Damodar Sahu - Academia.edu (original) (raw)

Papers by Damodar Sahu

Research paper thumbnail of Identifying children with high mortality risk

Research paper thumbnail of Aging of HIV epidemic in India: Insights from HIV estimation modeling under the national aids control programme

Indian Journal of Public Health, 2020

People living with HIV are gradually getting older as a result of better survival with increased ... more People living with HIV are gradually getting older as a result of better survival with increased uptake of antiretroviral treatment in India. We aimed to quantify the aging HIV-infected population in India by undertaking a mathematical model analysis of 2017 rounds of HIV burden estimations under the National AIDS Control Programme. Our analysis projects that the mean age of HIV-infected people will increase from 38.4 years in 2005 to 45.5 years in 2025 with the proportion of HIV-infected people aged 50 years or older increasing from 19% in 2005 to 37% in 2025. This aging HIV epidemic is anticipated to lead to more non-AIDS morbidities, increased treatment complexity, and an inevitable need for multidisciplinary health-care services to ensure continued high-quality survival.

Research paper thumbnail of Coverage, quality, and correlates of childhood immunization in slums under national immunization program of India: A cross-sectional study

Research paper thumbnail of Perceptions of childhood vaccination practices among beneficiaries and healthcare service providers in slums under the national immunization program of India: a qualitative study

Journal of Health Research, Apr 29, 2021

Purpose-A qualitative study can help in understanding the unpolluted perspectives of key stakehol... more Purpose-A qualitative study can help in understanding the unpolluted perspectives of key stakeholders involved in the vaccination practices and can explore vital factors that could influence vaccination-related behaviors and their utilization. This study aims to document the perceptions of caretakers, community members and healthcare service providers related to childhood vaccination practices in slums under the national immunization program (NIP) of India. Design/methodology/approach-This was a qualitative community-based cross-sectional study. Focus group discussions with caretakers, community members and healthcare service providers were used to build a holistic, detailed description and analysis of the factors associated with childhood vaccination practices within its real-world context. Findings-Lack of awareness, fear of adverse events following immunization, inappropriate timing of vaccination sessions, loss of daily earnings, migration, lack of good behavior of health staffs, shortage of logistics and vaccines, limited resources and infrastructures and high expectations of beneficiaries were some of the vital barriers impacting vaccination practices in slums. Research limitations/implications-Though this study provides significant good information on the indicators that can be considered to improve the vaccination practices in any slum settings, it has is also a limitations too due to its setting. Therefore, one needs to be cautious while generalizing these results to other settings like rural. In addition, Though we believe that these strategies could be useful in any setting, it is also important to tailor these observations them as per the need of the society and the population. Also, this is a selfreported qualitative study and therefore the perspectives reported in this study need to be taken with caution. Further, low vaccination, poor awareness, compromised healthcare services, high expectations could be considered as a stigma/fear among the responders and therefore there is always a chance of underreporting.

Research paper thumbnail of Correlates of HIV prevalence among female sex workers in four north and east Indian states: findings of a national bio-behavioural survey

International Journal of Std & Aids, Sep 20, 2018

The socio-demographic, sex work characteristics and the factors affecting HIV prevalence among fe... more The socio-demographic, sex work characteristics and the factors affecting HIV prevalence among female sex workers (FSWs) are not well known in low prevalence states showing rising trends within the HIV epidemic. This paper studies these attributes among FSWs in three north (Punjab, Rajasthan and Uttar Pradesh) and one east Indian states (Jharkhand). Integrated Biological and Behavioural Surveillance (IBBS) data, collected from 4491 FSWs in the study states, were analysed, with HIV status as the dependent variable and several socio-demographic, sex work, knowledge and agency characteristics as independent variables. Multivariate analysis found a number of factors such as age above 25 years (adjusted odds ratio [AOR] 5.0, 95% confidence interval [CI] 1.4-18.1), client solicitation in rented rooms (AOR 2.8, 95% CI 1.2-6.4) and the use of mobile phones for client solicitation (AOR 5.1, 95% CI 1.6-16.0) to be significantly associated with HIV risk. The study found low levels of HIV programme services uptake and HIV/AIDS knowledge among FSWs in the study states. There is an urgent need to focus on these risk factors for improving the effectiveness of the ongoing HIV prevention efforts and attaining the 'Sustainable Development Goals' goal of 'Ending the AIDS epidemic' by 2030.

