Shashi Kant - Academia.edu (original) (raw)

Papers by Shashi Kant

Research paper thumbnail of Making a postgraduate journal club an effective learning opportunity: Experience from the Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi

The National medical journal of India

Research paper thumbnail of Prevalence and determinants of sexually transmitted infections (stis) among male migrant factory workers in Haryana, North India

Indian Journal of Public Health, 2015

Male migrant workers display high risk sexual behavior and have been shown to have higher prevale... more Male migrant workers display high risk sexual behavior and have been shown to have higher prevalence of sexually transmitted infections (STIs), which make them more vulnerable to HIV infection. We aimed to estimate the prevalence of self-reported STIs and delineate their determinants among male migrant factory workers in Faridabad, Haryana. Male workers in two selected factories, who were aged ≥18 years, were born outside Haryana (destination), and who had migrated to Haryana after the age of 15 years were eligible. Socio-demographic information, HIV/AIDS knowledge and behavior, and self-reported STI symptoms in the last 1 year were ascertained by face-to-face interview. Determinants of STIs were identified by regression analysis. Totally 755 eligible workers participated. Mean ± SD age was 31.4 ± 8.2 years and migration duration was 9.5 ± 6.7 years. At least one STI symptom was reported by 41.7% of the participants (burning micturition- 35%, inguinal bubos-5.2%, genital ulcers- 2.6%, urethral pus discharge- 1.3%). Factors associated with STIs were higher age at migration, lower HIV/AIDS knowledge, paid sex in the last year, non-use of condoms during the last non-spousal sex, and unfavorable intention to use condom. Prevalence of self-reported STIs among these migrant men was high. Targeted Interventions among migrant workers need to be strengthened for control and prevention of STIs.

Research paper thumbnail of Lupus Erythematosus Immunological Synapse in Systemic Compartmentalization in the Altered Dynamics of Kv1.3 Channel

Research paper thumbnail of Sunlight exposure and development of rickets in Indian toddlers

The Indian Journal of Pediatrics, 2009

To study the role of sunlight exposure in determining the vitamin D status of underprivileged tod... more To study the role of sunlight exposure in determining the vitamin D status of underprivileged toddlers.

Research paper thumbnail of Choices of ecosystem capital without discounting and prices

Environmental monitoring and assessment

In the last decade, neo-classical economists have used the Consumption-Growth Based Utility (CGBU... more In the last decade, neo-classical economists have used the Consumption-Growth Based Utility (CGBU) framework to suggest an appropriate discount rate for eco-system capital. The CGBU framework, being based on the simplicity and single-valued nature of man-made capital, is subject to many limitations. Three general limitations of the framework, irrespective of its use for man-made capital or ecosystem capital, paradox of consumption growth, expectations' insensitive utility specification, and insensitivity to the nature of returns, are discussed. With respect to its use for ecosystem capital, the framework has two limitations: ecosystems cannot be commoditized and ecosystem capital satisfies differentiated needs, and, hence, gross substitution between different components of ecosystem capital or between ecosystem capital and man-made capital is not possible. Therefore, the rate of discount for ecosystem capital suggested on the basis of the framework is arbitrary. In the context o...

Research paper thumbnail of Improved estimates of India's HIV burden in 2006

The Indian journal of medical research, 2009

HIV estimates in India were based on HIV sentinel surveillance (HSS) data and several assumptions... more HIV estimates in India were based on HIV sentinel surveillance (HSS) data and several assumptions. Expansion of sentinel surveillance to all districts and community based HIV prevalence measured by National Family Health Survey-3 (NFHS-3) in 2006 provided opportunity to replace many of the assumptions with evidence based information and improve the HIV estimate closer to reality. This article presents a detailed account of the methodology used for the 2006 HIV burden estimates for India. State-wise adult HIV prevalence among different risk groups observed from HSS 2006 was adjusted for site level variations using a random effects model and for the previous four years the same was back calculated using trend equations derived from a mixed effects logistic regression model based on consistent sites prevalence. The adjusted HIV prevalence among the general population was calibrated to the estimates from NFHS-3. Overall point estimates of adult HIV prevalence in each State for 2002-2006...

