Gajanan Velhal - Academia.edu (original) (raw)

Papers by Gajanan Velhal

Bharati Vidyapeeth Medical Journal, Mar 31, 2024

Introduction: Sustainable Development Goal (SDG)-6 highlights the importance of clean water and s... more Introduction: Sustainable Development Goal (SDG)-6 highlights the importance of clean water and sanitation.The Swachh Bharat Mission, a flagship program of the Government of India, aims at ensuring the availability and sustainable management of water, hygiene, and universal access to effective systems for disposing of waste, especially in rural areas; this, in turn, is of mammoth importance for achieving the SDG-6 by 2030. The present study was thus devised to determine the availability of sanitation facilities and assess the knowledge, attitude, and practices regarding hygiene among residents of villages in Southeastern Maharashtra. Materials and Methods: This community-based study used a multistage sampling technique to select study participants. The duration of the study was one month. The study involved 1663 participants. A Marathi-translated version of the pretested questionnaire was used, which enquired about the socio-demographic details, availability of water and sanitation facilities along with questions to assess the knowledge, attitude, and practice regarding sanitary latrines, use of footwear, hand washing, and domestic waste disposal. Association of socio-demographic profile with different parameters assessed in the questionnaire was assessed using SPSS software (version 26.0); results were considered significant if p<0.05. Results: The study involved 1663 participants with a mean age of 36.7 years, (SD=12.9 years). Water was available to all the households. All the villages had an open drainage system. Sanitation facilities were lacking in 23 households. Open-air defecation was practiced in 6.9% of the households. All the family members used footwear while going out in 68% of the households. Hand-washing was practiced by 43% of the population. Sixty-nine percent of the study participants disposed of domestic waste in the garbage pits dug in their backyard which was later burnt, whereas 31% disposed of in the surrounding premises. Conclusion: Open defecation still exists. The awareness regarding sanitation, footwear use, hand washing, and domestic waste disposal was better among literate participants. With just a few years left to the 2030 deadline to achieve the SDGs, we must inject a sense of urgency and immediately accelerate our actions at the individual and community levels.

Indian Journal of Community Medicine, Apr 1, 2021

PubMed, Nov 29, 2022

Background: Contact tracing (CT) is an effective tool for breaking the chains of transmission in ... more Background: Contact tracing (CT) is an effective tool for breaking the chains of transmission in infectious disease outbreaks. This study was conducted to observe the trend of isolation and quarantine, assess the source of infection and contacts, and assess the effectiveness of CT in the early detection of infection among health-care workers (HCWs). Methods: This study was conducted using secondary analysis of routine CT records of HCWs of a tertiary care hospital in Mumbai from April 9, 2020, to December 31, 2020. Details of all HCWs exposed or infected with COVID-19 were collected in a standard format developed for this purpose telephonically. The exposed HCWs were further divided into high-risk (HR)/low-risk (LR) contacts and quarantined. Results: A total of 744 HCWs were isolated during this period and 1486 contacts were quarantined against them. Majority of the HCWs affected from COVID-19 were resident doctors, interns, and nursing staff. More than 81% of the positive HCWs were symptomatic. The overall ratio between isolated HCWs and quarantined HCWs is 1:2. A total of 88 (6%) HCWs tested positive from quarantine. The test positivity rate among HR contacts was 9.01% and among LR contacts was 2.72%. Conclusions: Effective CT of positive HCWs greatly aids in the early identification of contacts and timely quarantine. Over a period of time, the number of HCWs getting isolated or quarantined is found to decrease. This is the true success of CT. This strategy can be implemented among other medical colleges and hospitals too.

