Tuberculosis Archives - InnoHEALTH magazine

Pandemic Blowback on Indian Rural Healthcare

InnoHEALTH magazine digital team — Tue, 05 Apr 2022 05:13:32 +0000

Three consecutive waves of COVID-19 have evidently expressed an insufficient rural health infrastructure In India three consecutive waves of COVID-19 have exposed the seriously compromised state of rural health infrastructure. Interestingly, non-government organizations, enterprises and charities contributed to the dire situation by way of providing personal protective equipment, medical supplies, appliances, rapid testing kits, including monetary aid. Their participation did provide some respite to the struggling rural healthcare setups in confronting the SARS Cov-2 onslaught, but it pointed towards the need for improved strategic policies to build up the rural healthcare systems to face future unforeseen emergencies.

Rural children in general and, girl child in particular due to prevalent gender discrimination, tend to face worst health outcomes.

It is well-known that in India there exist substantial differences between the urban and rural areas, with poverty affecting lives of people starting from early childhood and increasing as one grows older. Living conditions aside, rural areas also suffer from the lack of social sector services in general. Rural children in general and, girl child in particular due to prevalent gender discrimination, tend to face worst health outcomes. The health disparities between rural and urban children, as well as interstate disparities in health status go hand-in-hand to projecting concerning scenarios for the country. Again, the rural and tribal areas have fewer movement and connectivity options than urban areas. The settlements are dispersed more than urban areas. This necessitates evolving location-specific healthcare service delivery systems for rural areas.

The first pandemic wave in the country affected health and social welfare aspects of women and children, belonging to poorer section of society, adversely. Many pregnant women, without access to proper medical care during childbirth, lost their lives; while some gave birth to underweight and stunted children. These children obviously got subjected to life-long health problems. As observed, in ordinary times, the Indian healthcare systems, more so rural health facilities, face operational challenges, and the challenges observably grew manifold during the pandemic causing catastrophic effects on socio-economic spheres.

The rural healthcare system in rural India, primarily developed on the suggestions of Bhore Committee Report, guided Government of India in adopting population-based norms for establishing the three-tier public health care facilities, as Sub-Centre (SC), Primary Health Centre (PHC), and Community Health Centre (CHC). The current status, of these rural health facilities, as obtained from latest Ministry of Health & Family Welfare statistical data upload in their website, indicate shortfall at the three-tier set up as, 18% at the SC level, that consist of 158417 SCs, 22% at the PHC level that consist of 25743 PHCs and 30% at the CHC level that total 5624 CHCs. According to the National Health Profile 2021, in government hospitals one allopathic doctor is available to cater to 11,082 people, one bed per 1,844 people is the current allocation, and one state-run hospital available for every 55,591 people.

In spite of the elevation in rural health facilities over the years, the manpower availability is notably underneath the wanted tiers, as per World Health Organization suggested levels.

In spite of the elevation in rural health facilities over the years, the manpower availability is notably underneath the wanted tiers, as per World Health Organization suggested levels. Of the sanctioned posts, at the SC level 14 per cent posts of Health Workers (Female)/ ANM, and 37 per cent of Health Workers (Male) were vacant, as Government Rural Health Statistics (RHS)2019-20 indicated. The RHS also stated that the number and post-wise shortage in rural health set up as, 1,704 posts of doctors in PHCs across the rural areas, as well as 5,772 posts of nursing staff, 5,066 positions in female health workers, 6,240 posts of pharmacists, and 12,098 posts of laboratory technicians. The report further added that- of the total 155404 Sub Centre across the country, only 5383 SCs was functioning as per IPHS norms, only 8514 PHCs were functioning on 24×7 basis out of existing 24918 PHCs, and just 4957 CHCs, of the sanctioned 20732 CHCs, were currently functioning in rural areas. An International Journal paper published in December 2020 found that rural India has 3.2 government hospital beds per 10,000 people and that some big states such as, Uttar Pradesh with 2.5 with beds, Rajasthan 2.4 with beds, Jharkhand 2.3 with beds, Maharashtra with 2.0 beds and Bihar with 0.6 beds respectively, stood below the national average. Evidently, the rural healthcare set-up does not provide assuring state of affairs, currently. Besides, there is among the states, dissimilarity as far as access to medical care, appropriation of public health expenditure as well as achieving health outcomes. Obvious therefore that even without the pandemic or unforeseen emergencies, the rural health infrastructure is always stressed, while historically having less access to health services as the figure below will indicate.

Source: Ministry of Health and Family Welfare

The rural public health service management, especially in preventing, controlling or eliminating major communicable diseases, such as Tuberculosis, Malaria, and in reducing the risk of deaths in maternal and perinatal diseases has remained a challenge. In India, endemic diseases caused by infection or lack of nutrition still account for over two-thirds of mortality and morbidity. With rural areas lacking access to elementary healthcare, there remain abundant challenges to setting up strong emergency medical services, as well.

Both increases in government spending and private sector initiatives have improved the health infrastructure, but given the rising demographic pressure in India, this increase does not seem to make the desired difference. It is the extension of life expectancy that has a direct impact on many households. The rising healthcare cost exacerbates the problem for lower- and middle-class households, as well. The suggestive way forward, at this juncture, at empowering rural healthcare systems and building healthy rural communities, can be as follows-

Maximize the implementation of Health and Wellness at the Sub Centres and Primary Health Centres levels–

The health and wellness concept under Ayushman Bharat was an excellent start, as the same advocated a more comprehensive, well-equipped, and well-staffed model of primary healthcare in government sub-centres and primary health centers. Updating them in rural areas will undoubtedly enable in achieving the degree of readiness required in rural India in the event of a pandemic or other unforeseen emergency.

Extended public-private partnerships (PPP) to support healthcare inclusion-

PPP partnerships evidently have potential to revolutionize the rural healthcare system in India, while simultaneously ensuring a long-term viable solution. As the country’s population is growing, government efforts will not be enough to strengthen the healthcare system. PPP can assist in overcoming monetary, specialized, pedagogy, and human capital constraints. Private players can also ensure that Government policies at improving rural healthcare infrastructure are implemented appropriately. Continuing partnerships will improve access to healthcare, especially in the inaccessible rural areas, because individual actors’ extensive expertise, experience and financial resources may aid in the development of novel solutions.

Organise a supervisory committee on the ground–

a local supervision committee formation needed for developing a centrepiece masterplan for improving access to better healthcare and overseeing the implementation of rural healthcare projects. Though the majority of rural healthcare programs often get off to a terrific start, the outcomes are not always as anticipated. To revive rural healthcare service systems, through efficient monitoring of rural healthcare strengthening operations, the local supervisory committee is required.

Doctors working in rural areas encounter several problems when it comes to accessing training opportunities due to their location.

Continuous competency development and mentoring-

Another key concern in rural regions is skill development and mentoring. The CHCs, which acts as a referral of PHCs in rural areas, currently have a 76.1 percent shortage of specialists, as the Ministry of Health and Family Welfare recent report indicated. Doctors working in rural areas encounter several problems when it comes to accessing training opportunities due to their location. In that scenario deployed Doctors can benefit from skill development courses, and ongoing learning programs to assist address the dearth of trained doctors in rural areas. A focused mentoring program, including online or offline sessions, skill upgradation and exchange programs could be extremely helpful in this situation.

