India needs to work aggressively to combat MDR-TB

Tuberculosis has been and still is a menace worldwide. With nearly one-third of the population infected with Mycobacterium Tuberculosis, TB is the second most reason of death from infectious disease after HIV with Asia and Africa contributing to the maximum number of fatalities.

Though there is good news with WHO coming up with the recommendations this year aiming to speed up detection and improve treatment outcomes for multidrug resistant tuberculosis (MDR-TB) through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen, India has a long way to go to acquire the benefit of this new regimen.

India, one of the Asian countries and is a land of many cultures with people following different ways of living. The country has made a mark in the globe with rapid progress in the area of science and technology. New innovations and advancement in the health sector is another factor that it can boast of. But the irony is that even in this culturally wealthy and techno-rich country nearly 24 percent of the people live below the poverty line today.

With more than 276 million people living from hand to mouth, the administration needs to gear up working towards a zero tuberculosis population aimed at fulfilling the Sustainable Development Goals by 2030.

The World Health Organization has reduced the treatment period for MDR –TB patients between 9 to 12 months, but still the cost of the treatment and availability of the diagnostic facility and medicines is still a major concern for many.

Amina Devi, a mother of 5 had no idea of what Multidrug Resistant Tuberculosis is; she only knows that she has fever from time to time and some glands in her arm pits for which she needs to take treatment from a medical practitioner in the area she stays. Her husband being an alcoholic hardly has time to fend for the family.

There are various conditions which add to cases like Amina Devi in the area she stays. Lack of registered Medical Practitioners in the fringes of the National Capital Region, a diagnostic laboratory which is 12 kilometres away and caters to some basic tests only, and with no hospitals nearby adds to the intensity of the problem.

The only laboratory which is the nearest to this area and does the MDR-TB test is about 25 kilometres away in Delhi, the capital of India.

The price for MDR-TB test is INR 2000, an amount quite luxurious for a family which lives on its day to day earnings.

Nasiruddin, a rickshaw puller who earns INR 200 a day says he cannot even think about such expenditure.

“I never go to the doctor, If I do, I will have to pay his fees which is more than my one day’s earnings and then he will give me medicines which are again costly. I send my three daughters to school, and I need to feed them too,” he says.

Though there are polyclinics and government hospitals, very few conduct such tests. Most of the population here has no idea of the disease and the tests and treatments available.

People like Amina Devi and Nasiruddin carry such disease which is then passed on to other members of the families thus increasing the number of population suffering from tuberculosis which is MDR in nature adding to that there are many a patient who have also been affected by Human Immunodeficiency Virus or HIV as the risk of developing Tuberculosis among HIV patients is said to 26 tp 31 times greater according to the World Health Organisation.

According to Dr Fuad Mirzayev of WHO Global TB Programme, the shorter MDR-TB regimen done among 1,205 patients in Bangladesh, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, DR Congo, Niger, Swaziland, and Uzbekistan reveals that :
• Treatment success versus all other outcomes was reported in 84 percent of these patients against 62 percent in a comparable selection of MDR-TB patients treated with a variety of individualized regimens of longer duration.

• In patients who did not complete treatment successfully, 7 percent died, 6 percent were lost to follow up, and 3 percent had a treatment failure.

• Relapse was incompletely assessed in the studies reviewed (in 2 countries it was assessed at 24 months after treatment; in 1 other at 12 months). Relapse was only observed in 3 patients

Now to achieve the results of this new regimen, and move aggressively towards the SDG 2030 India needs to give maximum priority to health from both the national and the state perspective, because only a healthy nation can come with healthy economy.
Each and every individual should have access to basic health services irrespective of the economic background the individual comes from.
Make MDR-TB tests affordable and accessible so that all suspected cases can get the benefit of this regimen.

Curbing Tobacco Usage : Call of the hour

A narrow lane leads us to a poorly lit small dingy room of a four storage building in the suburbs of Delhi. Veer Prakash is lying in a cot coughing on and off. His wife Lila Devi dusts off the two small tools in the corner and arranges the same for us to sit.

“His cough has aggravated with time, the medicines are costly. It is difficult to hospitalise him but we now feel that, it is very much necessary, but where will the money come from,” laments Lila Devi who somehow manages to feed the family of five by doing odd jobs after she is through with her household chores.

