Self-care for Health for All - An Utopian Vision or a Pragmatic Plan?

The World Health Organization (WHO) identified the importance of self-care interventions in achieving Universal Health Coverage in 2019. It urges every country to include self-care interventions in their policies and guidelines. To guide the countries in this process, it released guidelines in 2019 and revised them in 2022. However, implementation of new interventions is not a path free of thorns. These guidelines have their own set of strengths and limitations that will differ from country to country.

The impact of Covid-19 in Chhattisgarh, India: A descriptive study.

Background: India is among the most severely affected countries in the ongoing Covid-19 pandemic, second to the USA. Until July 2022, there were 43 million confirmed Covid-19 cases, with 0.53 million Covid-19 deaths in India. Chhattisgarh, the twelfth-highest affected state by Covid-19 disease, has had an enormous mortality toll, with 14,046 deaths by 15th July 2022. This study is a descriptive analysis of the Covid-19 deaths across Chhattisgarh from September 2021 to February 2022 (the third pandemic wave). Materials and Methods: All Covid-19 deaths that occurred between September 2021 to February 2022 were line-listed, and family members of all who died in the hospital were interviewed. Results: 356 Covid-19 deaths were included in the present study. The top three districts which observed maximum deaths (63.48%) were Raipur (27.53%), Durg (15.45%), and Bilaspur (7.87%). Around 50% of the deceased were of age 65 years or above. The male deaths were twice as compared to the female deaths. The RT-PCR was the most used testing method, followed by RAT. Most of the admissions (58%) were in a government facility. Among the deceased, 60% had one or two associated comorbidities. Hypertension and Diabetes were the most common comorbidity identified. Almost 90% of patients were symptomatic. Breathlessness was the most common symptom. Half of the deceased were not vaccinated. The median expenditure on Covid-19 management was ₹ 50,000 (€ 565.13). Conclusion: The deaths in the study were urban-centric. Higher Covid-19 mortality was observed in unvaccinated older men (≥65 years) with one or more comorbidity.

Feeding practices and nutritional status of children (6-23 months) in an urban area of Raipur, Chhattisgarh, India.

Background: The first 1,000 days of a child's life is a critical window for growth faltering, deficiencies, and common childhood illnesses. Even with optimum breastfeeding, children 6-23 months are at higher risk of being undernourished if they do not receive adequate and appropriate complementary feeding. Therefore, this study was carried out to assess the nutritional status of children 6-23 months and find the association between sociodemographic profile and nutritional status. Materials and Methods: Mothers of 411 children of age 6-23 months in an urban area of Raipur were interviewed using a pretested questionnaire based on the WHO indicators to record their complementary feeding practices. Weight, height, and mid-upper arm circumference (MUAC) was taken to assess the nutritional status. Overall and specific (sex-wise and severity-wise) prevalence rate of stunting, wasting, and underweight were calculated. The distribution of these according to various factors like infant and young child feeding practices, and details of study subject and family were calculated. Chi-square test of significance was applied to find the association between nutritional status and independent variables and their strength of association. Results: The prevalence of wasting was 25%, underweight 30%, and stunting 15%. Statistically significant association of underweight with age of the parents, both mother and father, was observed (P < 0.05). Minimum dietary diversity was achieved by only 4.1% and minimum acceptable diet by 2.4% children. Conclusions: The prevalence of wasting and undernutrition was assessed. Complementary feeding indicators were unsatisfactory among children. Ending all forms of malnutrition is the global goal. The Sustainable Development Goals (SDGs) that directly affect or indirectly influence nutrition have to be recalled at this stage and addressing malnutrition is a key element required to achieving them.

Adverse reactions after Covid-19 vaccination in persons affected by leprosy: A scoping review.