SAARC journal of tuberculosis, lung diseases and HIV/AIDS, Oct 18, 2012

Introduction: In compliance with guidelines from NACP III, wide spread activities are continued, ... more Introduction: In compliance with guidelines from NACP III, wide spread activities are continued, by public, private and NGO sectors, to enhance the level of knowledge about HIV/AIDS among vulnerable adolescent and young adult population in urban areas, in the forms of various projects, so as to facilitate positive behavioural changes among them. Present cross-sectional study, was conducted in three, representative administrative wards (namely L, K/East & R/North) of Municipal Corporation of Greater Mumbai (MCGM), India, in December 2010, to assess the level of knowledge and attitudes about HIV/ AIDS amongst the adolescents and young adults. Methodology: Total 4306, adolescents and young adults representing all 28 health posts from selected wards were interviewed by 100 trained NSS volunteers of University of Mumbai, under the leadership of Department of Community Medicine, T. N. Medical College & Nair Hospital. Data was analysed with the help of statistical software (SPSS). Results: Seventy-nine percent (3407/4306) and 49.81% (2145/4306), of respondents had heard about HIV/AIDS, and STI/RTIs respectively. Unsafe sexual relationship, as route of transmission is known to 51.81 % (2231/4306) respondents, whereas use of condom, as preventive measure is known to 87% (3746) of people. Only 30.05% (1294/4306) respondents know nearby testing facilities. Everybody should be tested for HIV, to reduce transmission, is believed by 93.96%, (4046/4306) respondents. Knowledge grade given to each respondent based on the score obtained by them out of total obtainable 25 score, reveals, 57.36%, (2470/4306), in poor grade. Multinomial logistic regression confi rms the signifi cant infl uence of age and education status of respondents on their knowledge and positive attitudes.] Conclusion: When compared with other relevant studies, the present status of knowledge of adolescents and young adults from slums of Mumbai appears to be poor and justifi es the need for intensifi ed efforts towards improving the same, taking into account their vulnerability. Well planned coordinated efforts of public, private and NGO sectors, would go a long way to get the desired impact.

Annals of Tropical Medicine and Public Health, 2012

Journal of Clinical and Diagnostic Research, 2022

Vaccination history: After receiving the first dose, 15 (55.56%) cases had minor symptoms like fe... more Vaccination history: After receiving the first dose, 15 (55.56%) cases had minor symptoms like fever, sore throat, headache, myalgia, local arm pain. The mean duration of these symptoms was 15.11 hours (1-48 hours). After receiving the second dose, three of these cases had symptoms like headache,

Indian Journal of Medical Research, 2020

A 17 yr old male child†, a known case of Wilson’s disease, presented to the outpatient department... more A 17 yr old male child†, a known case of Wilson’s disease, presented to the outpatient department of the Kasturba Hospital, Chinckpokli, Mumbai, India, in October 2019, with fever (38.6°C) for two days, yellowish discolouration of the sclera (Figures A and C), skin (Figures B, D, and E). On examination, the patient was not oriented to time, place and person. Pallor and icterus were noted along with mild splenomegaly (Figure B). Bilateral flapping tremors were present (Video). Bilateral Kayser–Fleischer ring was seen (Figure A and C arrows). His haemoglobin level was 8.6 gm%, total and direct bilirubin were 32.7 mg% and 14.9 mg% respectively. Liver enzymes were elevated (SGOT: 617 U/l, SGPT: 607 U/l, alkaline phosphate 93IU/L,) prothrombin time was 26.2 sec, international normalization ratio was 2.54 (Nazer score was 12), blood urea nitrogen 11 mg% and creatinine was 0.6 mg%. Leptospirosis, dengue fever and malaria were ruled out. Viral markers were also negative (for HBV, HCV, HAV, HEV). The serum ceruloplasmin level was 0.03 O.D. and urinary copper excretion was 210 μg/24 h. He was referred to KEM Hospital, Mumbai for further management. He was treated with a combination of D-penicillamine (250 mg), injection 1 Video available at ijmr.org.in. Figure. (A and C) show yellowish discolouration of sclera. (B, D and E) Yellowish discolouration of the skin. (B) Mild splenomegaly. (A and C) (arrows) Bilateral Kayser–Fleischer ring: brownish ring rimming the cornea. D

