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Background: India has 2.1 million people living with HIV/AIDS (PLHIV). The objective of this study was to ascertain the extent of anti-retroviral therapy (ART) adherence and reasons for nonadherence among PLHIV in India. Methods: We conducted a systematic review and meta-analysis using the following criteria: (1) Observational or experimental studies conducted in India and (2) English language studies. Published during January 2012-June 2018 with data collection during the same period (3). 95% ART adherence rate (primary outcome). We reviewed bibliographic databases (PubMed, Scopus) and extracted relevant data. The forest plot was used to display the meta-analysis results. Analyses were performed in Stata 14 using the "Metaprop_one" function. Results: A total of 511 records were identified after removing duplicates, 59 full-texts were screened of which 15 studies were included in the meta-analysis. Only one study was conducted in rural India, with <95% adherence reported by all its participants. The PLHIV reported several reasons for their ART nonadherence including forgetfulness (8/15), running out of pills (3/15), distance from the health center and associated travel (2/15), alcohol abuse (3/15), concealment of HIV status from family (2/15, felt stigma (2/15), depressive symptoms (2/15), and fear of side-effects (2/15). The overall pooled estimate of ART adherence was 54.1% (95% confidence interval [CI] 27%-81%), while among facility-based studies, the ≥95% adherence rate was significant higher. 62% (95% CI 46%-0.78%). Conclusions: Despite the universal provision of free of cost ART to all PLHIV in government health facilities in India, suboptimal adherence to treatment persists in nearly half of these patients.
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BACKGROUND: Post-coronavirus disease 2019 (COVID-19) symptoms were widely reported. However, data on post-COVID-19 conditions following infection with the Omicron variant remained scarce. This prospective study was conducted to understand the prevalence, patterns, and duration of symptoms in patients who had recovered from COVID-19. METHODS: A prospective study was conducted across 11 districts of Delhi, India, among individuals who had recovered from COVID-19. Study participants were enrolled, and then returned for post-recovery follow-up at 3 months and 6 months interval. RESULTS: The mean age of study participants was 42.07 years, with a standard deviation of 14.89 years. The majority of the participants (79.7%) reported experiencing post-COVID-19 symptoms. The most common symptoms included joint pain (36.0%), persistent dry cough (35.7%), anxiety (28.4%), and shortness of breath (27.1%). Other symptoms were persistent fatigue (21.6%), persistent headache (20.0%), forgetfulness (19.7%), and limb weakness (18.6%). The longest duration of symptom was observed to be anxiety (138.75±54.14 days), followed by fatigue (137.57±48.33 days), shortness of breath (131.89±60.21 days), and joint pain/swelling (131.59±58.76 days). At the first follow-up visit, 2.2% of participants presented with abnormal electrocardiogram readings, but no abnormalities were noticed during the second follow-up. Additionally, 4.06% of participants exhibited abnormal chest X-ray findings at the first followup, which decreased to 2.16% by the second visit. CONCLUSION: The most frequently reported post-COVID-19 symptoms were joint pain, dry cough, anxiety and shortness of breath. These clinical symptoms persisted for up to 6 months, with evidence of multi-system involvement. Consequently, findings highlighted the need for long-term follow-up during the post-COVID-19 period.
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Editor's Note: The following article discusses the timely topic Clinical Guidance in the areas of Evidence-Based Early Hearing Detection and Intervention Programs. This article aims to discuss areas of services needed, guidance to countries/organizations attempting to initiate early hearing detection and intervention systems. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. In Ear and Hearing, our long-term goal for the Point of View article is to stimulate the field's interest in and to enhance the appreciation of the author's area of expertise. Hearing is an important sense for children to develop cognitive, speech, language, and psychosocial skills. The goal of universal newborn hearing screening is to enable the detection of hearing loss in infants so that timely health and educational/therapeutic intervention can be provided as early as possible to improve outcomes. While many countries have implemented universal newborn hearing screening programs, many others are yet to start. As hearing screening is only the first step to identify children with hearing loss, many follow-up services are needed to help them thrive. However, not all of these services are universally available, even in high-income countries. The purposes of this article are (1) to discuss the areas of services needed in an integrated care system to support children with hearing loss and their families; (2) to provide guidance to countries/organizations attempting to initiate early hearing detection and intervention systems with the goal of meeting measurable benchmarks to assure quality; and (3) to help established programs expand and improve their services to support children with hearing loss to develop their full potential. Multiple databases were interrogated including PubMed, Medline (OVIDSP), Cochrane library, Google Scholar, Web of Science and One Search, ERIC, PsychInfo. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. Eight essential areas were identified to be central to the integrated care: (1) hearing screening, (2) audiologic diagnosis and management, (3) amplification, (4) medical evaluation and management, (5) early intervention services, (6) family-to-family support, (7) D/deaf/hard of hearing leadership, and (8) data management. Checklists are provided to support the assessment of a country/organization's readiness and development in each area as well as to suggest alternative strategies for situations with limited resources. A three-tiered system (i.e., Basic, Intermediate, and Advanced) is proposed to help countries/organizations at all resource levels assess their readiness to provide the needed services and to improve their integrated care system. Future directions and policy implications are also discussed.