Background: Leprosy reactions are the main pathway leading to severe nerve damage and disability. These reactions can occur at any time. The coronavirus disease 2019 (Covid-19) pandemic led to a catastrophic loss of human life and has had a devastating impact on persons affected by leprosy. Objective: To achieve deep insight into the subject of adverse reactions acquired after Covid vaccinations in persons affected by leprosy through a literature review. Materials and Methods: A scoping review was conducted in the studies published between July 2021 and June 2022 using the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) checklist. Results: Using the search strategy, a total of 130 articles were found, of which five were relevant to the study. The adverse reactions were acquired mostly in males [9 (81.8%)]; the majority of them belong to borderline tuberculoid [4 (36.4%)], and most of them were released from treatment (multi-drug therapy) [7 (63.6%)]. Conclusion: Surveillance and management of adverse events following immunization (AEFI) are essential; even minor AEFI should be reported and documented in a line list.

Undiagnosed hypertension and associated factors among adults in the urban field practice area of AIIMS Raipur: A community-based screening survey.

Introduction: Undiagnosed hypertension (HTN) increases the risk of severe consequences such as chronic kidney disease (CKD), hypertensive retinopathy, heart failure, and stroke. Population-based screening can be used to expose the hidden diseased mass with active disease. Thus, a screening survey was conducted to estimate the proportion of people with HTN among apparently healthy adults of age ≥30 years residing at the urban field practice area (UHTC) of AIIMS, Raipur, and also determine the predictors of undiagnosed HTN among the study participants. Methodology: This was a community-based cross-sectional study conducted over 2 months duration in the Ramnagar area, which comes under the urban field practice area of AIIMS Raipur using the STEPS tool is an acronym of study tool provided by WHO i.e. STEPwise approach to NCD risk factor surveillance consisting of three steps viz. questionnaire for behavioural risk factors, physical measurements and biochemical measurements. Results: In this study, 24.2% (95%, confidence interval [CI]: 20.1-28.2) of participants screened positive for HTN. The proportion of males who screened positive for HTN was 28.8% (95% CI: 22.6-35), whereas the proportion of females who screened positive for HTN was 19.6% (95% CI: 14.3-25). In this study, elderly (>60 years), male gender, daily tobacco use, greater waist circumference (male >90 cm and female >80 cm), and daily salt intake of more than 5 g were found to have higher odds of having HTN. Conclusion: The prevalence of undiagnosed HTN in the UHTC of AIIMS Raipur was quite high.

An Analysis of COVID-19 Mortality in Chhattisgarh: A Two-Year Study on Demographics, Trends, and Impacts.

Background The COVID-19 pandemic, caused by the novel coronavirus, has had a profound impact on global health, significantly affecting demographics worldwide. As India's twelfth most affected state, Chhattisgarh has experienced substantial COVID-19-related fatalities. This study aims to analyze the temporal, geographical, and demographic distribution and trends in COVID-19 mortality reported by the Department of Health and Family Welfare, Chhattisgarh, spanning from the onset of the pandemic until March 2022 (two years). Methods Data about all COVID-19 deaths recorded between March 2020 and March 2022 were collected from the State Surveillance Unit, Department of Health and Family Welfare, Chhattisgarh, and subsequently compiled in a Microsoft Excel sheet (Microsoft, Redmond, Washinton) for analysis. Results A comprehensive dataset of 14,038 deaths was examined during the study period. Of these, 24.5% (3446), 72.2% (10141), and 3.3% (451) occurred in 2020, 2021, and 2022, respectively. The top five districts in Chhattisgarh with the highest COVID-19 mortality rates were identified as follows: 1) Raipur (23.5%), 2) Durg (13.4%), 3) Bilaspur (8.9%), 4) Raigarh (7.05%), and 5) Janjgir Champa (6.25%). The mean age of the deceased individuals was determined to be 55.44 years, with a standard deviation of 15.14 years. Furthermore, the impact of the pandemic was found to affect males compared to females in Chhattisgarh disproportionately. Conclusion Over the two-year study period, three distinct waves of COVID-19 were observed, with the second wave being the most devastating, particularly for the elderly population. Understanding the demographic characteristics and trends in COVID-19 mortality is crucial for implementing targeted public health measures and interventions to mitigate the impact of future infectious disease outbreaks.

