Prevalence of depression among the elderly (60 years and above) population in India, 1997-2016: a systematic review and meta-analysis.

BACKGROUND: There is lack of information on the magnitude of depression among elderly population in India. This systematic review and meta-analysis aimed to estimate the prevalence of depression among elderly population in India. METHODS: PubMed, Scopus, Web of Science, Embase, PsycINFO, IndMed, and Google Scholar were searched to identify articles reported community-based prevalence of depression among elderly population using screening tools. This study included the articles published during the years 1997 to 2016. Studies conducted in the special population groups, hospitals, reported only a subcategory of depression, and not specified the screening tool were excluded. Data were extracted from published reports and any missing information was requested from authors. Estimates were pooled using random-effects meta-analyses. Subgroup and sensitivity analysis were performed. The publication bias was evaluated by using Egger's test and visual inspection of the symmetry in funnel plots. RESULTS: Fifty-one studies from 16 States of India were included as 56 datasets, which estimated the prevalence of depression among Indian elderly population as 34.4% (95% CI: 29.3-39.7). In sub-group analysis, the pooled prevalence was higher among females, rural populations, and in the eastern part of the country. Studies using non-probability sampling, and GDS and CES-D screening tool showed higher prevalence. Exclusion of the studies with sample size less than 100 and low-quality studies (score < 5/8) had no effect on the estimate of the prevalence. The studies that excluded dementia before assessment of depression had lower prevalence. CONCLUSION: About one third elderly population of India suffered from depression with female preponderance. The estimates varied with type of study tool, geographic region, sampling methods, and presence of dementia. The pooled estimate should be interpreted with caution as the studies included in this review had varied methodological approach and screening tools.

Factors causing early maternity discharge of uncomplicated normal delivery cases at government health facilities in Northern India: An exploratory study.

INTRODUCTION: Most of the neonatal and maternal deaths occur within the first 48 hours post-delivery. Hence, this time period is very crucial for the survival of newborns and mothers both. As per maternal and child health program guidelines in India, it is clearly mentioned that all the government health facilities should discharge the mother and baby only after 48 hours of delivery in case of normal delivery and after 7 days in case of delivery conducted by cesarean sections. AIM: The aim of the study was to find the various factors responsible for early maternity discharge (<48 h) of normal vaginal deliveries (NVDs) conducted at government health facilities. MATERIAL AND METHODS: The study was conducted in a rural block of Haryana, North India, from May to June, 2015. Postnatal women with NVD within 6 months of duration from initiation of the study were included after taking proper informed consent. A questionnaire was developed by the investigators to interview the women. The questionnaire consists of 26 items which included the socio-demographic details and questions on various factors affecting postnatal stay at the health facility. RESULTS: A total of 40 postnatal women consented and participated in the study. Their mean age was 23.46 ± 5.63 years. Majority of them (24, 60.0%) were having their first child. Out of them, 12 delivered at primary health centers (PHCs), 18 at community health centers, and the rest at the district hospital. A total of 24 (60%) of them were discharged early (<48 h) as per laid guidelines. It was observed that primiparity, delivery at PHC, normal birth weight of baby, and term deliveries were significantly associated with early discharge. Among those who had NVD and stayed beyond 48 h, most of them mentioned that the round-the-clock availability of doctors/nurses was the main reason for their staying at the health facility. CONCLUSION: The proportion of postpartum women discharged early is high and alarming. There is a need for essential counseling to be imparted to the mothers by doctors/nurses at all the health facilities for staying till 48 hours and by health workers during the antenatal period of the importance of the stay at the facility post delivery.

Estimation of the prevalence of depression using diagnostic instruments in the elderly population in India, 2000-2019: a systematic review protocol.