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Diagnóstico Precoz , Pérdida Auditiva , Tamizaje Neonatal , Humanos , Tamizaje Neonatal/normas , Recién Nacido , Pérdida Auditiva/diagnóstico , Pérdida Auditiva/terapia , Pérdida Auditiva/rehabilitación , Medicina Basada en la Evidencia , Pruebas Auditivas , Salud Global , Intervención Médica Temprana , Lactante , Vías ClínicasRESUMEN
Political will is the key to public health policy-making and a major driving force for the attainment of Universal Health Coverage (UHC) in any nation. To achieve UHC, the Indian government laid down National Health Policy in 1983 and updated it in 2002 and recently in 2017. This recent policy emphasized increasing healthcare spending and economic growth. In the current budget, there is an increment in the share of GDP of 0.34% from the previous year's allocation, but still staggering for the envisaged 2.5% to achieve UHC. Enthusiastic announcements of opening 157 new nursing colleges, a separate programme for eliminating sickle cell anemia by 2047, and Centers of excellence establishment for pharma companies for promoting research and development and focusing on Particularly Vulnerable Tribal Groups (PVTGs) are the few overarching and new highlights in the current budget. But, in a country so huge and varied in terms of its needs in every sector, the announcements in the financial budget speech taking India forward in becoming a "shining star" is a matter of debate. This is an attempt to review the budget for this financial year in the healthcare sector and what it means: is the country willing to build a self-driven healthcare sector in the Amrit Kaal with strong public finances and a robust financial sector through "efforts by all"?
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INTRODUCTION: With growing trends in tobacco consumption, it has been observed that the age of initiation is gradually decreasing. To combat the deep-rooted problem of the Society, we need to target the adolescents at the time of their first consumption of tobacco forms. Hence, this study was conducted to assess the pattern of smokeless tobacco use among school going adolescents in senior secondary schools with the assessment of the sociodemographic factors responsible for initiation of smokeless tobacco use by adolescents. METHODS: A cross-sectional survey of total sample of 714 students across 9-11 standards in 3 schools of Delhi was done using a self-administered questionnaire after obtaining approval from Institutional Ethics Committee and School Health Scheme, Delhi. RESULT: Consumption of tobacco was found to be 27.9% at a frequency of 6-9 days in a period of one month and a majority of 31 (39.2%) students initiated the use in the age group of 10-11 years. Among the different SLT products, pan masala combined with zarda with 56 (70.8%) users, was found to be the most commonly consumed SLT product. Grocery shops were preferred POS among the students as (67%) of students obtained the SLT product from this POS. 56 (70.8%) of the students wanted to quit the habit of SLT use whereas 49 (62%) students tried to quit the habit and 43 (54.4%) students sought help in order to quit the habit. DISCUSSION: Such alarming results in terms of low age of initiation in Delhi is an emerging health problem. Adequate cessation programmes and schemes must be developed and strict implementation of laws and policies to achieve a tobacco free youth is the need of hour.
