Clinico-epidemiological profile and outcomes of adults with COVID-19: A hospital-based retrospective study in Kerala, India.

Introduction: The clinical and epidemiological presentations of patients with coronavirus disease 2019 (COVID-19) in India is still not well explored. We studied the epidemiological and clinical profile and outcomes of COVID-19 patients admitted to a tertiary care private hospital in Kerala, India. Methods: In this retrospective study, we analyzed data of 476 adult (≥18 years) COVID-19 patients admitted to a tertiary care hospital in Kerala from September 1, 2020 to March 31, 2021. The patients were categorized into mild, moderate, and severe cases and followed till discharge or death. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23.0 with a significance set at P < 0.05. Results: The median age was 57 years (56% men). Mild, moderate, and severe cases accounted for 17%, 65%, and 18%, respectively. Around 75% had at least one comorbidity, and 51% had multiple comorbidities. The most common comorbidities were diabetes (45%), hypertension (44%), dyslipidemia (15%), and cardiac problems (12%). The elevated D-dimer values among patients in different categories were significantly different, with 74% in severe, 46% in moderate, and 19% in mild category patients. Serum ferritin, C-reactive protein, lactic acid dehydrogenase, and neutrophil to lymphocyte ratio values were significantly higher for severely ill patients. Thirty deaths (67% men) occurred during the study period, with a case fatality rate of 6.3%. Mortality mainly happened in the older age group (80%) and those with multimorbidity (90%). Conclusion: Age and multimorbidity are the major contributing factors for death in hospitalized COVID-19 patients. Generalization of the findings necessitates well-designed large-scale studies.

Interventions to Reduce Pesticide Exposure from the Agricultural Sector in Africa: A Workshop Report.

Despite the fact that several cases of unsafe pesticide use among farmers in different parts of Africa have been documented, there is limited evidence regarding which specific interventions are effective in reducing pesticide exposure and associated risks to human health and ecology. The overall goal of the African Pesticide Intervention Project (APsent) study is to better understand ongoing research and public health activities related to interventions in Africa through the implementation of suitable target-specific situations or use contexts. A systematic review of the scientific literature on pesticide intervention studies with a focus on Africa was conducted. This was followed by a qualitative survey among stakeholders involved in pesticide research or management in the African region to learn about barriers to and promoters of successful interventions. The project was concluded with an international workshop in November 2021, where a broad range of topics relevant to occupational and environmental health risks were discussed such as acute poisoning, street pesticides, switching to alternatives, or disposal of empty pesticide containers. Key areas of improvement identified were training on pesticide usage techniques, research on the effectiveness of interventions targeted at exposure reduction and/or behavioral changes, awareness raising, implementation of adequate policies, and enforcement of regulations and processes.

Exposure to mosquito coil and biomass fuel smoke and respiratory health in rural Tamil Nadu, India.

BACKGROUND: Mosquito coil smoke, along with biomass fuel smoke, are sources of indoor air pollution. Biomass fuel smoke has been studied as a risk factor for poor respiratory outcomes. However, in an Indian context, few studies examine the effect of mosquito coil exposure on poor respiratory outcomes at the community level. OBJECTIVES: To estimate the prevalence of the biomass fuel and mosquito coil use and to determine the association between the use of bio-mass fuel and mosquito coil and poor respiratory health. METHODS: A cross-sectional survey of 4662 individuals (above the age of 30 years) was conducted using a pre-tested questionnaire. Trained interviewers collected data on current and past use of biomass fuels and mosquito coils, usage practices and respiratory health. We computed proportions for exposure variables namely biomass fuel, mosquito coil use and other covariates. We conducted univariate analysis, followed by multivariate logistic regression. RESULTS: The prevalence of ever use of biomass fuels was high (wood: 97.9%; cow dung cake: 76.0% and crop residue: 54.4%). Current use of wood, cow dung cake and crop residue was prevalent among 75.7, 24.3 and 30.9% respondents, respectively. Almost 70% of respondents had ever used mosquito coils, whereas 54% were current users. Overall, 5.5% respondents had poor respiratory health either due to chronic bronchitis or asthma. In multivariate analysis, use of combination of all three biomass fuel types (adjusted odds ratio [AOR] 1.69, 95% confidence interval [CI]: 1.13-2.54) and use of mosquito coil more than or equal to 5 days per week (AOR 1.43, 95% CI: 1.04-1.99) were associated with poor respiratory health after adjusting for covariates age, gender, smoking, kitchen type and for each other. CONCLUSIONS: Use of biomass fuels and mosquito coils was high in the study population and was associated with poor respiratory health. Therefore, mosquito coil smoke should also be considered an important source of indoor air pollution, similar to biomass fuel exposure. Community education about these sources of indoor air pollution and increased coverage of cleaner fuels and alternative mosquito control methods should be the way forward in the rural areas.

