Sumit Malhotra

Correlates of tobacco quit attempts and cessation in the adult population of India: secondary analysis of the Global Adult Tobacco Survey, 2009–10

BackgroundNearly 275 million adults (15 years and above) use tobacco in India, which contributes substantially to potentially preventable morbidity and mortality. There is good evidence from developed country settings that use of tobacco cessation services influences intention to quit, with a higher proportion of attempts being successful in fully quitting. There is little evidence about cessation and quitting behaviour in the Indian context. This study assesses the socio-demographic characteristics and cessation services used by adults i) who attempted to quit smoked and smokeless tobacco and ii) who were successful in quitting.MethodsThe study was a cross-sectional secondary data analysis of the Global Adult Tobacco Survey, India, 2009–10. There were 25,175 ever tobacco users aged 21 years and above included in the study. Bivariate and multivariate logistic regression analysis was done to determine associations between socio-demographic variables and cessation services utilized with attempts to quit tobacco and successful quitting.ResultsOf the ever tobacco users, 10,513 (42%) made an attempt to quit tobacco, and of these 4,395 (42%) were successful. Significant associations were demonstrated between male gender, increasing educational attainment and higher asset quintiles for both those who attempted to quit and those who were successful. Younger age groups had higher odds of quit attempts than all except the oldest age group, but also had the lowest odds of successful quitting. Heath care provider advice was positively associated with attempts to quit, but both advice and use of cessation aids were not associated with successful quitting.ConclusionsThis study provides the first national evidence on the relationships between quitting attempts and successful quitting with socio-demographic characteristics, health care provider advice and use of cessation services. The findings of the study have important implications for scaling up tobacco cessation services in India, and indicate a need to re-examine in greater detail the effects of socio-demographic factors, type of tobacco product used and levels of dependency on quitting. Health system factors such as coverage and accessibility of cessation services, type of service, and its duration and follow up also have to be examined in detail to ascertain effects on quitting behavior.

Training of community healthcare providers and TB case detection in Bangladesh

BACKGROUND For several years, BRAC (previously known as the Bangladesh Rural Advancement Committee) has been assisting with national TB control efforts in Bangladesh and has especially focused on training of community healthcare personnel. This study attempts to determine whether there is any association between a community-based TB training programme in peri-urban Dhaka and TB case finding within the same catchment area. METHODS This was a cross-sectional retrospective study using laboratory sputum registers and annual BRAC training reports. RESULTS Between 2005 and 2010, there were 536 training activities for community healthcare providers with 9037 people trained. Numbers of patients attending laboratories with suspected TB increased from 8211 in 2004 (before training) to 10 961 in 2005 (start of training) with the proportion diagnosed with smear-positive TB increasing from 7.1% to 11.2%. Thereafter, the numbers with suspected and diagnosed TB remained similar up to 2010. The most important sources of referral of patients for investigation were community health volunteers and self-referring patients accounting for 58% of all patients. CONCLUSION In this operational research study in peri-urban Dhaka, there was an initial increase in TB case finding with numbers then reaching a plateau despite continued training activities. Further prospective evaluation is required to understand these phenomena.

Rapid Assessment of Visual Impairment in Urban Population of Delhi, India

Purpose To determine the prevalence, causes and associated demographic factors related to visual impairment amongst the urban population of New Delhi, India. Methods A population-based, cross-sectional study was conducted in East Delhi district using cluster random sampling methodology. This Rapid Assessment of Visual Impairment (RAVI) survey involved examination of all individuals aged 40 years and above in 24 randomly selected clusters of the district. Visual acuity (VA) assessment and comprehensive ocular examination were done during the door-to-door survey. A questionnaire was used to collect personal and demographic information of the study population. Blindness and Visual Impairment was defined as presenting VA <3/60and <6/18 in the better eye, respectively. Descriptive statistics were computed along with multivariable logistic regression analysis to determine associated factors for visual impairment. Results Of 2421 subjects enumerated, 2331 (96.3%) were available for ophthalmic examination. Among those examined, 49.3% were males. The prevalence of visual impairment (VI) in the study population, was 11.4% (95% C.I. 10.1, 12.7) and that of blindness was 1.2% (95% C.I. 0.8, 1.6). Uncorrected refractive error was the leading cause of VI accounting for 53.4% of all VI followed by cataract (33.8%). With multivariable logistic regression, the odds of having VI increased with age (OR= 24.6[95% C.I.: 14.9, 40.7]; p<0.001). Illiterate participants were more likely to have VI [OR= 1.5 (95% C.I.: 1.1,2.1)] when compared to educated participants. Conclusions The first implementation of the RAVI methodology in a North Indian population revealed that the burden of visual impairment is considerable in this region despite availability of adequate eye care facilities. Awareness generation and simple interventions like cataract surgery and provision of spectacles will help to eliminate the major causes of blindness and visual impairment in this region.