Veer Prakash’s cough has become chronic, he is a chain smoker, he smokes bidi, a form of cheap cigarette which is made by wrapping raw tobacco with tendu or temburni leaf (the plant is native to Asia only) and is also an alcoholic. During previous visit to the doctors, he was warned against smoking. But addiction has won over the will power of the man.

Persistent cough and poor health has limited his movement till the four walls and to the nearby lanes at times. He has become incapable of earning any penny.

In such a situation, it’s not only the man of the house but all the family members have fallen prey to the uncalled for condition as they are passive smokers.

According to a data shared by Dr Tara Singh Bam of the Union during a webinar arranged by Citizens News Service  on the 24^th of May Tobacco kills 8 million people across the Globe in a year.

About 800 million adult men worldwide smoke cigarette, while among the women also, the number have risen considerably with 200 million adding to the smokers community.

The sufferings of Veer Prakash and his family is just a single example. There are many who undergo similar shattering life because of tobacco consumption or inhalation.

It has also been seen that the number of smokers are more among the low income group people than those earning a decent amount for their livelihood.

With the tobacco consumption contributing significantly to the deteriorating global health scenario the World Health Organisation came up with the first international treaty – Framework  Convention on Tobacco Control (FCTC) on 21^st May 2003, which came into force by 27^th February 2005. Since then it has become one of the widely embraced treaties in the history of the United Nations.

While the guidelines according to the treaty are in place, the commitments are also there, but the action is slow which is adding to the concerns.

The WHO Framework Convention on Tobacco Control (WHO FCTC) is the first international treaty negotiated under the auspices of WHO

In India though a number of measures have been taken to curb smoking in accordance to the treaty with various kinds of pictorial warnings in cigarette packets, the impact is miniscule in India.

“Yes, I do see the warnings in the packet, it is disturbing, but I am unable to give up smoking,” says Ashish, a 30 year old software developer.

India ranks second amongst the tobacco consuming countries in the globe the first being China. Tobacco is used in various forms in India, either as bidis or as cigarettes or in hookahs a traditional way of smoking. It is also used a Gutkhas and panmasala and the youths including teenagers are catching fast in such unhealthy habit.

The people of North-eastern India consume tobacco in the most peculiar way. Most of the people chew the tobacco leaf with a kind of leaf locally called paan and betel nut with slaked lime, while there are many others who just fold the tobacco leaf and keep it in their mouth for long hours to derive a high.

World Health Organisation has recently came up with the idea favouring plain packaging on the cover of tobacco products with only pictorial warning and no mention of any brands, which had already been tried in Australia.

The result was very good there. The numbers of people refraining from buying such products were positive in Nepal too.

The overall health status in these countries were overwhelming.

Tobacco use is responsible for a number of chronic diseases like cancer, diseases of the lungs, cardiovascular diseases, and respiratory diseases.

While there is a need to curb the availability of tobacco and tobacco products abundantly and easily available in the market, there is also a need to raise awareness on this issue among the smokers and young adolescents so that they stay away from such products which is detrimental for health.

Centre for Environmental Health : An initiative to address causes of Health outside the Health Sector

Public Health Foundation of India and Tata Institute of Social Science has embarked on a unique project to address the effects of various kinds of pollution on health.

The joint initiative witnessed the launch of the Centre for Environmental Health on 19th of March.

The initiative would work towards building capacity, promoting research, advocacy and communication on environmental health.

The centre would undertake activities aimed at building institutional capacity and action research for environmental health, establish programs for education and training in environmental health for public health practitioners, community groups and local volunteers.

The initiative would cultivate a network of partners and collaborators to engage in multi-sectoral, cross-cultural action research, basic research and policy advocacy.

It would further engage the public and health professionals through media and health communication activities.

Environmental Health risk factors such as exposure to Air, Water and Chemical Pollution, in addition to lack of access to clean water and adequate sanitation facilities contribute significantly to India’s disease burden.

Addressing these determinants of health outside the health sector requires strong scientific evidence in the Indian context, where exposures are often manifold higher than in developed countries, and a pathway to turn the science into actionable policy.

