rajaram yadav | International Institute for Population Sciences, Mumbai (original) (raw)

Papers by rajaram yadav

Indian Journal of Medical Research, 2020

Background & objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infecti... more Background & objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread rapidly, causing unprecedented case fatalities across the world. The first laboratory-confirmed case of COVID-19 and also the first death associated with the disease in the eastern part of Uttar Pradesh (UP) was reported from Basti on March 31, 2020. The present study describes a cluster of 17 cases including one death of confirmed COVID-19 in Basti, UP, India. Methods: A 25 year old male from Basti, UP, India, who died of respiratory failure was diagnosed post-mortem as SARS-CoV-2 positive. Contact tracing carried out by the district administration found 16 cases positive among tested contacts. A detailed retrospective investigation in the form of one-to-one interview was carried out with 16 recovered individuals to understand the transmission dynamics and clinical characteristics. Results: The findings showed that the cluster transmission occurred at three levels: first was direct contact with the index case which resulted in two secondary cases. Second, at a household level where four of the seven susceptible contacts got infected, and the third was an event (funeral) where 50 individuals participated and this resulted in seven SARS-CoV-2-infected individuals in whom infection could be directly linked to a funeral gathering. The index case had associated comorbidities and succumbed to death. Most of the cases were asymptomatic except two individuals, who developed mild symptoms. The mean duration of quarantine facility was 21.6±7.3 days, and the average time taken for the first negative test after testing positive to COVID-19 was 12±4.1 days. Interpretation & conclusions: The funeral acted as a super-spreader event for the transmission of infection among family members, relatives and others. Active contact tracing and confirmation of infection among the contacts led to the isolation of 16 SARS-CoV-2 positive cases and hence the limited spread of the disease. Asymptomatic carriers and super-spreader events are among the major challenges in the control and prevention of SARS-CoV-2 transmission. Early testing, quarantine and social distancing may play key role in breaking the chain of transmission.

Zoonoses and Public Health

BMJ Open

ObjectiveTo determine the Japanese encephalitis (JE)-associated long-term functional and neurolog... more ObjectiveTo determine the Japanese encephalitis (JE)-associated long-term functional and neurological outcomes, the extent of reduced social participation and predictors of poor outcomes among paediatric JE survivors.DesignA retrospective cohort study.SettingLaboratory-confirmed JE-positive paediatric cases (<16 years of age) hospitalised at the paediatric ward of Baba Raghav Das Medical College, Gorakhpur, India, between 1 January 2017 and 31 December 2017, were followed up after 6–12 months of hospital discharge.Participants126 patients were included in the study; median age was 7.5 years (range: 1.5–15 years), and 74 (58.73%) were male.Outcome measuresFunctional outcome defined by Liverpool Outcome Score (LOS) dichotomised into poor (LOS=1–2) and good (LOS=3–5) outcome groups compared for demographic, clinical and biochemical parameters for prognostic factors of poor outcomes. Social participation of patients scaled on Child and Adolescent Scale of Participation score 2–5.Resu...

PLOS Global Public Health

Treatment-seeking behaviour is closely associated with the health status of individuals and count... more Treatment-seeking behaviour is closely associated with the health status of individuals and countries. About 800 million people have no access to health services in the developing world. Though the situation has been improving, the inequalities across geographical regions, socioeconomic status, and disease types continued to persist. The available literature suggests research gaps in examining the unmet need for treatment-seeking from public health facilities across sociodemographic characteristics, regions, and specific diseases. Data for this study comes from the three rounds of National Sample Survey (NSS) (2004, 2014, 2018). We applied descriptive, bivariate, and multivariable analysis to investigate the unmet need for treatment-seeking for public health facilities across sociodemographic characteristics, regions, and specific diseases between 2004 and 2018. The unmet need for treatment-seeking from public health facilities remained high at 60% in 2004 to 62% in 2018. However, t...