Profile and predictors of babies admitted to SNCUs of two tribal districts of Chhattisgarh.

Background: The neonatal period is the crucial and vulnerable period of the human life cycle. Various research has been conducted worldwide that provide the baseline data on clinical profiles and predictors of outcomes of babies admitted to sick newborn care units (SNCUs). Nonetheless, studies on tribal areas and community outreach areas are rare. In the present study, predictors and profiles of patients admitted to SNCU, in the Dantewada and Bijapur districts of Chhattisgarh, India, were evaluated which shall help prioritize patient care and preventive approaches. Methods: This retrospective study was undertaken from January 2019 to December 2020 in the SNCUs of Dantewada and Bijapur. Neonatal and maternal characteristics, course during labor, treatment given to the neonates, and outcome data were obtained and analysed. Results: In total, 1,531 neonates were enrolled in the study. Mothers had a mean age of 25.6 years (standard deviation [SD] ±4.9) with birth spacing less than 2 years (60.3%) and antenatal care (ANC) visits less than 4 (50.4%). Neonates were low birth weight (43.75%) and were home-delivered (15.8%). One hundred forty-nine neonates died. In the multivariate regression model, extremely low birth weight babies, less than 1 kg (odds ratio [OR]: 11.59 confidence interval [CI] 4.625-31.58), gestational age less than 34 weeks (OR: 2.13 CI 1.291-3.532), central cyanosis (OR: 10.40 CI: 3.269-32.35), duration of IV fluid > 3 days (OR: 2.16 CI 0.793-0.880), duration of antibiotic >3 days (OR 0.63 CI 0.408-0.979) were found to be independent predictors of mortality among neonates. Conclusion: The prevalence of newborns aged less than 12 h is higher among the study population. Birth asphyxia, prematurity, neonatal jaundice, and sepsis were fundamental and leading causes of morbidity. Preterm birth and low birth weight babies had significantly high mortality. The government needs to focus on marginalized communities with target-based interventions and policies.

Awareness About Folic Acid Supplementation in First-Trimester Pregnant Women of Rural Raipur District, Chhattisgarh, and Its Determinants: A Cross-Sectional Study.

BACKGROUND: Women are supplemented with folic acid (FA) during pregnancy as well as preconceptionally to prevent neural tube defects (NTDs) in newborns. To understand the importance of FA supplementation, women need to have awareness about the same, which in turn may be influenced by different factors. It is also known that both FA and vitamin B12 deficiency tend to cause NTDs in newborns and anemia. Very few studies have studied the relationship between hemoglobin, FA, and vitamin B12 levels. In this study, we aim to estimate the level of awareness of FA supplementation among pregnant women in the first trimester of pregnancy and the factors determining the presence of awareness regarding the same. Also, we aim to estimate any correlation between hemoglobin, FA, and vitamin B12 levels among a subset of pregnant women. METHODS: A cross-sectional study was conducted in the Abhanpur Block of Raipur district in Chhattisgarh among 399 pregnant women in their first trimester of pregnancy, in which their knowledge was assessed using a pretested semistructured questionnaire. Each participant's knowledge score regarding FA supplementation was calculated and scored based on six indicators and classified as low, intermediate, and high scores. Logistic regression was applied to find out any significant association between knowledge about FA supplementation with any other sociodemographic variables. Scatter plots were used to assess the correlation of FA with hemoglobin, vitamin B12, and knowledge scores among 104 participants. RESULTS: The majority (77.9%) of women had low knowledge scores with a mean score of 1.4 (0.15). It was found that only 45.6% of the participants knew the importance of FA supplementation, and the majority (23.1%) were informed by auxiliary nurse midwives (ANMs) followed by doctors. The majority (41.6%) of the study participants also did not know when to start FA, and only 1.3% knew that FA should be taken preconceptionally. On multivariable logistic regression, women who lived in joint families had significantly higher odds of having intermediate knowledge compared to those who lived in nuclear families. Although not statistically significant, there was a positive correlation between serum vitamin B12 and FA levels and also between hemoglobin and serum FA levels. However, a significant positive correlation was found between serum FA levels and the knowledge scores of the study participants. CONCLUSION: The majority of study participants had poor knowledge and awareness regarding FA supplementation. So, health education, as well as information, education, and communication (IEC) activities, is required to improve the knowledge about FA supplementation among women of reproductive age in the community. A better understanding of FA supplementation can lead to adherence to FA consumption and prevent NTDs among newborns.