This is the nexus at which the Centre for Environmental Health aims to work in, with the understanding that developing this platform for research and policy translation will require significant capacity building in many areas including environmental epidemiology, exposure science, policy analysis and statistics, among other disciplines.

According to researchers at the University of British Columbia in Canada, about 1.4 million people in India and 1.6 million in its northern neighbor died of illnesses related to air pollution in 2013.

There are around 40 million DALYs annually, and is the second most important risk factor for ill health in India after poor diets.

Over 50% of Indians still defecate in the open, and over 120 million Indians lack access to improved sources of water, adding significantly to the burden of child deaths in rural and urban India.

This collaborative effort aims to set up the much-needed platform in India for dedicated and high quality research and capacity building in the area of environmental health.

The centre will also establish a policy engagement platform, with regular meetings with government, civil society, academia and the private sector, to develop pathways to implementation.

Through this broad array of activities, the centre will aim to catalyse environmental health research in India, with the ultimate aim of influencing evidence-informed policy making across sectors.

Courtesy : Public Health Foundation of India

 

 

 

 

 

Major New Global Study Identifies a Cost Effective Treatment of Acute Stroke

New Delhi, 10th May, 2016: Stroke or brain attack is the leading cause of death and disability in rural India. An estimated 1.2 million people in India suffer ischaemic strokes each year.

Worldwide, the figures are estimated to be 2 million in China; 640,000 in the USA; 120,000 in the UK and 40,000 in Australia.

Professor Jeyaraj D Pandian from Christian Medical College, Ludhiana, says intravenous rtPA (or alteplase) therapy is the currently approved therapy within 4.5 hrs after the onset of stroke symptoms. This drug breaks and dissolves the clot in the blocked artery in the brain. Unfortunately very few patients in India receive this drug because of late arrival to the hospital or unable to afford this treatment. The cost of this drug is about Rs 67,000. The high cost of the drug, lack of health infrastructure and public awareness about stroke are the reasons for underutilisation of this treatment in India.
Researchers at the George Institute for Global Health investigated a modified dosage of rtPA which can be considered to be given at a subsidised rate at all government hospitals to eligible patients that can reduce serious bleeding in the brain and improve survival rates. It is hoped that the findings from this trial called ‘ENCHANTED’ involving more than 3000 patients in 100 hospitals worldwide could change the way the most common form of stroke is treated globally.
The study shows that if we reduce the level of dosage, most of the clot busting/ dissolving benefits of the higher dose is maintained, but there is significantly less bleeding inside the brain, thereby improving the survival rates. On a global scale, this approach could save the lives of many tens of thousands of people.

KEY FINDINGS:

· Compared to standard dose (0.9mg/kg body weight), the lower dose (0.6mg/kg) of rtPA reduced rates of serious bleeding in the brain, known as intracerebral haemorrhage (ICH), by two thirds.

· After 90 days, 8.5 per cent of patients had died after receiving low dose rtPA, compared to 10.3 per cent who received the standard dose.

· The survival benefit was offset by a slight rise in the amount of people suffering residual disability. For every 1000 patients treated, low dose rtPA, compared to the standard dose, 41 more people had physical disabilities, such as needing help dressing or walking, but 19 fewer people died.
These differing effects meant that the trial was unable to show conclusively that the low dose was as effective as standard dose rtPA in terms of survivors being free of any disability. rtPA is used to dissolve clots that block a blood vessel in a patient’s brain within the first few hours after the onset of stroke symptoms. Yet, because many people with stroke arrive at hospital after this crucial time window, only around five per cent of eligible people currently receive this therapy in most countries.

There is great variation in arrival time taken by patients in India, only 14.7% stroke patients reach hospital in time to be eligible for rtPA therapy. There are approximately 55 stroke units in the country largely in private sector hospitals. There are only few stroke units in Government Tertiary care hospitals including medical colleges in the nation. There is an enormous need to start stroke units in Government hospitals at least at district level.

Professor Anderson, the Principal Investigator of The George Institute for Global Health, said he hoped the lower dose would become the standard in situations where a doctor considers the risk of ICH to be high in a particular patient.

Professor Anderson added: “There is a trade off with the lower dose in regards to recovery of functioning, but being alive is surely preferable to most patients than suffering an early death.”