Frontiers in Public Health, 2022

BackgroundNoncommunicable disease (NCD) multimorbidity throws a unique challenge to healthcare sy... more BackgroundNoncommunicable disease (NCD) multimorbidity throws a unique challenge to healthcare systems globally in terms of not only management of disease, but also familial, social, and economic implications associated with it.ObjectiveTo assess the prevalence of NCD multimorbidity and its associated risk factors along with health expenditures among adults (≥18 years) living in a rural area.MethodsA secondary data analysis of the first-round survey done as part of the Gorakhpur Health and Demographic Surveillance Site (GHDSS) was done. Information related to self-reported morbidity and other variables related to sociodemographics and out-of-pocket expenditure (OOPE) was captured using a pretested questionnaire. Multivariable cluster adjusted binomial regression analysis was done to identify factors associated with multimorbidity.ResultsThe overall prevalence of NCD multimorbidity was found to be 1.8% (95% CI: 1.7–1.9%). The prevalence of NCD multimorbidity was highest among elderly...

Epidemiology and Infection, 2021

We report a familial cluster of 24 individuals infected with severe acute respiratory syndrome-co... more We report a familial cluster of 24 individuals infected with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). The index case had a travel history and spent 24 days in the house before being tested and was asymptomatic. Physical overcrowding in the house provided a favourable environment for intra-cluster infection transmission. Restriction of movement of family members due to countrywide lockdown limited the spread in community. Among the infected, only four individuals developed symptoms. The complete genome sequences of SARS-CoV-2 was retrieved using next-generation sequencing from eight clinical samples which demonstrated a 99.99% similarity with reference to Wuhan strain and the phylogenetic analysis demonstrated a distinct cluster, lying in the B.6.6 pangolin lineage.

In India all three indicators of child malnutrition have lower prevalence in urban areas in compa... more In India all three indicators of child malnutrition have lower prevalence in urban areas in comparison to rural areas. In fact children from backward socio-economic strata are high in proportion to be malnourished than their counterparts in all the three dimensions of measurements. These discrepancies in poor socio-economic conditions may also be due to lack of knowledge about child care, poor condition of water and sanitation, lack of access of health care services in rural areas. There is not much difference in prevalence of malnutrition in male and female. In all the major states prevalence of stunting and underweight is higher among poor in comparison to non-poor. At the national level there is significance difference among poor and non-poor in terms of prevalence of all three indicators of child malnutrition. Poor children are more undernourished, it may be due to the lower purchasing power of nutritious food among poor families. Since they are poor, their hygienic condition ma...

International Journal Of Community Medicine And Public Health, 2021

Background: Child undernutrition is a major public health problem in many low and middle income c... more Background: Child undernutrition is a major public health problem in many low and middle income countries and malnutrition alone accounted for 45% (3 million deaths annually) deaths among under-five children. Malnutrition is the concealed cause of one out of every two such deaths. A study was undertaken to examine the trends, determinants and socioeconomic-related inequalities in childhood undernutrition in empowered action group (EAG) states, India. The secondary data of the two rounds of National Family Health Survey, NFHS-3 (2005-06) and NFHS-4 (2015-16) comprising of 16,802 and 128,400 children aged 0-59 months respectively was analysed.Methods: Non-linear Fairlie decomposition was used to identify and quantify the separate contribution of different socioeconomic characteristics in gap of childhood malnutrion between 2006 and 2016.Results: Results show that the prevalence of undernutrition has decreased in EAG states during the last one decade, but the prevalence of wasting is r...

Injury Prevention, 2020

BackgroundWhile there is a long history of measuring death and disability from injuries, modern r... more BackgroundWhile there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.MethodsIn this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.ResultsGBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in te...