Research paper thumbnail of Assessment of effectiveness of targeted intervention program under national AIDS control program among injecting drug users across India

Indian Journal of Public Health, 2023

Research paper thumbnail of Quality of anthropometric data in India's National Family Health Survey: Disentangling interviewer and area effect using a cross-classified multilevel model

SSM-Population Health, Sep 1, 2022

Research paper thumbnail of Potential gain in life expectancy by gender after elimination of a specific cause of death in urban India

International Journal of Community Medicine and Public Health, Apr 24, 2020

Life expectancy is a statistical measure to depict average life span a person is expected to live... more Life expectancy is a statistical measure to depict average life span a person is expected to live at a given age under given age-specific mortality rates. 1 It is convenient, representative and comprehensive indicator to judge social and economic status and quality of life of a country or region; more intuitive than mortality rates; easy to interpret in terms of expectation of life and is most commonly used by policy-makers to set out national strategies for health. 2-3 Life expectancy in women was higher than in men in mid-2000 and women live longer in nearly all countries of the world probably due to social and economic transformation benefitting women more than men. 4 It is worthy to mention that in India in 1970-75, the urban life expectancy at birth for female (59.2 years) was slightly more than for male (58.8 years) and the same trend is continuing till now. In 2012-16, the female life expectancy (73.5 years) is also higher than that of male (70.9 years) by about three years. 5

Research paper thumbnail of Health Inequalities in Under-Five Mortality: An Assessment of Empowered Action Group (EAG) States of India

Journal of health economics and outcomes research, Dec 18, 2020

Background: The effect of childhood well-being programs is commonly interconnected with a change ... more Background: The effect of childhood well-being programs is commonly interconnected with a change in mortality trends. The proportion of disparity shows that inequality in child mortality is more collective in the similarly evolved states than the poorer states in India. Objective: To estimate and compare the health inequality of under-five mortality in Empowered Action groups (EAG) states of India. Methods: Data from the National Family Health Survey (NFHS-4) was used only for the EAG States of India. Under-five mortality rates (U5MR) were calculated for associated background characteristics by using the life table method. Wealth inequality was assessed separately for all EAG states by calculating measures of concentration index (CI). Concentration curves (CC) were also plotted to see the difference in inequality. Results: Higher U5MR was observed in all EAG states compared with estimates for overall India. On comparing estimates of inequality, CI values show the substantial burden of U5MR among EAG states of India. The CC shows the lowest inequality in EAG states of India. Conclusion: The results suggested the need to receive various health strategy intercessions in agreement with the instance of ever-changing commitments of economic components to child health disparities in EAG states. Measuring the impact of determinants to wealth-related inequality in U5MR helps in lining up the interventions targeted at improving child survival.

Research paper thumbnail of Findings from the 2017 HIV estimation round & trend analysis of key indicators 2010-2017: Evidence for prioritising HIV/AIDS programme in India

Indian Journal of Medical Research, 2020

Background & objectives: The National AIDS Control Organisation (NACO) and the ICMR-National ... more Background & objectives: The National AIDS Control Organisation (NACO) and the ICMR-National Institute of Medical Statistics, the nodal agency for conducting HIV estimations in India, have been generating HIV estimates regularly since 2003. The objective of this study was to describe India's biennial HIV estimation 2017 process, data inputs, tool, methodology and epidemiological assumptions used to generate the HIV estimates and trends of key indicators for 2010-2017 at national and State/Union Territory levels. Methods: Demographic Projection (DemProj) and AIDS Impact Modules (AIM) of Spectrum 5.63 software recommended by the United Nations Programme on HIV and AIDS Global Reference Group on HIV Estimates, Modelling and Projections, were used for generating HIV estimations on key indicators. HIV sentinel surveillance, epidemiological and programme data were entered into Estimation Projection Package (EPP), and curve fitting was done using EPP classic model. Finally, calibration was done using the State HIV prevalence of two rounds of National Family Health Survey (NFHS) -3 and -4 and Integrated Biological and Behavioural Surveillance (IBBS), 2014-2015. Results: The national adult prevalence of HIV was estimated to be 0.22 per cent in 2017. Mizoram, Manipur and Nagaland had the highest prevalence over one per cent. An estimated 2.1 million people were living with HIV in 2017, with Maharashtra estimated to have the highest number. Of the 88 thousand annual new HIV infections estimated nationally in 2017, Telangana accounted for the largest share. HIV incidence was found to be higher among key population groups, especially people who inject drugs. The annual AIDS-related deaths were estimated to be 69 thousand nationally. For all indicators, geographic variation in levels and trends between States existed. Interpretation & conclusions: With a slow decline in annual new HIV infections by only 27 per cent from 2010 to 2017 against the national target of 75 per cent by 2020, the national target to end AIDS by 2030 may be missed; although at the sub-national level some States have made better progress to reduce new HIV infection. It calls for reinforcement of HIV prevention, diagnosis and treatment efforts by geographical regions and population groups.