Professor Jeyaraj D Pandian,who was involved in the concept and design of the study and who is also the honorary professor of the George Institute in Sydney, emphasises that: “The results of this trial provide important information when discussing clot-busting treatment with patients and their families. Most patients who have a major stroke want to know they will survive but without being seriously dependent on their family. We have shown this to be the case with the lower dose of the drug.”

Courtesy : The George Institute for Global Health

Addressing Asthma problem – a big challenge

This is the fourth day this week that Ashmi has failed to turn up for her school. A student of fourth standard, Ashmi has been performing very well consistently and has been an achiever for the third consecutive year. Mrs Hemvat, her class teacher is really worried today. “She is not only a bright student but also is a very active child who takes part in most of the activities. But this year she is absent most of the days,” said Mrs Hemvat.

Ashmi has been facing breathing difficulties frequently these days.

Asthma – a Non Communicable Disease, is characterized by breathlessness, whizzing, and bouts of cough accompanied with headache and weakness.

Ashmi has been suffering from breathing difficulties for the past two years and the frequency has increased this year. Regular visits to the doctors have resulted in the administration of high dosage of cortisone, regular usage of inhalers and antibiotics.

“Initially she did have problems, I did not sleep for nights together as she had wheezing sound with bouts of cough and I used to be very scared. We visited the pediatrician time to time and he gave her steroids. She was fine then. But she keeps getting the attacks though of a lesser intensity. I have stopped visiting the doctor as we all hear about the side effects of cortisone,” said Ashmi’s mother, Mrs Dutta.

Mrs Dutta is also confused about her condition, most of the time she refuses to go to school saying she is having breathing difficulties. But these days the wheezing sound and the bouts of cough are missing in most of the days.

Asthma, according to WHO estimates has already affected more than 235 million people across the Globe but according to the Global burden of the Disease study, the number of people suffering is much higher at around 334 million.

Few days later when the writer visited a small time clinic in an urban slum, a chit chat with the Registered Medical Practitioner, Dr Grover revealed that everyday there are five to six children visiting the clinic with breathing difficulties.

The high pollution, dusty weather accompanied with unhygienic living conditions is the reason for such high number of children suffering from breathing difficulties.

Dr P K Goswami, Senior Advisor, Institute for Global Development raises concern on rampant usage of fossil fuels by the marginalized section of the people both in urban and rural areas.

“Commonest cause of asthma in our country is because of pollution from fuel like cow dung, straws, wood, kerosene etc. killing young women and young children in all low income countries particularly India. Other causes may be smoking, lack of physical activity and air pollution,” said Dr P K Goswami.
One of the common pulmonary disease caused by fossil fuel use is Chronic Obstructive Pulmonary Disease (COPD), a crippling pulmonary infection caused by use of fossil fuels form of asthma.

“Resorting to usage of gaseous fuel for household purposes is the only way we can minimize the number of asthma patients”, he further added.

Asthma is not a curable disease, but can be managed to a great extent if diagnosed and treated early.
Most of the asthma patients go untreated because the disease is not diagnosed or under treated when diagnosed.

While the disease is prevalent in those who belong to a marginalized background, many belonging to well off families are also facing problems because of improper diagnosis.

An article in the Times of India has quoted Dr S K Chhabra, head of cardio-respiratory physiology, at V P Chest Institute saying , “wrong diagnosis of the disease have led many of the patients not suffering from asthma being administered inhalers with steroids which can have a serious effect on the patient.”

Asthma is not a minor disease to combat. A person suffering from the NCD faces physical problems but also other problems like Social, Psychological, Economic problems.

“ I love dancing and want to learn the same in an Institute, but Mamma is scared, there are times when I am in full form and when am enjoying the art form I get bouts of cough and breathing difficulties. I feel very bad,” says Sushma, a ten year old who aspires to be a dancer.

According to the World Health Organisation estimates, over 80 percent of asthma deaths occur in low and lower-middle income countries. The disease is predicted to increase worldwide over the next 10 years.

It has been seen that indoor pollution also results in Asthma attacks. Proper ventilation in the house, refraining from deodorants, air fresheners or any kind of aromatic substances triggers such attacks.

Sticking to local sustainable food instead of the junk food available across and resorting to regular exercises has been seen to a great extent effective in tackling the disease.