Indian Journal of Medical Research, 2020

Background & objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infecti... more Background & objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread rapidly, causing unprecedented case fatalities across the world. The first laboratory-confirmed case of COVID-19 and also the first death associated with the disease in the eastern part of Uttar Pradesh (UP) was reported from Basti on March 31, 2020. The present study describes a cluster of 17 cases including one death of confirmed COVID-19 in Basti, UP, India. Methods: A 25 year old male from Basti, UP, India, who died of respiratory failure was diagnosed post-mortem as SARS-CoV-2 positive. Contact tracing carried out by the district administration found 16 cases positive among tested contacts. A detailed retrospective investigation in the form of one-to-one interview was carried out with 16 recovered individuals to understand the transmission dynamics and clinical characteristics. Results: The findings showed that the cluster transmission occurred at three levels: first was direct contact with the index case which resulted in two secondary cases. Second, at a household level where four of the seven susceptible contacts got infected, and the third was an event (funeral) where 50 individuals participated and this resulted in seven SARS-CoV-2-infected individuals in whom infection could be directly linked to a funeral gathering. The index case had associated comorbidities and succumbed to death. Most of the cases were asymptomatic except two individuals, who developed mild symptoms. The mean duration of quarantine facility was 21.6±7.3 days, and the average time taken for the first negative test after testing positive to COVID-19 was 12±4.1 days. Interpretation & conclusions: The funeral acted as a super-spreader event for the transmission of infection among family members, relatives and others. Active contact tracing and confirmation of infection among the contacts led to the isolation of 16 SARS-CoV-2 positive cases and hence the limited spread of the disease. Asymptomatic carriers and super-spreader events are among the major challenges in the control and prevention of SARS-CoV-2 transmission. Early testing, quarantine and social distancing may play key role in breaking the chain of transmission.

Sri Lanka Journal of Child Health, 2018

Background: Vaccination is the most costeffective intervention to improve health and reduce morbi... more Background: Vaccination is the most costeffective intervention to improve health and reduce morbidity and mortality due to vaccine-preventable diseases in the child population. The South Asian region was home to 1.8 of the 6 million babies who died within twenty-eight days of birth in 2015. Objective: To describe the status and its determinants of immunisation coverage in three South Asian countries, India, Bangladesh and Nepal.

Injury Prevention, 2020

BackgroundPast research in population health trends has shown that injuries form a substantial bu... more BackgroundPast research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.MethodsWe reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).FindingsIn 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty...

The Lancet, 2017

Background Monitoring levels and trends in premature mortality is crucial to understanding how so... more Background Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends. Methods We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016. Findings The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72•3% (95% uncertainty interval [UI] 71•2-73•2) of deaths in 2016 with 19•3% (18•5-20•4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8•43% (8•00-8•67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006-16-age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1•80 million deaths (95% UI 1•59 million to 1•89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176-181) increase in deaths in ages 90-94 years and a 210% (208-212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2•89%); the median annualised rate of change for all other causes was lower (a decrease of 1•59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe.

JAMA oncology, Jan 3, 2016

Cancer is the second leading cause of death worldwide. Current estimates on the burden of cancer ... more Cancer is the second leading cause of death worldwide. Current estimates on the burden of cancer are needed for cancer control planning. To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 32 cancers in 195 countries and territories from 1990 to 2015. Cancer mortality was estimated using vital registration system data, cancer registry incidence data (transformed to mortality estimates using separately estimated mortality to incidence [MI] ratios), and verbal autopsy data. Cancer incidence was calculated by dividing mortality estimates through the modeled MI ratios. To calculate cancer prevalence, MI ratios were used to model survival. To calculate YLDs, prevalence estimates were multiplied by disability weights. The YLLs were estimated by multiplying age-specific cancer deaths by the reference life expectancy. DALYs were estimated as the sum of YLDs and YLLs. A sociodemographic index (SDI) wa...