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Tabaco sin Humo , Adolescente , Humanos , Niño , Estudios Transversales , Uso de Tabaco/epidemiología , India/epidemiología , Instituciones AcadémicasRESUMEN
Introduction: Exposure to secondhand smoke (SHS) is an established causal risk factor for cardiovascular disease (CVD) and chronic lung disease. Numerous studies have evaluated the role of tobacco in COVID-19 infection, severity, and mortality but missed the opportunity to assess the role of SHS. Therefore, this study was conducted to determine whether SHS is an independent risk factor for COVID-19 infection, severity, mortality, and other co-morbidities. Methodology: Multicentric case-control study was conducted across six states in India. Severe COVID-19 patients were chosen as our study cases, and mild and moderate COVID-19 as control were evaluated for exposure to SHS. The sample size was calculated using Epi-info version 7. A neighborhood-matching technique was utilized to address ecological variability and enhance comparability between cases and controls, considering age and sex as additional matching criteria. The binary logistic regression model was used to measure the association, and the results were presented using an adjusted odds ratio. The data were analyzed using SPSS version 24 (SPSS Inc., Chicago, IL, USA). Results: A total of 672 cases of severe COVID-19 and 681 controls of mild and moderate COVID-19 were recruited in this study. The adjusted odds ratio (AOR) for SHS exposure at home was 3.03 (CI 95%: 2.29-4.02) compared to mild/moderate COVID-19, while SHS exposure at the workplace had odds of 2.19 (CI 95%: 1.43-3.35). Other factors significantly related to the severity of COVID-19 were a history of COVID-19 vaccination before illness, body mass index (BMI), and attached kitchen at home. Discussion: The results of this study suggest that cumulative exposure to secondhand cigarette smoke is an independent risk factor for severe COVID-19 illness. More studies with the use of biomarkers and quantification of SHS exposure in the future are needed.
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COVID-19 , Contaminación por Humo de Tabaco , Humanos , COVID-19/epidemiología , Vacunas contra la COVID-19 , Estudios de Casos y Controles , Contaminación por Humo de Tabaco/efectos adversos , Índice de Masa CorporalRESUMEN
OBJECTIVE: Tobacco use is associated with mortality in low- and middle-income countries including India with dual burden of smoking and smokeless tobacco (SLT). Aligning with the FCTC, India has made substantial amendments in strengthening graphic warning under Cigarettes and Other Tobacco Products Act (COTPA) for sections 7,8 9 and "Specified warning". Compliance assessment studies are necessary to understand current status of implementation for packaging laws. This study aimed to assess the compliance of COTPA sections 7,8 9 and Cigarettes and other Tobacco Products (Packaging and Labelling) Third Amendment Rules, 2020 in Delhi. METHODS: Cross-sectional study was conducted in two districts of Delhi selected by simple random sampling. Fifteen points of sales were selected from each district through purposive sampling and 57 smoking and smokeless tobacco products were collected with Indian and foreign origin. An observation checklist for product analysis was prepared and pack analysis done based on COTPA sections 7,8 and 9 along with Third Amendment,2020 which included pictures and warnings to be circulated in 2021. RESULT: Total 57 samples has smoking (49.1%), smokeless (50.9%) with no SLT product of foreign origin. SLT and foreign products had low compliance of Section 7 and third amendment 2020 rules which includes manufacturing date and origin. Indian smoking products were highly compliant to section 8 and 9 whereas foreign and SLT products showed low compliance to section 8. COTPA Third Amendment Rules (2020) compliance was seen in Indian products with regards to SW (68.4%), PW (61.4%) and quit line (78.9%) with no compliance at all for foreign products. CONCLUSION: Foreign brands and SLT products had low compliance with sections 7 and 8 of COTPA and its amendments (2020). Compliance with illicit trade and SW needs regulation and strict implementation of law for SLT products.
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Productos de Tabaco , Tabaco sin Humo , Humanos , Etiquetado de Productos , Estudios Transversales , India/epidemiologíaRESUMEN
INTRODUCTION: Illicit smokeless tobacco (ST) trade has seldom been documented despite ST use in at least 127 countries across the world. Based on non-compliance with packaging regulations, we report the proportion of illicit ST products from samples on sale in Bangladesh, India and Pakistan where 85% of global ST users reside. METHODS: We purchased unique ST products from tobacco sellers in two purposively selected administrative areas (division/district) in each of the three countries. The criteria to determine illicit ST products were based on country-specific legal requirements for ST packaging and labelling. These requirements included: 'market retail price disclosure', 'sale statement disclosure', 'pictorial health warning (PHW) pertinence', 'appropriate textual health warning' and 'using misleading descriptors (MDs)'. Non-compliance with even one of the legal requirements was considered to render the ST product illicit. RESULTS: Almost all ST products bought in Bangladesh and India were non-compliant with the local packaging requirements and hence potentially illicit, all products in Pakistan lacked desirable features. The most common feature missing was health warnings: 84% packs in Bangladesh, 93% in India, and 100% in Pakistan either did not have PHW or their sizes were too small. In Bangladesh, 61% packs carried MDs. In India and Pakistan, the proportions of such packs were 32% and 42%, respectively. CONCLUSIONS: Weak and poorly enforced ST control policies may be slowing the progress of tobacco control in South Asia. Standardised regulations are required for packaging and labelling ST. Improving compliance and reducing sale of cheap illicit products may require business licensing and market surveillance.
