Interventions to Ensure the Continuum of Care for Hypertension During the COVID-19 Pandemic in Five Indian States-India Hypertension Control Initiative.

Background: Hypertension is the leading risk factor for cardiovascular disease in India, but less than 10% of the estimated people with hypertension have blood pressure under control. The India Hypertension Control Initiative (IHCI) was implemented to strengthen hypertension management and control in public sector health facilities. Since late March 2020, lockdown due to the COVID-19 pandemic limited healthcare access and disrupted the provision of essential health services. IHCI quickly implemented adaptive interventions to improve access to medications. Objectives: To estimate the availability of antihypertensive drugs in peripheral public sector facilities during the lockdown and the proportion of patients who received drugs through community drug distribution, i.e., through Health and Wellness Centers (HWCs)/Sub-Centers (SCs), the most peripheral public sector health facilities for primary care, and home delivery. Methods: We collected data from 29 IHCI districts of 5 states (Kerala, Madhya Pradesh, Maharashtra, Punjab, and Telangana) during April-May 2020. The population included individuals diagnosed with hypertension and enrolled under IHCI in all public sector primary care health facilities. We contacted a convenience sample of more than one-third of the functional HWC/SC and analyzed the proportion of facilities and patients who received drugs. We also contacted a convenience sample of patients telephonically to estimate their self-reported availability of drugs. Conclusion: Of the 4245 HWC/SC, more than one-third were contacted telephonically, and 85-88% had received antihypertensive medications for community-level distribution. Among 721,675 patients registered until March 2020, 38.4% had received drug refills through HWC/SC or home delivery by frontline workers during the lockdown. We demonstrated the feasibility of community-level drug distribution for patients with hypertension during the COVID-19 lockdown in India. The adaptive strategy of community-based drug distribution through HWC/SC and home delivery appears feasible and may help improve access to hypertension care during the COVID-19 pandemic and beyond.

India Hypertension Control Initiative-Hypertension treatment and blood pressure control in a cohort in 24 sentinel site clinics.

The India Hypertension Control Initiative (IHCI) is a multi-partner initiative, implementing and scaling up a public health hypertension control program across India. A cohort of 21,895 adult hypertension patients in 24 IHCI sentinel site facilities in four Indian states (Punjab, Madhya Pradesh, Maharashtra, and Telangana), registered from January 2018 until June 2019 were assessed at baseline and then followed up for blood pressure (BP) control and antihypertensive medication use. Among all registrations, 11 274 (51%) of the patients returned for a follow-up visit between July 2019 and September 2019. Among patients returning for follow-up, 26.3% had BP controlled at registration, and 59.8% had BP controlled at follow-up (p < .001). The absolute improvement in BP control was more than two times greater in primary care (48.1 percentage point increase) than secondary care facilities (22.9 percentage point increase). Most IHCI patients received prescriptions according to state-specific treatment protocols. This study demonstrates that a scalable public health hypertension control program can yield substantial BP control improvements, especially in primary care settings. However, high loss to follow-up limits population health impact; future efforts should focus on improving systems to increase the likelihood that patients will return to the clinic for routine hypertension care.

Amniotic fluid index in normal pregnancy: an assessment of gestation specific reference values among Indian women.

AIM: To obtain a gestational reference range for the amniotic fluid index (AFI) among Indian women. METHODS: An analysis of AFI estimations was undertaken in 517 Indian women with normal pregnancy between 16 and 42 weeks of gestation. It was a prospective, cross-sectional study conducted in a university teaching hospital. Women with fetal anomalies, pregnancy-induced hypertension, diabetes mellitus, and other maternal complications were excluded from the study. The median, the 5th and the 95th percentile values were calculated for each gestational week and these values were compared with other studies. RESULTS: The median reached its peak at the 27th week of gestation. We observed approximately 6 cm as the lower limit of normal (5th percentile) and approximately 18 cm (95th percentile) as upper limit of normal AFI at term for our population, whereas in the Caucasian population, the values were approximately 7 cm and approximately 20 cm, respectively. All gestation specific AFI values were lower in the studied population of Indian women compared with other studies on Caucasian population (P < 0.01 for 5th percentile & P < 3.26 x 10(-7) for 95th percentile), but slightly higher than the Chinese population. CONCLUSION: Amniotic fluid index values differ in different populations. We standardized the reference values for normal AFI in Indian women. We found that they are lower in the population studied compared with reported values in the Caucasian population, but slightly higher than the Chinese population.