Healthcare

Background: The healthcare infrastructure of a country determines the health-seeking behaviour of... more Background: The healthcare infrastructure of a country determines the health-seeking behaviour of the population. In developing countries such as India, there is a great disparity in the distribution of healthcare institutions across urban and rural areas with disadvantages for people living in rural areas. Objectives: Our objectives were to study the health-seeking behavior and factors associated with the use of formal healthcare among the Gorakhpur Health and Demographic Surveillance System (GHDSS) cohort of North India. Methods: The study was conducted in 28 villages from two rural blocks in the Gorakhpur district of eastern Uttar Pradesh, North India. Structured questionnaires were used to collect the data with regard to demographics, health-seeking behaviour and healthcare utilization. An adjusted odds ratio with 95% confidence interval was used to report the factors associated with the utilization of healthcare. Results: Out of 120,306 individuals surveyed, 19,240 (16%) indivi...

Journal of Multidisciplinary Research in Healthcare

Background: It is well known that child nutrition is affected by many factors like socio-cultural... more Background: It is well known that child nutrition is affected by many factors like socio-cultural, economic and demographic, etc. Studies found that maternal education, wealth index, and ethnicity have an influence on child nutrition. In this paper, comparative study of malnutrition among children and mothers between 1992-93 and 2005-06 has been done. Objective: The main objective of the paper is to study how progress in demographic and other socioeconomic factors influence nutritional status of mother and children. Data and Methods: First round (1992-93) and third round (2005-06) of National Family Health Survey has been used to reach the objective of the study. To show the progress in nutritional status, percentage change in prevalence of malnutrition in different background characteristics from 1992-93 to 2005-06 has been calculated. To show the progress in different background characteristics and its effect on child malnutrition decomposition analysis has been done. Result: Almost all variable are significantly associated with child malnutrition thus more contribution of any variable in bringing the change in prevalence of malnutrition shows the more progress in that variable from 1992-93 to 2005-06. The decomposition analysis clearly shows that the condition of mother's Yadav, R Paul, K Saha, S 134 education and timing to initiate breastfeeding are found to be contributing significantly to the reduction of underweight among children between 1992-93 and 2005-06. Conclusion: This study shows that improvement in mother's education contributed the most in improving the nutritional status of children. Thus by increasing the educational in female under-nutrition can be reduced to a larger extent.

Indian Journal of Medical Research, 2020

Background & objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infecti... more Background & objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread rapidly, causing unprecedented case fatalities across the world. The first laboratory-confirmed case of COVID-19 and also the first death associated with the disease in the eastern part of Uttar Pradesh (UP) was reported from Basti on March 31, 2020. The present study describes a cluster of 17 cases including one death of confirmed COVID-19 in Basti, UP, India. Methods: A 25 year old male from Basti, UP, India, who died of respiratory failure was diagnosed post-mortem as SARS-CoV-2 positive. Contact tracing carried out by the district administration found 16 cases positive among tested contacts. A detailed retrospective investigation in the form of one-to-one interview was carried out with 16 recovered individuals to understand the transmission dynamics and clinical characteristics. Results: The findings showed that the cluster transmission occurred at three levels: first was direct contact with the index case which resulted in two secondary cases. Second, at a household level where four of the seven susceptible contacts got infected, and the third was an event (funeral) where 50 individuals participated and this resulted in seven SARS-CoV-2-infected individuals in whom infection could be directly linked to a funeral gathering. The index case had associated comorbidities and succumbed to death. Most of the cases were asymptomatic except two individuals, who developed mild symptoms. The mean duration of quarantine facility was 21.6±7.3 days, and the average time taken for the first negative test after testing positive to COVID-19 was 12±4.1 days. Interpretation & conclusions: The funeral acted as a super-spreader event for the transmission of infection among family members, relatives and others. Active contact tracing and confirmation of infection among the contacts led to the isolation of 16 SARS-CoV-2 positive cases and hence the limited spread of the disease. Asymptomatic carriers and super-spreader events are among the major challenges in the control and prevention of SARS-CoV-2 transmission. Early testing, quarantine and social distancing may play key role in breaking the chain of transmission.