Research paper thumbnail of Barriers and opportunities for improving childhood immunization coverage in slums: A qualitative study

Preventive medicine reports, Jun 1, 2019

There is substantial variability in immunization coverage trends across the globe which can be at... more There is substantial variability in immunization coverage trends across the globe which can be attributed to a number of factors such as demographic profile, socioeconomic characteristics and political environment. Vaccine preventable diseases contribute to severe disease burden when coverage is low, particularly, in slums. Present qualitative study explored barriers, opportunities, and key facilitators of childhood immunization. This was a community based cross-sectional study conducted in the slum areas of Mumbai, India. Data from the observations of immunization sessions and interviews of end users, healthcare service providers, and influencers were collected and analyzed. Lack of time, poor awareness, fear of adverse event, loss of daily income, and migrant population were some of the major reasons to not get immunized. Also, lack of good behavior of staff was another crucial factor perceived by caretakers as barrier in the immunization. Stakeholders agreed that immunization is a shared responsibility involving community, service providers, and policy makers. There was general consensus that immunization practices have improved over the last few years. However, its positive impact is yet to be fully seen in populations that belong to lower socioeconomic strata, thus warranting additional efforts to improve the immunization coverage in slums. Effective communication, process improvement at various levels, active involvement of communities in the immunization activities, building trust and accountability, and constructive feedback are some of the essential elements to strengthen the immunization program. Strategies to improve immunization services in such settings should be based on interactions with stakeholders and understanding their perspectives.

Research paper thumbnail of Evaluation of a Hospitalized Pediatric COVID-19 Cohort from Indian National Clinical Registry of COVID-19

Indian Journal of Pediatrics

Objective To evaluate the factors associated with mortality of a multicentric cohort of hospitali... more Objective To evaluate the factors associated with mortality of a multicentric cohort of hospitalized COVID-19 patients, 0-18 y old, from 42 centers across India. Methods The National Clinical Registry for COVID-19 (NCRC) is an ongoing prospective data collection platform enrolling COVID-19 patients diagnosed by real-time PCR or rapid antigen test. The data are collected in prestructured e-capture forms. The sociodemographic, clinical, laboratory, and hospital outcome data from 1 st September 2020 to 20 th February 2022 were analyzed. Results Of the 1244 enrolled hospitalized COVID-19 patients aged 0-18 y, 98 and 124 were infants and neonates, respectively. Only 68.6% children were symptomatic at admission, with fever being the most common symptom. Diarrhea, rash, and neurological symptoms were also noted. At least 1 comorbidity was present in 260 (21%) children. The in-hospital mortality rate was 6.2% (n = 67), the highest in infants (12.5%).

Research paper thumbnail of Vaccination saves lives: a real-time study of patients with chronic diseases and severe COVID-19 infection

QJM: An International Journal of Medicine

ObjectivesThis study aims to describe the demographic and clinical profile and ascertain the dete... more ObjectivesThis study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalized coronavirus disease 2019 (COVID-19) adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC).MethodsNCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1st September 2020 to 26th October 2021 were examined.ResultsAnalysis of 29 509 hospitalized, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18 752 (63.6%)] showed that 15 678 (53.1%) had at least one comorbidity. Among 25 715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n = 3957). Adjusted odds of dying were significantly higher in age group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy and tuberculos...

Research paper thumbnail of Gender differences in COVID-19 knowledge, risk perception, and public stigma among the general community: Findings from a nationwide cross-sectional study in India

International Journal of Disaster Risk Reduction

Research paper thumbnail of Challenges in Accessing and Delivering Maternal and Child Health Services during the COVID-19 Pandemic: A Cross-Sectional Rapid Survey from Six States of India

International Journal of Environmental Research and Public Health

Background/Objectives: Globally, the COVID-19 pandemic and its prevention and control policies ha... more Background/Objectives: Globally, the COVID-19 pandemic and its prevention and control policies have impacted maternal and child health (MCH) services. This study documents the challenges faced by patients in accessing MCH services, and the experiences of health care providers in delivering those services during the COVID-19 outbreak, explicitly focusing on the lockdown period in India. Methods: A cross-sectional study (rapid survey) was conducted in 18 districts from 6 states of India during March to June, 2020. The sample size included 540 MCH patients, 18 gynaecologists, 18 paediatricians, 18 district immunisation officers and 108 frontline health workers. Bivariate analysis and multivariable analysis were used to assess the association between sociodemographic characteristics, and challenges faced by the patients. Results: More than one-third of patients (n = 212; 39%) reported that accessing MCH services was a challenge during the lockdown period, with major challenges being tra...