Coherent machine upgrade and paramedic training-

Essential amenities, such as most up-to-date medical equipment and skilled medical personnel to operate them, are lacking in rural areas. While medical equipment can still be upgraded on a regular basis, training courses for nurses and paramedical workers on how to handle, operate and manage these machines are also necessary. As new technologies become available, the requirement for training becomes more pronounced and required to be recognized.

In summing up, it needs to be pointed out that it is difficult to overhaul the country’s rural healthcare system within a short timeline, and that a piecemeal approach to improving rural healthcare facilities will be futile. But, with the ongoing dedication and regular efforts can a sturdy rural healthcare system be developed. Implementing the procedures outlined above will have positive benefits in the long run and will contribute to the development of a robust rural health care management system. Beyond COVID, the central objective should be to devise preparedness strategies for unforeseen emergencies, rather than focusing simply on short-term fixes that will return the system to its previous state once external help is withdrawn.

Composed by: “Dr. Gautam Kr Ghosh, is Ph.D in sociology with PG diploma in Reproductive and Child Health Management, and is research scientist at ICMR NICED, Kolkata, India.”

Composed by: “Aprita De, holds Masters in Public Health degree, and is working as Junior Consultant, NHSRC, Ministry of Health and Family Welfare, New Delhi.”

The post Pandemic Blowback on Indian Rural Healthcare appeared first on InnoHEALTH magazine.

Dozee bags Assocham 'Start-up of the Year 2019 Award'

InnoHEALTH Magazine — Wed, 06 Nov 2019 10:00:04 +0000

Adding another feather on the cap, Made-in-India technology Dozee received the Tech Start-up of the Year 2019 Award at Assocham’s Emerging Digital Technologies Summit and Awards held in New Delhi on 31 October, 2019.

Speaking on the occasion, Mudit Dandwate, CEO & Co-founder Dozee said, “I am glad and humbled to have received this award. I take this opportunity to congratulate the entire Dozee team whose tireless efforts have made it possible. Also, I would like to thank Assocham for bestowing us with the honour. This award all the more inspires us to put in our best efforts every day and work towards our mission of ‘Simplifying Healthcare’.”

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Dozee is a patented contact-free health monitor, invented by Mudit Dandwate and Gaurav Parchani, graduates from IIT. It is a thin sensor sheet which goes below the mattress and monitors heart health, respiration, sleep quality and stress levels with 98.4% accuracy as compared to medical devices. It’s AI-powered technology not only flags cases of health deterioration before they become serious but also provides personalized recommendations to improve health.

Dozee has saved 36 lives so far by alerting users about health deterioration and helping them detect Tuberculosis, Arrhythmia, Pneumonia, Pulmonary Edema, Cardiac arrest and underdiagnosed conditions such as Sleep Apnea.

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The device is built specifically for home settings, requires no technical expertise to set up and provides an effective remote monitoring service that enables high-skilled medical staff to take decisions remotely.

Innovation Pitches from Global & Indian Companies in InnoHEALTH 2018 conference

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Social Behavior Modification for Unmet Need of Prevention

InnoHEALTH Magazine — Fri, 01 Nov 2019 06:45:48 +0000

Resource poor communities are unable to afford expensive, supply side solutions for deficiencies in healthcare. Lack of finances, medical manpower, drugs and technology renders poor communities vulnerable to diseases, many of which are either preventable or curable. Unmet needs of preventive care often turn a completely preventable disease into a condition requiring expensive secondary or tertiary care, which further burdens the alreadymeagre resources.

The solution may lie in improving the demand side of the healthcare. Modifying social health behaviour may be the least expensive method to reduce disease burden in a community. Save a Mother (SAM), a healthcare NGO, works on the demand side by embedding in the communities to carry prevention to the doorstep. SAM has developed an Effective Social Persuasion platform (SAM-ESP), a model forsocial behaviour change, which reduces disease burden. In the past 11 years, SAM has successfully replicated the solution in different locations in India.

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Established in 2008, SAM has focussed on five themes: maternal and infant mortality reduction, population stabilization, TB control and malnutrition. SAM has worked with vulnerable communities of 3 million people living in 1800 villages and one urban slum, located in 10 districts of 4 states of India. SAM has shown considerable success in all the programs at all locations. SAM is currently active in five districts.

SAM selects the target population on the following criteria:
Targeting vulnerability: SAM works with the poor and vulnerable communities who lack education, income, assets, status and access to healthcare.
Targeting pregnant, infants and children: SAM follows all pregnant women, infants and children under 5 years in the community.
Targeting reproductive age: For population stabilisation, SAM targets reproductive age group women and married couples between ages 18 and 49 years and adolescent girls from 10 to 19 years.
Targeting disease: SAM targets the families and contacts all TB patients, malnourished children and high-risk pregnant women.
SAM-ESP Innovation: SAM has developed a cost-effective platform for changing health behaviour ofa community. Health activists, in partnership with local public and private healthcare stakeholders, convert awareness to actionable knowledge. SAM has successfully used its Effective Social Persuasion Platform (SAM-ESP) in multiple locations. ESP relies on seven assumptions.
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Behaviour modification is the least expensive way to reduce disease burden.

Health is an individual and community responsibility; ownership of this responsibility empowers a community to demand healthcare rights. A campaign to push health information may improve awareness but is not sufficient by itself. Awareness is just one of many steps to change behaviour. Other essential steps include: a sustained, intensive, repetitive campaign without a predefined end time-point, encouraging peer to peer nudge and a methodical transfer of ownership to the community leaders.

Messages scripted by the community encourages their ownership. Trained volunteer activists can lead and sustain the ESP without external help.

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An established SAM-ESP platform can be used to address multiplehealth problems. SAM-ESP is not yetanother awareness building program. Awareness is often assumed to be equal to behaviour change. In practice, it is not true. Communication programs and prevalent awareness programs merely touch the surface without translating into significant behaviour change. SAM-ESP is a multi-step process, where awareness in just one of many steps for a sustainable behaviour change.

SAM promotes community ownership of both health and healthcare. SAM believes, that health is an individual and community responsibility and getting healthcare, as a right, has to be learned. SAM-ESP is a peoples’ program, which ensures that the health system is responsive and accountable.

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SAM trains volunteer health activists who lead the program and develops a cadre of social entrepreneurs, who sell contraceptives, sanitary pads and nutritional products. SAM field workers are from the community where they live and work. They are available 24/7 and take health to the doorstep of the recipients. The program sets no predetermined end date; repetitive training continues till SAM meets the objectives.

The following steps describe its execution:

Organize, create structure and build leadership capacity: SAM has well-trained field staff and managers;the voluntary directors of the organization are professionals from healthcare and management. Each district has a manager, trainers, and supervisors who are selected from the local population. They receive intensive training not only in health issues but also in motivational techniques, training methods and leadership.

Develop messages: SAM believes that a good message should be simple without technical jargon, short with less than five points, easy to understand without explanation and emotionally connected with a local need. For better retention, a message could be in the form of a story, song or a slogan. Some messages should be created by the community to feel ownership.