Research paper thumbnail of Correlates of Intention to Use Condom among Male Migrant Factory Workers in Northern India

Journal of clinical and diagnostic research : JCDR, 2014

Consistent condom use among high-risk groups, which in turn are dependant on favourable condom us... more Consistent condom use among high-risk groups, which in turn are dependant on favourable condom use intention is important for the success of HIV/AIDS prevention programmes. We aimed to determine intention to use condom and delineate their correlates in a sample of male migrant workers in northern India. This was a cross-sectional facility based survey conducted in 2011. Inclusion criteria were: male migrant workers aged ≥18 years, who were born outside Haryana, who had moved to current location after 15 years of age, who had worked in the current factory for at least one year and who were able to give valid consent. Face-to-face interviews were conducted with semi-structured questionnaire. Since this analysis was a secondary objective of a larger migrant study, sample size was not calculated separately. Intention to use condom was measured on a five point Likert scale and expressed as a linear score (higher the score more unfavourable the intention). A linear regression analysis was...

Research paper thumbnail of Effect of sedentary activity on telomere length may not be so straightforward

British journal of sports medicine, Jan 8, 2015

Research paper thumbnail of Effect of vitamin A administered at Expanded Program on Immunization contacts on antibody response to oral polio vaccine

European Journal of Clinical Nutrition, 2002

Objective: Vitamin A supplementation to mothers in the postpartum period and to their infants at ... more Objective: Vitamin A supplementation to mothers in the postpartum period and to their infants at routine immunization contacts is being considered to reduce vitamin A deficiency in infancy. This study was conducted to determine the impact of maternal and infant vitamin A supplementation on antibody response to oral polio vaccine (OPV).Design: Randomized, double blind, placebo-controlled trial.Interventions: Mothers in the intervention

Research paper thumbnail of Cause of death during 2009-2012, using a probabilistic model (InterVA-4): an experience from Ballabgarh Health and Demographic Surveillance System in India

Global health action, 2014

The present study aimed to estimate the age and cause-specific mortality in Ballabgarh Health and... more The present study aimed to estimate the age and cause-specific mortality in Ballabgarh Health and Demographic Surveillance System (HDSS) site for the years 2009 to 2012, using a probabilistic model (InterVA-4). All Deaths in Ballabgarh HDSS from January 1, 2009, to December 31, 2012, were included in the study. InterVA-4 model (version 4.02) was used for assigning cause of death (COD). Data from the verbal autopsy (VA) tool were extracted and processed with the InterVA-4 model. Cause-specific mortality rate (CSMR) per 1,000 person-years was calculated. A total of 2,459 deaths occurred in the HDSS during the year 2009 to 2012. Among them, 2,174 (88.4%) valid VA interviews were conducted. Crude death rate ranged from 7.1 (2009) to 6.4 (2012) per 1,000 population. The CSMR per 1,000 person-years over the years (2009-2012) for non-communicable diseases, communicable diseases, trauma, neoplasm, and maternal and neonatal diseases were 1.78, 1.68, 0.68, 0.49, and 0.48, respectively. The mo...

Research paper thumbnail of HIV/AIDS-related mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

Global Health Action, 2014

Background: As the HIV/AIDS pandemic has evolved over recent decades, Africa has been the most af... more Background: As the HIV/AIDS pandemic has evolved over recent decades, Africa has been the most affected region, even though a large proportion of HIV/AIDS deaths have not been documented at the individual level. Systematic application of verbal autopsy (VA) methods in defined populations provides an opportunity to assess the mortality burden of the pandemic from individual data. Objective: To present standardised comparisons of HIV/AIDS-related mortality at sites across Africa and Asia, including closely related causes of death such as pulmonary tuberculosis (PTB) and pneumonia. Design: Deaths related to HIV/AIDS were extracted from individual demographic and VA data from 22 INDEPTH sites across Africa and Asia. VA data were standardised to WHO 2012 standard causes of death assigned using the InterVA-4 model. Between-site comparisons of mortality rates were standardised using the INDEPTH 2013 standard population. Results: The dataset covered a total of 10,773 deaths attributed to HIV/AIDS, observed over 12,204,043 person-years. HIV/AIDS-related mortality fractions and mortality rates varied widely across Africa and Asia, with highest burdens in eastern and southern Africa, and lowest burdens in Asia. There was evidence of rapidly declining rates at the sites with the heaviest burdens. HIV/AIDS mortality was also strongly related to PTB mortality. On a country basis, there were strong similarities between HIV/AIDS mortality rates at INDEPTH sites and those derived from modelled estimates. Conclusions: Measuring HIV/AIDS-related mortality continues to be a challenging issue, all the more so as anti-retroviral treatment programmes alleviate mortality risks. The congruence between these results and other estimates adds plausibility to both approaches. These data, covering some of the highest mortality observed during the pandemic, will be an important baseline for understanding the future decline of HIV/AIDS.