Delay in initiation of treatment after diagnosis of pulmonary tuberculosis in primary health care setting: eight year cohort analysis from district Faridabad, Haryana, North India

INTRODUCTION Delay in initiation of tuberculosis (TB) treatment may have a tremendous impact on disease transmission, development of drug resistance, poor outcome and overall survival of TB patients. The delay can occur at various levels. Delay in initiation of treatment after diagnosis is mostly due to health system failure and has immense programmatic implications. It has not been studied extensively in the Indian setting. METHODS The authors did a cohort analysis of all TB patients initiated on treatment from two primary health centres (PHCs) at Ballabgarh Health and Demographic Surveillance System between January 2007 and December 2014. Diagnosis and treatment of TB in the study area was done as per the protocol envisaged in the national program. Information related to demography, details of diagnosis and treatment of TB and outcome of treatment were extracted from the TB register. Delay in initiation of treatment after diagnosis was considered if the gap between diagnosis and treatment was greater than 7 days. Bivariate and multivariate analyses were done to find the association of various factors with delay in initiation of treatment after diagnosis. RESULTS Out of 885 patients, 662 patients started treatment for pulmonary TB. Mean time interval between diagnosis and initiation of treatment was 8.95 days. Only 57.7% of pulmonary TB patients were started on treatment within 7 days of diagnosis, and an additional 24.5% were started on treatment 8-14 days after diagnosis. Patients on retreatment regimens and those residing in villages without a PHC were more likely to have delayed initiation of treatment (odds ratio (OR)=1.82 (1.3-2.7, p=0.001) and OR=1.62 (1.1-2.5, p=0.01) respectively). Delay in initiation of treatment was also associated with unfavourable treatment outcome such as default, failure or death. CONCLUSIONS There is a need to have healthcare changes related to TB care to enable initiation of treatment as early as possible. Pretreatment counselling especially for retreatment patients is of utmost importance.

Prevalence of Trachoma in Car-Nicobar Island, India after Three Annual Rounds of Mass Drug Administration with Azithromycin.

Background A high proportion of active trachoma infection in children of Car-Nicobar Island was reported through the Trachoma Rapid Assessment survey conducted in year 2010 by the same researchers. Annual mass drug treatment with azithromycin was administered from years 2010–12 to all individuals residing in this island for reducing the burden of active trachoma infection. A cross-sectional prevalence survey was conducted in the year 2013 to assess the post-treatment burden of trachoma in this population. Methods In the 15 randomly selected compact segments from each village of the island, children aged 1–9 years were examined for evidence of active trachoma infection and participants aged ten years and above were examined for trachomatous trichiasis and corneal opacity. Results A total of 809 children (1–9 years) and 2735 adults were examined. Coverage with azithromycin for all the three rounds was more than 80%. The prevalence of active trachoma infection in children aged 1–9 years old was 6.8% (95% CI 5.1, 8.5) and Trachomatous Trichiasis (TT) was 3.9% (95% CI 3.2, 4.6). The risk factors associated with active trachoma infection were older age and unclean faces. The risk factors associated with TT were older age and lower literacy level. Conclusion Trachoma has not been eliminated from Car-Nicobar Island in accordance to ‘Global Elimination of Trachoma, 2020’ guidelines. Sustained efforts and continuous surveillance admixed with adequate programmatic response is imperative for elimination of trachoma in the island.

Prevalence of neural tube defects in a rural area of north india from 2001 to 2014: A population-based survey