Zoonoses and Public Health

BMJ Open

ObjectiveTo determine the Japanese encephalitis (JE)-associated long-term functional and neurolog... more ObjectiveTo determine the Japanese encephalitis (JE)-associated long-term functional and neurological outcomes, the extent of reduced social participation and predictors of poor outcomes among paediatric JE survivors.DesignA retrospective cohort study.SettingLaboratory-confirmed JE-positive paediatric cases (<16 years of age) hospitalised at the paediatric ward of Baba Raghav Das Medical College, Gorakhpur, India, between 1 January 2017 and 31 December 2017, were followed up after 6–12 months of hospital discharge.Participants126 patients were included in the study; median age was 7.5 years (range: 1.5–15 years), and 74 (58.73%) were male.Outcome measuresFunctional outcome defined by Liverpool Outcome Score (LOS) dichotomised into poor (LOS=1–2) and good (LOS=3–5) outcome groups compared for demographic, clinical and biochemical parameters for prognostic factors of poor outcomes. Social participation of patients scaled on Child and Adolescent Scale of Participation score 2–5.Resu...

PLOS Global Public Health

Treatment-seeking behaviour is closely associated with the health status of individuals and count... more Treatment-seeking behaviour is closely associated with the health status of individuals and countries. About 800 million people have no access to health services in the developing world. Though the situation has been improving, the inequalities across geographical regions, socioeconomic status, and disease types continued to persist. The available literature suggests research gaps in examining the unmet need for treatment-seeking from public health facilities across sociodemographic characteristics, regions, and specific diseases. Data for this study comes from the three rounds of National Sample Survey (NSS) (2004, 2014, 2018). We applied descriptive, bivariate, and multivariable analysis to investigate the unmet need for treatment-seeking for public health facilities across sociodemographic characteristics, regions, and specific diseases between 2004 and 2018. The unmet need for treatment-seeking from public health facilities remained high at 60% in 2004 to 62% in 2018. However, t...

Frontiers in Public Health, 2022

BackgroundNoncommunicable disease (NCD) multimorbidity throws a unique challenge to healthcare sy... more BackgroundNoncommunicable disease (NCD) multimorbidity throws a unique challenge to healthcare systems globally in terms of not only management of disease, but also familial, social, and economic implications associated with it.ObjectiveTo assess the prevalence of NCD multimorbidity and its associated risk factors along with health expenditures among adults (≥18 years) living in a rural area.MethodsA secondary data analysis of the first-round survey done as part of the Gorakhpur Health and Demographic Surveillance Site (GHDSS) was done. Information related to self-reported morbidity and other variables related to sociodemographics and out-of-pocket expenditure (OOPE) was captured using a pretested questionnaire. Multivariable cluster adjusted binomial regression analysis was done to identify factors associated with multimorbidity.ResultsThe overall prevalence of NCD multimorbidity was found to be 1.8% (95% CI: 1.7–1.9%). The prevalence of NCD multimorbidity was highest among elderly...

Epidemiology and Infection, 2021

We report a familial cluster of 24 individuals infected with severe acute respiratory syndrome-co... more We report a familial cluster of 24 individuals infected with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). The index case had a travel history and spent 24 days in the house before being tested and was asymptomatic. Physical overcrowding in the house provided a favourable environment for intra-cluster infection transmission. Restriction of movement of family members due to countrywide lockdown limited the spread in community. Among the infected, only four individuals developed symptoms. The complete genome sequences of SARS-CoV-2 was retrieved using next-generation sequencing from eight clinical samples which demonstrated a 99.99% similarity with reference to Wuhan strain and the phylogenetic analysis demonstrated a distinct cluster, lying in the B.6.6 pangolin lineage.