Research paper thumbnail of Cause-specific childhood mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

Global Health Action, 2014

Background: Childhood mortality, particularly in the first 5 years of life, is a major global con... more Background: Childhood mortality, particularly in the first 5 years of life, is a major global concern and the target of Millennium Development Goal 4. Although the majority of childhood deaths occur in Africa and Asia, these are also the regions where such deaths are least likely to be registered. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective: To present a description of cause-specific mortality rates and fractions over the first 15 years of life as documented by INDEPTH Network sites in sub-Saharan Africa and south-east Asia. Design: All childhood deaths at INDEPTH sites are routinely registered and followed up with verbal autopsy (VA) interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provided persontime denominators for mortality rates. Cause-specific mortality rates and cause-specific mortality fractions are presented according to WHO 2012 VA cause groups for neonatal, infant, 1Á4 year and 5Á14 year age groups. Results: A total of 28,751 childhood deaths were documented during 4,387,824 person-years over 18 sites. Infant mortality ranged from 11 to 78 per 1,000 live births, with under-5 mortality from 15 to 152 per 1,000 live births. Sites in Vietnam and Kenya accounted for the lowest and highest mortality rates reported. Conclusions: Many children continue to die from relatively preventable causes, particularly in areas with high rates of malaria and HIV/AIDS. Neonatal mortality persists at relatively high, and perhaps sometimes underdocumented, rates. External causes of death are a significant childhood problem in some settings.

Research paper thumbnail of Organizations, Institutions, External Setting and Institutional Dynamics

Sustainability, Economics, and Natural Resources, 2005

Research paper thumbnail of Mortality from external causes in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System Sites

Global Health Action, 2014

Background: Mortality from external causes, of all kinds, is an important component of overall mo... more Background: Mortality from external causes, of all kinds, is an important component of overall mortality on a global basis. However, these deaths, like others in Africa and Asia, are often not counted or documented on an individual basis. Overviews of the state of external cause mortality in Africa and Asia are therefore based on uncertain information. The INDEPTH Network maintains longitudinal surveillance, including cause of death, at population sites across Africa and Asia, which offers important opportunities to document external cause mortality at the population level across a range of settings. Objective: To describe patterns of mortality from external causes at INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories. Design: All deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. Results: A total of 5,884 deaths due to external causes were documented over 11,828,253 person-years. Approximately one-quarter of those deaths were to children younger than 15 years. Causes of death were dominated by childhood drowning in Bangladesh, and by transport-related deaths and intentional injuries elsewhere. Detailed mortality rates are presented by cause of death, age group, and sex. Conclusions: The patterns of external cause mortality found here generally corresponded with expectations and other sources of information, but they fill some important gaps in population-based mortality data. They provide an important source of information to inform potentially preventive intervention designs.

Research paper thumbnail of Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites

Global Health Action, 2014

Background: Mortality from non-communicable diseases (NCDs) is a major global issue, as other cat... more Background: Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective: To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15Á64 years) and older (65' years) NCD mortality. Design: All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. Results: A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15Á64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality. Conclusions: These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian settings. This comes against a background of global concern about the burden of NCD mortality, especially among adults aged under 70, and provides an important baseline for future work.