INTRODUCTION: Depression is a common mental disorder in the elderly population, which significantly impacts their quality of life. However, correct estimates of its magnitude are not available in the elderly in India. The present systematic review and meta-analysis would attempt to estimate the prevalence of depression using diagnostic instruments among elderly persons aged 60 years and above. METHODS AND ANALYSIS: Searches will be performed in PubMed, Scopus, Embase, Web of Science, CINAHL and PsycINFO. Community-based cross-sectional and cohort studies (2001 to September 2019) reporting the prevalence of depression in the elderly, using diagnostic instruments will be included. Studies conducted among chronic disease patients, in-hospital patients and special groups such as with disaster-stricken populations, and studies reporting the only one or two subcategories of depression, will be excluded. Disagreements in study selection and data abstraction will be resolved by consensus and arbitration by a third reviewer. AXIS critical appraisal tool will be used for quality assessment of individual studies. Findings of eligible studies will be pooled using fixed-effects or random-effects meta-analysis whichever is appropriate. Heterogeneity between studies will be examined by Cochran's Q test and quantified by I² statistic. A cumulative meta-analysis will be used to detect temporal trends in the prevalence of depression and the effect of poor-quality studies on the pooled estimate. Publication bias will be assessed by visual inspection of funnel plots and the Egger test. ETHICS AND DISSEMINATION: No ethical approval will be needed because it will be a systematic review. Data from previously published studies will be retrieved and analysed. Findings will be disseminated through a peer-reviewed publication in a scientific journal and conferences. PROSPERO REGISTRATION NUMBER: CRD42019138453.

Management of interstitial lung diseases: A consensus statement of the Indian Chest Society (ICS) and National College of Chest Physicians (NCCP).

BACKGROUND: Interstitial lung disease (ILD) is a complex and heterogeneous group of acute and chronic lung diseases of several known and unknown causes. While clinical practice guidelines (CPG) for idiopathic pulmonary fibrosis (IPF) have been recently updated, CPG for ILD other than IPF are needed. METHODS: A working group of multidisciplinary clinicians familiar with clinical management of ILD (pulmonologists, radiologist, pathologist, and rheumatologist) and three epidemiologists selected by the leaderships of Indian Chest Society and National College of Chest Physicians, India, posed questions to address the clinically relevant situation. A systematic search was performed on PubMed, Embase, and Cochrane databases. A modified GRADE approach was used to grade the evidence. The working group discussed the evidence and reached a consensus of opinions for each question following face-to-face discussions. RESULTS: Statements have been made for each specific question and the grade of evidence has been provided after performing a systematic review of literature. For most of the questions addressed, the available evidence was insufficient and of low to very low quality. The consensus of the opinions of the working group has been presented as statements for the questions and not as an evidence-based CPG for the management of ILD. CONCLUSION: This document provides the guidelines made by consensus of opinions among experts following discussion of systematic review of evidence pertaining to the specific questions for management of ILD other than IPF. It is hoped that this document will help the clinician understand the accumulated evidence and help better management of idiopathic and nonidiopathic interstitial pneumonias.

Ambiguity about Selection of Cardiovascular Risk Stratification Tools: Evidence from a North Indian Rural Population.

BACKGROUND: Several nonlaboratory based cardiovascular disease (CVD) risk scoring tools are available for resource-limited settings, but the performance of these tools remains to be established in Indian population. This study aimed to assess and compare the performance of the World Health Organization (WHO)/International Society for Hypertension (ISH) risk prediction chart and the Framingham Risk Score (FRS) calculator in an Indian setting. MATERIALS AND METHODS: This cross-sectional study was carried out among 283 participants aged 30-74 years who attended screening camps in the rural area of Punjab from October to December 2015. Nonlaboratory-based WHO/ISH risk prediction chart for South-East Asia Region and FRS calculator was used to assess the 10-year risk of cardiovascular event. Chi-square test for trend and quadratic weighted kappa were used for analysis. RESULTS: Of total participants, 67.1% were female. Mean age of the study participants was 52.1 (standard deviation ± 11.6) years. Using the WHO/ISH risk prediction chart, 11.3% and 4.9% of the participants were found to have high and very high risk, respectively, whereas, FRS calculator predicted high risk in 13.8% and very high risk in 12.0% for developing CVD in next 10 years. Agreement level between two risk prediction tools was good (67.8%). CONCLUSION: Although the good agreement was seen between WHO/ISH risk prediction chart and FRS calculator, the proportions of participants having a high and very high risk of CVD identified by these risk prediction tools are significantly different. In resource constraint setting like India, CVD risk prediction tools should be validated for local population by prospective cohort studies to ensure judicious use of resources.

