Estimation of the health and economic burden of human brucellosis in India.

High seroprevalence estimates of brucellosis in livestock species and humans in India suggest that the disease is a significant public health concern in the country. We developed an economic model and conducted an assessment of the impact of human brucellosis in India to describe the current situation to help formulate prevention and control strategies. Economic losses of human brucellosis were calculated based on the official records and the data from epidemiological surveys conducted in India. These data were used to estimate the disability adjusted life years (DALYs) due to human brucellosis. Uncertainty was incorporated in the model by applying probability distributions for certain input parameters. The analyses were further supplemented by conducting sensitivity analyses to determine which parameters had the biggest influence on the outcome of economic losses. The annual median losses due to human brucellosis were estimated to be Rs 627.5 million (uncertainty interval [95% UI] Rs 534.8-741.2 million; US $ 10.46 million) with a loss of Rs 442.3 million (95% UI 371.0-516.0; US $ 7.37 million) among adults and Rs 185.0 million (95% UI 124.0-255.0; US $ 3.08 million) among children. Human brucellosis in India caused a loss of 177 601 (95% UI 152 695-214 764) DALYs at the rate of 0.15 (95% UI 0.13-0.17) DALYs per thousand persons per year. The DALYs were found to be 0.29 (95% UI 0.08-0.70) per thousand persons per year in occupational and 0.13 (95% UI 0.06-0.18) in non-occupational adult population. This is the first systematic analysis of the health impact of human brucellosis in India and of indirect/production losses occurring due to human brucellosis anywhere in the world. The results indicate that brucellosis causes considerable economic losses and has a reasonable health impact, particularly among occupational groups. Intervention policies need to be strengthened to reduce the socio-economic impact of human brucellosis in India.

Estimation of the health and economic burden of neurocysticercosis in India.

Taenia solium is an endemic parasite in India which occurs in two forms in humans: cysticercosis (infection of soft tissues) and taeniosis (intestinal infection). Neurocysticercosis (NCC) is the most severe form of cysticercosis in which cysts develop in the central nervous system. This study was conducted to estimate health and economic impact due to human NCC-associated active epilepsy in India. Input data were sourced from published research literature, census data and other official records. Economic losses due to NCC-associated active epilepsy were estimated based on cost of treatment, hospitalisation and severe injury as well as loss of income. The disability-adjusted life years (DALYs) due to NCC were estimated by combining years of life lost due to early death and the number of years compromised due to disability taking the disease incidence into account. DALYs were estimated for five age groups, two genders and four regions, and then combined. To account for uncertainty, probability distributions were used for disease incidence data and other input parameters. In addition, sensitivity analyses were conducted to determine the impact of certain input parameters on health and economic estimates. It was estimated that in 2011, human NCC-associated active epilepsy caused an annual median loss of Rupees 12.03 billion (uncertainty interval [95% UI] Rs. 9.16-15.57 billion; US $ 185.14 million) with losses of Rs. 9.78 billion (95% UI Rs. 7.24-13.0 billion; US $ 150.56 million) from the North and Rs. 2.22 billion (95% UI Rs. 1.58-3.06 billion; US $ 34.14 million) from the South. The disease resulted in a total of 2.10 million (95% UI 0.99-4.10 million) DALYs per annum without age weighting and time discounting with 1.81 million (95% UI 0.84-3.57 million) DALYs from the North and 0.28 million (95% UI 0.13-0.55 million) from the South. The health burden per thousand persons per year was 1.73 DALYs (95% UI 0.82-3.39). The results indicate that human NCC causes significant health and economic impact in India. Programs for controlling the disease should be initiated to reduce the socio-economic impact of the disease in India.

Data and the associated R code used to estimate health and economic burden of neurocysticercosis in India.

This article contains epidemiological, demographic and other data used for estimating health and economic burden of neurocysticercosis (NCC)-associated active epilepsy in India [1]. Most of the data are embedded in the R-code used for analyses so that the reader is able to replicate the results or adapt the code to their own data. However, data used to conduct sensitivity analyses to evaluate the effect of changing important input values such as prevalence and per capita income on health and economic impact of NCC in India are included in tables. Results from sensitivity analyses are also presented in tables and figures. The paper also includes three scenarios with different age weighting (k) and time discounting (r) values used to estimate health and economic burden of NCC in India. The data for the scenario without any age weighting and time discounting are presented in "Estimation of the health and economic burden of neurocysticercosis in India" [1].