Research paper thumbnail of Malaria mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

Global Health Action, 2014

Background: Malaria continues to be a major cause of infectious disease mortality in tropical reg... more Background: Malaria continues to be a major cause of infectious disease mortality in tropical regions. However, deaths from malaria are most often not individually documented, and as a result overall understanding of malaria epidemiology is inadequate. INDEPTH Network members maintain population surveillance in Health and Demographic Surveillance System sites across Africa and Asia, in which individual deaths are followed up with verbal autopsies. Objective: To present patterns of malaria mortality determined by verbal autopsy from INDEPTH sites across Africa and Asia, comparing these findings with other relevant information on malaria in the same regions. Design: From a database covering 111,910 deaths over 12,204,043 person-years in 22 sites, in which verbal autopsy data were handled according to the WHO 2012 standard and processed using the InterVA-4 model, over 6,000 deaths were attributed to malaria. The overall period covered was 1992Á2012, but two-thirds of the observations related to 2006Á2012. These deaths were analysed by site, time period, age group and sex to investigate epidemiological differences in malaria mortality. Results: Rates of malaria mortality varied by 1:10,000 across the sites, with generally low rates in Asia (one site recording no malaria deaths over 0.5 million person-years) and some of the highest rates in West Africa (Nouna, Burkina Faso: 2.47 per 1,000 person-years). Childhood malaria mortality rates were strongly correlated with Malaria Atlas Project estimates of Plasmodium falciparum parasite rates for the same locations. Adult malaria mortality rates, while lower than corresponding childhood rates, were strongly correlated with childhood rates at the site level. Conclusions: The wide variations observed in malaria mortality, which were nevertheless consistent with various other estimates, suggest that population-based registration of deaths using verbal autopsy is a useful approach to understanding the details of malaria epidemiology.

Research paper thumbnail of Alternative Medicine Use in Dialysis Patients: Potential for Good and Bad!

Nephron Clinical Practice, 2007

Although alternative medicines are widely used within the general population, the extent of their... more Although alternative medicines are widely used within the general population, the extent of their use within the dialysis population is unknown. It is possible that dialysis patients may be more likely to turn towards alternative therapies in view of the chronicity of their disease. In addition, this particular patient population could be at an increased risk of toxicity from these therapies due to an absence of renal excretion. A detailed assessment of complementary and alternative medicine use in our dialysis patients revealed that 18% of our patients had used or were using some form of alternative medicine therapy. An additional 63% of our patients, however, were willing to use a complementary or alternative medication. Our results suggest that hemodialysis patients are extremely receptive to the use of such therapies and are therefore exposed to all their potential benefit and harm.

Research paper thumbnail of Scaffolding by ERK3 regulates MK5 in development

The EMBO Journal, 2004

Extracellular-regulated kinase 3 (ERK3, MAPK6) is an atypical member of the ERKs, lacking the thr... more Extracellular-regulated kinase 3 (ERK3, MAPK6) is an atypical member of the ERKs, lacking the threonine and tyrosine residues in the activation loop, carrying a unique C-terminal extension and being mainly regulated by its own protein stability and/or by autophosphorylation. Here we show that ERK3 specifically interacts with the MAPKactivated protein kinase 5 (MK5 or PRAK) in vitro and in vivo. Expression of ERK3 in mammalian cells leads to nuclear-cytoplasmic translocation and activation of MK5 and to phosphorylation of both ERK3 and MK5. Remarkably, activation of MK5 is independent of ERK3 enzymatic activity, but depends on its own catalytic activity as well as on a region in the C-terminal extension of ERK3. In mouse embryonic development, mRNA expression patterns of ERK3 and MK5 suggest spatiotemporal coexpression of both kinases. Deletion of MK5 leads to strong reduction of ERK3 protein levels and embryonic lethality at about stage E11, where ERK3 expression in wild-type mice is maximum, indicating a role of this signalling module in development.

Research paper thumbnail of HIV prevalence among TB patients attending DOTS centres in rural Haryana, India

Research paper thumbnail of CONGENITAL CYTOMEGALOVIRUS INFECTION IN A HIGHLY SEROPOSITIVE SEMI-URBAN POPULATION IN INDIA

The Pediatric Infectious Disease Journal, 2008

To determine the incidence and natural history of congenital cytomegalovirus (CMV) infection in a... more To determine the incidence and natural history of congenital cytomegalovirus (CMV) infection in a population of women with near universal serologic reactivity for CMV, a prospective study of 423 women attending the antenatal clinic of the Comprehensive Rural Health Center in northern India was conducted. All 9 (2.1%) CMV positive infants were born to mothers who were CMV seropositive at the first antenatal visit. One child had hepatosplenomegaly at birth and another child had mild unilateral hearing loss at 4 months of age.

