National Institute of Epidemiology


National Institute of Epidemiology

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Murhekar M.,National Institute of Epidemiology
American Journal of Tropical Medicine and Hygiene | Year: 2017

Diphtheria is an acute disease caused by exotoxin-producing Corynebacterium diphtheriae. Globally, diphtheria has been showing a declining trend due to effective childhood vaccination programs. A substantial proportion of global burden of diphtheria is contributed by India. Hospital-based surveillance studies as well as diphtheria outbreaks published in last 20 years (1996-2016) indicate that diphtheria cases are frequent among school-going children and adolescents. In some Indian states, Muslim children are affected more. As per the national level health surveys, coverage of three doses of diphtheria vaccine was80%during 2015-2016. Information about coverage of diphtheria boosters is not routinely collected through these surveys, but is expected to be low. Few studies also indicate low diphtheria immunity among school-going children and adults. The strategies for prevention of diphtheria need to focus on improving coverage of primary and booster doses of diphtheria vaccines administered as a part of Universal Immunization Program as well as introducing diphtheria vaccine for school-going children. © 2017 by The American Society of Tropical Medicine and Hygiene.

Pal P.,National Institute of Epidemiology | Kaur P.,National Institute of Epidemiology Indian Council of Medical Research
International Journal of Adolescent Medicine and Health | Year: 2017

Background: Adolescents constituted 19% population of India in 2011. Adolescents have health seeking behaviour different from that of adults. We estimated the utilisation of available health care services by adolescents and awareness regarding various health issues in the urban and rural Dehradun District, Uttarakhand, India. We also described knowledge and practices of public sector health care providers. Methodology: We conducted a cross-sectional survey among adolescents 10-19 years in the urban Dehradun and rural Chakrata block of the Dehradun District. We used cluster sampling with sample size 680 each in urban and rural areas. We collected data from adolescents using semi structured questionnaire on health awareness and utilisation of health care services. Public sector health care providers were surveyed about their knowledge and practices regarding adolescents health. Results: We surveyed 1463 adolescents. The overall mean age was 14.4 (2.6) years, about half being females. Half of the adolescents who had any illness used the public sector. Awareness about anaemia was 48% in urban and 12% in rural areas. A higher proportion of females (Rural: 89%, Urban: 76%) were aware of condoms as contraceptives than males (Rural: 68%, Urban: 12%). Only 62% of doctors and 49% of paramedical staff had knowledge regarding services under Adolescents Reproductive and Sexual Health (ARSH). Conclusion: Awareness regarding various health issues was low among males as compared to females, especially in rural areas. School based health promotion programs should be carried out to increase awareness among adolescents. Health facilities should be strengthened to provide adolescent friendly health services to enhance utilisation.

Subramanian T.,National Institute of Epidemiology
Indian journal of medical ethics | Year: 2013

The growing public concern about the ethical conduct of healthcare professionals highlights the need to incorporate clinical ethics in medical education. This study examined the knowledge and practice of clinical ethics among healthcare providers in a government hospital in Chennai. A sample of 51 treating physicians and 58 other non-physician service providers from the hospital answered a self-administered, semi-structured questionnaire on their knowledge of and adherence to ethical principles, and the problems they faced related to healthcare ethics. More than 30% did not give a definition of healthcare ethics, and 40% did not name a single ethical principle. 51% stated that they witnessed ethical problems in their settings and named patient dissatisfaction, gender bias by provider, and not maintaining confidentiality. The responses of healthcare providers to various ethical scenarios are reported.

Vijayakumar L.,SNEHA | Vijayakumar L.,Voluntary Health Services | Kumar M.S.,National Institute of Epidemiology | Vijayakumar V.,Voluntary Health Services
Current Opinion in Psychiatry | Year: 2011

Purpose of Review: To address gaps identified in earlier reviews, namely, the comparative influence of substance use on attempted suicide and completed suicide; the proximal role of substance use as a trigger of suicidal behaviour; the association between substances and suicidal behaviour; suicide and substance use disorders in youth; and the influence of combinations of risk factors, including psychiatric morbidity, on suicide. Recent Findings: The presence of an alcohol use disorder is confirmed as a distal risk factor for completed suicide, as well as attempted suicide. Alcohol use at the time of the suicide attempt is associated with low-risk methods. The use of other substances as a trigger of suicidal behaviour is highlighted in recent studies, but the circumstances leading to the suicidal act and the direct influence of substances in suicidal behaviour need to be explored further. Inhalant use and cocaine use are particularly associated with suicidal behaviour. Young people with multiple risk behaviours, such as substance use and risky sexual behaviours, are at high risk for suicidal behaviour. Psychiatric comorbidity with substance use escalates the risk for suicidal behaviour. Environmental interventions, such as reduction in the number of bars, may be helpful in reducing alcohol-related morbidity, including suicides. Summary: Prevention strategies for reducing suicidal behaviour among substance users need to be prioritized at the individual and the national level through effective design, policy and implementation. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Kasabi G.S.,National Institute of Epidemiology
Emerging infectious diseases | Year: 2013