In India all three indicators of child malnutrition have lower prevalence in urban areas in compa... more In India all three indicators of child malnutrition have lower prevalence in urban areas in comparison to rural areas. In fact children from backward socio-economic strata are high in proportion to be malnourished than their counterparts in all the three dimensions of measurements. These discrepancies in poor socio-economic conditions may also be due to lack of knowledge about child care, poor condition of water and sanitation, lack of access of health care services in rural areas. There is not much difference in prevalence of malnutrition in male and female. In all the major states prevalence of stunting and underweight is higher among poor in comparison to non-poor. At the national level there is significance difference among poor and non-poor in terms of prevalence of all three indicators of child malnutrition. Poor children are more undernourished, it may be due to the lower purchasing power of nutritious food among poor families. Since they are poor, their hygienic condition ma...

International Journal Of Community Medicine And Public Health, 2021

Background: Child undernutrition is a major public health problem in many low and middle income c... more Background: Child undernutrition is a major public health problem in many low and middle income countries and malnutrition alone accounted for 45% (3 million deaths annually) deaths among under-five children. Malnutrition is the concealed cause of one out of every two such deaths. A study was undertaken to examine the trends, determinants and socioeconomic-related inequalities in childhood undernutrition in empowered action group (EAG) states, India. The secondary data of the two rounds of National Family Health Survey, NFHS-3 (2005-06) and NFHS-4 (2015-16) comprising of 16,802 and 128,400 children aged 0-59 months respectively was analysed.Methods: Non-linear Fairlie decomposition was used to identify and quantify the separate contribution of different socioeconomic characteristics in gap of childhood malnutrion between 2006 and 2016.Results: Results show that the prevalence of undernutrition has decreased in EAG states during the last one decade, but the prevalence of wasting is r...

Injury Prevention, 2020

BackgroundWhile there is a long history of measuring death and disability from injuries, modern r... more BackgroundWhile there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.MethodsIn this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.ResultsGBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in te...

Indian Journal of Medical Research, 2020

Background & objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infecti... more Background & objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread rapidly, causing unprecedented case fatalities across the world. The first laboratory-confirmed case of COVID-19 and also the first death associated with the disease in the eastern part of Uttar Pradesh (UP) was reported from Basti on March 31, 2020. The present study describes a cluster of 17 cases including one death of confirmed COVID-19 in Basti, UP, India. Methods: A 25 year old male from Basti, UP, India, who died of respiratory failure was diagnosed post-mortem as SARS-CoV-2 positive. Contact tracing carried out by the district administration found 16 cases positive among tested contacts. A detailed retrospective investigation in the form of one-to-one interview was carried out with 16 recovered individuals to understand the transmission dynamics and clinical characteristics. Results: The findings showed that the cluster transmission occurred at three levels: first was direct contact with the index case which resulted in two secondary cases. Second, at a household level where four of the seven susceptible contacts got infected, and the third was an event (funeral) where 50 individuals participated and this resulted in seven SARS-CoV-2-infected individuals in whom infection could be directly linked to a funeral gathering. The index case had associated comorbidities and succumbed to death. Most of the cases were asymptomatic except two individuals, who developed mild symptoms. The mean duration of quarantine facility was 21.6±7.3 days, and the average time taken for the first negative test after testing positive to COVID-19 was 12±4.1 days. Interpretation & conclusions: The funeral acted as a super-spreader event for the transmission of infection among family members, relatives and others. Active contact tracing and confirmation of infection among the contacts led to the isolation of 16 SARS-CoV-2 positive cases and hence the limited spread of the disease. Asymptomatic carriers and super-spreader events are among the major challenges in the control and prevention of SARS-CoV-2 transmission. Early testing, quarantine and social distancing may play key role in breaking the chain of transmission.

Sri Lanka Journal of Child Health, 2018

Background: Vaccination is the most costeffective intervention to improve health and reduce morbi... more Background: Vaccination is the most costeffective intervention to improve health and reduce morbidity and mortality due to vaccine-preventable diseases in the child population. The South Asian region was home to 1.8 of the 6 million babies who died within twenty-eight days of birth in 2015. Objective: To describe the status and its determinants of immunisation coverage in three South Asian countries, India, Bangladesh and Nepal.