Predictors of Mortality among Patients Hospitalized with COVID-19 during the First Wave in India: A Multisite Case-Control Study.

Severe acute respiratory syndrome coronavirus 2 disease (COVID-19) has caused more than 6 million deaths globally. Understanding predictors of mortality will help in prioritizing patient care and preventive approaches. This was a multicentric, unmatched, hospital-based case-control study conducted in nine teaching hospitals in India. Cases were microbiologically confirmed COVID-19 patients who died in the hospital during the period of study and controls were microbiologically confirmed COVID-19 patients who were discharged from the same hospital after recovery. Cases were recruited sequentially from March 2020 until December-March 2021. All information regarding cases and controls was extracted retrospectively from the medical records of patients by trained physicians. Univariable and multivariable logistic regression was done to assess the association between various predictor variables and deaths due to COVID-19. A total of 2,431 patients (1,137 cases and 1,294 controls) were included in the study. The mean age of patients was 52.8 years (SD: 16.5 years), and 32.1% were females. Breathlessness was the most common symptom at the time of admission (53.2%). Increasing age (adjusted odds ratio [aOR]: 46-59 years, 3.4 [95% CI: 1.5-7.7]; 60-74 years, 4.1 [95% CI: 1.7-9.5]; and ≥ 75 years, 11.0 [95% CI: 4.0-30.6]); preexisting diabetes mellitus (aOR: 1.9 [95% CI: 1.2-2.9]); malignancy (aOR: 3.1 [95% CI: 1.3-7.8]); pulmonary tuberculosis (aOR: 3.3 [95% CI: 1.2-8.8]); breathlessness at the time of admission (aOR: 2.2 [95% CI: 1.4-3.5]); high quick Sequential Organ Failure Assessment score at the time of admission (aOR: 5.6 [95% CI: 2.7-11.4]); and oxygen saturation < 94% at the time of admission (aOR: 2.5 [95% CI: 1.6-3.9]) were associated with mortality due to COVID-19. These results can be used to prioritize patients who are at increased risk of death and to rationalize therapy to reduce mortality due to COVID-19.

Situational Analysis of Water, Sanitation, and Hygiene in Health-care Facilities of a District in Central India.

Background: Water, sanitation, and hygiene (WASH) in health-care facilities is fundamental for providing quality, people-centered care and critical to achieving quality and accessible health services. This study aimed to assess the status of the WASH infrastructure in health-care facilities of Raipur district, Chhattisgarh, India. Methodology: This was a hospital-based cross-sectional study carried out in all public health-care facilities of Abhanpur block, Raipur district, Chhattisgarh, India, between 2019 and 2020 using an adapted version of joint monitoring program's (JMP) core questions, indicators, and service ladder framework. Results: A total of 2 community health centers (CHCs), 7 primary health centers (PHCs), and 34 subhealth centers (SHCs) were included in the present study. All CHCs (100%) had essential water, sanitation, hygiene, and waste management services. Among PHCs, 85.7% had water from improved and hygienic sources, only 57.1% had basic sanitation, and 100% had vital essential waste management services. Among SHCs, 55.9% had essential water, 2.9% had basic sanitation, 20.6% had basic hygiene, and 35.3% had necessary waste management services. Overall, it was found that 62.8% of health-care facilities had necessary water services, 16.3% had basic sanitation services, 34.9% had essential hygiene services, and 48.8% had basic waste management services. Conclusion: The status of WASH infrastructure in health-care facilities of Raipur district is either limited or not available, especially concerning sanitation services, hygiene, and waste management services. It is the need of the hour to ensure a coordinated response that in all health-care facilities, WASH services are made available and accessible.