Research paper thumbnail of Survey implementation process and interviewer effects on skipping sequence of maternal and child health indicators from National Family Health Survey: An application of cross-classified multilevel model

Research paper thumbnail of Analysis of a Targeted Intervention Programme on the Risk Behaviours of Injecting Drug Users in India: Evidence From the National Integrated Biological and Behavioural Surveillance Survey

Journal of Preventive Medicine and Public Health

Objectives: This study provides insights on the impact of a targeted intervention (TI) programme ... more Objectives: This study provides insights on the impact of a targeted intervention (TI) programme on behaviour change among injecting drug users (IDUs) in India.Methods: This paper examined the data from the Integrated Biological and Behavioural Surveillance 2014-2015 for IDUs in India. Logistic regression was performed to understand the factors (TI programme services) that affected injecting risk behaviours by adjusting for covariates. Propensity score matching was conducted to understand the impact of the TI programme on using new needles/syringes and sharing needles/syringes in the most recent injecting episode by accounting for the covariates that predicted receiving the intervention.Results: Participants who received new needles and syringes from peer educators or outreach workers were 1.3 times (adjusted odds ratio, 1.29; 95% confidence interval [CI], 1.09 to 1.53) more likely to use new needles/syringes during most recent injecting episode than participants who did not receive...

Research paper thumbnail of Diversity in HIV epidemic transitions in India: An application of HIV epidemiological metrices and benchmarks

PLOS ONE

Background The Joint United Nations Programme on AIDS (UNAIDS) has emphasized on the incidence-pr... more Background The Joint United Nations Programme on AIDS (UNAIDS) has emphasized on the incidence-prevalence ratio (IPR) and incidence-mortality ratio (IMR) to measure the progress in HIV epidemic control. In this paper, we describe the status of epidemic control in India and in various states in terms of UNAIDS’s recommended metrices. Method The National AIDS Control Programme (NACP) of India spearheads work on mathematical modelling to estimate HIV burden based on periodically conducted sentinel surveillance for providing guidance to program implementation and policymaking. Using the results of the latest round of HIV Estimations in 2019, IPR and IMR were calculated. Results National level IPR was 0.029 [0.022–0.037] in 2019 and ranged from 0.01 to 0.15 in various States and Union Territories (UTs). Corresponding Incidence-Mortality Ratio was at 0.881 [0.754–1.014] nationally and ranged between 0.20 and 12.90 across the States/UTs. Conclusions Based on UNAIDS recommended indicators f...

Research paper thumbnail of Vaccination saves lives: How do patients with chronic diseases and severe COVID-19 fare? Analysis from India’s National Clinical registry for COVID-19

ObjectivesThis study aims to describe the demographic and clinical profile and ascertain the dete... more ObjectivesThis study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalised COVID-19 adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC).MethodsNCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1st September 2020 to 26th October 2021 were examined.ResultsAnalysis of 29,509 hospitalised, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18752 (63.6%)] showed that 15678 (53.1%) had at least one comorbidity. Among 25715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n=3957). Adjusted odds of dying were significantly higher in age-group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy, and tuberculosis, presenting with dyspnea and...

Research paper thumbnail of Analysis of predictors and outcomes of COVID-19 patients requiring ICU admission from COVID 19

BackgroundSevere Corona virus disease (COVID-19) is associated with high mortality. Although sing... more BackgroundSevere Corona virus disease (COVID-19) is associated with high mortality. Although single centre intensive care units (ICU) have reported clinical characteristics and outcomes, no large scale multicentric study from India has been published. The present retrospective, multi-centre study was aimed to describe the predictors and outcomes of COVID-19 patients requiring ICU admission from COVID-19 Registry of Indian council of Medical Research (ICMR), India.MethodsProspectively collected data from multiple participating institutions was entered in the electronic National Clinical Registry of COVID 19. We enrolled patients aged>18 years with COVID-19 pneumonia requiring ICU admission between March 2020 and August 2021. Exclusion criteria were negative RT PCR, death within 24 hours of ICU admission, or patients with incomplete data in the registry Their demographic characteristics, laboratory variables, ICU severity indices, treatment strategies and outcomes were analysed.Res...

