Background: There is emerging evidence that patients with Latent Tuberculosis Infection(LTBI) and Tuberculosis(TB) disease have an increased risk of the SARS-CoV-2 infection and predisposition towards developing severe COVID-19 pneumonia. In this study we attempted to estimate the number of TB patients infected with SARS-CoV-2 and have severe disease during the COVID-19 epidemic in Delhi, India. Methods: Susceptible-Exposed-Infectious-Recovered (SEIR) model was used to estimate the number of COVID-19 cases in Delhi. Assuming the prevalence of TB in Delhi to be 0.55%, 53% of SARS-CoV2 infected TB cases to present with severe disease we estimated the number of SARS-CoV2 infected TB cases and the number of severe patients. The modelling used estimated R 0 for two scenarios, without any intervention and with public health interventions. Results: We observed that the peak of SARS-CoV-2-TB co-infected patients would occur on the 94th day in absence of public health interventions and on 138th day in presence of interventions. There could be 20,880 SARS-CoV-2 infected TB cases on peak day of epidemic when interventions are implemented and 27,968 cases in the absence of intervention. Among them, there could be 14,823 patients with severe disease when no interventions are implemented and 11,066 patients with severe disease in the presence of intervention. Conclusion: The importance of primary prevention measures needs to be emphasized especially in TB patients. The TB treatment centres and hospitals needs to be prepared for early diagnosis and management of severe COVID-19 in TB patients.
Background: There are apprehensions amongst healthcare worker (HCWs) about COVID-19. The HCWs have been given hydroxychloroquine (HCQ) chemoprophylaxis for seven weeks as per Government of India guidelines. Objectives: To assess the apprehensions amongst HCWs about COVID-19 and to document accessibility, adherence and side effects related to HCQ prophylaxis in HCWs. Methods: A longitudinal follow up study was conducted in a tertiary care hospital. HCQ was given in the dose of 400 mg twice on day one, and then 400 mg weekly for seven weeks. 391 HCWs were interviewed using semi-structured questionnaire. Results: 62.2% HCWs expressed perceived danger posted by COVID-19 infection. Doctors (54%) showed least acceptance and paramedics (88%) showed highest acceptance to chemoprophylaxis. 17.5% participants developed at least one of the side effects to HCQ. Females and nursing profession were significantly associated with adverse effects. Common side effects were gastro-intestinal symptoms, headache and abnormal mood change. Most of these were mild, not requiring any intervention. Gender, professions and perceived threat of COVID-19 were significantly associated with acceptance and adherence to HCQ prophylaxis. Conclusion: Two thirds of HCWs had perceived danger due to COVID-19. Three fourth of the HCWs accepted chemoprophylaxis and four out of five who accepted had complete adherence to prophylaxis schedule. One out of five had developed at least one of side effects; however, most of these were mild not requiring any intervention.
Background: Malnutrition is a consequence of food insecurity. Food insecurity in India became a public health problem due to explosive population growth and widening gap between rich and poor. It also has a detrimental effect on factors related to health and social well-being of the family. Objectives: The study was conducted to determine the prevalence of food insecurity at household level in rural population and factors associated with it. Subjects and Methods: A community-based cross-sectional study was conducted among the households of rural Puducherry. The adult females in the households were interviewed with a pretested semi-structured questionnaire in which, along with sociodemographic factors, food insecurity was assessed using the Household Food Insecurity Access Scale. Univariate and multivariate logistic regression analysis was done to identify the factors associated with food insecurity. Results: Out of 299 households that were assessed for food insecurity, 31.7% (95% confidence interval [CI]: 26.6–37.4) had food insecurity. Out of 95 households with food insecurity, 51 (17%), 37 (13%), and 7 (2%) had severe, moderate, and mild food insecurity, respectively. In univariate analysis, the presence of children in the family, using below poverty line ration card, and socioeconomic status were significantly associated with food insecurity. In multivariate analysis, socioeconomic status was significantly associated with food insecurity (rate ratio: 3.59; P < 0.001 [95% CI: 1.68–7.67]). Conclusions: One in three families experienced the food insecurity, and it was more among households with children. It has to be addressed to prevent nutrition-related disorders in community, particularly in children.
Objectives:The study aimed to estimate the disease burden due to COVID-19 in the scenarios of unchecked spread and with various public health interventions in New Delhi.Methods: We adopted Susceptible, Exposed, Infected and Recovered (SEIR) model to estimate the course of COVID-19 outbreak in Delhi population and effect of public health intervention on the pandemic. We first estimated the basic reproductive rate (R 0 ) based on the evidence from Wuhan, then ran the model considering no intervention implemented, followed by case isolation, social distancing, and lockdown, each implemented in isolation and in combinations to estimate the number of cases. Markov's model was used to estimate the number of cases in various clinical scenarios of the disease. Sensitivity analysis conducted to estimate the effect of asymptomatic cases on case based interventions.Results: Estimated R 0 in Delhi population was 6.18 (range 4.15 -12.2). Effective reproductive rate (R t ) was least for case isolation (3.5). Lockdown showed highest reduction (28%) in number of prevalent cases on peak day and 22% reduction in patients in need of intensive care unit (ICU). Case isolation and lockdown together resulted in 50% reduction in number of prevalent cases and 42% reduction in patients in need of ICU care. Sensitivity : medRxiv preprint 2 analysis showed that the effect of case isolation was inversely proportionate to the proportion of asymptomatic (hidden) cases. Conclusions:Interventions should be implemented in combinations of individual and community level interventions to gain better outcome. Identifying and isolation of all cases as early as possible is important to flatten the pandemic curve.
Introduction:Uncontrolled blood pressure (BP) among hypertensive patients leads to life-threatening complications, hospitalization, and premature mortality. Knowledge on the burden of uncontrolled BP and its correlates will help in devising strategies to achieve goal BP. We aimed to determine the proportion who have not achieved goal BP and its associated factors among hypertensive patients in a Primary Health Centre (PHC).Materials and Methods:A facility-based cross-sectional analytical study was conducted among the hypertensive patients attending chronic disease clinic of PHC at Ramanathapuram, Puducherry. BP was measured and goal BP was defined based on Joint National Committee-8 criteria. The interview was conducted using semi-structured questionnaire capturing sociodemographic details, behavioral characteristics, physical activity with the International Physical Activity Questionnaire (IPAQ), medication adherence with Morisky Medication adherence scale-8 (MMAS-8), and stress with perceived stress scale. The data were entered and analyzed using EpiData software. The proportion “not achieved goal BP” was expressed as percentage and association were measured using prevalence ratios (PRs) with 95% confidence interval (CI).Results:Of total 259 hypertensives studied, 140 (54.1%) were aged above 60 years, and 161 (62.2%) were females. Overall, 63 (24.3%) participants had not achieved goal BP. On univariate analysis, individuals aged 45–59 years (PR-2.1 [95% CI: 1.4–3.4]), being male (PR-1.6 [95% CI: 1.1–2.4]) and employed (PR-2.0 [95% CI: 1.1–3.5]) were associated with not achieving goal BP.Conclusion:One-fourth of patients treated for hypertension in PHC failed to achieve goal BP. Considering the consequences of uncontrolled BP, cost-effective, context-specific interventions at the primary health-care level are needed.
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