People interested in the research are advised to contact the author for the final version of the ... more People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Link to publication General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the "Taverne" license above, please follow below link for the End User Agreement:
International Journal of Medical Science and Public Health, 2016
Background: In India, Revised National Tuberculosis (TB) control programme (RNTCP) offers free di... more Background: In India, Revised National Tuberculosis (TB) control programme (RNTCP) offers free diagnosis and treatment for TB, based on the Directly Observed Treatment Short (DOTS) course strategy. Under RNTCP, sputum conversion rate (SCR), at the end of 2 months of treatment is an important operational indicator, which is ideally expected to be 90%. Objectives: The objective of the present work was to investigate the factors associated with low SCR at the end of 2 months of treatment in Sira TB unit, Tumkur District, India. Material and Methods: It is a retrospective cohort study of all new sputum smear-positive patients registered in RNTCP in 2011. Data were retrieved from the TB register maintained at the District TB center. Chi-square and Student’s t-test were used for analysis of the study variables between patients who were sputum positive and sputum negative at the end of 2 months of treatment. Multivariate logistic regression was applied to determine the risk contributed by the variables towards non-conversion of sputum. Results: Of the 268 included patients, 66.7% patients were sputum negative. Patients aged ≥ 45 years were twice prone to be sputum positive (OR = 2.14) (P = 0.007). The odds of being sputum positive after 2 months of treatment was observed to be significantly high (OR = 7.12; 95% C.I. = 1.52–33.22; P = 0.01) for sputum grade 3+ at the time of diagnosis, respectively. Conclusion: Elderly patients with a high bacilli load should be advised and counselled well regarding adherence to treatment. Further, advice should be given on preventing spread of the disease by practising cough hygiene, as they are more infectious than other patients with less sputum-positive grade.
We comparatively assessed the performance of six simple obesity indices to identify adults with c... more We comparatively assessed the performance of six simple obesity indices to identify adults with cardiovascular disease (CVD) risk factors in a diverse and contemporary South Asian population. 8,892 participants aged 20-60 years in 2010-2011 were analyzed. Six obesity indices were examined: body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), log of the sum of triceps and subscapular skin fold thickness (LTS), and percent body fat derived from bioelectric impedance analysis (BIA). We estimated models with obesity indices specified as deciles and as continuous linear variables to predict prevalent hypertension, diabetes, and high cholesterol and report associations (prevalence ratios, PRs), discrimination (area-under-the-curve, AUCs), and calibration (index χ2). We also examined a composite unhealthy cardiovascular profile score summarizing glucose, lipids, and blood pressure. No single obesity index consistently performed statistically si...
COPD: Journal of Chronic Obstructive Pulmonary Disease, 2015
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death globally. In a... more Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death globally. In addition to the mortality associated with it, people with COPD experience significant morbidity, making this set of conditions a major public health concern. Infections caused by influenza virus are a preventable cause of morbidity and vaccination has been shown to be effective. The evidence of their benefit in persons with COPD mainly comes from high-income countries where influenza vaccination is used in routine practice, but little is known about the effectiveness, cost-effectiveness, and scalability of vaccination in low- and middle-income countries. We therefore systematically reviewed and present evidence related to vaccination against influenza in persons with COPD with a special focus on studies from low- and middle-income countries (LMICs). Available data from 19 studies suggest that the use of influenza vaccine in persons with COPD is beneficial, cost-effective, and may be relevant for low- and middle-income countries. Wider implementation of this intervention needs to take into account the health care delivery systems of LMICs and use of prevalent viral strains in vaccines to be most cost effective.
Introduction: Cardiovascular disease has been recognised to be a major cause of morbidity and mor... more Introduction: Cardiovascular disease has been recognised to be a major cause of morbidity and mortality in Chronic Kidney Disease (CKD). Lipid abnormalities were originally considered as complications of end stage renal disease; these changes can be present in early stages of CKD and may actively participate in the pathogenesis of serious complications such as atherosclerotic vascular disease. The dyslipidaemia can be influenced by several intrinsic (nephrotic range proteinuria, diabetes mellitus, hereditary disorders of lipid metabolism) or exogenous (erythropoietin administration, steroids, calcineurin inhibitors, etc.) factors. Objectives: Study of Carotid Intimal Medial thickness(CIMT) in different stages of CKD and its relation with lipid profile and comparing with similar control group. Methods: Inclusion criteria: Patients with CKD between the age group 18-85years, Exclusion criteria: patients with acute kidney injury, ischemic heart disease disease, stroke, on hypolipidaemic drugs. 70 cases of CKD were selected on basis of simple random sampling technique. 30 age and sex matched healthy control were taken. CKD patients were classified into different stages according to glomerular filtration rate. Results: Study showed 18 (25.7%) of the patients belonged to 4 th and 5 th decade. There was male preponderance 39 (55.7%). Most common etiology of CKD was Diabetic Nephrology 21 (30%). 16 (22.9%) patients were found to have Hypercholesterolemia, 42 (60%) had Triglyceride level !150 mg/dl. 23 (32.9%) patients had serum HDL-C 30 mg/dl. The mean CIMT in patients was 0.84AE0.23mm and control was 0.46AE0.19mm. There was statistically significant (p < 0.001) difference in CIMT between two groups. There was significant Univariate positive co-relation between CIMT and age (r¼0.605, p<0.001), BMI (r¼0.377, p¼0.001). Total cholesterol (r¼0.236, p<0.018) and serum Triglyceride (r¼0.387, p<0.001). Statistically significant correlation was found between CIMT and eGFR, VLDL and HDL-C. Conclusion: CIMT is significantly higher in CKD patients and is very well co-related with traditional cardiovascular risk factors like age, BMI, total Cholesterol and Triglyceride. Assessment of CIMT in different stages of CKD may act as a marker for premature or established atherosclerosis.