Prevalence and Predictors of Depression in Community-Dwelling Elderly in Rural Haryana, India.

BACKGROUND: Depression in the elderly has been emerged as a serious public health challenge in the developing countries. Elderly population with depression is on rise in India, but is not adequately addressed. This study was planned to ascertain the prevalence of depression among elderly in a rural population of Haryana and assess its socio-demographic correlates. METHODS: This study was a community based, cross sectional study, which was conducted in Community Health Centre (CHC), Chiri of Rohtak district (Haryana, India). Of total 124 Anganwadi centres in study area, 10 were randomly selected. A total 500 elderly persons aged 60 years and above were randomly screened for depression. Long form of Geriatric Depression Scale (GDS- 30) was used with cut off score at 22. The Pearson's Chi-squared test, student's t test, and multiple logistic regression were used to assess the association of depression in the elderly with its risk factors. RESULT: In our study, the prevalence of depression in the elderly was 14.4% (95% CI: 11.6- 17.8). Mean age of study population was 68.5 ± 7.7 years. Depression in the elderly had significant association with female gender [OR=2.7 (95% CI 1.4- 5.0)], not being consulted for major decisions [OR=2.7 (95% CI 1.5- 4.7)], presence of any chronic morbidity [OR=2.4 (95% CI 1.3- 4.5)], spending day without doing any activity, work or hobby [OR=3.8 (2.1- 7.1)], and death of any close relative in the last 1 year [OR=2 (1.1- 3.7)] after adjustment of various factors. CONCLUSION: Our study revealed that the prevalence of depression in the elderly was 14.4% in a rural community of north India.

Hypertension Vaccine may be a boon to millions in developing world.

Hypertension affects around 40% adults aged 25 years and more worldwide, and accounts for 7% of total disability-adjusted life-years. A simple algorithmic program is required to manage hypertension consisting of screening, life style measures, treatment and follow-up, a reliable drug supply and distribution system, and a credible health information system. Despite availability of effective antihypertensive drugs, long term treatment is still costly, tedious, and at the population level rather unsuccessful. Hypertension leaves patients and families with an avoidable heavy economic burden due to failure to control blood pressure. Health policy needs to address gross imbalance between prevention and management by increasing contribution to the preventive programs. During 21st century, the risk factors for morbidity and mortality have been changed, and researchers have started to work upon vaccines against lifestyle diseases like hypertension, diabetes etc. Researchers began experimenting with vaccines against the renin-angiotensin system to control hypertension around six decades ago. The vaccine candidates against hypertension namely ATR12181, pHAV-4Ang IIs, CYT006-AngQb, AngI-R, ATRQß-001 have shown promising results. A candidate vaccine, CYT006-AngQb, has crossed initial phase and moved into phase 2 trials. However, more human studies in subsequent phases of trials are required to establish the safety and efficacy of anti-hypertensive vaccine. If proved safe and cost effective, a vaccine even with 50% efficacy against hypertension may protect about 90 million people from hypertension and its heavy economic burden. It can be an appropriate solution for low compliance to antihypertensive drug therapy as well as an avalanche to induce efforts on various chronic disease vaccine development programs.

Pentavalent vaccine: a major breakthrough in India's Universal Immunization Program.

Immunization is one of the most important public health interventions and a cost effective strategy to control the infectious diseases especially in children. Complete immunization coverage in India has increased from below 20% in the 1980s to nearly 61% at present, but still more than 1/3rd children remain un-immunized. Advent of combination vaccines has facilitated incorporation of additional vaccines into immunization schedule. Pentavalent vaccine, against five killer diseases-diphtheria, pertussis, tetanus, hepatitis B and Hemophilus influenza type B (Hib), has been introduced in almost all GAVI eligible countries by 2011. Government of India introduced the vaccine in two states in pilot phase and has given green signal to six more states. The use of pentavalent vaccine automatically raises the coverage level of hepatitis B and Hib vaccines. If the vaccines are provided individually, the coverage of hepatitis B and Hib vaccines usually lags behind DPT coverage. This gap can be filled by using pentavalent vaccine in routine immunization programmes.