An Assessment of the Profile and Predictors of Outcomes in COVID-19 Patients Hospitalized in a Tertiary Care Institute in Central India.

Background Coronavirus disease 2019 (COVID-19) is the largest pandemic that has affected people around the globe. Various researches have been conducted worldwide, but there is a scarcity of data from Central India on the relationship between several risk factors for infection and mortality. Our study assessed the predictors and patient profiles of those with COVID-19, which will aid in prioritizing patient treatment and preventive measures. Methods A retrospective study was done between March and December 2020. The study included 5,552 COVID-19 patients admitted to the All India Institute of Medical Sciences (AIIMS), Raipur. A validated questionnaire form provided by the WHO was used. Data for multiple clinical and nonclinical parameters were collected, and analysis was done using SPSS version 26 (IBM Corp., Armonk, NY, USA) and STATA version 12 (StataCorp LLC, College Station, TX, USA). Mortality and risk assessment of patients was done using multivariate logistic regression. Result In our study cohort of 5,552 COVID-19 patients, the median age was found to be 47 years (interquartile range (IQR): 31-60 years; range: 14-100 years), and 3,557 (64%) were male. Predominantly, patients presented with fever (41.30%), cough (40.20%), and dyspnea (29.29%). The major comorbidities were hypertension (29.70%), diabetes (25.40%), and chronic cardiac disease (5.79%). The common complications were liver dysfunction (26.83%), viral pneumonitis (23.66%), acute renal injury (15.25%), and acute respiratory distress syndrome (ARDS) (13.41%). In multivariate analysis, age (more than 40 years) (odds ratio (OR): 2.63; 95% confidence interval (CI): 1.531-4.512; p<0.001), diabetes (OR: 1.61; 95% CI: 1.088-2.399; p=0.017), obesity (OR: 6.88; 95% CI: 2.188-12.153; p=0.004), leukocytosis (OR: 1.74; 95% CI: 1.422-2.422; p<0.001), lymphocytopenia (OR: 2.54, 95% CI: 1.718-3.826; p<0.001), thrombocytopenia (OR: 1.15; 95% CI: 1.777-8.700; p=0.001), and ferritin concentration > 1,000 ng/mL (OR: 4.67; 95% CI: 1.991-10.975; p<0.001) were the independent predictors of mortality among COVID-19 patients. Conclusion The leading comorbidities in our study were hypertension, followed by diabetes. Patients who were 40 years or older, obese patients, and diabetic patients have a higher mortality risk. The poor prognostic predictors in COVID-19 patients were high ferritin levels (>1,000 ng/mL), leukocytosis, lymphocytopenia, and thrombocytopenia.

"Vaccinate every child against COVID-19": A scientific or socioeconomic need?

The global pandemic of COVID-19 has created havoc worldwide. By the first week of December 2021, 0.26 billion COVID-19 infected cases and 5.2 million deaths have been reported globally.[1] United Nations Children Fund (UNICEF) reports that more than 10,000 children and adolescents have died from COVID-19, with a case fatality rate of 0.3%. Out of 299 vaccine candidates, 28 are available to the general population in less than 1 year.[2] For children, WHO permitted vaccine Pfizer/BioNTech, Sinovac, and Sinopharm, Drug Controller General of India's approved ZyCov-D and Covaxin, and the Cuban government approved Soberna 2, and Soberna plus are available.[3] Italy, Germany, France, Norway, Switzerland, Israel, Dubai, Japan, Canada, and the US have already started vaccinating their children. This step may decrease the transmissibility and mutations of the virus and thus restore normalcy. For India, it is a question of "To be or not to be?" Indian researchers have warned of the long-term impact of the pandemic on the health, development, learning, and behavior of children, thus pushing the agenda of vaccination and opening of schools. All attempts at opening schools have failed in the last 2 years. Vaccinating children is not easy as it has taken nearly 1 year to vaccinate half of the adult Indian population. In these circumstances, rather than "vaccine for all," "vaccine for (chronically) ill" is the only feasible solution for children.