American college of Allergy, Asthma and Immunology states that Asthma is among the most common chronic childhood illnesses, accounting for 10.5 million missed school days a year. It also accounts for 14.2 million lost workdays for adults.

The researchers there also estimate asthma-related costs, including the direct cost of health care and indirect costs such as decreased worker productivity, at around $60 billion annually.

Combating the killer Disease – Tuberculosis, an endless initiative towards a zero TB milestone.

It has been more than two years that Anita (name changed) have been suffering from fever on and off, body ache, weakness etc. Anita says she has learnt to live with her condition. She sees a local medicine practitioner whenever the problem aggravates.

She was advised antibiotics as the doctor suspected Tuberculosis because of her condition such as enlargement of lymph. She did take the medicine for a few days but discontinued when she felt better. But the problem recurred some months later. Again the same treatment for few days but Anita failed to complete the full course again.

Anita is an example of one such case in Delhi. There are many migrant workers like her who move to a bigger city in India in search of livelihood and then migrate to another city when they find a better opportunity.

Thus tracking such cases of tuberculosis and giving them complete treatment becomes very difficult there by adding to a number of Multi – Drug – Resistant Tuberculosis cases.

Tuberculosis continues to be killer disease in India. It has been 68 years since the country has achieved Independence from British rule, but we are yet to free ourselves from the clutches of Tuberculosis. Though the Federal government claims to have come up with many initiatives to combat the disease, there are still a large number of people who are undiagnosed or are under diagnosed adding to the population of the affected people. And this happening despite treatment being available to completely cure the disease and bring a normal and healthy life to the person affected.

According to Medical Practitioners, the problem lies with the complications associated with the disease when people fail to undergo the diagnosis or they are lethargic enough to care for treatment or prevention.

Experts say one should be very clear of the symptoms of tuberculosis. One needs to go for immediate check-up when he or she realizes that they are suffering from continuous cough for more than two weeks and is not responding to any of the medications or to antibiotics or to any other home remedies.

Even if tests are negative in certain cases the doctors take a call on prescribing medicine for a period of six months to prevent one from having TB.

Multi Drug Resistant Tuberculosis happens when a person stops taking medication half way and then the treatment becomes very difficult. The patient does not respond to any treatment further. So it is essential for a patient to complete a full course to combat the disease.

The mode of transfer of infection from one person to another person is through air. And to add to this the rising air pollution majorly in the metropolitan cities, the number of cases are constantly increasing adding to the graph. The other cities too are in the grip of pollution these days.

TB increases the risk of developing lung cancer. Smokers are at risk to develop respiratory diseases.

Tuberculosis is a menace and a major problem worldwide.

The main reason that can be attributed to the hike in the number of tuberculosis cases is lack of Primary Health Care at the door step of every citizen. Primary Health Centres and their sub-centres are supposed to meet the health care needs of rural population.

But absence of the same in many areas or presence of non-functioning or mal-functioning Primary Health Care units has added to the dilapidated health status of the vulnerable population.

Poverty is another reason contributing to the rise of the disease. With either or no shelter and poor reach to good food, health and hygiene, the disease spreads like wild fire.

Again migration from one place to another in search of work is another factor. Many a times those starting treatment under the government of India’s DOTS initiative discontinue the treatment half way when they migrate another place there by adding to the number of Multi Drug Resistant cases.

An estimated 40 percent of Indian population is infected with Tuberculosis. Every year 12 lakh Indians are identified with newly diagnosed TB. Only 58 percent are diagnosed and the rest are left undiagnosed or under diagnosed.

Over 10 lakh Indians with Tuberculosis are not notified. Over 40 percent Indian children are currently under diagnosed in India. TB affects everyone irrespective of age, class or caste. It can affect anyone at any time, be they rich or poor. It effects anyone irrespective of the background they hail from.

The World Health Organisation has come up with a strategy to counter the killer disease and make this world a more comfortable place to live in.

The strategy aims to end the global TB epidemic, with targets to reduce TB deaths by 95 percent and to cut new cases by 90 percent between 2015 and 2035, and to ensure that no family is burdened with catastrophic expenses due to TB. It sets interim milestones for 2020, 2025, and 2030.

