh as compared with the lowest in Kerala in 2016, highlighting the vast health inequalities between the states.

Large differences between states in the changing disease profile of the total disease burden in India measured as DALYs, 61% was due to communicable, maternal, neonatal, and nutritional diseases (termed infectious and associated diseases in this summary for simplicity) in 1990, which dropped to 33% in 2016. There was a corresponding increase in the contribution of non-communicable diseases from 30% of the total disease burden in 1990 to 55% in 2016, and of injuries 18 %.

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Digital India Healthy India

InnoHEALTH Magazine — Fri, 27 Apr 2018 06:34:46 +0000

New India, Digital India, Make India, Innovate India in making a ‘Healthy’ India

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India is a country of diversity with 1.3 billion population of which 70 per cent resides in villages and have access to 30 per cent of medical assets of the country. Poverty is a significant issue of the country, despite having one of the fastest-growing economies in the world, clocked at an economic growth of 7.6 per cent in 2015. It is estimated that 23.6 per cent of Indian population, or about 276 million people, live below $1.25 per day.

As Health is a state subject-there is lot of mismatch in states like Kerala and Punjab have best health indicators, while Uttar Pradesh is the poorest as per the NITI Aayog report. Indian government spends approx. 1.5 per cent of its GDP on health sector and mplans to make it 2.5 per cent which is much less than many developing countries while the USA has dedicated 16 per cent of its GDP. India is riddled with very basic public health issues leading to disease burden. Keeping this in mind, Prime Minister Narendra Modi has launched six initiatives: Open Defecation free country by 2019, Swachh Bharat Mission, National Health Policy 2017, Digital India with e-health, medical device manufacturing and door-to-door screening of chronic diseases.

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The healthcare needs holistic approach which depends on multiple factors. The present government has taken many positive steps including launching of National Health Policy 2017 after the gap of 12 years. It has announced many initiatives like health insurance of people who cannot afford basic healthcare and upgrading of health infrastructure.

The regulation of medical devices have been brought out and is applicable w.e.f January 1, 2018 ending uncertainty of medical device manufacturers having global market of 220 billion US dollar. Challenges bring opportunities such as Indian healthcare market is around US$ 100 billion while it is expected to grow US$ 280 billion by 2020. The healthcare IT market is US$ one billion and is expected to grow 1.5 times by 2020. There is requirement of 7 lakh hospital beds which need investment opportunities of 25-30 billion US dollar. We need to bring innovations in hospital planning,devices, diagnostics, drugs and use of technology to reduce healthcare delivery cost and yet quality.

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We failed targets of Health for All by 2000, National Rural Health Mission, and Millennium Development Goals and now launched Universal Health Coverage; its success would depend on providing healthcare facilities and strict accountability. We need to focus on primary health care and customise our healthcare delivery system by learning from experiences of other countries.

The concept of Diagnosis Related Group (DRG) making financial package for group of diseases which is known to patients, providers and third party payors should be considered by improving deficiency found in its execution by the USA.

The various schemes of present government are appreciable but success would depend on strict monitoring, corporate hospitals have high cost and many unethical practices are reported every day in media. Public hospitals to National Rural Health Mission have not delivered as required because of corruption, lack of resources and application of management practices. The need is not old wine in new bottle but strict control in implementation of various schemes launched.

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Read all the issues of InnoHEALTH magazine:
InnoHEALTH Volume 1 Issue 1 (July to September 2016) – https://goo.gl/iWAwN2
InnoHEALTH Volume 1 Issue 2 (October to December 2016) – https://goo.gl/4GGMJz
InnoHEALTH Volume 2 Issue 1 (January to March 2017) – https://goo.gl/DEyKnw
InnoHEALTH Volume 2 Issue 2 (April to June 2017) – https://goo.gl/Nv3eev
InnoHEALTH Volume 2 Issue 3 (July to September 2017) – https://goo.gl/MCVjd6
InnoHEALTH Volume 2 Issue 4 (October to December 2017) – http://amzn.to/2B2UMLw
InnoHEALTH Volume 3 Issue 1 (January to March 2018) – https://goo.gl/fksdQx
InnoHEALTH Volume 3 Issue 2 (April to June 2018) – https://goo.gl/grbtRo