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Train health activists: Master trainers train volunteer health activists to be responsible for village health issues. Training is repetitive and intense.

Teach people: SAM organizes the village into a healthcare community. Field supervisors motivate and mobilize villagers and discuss each topic of healthcare with a specific training module. SAM uses local community resources to create training material and health leaders script their own songs and slogans. Activists meet villagers repeatedly to discuss best practices. Repetitive training of health activists and villagers is essential.

Cooperation with public and private health systems: SAM establishes linkage with the local private and public health system. Utilizing all available public health resources is an essential component of the program. Public health workers are invited to all meetings. This linkage creates awareness, which improves demand of healthcare and encourages accountability.

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Evaluation and improvement: Programs are monitored by community involvement and by participatory research action. Results lead tocourse correction.
Replicate: Solutions are validated and replicated in other locations.

Measuring impact: Each program starts with a baseline and finishes with an end-line evaluation. SAM defines objectives, activities, outputs and outcomes before the start of the program. They measure monthly progress against all these parameters.

Process of measuring impact is a four-step process:
Data Collection at community level: The field workers collect data during house visits and community meetings. They upload it on a smartphone.
Data review at block level: Field officers collate and review data every month at a block level. They validate it through client interaction.

Data validation at district level: SAM validates data through a monitor and evaluation protocol which includes field visits, focus groups and comparison with public health data. SAM compares outcomes and impact with similar programs run by the government and other private organisations.

External agency evaluation: Periodically, SAM engages external agencies to evaluate its work. The funding partners also send external evaluators to check the progress and impact.

Direct impact: Since inception, SAM has trained 37,000 volunteer health activists who live in the villages and are available to the community. SAM has directly impacted over 1,150,000 million people through maternal, child health, population stabilisation and TB control programs.

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Through maternal, child health and population stabilization programs, SAM has directly impacted: 530,000 women and over approximately 100,000 infants. SAM follows all (100%) pregnant women in the villages and has reduced maternal mortality by 90% and infant mortality by 60%. In some places, SAM has done even better. In the past 6 years, in 167 villages of Gadag, Karnataka; maternal mortality rate has decreased to 15.8 from 364 and the Infant mortality rate has decreased to 5 from 46.

Through population stabilizations program, the marriage of girls under 18 years of age has decreased to almost zero. Contraceptive use has increased from 28% to 62% and supplychain management has reduced the unmet need for contraception from 10.8 % to 2% been running in 700 villages. 287,042 people have participated in 14,552 community meetings. 13,973 people have had sputum tested. Sputum was positive for TB in 1329 people and 14 had multiple drug resistant TB. All received supervised treatment. SAM has directly helped with education and surveillance of 130,000 contacts of TB patients and helped another 317,000 community members with awareness program. TB detection rate has improved 3.7 times.

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Indirect impact: SAM estimates that approximately 0.9 to 1 million people, who did not actively participate in its programs, became aware of the benefits from those who attended our programs.

Women feel empowered, which has opened their minds to many choices in life. They express their opinions freely. Men and elderly women, who were suspicious and objected to their women attending public meetings, have mellowed their resistance and have even become enablers. Girls attend school more regularly and the number of girls attending college has increased. Adolescents participation has increased. Public health system and their workers are more responsive to public demand.Local elected politicians are responsive.

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Discussion: Multiple theories have attempted to explain the health behaviour of individuals. The most popular is the Health Belief Model (HBM), which was developed about 40 years back. It postulates that people make healthcare decisions based on perceived susceptibility to disease and consequences. The response is tempered by perceived benefits of action and with a belief that benefits outweigh risks. While this theory, like other theories, builds a plausible reference point to explain behaviour, it gives no guidance for modification of individual behaviour.

Theory of Planned Behaviour suggests that a person should be empowered with ability (self-efficacy) to change behaviour. The person should believe that the behaviour will improve his health and is socially approved. It has also been recommended that principles of marketing could be applied to a social cause, where the product to be sold is behaviour change.

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SAM model comes close to a hybrid variety of HBM, building self-efficacy and social marketing. SAM tries todevelop social efficacy through the agency of health activists by using techniques similar to social marketing. SAM Effective Social Persuasion is a people’s platform, which needs further elucidation and expansion. SAM is looking to use entertainment education or gamification for behaviour modification and use of technology in early detection of noncommunicable diseases. SAM seeks collaboration with others for mutual learning, sharing resources and scaling-up the program in vulnerable population.

About the author

Dr. Shiban Ganju is the Chairman of Atrimed Pharmaceuticals and Founder of Save A Mother Foundation, USA. He has dedicated his life to healthcare. Dr. Ganju graduated from AIIMS New Delhi and received advanced training in Internal Medicine and Gastroenterology both in India and USA. He is a consultant specializing in gastroenterology, liver disease and nutrition in hospitals in the greater Chicago area. His commitment to and understanding of how to drive improvements in health outcomes has benefitted big strata of society.

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Snakebite: A Public Health Problem

InnoHEALTH Magazine — Tue, 04 Jun 2019 09:54:48 +0000

India used to be dubbed as a country of snake charmers in just decades ago, but few would know about the darker side of snakes – snakebite. An estimated 28 lakh cases of snake bites occur in India and about 50,000 Indians die due to snakebites every year. Yet it remains a neglected public health problem.

Many of the deaths and disabilities due to snake bites can be averted if health authorities take steps to prevent snake bites as well as improve facilities for treating those bitten by venomous snake bites. Snakebite mitigation needs concerted efforts just like other public health problems such as malaria and tuberculosis.

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Poor health facilities in rural areas are a major reason due to which snakebite victims do not get adequate care. First, people don’t reach health facilities in time due to lack of transport and even if they do so, healthcare personnel have inadequate knowledge of snakebite management and lack effective antivenom, according to a new study published last month in the medical journal, The BMJ.

“Most snakebite victims die before they reach a health facility because they first approach a traditional healer for treatment. The quality of available antivenom in health facilities is another problem,” pointed out Dr. Ravikar Ralph, a member of the research team from Christian Medical College Vellore, while presenting his findings at a meeting here.

The antivenom manufactured inIndia is exclusively against venoms offour major snake species and is not effective against other species prevalent in different regions. It has also been seen that there is an intra-species variation of venom of the four major species. In addition, the antivenom products available vary in their neutralization efficacy and clinical effectiveness, the study pointed out. The quality of liquid antivenom is also compromised due to problems in maintenance of cold chain during transportation as it must be stored between 2 to 8 degrees.

The call to end the neglected tropical diseases (NTDs) under the Sustainable Development Goals framework has brought the problem of snakebite into focus, and this could be an opportunity to take up research in this neglected public health problem, the study has said.

The special issue of the medical journal has focused on neglected diseases such as lymphatic filariasis, kala-azar, neonatal sepsis, and multidrug-resistant enteric fever. It was supported by the Drugs for Neglected Diseases initiative (DNDi). “This collection highlights the notable successes of public health programs in neglected diseases in South Asia and identifies areas where research and supportive policy are needed to sustain plans for control or elimination,” said Dr. Suman Rijal, Head of DNDi, India.