The resolution calls on governments to adapt and implement the strategy with high-level commitment and financing. It reinforces a focus within the strategy on serving populations highly vulnerable to infection and poor health care access, such as migrants.

The strategy and resolution highlight the need to engage partners within the health sector and beyond, such as in the fields of social protection, labour, immigration and justice.

The WHO plays a critical role in monitoring drug quality in poorer countries through its Prequalification of Medicines Program, which ensures that treatments supplied by U.N. agencies such as UNICEF are of acceptable quality.

Tuberculosis and neonatal preterm birth complications continue to take a high toll on health

 

Life expectancy in India has increased since 1990, but healthy life expectancy grew more slowly; ischemic heart disease, chronic obstructive pulmonary disease (COPD), lower respiratory infections, tuberculosis and neonatal disorders caused the most health loss in India.

SEATTLE (USA) / NEW DELHI (INDIA) — People in India are living longer, but healthy life expectancy has increased more slowly and a complex mix of fatal and nonfatal ailments cause a tremendous amount of health loss, according to a new analysis of 306 diseases and injuries in 188 countries.

Thanks to marked declines in death and illness caused by HIV/AIDS and malaria in the past decade and advances made in addressing communicable, maternal, neonatal, and nutritional disorders, health has improved significantly around the world. Global life expectancy at birth for both sexes rose by 6.2 years (from 65.3 in 1990 to 71.5 in 2013), while healthy life expectancy at birth rose by 5.4 years (from 56.9 in 1990 to 62.3 in 2013).

Healthy life expectancy takes into account not just mortality but the impact of nonfatal conditions and summarizes years lived with disability and years lost due to premature mortality. The increase in healthy life expectancy has not been as dramatic as the growth of life expectancy, and as a result, people are living more years with illness and disability.

This is also true in India. Life expectancy increased by 6.9 years for men between 1990 and 2013 and 10.3 years for women in the same period. But healthy life expectancy increased by less: men gained 6.4 years and women gained 8.9 years. Life expectancy for women in India still outpaces that of men, 68.5 years compared to 64.2 years.

“Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition” examines fatal and nonfatal health loss across countries. Published in The Lancet on August 27, the study was conducted by an international consortium of researchers working on the Global Burden of Disease (GBD) study, including from the Public Health Foundation of India (PHFI), and led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

For most countries, changes in healthy life expectancy for males and females between 1990 and 2013 were significant and positive, but in dozens of countries, including Botswana, Belize, and Syria, healthy life expectancy in 2013 was not significantly higher than in 1990.

The study’s researchers use DALYs, or disability-adjusted life years, to compare the health of different populations and health conditions across time. One DALY equals one lost year of healthy life. DALYs are measured as the sum of years of life lost due to early death and years of healthy life lost due to disability.

In India, the leading causes of health loss, as measured by DALYs, in 2013 were ischemic heart disease (IHD), chronic obstructive pulmonary disease (COPD), lower respiratory infections, tuberculosis, neonatal preterm birth complications, neonatal encephalopathy, diarrheal diseases, cerebrovascular disease, road injury, and low back and neck pain. Neonatal encephalopathy and tuberculosis were not among the leading causes of health loss globally.

Causes of health loss differed by gender in India as well. For Indian men, the top-five causes of DALYs in 2013 were IHD, tuberculosis, COPD, neonatal encephalopathy, and neonatal preterm birth complications. For women, the top five were IHD, lower respiratory infections, diarrheal diseases, COPD, and neonatal preterm birth complications. For Indian men, the fastest-growing leading causes of health loss between 1990 and 2013 were self-harm, IHD, and cerebrovascular disease, which increased at rates of 149.9%, 79.9%, and 59.8%, respectively. Only IHD was in the top-10 causes of male DALYs in 1990. For women, the largest increases among the leading causes of DALYs occurred for IHD (69%), depressive disorders (66.1%), and cerebrovascular disease (36.8%). Only IHD was among the 10 leading causes of health loss for women in 1990.

“Healthy life expectancy in India is 12 years lower for women and 8 years lower for men than in neighboring Sri Lanka,” said study co-author Dr. Lalit Dandona who is Professor at PHFI and IHME and led the work of this study in India. “This difference indicates that substantial health improvements in India are possible and that public policy should make this a top priority in order to enable India reach its optimal development potential.”