Research paper thumbnail of Identifying children with high mortality risk

Research paper thumbnail of Aging of HIV epidemic in India: Insights from HIV estimation modeling under the national aids control programme

Indian Journal of Public Health, 2020

People living with HIV are gradually getting older as a result of better survival with increased ... more People living with HIV are gradually getting older as a result of better survival with increased uptake of antiretroviral treatment in India. We aimed to quantify the aging HIV-infected population in India by undertaking a mathematical model analysis of 2017 rounds of HIV burden estimations under the National AIDS Control Programme. Our analysis projects that the mean age of HIV-infected people will increase from 38.4 years in 2005 to 45.5 years in 2025 with the proportion of HIV-infected people aged 50 years or older increasing from 19% in 2005 to 37% in 2025. This aging HIV epidemic is anticipated to lead to more non-AIDS morbidities, increased treatment complexity, and an inevitable need for multidisciplinary health-care services to ensure continued high-quality survival.

Research paper thumbnail of Coverage, quality, and correlates of childhood immunization in slums under national immunization program of India: A cross-sectional study

Research paper thumbnail of Perceptions of childhood vaccination practices among beneficiaries and healthcare service providers in slums under the national immunization program of India: a qualitative study

Journal of Health Research, Apr 29, 2021

Purpose-A qualitative study can help in understanding the unpolluted perspectives of key stakehol... more Purpose-A qualitative study can help in understanding the unpolluted perspectives of key stakeholders involved in the vaccination practices and can explore vital factors that could influence vaccination-related behaviors and their utilization. This study aims to document the perceptions of caretakers, community members and healthcare service providers related to childhood vaccination practices in slums under the national immunization program (NIP) of India. Design/methodology/approach-This was a qualitative community-based cross-sectional study. Focus group discussions with caretakers, community members and healthcare service providers were used to build a holistic, detailed description and analysis of the factors associated with childhood vaccination practices within its real-world context. Findings-Lack of awareness, fear of adverse events following immunization, inappropriate timing of vaccination sessions, loss of daily earnings, migration, lack of good behavior of health staffs, shortage of logistics and vaccines, limited resources and infrastructures and high expectations of beneficiaries were some of the vital barriers impacting vaccination practices in slums. Research limitations/implications-Though this study provides significant good information on the indicators that can be considered to improve the vaccination practices in any slum settings, it has is also a limitations too due to its setting. Therefore, one needs to be cautious while generalizing these results to other settings like rural. In addition, Though we believe that these strategies could be useful in any setting, it is also important to tailor these observations them as per the need of the society and the population. Also, this is a selfreported qualitative study and therefore the perspectives reported in this study need to be taken with caution. Further, low vaccination, poor awareness, compromised healthcare services, high expectations could be considered as a stigma/fear among the responders and therefore there is always a chance of underreporting.

Research paper thumbnail of Correlates of HIV prevalence among female sex workers in four north and east Indian states: findings of a national bio-behavioural survey

International Journal of Std & Aids, Sep 20, 2018

The socio-demographic, sex work characteristics and the factors affecting HIV prevalence among fe... more The socio-demographic, sex work characteristics and the factors affecting HIV prevalence among female sex workers (FSWs) are not well known in low prevalence states showing rising trends within the HIV epidemic. This paper studies these attributes among FSWs in three north (Punjab, Rajasthan and Uttar Pradesh) and one east Indian states (Jharkhand). Integrated Biological and Behavioural Surveillance (IBBS) data, collected from 4491 FSWs in the study states, were analysed, with HIV status as the dependent variable and several socio-demographic, sex work, knowledge and agency characteristics as independent variables. Multivariate analysis found a number of factors such as age above 25 years (adjusted odds ratio [AOR] 5.0, 95% confidence interval [CI] 1.4-18.1), client solicitation in rented rooms (AOR 2.8, 95% CI 1.2-6.4) and the use of mobile phones for client solicitation (AOR 5.1, 95% CI 1.6-16.0) to be significantly associated with HIV risk. The study found low levels of HIV programme services uptake and HIV/AIDS knowledge among FSWs in the study states. There is an urgent need to focus on these risk factors for improving the effectiveness of the ongoing HIV prevention efforts and attaining the 'Sustainable Development Goals' goal of 'Ending the AIDS epidemic' by 2030.