Credits: India Science Wire

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Tuberculosis: An Ancient Foe

InnoHEALTH Magazine — Fri, 03 May 2019 10:22:56 +0000

Deepti was sixteen years old, writing her board exams when she developed a cough that just wouldn’t go away. After conventional treatment for a month, her doctor advised her to get a chest x-ray which revealed that she had contracted tuberculosis (TB). Despite treatment, Deepti’s condition continued to worsen. She had contracted a strain of TB that was resistant to multiple drugs (MDR or multi-drug resistant) and would need surgery to remove part of her decaying lungs. She was given six months to live. In stark contrast to the lifestyle of Deepti; Salma, a resident of the Dharavi slums nearby, had gone to twelve different doctors searching for a cure for this disease. The strain she had contracted has been dubbed TDR or totally drug resistant and was resistant to 12 different anti-TB drugs. The disease ravaged her for two years, costed money she didn’t have and finally, claimed her life.

India bears the dubious distinction of having the world’s largest number of deaths due to TB; 423,000 people in India succumbed to the disease in 2016, accounting for a third of the entire world’s TB mortality. These TB related deaths that have been identified and reported, the real numbers may be far graver. India has an estimated 1.3 million “missing” TB patients, who may not have been diagnosed or who have not returned for a follow-up post-diagnosis, untreated and potentially spreading TB to others. In addition, WHO estimates that India saw 2.7 million new TB cases in 2016. When compared to the 6.3 million new cases worldwide, Indians accounted for a whopping 25% of all new TB infections.

This is because of the singular and unique ability of the TB bacterium to hide inside the human body in a dormant state without causing the disease or revealing any outward symptoms. Such cases are classified as latent TB infections and can be revealed by diagnostic tests in healthy seemingly uninfected individuals. Studies indicate that close to 40% of the Indian population is positive for latent TB and without treatment 5%-10% of these will develop active TB at some point in their lives. Unfortunately, due to the high burden of TB in India, the detection and treatment of latent TB are not prioritized, resulting in a huge reservoir of dormant and potentially infectious bacteria primed to emerge under favorable conditions.

In 2017, 10 million people were infected with TB and 1.6 million died worldwide, surpassing AIDS as the world’s leading cause of death due to an infectious disease. WHO has designated March 24t has the World TB Day to raise public awareness about TB and its deleterious effects on health, society and the economy. In 2015, it began to implement the ‘End TB Strategy’ which envisions a world free of TB with zero TB related deaths and zero incidences of the disease. In order to do this, WHO aims to support and promote a patient-centric approach to care and prevention, encourage proactive policies and support systems by involving the government and private sector healthcare and finally intensify research and innovation in the field of TB treatment, prevention, and diagnosis. The Government of India has instituted a similar strategy, the Revised National Tuberculosis Control Program (RNTCP). RNTCP involves adopting WHO guidelines of Direct Observation Therapy (DOT) to the Indian scenario and includes direct monitoring and administration of anti-TB drugs to the patient, rapid TB diagnosis and treatment, and increased partnership between public and private healthcare systems. RNTCP’s objective is to eliminate TB by 2025. The plan outlines four directives – Detect, Treat, Prevent and Build and includes a system for free and sensitive diagnostic tests for TB, screening of the high-risk population, free TB drugs for all patients, implementation of a uniform treatment regimen, increased social support and monitoring and treatment of latent TB. Finally, the plan will work towards translation of political commitment to action through strengthening support structures for surveillance, research, and innovation.

Several technological innovations have facilitated easier and improved patient monitoring, such as 99DOTS which is a low-cost solution for improving patient compliance during TB treatment. Patients using 99DOTS receive medication in specially packaged blister packs. Dispensation of a dose reveals a hidden and unique phone number that the patients can call for free and confirm that the medication has been taken. In this way, remote monitoring of patient compliance has been made possible. Several digital adherence technologies have also been developed as an electronic way to monitor medication and provide reminders. These include digital pill boxes (evriMED, Wisepill, etc.) that are given to patients with their medication inside. The digital boxes provide visual cues such as colored LED lights which turn on and remind the patient of the dose and the medicine that is due. These boxes can also record medication events in real time by logging the opening of the box for each dose, allowing for real-time monitoring of patient compliance. Pilot studies are also underway in the US for ingestible sensors that are embedded inside each pill, which transmits information that the pill was consumed upon activation inside the patient’s stomach. However, the cost of such technology is yet to be estimated and given WHO and Govt. of India goals to reduce the economic burden of TB, cost-effective ingestible sensors may remain only a distant possibility.

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Risk Factors for TB

Being primarily a respiratory disease, TB is disseminated by airborne infection as the bacteria is exhaled from an infected individual and inhaled by another. This often happens in poorly ventilated and over-crowded settings typically seen in cramped housing where the disease can spread like wildfire. Indeed, earlier TB was thought to be hereditary as it used to wipe out entire households. Weakening of the body’s immune system due to age, substance abuse, air pollution, diabetes, HIV infection, and malnutrition, among others, play a major role in increasing susceptibility to TB. Its spread is seen across the socio-economic strata. As Dr. Zarir Udwadia, one of the world’s leading pulmonologists puts it, “TB does not distinguish between the chauffeur driving the Mercedes and the CEO sitting at the back!”

Detection and Diagnosis of TB

One of the main challenges in the fight against TB is the very first step of diagnosis. Millions of TB cases go undetected and unrecorded all over the world due to the shortcomings of technology. Conventional TB diagnosis is performed by sputum smear microscopy, wherein the sputum of the patient is examined under a microscope for TB bacilli. However, this approach is only 36-43% sensitive which means that many cases of TB infection are missed by this method.

Sputum smear microscopy also suffers from false positives, as some non-TB bacilli may also pick up the TB specific stain. Therefore, a positive sputum smear needs to be confirmed by culturing the bacilli obtained from the sputum in the lab, which can then be tested to confirm TB. Unfortunately, growing patient strains and analyzing them requires resources and technical expertise that are not available in most of the high prevalence countries. In addition, growth-based confirmation of TB positivity takes a minimum of 21 days since the growth rate of the bacilli is extremely slow.

A third technique, which involves the detection of TB DNA using polymerase chain reaction (PCR) and named Xpert MTB/RIF promises results of sample positivity within 2 hours and is currently the gold standard in PCR based TB diagnosis. However, this system suffers from high costs per assay and the requirement for infrastructure and constant electricity, which are not available in many cases.

Treatment for TB

Active TB infections are treated with a standard 6-9 months treatment regimen involving four antibiotics: rifampin, isoniazid, ethambutol, and pyrazinamide for varying durations. This treatment duration is one of the longest for bacterial infectious disease, second only to the treatment of leprosy. Side effects like itching, rashes, fever, nausea, diarrhea and reddish/orange discoloration of body fluids including urine, tears, and saliva is another cause of worry which takes a physical, emotional and mental toll on the patient.

