Clinico-epidemiological profile and outcomes of adults with COVID-19: A hospital-based retrospective study in Kerala, India.

Introduction: The clinical and epidemiological presentations of patients with coronavirus disease 2019 (COVID-19) in India is still not well explored. We studied the epidemiological and clinical profile and outcomes of COVID-19 patients admitted to a tertiary care private hospital in Kerala, India. Methods: In this retrospective study, we analyzed data of 476 adult (≥18 years) COVID-19 patients admitted to a tertiary care hospital in Kerala from September 1, 2020 to March 31, 2021. The patients were categorized into mild, moderate, and severe cases and followed till discharge or death. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23.0 with a significance set at P < 0.05. Results: The median age was 57 years (56% men). Mild, moderate, and severe cases accounted for 17%, 65%, and 18%, respectively. Around 75% had at least one comorbidity, and 51% had multiple comorbidities. The most common comorbidities were diabetes (45%), hypertension (44%), dyslipidemia (15%), and cardiac problems (12%). The elevated D-dimer values among patients in different categories were significantly different, with 74% in severe, 46% in moderate, and 19% in mild category patients. Serum ferritin, C-reactive protein, lactic acid dehydrogenase, and neutrophil to lymphocyte ratio values were significantly higher for severely ill patients. Thirty deaths (67% men) occurred during the study period, with a case fatality rate of 6.3%. Mortality mainly happened in the older age group (80%) and those with multimorbidity (90%). Conclusion: Age and multimorbidity are the major contributing factors for death in hospitalized COVID-19 patients. Generalization of the findings necessitates well-designed large-scale studies.

Universalizing health services in India: the techno-managerial fix.

The non-universal nature of health services in India can also be the result of many reforms and milestones the health services had passed through since independence. The reform era during the post-nineties is replete with many new trends in organizational strategies which could have led to crises in health services. The salient crises need to be dissected from a larger societal crisis and the specific crises in the health services system. It is evident that non-accessibility and non-availability and the sub-optimal functioning of the primary health centers are perennial issues which could not be addressed by indigenous, imposed or cocktail reforms (such as National Rural Health Mission) and by targeting as these only tinker with the health services. Needless to reiterate that there is a need to address the social dimensions which fall outside the technical sphere of health services. This paper based on an analytical review of relevant literature concludes that any efforts to universalize health and health-care can not only focus on technical components but need to address the larger social determinants and especially the societal crisis, which engender ill-health.

The use of traditional, complementary and alternative medicine in Sri Lankan cancer care: results from a survey of 500 cancer patients.

OBJECTIVES: While the introduction of biomedicine within the Sri Lankan healthcare system has resulted in reduced reliance on traditional, complementary and alternative medicine (TCAM) over the last century in Sri Lanka, treatment modalities such as Ayurveda, Sinhala and traditional religious practices still receive considerable public support. Cancer is an increasing burden in Sri Lanka, and whilst Sri Lankans are known to use TCAM for everyday ailments, there has been no research examining the role of TCAM in the context of cancer. The aim of this study was to evaluate the prevalence and patterns of TCAM use by cancer patients. STUDY DESIGN: Cross-sectional survey. METHODS: Data were obtained from two Sri Lankan hospitals using a consecutive convenience sample of 500 cancer patients currently receiving biomedical treatment, over a 10-week period in 2008. RESULTS: Analyses showed that 67.4% of those surveyed used one or more TCAM in conjunction with biomedicine for cancer treatment. The most common were Sinhala, Ayurveda and traditional religious practices. Of those patients who used TCAM, 95.0% gave the main reason for usage as 'they thought it would cure their cancer'. The strongest reason for not using TCAM was on advice from their doctor (80.5%). CONCLUSIONS: The high use of TCAM amongst cancer patients in Sri Lanka raises numerous important issues, including those related to patient safety, potential benefit, interactions with biomedical cancer treatments, and delays in seeking biomedical cancer care. Further research is needed to explore the decision-making processes of cancer patients, including the perceived benefits/limitations of key processes in biomedical and TCAM care.

Social exclusion, caste & health: a review based on the social determinants framework.