To determine the cause of the recent upsurge in Kyasanur Forest disease, we investigated the outbreak that occurred during December 2011-March 2012 in India. Male patients >14 years of age were most commonly affected. Although vaccination is the key strategy for preventing disease, vaccine for boosters was unavailable during 2011, which might be a reason for the increased cases.

To predict dwellings for the presence of Aedes larvae rapidly based on Premises Condition Index (PCI) factors, we studied the possible presence of Aedes species mosquitoes larvae among houses in the Chidambaram urban of Cuddalore District in Tamil Nadu, India based on the scores of variables in PCI, namely House, Yard and degree of shadow. Data of these variables were collected in September and October 2006 from 1813 houses in the Chidambaram urban area during the intensive vector control activities employed for the prevention and control of Chikungunya. Methods: The association between presence of larvae and the variables of PCI was tested by Chi-square and Correlation. The predictability of the presence of Aedes larvae based on PCI factors was computed by logistic regression. Results: The study shows 301 containers in 132 houses were found positive with Aedes species out of 1813 houses surveyed. It was further observed that the probability of presence of positive premises was four times higher in the premises with 75% shadow compared with premises with a 25% shadow. These findings showed a significant association (p < 0.001) with positive premises. Conclusions: It is concluded that this study helps in conducting rapid survey to identify the presence of Aedes larvae with a minimum number of staff for both inspection and treatment of Aedes larvae during the epidemic situation. © 2012.

Thakur R.,Government of Himachal Pradesh | Murhekar M.,National Institute of Epidemiology
Indian Journal of Tuberculosis | Year: 2013

Background: Delay in TB diagnosis and treatment is associated with increased transmission, morbidity and mortality. Patient and provider factors are responsible for such delays. We conducted a study to estimate these delays and identify associated factors among new sputum positive (NSP) TB patients in Mandi district, Himachal Pradesh. Methods: We interviewed 234 NSP patients to collect information on their health seeking behaviour. We conducted univariate and multivariate analysis to identify factors associated with longer delays. Results: Median patient, health system and total delay were 15, 13 and 36 days respectively. Significant factors associated with total delay included patients' knowledge about TB, seeking care from non-specialized individuals as the first action, consulting >2 health facilities before diagnosis and consulting private health facilities. Patients with low family income and those who had high expenditure on consultations before initial diagnosis were associated with patient and health system delay respectively. Conclusion: It is necessary to increase community awareness about TB symptoms and availability of free treatment at public health facilities. Educating private physicians about the need for maintaining a high index of suspicion of tuberculosis and sensitizing drug-store owners to refer the chest symptomatics to government health facilities would also help in reducing these delays. © The Tuberculosis Association of india, Inc. All rights reserved.

Globally, 1 billion people live in slums. There are few reports of high prevalence of noncommunicable disease (NCD) risk factors among the urban poor. The prevalence of NCD risk factors in the slums in North 24 Parganas, West Bengal, India was estimated. Cross-sectional survey in 24 slums selected using cluster sampling method was conducted. Questionnaire for behavioral risk factors was used and anthropometric and blood pressure measurements were done. The study population included 1052 participants aged 25-64 years, 528 (50%) were males. Among males, 206 (39%) were current smokers and 154 (29%) were current alcohol users. Central obesity was prevalent among 32.8% males and 56.1% females and 115 (10.9%) had body mass index ≥27.5 kg/m 2 . Hypertension was prevalent among 35% males and 33% females. We observed high prevalence of NCD risk factors among urban slum dwellers that need to be addressed with health promotion programs and strengthening of primary health care system.

