A systematic review of excess all-cause mortality estimation studies in India during COVID-19 pandemic.

Background: Mortality statistics are fundamental to understand the magnitude of the COVID-19 pandemic. Due to limitation of real-time data availability, researchers had used mathematical models to estimate excess mortality globally during COVID-19 pandemic. As they demonstrated variations in scope, assumptions, estimations, and magnitude of the pandemic, and hence raised a controversy all over the world. This paper aims to review the mathematical models and their estimates of mortality due to COVID-19 in the Indian context. Methods: The PRISMA and SWiM guidelines were followed to the best possible extent. A two-step search strategy was used to identify studies that estimated excess deaths from January 2020 to December 2021 on Medline, Google Scholar, MedRxiv and BioRxiv available until 0100 h, 16 May 2022 (IST). We selected 13 studies based on a predefined criteria and extracted data on a standardised, pre-piloted form by two investigators, independently. Any discordance was resolved through consensus with a senior investigator. Estimated excess mortality was analysed using statistical software and depicted using appropriate graphs. Results: Significant variations in scope, population, data sources, time period, and modelling strategies existed across studies along with a high risk of bias. Most of the models were based on Poisson regression. Predicted excess mortality by various models ranged from 1.1 to 9.5 million. Conclusion: The review presents a summary of all the estimates of excess deaths and is important to understand the different strategies used for estimation, and it highlights the importance of data availability, assumptions, and estimates.

Mid-level health providers (MLHPs) in delivering and improving access to primary health care services - a narrative review.

Background: For primary healthcare systems to bring care closer to the communities, the availability of appropriate human resources is crucial. The primary care workforce in the world is expanding to include non-physician health workers (NPHWs) to increase its capacity. Also, NPHWs as mid-level health providers (MLHPs) are currently being employed in high- and low-income countries to assist doctors and specialists to make up for the scarcity of health professionals. Given the wide prevalence in the deployment of NPHWs as mid-level health providers, this article collates recent evidence on the role of MLHPs in improving access to primary healthcare services, and their enablers and barriers in integrating them in primary care teams. The article also presents gaps in evidence and recommendations for the way forward. Methods: A systematic search of contemporary literature published from January 2012 to September 2022 was undertaken using two bibliographic databases (PubMed and Cochrane) and hand searching the reference list of retrieved papers. Duplicates, papers older than ten years, and whose focus was not on primary healthcare were excluded. The papers finalised for appraisal were scrutinised for key themes and their summaries were collated for analysis. The papers comprised of twenty-four quantitative, twenty-three qualitative, and nine mixed approach study designs (n = 56) due to which a narrative approach was conducted as per guidelines. Results: The review identified and presents the following themes - task shifting and its effectiveness in service delivery, quality of care, enablers and barriers of NPHWs in primary health care in both HIC and LMIC settings. Conclusion: Task-shifting interventions need effective engagement and constant coordination with relevant stakeholders. For this, policymakers, public health researchers, healthcare professionals of all cadres and community members need to be involved across all stages of introduction and absorption of the cadre into the primary healthcare delivery system.

Effect on essential health services during COVID-19 at the Primary level in India.