Research paper thumbnail of Making a postgraduate journal club an effective learning opportunity: Experience from the Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi

The National medical journal of India

Research paper thumbnail of Prevalence and determinants of sexually transmitted infections (stis) among male migrant factory workers in Haryana, North India

Indian Journal of Public Health, 2015

Male migrant workers display high risk sexual behavior and have been shown to have higher prevale... more Male migrant workers display high risk sexual behavior and have been shown to have higher prevalence of sexually transmitted infections (STIs), which make them more vulnerable to HIV infection. We aimed to estimate the prevalence of self-reported STIs and delineate their determinants among male migrant factory workers in Faridabad, Haryana. Male workers in two selected factories, who were aged ≥18 years, were born outside Haryana (destination), and who had migrated to Haryana after the age of 15 years were eligible. Socio-demographic information, HIV/AIDS knowledge and behavior, and self-reported STI symptoms in the last 1 year were ascertained by face-to-face interview. Determinants of STIs were identified by regression analysis. Totally 755 eligible workers participated. Mean ± SD age was 31.4 ± 8.2 years and migration duration was 9.5 ± 6.7 years. At least one STI symptom was reported by 41.7% of the participants (burning micturition- 35%, inguinal bubos-5.2%, genital ulcers- 2.6%, urethral pus discharge- 1.3%). Factors associated with STIs were higher age at migration, lower HIV/AIDS knowledge, paid sex in the last year, non-use of condoms during the last non-spousal sex, and unfavorable intention to use condom. Prevalence of self-reported STIs among these migrant men was high. Targeted Interventions among migrant workers need to be strengthened for control and prevention of STIs.

Research paper thumbnail of Lupus Erythematosus Immunological Synapse in Systemic Compartmentalization in the Altered Dynamics of Kv1.3 Channel

Research paper thumbnail of Sunlight exposure and development of rickets in Indian toddlers

The Indian Journal of Pediatrics, 2009

To study the role of sunlight exposure in determining the vitamin D status of underprivileged tod... more To study the role of sunlight exposure in determining the vitamin D status of underprivileged toddlers.

Research paper thumbnail of Choices of ecosystem capital without discounting and prices

Environmental monitoring and assessment

In the last decade, neo-classical economists have used the Consumption-Growth Based Utility (CGBU... more In the last decade, neo-classical economists have used the Consumption-Growth Based Utility (CGBU) framework to suggest an appropriate discount rate for eco-system capital. The CGBU framework, being based on the simplicity and single-valued nature of man-made capital, is subject to many limitations. Three general limitations of the framework, irrespective of its use for man-made capital or ecosystem capital, paradox of consumption growth, expectations' insensitive utility specification, and insensitivity to the nature of returns, are discussed. With respect to its use for ecosystem capital, the framework has two limitations: ecosystems cannot be commoditized and ecosystem capital satisfies differentiated needs, and, hence, gross substitution between different components of ecosystem capital or between ecosystem capital and man-made capital is not possible. Therefore, the rate of discount for ecosystem capital suggested on the basis of the framework is arbitrary. In the context o...

Research paper thumbnail of Improved estimates of India's HIV burden in 2006

The Indian journal of medical research, 2009

HIV estimates in India were based on HIV sentinel surveillance (HSS) data and several assumptions... more HIV estimates in India were based on HIV sentinel surveillance (HSS) data and several assumptions. Expansion of sentinel surveillance to all districts and community based HIV prevalence measured by National Family Health Survey-3 (NFHS-3) in 2006 provided opportunity to replace many of the assumptions with evidence based information and improve the HIV estimate closer to reality. This article presents a detailed account of the methodology used for the 2006 HIV burden estimates for India. State-wise adult HIV prevalence among different risk groups observed from HSS 2006 was adjusted for site level variations using a random effects model and for the previous four years the same was back calculated using trend equations derived from a mixed effects logistic regression model based on consistent sites prevalence. The adjusted HIV prevalence among the general population was calibrated to the estimates from NFHS-3. Overall point estimates of adult HIV prevalence in each State for 2002-2006...

