Vk Agrawal

Lymphatic Filariasis in India : Problems, Challenges and New Initiatives

Filariasis is a major public health problem in India and inspite of existence of the National Filaria Control Programme since 1955, currently there may be up to 31 million microfilaraemics, 23 million cases of symptomatic filariasis, and about 473 million individuals potentially at risk of infection. Over the last 10 years advances have led to new diagnostic/ treatment tools and control strategies for filariasis. The new control strategy aims at transmission control through mass treatment and at disease control through individual patient management. As a signatory to 50(th) World Health Assembly resolution on global elimination of lymphatic filariasis in 1997, revised filariasis control program was launched in India in 13 districts in seven endemic states where mass drug administration was undertaken. Single dose mass administration annually in combination with other techniques has already eliminated lymphatic filariasis from Japan, Taiwan, South Korea and Solomon Islands and markedly reduced the transmission in China. Very high treatment coverage (probably > 85%) is required to achieve interruption of transmission and elimination in India. Hence, there is an urgent need for effective drug delivery strategies that are adapted to regional differences. This requires powerful advocacy tools and strategies as well as procedures for monitoring and evaluating the impact of elimination programme.

National Health Programmes of India

This book provides information on various national health programmes, national policies and legislations related to health in India. This edition is thoroughly updated and many new chapters of public health importance such as reproductive and child health programme-II, National Rural Health Mission, Integrated Disease Surveillance Project, and Millennium Development Goals are also included. These new chapters will be beneficial to teachers and students. This is the unique book, which is not only useful for the postgraduate but also the undergraduate medical, nursing, and social science students. The quality and contents of the material presented in the book is quite optimal. In this edition the author has included summary at the end of topic, which is very beneficial for quick reviews. Author has touched the millennium development goals as a short topic and it is felt that the next edition should deal with the topic as a separate chapter. This edition is an attempt to enrich the different public health experts, policy makers, project officers and social workers with new events and happening in the field of health programmes and policies of India.

Prevalence and Determinants of Hypertension in a Rural Community

BACKGROUND There are few epidemiological studies on prevalence of hypertension and its determinants in rural population. This cross sectional study was done to determine the same in a rural community. METHODS A random sample of 406 people (218 men and 188 women) of 30 years and above was selected from a rural area. The pre tested proforma was used to collect the data by trained doctors. RESULT Prevalence of smoking and tobacco use was 16%, alcohol intake 9.4 %, daily salt intake (≥ 5 gram) 34.2%, daily saturated fat intake (≥ 10 % of daily energy intake) 47 .0 % and physical inactivity (work and leisure) as 18.5%. Body Mass Index (BMI) was ≥ 25 in 18 % and ≥ 30 in 3.2% men and women. Prevalence of truncal obesity (Waist Hip Ratio: men ≥ 0.9; women ≥ 0.8) was 8.5% with higher incidence in men. Prevalence of abdominal obesity (men ≥ 102 cms; women ≥ 88 cms) was found in 15.7 % with higher incidence in men. Differences in prevalence of risk factors between men and women were statistically significant in case of smoking, alcohol consumption and abdominal obesity. 18.5% men and women were suffering from systolic hypertension (≥ 140 mg Hg) and 15 % from diastolic hypertension (≥ 90 mg Hg). Prevalence of risk factors for hypertension was significantly more among subjects suffering from systolic and diastolic hypertension than normotensive subjects. CONCLUSION Prevalence of systolic hypertension in rural community was 18.5 % and of diastolic hypertension 15% with higher prevalence in the age group of 60 years and above, in case of men and women. There was a significant linear trend in prevalence of systolic hypertension with respect to age group in men whereas it was not significant in case of women.

Dengue Vaccine: The Current Status

Dengue fever is a re-emerging public health problem with two-fifths of the world population being at risk of infection. Since there are no antiviral drugs available against the dengue virus, and vector control programmes have been largely unsuccessful in preventing outbreaks, vaccination seems to be the most viable option for preventing infection. An ideal dengue vaccine should provide long lasting immunity against all four serotypes of the virus. The envelope protein of the virus plays a key role in vaccine development. The present day candidate vaccines includes a live attenuated tetravalent vaccine, intertypic chimaeric vaccines based on live attenuated dengue virus vectors, chimaeric vaccines based on the live attenuated Yellow Fever 17D vector and recombinant vaccines which include vaccines based on flavivirus and non-flavivirus vectors. Tetravalent live attenuated vaccines, intertypic chimaeric vaccines and chimaeric vaccines are being tested in human trials. Recombinant DNA vaccines based on flavivirus and non-flavivirus vectors are being tested in animal trials. Recent studies have shown that the tetravalent formulations may elicit an unbalanced immune response. Research is continuing to find means of obtaining a balanced response to all antigens in the tetravalent formulations.