Background: Coronavirus diesease (COVID-19) led to increased demand on the Indian health system due to the pandemic as well as other communicable and non-communicable diseases. Guidance was thus issued by the Ministry of Health and Family Welfare (MoHFW), India, in April 2020 to maintain the delivery of essential health services. Objectives: To determine the extent of disruptions of essential healthcare services, identify associated factors, and establish pertinent correlations to address specific needs. Methods: The Mother and child tracking facilitation centre (MCTFC) conducted a telephonic survey with the front-line workers (FLWs) and beneficiaries in 21 Indian states. The sample size was determined using the infinite population sample size formula, and respondents were selected through a computer-generated random sequence technique. Data were quantitatively analysed using STATA-16. Descriptive univariate analysis was conducted using the Chi-square test. Findings: The majority of the essential health services were being satisfactorily delivered by FLWs (N = 1596; accredited social health activist (ASHA) = 798, auxiliary nurse midwife (ANM) = 798), where most of the beneficiaries (N = 1410; Pregnant Women = 708, Postnatal Women = 702) continued accessing services with minor issues concerning referral transport. FLWs reported issues in the provisioning of medicines (P = 0.000) for patients with non-communicable diseases and more ANMs than ASHAs reported it. FLWs commonly experienced challenges in extending services due to community resistance and unavailability of general health services at healthcare facilities, where a greater number of ASHAs faced it (P = 0.000). Both FLWs and beneficiaries (N = 3006; FLWs = 1596, beneficiaries = 1410) demonstrated appropriate COVID-19 knowledge and behavior. Conclusion: Although overwhelmed, the Indian health system performed satisfactorily well during pandemic in terms of essential health services.

Adding health to years: A review of the National Programme for Health Care of the Elderly (NPHCE) in India.

The global share of elderly persons (60 years and above) is expected to rise from 13.4% in 2020 to 21.3% by 2050. In India, the elderly population accounts for 8.6% of the total population. A large share of responsibility on ensuring the health and well-being befalls on the government. Driven by the vision of healthy ageing, the National Programme for the Health Care of Elderly (NPHCE) was launched in 2011 by the Ministry of Health and Family Welfare. Yet, its effective implementation is challenged by the changing landscapes and epidemiological transitions. This review article explores the progress of elderly care with NPHCE, with a special focus on its implementation status, service delivery, and human resources to provide future directions for the program. It primarily uses the Common Review Mission Reports (2007-2019), archival sources from government websites, and relevant literature from PubMed, MEDLINE, and Google Scholar to provide an informed perspective of elderly care in India. We conclude that NPHCE requires strengthening through collaborative action between the relevant stakeholders. Strong implementation of appropriate policies and programs to address health care challenges of the ageing population is of crucial importance for India to achieve the health care needs of its elderly. As the elderly population is set to grow dramatically in the next few decades, this review article reveals areas needing urgent attention to strengthen elderly care through NPHCE in India.

Home-based newborn care (HBNC) under the national health mission in urban India - A cross country secondary analysis.

Background: There is a paucity of evidence in the coverage of the home-based newborn care (HBNC) program delivered through the National Urban Health Mission (NUHM). Hence, an analysis was undertaken to identify gaps and progress in its implementation and inform policy and strategies to achieve universal access to newborn services. Objectives: The study aimed to evaluate and understand the status of the HBNC program in urban areas of India through a health systems approach. Methods: Cross-sectional intra-country study was undertaken based on facility records and supporting literature available in the public domain. After categorizing the states into four groups, the programme's status in urban areas was analysed and presented in median and interquartile ranges. Statistical significance in the difference between the medians across the groups was checked using the Kruskal Wallis test. Results: Overall, the median full HBNC coverage was less than one-fifth (< 20%) of the total reported live births (P = 0.17). Excepting the union territories (UTs), the median coverage was found to be less than one-fifth (< 20%) of the reported institutional deliveries (P = 0.16) and more than half (> 50%) of the reported home deliveries (P = 0.83) in urban areas. The differences in the medians across the groups were not statistically significant. Conclusion: The differential coverage calls for strengthening referral linkages to specialized newborn care facilities, ensuring skilled personnel at varying levels of facilities, and improving the engagement of frontline workers in urban communities under the NUHM.

A rapid review of evidence on the determinants of and strategies for COVID-19 vaccine acceptance in low- and middle-income countries.

