ABSTRACT
Introduction: COVID-19, a multisystem disease, has implications for various immunity and infection biomarkers. Yoga (Y), meditation (M), and pranayama (P), and their combinations have shown positive changes on those biomarkers among other than COVID-19 patients and healthy people. So, we aimed to document the evidence of possible implication in a systematic way. Materials and Methods: We screened 84 full texts, published in the last ten years, from three databases, from which only 44 met the eligibility criteria, and then extracted the data related to demographic characteristics, intervention, results, and strengths and limitations in two MS-Excel grids, and then presented them in tables and figures. Furthermore, we carried out meta-analysis including subgroup and sensitivity analysis using a random effects model of 11 RCTs and reported the mean difference, heterogeneity, and p value with 95% CI and presented them with forest and funnel plots and the tables. Results: Twenty-five biomarkers of 4023 participants (range, 15-413) from 13 countries, healthy and clinical, from both sexes above 18 years, and from mainly clinical settings, were reported. YMP intervention, in solitary or in different possible combinations with varied durations among clinical and pregnant (range, 960-4800 minutes) and healthy (960-8400 minutes, excluding two studies of 20 minutes only) participants, was reported. It was revealed that 25 biomarkers, nine among the apparently healthy, 14 among the patients, and two among the pregnant, changed favourably (p < 0.05). Furthermore, either in meta- or subgroup-analysis, mean differences of IL-6 (-1.44 pg/ml) (95% CI) (-2.33, -0.55), (p = 0.002, I 2 = 82%), Cortisol (-40.75 pg/ml) (95% CI) (-64.13, -17.38), (p = 0.0006, I 2 = 87%), and TNF-α (-3.40 pg/ml) (95% CI) (-4.83, -1.98), (p < 0.0001, I 2 = 79%) showed statistically significant changes. Nonetheless, considerable heterogeneity and publication bias were observed among the studies. Conclusion: Although more than two dozens of biomarkers in individual studies showed favourable changes, only IL-6, Cortisol, and TNF-α produced significant combined results, even then with much less certainty. Further meta-analysis of biomarkers of COVID-19 patients is highly recommended. Registration: CRD42021283894.
ABSTRACT
Background Gujarat, India, is home to severe acute malnutrition. Wasting in children is associated with a higher risk of death if not treated properly. The present study identified children under five years of age with severe acute malnutrition (SAM). It provided energy-dense nutrition supplement (EDNS) during the rising cases of COVID-19 to treat them as per the guidelines of the government of Gujarat in Devbhumi Dwarka District of Gujarat State, India. Methods A descriptive research design was used in the study. Children were screened by a Nutrition Assistant in the presence of an Anganwadi Worker (AWW), Auxiliary Nurse Midwife (ANM)/Community Health Officer (CHO) at Anganwadi Centre or the Child's home using weight/length Z score <-3 standard deviations (SDs) or mid-upper arm circumference (MUAC) <11.5 and identified severe acute malnourished children were provided EDNS (WHO composition) for a period of seven days initially for a starting period as per the child's body weight then followed up to eight weeks. Data was entered on the spot in a Google sheet, which nutrition assistants maintained. Data were analyzed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States) and Microsoft Excel 2019. Results The study revealed that 23% of children were considered in the SAM category, followed by 21% in the Bhanvad block and 24% in the Dwarka block. For the Bhanvad block, 40% of the children were treated normally with a maximum weight gain of 1 to 2 kgs (63%). Similarly, for the Dwarka block, 29% of children were treated normally with a weight gain of 1 to 2 kgs (64%). Conclusions The study identified children with SAM and provided EDNS for eight weeks. To strengthen the program, the engagement of frontline functionaries of government should be increased, which plays an active role in the community and can be a bridge to the community. As in the community-based management of acute malnutrition (CMAM) program, Accredited Social Health Activists (ASHAs) are responsible for reaching out the ready-to-use therapeutic food (RUTF) to the mothers, weighing of children is done jointly by AWWs and ASHAs on a weekly basis, as well as counselling of the mothers on care and feeding practices and hygiene, and therefore every ASHA receives an incentive of Rs. 25 per child per week to monitor the progress of the child, reach out the therapeutic food, and counsel the mother. This system should be linked with Prime Minister's Overarching Scheme for Holistic Nutrition (POSHAN) on wheels program.