Research paper thumbnail of Assessment of effectiveness of targeted intervention program under national AIDS control program among injecting drug users across India

Indian Journal of Public Health, 2023

Research paper thumbnail of Quality of anthropometric data in India's National Family Health Survey: Disentangling interviewer and area effect using a cross-classified multilevel model

SSM-Population Health, Sep 1, 2022

Research paper thumbnail of Potential gain in life expectancy by gender after elimination of a specific cause of death in urban India

International Journal of Community Medicine and Public Health, Apr 24, 2020

Life expectancy is a statistical measure to depict average life span a person is expected to live... more Life expectancy is a statistical measure to depict average life span a person is expected to live at a given age under given age-specific mortality rates. 1 It is convenient, representative and comprehensive indicator to judge social and economic status and quality of life of a country or region; more intuitive than mortality rates; easy to interpret in terms of expectation of life and is most commonly used by policy-makers to set out national strategies for health. 2-3 Life expectancy in women was higher than in men in mid-2000 and women live longer in nearly all countries of the world probably due to social and economic transformation benefitting women more than men. 4 It is worthy to mention that in India in 1970-75, the urban life expectancy at birth for female (59.2 years) was slightly more than for male (58.8 years) and the same trend is continuing till now. In 2012-16, the female life expectancy (73.5 years) is also higher than that of male (70.9 years) by about three years. 5

Research paper thumbnail of Health Inequalities in Under-Five Mortality: An Assessment of Empowered Action Group (EAG) States of India

Journal of health economics and outcomes research, Dec 18, 2020

Background: The effect of childhood well-being programs is commonly interconnected with a change ... more Background: The effect of childhood well-being programs is commonly interconnected with a change in mortality trends. The proportion of disparity shows that inequality in child mortality is more collective in the similarly evolved states than the poorer states in India. Objective: To estimate and compare the health inequality of under-five mortality in Empowered Action groups (EAG) states of India. Methods: Data from the National Family Health Survey (NFHS-4) was used only for the EAG States of India. Under-five mortality rates (U5MR) were calculated for associated background characteristics by using the life table method. Wealth inequality was assessed separately for all EAG states by calculating measures of concentration index (CI). Concentration curves (CC) were also plotted to see the difference in inequality. Results: Higher U5MR was observed in all EAG states compared with estimates for overall India. On comparing estimates of inequality, CI values show the substantial burden of U5MR among EAG states of India. The CC shows the lowest inequality in EAG states of India. Conclusion: The results suggested the need to receive various health strategy intercessions in agreement with the instance of ever-changing commitments of economic components to child health disparities in EAG states. Measuring the impact of determinants to wealth-related inequality in U5MR helps in lining up the interventions targeted at improving child survival.

Research paper thumbnail of Findings from the 2017 HIV estimation round & trend analysis of key indicators 2010-2017: Evidence for prioritising HIV/AIDS programme in India

Indian Journal of Medical Research, 2020

Background & objectives: The National AIDS Control Organisation (NACO) and the ICMR-National ... more Background & objectives: The National AIDS Control Organisation (NACO) and the ICMR-National Institute of Medical Statistics, the nodal agency for conducting HIV estimations in India, have been generating HIV estimates regularly since 2003. The objective of this study was to describe India's biennial HIV estimation 2017 process, data inputs, tool, methodology and epidemiological assumptions used to generate the HIV estimates and trends of key indicators for 2010-2017 at national and State/Union Territory levels. Methods: Demographic Projection (DemProj) and AIDS Impact Modules (AIM) of Spectrum 5.63 software recommended by the United Nations Programme on HIV and AIDS Global Reference Group on HIV Estimates, Modelling and Projections, were used for generating HIV estimations on key indicators. HIV sentinel surveillance, epidemiological and programme data were entered into Estimation Projection Package (EPP), and curve fitting was done using EPP classic model. Finally, calibration was done using the State HIV prevalence of two rounds of National Family Health Survey (NFHS) -3 and -4 and Integrated Biological and Behavioural Surveillance (IBBS), 2014-2015. Results: The national adult prevalence of HIV was estimated to be 0.22 per cent in 2017. Mizoram, Manipur and Nagaland had the highest prevalence over one per cent. An estimated 2.1 million people were living with HIV in 2017, with Maharashtra estimated to have the highest number. Of the 88 thousand annual new HIV infections estimated nationally in 2017, Telangana accounted for the largest share. HIV incidence was found to be higher among key population groups, especially people who inject drugs. The annual AIDS-related deaths were estimated to be 69 thousand nationally. For all indicators, geographic variation in levels and trends between States existed. Interpretation & conclusions: With a slow decline in annual new HIV infections by only 27 per cent from 2010 to 2017 against the national target of 75 per cent by 2020, the national target to end AIDS by 2030 may be missed; although at the sub-national level some States have made better progress to reduce new HIV infection. It calls for reinforcement of HIV prevention, diagnosis and treatment efforts by geographical regions and population groups.