Public health implications of Sabarimala mass gathering in India: A multi-dimensional analysis.

INTRODUCTION: Mass gathering for religious and spiritual purposes are common in India. However, mass gathering health and travel medicine is still in its infancy in India. OBJECTIVES: The study explored bio-medical, environmental and psycho-social dimensions of mass gathering in Sabarimala pilgrimage, which is annually attended by 25 million pilgrims. METHODS: In a cross sectional design, the investigators travelled the pilgrim trail and stayed in the shrine area to conduct the interviews (sample = 1259), to observe the practices as well as to assess the environmental conditions including sanitation. We did in-depth interviews of a subset of samples of the pilgrims, laboratory tests for water quality and secondary analysis of health services data. RESULT: 43.4% pilgrims reported at least one health problem. Leg pain, joint/muscle pain, breathlessness, were the common symptoms. Pilgrims expressed concern about drinking water and food safety and majority of them felt the crowd management as unsatisfactory. Untreated sewage and solid waste were found to pollute the water downstream. Average patient presentation rate for 2014-2017 was 4999.6 per 100,000 pilgrims and referral to Hospital Rate was 19 per 100,000 pilgrims. Mortality rate ranged from 18.5 to 21 per 100,000 pilgrims among those who attended the health centers for ailments. Death due to Coronary Artery Heart Disease (CAHD) has slightly decreased over the period of 3 years from 97.6% to 85.1%. CONCLUSION: Data with respect to safety, health and environment at the pilgrim sites need to be continuously assessed to understand changes and trends and to develop an effective mass gathering and safe pilgrimage policy (MGSPP).

Perceptions of State Government stakeholders & researchers regarding public health research priorities in India: an exploratory survey.

Public health research has several stakeholders that should be involved in identifying public health research agenda. A survey was conducted prior to a national consultation organized by the Department of Health Research with the objective to identify the key public health research priorities as perceived by the State health officials and public health researchers. A cross-sectional survey was done for the State health officials involved in public health programmes and public health researchers in various States of India. A self-administered semi-structured questionnaire was used for data collection. Overall, 35 State officials from 15 States and 17 public health researchers participated in the study. Five leading public health research priorities identified in the open ended query were maternal and child health (24%), non-communicable diseases (22%), vector borne diseases (6%), tuberculosis (6%) and HIV/AIDS/STI (5%). Maternal and child health research was the leading priority; however, researchers also gave emphasis on the need for research in the emerging public health challenges such as non-communicable diseases. Structured initiatives are needed to promote interactions between policymakers and researchers at all stages of research starting from defining problems to the use of research to achieve the health goals as envisaged in the 12th Plan over next five years.

High prevalence of household pesticides and their unsafe use in rural South India.

OBJECTIVE: To estimate the prevalence of usage, unsafe practices and risk perception regarding household pesticides in a rural community of Tamil Nadu, India. MATERIALS AND METHODS: In a cross-sectional survey we used a pre-tested questionnaire and trained interviewers to collect information on household pesticide use for the past 6 months from any adult member of randomly selected households. RESULTS: Out of 143 households, 95% used at least one household pesticide (95% CI: 93.5-99.5) and 94% used at least one household pesticide specifically for mosquito control. The most commonly used pesticides were mosquito coils (75%), mosquito liquid vaporizers (36%), ant-killing powder (24%) and moth/naphthalene balls (18%). The major non-chemical methods of pest control were rat traps (12%) and mosquito bed nets (7.5%). Out of the mosquito coil users, 61% kept the windows and doors closed while the coil was burning. Out of the moth ball users, 88% left them in the place of use till they fully vaporized. Nearly half of the users did not know that household pesticides were harmful to their health and the health of their children. CONCLUSIONS: The use of household pesticides was highly prevalent in this rural community. The prevalence of unsafe practices while handling them was also high. We recommend that the users of household pesticides be educated about the health hazards and about safe practices and non-chemical methods of pest control be promoted.

Use of pesticides and its impact on health of farmers in South India.

The relationship between extent of pesticide use and signs and symptoms of illnesses due to exposure was assessed in a cross-sectional survey of 631 farmers (537 men and 94 women) in South India. Responses to questionnaires showed that 433 farmers (68.6%) sprayed pesticides themselves and were thus directly exposed. More than 75% used moderately or highly hazardous pesticides; 88% used no protection while handling pesticides. About 50% of sprayers mixed different brands. Retailers were the source of information about pesticides for 56%. The farmers reported excessive sweating (36.5%), burning/stinging/itching of eyes (35.7%), dry/sore throat (25.5%), and excessive salivation (14.1%), all more prevalent among sprayers. Among men, excessive sweating and eye and throat problems were significantly associated with exposure. There is a need to raise farmers' and authorities' awareness of the need to use protective gear when handling pesticides.