Research paper thumbnail of Correlates of Intention to Use Condom among Male Migrant Factory Workers in Northern India

Journal of clinical and diagnostic research : JCDR, 2014

Consistent condom use among high-risk groups, which in turn are dependant on favourable condom us... more Consistent condom use among high-risk groups, which in turn are dependant on favourable condom use intention is important for the success of HIV/AIDS prevention programmes. We aimed to determine intention to use condom and delineate their correlates in a sample of male migrant workers in northern India. This was a cross-sectional facility based survey conducted in 2011. Inclusion criteria were: male migrant workers aged ≥18 years, who were born outside Haryana, who had moved to current location after 15 years of age, who had worked in the current factory for at least one year and who were able to give valid consent. Face-to-face interviews were conducted with semi-structured questionnaire. Since this analysis was a secondary objective of a larger migrant study, sample size was not calculated separately. Intention to use condom was measured on a five point Likert scale and expressed as a linear score (higher the score more unfavourable the intention). A linear regression analysis was...

Research paper thumbnail of Effect of sedentary activity on telomere length may not be so straightforward

British journal of sports medicine, Jan 8, 2015

Research paper thumbnail of Effect of vitamin A administered at Expanded Program on Immunization contacts on antibody response to oral polio vaccine

European Journal of Clinical Nutrition, 2002

Objective: Vitamin A supplementation to mothers in the postpartum period and to their infants at ... more Objective: Vitamin A supplementation to mothers in the postpartum period and to their infants at routine immunization contacts is being considered to reduce vitamin A deficiency in infancy. This study was conducted to determine the impact of maternal and infant vitamin A supplementation on antibody response to oral polio vaccine (OPV).Design: Randomized, double blind, placebo-controlled trial.Interventions: Mothers in the intervention

Research paper thumbnail of Cause of death during 2009-2012, using a probabilistic model (InterVA-4): an experience from Ballabgarh Health and Demographic Surveillance System in India

Global health action, 2014

The present study aimed to estimate the age and cause-specific mortality in Ballabgarh Health and... more The present study aimed to estimate the age and cause-specific mortality in Ballabgarh Health and Demographic Surveillance System (HDSS) site for the years 2009 to 2012, using a probabilistic model (InterVA-4). All Deaths in Ballabgarh HDSS from January 1, 2009, to December 31, 2012, were included in the study. InterVA-4 model (version 4.02) was used for assigning cause of death (COD). Data from the verbal autopsy (VA) tool were extracted and processed with the InterVA-4 model. Cause-specific mortality rate (CSMR) per 1,000 person-years was calculated. A total of 2,459 deaths occurred in the HDSS during the year 2009 to 2012. Among them, 2,174 (88.4%) valid VA interviews were conducted. Crude death rate ranged from 7.1 (2009) to 6.4 (2012) per 1,000 population. The CSMR per 1,000 person-years over the years (2009-2012) for non-communicable diseases, communicable diseases, trauma, neoplasm, and maternal and neonatal diseases were 1.78, 1.68, 0.68, 0.49, and 0.48, respectively. The mo...

Research paper thumbnail of HIV/AIDS-related mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

Global Health Action, 2014

Background: As the HIV/AIDS pandemic has evolved over recent decades, Africa has been the most af... more Background: As the HIV/AIDS pandemic has evolved over recent decades, Africa has been the most affected region, even though a large proportion of HIV/AIDS deaths have not been documented at the individual level. Systematic application of verbal autopsy (VA) methods in defined populations provides an opportunity to assess the mortality burden of the pandemic from individual data. Objective: To present standardised comparisons of HIV/AIDS-related mortality at sites across Africa and Asia, including closely related causes of death such as pulmonary tuberculosis (PTB) and pneumonia. Design: Deaths related to HIV/AIDS were extracted from individual demographic and VA data from 22 INDEPTH sites across Africa and Asia. VA data were standardised to WHO 2012 standard causes of death assigned using the InterVA-4 model. Between-site comparisons of mortality rates were standardised using the INDEPTH 2013 standard population. Results: The dataset covered a total of 10,773 deaths attributed to HIV/AIDS, observed over 12,204,043 person-years. HIV/AIDS-related mortality fractions and mortality rates varied widely across Africa and Asia, with highest burdens in eastern and southern Africa, and lowest burdens in Asia. There was evidence of rapidly declining rates at the sites with the heaviest burdens. HIV/AIDS mortality was also strongly related to PTB mortality. On a country basis, there were strong similarities between HIV/AIDS mortality rates at INDEPTH sites and those derived from modelled estimates. Conclusions: Measuring HIV/AIDS-related mortality continues to be a challenging issue, all the more so as anti-retroviral treatment programmes alleviate mortality risks. The congruence between these results and other estimates adds plausibility to both approaches. These data, covering some of the highest mortality observed during the pandemic, will be an important baseline for understanding the future decline of HIV/AIDS.