Research paper thumbnail of Barriers and opportunities for improving childhood immunization coverage in slums: A qualitative study

Preventive medicine reports, Jun 1, 2019

There is substantial variability in immunization coverage trends across the globe which can be at... more There is substantial variability in immunization coverage trends across the globe which can be attributed to a number of factors such as demographic profile, socioeconomic characteristics and political environment. Vaccine preventable diseases contribute to severe disease burden when coverage is low, particularly, in slums. Present qualitative study explored barriers, opportunities, and key facilitators of childhood immunization. This was a community based cross-sectional study conducted in the slum areas of Mumbai, India. Data from the observations of immunization sessions and interviews of end users, healthcare service providers, and influencers were collected and analyzed. Lack of time, poor awareness, fear of adverse event, loss of daily income, and migrant population were some of the major reasons to not get immunized. Also, lack of good behavior of staff was another crucial factor perceived by caretakers as barrier in the immunization. Stakeholders agreed that immunization is a shared responsibility involving community, service providers, and policy makers. There was general consensus that immunization practices have improved over the last few years. However, its positive impact is yet to be fully seen in populations that belong to lower socioeconomic strata, thus warranting additional efforts to improve the immunization coverage in slums. Effective communication, process improvement at various levels, active involvement of communities in the immunization activities, building trust and accountability, and constructive feedback are some of the essential elements to strengthen the immunization program. Strategies to improve immunization services in such settings should be based on interactions with stakeholders and understanding their perspectives.

Research paper thumbnail of Evaluation of a Hospitalized Pediatric COVID-19 Cohort from Indian National Clinical Registry of COVID-19

Indian Journal of Pediatrics

Objective To evaluate the factors associated with mortality of a multicentric cohort of hospitali... more Objective To evaluate the factors associated with mortality of a multicentric cohort of hospitalized COVID-19 patients, 0-18 y old, from 42 centers across India. Methods The National Clinical Registry for COVID-19 (NCRC) is an ongoing prospective data collection platform enrolling COVID-19 patients diagnosed by real-time PCR or rapid antigen test. The data are collected in prestructured e-capture forms. The sociodemographic, clinical, laboratory, and hospital outcome data from 1 st September 2020 to 20 th February 2022 were analyzed. Results Of the 1244 enrolled hospitalized COVID-19 patients aged 0-18 y, 98 and 124 were infants and neonates, respectively. Only 68.6% children were symptomatic at admission, with fever being the most common symptom. Diarrhea, rash, and neurological symptoms were also noted. At least 1 comorbidity was present in 260 (21%) children. The in-hospital mortality rate was 6.2% (n = 67), the highest in infants (12.5%).

Research paper thumbnail of Vaccination saves lives: a real-time study of patients with chronic diseases and severe COVID-19 infection

QJM: An International Journal of Medicine

ObjectivesThis study aims to describe the demographic and clinical profile and ascertain the dete... more ObjectivesThis study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalized coronavirus disease 2019 (COVID-19) adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC).MethodsNCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1st September 2020 to 26th October 2021 were examined.ResultsAnalysis of 29 509 hospitalized, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18 752 (63.6%)] showed that 15 678 (53.1%) had at least one comorbidity. Among 25 715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n = 3957). Adjusted odds of dying were significantly higher in age group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy and tuberculos...

Research paper thumbnail of Gender differences in COVID-19 knowledge, risk perception, and public stigma among the general community: Findings from a nationwide cross-sectional study in India

International Journal of Disaster Risk Reduction

Research paper thumbnail of Challenges in Accessing and Delivering Maternal and Child Health Services during the COVID-19 Pandemic: A Cross-Sectional Rapid Survey from Six States of India

International Journal of Environmental Research and Public Health

Background/Objectives: Globally, the COVID-19 pandemic and its prevention and control policies ha... more Background/Objectives: Globally, the COVID-19 pandemic and its prevention and control policies have impacted maternal and child health (MCH) services. This study documents the challenges faced by patients in accessing MCH services, and the experiences of health care providers in delivering those services during the COVID-19 outbreak, explicitly focusing on the lockdown period in India. Methods: A cross-sectional study (rapid survey) was conducted in 18 districts from 6 states of India during March to June, 2020. The sample size included 540 MCH patients, 18 gynaecologists, 18 paediatricians, 18 district immunisation officers and 108 frontline health workers. Bivariate analysis and multivariable analysis were used to assess the association between sociodemographic characteristics, and challenges faced by the patients. Results: More than one-third of patients (n = 212; 39%) reported that accessing MCH services was a challenge during the lockdown period, with major challenges being tra...

