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.
COVID-19 is an emerging viral disease affecting more than 200 countries worldwide and it present with varied clinical profile throughout the world. Without effective drugs to cure COVID-19, early identification and control of risk factors are important measures to combat COVID-19. This study was conducted to determine the clinical profile and risk factors associated with mortality among COVID-19 patients in a tertiary care hospital in South India. This record-based longitudinal study was conducted by reviewing the case records of COVID-19 patients admitted for treatment from June 2020 to September 2020 in a tertiary care centre in South India. The clinical details, discharge/death details, were collected and entered in MS Excel. Potential risk factors for COVID-19 mortality were analysed using univariate binomial logistic regression, generalized linear models (GLM) with Poisson distribution. Survival curves were made using the Kaplan-Meier method. Log-rank test was used to test the equality of survivor functions between the groups. Out of 854 COVID-19 patients, 56.6% were men and the mean (standard deviation) age was 45.3(17.2) years. The median survival time was significantly lesser in male COVID-19 patients (16 days) as compared to female patients (20 days). Increasing age, male gender, patients presenting with symptoms of fever, cough, breathlessness, smoking, alcohol consumption, comorbidities were significantly associated with mortality among COVID-19 patients. Patients with older age, male gender, breathlessness, fever, cough, smoking and alcohol and comorbidities need careful observation and early intervention. Public health campaigns aimed at reducing the prevalence of risk factors like diabetes, hypertension, smoking and alcohol use are also needed.
Low birth weight (LBW) is a major cause for neonatal morbidity and mortality. Apart from various medical risk factors, social factors also have an impact on birth weight. The objective of the study were to review the globally available evidences on the association between LBW and social factors like social support, spouse support and spouse abuse experienced by the mothers during the antenatal period. A narrative review was done during 2017 in which various literatures available “PubMed” and “Google Scholar” related to the social factors like social support, spouse support and spouse abuse and low birth weight were reviewed after checking for full text availability and removing duplicates. The antenatal mothers with high perceived social support was associated with 60% lesser odds of having LBW. Mothers with high perceived spouse support had 23% lesser odds of having LBW both of which might act through financial, moral, emotional and behavioral pathways. Various studies have found positive association between LBW and spouse abuse and the OR ranged from 1.3 to 3.8. The definitions and instruments used for the social support, spouse support and spouse abuse are varied making it difficult to interpret varied results in different study settings. With the available few evidences it can be concluded that lack of spouse support and social support and the presence of spousal abuse during antenatal period increases the odds of still birth, preterm birth and low birth weight among children.
Background: School absenteeism during menstruation and its related effects are preventable through identification of factors associated with it and implementation of region specific appropriate public health measures. Objectives: To assess the prevalence of school absenteeism during menstruation and its associated factors among adolescent girls residing in the resettlement colonies of Delhi. Methods: A community-based cross-sectional study was conducted in the urban resettlement colonies of Delhi during 2019 in which 712 school going adolescent girls were interviewed. The details about school absenteeism, its perceived reasons, various socio-demographic details, menstrual hygiene practices were assessed using pretested semi structured questionnaire. The data were entered in MS Excel and analysed using STATA statistical software version 14. Results: The prevalence of school absenteeism during menstruation among adolescent girls of resettlement colony was 43.1%(95% CI:39.5 – 46.7). Out of 307 girls who had school absenteeism, 285(92.8%) had missed for 1-3days. The most common self-reported reasons for school absenteeism during menstruation were pain during menstruation (75.6%) followed by staining of cloths(43.6%) and uncomfortable feeling(39.4%). Studying in government school (PR=1.4, 95% CI:1.1-2.0), suffering from menstruation-related problems(aPR=1.9, 95% CI:1.5-2.4) and pads being provided from schools(PR=1.3, 95% CI:1.1-1.7) were significantly associated with school absenteeism. Conclusions: Almost half of the adolescent girls in resettlement colonies had school absenteeism. The characteristics like government school, pads being provided from school, menstruation related problems like weakness, irritation, perceived weight gain and breast pain was significantly associated with school absenteeism. The factors associated with school absenteeism needs to be addressed with appropriate public health interventions.
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.
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.
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