Since most infected individuals begin to feel better after a few weeks of treatment and the length and side-effects of the drug treatment are arduous, many patients stop the treatment prematurely or skip doses. Rampant patient non-compliance when it comes to the completion of anti-TB therapy is one of the main factors for the emergence of a more severe form of the disease, one which is resistant to common drugs! This is a big reason for TB reactivation and the continued prevalence of this disease even though it is completely curable in most cases.

Drug resistance in TB has been known since the first antibiotics to treat this disease were put into place. An increasingly larger repertoire of drug-resistant strains necessitated and increasingly larger arsenal of drugs to treat the disease. As of today, TB strains resistant to one of the first line of four antibiotics are called resistant strains. Strains resistant to two first-line antibiotics are called multi-drug resistant strains of TB or MDR-TB. These are treated with a second line of antibiotics, consisting of fluoroquinolones (levofloxacin, moxifloxacin, and gatifloxacin) or injectable drugs such as amikacin, kanamycin, and streptomycin. More recently, the third category of strains labeled Extensively drug-resistant- or XDR-TB has been described with resistance to a fluoroquinolone and at least one of three injectable drugs. A total of 12 drugs are approved today, each of which individually and in combination is used to treat these three categories of TB, MDR-TB, and XDR-TB. However, a little characterized fourth type of strain dubbed totally drug-resistant- or TDR-TB has been reported in India, Italy, Iran, and South Africa. These strains are completely resistant to all known anti-TB medication and given the airborne and infectious nature of the disease, are ticking time bombs of catastrophe.

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Newer Strategies in TB Healthcare

The emergence of drug resistance, the persistently high rate of TB incidence and TB mortality and the challenges associated with patient non-compliance demand improved methods to detect TB with high accuracy, newer drugs to treat resistant forms of TB and increased awareness of the disease.

Bedaquiline and delamanid are two new drugs for TB that have shown promising results in clinical trials after nearly 40 years of failed attempts. These two drugs have received approval for use in the treatment of MDR- and XDR-TB. Additionally, a new drug combination involving bedaquiline, pretomanid and linezolid is reported to have successfully treated XDR-TB in six months with a lower mortality rate than current treatments. However, these new treatment regimens are yet to enter mainstream clinical practice, with further and larger clinical trials needed to make an accurate cost-benefit analysis of these strategies.

Looking to the Future

Although the current situation of TB in India and worldwide looks bleak, the global TB incidence is falling at a rate of 2% per year. According to WHO, this rate needs to increase to 5% to achieve the WHO Global Plan to End TB milestones of reaching 90% of all people with TB through national TB programmes, reaching at least 90% of vulnerable high-risk population through affordable treatment and achieve at least 90% success in the treatment of all people diagnosed with TB. Achieving both WHO and RNTCP milestones will require a concerted effort by policymakers, healthcare providers, TB researchers, patients, and the general public. What we need today is increased public spending on healthcare to make TB therapy affordable and accessible, improvement of research funding and infrastructure and stronger public awareness campaigns to disseminate the reality and requirements of ending TB.

Over just the past two centuries, TB is estimated to have killed 1 billion people, which is more than the number of people killed due to AIDS, cholera, influenza, plague, and smallpox combined! It is time we take the initiative and responsibility to help the millions that are suffering from this deadly disease.

About the Author

Vignesh Narayan is a scientist and science writer at the Indian Institute of Science who currently studies the molecular biology of the TB pathogen Mycobacterium tuberculosis in an attempt to understand how the bacterium senses and responds to its environment and develop new drugs and drug targets to combat the disease.

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Faster Diagnostic Tests Developed for TB

InnoHEALTH Magazine — Thu, 14 Feb 2019 09:10:58 +0000

Tuberculosis (TB) claims two million lives each year globally. Early detection and treatment are crucial to prevent spread, outbreaks, and development of resistance. Scientists at the Translational Health Science and Technology Institute (THSTI) Haryana and All India Institute of Medical Sciences (AIIMS) New Delhi have jointly developed highly sensitive and rapid tests for detection of tuberculosis infection in lungs and surrounding membranes.

TB spreads from one person to another through inhalation of infected air. When the bacteria attacks the lungs, the disease manifests itself in a pulmonary form. It is the most common form of TB. But about 15% of new patients in 2016 were found infected with extrapulmonary TB where organs other than lungs may be affected. Till now, detection of all forms of TB is mostly based on sputum smear microscopy and culture tests. While smear microscopy is simple and rapid, it has low sensitivity. Culture test is highly sensitive but takes 2 to 8 weeks to get results.

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Also read: India aims to eliminate TB by 2025

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Conventional diagnostic tests use antibodies for detection of bacterial proteins in sputum samples. However, such tests suffer from limitations including batch-to-batch variability, limited shelf-life, and cost.

To address these problems, the researchers have now developed two DNA aptamer-based tests – Aptamer Linked Immobilized Sorbent Assay (ALISA) and Electro-Chemical Sensor (ECS) for detection of a bacterial protein in the sputum.

Aptamers are DNA, RNA or peptide molecules that bind to specific molecular targets. They are known to bind the right target (which defines sensitivity) and at the same time rule out any non-specific binding to other targets (specificity). The performance of the newly developed tests was compared with antibody-based tests in 314 sputum samples. ALISA showed 92% sensitivity while the antibody-based method was 68% sensitive.

The research team used ALISA to detect a bacterial protein, HspX. This method, however, took five hours to yield results because it requires sputum immobilization which is a time-consuming step. So the team made efforts to develop a simplified ECS test. In this, aptamer was immobilized with an electrode and upon binding to HspX in the sputum sample, a drop in the electrical signal was recorded.

The ECS test can be used for screening of samples in the field as it takes as less as 30 minutes to deliver results. It is highly sensitive and could detect HspX protein in 91% of the samples tested in this study. In addition, there is no need for sputum sample preparation which is a complex and time-consuming process.

The aim is to develop aptamers for detection of multiple bacterial proteins simultaneously which is expected to lead a more robust test said Dr. Tarun Sharma, a member of the research team. The aptamer-based screening tests for pulmonary TB, pleural TB, and TB meningitis hold immense promise for a country like India, where the disease burden in high and primary healthcare is only a dream for many. The ECS platform could be used in a mobile screening van at the point-of-care explained Dr. Jaya Tyagi, who led the research team AIIMS hoping that these tests are adopted by the TB programs in the country.

The group used the aptamer-based test also for the detection of pleural TB, the second most prevalent form of extrapulmonary TB. Early diagnosis of pleural TB is limited by the availability of a sensitive and rapid test. The performance of existing DNA-based tests varies widely due to low bacterial load in the pleural fluid sample.

There is no test for making a confirmed diagnosis of pleural TB. Even WHO-endorsed Gene Xpert has a poor sensitivity of 22%. On the contrary, the aptamer-based test for pleural TB has shown 93% sensitivity and is cost-effective explained Dr. Sagarika Haldar, a member of the research team.

The research teams were led by Dr. Jaya Tyagi (AIIMS), Dr. Tarun Sharma and Dr. Sagarika Haldar (THSTI) including other colleagues from the institutes. The pulmonary TB results were published in the journal ACS Infectious Diseases and the pleural TB results were published in Analytical Biochemistry. The studies were funded by the Department of Biotechnology, Department of Science and Technology, and THSTI.