Research paper thumbnail of Survey implementation process and interviewer effects on skipping sequence of maternal and child health indicators from National Family Health Survey: An application of cross-classified multilevel model

Research paper thumbnail of Analysis of a Targeted Intervention Programme on the Risk Behaviours of Injecting Drug Users in India: Evidence From the National Integrated Biological and Behavioural Surveillance Survey

Journal of Preventive Medicine and Public Health

Objectives: This study provides insights on the impact of a targeted intervention (TI) programme ... more Objectives: This study provides insights on the impact of a targeted intervention (TI) programme on behaviour change among injecting drug users (IDUs) in India.Methods: This paper examined the data from the Integrated Biological and Behavioural Surveillance 2014-2015 for IDUs in India. Logistic regression was performed to understand the factors (TI programme services) that affected injecting risk behaviours by adjusting for covariates. Propensity score matching was conducted to understand the impact of the TI programme on using new needles/syringes and sharing needles/syringes in the most recent injecting episode by accounting for the covariates that predicted receiving the intervention.Results: Participants who received new needles and syringes from peer educators or outreach workers were 1.3 times (adjusted odds ratio, 1.29; 95% confidence interval [CI], 1.09 to 1.53) more likely to use new needles/syringes during most recent injecting episode than participants who did not receive...

Research paper thumbnail of Diversity in HIV epidemic transitions in India: An application of HIV epidemiological metrices and benchmarks

PLOS ONE

Background The Joint United Nations Programme on AIDS (UNAIDS) has emphasized on the incidence-pr... more Background The Joint United Nations Programme on AIDS (UNAIDS) has emphasized on the incidence-prevalence ratio (IPR) and incidence-mortality ratio (IMR) to measure the progress in HIV epidemic control. In this paper, we describe the status of epidemic control in India and in various states in terms of UNAIDS’s recommended metrices. Method The National AIDS Control Programme (NACP) of India spearheads work on mathematical modelling to estimate HIV burden based on periodically conducted sentinel surveillance for providing guidance to program implementation and policymaking. Using the results of the latest round of HIV Estimations in 2019, IPR and IMR were calculated. Results National level IPR was 0.029 [0.022–0.037] in 2019 and ranged from 0.01 to 0.15 in various States and Union Territories (UTs). Corresponding Incidence-Mortality Ratio was at 0.881 [0.754–1.014] nationally and ranged between 0.20 and 12.90 across the States/UTs. Conclusions Based on UNAIDS recommended indicators f...

Research paper thumbnail of Vaccination saves lives: How do patients with chronic diseases and severe COVID-19 fare? Analysis from India’s National Clinical registry for COVID-19

ObjectivesThis study aims to describe the demographic and clinical profile and ascertain the dete... more ObjectivesThis study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalised COVID-19 adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC).MethodsNCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1st September 2020 to 26th October 2021 were examined.ResultsAnalysis of 29,509 hospitalised, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18752 (63.6%)] showed that 15678 (53.1%) had at least one comorbidity. Among 25715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n=3957). Adjusted odds of dying were significantly higher in age-group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy, and tuberculosis, presenting with dyspnea and...

Research paper thumbnail of Analysis of predictors and outcomes of COVID-19 patients requiring ICU admission from COVID 19

BackgroundSevere Corona virus disease (COVID-19) is associated with high mortality. Although sing... more BackgroundSevere Corona virus disease (COVID-19) is associated with high mortality. Although single centre intensive care units (ICU) have reported clinical characteristics and outcomes, no large scale multicentric study from India has been published. The present retrospective, multi-centre study was aimed to describe the predictors and outcomes of COVID-19 patients requiring ICU admission from COVID-19 Registry of Indian council of Medical Research (ICMR), India.MethodsProspectively collected data from multiple participating institutions was entered in the electronic National Clinical Registry of COVID 19. We enrolled patients aged>18 years with COVID-19 pneumonia requiring ICU admission between March 2020 and August 2021. Exclusion criteria were negative RT PCR, death within 24 hours of ICU admission, or patients with incomplete data in the registry Their demographic characteristics, laboratory variables, ICU severity indices, treatment strategies and outcomes were analysed.Res...