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OBJECTIVES: Menstrual hygiene management (MHM) in developing countries is linked to human rights, social justice, and the education and empowerment of young girls. The objective of this study was to assess menstrual hygiene practices and their determinants among adolescent girls, including school dropouts, and the effects of pad distribution programs in urban resettlement areas of Delhi, India. METHODS: A cross-sectional study was conducted from March 2019 to February 2020 in urban resettlement colonies and 2 villages of Delhi among 1,130 adolescent girls aged 10 to 19 years, who were interviewed face to face. RESULTS: In total, 954 participants (84.4%) used only disposable sanitary pads, 150 (13.3%) used both sanitary pads and cloths, and 26 (2.3%) used only cloths (n=1,130). Most school-going girls utilized the scheme for pad distribution, but only two-thirds of the girls who were out of school utilized the scheme. In the adjusted analysis, girls with lower educational status, those who had dropped out of school, and those from the Muslim religious community were more likely to use cloths for MHM. CONCLUSION: More than 4 out of 5 adolescent girls in Delhi in low-income neighborhoods preferred sanitary pads for MHM. The government free pad scheme reached near-universal utilization among school-going girls (97%), but the subsidized pad scheme for girls who did not attend school was insufficiently utilized (75%).
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Background: India has over 50 million workers employed in industries with exposure to very high sound levels, predisposing them to noise-induced hearing loss (NIHL). Methods: We conducted a systematic review and meta-analysis by using the following criteria: (1) Observational or experimental studies conducted in India; (2) English language studies; (3) Published during January 2010-December 2019; (4) Primary outcome: proportion of participants detected with NIHL. We reviewed bibliographic databases (PubMed, Scopus, and DOAJ) and Google Scholar, and extracted the relevant data. Results: A total of 160 documents were identified after removing duplicates, and 33 full texts were screened, of which 22 studies were included. The mean (SD) effective sample size of the studies was 107.1 (78.9). The pooled proportion of participants with NIHL irrespective of the category was 0.49 (95%CI: 0.22-0.76) and that of hearing loss was 0.53 (95%CI: 0.28- 0.78). Most studies reported that none of the workers, especially in the informal sectors, used auditory protection. Conclusions: NIHL is a major neglected public health occupational health challenge in India linked with adverse social determinants of health. Sustained advocacy for implementation of legislative and behavior change communication for protecting the hearing of workers is warranted.
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Background: There is no published decision model for informing hearing health care resource allocation across the lifespan in low- and middle-income countries. We sought to validate the Decision model of the Burden of Hearing loss Across the Lifespan International (DeciBHAL-I) in Chile, India, and Nigeria. Methods: DeciBHAL-I simulates bilateral sensorineural hearing loss (SNHL) and conductive hearing loss (CHL) acquisition, SNHL progression, and hearing loss treatment. To inform model inputs, we identified setting-specific estimates including SNHL prevalence from the Global Burden of Disease (GBD) studies, acute otitis media (AOM) incidence and prevalence of otitis-media related CHL from a systematic review, and setting-specific pediatric and adult hearing aid use prevalence. We considered a coefficient of variance root mean square error (CV-RMSE) of ≤15% to indicate good model fit. Findings: The model-estimated prevalence of bilateral SNHL closely matched GBD estimates, (CV-RMSEs: 3.2-7.4%). Age-specific AOM incidences from DeciBHAL-I also achieved good fit (CV-RMSEs=5.0-7.5%). Model-projected chronic suppurative otitis media prevalence (1.5% in Chile, 4.9% in India, and 3.4% in Nigeria) was consistent with setting-specific estimates, and the incidence of otitis media-related CHL was calibrated to attain adequate model fit. DeciBHAL-projected adult hearing aid use in Chile (3.2-19.7% ages 65-85 years) was within the 95% confidence intervals of published estimates. Adult hearing aid prevalence from the model in India was 1.4-2.3%, and 1.1-1.3% in Nigeria, consistent with literature-based and expert estimates. Interpretation: DeciBHAL-I reasonably simulates hearing loss natural history, detection, and treatment in Chile, India, and Nigeria. Future cost-effectiveness analyses might use DeciBHAL-I to inform global hearing health policy. Funding: National Institutes of Health (3UL1-TR002553-03S3 and F30 DC019846).