Allam R.R.,National Institute of Epidemiology
Indian journal of public health | Year: 2013

The first case of pandemic Influenza A (H1N1) in India was reported from Hyderabad, Andhra Pradesh on 16 th May 2009. Subsequently, all suspected cases seeking treatment from A (H1N1) treatment centers and their contacts were tested. Laboratory confirmed cases were hospitalized and treated with antivirals according to national guidelines. We reviewed the surveillance data to assess the morbidity and mortality due to A (H1N1) in the state of Andhra Pradesh (population-76,210,007) during the period from May 2009 to December 2010. We obtained the line-list of suspected (influenza like illness as per World Health Organization case definition) and laboratory confirmed cases of A (H1N1) from the state unit of integrated disease surveillance project. We analyzed the data to describe the distribution of case-patients by time, place and person. During May 2009 to December 2010, a total of 6527 suspected (attack rate: 8.6/100,000) and 1480 (attack rate: 1.9/100,000) laboratory confirmed cases were reported from the State. Nearly 90% of the suspected and 93% of the confirmed cases was from nine districts of Telangana region, which includes Hyderabad. Nearly 65% of total confirmed cases were reported from Hyderabad. The attack rate was maximum (2.6/100,000) in the age group of 25-49 years. The cases peaked during August-October. 109 case-patients died (Case fatality ratio: 7%) and most (80%) of these patients had comorbid conditions such as diabetes (24%), chronic obstructive pulmonary disease (20%), hypertension (11%) and pregnancy (11%). Case fatality was higher (16%) among patients who were older than 60 years of age compared with other age groups. In Andhra Pradesh, H1N1 transmission peaked during August-October months and predominately affected adults. Case fatality was higher in patients older than 60 years with comorbid conditions.

News Article | November 12, 2016

The late Vasanthapuram Kumaraswami, MD, PhD (1950-2016), a pioneer in the fight against neglected tropical diseases, was awarded today the second annual Kyelem Prize at the annual meeting of the Coalition for Operational Research on Neglected Tropical Diseases, or COR-NTD. The award – received by Dr. Kumaraswami’s children Sameer and Manjusha Vasanthapuram – recognized a lifelong commitment to bringing innovative solutions to the fight against debilitating neglected tropical diseases. “It’s so fitting that Dr. Kumaraswami has been selected for this honor, which itself is given in memory of Dominique Kyelem,” said Julie Jacobson, MD, senior program officer with the Bill & Melinda Gates Foundation, who won the inaugural Kyelem Prize in 2015 and presented this year’s award. “Both men achieved amazing strides to prevent disease in the developing world, and both did so with a spirit of humility and optimism.” Dr. Kumaraswami worked for 40 years to eliminate lymphatic filariasis, which can cause a disfiguring condition called elephantiasis. He was the director-in-charge of the National Institute for Research in Tuberculosis (formerly the Tuberculosis Research Centre) and the National Institute of Epidemiology, both institutes of the Indian Council for Medical Research. In these roles, Kumaraswami pioneered research on the impact of a medicine called ivermectin on lymphatic filariasis. He also contributed to the founding of the Global Programme to Eliminate Filariasis, and propelled stakeholders to expand mass drug administration programs in India and the South-East Asia region to control the disease. After he retired, he joined the Atlanta-based Task Force for Global Health in Atlanta for two years as associate director of international programs. “Dr. Kumaraswami’s genius was not just his achievements – it was, rather, his ability to provide that spark, that environment, that opportunity for people to come together and work together to achieve great things, both at home in India and at home in the world,” said Eric Ottesen, MD, director of the Neglected Tropical Diseases Support Center, a program of The Task Force for Global Health that serves as the COR-NTD Secretariat. The 2016 Kyelem Prize was announced at the close of the COR-NTD meeting in Atlanta. Nearly 400 researchers, program implementers, donors, and representatives of the World Health Organization convened for the meeting to identify key questions facing programs aimed at eliminating neglected tropical diseases such as lymphatic filariasis. “Dr. Kumaraswami dedicated his life to ensuring that as many people as possible received treatment for lymphatic filariasis,” said Dr. Jacobson. “He leaves a large hole, but our coalition is determined to march forward and carry out both his and Dr. Kyelem’s legacy.” About the Coalition for Operational Research on Neglected Tropical Diseases: The Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD) is a group of researchers, program implementers and their supporters with the shared goal of optimizing NTD control and elimination. Supported by grants from the Bill & Melinda Gates Foundation and the U.S. Agency for International Development to the Neglected Tropical Diseases Support Center at the Task Force for Global Health – which serves as the Coalition Secretariat – the aim of COR-NTD is to create new synergies within the operational research community for NTDs and align that research with the program needs. Learn more at About The Task Force for Global Health: The Task Force for Global Health works to reduce the global burden of disease and build public health systems that serve all people. Founded in 1984 by global health pioneer Dr. Willliam Foege, The Task Force consists of eight programs focused on neglected tropical diseases, vaccines, and health systems strengthening. It is affiliated with Emory University, headquartered in Decatur, GA, and has regional offices in Guatemala and Ethiopia. The Task Force received the 2016 Conrad N. Hilton Humanitarian Prize for its extraordinary contributions to alleviating human suffering. Learn more at

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