BACKGROUND: Vaccine acceptance and hesitancy among the general population and health care workers play an important role in successfully controlling the Coronavirus Disease (COVID)-19 pandemic. While there is evidence for vaccine hesitancy across the globe, wide variation in factors influencing vaccine acceptance has been reported, mainly from High-Income Countries (HIC). However, the evidence from Low- and Middle-Income Countries (LMICs) remains unclear. The objective of this review was to describe the determinants of vaccine acceptance and strategies to address those in an LMIC context. METHODS: The World Health Organization's (WHO) Measuring Behavioral and Social Drivers of Vaccination (BeSD) Increasing Vaccination Model was employed to identify factors that influenced vaccine acceptance. All evidence related to supply-side and demand-side determinants and social and health system processes were examined. A comprehensive search for published literature was conducted in three databases and grey literature in relevant websites of government, multinational agencies, and COVID-19 resource aggregators, followed by a narrative synthesis. RESULTS: Overall, the results showed that the vaccine acceptance rates differed across LMICs, with a wide variety of reasons cited for vaccine hesitancy. Vaccine acceptance was reportedly greater among males, those with higher education, elevated socio-economic status, the unmarried, those employed as health care workers. Evidence suggested that exposure to misinformation about COVID-19 vaccines and public concerns over the safety of vaccines may contribute to lower acceptance rates. Strategies to increase vaccine acceptance rates included direct engagement with communities through influencers, including community leaders and health experts; clear and transparent communication about COVID-19 vaccines, financial and non-financial incentives; and strong endorsement from health care workers. Trust in government was identified as a significant enabler of vaccine acceptance. CONCLUSIONS: There is a need for measures to address public acceptability, trust and concern over the safety and benefit of approved vaccines. Local context is essential to consider while developing programs to promote vaccine uptake. The governments worldwide also need to strategize to develop plans to address the anxiety and vaccine related concerns of community regarding vaccine hesitancy. There is a need for further research to evaluate strategies to address vaccine hesitancy in LMIC.

Factors Affecting Quality of Life among Post-Stroke Patients in the Sub-Himalayan Region.

Background Stroke is one of the most debilitating conditions contributing to significant disability and death globally. Identifying risk factors for quality of life (QoL) will enable to improve home-based rehabilitation in post-stroke phase. Objective This study was aimed to identify the risk factors of QoL in stroke patients in the sub-Himalayan region. Materials and Methods A cross-sectional hospital-based study assessed the QoL among stroke patients within a week after the onset of acute stroke and then re-evaluated at 3 months. World Health Organization QoL-BREF, Beck Depression Inventory, the Barthel Index, and Montreal Cognitive Assessment (MOCA) were used to seek data on QoL, depression, cognitive, and functional dependence status, respectively. Appropriate statistics were used to compute the results. Results In total, 129 stroke patients recruited, out of which 102 returned to a 3-month follow-up. QoL, MOCA, disability index, and depression score were compared using Wilcoxon Singed-rank test. In multivariate analysis, depression and disability together predicted 60% of the variance for physical QoL ( p < 0.0001). Similarly, poststroke depression and disability together predicted 61% of the variance for psychological QoL ( p < 0.0001) in stroke patients. Conclusion Findings indicated that depression and disability are leading risk factors of QoL in stroke patients. Early identification of poststroke depression and functional dependence status is, therefore, essential to devise screening procedure and to develop targeted intervention to improve rehabilitation outcomes.

Host plant nodule parameters associated with nitrogen fixation efficiency in French bean (Phaseolus vulgaris L) cultivars.

Two cultivars of French bean (Phaseolus vulgaris L.) viz. contender and arka komal were planted in polythene bags containing sand and grown under glasshouse conditions. The nodulation status, shoot/root biomass, activities of several nodule enzymes, total soluble protein and leghaemoglobin contents were monitored over the entire growth period. Allantoinase activity in leaves was measured to monitor the ureide degrading capacity. Significant genotype difference was observed in both the cultivars. All the parameters showed a decline after flowering except uricase, which declined before flowering. Malate dehydrogenase and isocitrate dehydrogenase showed a constant decline throughout the growth period. Degree of decline varied with the genotype for all the parameters. Leghaemoglobin content, PEP carboxylase activity and ureide degrading capacity of leaves did not show an appreciable decline in contender and were significantly higher than in arka komal. These factors can be used to increase nitrogen fixation in French bean.