Hypertension in Pregnancy: A Community-Based Study.

BACKGROUND: Hypertensive disorders during pregnancy occur in women with preexisting primary or secondary chronic hypertension, and in women who develop new-onset hypertension in the second half of pregnancy. The present study was undertaken to study the prevalence and correlates of hypertension in pregnancy in a rural block of Haryana. MATERIALS AND METHODS: This cross-sectional study was carried out in the all 20 subcenters under Community Health Center (CHC) Chiri, Block Lakhanmajra. All the pregnant women registered at the particular subcenter at a point of time of visit were included in the study. Appropriate statistical tests were used for analysis. RESULTS: A total of 931 pregnant women were included in the present study. Prevalence of hypertension in pregnancy was found to be 6.9%. Maternal age ≥25 years, gestational period ≤20 weeks, history of cesarean section, history of preterm delivery, and history of hypertension in previous pregnancy were found to be significantly associated with prevalence of hypertension in pregnancy. CONCLUSION: Nearly one in 14 pregnant women in rural areas of Haryana suffers from a hypertensive disorder of pregnancy. Early diagnosis and treatment through regular antenatal checkup is a key factor to prevent hypertensive disorders of pregnancy and its complications.

Malaria vaccine: a step toward elimination.

Malaria has long been recognized as a public health problem. At the community level, vector control, and antimalarial medicines are the main means for reducing incidence, morbidity, and mortality of malaria. A vaccine not only would bring streamlining in the prevention of morbidity and mortality from malaria but also would be more accessible if integrated with Expanded Programme of Immunization (EPI). Globally, an estimated 3.4 billion people are at risk of malaria. Most cases (80%) and deaths (90%) occurred in Africa, and most deaths (77%) are in children under 5 years of age. An effective vaccine has long been envisaged as a valuable addition to the available tools for malaria control. Although research toward the development of malaria vaccines has been pursued since the 1960s, there are no licensed malaria vaccines. The RTS,S/AS01 vaccine, which targets P. falciparum, has reached phase 3 clinical trials and results are promising. Malaria Vaccine Technology Road Map 2013 has envisaged the world aiming for a licensed vaccine by 2030 that would reduce malaria cases by 75% and be capable of eliminating malaria. It will not only fill the gaps of today's interventions but also be a cost-effective method of decreasing morbidity and mortality from malaria.

Human papillomavirus vaccine: a boon or curse.

Cervical cancer is the second most common cancer among women worldwide, with about 493,000 new cases diagnosed annually. Of 274,000 deaths due to cervical cancer each year, more than 80% occur in developing countries, and this proportion is expected to increase to 90% by 2020. Up to 70% of sexually active women will become infected with human papilloma virus (HPV) during their lifetime. Even though screening reduces the risk of cervical cancer, it does not prevent HPV infection or development of precancerous lesions which need careful follow-up and often need excision. It was observed in a study, pre-adolescent vaccination alone reduced cancer incidence by 44% and was more effective than screening alone. A combined approach of pre-adolescent vaccination and screening of adult women was more effective than either alone. The high probability of acquiring HPV infection once, one has become sexually active raises the question of whether the vaccine will be effective if given to girls who have already been infected with HPV type 16 or 18. In April 2010, The Indian parliament's Standing Committee on Health, began probing the use of HPV vaccines in 2 states after the reported deaths of 7 girls, and concluded that "safety and rights of children were highly compromised and violated." Though the question of immunization of older girls and women deserves attention, from a public health perspective, the first priority in resource-poor settings would be to vaccinate young adolescent girls.

HIV: is a vaccine the answer?

Getting to zero: zero new HIV infections, zero deaths from AIDS-related illness, zero discrimination is the theme of World AIDS Day 2012. Given the spread of the epidemic today, getting to zero may sound difficult, but significant progress is underway. The total annual loss for the entire country due to HIV is 7% of GDP, which exceeds India's annual health expenditure in 2004. The additional loss due to loss of labor income and increased medical expenditure as measured by the external transfers, account for 5% of the country's health expenditure and 0.23% of GDP. Given that the HIV incidence rate is only 0.27% in India, these losses are quite staggering. Despite the remarkable achievements in development of anti-retroviral therapies against HIV and the recent advances in new prevention technologies, the rate of new HIV infections continue to outpace efforts on HIV prevention and control. Thus, the development of a safe and effective vaccine for prevention and control of AIDS remains a global public health priority and the greatest opportunity to eventually end the AIDS pandemic.

Hepatitis C: is a vaccine the solution?

Hepatitis C Virus (HCV) infection is a major cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Following acute infection, 20% of people eliminate the virus over weeks or months and are often asymptomatic. The remaining 80% of people will develop chronic disease, of which approximately 20% will eventually develop liver cirrhosis and 1-5% will develop liver cancer. About 150 million people are chronically infected with HCV, and more than 350,000 people die every year from hepatitis C related liver diseases. The economic cost of hepatitis C is significant both to the individual and to the society. In the United States the average lifetime cost of the disease was estimated at $33,407 USD with the cost of a liver transplant approximately $200,000 USD. PEG-IFN and ribavirin treatment is also expensive and, at an average cost of approximately GB £7000 in the UK for a treatment course, is unaffordable in developing countries. Hepatitis C, not only brings down the quality of the life of individuals but also affect progress of the nation by adding financial burden. If we prevent the disease from occurring or find a perfect cure of the disease, in form of a prophylactic or therapeutic vaccine, it will be a boon to not only to the individual but to the nation as a whole.

Vaccination for safe travel to India.

Worldwide more than 900 million international journeys are undertaken every year. India is one of the favorite tourist destinations around the world. International travel exposes travelers to a range of health risks. Traveling to India possess a threat to travelers with waterborne diseases like bacterial diarrhea, hepatitis A and E, and typhoid fever; vector borne diseases like dengue fever, Japanese encephalitis, and malaria; animal contact disease like rabies. Furthermore diseases spreading through behavior aspects cannot be ruled out hence posing a risk for hepatitis B, HIV/AIDS, hepatitis C as well. Hence, before travel the travelers are advised about the risk of disease in the country or countries they plan to visit and the steps to be taken to prevent illness. Vaccination offers the possibility of avoiding a number of infectious diseases that may be countered abroad. There is no single vaccination schedule that fits all travelers. Each schedule must be individualized according to the traveler's previous immunizations, countries to be visited, type and duration of travel, and the amount of time available before departure.

Adult immunization: the need to address.

Vaccination is recommended throughout life to prevent vaccine-preventable diseases and their sequel. The primary focus of vaccination programs has historically been directed to childhood immunizations. For adults, chronic diseases have been the primary focus of preventive and medical health care, though there has been increased emphasis on preventing infectious diseases. Adult vaccination coverage, however, remains low for most of the routinely recommended vaccines. Though adults are less susceptible to fall prey to traditional infectious agents, the probability of exposure to infectious agents has increased manifold owing to globalization and increasing travel opportunities both within and across the countries. Thus, there is an urgent need to address the problem of adult immunization. The adult immunization enterprise is more complex, encompassing a wide variety of vaccines and a very diverse target population. There is no coordinated public health infrastructure to support an adult immunization program as there is for children. Moreover, there is little coordination among adult healthcare providers in terms of vaccine provision. Substantial improvement in adult vaccination is needed to reduce the health consequences of vaccine-preventable diseases among adults. Routine assessment of adult patient vaccination needs, recommendation, and offer of needed vaccines for adults should be incorporated into routine clinical care of adults.