Temporal changes in diabetes prevalence and achievement of care goals in urban South Asia from 2010 to 2016 - The Center for Cardio-metabolic Risk Reduction in South Asia Study.

AIM: Achievement of treatment targets among individuals with diabetes remains suboptimal in many parts of the globe. We aimed to assess changes in diabetes prevalence and achievement of diabetes care goals in South Asia using two consecutive cross-sectional population-based surveys. METHODS: Two representative samples of South Asian adults were recruited using identical methods from Chennai, Delhi, and Karachi in 2010-11 (n = 16,288; response rate-94.7%) and 2015-16 (n = 14,587; response rate-94.0%) through the Center for Cardio-metabolic Risk Reduction in South Asia (CARRS) Study. Quality of care goals were defined as HbA1c <53 mmol/mol (7.0%), blood pressure (BP) control: <140/90 mmHg, lipid control: LDL cholesterol <2.56 mmol/l (100 mg/dl), and self-reported non-smoking. RESULTS: Weighted prevalence of self-reported diabetes increased by 9.0% [13% (95%CI: 13-14) to 15% (14-15)] while that of newly diagnosed diabetes decreased by 16% [6.1% (5.7-6.6) to 5.1% (4.6-5.6)]. There were improvements in achieving glycaemic (25% to 30%, p = 0.002) and lipid (34% to 45%, p < 0.001) goals, but no notable improvements in BP control or smoking status. The proportion of individuals with self-reported diabetes meeting more than one target also increased. CONCLUSIONS: Diabetes prevalence continues to grow among urban South Asians and large gaps still exist in the attainment of treatment targets. Concerted policy, systemic, clinical and individual efforts are needed to close these care gaps.

A cross-sectional study of the prevalence and correlates of tobacco use in Chennai, Delhi, and Karachi: data from the CARRS study.

BACKGROUND: Tobacco burdens in India and Pakistan require continued efforts to quantify tobacco use and its impacts. We examined the prevalence and sociodemographic and health-related correlates of tobacco use in Delhi, Chennai (India), and Karachi (Pakistan). METHODS: Analysis of representative surveys of 11,260 participants (selected through multistage cluster random sampling; stratified by gender and age) in 2011 measured socio-demographics, tobacco use history, comorbid health conditions, and salivary cotinine. We used bivariate and multivariate regression analyses to examine factors associated with tobacco use. RESULTS: Overall, 51.8 % were females, and 61.6 % were below the age of 45 years. Lifetime (ever) tobacco use prevalence (standardized for world population) was 45.0 %, 41.3 %, and 42.5 % among males, and 7.6 %, 8.5 %, and 19.7 % among females in Chennai, Delhi, and Karachi, respectively. Past 6 month tobacco use prevalence (standardized for world population) was 38.6 %, 36.1 %, and 39.1 % among males, and 7.3 %, 7.1 %, and 18.6 % among females in Chennai, Delhi, and Karachi, respectively. In multivariable regression analyses, residing in Delhi or Karachi versus Chennai; older age; lower education; earning less income; lower BMI; were each associated with tobacco use in both sexes. In addition, semi-skilled occupation versus not working and alcohol use were associated with tobacco use in males, and having newly diagnosed dyslipidemia was associated with lower odds of tobacco use among females. Mean salivary cotinine levels were higher among tobacco users versus nonusers (235.4; CI: 187.0-283.8 vs. 29.7; CI: 4.2, 55.2, respectively). CONCLUSION: High prevalence of tobacco use in the South Asian region, particularly among men, highlights the urgency to address this serious public health problem. Our analyses suggest targeted prevention and cessation interventions focused on lower socioeconomic groups may be particularly important.

Tasman Spirit oil spill in Pakistan: research response and lessons learned.

BACKGROUND: This article presents lessons learned from an investigation of the acute human health effects of the "Tasman Spirit" oil spill from a perspective of conducting rapid response investigations in developing countries. METHODS: We reviewed various steps in our investigation, other studies on oil spills in Pakistan and around the world, and reflected upon our discussions and interactions with various stakeholders. RESULTS: The article highlights the importance of applying a public health, legal, and ethical framework for conducting rapid response investigations, developing a pre-established funding mechanism, and addressing study design issues, exposure and outcome measurements, political issues, community engagement, and communication of results. CONCLUSION: There is need to develop ethical and legal framework and funding mechanism for conducting rapid response research in developing countries. A repository of study protocols, validated tools, and laboratory methods for exposure and outcome assessment would be greatly beneficial.