ABSTRACT
Introduction COVID-19, a multisystem disease, has implications for various immunity and infection biomarkers. Yoga (Y), meditation (M), and pranayama (P), and their combinations have shown positive changes on those biomarkers among other than COVID-19 patients and healthy people. So, we aimed to document the evidence of possible implication in a systematic way. Materials and Methods We screened 84 full texts, published in the last ten years, from three databases, from which only 44 met the eligibility criteria, and then extracted the data related to demographic characteristics, intervention, results, and strengths and limitations in two MS-Excel grids, and then presented them in tables and figures. Furthermore, we carried out meta-analysis including subgroup and sensitivity analysis using a random effects model of 11 RCTs and reported the mean difference, heterogeneity, and p value with 95% CI and presented them with forest and funnel plots and the tables. Results Twenty-five biomarkers of 4023 participants (range, 15–413) from 13 countries, healthy and clinical, from both sexes above 18 years, and from mainly clinical settings, were reported. YMP intervention, in solitary or in different possible combinations with varied durations among clinical and pregnant (range, 960–4800 minutes) and healthy (960–8400 minutes, excluding two studies of 20 minutes only) participants, was reported. It was revealed that 25 biomarkers, nine among the apparently healthy, 14 among the patients, and two among the pregnant, changed favourably (p < 0.05). Furthermore, either in meta- or subgroup-analysis, mean differences of IL-6 (−1.44 pg/ml) (95% CI) (−2.33, −0.55), (p = 0.002, I2 = 82%), Cortisol (−40.75 pg/ml) (95% CI) (−64.13, −17.38), (p = 0.0006, I2 = 87%), and TNF-α (−3.40 pg/ml) (95% CI) (−4.83, −1.98), (p < 0.0001, I2 = 79%) showed statistically significant changes. Nonetheless, considerable heterogeneity and publication bias were observed among the studies. Conclusion Although more than two dozens of biomarkers in individual studies showed favourable changes, only IL-6, Cortisol, and TNF-α produced significant combined results, even then with much less certainty. Further meta-analysis of biomarkers of COVID-19 patients is highly recommended. Registration: CRD42021283894.
ABSTRACT
Background The Integrated Child Development Services (ICDS), a flagship program of the Government of India, is addressing the malnutrition, health, and development needs of young children, pregnant and lactating women, and adolescent girls for more than four decades. Although the program has been implemented for the past four decades, it could not bring the expected outcomes in terms of reducing malnutrition. The program's limited success can be attributed, among others, to insufficient skills of the program staff and inadequate convergence with the existing nutrition programs implemented through the health department. For the success of any program, advanced knowledge, improved skills, motivation, and the right attitude of the program staff are essential and can be instilled through the need-based training of the staff. The present study aimed at identifying gaps in existing training for health and ICDS program staff in the district and developing a capacity-building strategy to strengthen the implementation of the nutrition program in the district, including "Project Tushti," which aimed at combating malnutrition in Devbhumi Dwarka district of the Gujarat state. Methods The training needs assessment (TNA) was conducted using a descriptive cross-sectional study design. TNA is a method to determine program gaps and training required to fill in programmatic gaps. Appropriate use of TNA can promote designing effective training and nurture program staff productivity, thereby ensuring efficient use of resources for achieving desired program outcomes within the prescribed timeline. Considering the coronavirus disease 2019 (COVID-19)-led lockdown, convenient sampling was used to reach out to potential study participants. A total of 150 program staff from both health departments (particularly medical officers, taluka health officer, National Adolescent Health Program - Rashtriya Bal Swasthya Karyakram (RBSK) medical officer, community health officer from health and wellness center, female health workers, and Accredited Social Health Activists (ASHAs)) and ICDS team (chief district program officer, supervisor, Anganwadi workers, and helpers at Anganwadi center) were interviewed telephonically using a semi-structured interview guide. Interviews