Plasmodium falciparum Containment Strategy

World Health Organization (WHO) estimates 1.7-2.5 million deaths and 300-500 million cases of malaria each year globally. As an initiative WHO has announced Roll Back Malaria (RBM) programme aimed at 50% reduction in deaths due to malaria by 2010. The RBM strategy recommends combination approach with prevention, care, creating sustainable demand for insecticide treated nets (ITNs) and efficacious antimalarials in order to achieve sustainable malaria control. Malaria control in India has travelled a long way from National Malaria Control Programme launched in 1953 to National Vector Borne Diseases Control Programme in 2003. In India, the malaria eradication concept was based on indoor residual spraying to interrupt transmission and mop up cases by vigilance. This programme was successful in reducing the malaria cases from 75 million in 1953 to 2 million but subsequently resulted in vector and parasite resistance as well as increase in P falciparum from 30-48%. In view of rapidly growing resistance of Plasmodium falciparum to conventional monotherapies and its spread in newer areas, the programme was modified with inclusion of RBM interventions and revision of treatment guidelines for malaria. Early case detection and prompt treatment, selective vector control, promotion of personal protective measures including ITNs and information, education, communication to achieve wider community participation will be the key interventions in the revised programme.

Atovaquone/Proguanil : A New Drug Combination to Combat Malaria

Emerging drug resistance and intolerance to standard agents such as chloroquine, sulfadoxine/pyrimethamine and mefloquine has highlighted the need for new antimalarials. Although chloroquine remains the treatment of choice, a fixed dose combination of atovaquone/proguanil may be considered as the most promising alternative for prevention and treatment of malaria in chloroquine resistant areas. The combination has been found to be highly effective with a good tolerance and safety profile [1].

Miltefosine: First Oral Drug for Treatment of Visceral Leishmaniasis

Visceral leishmaniasis (VL) or kala-azar is caused by Leishmania donovani and transmitted to humans by female phlebotomine sandflies. Leishmaniasis is distributed worldwide infecting 12 million people, with about 1.5 million new cases each year. Along with Brazil, Sudan and Bangladesh, India contributes to 90% of the global burden of VL [1]. Soon National Leishmaniasis Control Programme in India may have a new drug to fight VL - miltefosine. Miltefosine (Impavido™) is the first oral drug for leishmaniasis, giving cure rates of 98%. The drug can be administered orally and has the potential to be used at the community level and even during an epidemic [2].

Pandemic Response and International Health Regulations

In 1377, Venice wrote the first recorded quarantine legislation to protect itself from rats on ships arriving from foreign ports [1]. The “transnationalization” of infectious diseases across geopolitical boundaries during cholera epidemics in 1830 and 1847 in Europe, catalysed the evolution of earliest multilateral governance of communicable diseases. In 1851, France convened the first International Sanitary Conference, which laid down the basic tenet of maximum protection against international spread of infectious diseases with minimum restriction [2]. A full century lapsed before the international sanitary rules were adopted in 1951 and these were amended in 1969 to become the International Health Regulations (IHR), revised in 1973 and 1981. Three communicable diseases cholera, plague, yellow fever currently must be reported under the IHR. New diseases have been emerging at the unprecedented rate. The international response to severe acute respiratory syndrome (SARS) emphasized the need to promptly report cases with the potential of international spread.

The Polymeal: A Natural, Safer and Probably Tastier Strategy to Reduce Cardiovascular Disease (Journal Scan) - Reply.

Table 1, which has compared the results of Polymeal is reproduced below. Polymeal have been compared with reference value. Changing over to Polymeal has beneficial effect. However it should not be recommended for people above 50 years of age having cardiovascular disease. Table 1 Lifetime effect (years) of Polymeal at age 50, stratified by sex

Field Adaptable Tests for Kala-Azar

Leishmaniasis is endemic in the tropical and subtropical regions. 12 million cases occur worldwide with 1 to 1.5 million cutaneous and 500,000 visceral leishmaniasis (kala-azar, VL) occuring fresh every year. Leishmania-HIV coinfection is emerging in southern Europe where 25 to 70% of adults with VL have AIDS as well. In the Indian subcontinent, the disease is almost exclusively caused by L donovani. Diagnosis of kala azar (VL) is by demonstration of amastigotes in splenic or bone marrow smears or by culture of leishmania promastigotes from clinical specimen. While the sensitivity of splenic smears could be as high as > 95%, it carries the risk of severe/fatal haemorrhage. Bone marrow aspiration is painful, cumbersome and has a low sensitivity (60-85%). Culture can not be used for routine clinical diagnosis as it requires expensive equipment and expertise [1].