Injury Prevention, 2020

BackgroundPast research in population health trends has shown that injuries form a substantial bu... more BackgroundPast research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.MethodsWe reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).FindingsIn 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty...

The Lancet, 2017

Background Monitoring levels and trends in premature mortality is crucial to understanding how so... more Background Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends. Methods We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016. Findings The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72•3% (95% uncertainty interval [UI] 71•2-73•2) of deaths in 2016 with 19•3% (18•5-20•4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8•43% (8•00-8•67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006-16-age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1•80 million deaths (95% UI 1•59 million to 1•89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176-181) increase in deaths in ages 90-94 years and a 210% (208-212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2•89%); the median annualised rate of change for all other causes was lower (a decrease of 1•59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe.

JAMA oncology, Jan 3, 2016

Cancer is the second leading cause of death worldwide. Current estimates on the burden of cancer ... more Cancer is the second leading cause of death worldwide. Current estimates on the burden of cancer are needed for cancer control planning. To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 32 cancers in 195 countries and territories from 1990 to 2015. Cancer mortality was estimated using vital registration system data, cancer registry incidence data (transformed to mortality estimates using separately estimated mortality to incidence [MI] ratios), and verbal autopsy data. Cancer incidence was calculated by dividing mortality estimates through the modeled MI ratios. To calculate cancer prevalence, MI ratios were used to model survival. To calculate YLDs, prevalence estimates were multiplied by disability weights. The YLLs were estimated by multiplying age-specific cancer deaths by the reference life expectancy. DALYs were estimated as the sum of YLDs and YLLs. A sociodemographic index (SDI) wa...

Healthcare

Background: The healthcare infrastructure of a country determines the health-seeking behaviour of... more Background: The healthcare infrastructure of a country determines the health-seeking behaviour of the population. In developing countries such as India, there is a great disparity in the distribution of healthcare institutions across urban and rural areas with disadvantages for people living in rural areas. Objectives: Our objectives were to study the health-seeking behavior and factors associated with the use of formal healthcare among the Gorakhpur Health and Demographic Surveillance System (GHDSS) cohort of North India. Methods: The study was conducted in 28 villages from two rural blocks in the Gorakhpur district of eastern Uttar Pradesh, North India. Structured questionnaires were used to collect the data with regard to demographics, health-seeking behaviour and healthcare utilization. An adjusted odds ratio with 95% confidence interval was used to report the factors associated with the utilization of healthcare. Results: Out of 120,306 individuals surveyed, 19,240 (16%) indivi...

Journal of Multidisciplinary Research in Healthcare

Background: It is well known that child nutrition is affected by many factors like socio-cultural... more Background: It is well known that child nutrition is affected by many factors like socio-cultural, economic and demographic, etc. Studies found that maternal education, wealth index, and ethnicity have an influence on child nutrition. In this paper, comparative study of malnutrition among children and mothers between 1992-93 and 2005-06 has been done. Objective: The main objective of the paper is to study how progress in demographic and other socioeconomic factors influence nutritional status of mother and children. Data and Methods: First round (1992-93) and third round (2005-06) of National Family Health Survey has been used to reach the objective of the study. To show the progress in nutritional status, percentage change in prevalence of malnutrition in different background characteristics from 1992-93 to 2005-06 has been calculated. To show the progress in different background characteristics and its effect on child malnutrition decomposition analysis has been done. Result: Almost all variable are significantly associated with child malnutrition thus more contribution of any variable in bringing the change in prevalence of malnutrition shows the more progress in that variable from 1992-93 to 2005-06. The decomposition analysis clearly shows that the condition of mother's Yadav, R Paul, K Saha, S 134 education and timing to initiate breastfeeding are found to be contributing significantly to the reduction of underweight among children between 1992-93 and 2005-06. Conclusion: This study shows that improvement in mother's education contributed the most in improving the nutritional status of children. Thus by increasing the educational in female under-nutrition can be reduced to a larger extent.