were conducted between May 10 and 16, 2020. Results Results reveal that about 49% of the health team and ICDS staff had not received nutrition-specific training in the last year. In terms of coverage, the training coverage was partial, and training content on nutrition was limited. Training contents were divided based on supervisory and implementing cadre feedback. Participants expressed the need for in-depth nutritional refresher training, including topics such as community-based management of acute malnutrition, identification of malnutrition, use of ICDS common application software, and soft skills such as communication skills and supportive supervision. Although 62% of participants preferred the face-to-face medium of training, they agreed with the online mode of training. Conclusion Findings indicate an urgent need for training, particularly in the district's nutrition domain for the staff involved in the implementation, and soft skills for supervisory level staff. Innovative training approaches using the digital platform can be explored for training delivery. The paper discusses innovative capacity-building strategies to address training needs effectively.
ABSTRACT
Yoga is recognized and practiced for different levels of prevention since antiquity. The current scoping review aimed to identify and document the evidence reporting the effect of yoga interventions on immunity against COVID-19 infection. Three databases--PubMed, Cochrane, and Google Scholar, were searched to identify eligible studies. Articles published in English after 2010 and assessing the impact of any form of yoga (such as yogasanas, meditations, or pranayamas) on immunological markers were included in the review. The studies without information of the intervention on immunity markers, and experience sharing reviews were excluded. The search yielded 45 eligible articles with majority of the studies being published from the USA and India. Most of the studies were randomized controlled trials, enrolling the adult population with a specific focus on diseases like HIV, cancer, and heart failure. It was observed that a variety of yoga interventions along with meditation and pranayama, in different combinations were used by the authors. However, all these studies unanimously reported improvement in immunological profile (indicated by improved biochemical markers) of an individual (irrespective of disease state and type) with yoga. Moreover, the beneficial effects of these traditional Indian interventions were also found to have a positive impact on overall physical and physiological wellbeing and quality of life. Findings from the existing literature indicate that the practice of yoga has the potential to strengthen cell-mediated immunity and hence could be used as an effective preventive measure against COVID-19 where immunity plays a critical role.
ABSTRACT
Background: District Health Authority in Ahmedabad, Gujarat has introduced Project Lifeline, 12-lead portable ECG devices across all primary health centers (PHC) in the district to screen cardiac abnormalities among high-risk and symptomatic adults for providing primary management and proper timely referral. The prime purpose of the study was to assess the cost-effectiveness of portable ECG for the screening of cardiovascular diseases (CVD) among high-risk and symptomatic adults at the PHC in Ahmedabad, Gujarat. Methods: Cost-effective analysis was conducted using a societal perspective. An incremental costing approach was adapted, and cost-effectiveness analysis was done using a decision-analytic model. We surveyed 73 patients who screened positive for cardiac abnormality, documented the type of ECG abnormalities, and diagnosed CVD. The program cost was obtained from the implementers. Transition probabilities were derived from primary data supported by expert opinion for the intervention arm, while a systematic search of the literature was undertaken to derive transition probabilities for the control arm. Results: The ECG screening at PHC saves 2.90 life years at an incremental cost of 89.97 USD (6657.47 INR), yielding a cost-effectiveness ratio of 31.07 USD (2,299.06 INR) per life-year saved, which is below the willingness to pay threshold. The budget impact analysis was also performed. Results are sensitive to the relative risk reduction associated with the non-participation and the cost of initial screening. Conclusion: Cost-effectiveness analysis clearly shows that the facility to screen cardiac abnormality at the PHC level is highly recommended for high-risk adults and symptomatic cases.