Experience, Challenges and Outcome of Implementing Universal New Born Hearing Screening in a Medical College Hospital Set Up.

In India, newborn hearing screening programs have been implemented as a part of research studies since early 1970s. Amongst the previously reported programs most are from the southern region and very few are from the west and the northern region of the country. There is a lack of evidence of such program in other region of the country. 1. To study the outcome, experience, and challenges faced during the implementation of the universal newborn hearing screening program in a medical college set up of Raipur, Chhattisgarh. 2. To determine the prevalence of hearing impairment with a two tier screening protocol with Otoacoustic emission and Auditory Brainstem Response. The Prospective Non randomised study was carried out between December 2017 and December 2019. A total of 1200 neonates delivered at the medical college, Raipur were screened using the two tier screening protocol. In our study, the prevalence of hearing loss was 2 per 1000 live births for bilateral hearing loss and 1 per 1000 live births for unilateral hearing loss. Implementing universal newborn screening in a vast country like India is a challenging task because of a high birth rate, diverse socio-economic and cultural background with limited resources. Though several hospitals and clinics have implemented the UNHS program, yet there is a dearth of literature regarding the program outcome, success, challenges, and lessons learnt. Therefore best practices of such evolved programs should be in public domain.

COVID-19 mental health challenges: A scoping review.

The COVID-19 pandemic has disordered the lives of millions in an unprecedented way. A state of mental health crisis has emerged across the globe. The lifestyle and well-being of the individual and social integrity have been adversely affected. One-third of US citizens and one in five Indian citizens suffer from depression due to this pandemic. This scoping review aimed to estimate the mental health challenges and their possible solutions in the recent two years (2020-2021). Our search strategy used search engines such as Medline, Google Scholar and PubMed. The search strategy used the MeSH keywords "Mental Health AND Covid-19". The findings emerged in the following key points: anxiety and depression, social isolation and quarantine, and vulnerable or high-risk groups. Out of 216 articles screened, 20 were found eligible to meet the inclusion criteria. Most of the studies focused on psychological anxiety, stress and mental disorder during the pandemic. Psychosocial assessment and monitoring in the context of COVID-19 should include inquiries about stressors related to COVID-19, like exposure to infected sources, infected family members, loss of loved ones, physical distance; secondary adverse events like economic loss, psychosocial effects like depression, anxiety, psychosomatic preoccupations, insomnia, increased substance use, domestic violence; and indicators of vulnerability like pre-existing physical or psychological conditions.

Assessment of the Impact of COVID-19 on Drug Store Management in a Tertiary Care Teaching Hospital of Central India.

INTRODUCTION: One-third of the annual hospital budget is spent on the purchase of medicines, materials, and supplies. Drug store management is a complex but critical process within the healthcare delivery system. Health supply chains, the import of active pharmaceutical ingredients, transportation, procurement, finished products have been disrupted by COVID-19. MATERIALS & METHODS: A retrospective, observational study was carried out at the Department of Hospital Administration, All India Institute of Medical Sciences (AIIMS), Raipur. Quantitative data about the pattern of consumption of 20 most commonly used drugs (10 antibiotics, three analgesics, three antipyretics, two anticoagulants, and two steroids), and 20 most frequently used consumables were sourced from existing records of the Central Pharmacy for 24 months between 1st January 2019 to 31st December 2020. RESULTS: A significant rise in the consumption pattern was seen in 25 drugs and consumables out of 40 total selected drugs and consumables. The maximum increase was observed in antibiotics followed by antipyretics, and the least increase was observed in analgesics followed by anticoagulants. Tablet Azithromycin 500 mg was the most frequently used antibiotic during the COVID-19 Period as compared to the Pre-COVID-19 period followed by injection Piperacillin + Tazobactam. The only antibiotic having a decline in consumption and also with the lowest consumption was tablet Metronidazole 400 mg. The highest increase in consumables occurs by 10088% in N95 Masks, followed by 573% in shoe covers, and 153% in face masks (three-layers), respectively. CONCLUSION: This study will enhance education to the pharmaceutical industries, policymakers to the Government, and other hospitals on how to better manage drug stores in future pandemic-like situations. Proper drug store management played a crucial role in medication usage that improved patient outcomes and prevented the misuse of medications. The pattern of changes in the consumption of drugs and consumables in the present study can be utilized by other hospitals in the third wave of the pandemic.