Research paper thumbnail of Cause-specific childhood mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

Global Health Action, 2014

Background: Childhood mortality, particularly in the first 5 years of life, is a major global con... more Background: Childhood mortality, particularly in the first 5 years of life, is a major global concern and the target of Millennium Development Goal 4. Although the majority of childhood deaths occur in Africa and Asia, these are also the regions where such deaths are least likely to be registered. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective: To present a description of cause-specific mortality rates and fractions over the first 15 years of life as documented by INDEPTH Network sites in sub-Saharan Africa and south-east Asia. Design: All childhood deaths at INDEPTH sites are routinely registered and followed up with verbal autopsy (VA) interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provided persontime denominators for mortality rates. Cause-specific mortality rates and cause-specific mortality fractions are presented according to WHO 2012 VA cause groups for neonatal, infant, 1Á4 year and 5Á14 year age groups. Results: A total of 28,751 childhood deaths were documented during 4,387,824 person-years over 18 sites. Infant mortality ranged from 11 to 78 per 1,000 live births, with under-5 mortality from 15 to 152 per 1,000 live births. Sites in Vietnam and Kenya accounted for the lowest and highest mortality rates reported. Conclusions: Many children continue to die from relatively preventable causes, particularly in areas with high rates of malaria and HIV/AIDS. Neonatal mortality persists at relatively high, and perhaps sometimes underdocumented, rates. External causes of death are a significant childhood problem in some settings.

Research paper thumbnail of Organizations, Institutions, External Setting and Institutional Dynamics

Sustainability, Economics, and Natural Resources, 2005

Research paper thumbnail of Mortality from external causes in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System Sites

Global Health Action, 2014

Background: Mortality from external causes, of all kinds, is an important component of overall mo... more Background: Mortality from external causes, of all kinds, is an important component of overall mortality on a global basis. However, these deaths, like others in Africa and Asia, are often not counted or documented on an individual basis. Overviews of the state of external cause mortality in Africa and Asia are therefore based on uncertain information. The INDEPTH Network maintains longitudinal surveillance, including cause of death, at population sites across Africa and Asia, which offers important opportunities to document external cause mortality at the population level across a range of settings. Objective: To describe patterns of mortality from external causes at INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories. Design: All deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. Results: A total of 5,884 deaths due to external causes were documented over 11,828,253 person-years. Approximately one-quarter of those deaths were to children younger than 15 years. Causes of death were dominated by childhood drowning in Bangladesh, and by transport-related deaths and intentional injuries elsewhere. Detailed mortality rates are presented by cause of death, age group, and sex. Conclusions: The patterns of external cause mortality found here generally corresponded with expectations and other sources of information, but they fill some important gaps in population-based mortality data. They provide an important source of information to inform potentially preventive intervention designs.

Research paper thumbnail of Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites

Global Health Action, 2014

Background: Mortality from non-communicable diseases (NCDs) is a major global issue, as other cat... more Background: Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective: To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15Á64 years) and older (65' years) NCD mortality. Design: All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. Results: A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15Á64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality. Conclusions: These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian settings. This comes against a background of global concern about the burden of NCD mortality, especially among adults aged under 70, and provides an important baseline for future work.