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The Covid-19 pandemic continues to stalk the globe, ever since the first outbreak in December 2019. Variants of concern and fear of subsequent pandemic waves continue to challenge every nation. The virus has caught communities off-guard many times with grave consequences.
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COVID-19 , Salud Pública , Brotes de Enfermedades , Humanos , Pandemias , Estigma SocialRESUMEN
Objective: This study aimed to determine the effect of a mHealth (text message) intervention compared with a structured health educational session on the oral care and hygiene practices of pregnant women. Materials and Methods: We conducted a pilot randomized control trial, parallel design superiority trial, with a 1:1 allocation ratio. A total of 76 pregnant women up to 20 weeks of gestational age and capable of reading mobile phone text messages were recruited during August-October 2020 from the antenatal clinic of a primary health center in a low-income urban agglomeration in Delhi, India. The mHealth intervention arm participants were sent a daily text message for 30 days, while all participants were provided a one-time, face-face, brief didactic structured educational session toward oral health promotion. Results: The baseline characteristics of both groups were comparable in terms of age structure, education, parity, and oral hygiene but differed in terms of oral health problems. Postintervention, although the twice-brushing frequency increased in both arms, only the mHealth arm revealed a statistically significant reduction in the incidence of missed twice-daily brushing episodes (P = 0.016). Conclusions: A mHealth-based daily text-message intervention for 1 month was not superior to a one-time brief didactic structured educational intervention for oral health promotion in antenatal women.
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The outbreak of coronavirus disease (COVID-19) has triggered changes and reforms in the health sector in India. As the pandemic points to a gap in the industry, it has led to the creation of new opportunities to solve problems. To help the country repair the damage caused by the virus pandemic, the Government of India announced that in the health budget 2021, promotion of health and well-being will be one of the six pillars. Investment in health infrastructure in the 2021 budget has increased significantly to welcome the much-needed increase in budget allocations of Rs. 2.3 lakh crore. Three areas will also be strengthened, including preventive health care and therapeutic health care. Special emphasis is placed on prevention, treatment, and health care. To promote primary health care, the country will establish 17,000 rural and 11,000 urban health care centers. Provision of affordable quality medical insurance will be provided by the government. The integrated and collaborative model of the public and private sectors in the provision of health services has led to a rapid expansion of work. This is an attempt to demonstrate the planned reforms in the health budget, especially during the COVID-19 pandemic. The budget of 2022-23 is about to be announced soon. It is to be seen how the financial allocation for the health sector impacts the health of the Indian people.
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Background: The public health emergency due to COVID-19 has placed an immense burden on the health care system. The strain for provision of health care services has also extended to routine services. The future impact of this decline in facility provision can be seen in morbidity and mortality indicators of the country. In a time when the country is working toward meeting the sustainable development goals (SDGs), COVID-19 has become a setback. Objective: This study tries to find the very challenges faced by frontline workers and the measures adopted to overcome the same. Materials and Methods: This was a mixed methods study conducted at various selected states across the country based on their vulnerability index. Data was collected via in-depth interviews among 120 frontline managers. Transcribed responses were coded. Framework analysis with preformed codes were done. Quantitative data are represented as frequencies and percentages. Results: Analysis showed increased work pressure, innovative approach adopted locally, and allaying fear by reinstating services helped as coping mechanisms to take care of routine health care services at the grassroots level. Conclusions: The conscious effort of all involved with the use of local solutions and innovations, along with intersectoral coordination and efficient use of resources paved the way for a good deliverance of health care to the society. The frontline managers minimized the damage by using available resources consciously and wisely.