By India Science Wire

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National Ageing Center Coming in New Delhi

InnoHEALTH Magazine — Wed, 19 Dec 2018 06:20:46 +0000

Ahead of an international day of old people on October 1, a foundation stone of the National Ageing Center has been laid recently at AIIMS in the national capital. The National Ageing Center will provide state of the art clinical care to the elderly population and shall play a key role in guiding research in the field of geriatric medicine and related specialties. The Centre will also be a key training facility for undergraduate and postgraduate courses. The Centre will provide multi-specialty healthcare and will have 200 general ward beds, which will include 20 medical ICU beds. The center will be developed at a cost of Rs 330 crores and shall be completed by February 2020.

On the occasion, Prime Minister Narendra Modi also dedicated the underground connecting tunnel between AIIMS and JNPA Trauma Centre, and Power Grid Vishram Sadan at AIIMS along with the 500 bedded New Emergency Block and 807 bedded Super Specialty Block at the Safdarjung Hospital to the nation.

Informatively, on the 70th anniversary of the Universal Declaration of Human Rights (UDHR), the United Nations International Day for Older Persons (UNIDOP) celebrates the importance of this Declaration and reaffirms the commitment to promoting the full and equal enjoyment of all human rights and fundamental freedoms by older persons.

Growing older does not diminish a person’s inherent dignity and fundamental rights.

On 14 December 1990, the United Nations General Assembly designated October 1 as the International Day for Older Persons. This was preceded by initiatives such as the Vienna International Plan of Action on Ageing – which was adopted by the 1982 World Assembly on Ageing – and endorsed later that year by the UN General Assembly.

In 1991, the General Assembly adopted the United Nations Principles for Older Persons. In 2002, the Second World Assembly on Ageing adopted the Madrid International Plan of Action on Ageing, to respond to the opportunities and challenges of population ageing in the 21st century and to promote the development of a society for all ages.

Almost 700 million people are now over the age of 60. By 2050, 2 billion people, over 20 percent of the world’s population, will be 60 or older. The increase in the number of older people will be the greatest and the most rapid in the developing world, with Asia as the region with the largest number of older persons, and Africa facing the largest proportionate growth.

The interdependence between older persons’ social integration and the full enjoyment of their human rights cannot be ignored, as the degree to which older persons are socially integrated will directly affect their dignity and quality of life.

Older human rights champions today were born around the time of the adoption of the UDHR in 1948. They are as diverse as the society in which they live: from older people advocating for human rights at the grass root and community level to high profile figures on the international stage. Each and everyone demands equal respect and acknowledgment for their dedication and commitment to contributing to a world free from fear and free from want.

The 2018 theme aims to:

Promote the rights enshrined in the Declaration and what it means in the daily lives of older persons;
Raise the visibility of older people as participating members of society committed to improving the enjoyment of human rights in many areas of life and not just those that affect them immediately;
Reflect on progress and challenges in ensuring full and equal enjoyment of human rights and fundamental freedoms by older persons; and
Engage broad audiences across the world and mobilize people for human rights at all stages.

On the day of laying of foundation stone for ageing persons, Mr. JP Nadda, Union Minister of Health and Family Welfare, Mr. Ashwini Kumar Choubey and Smt. Anupriya Patel, Ministers of State for Health and Family Welfare were also present at the event.

Addressing the participants, PM Modi said that our government has been successful in taking healthcare out of the ambit of the Health Ministry and today we have Rural Development Ministry, Water and Sanitation Ministry, and Child Development Ministry and AYUSH Ministry with our vision of healthcare.

He further added that our vision is not limited to hospitals, diseases, medicines, and super specialty care but also with the idea that affordable and equitable healthcare should be ensured for every citizen. PM Modi said that the government is equipping existing hospitals with all the modern facilities and at the same time it is also making sure that the healthcare facilities reach the remotest areas of the countries. He added that 58 district hospitals are being upgraded to medical colleges and the government has also sanctioned budgets for 24 new medical colleges.

PM Modi added that the global target for eliminating TB is 2030, but we have set 2025 as our target for India to eliminate TB, five years before the global target. He further stated that the government is providing Rs. 500 to the TB patients towards nutritional support.

The Prime Minister also mentioned the Ayushman Bharat programme. He said that under the National Health Protection Mission, 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) will be provided a coverage up to 5 lakh rupees per family per year for secondary and tertiary care hospitalization. This will be the world’s largest government-funded healthcare programme, he stated.

Mr. Nadda said that there has been a visible change in the tertiary healthcare in the country and assured that the government is committed to ensuring that the new AIIMS will meet the same standards of service as AIIMS, New Delhi. No effort will be spared to make them the very best, he added. He said that that the new AIIMS will have the same work culture and the government is taking all the steps to ensure that. He further stated that the Ministry in the past 4 years has not left any stone unturned – from monitoring the clean and effective implementation of national programmes to establishing 13 new AIIMS like institutes across the country. Reiterating the commitment of the government, he said under Ayushman Bharat, 150,000 sub-centers will be converted into Health and Wellness Centres (HWCs) that will deliver comprehensive primary healthcare.

“The HWC would provide preventive, promotive, and curative care for non-communicable diseases, dental, mental, geriatric care, palliative care, etc. He further stated that the government has initiated universal screening of common NCDs such as diabetes, hypertension and common cancers along with Tuberculosis and Leprosy and everybody above the age of 30 years will be screened for these diseases and as such this will eventually help in reducing the disease burden of the country. “We will implement the vision of the Prime Minister in letter and spirit,” he added.

The underground tunnel is providing connecting facility between AIIMS and JPNA Trauma Centre and will reduce the commute time between the two centers. The completed length connectivity between two centers is approximately 1 km and has been completed at a cost of Rs. 44 crores.

The Powergrid Vishram Sadan has a 300 bedded night shelter facility meant for the patients and their relatives visiting AIIMS main hospital and JPNA Trauma center at AIIMS. The 11-floor facility has been constructed at a cost of Rs. 32.67 crores and funded by the Power Grid Corporation.

New emergency block at Safdarjung Hospital will house 64 triage beds, red zone for children & adults and 90 ICU beds for victims of road traffic accidents, acute trauma suffered by individuals at home or work, acute poisoning and severe medical and surgical emergencies. The block has been developed at a cost of Rs. 346 crores.

Super Specialty Block at Safdarjung Hospital holds tertiary care facilities in the areas of cardiovascular sciences, neurosciences, pulmonary medicine, nephrology, and endocrinology and shall be offering the facility of a Heart Command Centre, respiratory care facility, sleep labs, 24×7 dialysis unit, MRI guided Braine Suite, etc. It also has a 228-bedded private ward. The super specialty block has been developed at a cost of Rs. 920 crores.

Also present at the event were Smt. Preeti Sudan, Secretary (Health); Prof. Randeep Guleria, Director, AIIMS New Delhi; Dr. Rajendra Sharma, Medical Superintendent, VMMC & Safdarjung Hospital, New Delhi and Mr. IS Jha, CMD, Powergrid Corporation along with the senior officers from the Health Ministry and faculty of AIIMS.