Economic losses occurring due to brucellosis in Indian livestock populations.

Brucellosis is a serious public health issue in India. Estimation of economic losses occurring due to brucellosis is required to help formulate prevention and control strategies, but has not been done in India. We estimated economic losses due to brucellosis by sourcing prevalence data from epidemiological surveys conducted in India. Data for livestock populations were obtained from official records. Probability distributions were used for many of the input parameters to account for uncertainty and variability. The analysis revealed that brucellosis in livestock is responsible for a median loss of US $ 3.4 billion (5th-95th percentile 2.8-4.2 billion). The disease in cattle and buffalo accounted for 95.6% of the total losses occurring due to brucellosis in livestock populations. The disease is responsible for a loss of US $ 6.8 per cattle, US$18.2 per buffalo, US $ 0.7 per sheep, US $ 0.5 per goat and US $ 0.6 per pig. These losses are additional to the economic and social consequences of the disease in humans. The results suggest that the disease causes significant economic losses in the country and should be controlled on a priority basis.

Veterinary public health in India: current status and future needs.

Veterinary public health (VPH) assumes huge significance in developing countries such as India. However, the implementation of VPH services throughout the country is still in its infancy. From 1970 onwards, many institutes, national and international organisations, professional societies, policies and personalities have contributed towards the development of VPH in India. Nevertheless, there is an urgent need to develop VPH still further as there are many issues, such as high population density, the re-emergence of zoonotic pathogens, environmental pollution and antimicrobial resistance, that require attention. The time has surely come to involve all stakeholders, ranging from primary producers (e.g., farmers) to policy-makers, so as to garner support for the holistic implementation of VPH services in India. To improve VPH activities and services, science-based policies enforced through stringent regulation are required to improve human, animal and environmental health. The emergence of the 'One Health' concept has ushered in new hopes for the resurrection of VPH in India. Applying tools such as the World Organisation for Animal Health (OlE) Day One Competencies and the OlE Tool for the Evaluation of Performance of Veterinary Services (PVS Tool) is essential to improve the quality of national Veterinary Services and to identify gaps and weaknesses in service provision, which can be remedied to comply with the OlE international standards. VPH initiatives started modestly but they continue to grow. The present review is focused on the current status and future needs of VPH in India.

Assessment of chlorpromazine as radiation sensitizer and protector.

In vitro studies of chlorpromazine (CPZ) a popular anti-psychotic drug has shown radiation sensitizing effects at higher celluar concentration and protective effect at a lower concentration. The present study was designed to evaluate both sensitizing and protective effects in the treatment of advanced cancer of the cervix treated with hypofractionated external radiation and intratumoural injection of chlopromazine. Twenty patients were treated with intratumoural CPZ and radiation, while, 23 patients received radiation alone. A 52.94% complete response was noted in CPZ arm while 39.1% complete response in the control. A trend towards improved response is seen in CPZ group. Similarly patients who received CPZ showed significantly low proctitis rates.

An analysis of the factors which impinge on a nurse's decision to enter, stay in, leave or re-enter the nursing profession.

As part of a wider study concerned with the changing nurse employment patterns a detailed questionnaire was completed by a total of 2325 qualified female nurses, 841 of whom were working fulltime in nursing, 634 were inactive, 678 were offering their services on a part-time basis and 172 were working in some other occupation. In a previous article the results of the analysis conducted on the responses to the attitude questions were presented. In this paper the replies to those questions aimed at soliciting the reasons felt to have impacted on the respondent's decision to take up nursing, to stay or to leave the profession and to re-enter the profession are analysed. As the questionnaires were distributed in the course of two projects separated by 4 years, what is of particular interest is the similarity of the two sets of results. These indicate that there is still a very high level of job satisfaction as evidenced by the extent to which nursing would be recommended to a friend or relative. The primary obvious reason for inactivity is the existence of a young child but when further intentions are explored it is clear that there is a large pool of qualified nurses keen to resume a career the main obstacle being the lack of sufficient flexibility of hours of working.