Burden of noncommunicable diseases and implementation challenges of National NCD Programmes in India.

BACKGROUND: Out of the total deaths globally, noncommunicable diseases (NCDs) account for 72% of the deaths. In India, as per the global burden of disease 2016 estimates, NCDs contributed to 62% of the deaths and 55% of the disability-adjusted life years, thereby posing a huge burden. Before 2010, there was no integrated programme, which addresses these NCDs, but there were many programmes parallelly running and catering to different aspects of these NCDs. Now almost 13 programmes are directly or indirectly contributing to the NCD prevention and control with many implementation challenges. METHODS: A review on the status of NCD burden estimates globally and nationally was undertaken. The National NCD Programme and other strategies associated with addressing the NCDs were searched using the search engines PubMed and Google Scholar along with the websites of national ministries, government portals and meeting proceedings. RESULTS: Health is a state subject, with National Health Mission (NRHM/NUHM) as a flagship programme of Ministry of Health and Family Welfare. There are 13 programmes contributing to NCD prevention and control directly or indirectly and the major one is the National Programme for prevention and control of cancer, diabetes, cardiovascular diseases and stroke (NPCDCS). The other initiatives taken for NCD prevention and control include the National Action Plan to achieve NCD targets by 2025 and development of Multisectoral Action Plan (2017-2022). The infrastructure for NPCDCS includes 524 district NCD cells, 565 district NCD clinics, 167 district cardiac care units, 164 district day care centres and 2759 Community Health Centre NCD clinics. The key challenges are with trained human resources for the screening of the NCDs, low budget allocation and utilisation, lack of access to diagnostics and regular supply of essential medicines. There is also poor focus on health promotion, multisectoral participation, surveillance, monitoring and evaluation of the programme at different levels of health care delivery. CONCLUSION: The government has taken different initiatives for the prevention and control but effective implementation is the major challenge in India. A health system strengthening with focus on health promotion in different settings, robust surveillance and access to individual clinical services is required. Collaborations with ministries, multisectoral approach, strengthening of referral system along with involvement/training of grassroot level workers who efficiently implement are needed. Bolstering of screening, diagnostic and treatment service will be fruitful.

Determinants of smokeless tobacco use in India.

Non-communicable diseases (NCDs) contributes to more than 50 per cent disability adjusted life years (DALYs) in India; and tobacco contributes to 7·4 per cent of DALYs which is next to diet and high blood pressure. According to Global Burden of Disease (GBD) 2015, tobacco use contributed to 5.9 per cent out of total DALYs in India. Smokeless tobacco (SLT) consumption is a multifactorial process influenced by varied range of contextual factors i.e., social, environmental, psychological and the genetic factors which are linked to the tobacco use. The determinants associated with the SLT use are gender, educational level, wealth index (inverse association), urban-rural residence, socio-economic status and low tax. Taking the view from tobacco control programmes, there is a need to address determinants of SLT use with State level monitoring and socio-economic inequalities, progress and review of the taxation of the SLT use in India.

Impact of Underlying Comorbidities on Mortality in SARS-COV-2 Infected Cancer Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: The evidence has shown that SARS CoV-2 infected patients with comorbidities are more likely to have severe disease sequel and mortality. In SARS-CoV-2 infected cancer patients risks associated with other underlying comorbidities might vary from those in non-cancer SARS CoV-2 infected patients. The relative impact of different underlying health conditions among patients with cancer and SARS CoV-2 infection remains yet to be explored. This systematic review aims to explore the prevalence of comorbidities among cancer patients with SARS CoV-2 infection and their impact on mortality. METHODS: Online databases PubMed, Embase, Scopus and Web of science were searched for articles published between 9th July 2019 to July 8th 2020.Studies of cancer patients (>18 years) with diagnosis of SARS CoV-2 infection, published in English were included. A random-effects modelling for the meta-analyses was applied to assess the pooled prevalence and odds ratio for mortality due to comorbidities in SARS CoV-2 infected cancer patients. RESULTS: Total 31studies with 4086 SARS-CoV-2 infectedcancer patientsmet the inclusion criteria. Most prevalent co-morbidities in cancer patients with SARS CoV-2 infection were hypertension [42.3% (95%CI:37.5- 47.0)], diabetes [17.8% (95% CI: 15.3-20.4)] and cardiovascular diseases [16.7% (95%CI:12.9-20.4)].The risk of mortality (pOR) was significantly higher in individuals with hypertension[1.6(95%CI 1.24-2.00)], cardiovascular diseases [2.2 (95%CI 1.49- 3.27)], chronic obstructive pulmonary diseases [1.4(95% CI 1.05-2.00)] and diabetes [1.35(95%CI 1.06-1.73)]. CONCLUSION: Our results indicates that the mortality in SARS-CoV-2 infected cancer patients is affected by preexisting non-cancer comorbidities. By identifying the comorbidities predictive for mortality, clinicians can better stratify the risk of cancer patients presenting with SARS-COV-2, on their initial contact with health services.
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Effectiveness of targeting the health promotion settings for non-communicable disease control in low/middle-income countries: systematic review protocol.

INTRODUCTION: Settings-based approaches to health promotion, involving holistic and multidisciplinary methods, which integrate action across risk factors are important. Major advantage of focusing on these settings is the continuous and intensive contact with the participant. Despite the apparent advantages of addressing non-communicable diseases (NCDs) using targeted interventions for several developed country settings, a relative lack of evidence of effectiveness of such interventions in low/middle-income countries has led to poor allocation of resources towards these interventions. The focus is therefore on the settings rather than any one condition, and we therefore expect the findings to generalise to NCD prevention and control efforts. We intend to estimate the effectiveness of targeted interventions in low/middle-income countries. METHODS AND ANALYSIS: We will search PubMed, Excerpta Medica Database, OVID, WHO Library and The Cochrane Library from the year 2000 to March 2018 without language restrictions. Study designs to be included will be randomised controlled trials. The primary outcome of effectiveness will be the percentage change in population having different behavioural risk factors. Subgroup analyses will be performed, and sensitivity analyses will be conducted to assess the robustness of the findings. ETHICS AND DISSEMINATION: No ethical issues are foreseen. The Institute Ethics Committee of the Post Graduate Institute of Medical Education and Research approved the doctoral research protocol under which this review is being done. Dissemination will be done by submitting scientific articles to academic peer-reviewed journals. We will present the results at relevant conferences and meetings. STUDY DESIGN: Systematic review. PROSPERO REGISTRATION NUMBER: CRD42016042647; Pre-results.