BACKGROUND Neural tube defects (NTDs) are one of the commonest birth defects. There was paucity of community-based data on occurrence of NTDs in India, especially from rural parts of the country. Against this background, the current study was carried out with main objectives to determine the prevalence of NTDs and its specific types (anencephaly, spina bifida and encephalocele) in a rural community setting over the time period 2001 to 2014. METHODS This was a community-based cross-sectional study carried out in 28 villages of Ballabgarh Tehsil of Faridabad district in north India (population ∼ 96,000). A household survey was undertaken by trained multi-purpose workers who enquired ever-married women about history of conception with outcome as NTD during the study period. The probable case of NTD was determined using a colored pictorial card with photographs of different types of NTDs. These cases were confirmed by doctors. RESULTS A total of 26,946 live births occurred during the years 2001 to 2014. A total of 140 confirmed cases of NTDs were identified. The live birth prevalence of NTDs was 24.1 per 10,000 live births (95% confidence interval, 18.8-30.6). The birth prevalence of NTDs for the years 2008 to 2014 was 50.8 (95% confidence interval, 39.9-63.8) per 10,000 live and stillbirths. The most common type of NTD was found to be spina bifida followed by anencephaly and encephalocele. CONCLUSION We found high prevalence of NTDs in rural community settings from north India for years 2001 to 2014.Birth Defects Research 109:203-210, 2017.© 2016 Wiley Periodicals, Inc.

Partnerships for organizing blood donation camp: An experience from rural North India

Background: Rural areas pose challenges for motivating villagers to donate blood. We organized a blood donation camp in a rural setting by engaging multiple stakeholders. We examined the factors that influenced blood donation. Methods: Local level stakeholders were involved in planning of the camp. Mobilization of donors was attempted through intensive awareness generation activities utilizing multiple channels. A list of willing blood donors was prepared. Results: Out of 152 willing donors, 88 reported to donation camp, and after screening, 67 donated the blood. Most of the willing donors were males (89.8%), and the mean standard deviation age was 31.9 (9.4) years. Deferral rate was 23.8%. Involvement of local stakeholders can result in creating a pool of donors in rural area which can mitigate the existing gap between demand and supply of blood in India.

Models for primary eye care services in India.

Blindness and visual impairment continues to be a major public health problem in India. Availability and easy access to primary eye care services is essential for elimination of avoidable blindness. ‘Vision 2020: The Right to Sight - India’ envisaged the need for establishing primary eye care units named vision centers for every 50,000 population in the country by the year 2020. The government of India has given priority to develop vision centers at the level of community health centers and primary health centers under the ‘National Program for Control of Blindness’. NGOs and the private sector have also initiated some models for primary eye care services. In the current situation, an integrated health care system with primary eye care promoted by government of India is apparently the best answer. This model is both cost effective and practical for the prevention and control of blindness among the underprivileged population. Other models functioning with the newer technology of tele-ophthalmology or mobile clinics also add to the positive outcome in providing primary eye care services. This review highlights the strengths and weaknesses of various models presently functioning in the country with the idea of providing useful inputs for eye care providers and enabling them to identify and adopt an appropriate model for primary eye care services.

Should sputum smear examination be carried out at the end of the intensive phase and end of treatment in sputum smear negative pulmonary TB patients

Background The Indian guidelines on following up sputum smear-negative Pulmonary tuberculosis (PTB) patients differ from the current World Health Organization (WHO) guidelines in that the former recommends two follow up sputum examinations (once at the end of intensive phase and the other at the end of treatment) while the latter recommends only one follow up sputum smear microscopy examination, which is done at the end of the intensive phase. This study was conducted to examine if there was any added value in performing an additional sputum smear examination at the end of treatment within the context of a national TB program. Methods This study was a descriptive record based review conducted in nine tuberculosis (TB) units in Delhi, India. All consecutive new sputum smear-negative PTB patients registered in these nine TB units from 1st January 2009 to 31st December 2009 were included in the study. Results Of 2567 new sputum smear-negative TB patients, 1973 (90%) had sputum specimens examined at the end of the intensive phase, of whom 36 (2%) were smear-positive: the majority (n = 28) successfully completed treatment with either the same or a re-treatment regimen. At treatment completion, 1766 (85%) patients had sputum specimens examined, of whom 16 (0.9%) were smear-positive: all these were changed to a re-treatment regimen. Amongst the sputum-positive patients identified as a result of follow up (n = 52), four were diagnosed with multi-drug resistant TB (MDR-TB), three of whom were detected after smear examination at the end of treatment. Conclusions Given the high burden of TB in India, a 0.9% additional yield of smear-positive sputum smears at the end of treatment translates to 3,297 cases of smear-positive PTB. End-of-treatment smear is a low-yield strategy for detection of smear-positive TB cases, although further studies are needed to determine its population-level impact and cost, particularly in relation to other TB control interventions.

Diabetic retinopathy screening programme utilising non-mydriatic fundus imaging in slum populations of New Delhi, India

To develop and implement a community‐based programme for screening of diabetic retinopathy (DR) in urban populations of Delhi.