Poverty and social exclusion are important socio-economic variables which are often taken for granted while considering ill-health effects. Social exclusion mainly refers to the inability of our society to keep all groups and individuals within reach of what we expect as society to realize their full potential. Marginalization of certain groups or classes occurs in most societies including developed countries and perhaps it is more pronounced in underdeveloped countries. In the Indian context, caste may be considered broadly as a proxy for socio-economic status and poverty. In the identification of the poor, scheduled caste and scheduled tribes and in some cases the other backward castes are considered as socially disadvantaged groups and such groups have a higher probability of living under adverse conditions and poverty. The health status and utilization patterns of such groups give an indication of their social exclusion as well as an idea of the linkages between poverty and health. In this review, we examined broad linkages between caste and some select health/health utilization indicators. We examined data on prevalence of anaemia, treatment of diarrhoea, infant mortality rate, utilization of maternal health care and childhood vaccinations among different caste groups in India. The data based on the National Family Health Survey II (NFHS II) highlight considerable caste differentials in health. The linkages between caste and some health indicators show that poverty is a complex issue which needs to be addressed with a multi-dimensional paradigm. Minimizing the suffering from poverty and ill-health necessitates recognizing the complexity and adopting a perspective such as holistic epidemiology which can challenge pure technocentric approaches to achieve health status.

OUTBREAK OF BANCROFTIAN FILARIASIS AMONG TROOPS AT AN ARMED FORCES STATION.

A large number of microfilaria (MF) positive cases were reported at a Military Hospital in 1994. The epidemiological investigations included mass night blood survey, detection of sector breeding places and entomological studies. Control measures were instituted concurrently and this included treatment of positive cases, sector control measures, personal protection and health education. The mass blood survey was continued in 1995 as well to find the outcome of control measures. A total of 215 MF positive cases were detected in 1994 with MF rate of 9.63. The only MF species identified was Wuchereria bancrofti. 203% cases were in the station for less than six months. 71.3% of MF positive cases were asymptomatic. As per state health authorities, Culex quinquefasciatus was the known vector for spread of the disease in the region. However, in present study, it could not be implicated as dissection of over 200 mosquitoes of this species was negative for filarial parasite. Our study stresses the importance of close monitoring of the disease by night blood surveys and effective integrated vector control measures.

Old priorities and new agenda of public health in India: is there a mismatch?

AIM: Structural adjustment programs and health sector reforms in India create new agenda in health services. The aim of this study is the analysis of the mismatch between the new health services agenda and epidemiological priorities, and exploration of the possible alternatives, such as decentralization. METHOD: Analysis of the disease pattern, health, and demographic indicators versus the pattern of investments and policy changes was performed. The possible alternatives were explored by the study of decentralization process attempted in Kerala, by anthropological field work and examination of primary documents. RESULTS: The post-reform period has witnessed a rise in the cases of communicable diseases and an increase in the frequency of epidemics in different parts of the country. The infant mortality rate has risen or decline has slowed down in many states. The new agenda, which includes gradual withdrawal of the State in the provision of health services and the process of privatization, has already been initiated in the country as a part of health sector reforms. The process of decentralization in Kerala was examined to highlight the role of people's planning in health under growing conditions of mismatch between the epidemiological priorities and new agenda. CONCLUSIONS: The new agenda could pose a serious threat to effective implementation of public health programs including control of communicable diseases. Public health programs and allocation of resources need to be rooted in the epidemiological and social context. The process of decentralization attempted in Kerala could be used as a tool to achieve this aim.

AN EPIDEMIOLOGICAL STUDY OF SNAKE BITES IN AN AREA IN THE FOOTHILLS OF THE NORTH WESTERN HIMALAYAS.

Cases of snake bite amongst troops, families, and defence civilians admitted to a service hospital were consistently high from 1985-1988 (rate 1.24-1.56 per 1000). Study of the cases revealed simple measures could have prevented a large number of casualties which in fact became true in 1989 (rate 0.43 per 1000) when strict enforcement of preventive measures was practised.

RESURGENCE OF MT MALARIA AMONGST TROOPS SERVING IN THE NORTH EAST.

Cases of MT malaria amongst troops serving in the North East are on the increase. Study of the malaria morbidity and mortality data of the past five years covering a population of about 1.65 lakhs revealed that there is a definite resurgence of malaria from an incidence of 0.39 per thousand in 1989 to 0.54 per thousand in 1992. Death due to malaria is a cause for concern especially since most of the troops are on chemoprophylaxis. A more realistic epidemiological approach to malaria control would be required to contain malaria.