Health systems with strong comprehensive primary health care (CPHC) are known to result in better... more Health systems with strong comprehensive primary health care (CPHC) are known to result in better health outcomes for people. In India, there is a recent push to strengthen CPHC through Ayushman Bharat. This study aimed to document lessons from successful CPHC initiatives in rural and urban India using a qualitative case study approach. A total of 72 CPHC initiatives were identified through desk review and 12 of these were studied as cases. The following two main models of CPHC delivery were seen in India: (a) a hospital or health centre with outreach and (b) social franchising model, prevalent in rural and urban contexts, respectively. Themes identified were related to organisation of services, workforce, financing and challenges in practice. Services being comprehensive, dialoguing with the community, addressing social determinants were themes under organisation of services. There is need for more generalists and training health professionals towards CPHC. Financing of CPHC especi...
Facility assessment. This provides the details of the assessment done for each health facility in... more Facility assessment. This provides the details of the assessment done for each health facility in the study. (DOCX 120 kb)
Facility assessment tool. This tool was created using documents (WHO Essential package of service... more Facility assessment tool. This tool was created using documents (WHO Essential package of services and the Indian public health standards) that describe minimum available resources that should be available at primary level care. (DOCX 102 kb)
Observation guide. This was a guide used to provide structure to the non-participant observations... more Observation guide. This was a guide used to provide structure to the non-participant observations. (DOCX 15 kb)
People interested in the research are advised to contact the author for the final version of the ... more People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Link to publication General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the "Taverne" license above, please follow below link for the End User Agreement:
International Journal of Medical Science and Public Health, 2016
Background: In India, Revised National Tuberculosis (TB) control programme (RNTCP) offers free di... more Background: In India, Revised National Tuberculosis (TB) control programme (RNTCP) offers free diagnosis and treatment for TB, based on the Directly Observed Treatment Short (DOTS) course strategy. Under RNTCP, sputum conversion rate (SCR), at the end of 2 months of treatment is an important operational indicator, which is ideally expected to be 90%. Objectives: The objective of the present work was to investigate the factors associated with low SCR at the end of 2 months of treatment in Sira TB unit, Tumkur District, India. Material and Methods: It is a retrospective cohort study of all new sputum smear-positive patients registered in RNTCP in 2011. Data were retrieved from the TB register maintained at the District TB center. Chi-square and Student’s t-test were used for analysis of the study variables between patients who were sputum positive and sputum negative at the end of 2 months of treatment. Multivariate logistic regression was applied to determine the risk contributed by the variables towards non-conversion of sputum. Results: Of the 268 included patients, 66.7% patients were sputum negative. Patients aged ≥ 45 years were twice prone to be sputum positive (OR = 2.14) (P = 0.007). The odds of being sputum positive after 2 months of treatment was observed to be significantly high (OR = 7.12; 95% C.I. = 1.52–33.22; P = 0.01) for sputum grade 3+ at the time of diagnosis, respectively. Conclusion: Elderly patients with a high bacilli load should be advised and counselled well regarding adherence to treatment. Further, advice should be given on preventing spread of the disease by practising cough hygiene, as they are more infectious than other patients with less sputum-positive grade.
We comparatively assessed the performance of six simple obesity indices to identify adults with c... more We comparatively assessed the performance of six simple obesity indices to identify adults with cardiovascular disease (CVD) risk factors in a diverse and contemporary South Asian population. 8,892 participants aged 20-60 years in 2010-2011 were analyzed. Six obesity indices were examined: body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), log of the sum of triceps and subscapular skin fold thickness (LTS), and percent body fat derived from bioelectric impedance analysis (BIA). We estimated models with obesity indices specified as deciles and as continuous linear variables to predict prevalent hypertension, diabetes, and high cholesterol and report associations (prevalence ratios, PRs), discrimination (area-under-the-curve, AUCs), and calibration (index χ2). We also examined a composite unhealthy cardiovascular profile score summarizing glucose, lipids, and blood pressure. No single obesity index consistently performed statistically si...