Journal of Clinical and Diagnostic Research, 2016

International journal of pharma and bio sciences, 2013

Background: In India every year, 1.8 million new cases of TB occur, of which about 0.8 million ar... more Background: In India every year, 1.8 million new cases of TB occur, of which about 0.8 million are sputum positive pulmonary TB cases. This study attempts to find out the treatment outcomes of smear positive cases and factors that affect the outcome. Methodology: Community based prospective observational study was conducted in urban slums of Mumbai. Total 281 newly diagnosed sputum smear positive TB cases were selected, followed-up, and treatment outcome was obtained within 1 month after completion of continuous phase of treatment. Results: Tuberculosis is common among the illiterates (nearly 60 %) and labourers (53%), people below poverty line (90%), living in overcrowded houses (75%). In the present study, 42.7% were cured, 24.56% were treatment completed, 8.19% had died, and 4.98% were failure and 19.57% were defaulters after treatment. The cure rates and treatment completion were comparatively better in the age groups of 0-49 years (44.50 & 26.7%) and among females (53.85% &32.31%). Defaulter, Death and failure are more in labourer (22.78%, 9.49 %& 7.59%) and illiterates (26.79%, 10.71% & 6.55%). Cure rates and treatment completion are low among smokers (39.1% & 21.85%) and tobacco chewer (29.73% & 16.22%). Conclusion: Lower cure rates and high defaulters are found to be associated with illiteracy and smoking, which can be modified by IEC and focus service delivery on high risk groups.

Indian Journal of Community Medicine, Feb 7, 2023

PLOS ONE

Introduction Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB PM-JAY) has enabled the Govern... more Introduction Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB PM-JAY) has enabled the Government of India to become a strategic purchaser of health care services from private providers. To generate base cost evidence for evidence-based policymaking the Costing of Health Services in India (CHSI) study was commissioned in 2018 for the price setting of health benefit packages. This paper reports the findings of a process evaluation of the cost data collection in the private hospitals. Methods The process evaluation of health system costing in private hospitals was an exploratory survey with mixed methods (quantitative and qualitative). We used three approaches–an online survey using a semi-structured questionnaire, in-depth interviews, and a review of monitoring data. The process of data collection was assessed in terms of time taken for different aspects, resources used, level and nature of difficulty encountered, challenges and solutions. Results The mean time taken for data col...

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH

Introduction: Coronavirus Disease-2019 (COVID-19) is an infectious disease. The most effective wa... more Introduction: Coronavirus Disease-2019 (COVID-19) is an infectious disease. The most effective way to slow down the transmission is by social distancing and following all the preventive protocols. Aim: To describe the outbreak of COVID-19 in forty Undergraduate (UG) medical students of a medical college in Mumbai during September 2021 steps taken to control the spread as well as to break the chain of transmission of COVID19 infection. Materials and Methods: The institutional contact tracing team contacted the positive case and identified contacts as soon as they were notified during September 2021 at Seth GSMC & KEMH, Mumbai, Maharashtra, India. A total of 40 students were isolated due to the contraction of COVID infection. History was taken by telephonic calls. Meetings were held among the institute and hostel authorities to prevent the spread. All the contacts of positive cases were separated in a quarantine facility. COVID appropriate behaviour (CAB) was implemented strictly and ...

PharmacoEconomics - Open

Background In low-and middle-income countries (LMICs), provisioning for surgical care is a public... more Background In low-and middle-income countries (LMICs), provisioning for surgical care is a public health priority. Ayushman Bharat Pradhan Mantri-Jan Aarogya Yojana (AB PM-JAY) is India's largest national insurance scheme providing free surgical and medical care. In this paper, we present the costs of surgical health benefit packages (HBPs) for secondary care in public district hospitals. Methods The costs were estimated using mixed (top-down and bottom-up) micro-costing methods. In phase II of the Costing of Health Services in India (CHSI) study, data were collected from a sample of 27 district hospitals from nine states of India. The district hospitals were selected using stratified random sampling based on the district's composite development score. We estimated unit costs for individual services-outpatient (OP) visit, per bed-day in inpatient (IP) and intensive care unit (ICU) stays, and surgical procedures. Together, this was used to estimate the cost of 250 AB PM-JAY HBPs.