Preparedness of primary and secondary health facilities in India to address major noncommunicable diseases: results of a National Noncommunicable Disease Monitoring Survey (NNMS).

BACKGROUND: The monitoring framework for evaluating health system response to noncommunicable diseases (NCDs) include indicators to assess availability of affordable basic technologies and essential medicines to treat them in both public and private primary care facilities. The Government of India launched the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) in 2010 to strengthen health systems. We assessed availability of trained human resources, essential medicines and technologies for diabetes, cardiovascular and chronic respiratory diseases as one of the components of the National Noncommunicable Disease Monitoring Survey (NNMS - 2017-18). METHODS: NNMS was a cross-sectional survey. Health facility survey component covered three public [Primary health centre (PHC), Community health centre (CHC) and District hospital (DH)] and one private primary in each of the 600 primary sampling units (PSUs) selected by stratified multistage random sampling to be nationally representative. Survey teams interviewed medical officers, laboratory technicians, and pharmacists using an adapted World Health Organization (WHO) - Service Availability and Readiness Assessment (SARA) tool on handhelds with Open Data Kit (ODK) technology. List of essential medicines and technology was according to WHO - Package of Essential Medicines and Technologies for NCDs (PEN) and NPCDCS guidelines for primary and secondary facilities, respectively. Availability was defined as reported to be generally available within facility premises. RESULTS: Total of 537 public and 512 private primary facilities, 386 CHCs and 334 DHs across India were covered. NPCDCS was being implemented in 72.8% of CHCs and 86.8% of DHs. All essential technologies and medicines available to manage three NCDs in primary care varied between 1.1% (95% CI; 0.3-3.3) in rural public to 9.0% (95% CI; 6.2-13.0) in urban private facilities. In NPCDCS implementing districts, 0.4% of CHCs and 14.5% of the DHs were fully equipped. DHs were well staffed, CHCs had deficits in physiotherapist and specialist positions, whereas PHCs reported shortage of nurse-midwives and health assistants. Training under NPCDCS was uniformly poor across all facilities. CONCLUSION: Both private and public primary care facilities and public secondary facilities are currently not adequately prepared to comprehensively address the burden of NCDs in India.

Baseline risk factor prevalence among adolescents aged 15-17 years old: findings from National Non-communicable Disease Monitoring Survey (NNMS) of India.

OBJECTIVE: To generate national estimates of key non-communicable disease (NCD) risk factors for adolescents (15-17 years) identified in the National NCD Monitoring Framework and, study the knowledge, attitudes and practices towards NCD risk behaviours among school-going adolescents. DESIGN AND SETTING: A community-based, national, cross-sectional survey conducted during 2017-2018. The survey was coordinated by the Indian Council of Medical Research-National Centre for Disease Informatics and Research with 10 reputed implementing research institutes/organisations across India in urban and rural areas. PARTICIPANTS: A multistage sampling design was adopted covering ages between 15 and 69 years-adolescents (15-17 years) and adults (18-69 years). The sample included 12 000 households drawn from 600 primary sampling units. All available adolescents (15-17 years) from the selected households were included in the survey. MAIN OUTCOME MEASURES: Key NCD risk factors for adolescents (15-17 years)-current tobacco and alcohol use, dietary behaviours, insufficient physical activity, overweight and obesity. RESULTS: Overall, 1402 households and 1531 adolescents completed the survey. Prevalence of current daily use of tobacco was 3.1% (95% CI: 2.0% to 4.7%), 25.2% (95% CI: 22.2% to 28.5%) adolescents showed insufficient levels of physical activity, 6.2% (95% CI: 4.9% to 7.9%) were overweight and 1.8% (95% CI: 1.0% to 2.9%) were obese. Two-thirds reported being imparted health education on NCD risk factors in their schools/colleges. CONCLUSION: The survey provides baseline data on NCD-related key risk factors among 15-17 years in India. These national-level data fill information gaps for this age group and help assess India's progress towards NCD targets set for 2025 comprehensively. Though the prevalence of select risk factors is much lower than in many developed countries, this study offers national evidence for revisiting and framing appropriate policies, strategies for prevention and control of NCDs in younger age groups.