COPD: Journal of Chronic Obstructive Pulmonary Disease, 2015
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death globally. In a... more Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death globally. In addition to the mortality associated with it, people with COPD experience significant morbidity, making this set of conditions a major public health concern. Infections caused by influenza virus are a preventable cause of morbidity and vaccination has been shown to be effective. The evidence of their benefit in persons with COPD mainly comes from high-income countries where influenza vaccination is used in routine practice, but little is known about the effectiveness, cost-effectiveness, and scalability of vaccination in low- and middle-income countries. We therefore systematically reviewed and present evidence related to vaccination against influenza in persons with COPD with a special focus on studies from low- and middle-income countries (LMICs). Available data from 19 studies suggest that the use of influenza vaccine in persons with COPD is beneficial, cost-effective, and may be relevant for low- and middle-income countries. Wider implementation of this intervention needs to take into account the health care delivery systems of LMICs and use of prevalent viral strains in vaccines to be most cost effective.
Introduction: Cardiovascular disease has been recognised to be a major cause of morbidity and mor... more Introduction: Cardiovascular disease has been recognised to be a major cause of morbidity and mortality in Chronic Kidney Disease (CKD). Lipid abnormalities were originally considered as complications of end stage renal disease; these changes can be present in early stages of CKD and may actively participate in the pathogenesis of serious complications such as atherosclerotic vascular disease. The dyslipidaemia can be influenced by several intrinsic (nephrotic range proteinuria, diabetes mellitus, hereditary disorders of lipid metabolism) or exogenous (erythropoietin administration, steroids, calcineurin inhibitors, etc.) factors. Objectives: Study of Carotid Intimal Medial thickness(CIMT) in different stages of CKD and its relation with lipid profile and comparing with similar control group. Methods: Inclusion criteria: Patients with CKD between the age group 18-85years, Exclusion criteria: patients with acute kidney injury, ischemic heart disease disease, stroke, on hypolipidaemic drugs. 70 cases of CKD were selected on basis of simple random sampling technique. 30 age and sex matched healthy control were taken. CKD patients were classified into different stages according to glomerular filtration rate. Results: Study showed 18 (25.7%) of the patients belonged to 4 th and 5 th decade. There was male preponderance 39 (55.7%). Most common etiology of CKD was Diabetic Nephrology 21 (30%). 16 (22.9%) patients were found to have Hypercholesterolemia, 42 (60%) had Triglyceride level !150 mg/dl. 23 (32.9%) patients had serum HDL-C 30 mg/dl. The mean CIMT in patients was 0.84AE0.23mm and control was 0.46AE0.19mm. There was statistically significant (p < 0.001) difference in CIMT between two groups. There was significant Univariate positive co-relation between CIMT and age (r¼0.605, p<0.001), BMI (r¼0.377, p¼0.001). Total cholesterol (r¼0.236, p<0.018) and serum Triglyceride (r¼0.387, p<0.001). Statistically significant correlation was found between CIMT and eGFR, VLDL and HDL-C. Conclusion: CIMT is significantly higher in CKD patients and is very well co-related with traditional cardiovascular risk factors like age, BMI, total Cholesterol and Triglyceride. Assessment of CIMT in different stages of CKD may act as a marker for premature or established atherosclerosis.
Health systems with strong comprehensive primary health care (CPHC) are known to result in better... more Health systems with strong comprehensive primary health care (CPHC) are known to result in better health outcomes for people. In India, there is a recent push to strengthen CPHC through Ayushman Bharat. This study aimed to document lessons from successful CPHC initiatives in rural and urban India using a qualitative case study approach. A total of 72 CPHC initiatives were identified through desk review and 12 of these were studied as cases. The following two main models of CPHC delivery were seen in India: (a) a hospital or health centre with outreach and (b) social franchising model, prevalent in rural and urban contexts, respectively. Themes identified were related to organisation of services, workforce, financing and challenges in practice. Services being comprehensive, dialoguing with the community, addressing social determinants were themes under organisation of services. There is need for more generalists and training health professionals towards CPHC. Financing of CPHC especi...
Facility assessment. This provides the details of the assessment done for each health facility in... more Facility assessment. This provides the details of the assessment done for each health facility in the study. (DOCX 120 kb)
Facility assessment tool. This tool was created using documents (WHO Essential package of service... more Facility assessment tool. This tool was created using documents (WHO Essential package of services and the Indian public health standards) that describe minimum available resources that should be available at primary level care. (DOCX 102 kb)
Observation guide. This was a guide used to provide structure to the non-participant observations... more Observation guide. This was a guide used to provide structure to the non-participant observations. (DOCX 15 kb)
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