Indian Journal of Community Medicine, 2022

Background: Subsequent to serosurveys 1 and 2 for COVID-19 carried out in three wards of Mumbai i... more Background: Subsequent to serosurveys 1 and 2 for COVID-19 carried out in three wards of Mumbai in July and August 2020, Municipal Corporation of Greater Mumbai conducted serosurvey 3 in March 2021. This was to identify the extent of exposure by testing specific IgG antibodies against COVID-19. Material and Methods: A cross-sectional study was conducted to find the prevalence of seropositivity in Mumbai, which included 10,197 samples belonging to patients visiting public dispensaries (slum population, 6006) and private (nonslum population, 4191) laboratories of Aapli Chikitsa network for blood investigations for non-COVID illnesses. The ward-wise number of unlinked anonymous samples from 24 wards was predecided by using probability proportionate sampling. The samples were collected using quota sampling technique as per predecided sample for each ward. These samples collected from nonimmunized individuals were tested for IgG antibodies at the Molecular Biology Laboratory of Kasturba Hospital for Infectious Diseases by chemiluminescence assay (CLIA) method. Results: The overall seropositivity was found to be 36.3% (41.6% in slum and 28.59% in nonslum population). It was more in city wards (38.28%) followed by western suburb (36.47%) and then eastern suburb wards (34.86%), matching with the proportion of cases in these wards during the study period. There was no significant difference in seropositivity among males and females and in different age groups. Conclusions: Seropositivity is higher in slum areas than nonslum areas. It has reduced in slum areas and increased in nonslum areas as compared to findings of serosurveys 1 and 2. This explains the detection of a greater number of cases from nonslum areas in the second wave. The average seropositivity of 36.3% justifies the necessity of immunization on a wider scale in the city. Periodic serosurveys are required at fixed intervals to monitor the trend of infection and level of herd immunity.

SSRN Electronic Journal, 2020

Background: In 2018, the Government of India launched Ayushman Bharat – Pradhan Mantri Jan Aarogy... more Background: In 2018, the Government of India launched Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana (AB - PMJAY), a large tax-funded health insurance scheme. Provider payment rates for the AB-PMJAY health benefit packages (HBPs) were determined through consultative process and review of existing publicly financed health insurance (PFHI) schemes. In this paper, we present findings of the Costing of Health Services in India (CHSI) study and the process of price revision in 2019. Methods: Reference costs were generated from first phase of CHSI study which sampled 11 tertiary public hospitals from 11 Indian states. Economic costs were estimated using mixed (top-down & bottom-up) micro-costing methods. Based on stakeholder consultations, the cost of HBPs were analysed with different combinations of fixed and variable costs. The HBP cost was compared with AB-PMJAY prices of 2018 and 2019 and the budgetary impact was estimated. Finding: Only 13% of the HBPs in 2018, were close to (± 10%) to the actual cost of providing care. More than one-third (42%) of the HBPs had price less than 50% of the cost. After revision of prices in 2019, the latter decreased to 20%. The evidence-informed revision of HBP prices is estimated to increase claims amount by 200 million (0·7%). Interpretation: Strategic purchasing and price-setting of HBPs require creation of systems of evidence generation on the cost of providing services. Further, research is recommended to develop a cost-function for unit cost estimation with changes in time, region, prices, skill-mix and other factors. Funding Department of Health Research. Funding Statement: The study is funded by Department of Health Research (DHR), Ministry of Health & Family Welfare, Government of India. Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: The present study was approved by the Institutional Ethics Committee (IEC) vide letter no. PGI/IEC/2018/00125A and Institutional Collaborative Committee (ICC) vide letter no. 79/30-Edu-13/111273 of Postgraduate Institute of Medical Education & Research, Chandigarh, India.

International Journal Of Community Medicine And Public Health, 2017

Background: HBSC seeks to identify and explore the extent of the inequalities related to socioeco... more Background: HBSC seeks to identify and explore the extent of the inequalities related to socioeconomic status (SES), age and gender among the younger age group, and highlight the need for preventive action. Hence, this study was carried out, to find out the social context as a determinant of their health and well-being. The objectives of the study were to study the socio-demographic characteristics of the students; to find the social determinants and its association with their perceived health outcomes.Methods: The study was carried out among 426 Municipal school students in Mumbai. They were enquired about their socio demographic characteristics, their personal habits and behaviour, relationship with their parents, siblings and friends, performance in school, academic pressures, and also about any health related complaints if they had. Results: The study shows less communication of students with their parents, more so with their fathers’. Students were seen to have more friends and...