“The relative contribution of Ischemic heart disease to the disease burden in India has doubled over the past 25 years, making it the leading cause of health loss among both men and women in India presently,” said Dr. K. Srinath Reddy who is President of PHFI and member of the GBD Scientific Council. “Major health system and policy shifts for more effective preventive and curative approaches for heart disease are needed in India to curtail this trend.”

“It is unacceptable that tuberculosis continues to be among the top five leading causes of disease burden in India in 2013, as it was a quarter century ago,” said Dr. Soumya Swaminathan who is Director-General of the Indian Council of Medical Research. “Systematic evidence-based approaches for tuberculosis control and ultimate elimination have to be rapidly implemented in India to improve the situation.”

“In the current epidemiological transition, road injuries is a major concern and one that predominantly affects men in the working and productive age group,” said Dr. Nobhojit Roy who is Professor at BARC Hospital and a co-author of the study. “Though preventable, road injuries have increased rank since 2005. Between 1990 and 2013, worldwide DALYs per 100,000 from communicable, maternal, neonatal and nutritional ailments declined by 42.4% but only by 30.9% from injuries.”

The study also examines the role that socio-demographic status – a combination of per capita income, population age, fertility rates, and average years of schooling – plays in determining health loss. Researchers’ findings underscore that this accounts for more than half of the differences seen across countries and over time for certain leading causes of DALYs, including maternal and neonatal disorders. But the study notes that socio-demographic status is much less responsible for the variation seen for ailments including cardiovascular disease and diabetes.

“Factors including income and education have an important impact on health but don’t tell the full story,” said IHME Director Dr. Christopher Murray who leads the GBD study globally. “Looking at healthy life expectancy and health loss at the country level can help guide policies to ensure that people everywhere can have long and healthy lives no matter where they live.”

Courtesy : Public Health Foundation of India

Langsat peel a potential source of natural antioxidants

Langsat, the fruit also found in the North Eastern part of India is believed to be a potential source of antioxidants.

Langsat (Lansium domesticum) is a tropical fruit that is commonly cultivated in Southeast Asia. The fruit is rich in fibre, vitamins and minerals, while the peel of langsat contains phenolics and carotenoids, and is traditionally used as an anti-diarrhoea medicine. Anti-oxidative components found in medicinal fruits such as langsat are natural alternatives to synthetic antioxidants (such as butylated hydroxytoluene and tertiary butylhydroquinone), which are added to food as preservatives despite being potentially carcinogenic. Past research has shown that some tropical fruits have higher antioxidant activity in their peel than in their pulp, but the literature on the presence of antioxidant in the peel of langsat has been scarce in Malaysia.

In a paper published in the Pertanika Journal of Tropical Agricultural Science, a research team from UCSI University and the Universiti Putra Malaysia in Malaysia evaluated the total phenolic content (phenols are anti-oxidative compounds) and antioxidant activity of langsat peel extract and peel extract fractions of langsat fruit. Their aim was to determine whether langsat peel has potential for the development of natural antioxidants, and whether fractionation is a suitable method for extracting these compounds.

The researchers found that the total phenolic content of langsat peel extract was up to four times higher than each of the extract fractions, while there was no significant difference among the extract fractions. Similarly, the peel extract also showed the highest antioxidant activity. The team concluded that langsat peel has antioxidant components that are ideal for developing nutraceuticals without fractionation. The researchers also recommended further studies to help identify the structure of the phenolic compounds found in langsat peel.

Courtesy : Asia Research News

Garlic effective against multi-drug resistant urinary tract infections (UTI)

Garlic juice can be an effective weapon against multi-drug resistant strains of pathogenic bacteria associated with urinary tract infections (UTI), according to a recent study published in the Pertanika Journal of Tropical Agricultural Science.

Garlic (Allium sativum) has been traditionally used for the treatment of diseases since ancient times.

Conducted by researchers at the Birla Institute of Technology and Sciences in India, the study found that “even crude extracts of garlic showed good activity against multidrug resistant strains where antibiotic therapy had limited or no effect. This provides hope for developing alternative drugs which may be of help in fighting the menace of growing antibacterial resistance,” the team states.