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Indian scientists detect new strain of dengue

InnoHEALTH Magazine — Tue, 10 Apr 2018 08:55:07 +0000

Scientists at Pune-based National Institute of Virology (NIV) have found a new genotype of dengue virus in patients who suffered due to one of the worst epidemics in recent years in Tamil Nadu. The study shows that the strain originated in Singapore and emerged in Tamil Nadu in 2012 and Kerala in 2013.

Even a single cell bacterium has not only DNA but also cell organelles. But viruses are just bits of DNA material in a wrap, and they use cellular mechanism of the host to multiply themselves. In doing so they damage the infected cells. The immune system of the body responds with production of specific antibodies, which destroy specific viruses.

Dengue virus comes in different types and each with different flavours. There are four serotypes of dengue virus – DENV-1 to 4. Each of them has multiple genotypes. The genotype variation can be subtle either in DNA material or the envelope. For example, DENV-1 comes in as many as five genotypes – Asia, South Pacific, Thailand, Malaysia and AM/AF.

When infected first time, the patient developed a life time immunity for that serotype due to presence of antibodies produced earlier. However, if the secondary infection is by another serotype, the immune system is confused, and the infection can become life threatening.

“Dengue virus has four antigenically defined serotypes and each serotype has multiple genotypes with several clades based on phylogenetic analysis of envelope or whole genome sequences” says D Cecilia of the Dengue Group at ICMR-NIV, Pune, who is the lead author of the new study. This makes developing an effective vaccine a major challenge.

During the last five years, the National Vector Borne Disease Control Programme (NVBDCP) reported 80,725 cases of dengue per year with a fatality rate of about 0.24%. The ten-year data for Tamil Nadu, 2007–2016 show an average of 2539 cases per year with fatality of 0.21%. This is less than the national average. However, during 2012 the cases spiked to 12,826 and deaths rose to 66, which implied fatality of 0.51%. This was a clear signature of a dengue epidemic. Epidemiological studies indicated that Tirunelveli in Tamil Nadu was the epicentre of the epidemic.

Past research had shown that the emergence of new genotype was the cause of the major dengue outbreak in late 1980s in India. Taking a cue, scientists led by Dr Cecilia collected blood samples from patients in South India during the 2012 outbreak with the help of Vellore-based Christian Medical College. The genome sequence of the virus collected from the samples were compared against the GenBank library which hosts all known dengue virus samples from 1943 to 2015.

The study revealed that DENV-1 Asian genotype had replaced the AF-AM type that was hitherto dominant in Tamil Nadu. “All four serotypes were circulating but DENV-1 was dominant, present in 52% of the serotyped samples” says Cecilia. Further, the study showed that the DENV-1 Asian genotype had also developed a new phenotype in the E gene. “This is the first time after 20 years we are observing change in genotype in India,” the scientist added.

DENV-1 originated in US and Japan during 1932. However, the Asian genotype of DENV-1 that emerged in Thailand. The Indian strains that caused havoc during the 2012-15 emerged in Singapore sometime in 2005. The same strain caused an epidemic in Singapore in 2005 and later in 2009 in Sri Lanka. “Phylogenetic analysis revealed that the Asian genotype was introduced from Singapore and shared 99% similarity with viruses, associated with large outbreaks in Singapore and Sri Lanka. The movement of DENV can affect dengue outbreaks and underscores the need for close molecular monitoring of DENV,” says Dr Cecilia.

The findings are published in journal Virology. The research team included D. Cecilia, J.A. Patil, M.B. Kakade, A. Walimbe, K. Alagarasu, B. Anukumar, from National Institute of Virology and A. Abraham from Christian Medical College, Vellore.

(Article shared from India Science Wire)

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