The Journal of medical research, 2018

Background: The present study was carried out to study the disease profile of diabetic patients i... more Background: The present study was carried out to study the disease profile of diabetic patients in an urban slum in Mumbai. Objective: To study the patient profile among type 2 diabetic patients. Methodology: Descriptive epidemiological study design was adopted. Sample size was fixed as 203.4 and samples are selected by simple random sampling technique. Important Finding: Mean age of patient is 56.09 (SD=10.55) years and mean duration of disease is 5.37 (SD=4.13) years. Mean fasting and post prandial blood sugar are 171.56 (SD=52.37) and 254.71 (SD=79.60) respectively. Mean BMI is 25.62 (SD= 5.16) which is above the normal BMI while daily calorie intake is 1889.17 (SD= 588.23). Principal Conclusion: Positive family history as an important risk factor. Hypertension is most common associated disease with diabetes. Ophthalmic complications are most frequent. 60% patients had diabetes past 5yrs.

International Journal of Community Medicine and Public Health, 2021

Reports of second infections with COVID-19 have intrigued researchers around the globe. They incr... more Reports of second infections with COVID-19 have intrigued researchers around the globe. They increase the burden on the already surging infected cases and add to the existing stigma around COVID. Moreover, it is mentally and physically taxing for the individual to go through the same stress for the second time. We aim to describe three cases of Re-Detected Positives (RDP) among healthcare workers in a tertiary care institute. The case histories were taken in detail over the telephone comparing the course, clinical history, contact history, and lab investigations of a first and second infection in each of them. A standard format developed for contact tracing in the institute was used for this. The period observed between two infections in these cases were 2-3 months and all the cases had tested negative by RTPCR before re-testing positive. Case 1: RDP by RTPCR 2.5 months after the first episode. He was asymptomatic, anti-bodies to SARS-Co-V 2 were also present in serum. Case 2 and 3:...

Journal of Family Medicine and Primary Care, 2021

Background: Leptospirosis is emerging as one of the growing public health problems in many parts ... more Background: Leptospirosis is emerging as one of the growing public health problems in many parts of India. It can occur in both rural and urban areas with varied risk factors. This study was taken up in three districts of Maharashtra namely—Mumbai, Ratnagiri, and Sindhudurg to understand the determinants of leptospirosis in both the urban and rural areas and look for differences if any. Materials and Methods: This cross-sectional study was carried out during the year 2017. A pretested validated questionnaire was used to collect data. Field observations were made. Eighty-seven cases from Sindhudurg and 14 from Ratnagiri and 307 cases from Mumbai were included in the study. Results: A total of 408 cases were included in the study. A total of 63 (62.4%) were males and 38 (37.6%) were females. Most cases belonged to the 20–35 year age group (37%). In rural areas, 32.7% of them visited government facilities first, whereas, in the urban areas, it was 73.9% (P = 0.006). Headache, myalgia, and prostration were more common in cases from rural areas (P = <0.05). Skin rash was found to be associated with urban cases of leptospirosis. The presence of rodents, cattle sheds, pets, and working in paddy fields were common environmental risks in rural areas, and using water for recreational activities were common in urban areas (P < 0.001). Conclusions: Context-specific risk factors were found significantly associated with the cases. No important difference was found in the epidemiology of leptospirosis in the urban and rural areas except the source of infection.

Journal of Family Medicine and Primary Care, 2020

Background: Healthcare workers at field level constitute a major pillar in the large public healt... more Background: Healthcare workers at field level constitute a major pillar in the large public health infrastructure of India. At this juncture, it becomes necessary to understand their role in achieving MDGs, issues, and challenges on the field and how 'prepared' they are to embark upon the new responsibilities in the coming 15 years to achieve the SDGs. This will form a springboard for the next generation of healthcare providers to successfully achieve the SDGs. Materials and Methods: This qualitative research study was conducted in the rural part of Thane district from September 2016- March 2017. Four Focus Group Discussions (FGDs) were done to assess the role, activities, reasons for successes and shortcomings of MDG indicators for healthcare providers and thereby assess preparedness for achieving health-related SDGs at the grass-root level. Results: Major challenges faced in the field were cultural barriers, poverty, illiteracy, fear, disregard for the health workers. There were challenges in human resource management such as workload, unpaid work, dissatisfaction, grievance redressal, leaves, etc., Suggested technical and health-centric interventions were skill development, supportive supervision, incentives and better implementation of new policies. Training in soft skills is needed. Conclusions: The health workers seem to be unaware of the term MDGs/SDGs but, showed a deep sense of commitment towards improving the health of people and meeting their work targets despite the challenges faced in the field. Their justified concerns need to be addressed to have better retention and improved performance.