Research paper thumbnail of Malaria mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

Global Health Action, 2014

Background: Malaria continues to be a major cause of infectious disease mortality in tropical reg... more Background: Malaria continues to be a major cause of infectious disease mortality in tropical regions. However, deaths from malaria are most often not individually documented, and as a result overall understanding of malaria epidemiology is inadequate. INDEPTH Network members maintain population surveillance in Health and Demographic Surveillance System sites across Africa and Asia, in which individual deaths are followed up with verbal autopsies. Objective: To present patterns of malaria mortality determined by verbal autopsy from INDEPTH sites across Africa and Asia, comparing these findings with other relevant information on malaria in the same regions. Design: From a database covering 111,910 deaths over 12,204,043 person-years in 22 sites, in which verbal autopsy data were handled according to the WHO 2012 standard and processed using the InterVA-4 model, over 6,000 deaths were attributed to malaria. The overall period covered was 1992Á2012, but two-thirds of the observations related to 2006Á2012. These deaths were analysed by site, time period, age group and sex to investigate epidemiological differences in malaria mortality. Results: Rates of malaria mortality varied by 1:10,000 across the sites, with generally low rates in Asia (one site recording no malaria deaths over 0.5 million person-years) and some of the highest rates in West Africa (Nouna, Burkina Faso: 2.47 per 1,000 person-years). Childhood malaria mortality rates were strongly correlated with Malaria Atlas Project estimates of Plasmodium falciparum parasite rates for the same locations. Adult malaria mortality rates, while lower than corresponding childhood rates, were strongly correlated with childhood rates at the site level. Conclusions: The wide variations observed in malaria mortality, which were nevertheless consistent with various other estimates, suggest that population-based registration of deaths using verbal autopsy is a useful approach to understanding the details of malaria epidemiology.

Research paper thumbnail of Alternative Medicine Use in Dialysis Patients: Potential for Good and Bad!

Nephron Clinical Practice, 2007

Although alternative medicines are widely used within the general population, the extent of their... more Although alternative medicines are widely used within the general population, the extent of their use within the dialysis population is unknown. It is possible that dialysis patients may be more likely to turn towards alternative therapies in view of the chronicity of their disease. In addition, this particular patient population could be at an increased risk of toxicity from these therapies due to an absence of renal excretion. A detailed assessment of complementary and alternative medicine use in our dialysis patients revealed that 18% of our patients had used or were using some form of alternative medicine therapy. An additional 63% of our patients, however, were willing to use a complementary or alternative medication. Our results suggest that hemodialysis patients are extremely receptive to the use of such therapies and are therefore exposed to all their potential benefit and harm.

Research paper thumbnail of Scaffolding by ERK3 regulates MK5 in development

The EMBO Journal, 2004

Extracellular-regulated kinase 3 (ERK3, MAPK6) is an atypical member of the ERKs, lacking the thr... more Extracellular-regulated kinase 3 (ERK3, MAPK6) is an atypical member of the ERKs, lacking the threonine and tyrosine residues in the activation loop, carrying a unique C-terminal extension and being mainly regulated by its own protein stability and/or by autophosphorylation. Here we show that ERK3 specifically interacts with the MAPKactivated protein kinase 5 (MK5 or PRAK) in vitro and in vivo. Expression of ERK3 in mammalian cells leads to nuclear-cytoplasmic translocation and activation of MK5 and to phosphorylation of both ERK3 and MK5. Remarkably, activation of MK5 is independent of ERK3 enzymatic activity, but depends on its own catalytic activity as well as on a region in the C-terminal extension of ERK3. In mouse embryonic development, mRNA expression patterns of ERK3 and MK5 suggest spatiotemporal coexpression of both kinases. Deletion of MK5 leads to strong reduction of ERK3 protein levels and embryonic lethality at about stage E11, where ERK3 expression in wild-type mice is maximum, indicating a role of this signalling module in development.

Research paper thumbnail of HIV prevalence among TB patients attending DOTS centres in rural Haryana, India

Research paper thumbnail of CONGENITAL CYTOMEGALOVIRUS INFECTION IN A HIGHLY SEROPOSITIVE SEMI-URBAN POPULATION IN INDIA

The Pediatric Infectious Disease Journal, 2008

To determine the incidence and natural history of congenital cytomegalovirus (CMV) infection in a... more To determine the incidence and natural history of congenital cytomegalovirus (CMV) infection in a population of women with near universal serologic reactivity for CMV, a prospective study of 423 women attending the antenatal clinic of the Comprehensive Rural Health Center in northern India was conducted. All 9 (2.1%) CMV positive infants were born to mothers who were CMV seropositive at the first antenatal visit. One child had hepatosplenomegaly at birth and another child had mild unilateral hearing loss at 4 months of age.