National noncommunicable disease monitoring survey (NNMS) in India: Estimating risk factor prevalence in adult population.

BACKGROUND: The primary objective of National NCD monitoring survey (NNMS) was to generate national-level estimates of key NCD indicators identified in the national NCD monitoring framework. This paper describes survey study protocol and prevalence of risk factors among adults (18-69 years). MATERIALS AND METHODS: NNMS was a national level cross-sectional survey conducted during 2017-18. The estimated sample size was 12,000 households from 600 primary sampling units. One adult (18-69 years) per household was selected using the World Health Organization-KISH grid. The study tools were adapted from WHO-STEPwise approach to NCD risk factor surveillance, IDSP-NCD risk factor survey and WHO-Global adult tobacco survey. Total of 8/10 indicators of adult NCD risk factors according to national NCD disease monitoring framework was studied. This survey for the first time estimated dietary intake of salt intake of population at a national level from spot urine samples. RESULTS: Total of 11139 households and 10659 adults completed the survey. Prevalence of tobacco and alcohol use was 32.8% (95% CI: 30.8-35.0) and 15.9% (95% CI: 14.2-17.7) respectively. More than one-third adults were physically inactive [41.3% (95% CI: 39.4-43.3)], majority [98.4% (95% CI: 97.8-98.8)] consumed less than 5 servings of fruits and / or vegetables per day and mean salt intake was 8 g/day (95% CI: 7.8-8.2). Proportion with raised blood pressure and raised blood glucose were 28.5% (95% CI: 27.0-30.1) and 9.3% (95% CI: 8.3-10.5) respectively. 12.8% (95% CI: 11.2-14.5) of adults (40-69 years) had ten-year CVD risk of ≥30% or with existing CVD. CONCLUSION: NNMS was the first comprehensive national survey providing relevant data to assess India's progress towards targets in National NCD monitoring framework and NCD Action Plan. Established methodology and findings from survey would contribute to plan future state-based surveys and also frame policies for prevention and control of NCDs.

Chronic kidney diseases: A realm for preventive nephrology.

Chronic Kidney Disease (CKD) is emerging as a major public health priority worldwide. It is a chronic condition influenced by lifestyle and behavior. The risk factors for CKD are highly prevalent among the Indian population, and the number of Indians at risk is increasing. Preventive measures focusing on reducing the prevalence of CKD by limiting exposure to risk factors could be cost effective in a country like India. Kidney diseases disproportionally affect disadvantaged populations and reduce the number of productive years of life. Furthermore, the prospect of financial burden discourages many patients from undergoing treatment, thereby leading to preventable morbidity and death. The management of patients with CKD is focused on early detection or prevention, treatment of the underlying cause (if possible) to curb progression and attention to secondary processes that contribute to ongoing nephron loss. Blood pressure control, inhibition of the renin-angiotensin system and disease-specific interventions are the cornerstones of therapy. Health literacy and self-management are critical to improving the outcomes of chronic conditions such as chronic kidney disease. Primary Care and Family physicians act as a bridge between the nephrologist specialist and the CKD patients; which will help in improving the quality of life, reduce physical and psychologic limitations and complications associated with CRF, and help patients return to their families, jobs, and social lives.