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Advances in Diagnostics

InnoHEALTH Magazine — Thu, 15 Nov 2018 05:26:03 +0000

Another area of interest throughout the InnoHEALTH 2018 conference was the Advances in Diagnostics. As one hand it brings the top industry leaders sharing their vision, where the sector is moving, on the other hand, the most promising startups and technologies. It provided a soft landing space where the top leaders were able to provide a pathway for the best ideas to be supported and overall improving the state of the health sector in the country.

The panel represents various industry working in cutting-edge research in radiology and diagnostics areas from India and Sweden.

(Hony) Brigadier Dr Arvind Lal with his keynote address described that only 10% of overall healthcare constituents diagnosis.He discussed the emerging trends in Diagnostics by putting forward four questions

What is happening in healthcare?
How will that affect us as pathologists?
What are the emerging technologies?
What can you do to better prepare yourself?

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Many trends relate to technological advances & the necessity to increase quality & efficiency. The new factor for the IVD industry, not previously seen, is the influence of educated & informed healthcare consumers. Clinical lab testing is one of the greatest bargains in healthcare but often draws the attention from cost-cutters. Lab professionals also will increasingly capitalize on these emerging opportunities & options.

The whole paradigm of healthcare is shifting and will continue to shift—from technological advances like electronic health records. This will change the historic doctor/patient relationship marking the onset of an era of patient empowerment in which the patient shall become more responsible for maintaining good health.

The Healthcare sector, in India, is at an inflection point and is poised for rapid growth At a CAGR of 21% – we will have an industry of 300 billion US $ by 2020. A combination of demographic and economic factors is expected to drive the growth of the sector.

The main points addressed the need to use the emerging trends in diagnostics such as

Wellness Health Model – the power of diagnostics to change the focus of healthcare from treating sickness to promoting wellness
The rise of the corporation – Consolidation & Automation
Role of PPP in Rural Healthcare – a private-private partnership
Need for Accreditation – Quality of samples and testing
Consumer-centric healthcare – Handheld devices and POC (Point of Care) testing
Growing in Digitisation

Dr. Ravi Gaur wanted the healthcare facilities available in metro cities should reach the remote areas too, that’s where innovations in diagnosis should take us. Dr. Vidur Mahajan’s company validates clinical test with their expertise and team of researches.

“Simple solutions for complex problems” is the lateral thinking behind Pawan Asalapuram who is currently working on eradication of TB in the country by his innovations in diagnosis methods. Use of his product, PCR, TB can be recognized in just 90 mins which usually takes 3 to 6 months.

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Dr. Richa Dayal suggested continuous monitoring devices. She then spoke on the data analysis part, where the study shows that India is researching on the data outsourced instead of self-published data as we lack in data. She demanded the support of policymakers in the area of diagnostics.

Mr. Anoop Shaji, final year undergraduate student He has delivered dozens of award-winning scientific presentations at various international, national scientific meets on his original novel, indigenously developed, potentially promising conceptual models. Anoop Shaji was the only dental student selected among 160 students all over India from all UG streams to be invited as a delegate to first ever Nobel prize series in connection to vibrant Gujarat 2017, which was presided by 9 Nobel laureates and the prime minister of India for conceptually developing a potential breakthrough for brain cancer treatment.

He became the voice of the young innovators in the conference and emphasized on POC (point of care) diagnosis. His current work is on a simple device detection of cancer with just one single drop of blood. Lab on the chip would be a boon in advancements in diagnostics and insisted on continuous efforts on it along with the financial and legal support.

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Environment is in Peril – Unknown Enemy on Prowl

InnoHEALTH Magazine — Mon, 04 Jun 2018 10:22:23 +0000

Introduction

In the 21st century, we are all connected. Population growth, mass urbanization, deforestation, climate change and increased travel have dramatically increased the risk that familiar diseases will spread and mutate, and new ones will emerge. As people enter new spheres of biodiversity, they come in closer contact with other species, increasing the risk of viruses jumping from animals to humans, and then spreading more widely.

It all sounds scaring, but it is stark reality facts on the ground which are almost ready for such a grim situation if corrective measures are not affecting in time.

She is not a wizard in crystal grazing to forecast future events, but certainly, she is a visionary and envisions that the spectre of diseases will loom over the planet earth in future. She is no one else but Janet Tobia who has won laurels for her documentary ”Unseen Enemy”.

The Emmy award-winning filmmaker Janet Tobia told InnoHEALTH Magazine that her movie Unseen Enemy examines why in the 21st century we are experiencing a rash of diseases that were once only outbreaks but have now become full-blown epidemics.

This year, the world recalls nightmarish memories of 1918 pandemic of influenza and screen through a popular movie “Unknown Enemy” on its first anniversary. “I had a little bird, its name was Enza, I opened the window, and in–flu-enza, was a popular rhyme for children while skipping ropes in those outrageous days.

Informatively, the 1918 flu pandemic (January 1918 – December 1920) was an unusually deadly influenza pandemic. Researchers say it infected 500 million people around the world, including people on remote Pacific islands and in the Arctic, and resulted in the death of 50 to 100 million (three to five percent of the world’s population).

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Disease had a greatly limited life expectancy in the early 20th century. Most influenza outbreaks disproportionately kill juvenile, elderly, or already weakened patients; in contrast, the 1918 pandemic predominantly killed previously healthy young adults. There are several possible explanations for the high mortality rate of the 1918 influenza pandemic. Some research suggests that the specific variant of the virus had an unusually aggressive nature. One group of researchers recovered the virus from the bodies of frozen victims and found that the transinfection in animals caused a rapid progressive respiratory failure and death through a cytokine storm (overreaction of body’s immune system).

More recent investigations, mainly based on original medical reports from the period of the pandemic, found that the viral infection itself was not more aggressive than any previous influenza. But that the special circumstances (malnourishment, overcrowded medical camps and hospitals, poor hygiene, etc.) promoted bacterial superinfection that killed most of the victims typically after a somewhat prolonged deathbed.

To maintain morale, wartime censors minimized early reports of illness and mortality in France, Germany, United Kingdom and the United States. Examining the recent epidemics of Ebola, Influenza and Zika; unseen enemy makes it clear that epidemics bring out the best and worst of human behaviour, and that their effect goes far beyond the terrible tolls of sickness and death.

‘‘We are all connected to any person, animal, and insect that may have an infectious disease incubating in them. And that connection is either incredibly dangerous or a powerful force for good. It is our choice which of those becomes true.’’

She says political leaders all over the world should address the problem. And play a key role in combating pandemics threats. There must be early detection and warning systems in place to detect outbreaks faster. Countries must work in close rapport both in the field of vaccines and drugs distribution, availability of diagnostic tools and research work in the discipline. Leaders will have to chip in together. Make strong health architecture at a global level – as a threat is looming on everyone.

We also need to use new mobile technology to reach out to affected and vulnerable populations, mobilize healthcare and make long-term investments in scientific research.

Finally, it is critical to invest in flu research both to improve the effectiveness of the current vaccine. And, more importantly, to develop a universal flu vaccine – one that would work against all types of flu, including potentially a new pandemic strain.