Urinary tract infection is the second most common infectious disease encountered in community practice. Worldwide, about 150 million people are diagnosed each year with UTI, at a total treatment cost in the billions of dollars. Although UTI is usually treated with antibiotics, “emerging antimicrobial resistance compels us to look back into traditional medicines or herbal products, which may provide appropriate/acceptable alternative solutions,” the authors argue.

Garlic has been traditionally used for the treatment of diseases since ancient times. A wide range of microorganisms – including bacteria, fungi, protozoa and viruses – are known to be sensitive to garlic preparations. Allicin and other sulphur compounds are thought to be the major antimicrobial factors in garlic.

In this study, the team found that 56% of 166 bacteria strains isolated from the urine of people with UTI showed a high degree of resistance to antibiotics. However, about 82% of the antibiotic resistant bacteria were susceptible to a crude aqueous extract of Allium sativum.

According to the researchers, “ours is the first study to report the antibacterial activity of aqueous garlic extract against multidrug resistant bacterial isolates from infected urine samples leading to UTI.”

“To conclude, there is evidence that garlic has potential in the treatment of UTI and maybe other microbial infections,” says the team. “However, it is necessary to determine the bio availability, side effects and pharmacokinetic properties in more detail.”

Courtesy : Asia Research News

Hike in food prices is linked to higher risk of malnutrition among Indian children.

According to Public Health Foundation of India, the hike in food prices is linked to higher risk of malnutrition among Indian children.

The research is based on the observation of the children who have low weight when compared with their height… a measure based on World Health Organisation Standards.

They observed progress in child nutrition between 2002 and 2006 when the proportion of wasted children in (undivided) Andhra Pradesh fell slightly from 19% to 18%. However, this improvement had reversed by 2009 when 28% of children were wasting – an increase of 10 percentage points compared with 2006.

This was after high inflation in food prices, beginning in 2007 and continuing through 2009. The research paper is published in the online version of the Journal of Nutrition.

The study was conducted by researchers from the Public Health Foundation of India and the University of Oxford, with a team from Stanford University and the London School of Hygiene and Tropical Medicine.
They focused on the effect of food prices on child nutrition in the Andhra Pradesh, one of India’s largest states, using data from the Young Lives project based at Oxford University.

The researchers have used survey data from a sample of 1,918 children from poor, middle-income, and wealthy households living in the state, since 2002 for a longitudinal study of child poverty.

The research team combined children’s weight and height measurements from the Young Lives data with official government data on household level expenditure and consumption patterns of food from the Indian National Sample Survey Office and the National Nutrition Monitoring Bureau in order to calculate how much children ate across food categories.

The researchers found that children’s food consumption dropped significantly between 2006 and 2009 as food prices increased. There were corresponding increases in wasting among children from poor and middle-income households, but not high-income households between 2006 and 2009. The paper suggests this supports the theory that poorer households have the smallest food reserves and are therefore hardest hit by rising food prices.

The researchers examined interview data from each household on food expenditure based on 15-day periods in 2006 and 2009 across eight food categories (rice, wheat, legumes, meat, fish, eggs, milk, fruit and vegetables).

To examine the rise in food prices, the researchers used monthly price records collected by the Government of India.

Lead author of the study Dr Sukumar Vellakkal, Public Health Foundation of India, said: ‘Our findings suggest that poorer households face the greatest risk of malnutrition, in spite of the Public Distribution System, which provides subsidised food to a large proportion of the population. Better targeting of food security policies may be necessary to meet the needs of India’s most vulnerable households.’

“India’s remarkable economic growth in the last decade had not translated in to betterment of children nutrition status because of the rising food prices, we need specific policies help to ensure the affordability of food in the context of higher food prices for promoting children’s nutrition” Dr. Vellakkal added.

Study co-author Dr Jasmine Fledderjohann, of the University of Oxford, said: ‘Our findings show a sharp increase in wasting associated with food price spikes. It is possible that this rise would have been even greater without governmental programmes like the Public Distribution Scheme or the Midday Meal Scheme, which provides free meals to school children. It’s important to recognise that households may try a number of strategies to cope with rising food prices, such as going without, or switching to low-cost alternatives. More detailed research is needed in this area.’