She recalls that the 1918 influenza pandemic killed more than 50 million people around the world. In India alone, 17 million lost their lives and so her movie cameras rivet around a potential global scenario. Emerging epidemics have a propensity to burst anywhere and anytime because of the fast changing global environment.

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She visualizes a scenario where India can play a major role because of its expertise in carrying out past massive health care programmes. Smallpox eradication and polio vaccination programme vindicate the fact about country’s efficacy to turntables. It is the need of the hour that such an expert was implemented for the elimination of infectious diseases to stave off the threat of the outbreak of pandemics in the global village.

In addition to urbanization and living in a highly connected world, deforestation is leading to closer contact with animals, which may infect us with deadly viruses. With climate change, vectors like mosquitoes are moving up north into newer regions. Suppose, antimicrobial resistance is added to this mix, and then there will be a new virus and drug-resistant infections. If we don’t have antibiotics that work, then you would be infected and untreatable.

The Director of the film minces no words to articulate her views on the unseen enemy. Ebola, for example, may have emerged in West Africa, a new part of Africa, because of deforestation there. AIDS moved out of the forests of Africa to spread around the world. Today there are over 20 million people living with HIV-AIDS. In addition to the new virus, we now also have new drug-resistant strains of once badly feared tuberculosis and malaria developing.

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She says reports are in circulation that new strains of influenza are infecting birds in China. But the day might not be far away. When these microbes may learn the clandestine art of migrating from birds to human beings.

In populous countries, people live in dense pockets in the overburdened urban swathes. Not only that they travel in crowded public transports and if an infected, suffering from a contagious infection, sneezes or coughs, there is an instant spreading of the infection. The virus, the unseen enemy, infects people who are generally oblivious of the lurking threat.

During the outbreak of such epidemics, people are advising to be cautious to mount their own defence to protect themselves. In India, a sea of humanity moves every day from one place to another. And in case of the outbreak of such diseases, travelling of infection can be very fast.

In case of India, there is a heavy burden of noncommunicable diseases and chronic diseases that often compromise immunity. Deaths from flu are higher in diabetics than the general population.

The seasonal flu shot is the best tool. There is some evidence to show that taking the flu shot two years in a row gives you more protection than if you skipped a year. There is also some evidence on how people receiving a flu shot for the first time. And have the strongest immune protection reaction, while other studies say this isn’t true.

India’s smallpox eradication campaign is the most successful healthcare drive in history. During the time more than 100,000 health workers visited over 100 million households to eradicate smallpox. So, India has a blueprint to deal with a future pandemic.

Filmmakers had looked at previous epidemics and infections. AIDS was lurking in their minds. But the sudden spurt of Ebola and Zika virus’ cases turned the film into a real-time saga. And both AIDS and SARS slipped into the background.

In the global village narrative, every citizen is open to risk factors in case of pandemics. The diseases assail everything whatever comes into their way – may it be health or wealth. When a pandemic happens, people don’t work, economies collapse, and the even social fabric is dismembered. People attempt to avoid their own infected close relatives and friends. Out of fear that they will be the next seizure if precautions were not clamped.

In case of pandemics, whatever happens on the front line in Liberia affects people in Europe and North America. We all share knowledge platforms, travel frequently and export and import cheaper goods so microbes also travel freely. For her, Ebola is the test case. According to the Director, Ebola was not handled swiftly at the stage of the outbreak. Otherwise, it could have been bridled at that stage rather it turned into the epidemic.

She recalls that Zika virus too had sprung a surprise. It was never visualized. No one thought that a virus first identified in the 1940s in Uganda would travel halfway across the world. First to the South Pacific and then to South America, and now to North America. We are still trying to understand, why this virus that particularly dangerous would in Brazil produce such terrible birth defects.

Zika is essentially a pandemic as it affects so many countries and continents. It could affect more because the mosquitoes will be able to move further north as the globe warms up.

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Specific health situation of Indian states

InnoHEALTH Magazine — Thu, 03 May 2018 09:14:37 +0000

Importance of understanding the specific health situation of each state

Understanding the health and disease trends in groups of states at a similar level of development or epidemiological transition is an important intermediate step in teasing apart the heterogeneity of disease and risk factor epidemiology in India. However, effective action to improve health must finally be based on the specific health situation of each state. This point is elucidated by significant variations in the burden from leading diseases and risk factors in 2016 between the following pairs of states that have physical proximity and are at similar levels of development and epidemiological transition.

The major EAG states of Madhya Pradesh and Uttar Pradesh both have a relatively lower level of development indicators and are at a similar less advanced epidemiological transition stage. However, Uttar Pradesh had 50% higher disease burden per person from chronic obstructive pulmonary disease, 54% higher burden from tuberculosis, and 30% higher burden from diarrheal diseases, whereas Madhya Pradesh had 76% higher disease burden per person from stroke.

The cardiovascular risks were generally higher in Madhya Pradesh, and the unsafe water and sanitation risk was relatively higher in Uttar Pradesh. The two North-East India states of Manipur and Tripura are both at a lower-middle stage of epidemiological transition but have quite different disease burden rates from specific leading diseases.

Tripura had 49% higher per person burden from ischaemic heart disease, 52% higher from stroke, 64% higher from chronic obstructive pulmonary disease, 159% higher from iron-deficiency anaemia, 59% higher from lower respiratory infections, and 56% higher from neonatal disorders.

Manipur, on the other hand, had 88% higher per person burden from tuberculosis and 38% higher from road injuries. Regarding the level of risks, child and maternal malnutrition, air pollution, and several of the cardiovascular risks were higher in Tripura.

The two adjoining north Indian states of Himachal Pradesh and Punjab both have a relatively higher level of development indicators and are at a similar more advanced epidemiological transition stage. However, there were striking differences between them in the level of burden from specific leading diseases.

Punjab had 157% higher per person burden from diabetes, 134% higher burden from ischaemic heart disease, 49% higher burden from stroke, and 56% higher burden from road injuries.

On the other hand, Himachal Pradesh had 63% higher per person burden from chronic obstructive pulmonary disease. Consistent with these findings, Punjab had substantially higher levels of cardiovascular risks than Himachal Pradesh.

The Executive summary says these examples highlight why it is necessary to understand the specific disease burden trends in each state, over and above the useful broad insights provided by trends common for groups of states at similar levels of epidemiological transition, if health action has to be planned for the specific context of each state.

The chances of achieving the overall health targets set by India would be much higher if the biggest health problems and risks in each state are tackled on priority than with a more generic approach that does not take into account the specific disease burden trends in each state.

Application of the state-level disease burden findings and future work. The findings in this report of the India State-level Disease Burden Initiative can be used for planning of state health budgets, prioritisation of interventions relevant to each state, informing the government’s Health Assurance Mission in each state, monitoring of health-related Sustainable Development Goals targets in each state, assessing impact of large-scale interventions based on time trends of disease burden, and forecasting population health under various scenarios in each state.

Future plans of the India State-level Disease Burden Initiative include annual updates of the estimates based on newly available data, and more disaggregated findings such as the rural-urban estimates planned for next year and sub-state level estimates subsequently when adequate data become available.

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