Prevalence of Disability in Children and Adolescents in India, 2011

Background: Child disability is an emerging global health priority. There is lack of statebased analysis of all types of disabilities in children and adolescents in India. Objective: To measure the prevalence of disability and describe the types of disability by gender, advancing age, states and geographical regions in Indian population aged 19 years and below. Methods: Disability data restricted to age 19 years and below of the 2011 Census of India was analyzed. Disability rates per 100,000 children and adolescent population and age-adjusted disability rates were calculated. Results: Disability rate of 1640 per 100,000 was observed in those aged 19 years and below in India in 2011. Nine Indian states and Union Territories had disability rates above the national average. Of the total disability, hearing, seeing and movement related disabilities were 20, 18 and 13% respectively. Disability rates increased with the advancement of age; highest disability rate of 1926 per 100,000 in those aged 10 to 19 years. Males had higher disability rates compared to females (1754 vs. 1516 per 100,000). The disability rates were higher in urban than in rural areas (1805 vs. 1582 per 100,000). Conclusion: There was 1.6% of those aged 19 years and below in India with either physical or mental disability. Further studies on the underlying causes and prevention strategies are essential to reduce the burden of disability in the population aged 19 years and below

Sputum conversion and treatment success among tuberculosis patients with diabetes treated under the Tuberculosis Control Programme in an Urban setting in South India

Background: Studies from India on sputum conversion and tuberculosis (TB) treatment outcomes among TB patients with diabetes are limited. Objective: The objective of this study is to estimate the proportion of sputum smear conversion and successful treatment outcomes among diabetic–TB patients treated under Revised National TB Control Programme (RNTCP). Methodology: Information on TB disease, diabetes, sputum conversion, and treatment outcomes were collected from treatment cards of adult TB patients (age >18 years) treated in the District TB Centre TB Unit, Tiruchirapalli, Tamil Nadu from July 1, 2014, to October 31, 2015. Results: Diabetes was documented in 163 (14%) of 1131 TB patients. Sputum conversion was in 107 (94%) of 114 smear positive-TB patients. Successful TB treatment outcome was in 116 (85%) of 136 patients and 107 (86%) of 124 new TB patients. Conclusion: Sputum conversion was as per RNTCP target while treatment success rate among the new TB patients with diabetes was suboptimal

Predictors of unfavorable responses to therapy in rifampicin-sensitive pulmonary tuberculosis using an integrated approach of radiological presentation and sputum mycobacterial burden

INTRODUCTION: Despite the exalted status of sputum mycobacterial load for gauging pulmonary tuberculosis treatment and progress, Chest X-rays supplement valuable information for taking instantaneous therapeutic decisions, especially during the COVID-19 pandemic. Even though literature on individual parameters is overwhelming, few studies have explored the interaction between radiographic parameters denoting severity with mycobacterial burden signifying infectivity. By using a sophisticated approach of integrating Chest X-ray parameters with sputum mycobacterial characteristics, evaluated at all the three crucial time points of TB treatment namely pre-treatment, end of intensive phase and completion of treatment, utilizing the interactive Cox Proportional Hazards model, we aimed to precisely deduce predictors of unfavorable response to TB treatment. MATERIALS AND METHOD: We extracted de-identified data from well characterized clinical trial cohorts that recruited rifampicin-sensitive Pulmonary TB patients without any comorbidities, taking their first spell of anti-tuberculosis therapy under supervision and meticulous follow up for 24 months post treatment completion, to accurately predict TB outcomes. Radiographic data independently obtained, interpreted by two experienced pulmonologists was collated with demographic details and, sputum smear and culture grades of participants by an independent statistician and analyzed using the Cox Proportional Hazards model, to not only adjust for confounding factors including treatment effect, but also explore the interaction between radiological and bacteriological parameters for better therapeutic application. RESULTS: Of 667 TB patients with data available, cavitation, extent of involvement, lower zone involvement, smear and culture grade at baseline were significant parameters predisposing to an unfavorable TB treatment outcome in the univariate analysis. Reduction in radiological lesions in Chest X-ray by at least 50% at 2 months and 75% at the end of treatment helped in averting unfavorable responses. Smear and Culture conversion at the end of 2 months was highly significant as a predictor (p2 zones, were 3.05 (95% CI: 1.12–8.23) and 1.92 (95% CI: 0.72–5.08) respectively. Patients without cavitation, zonal involvement 2 zones and 3+ smear grade individually and independently forecasted a poorer TB outcome. The interaction model revealed that Zonal involvement confined to 2 zones, without a cavity and smear grade up to 2+, constituting “minimal disease”, had a better prognosis. Radiological clearance >50% along with smear conversion at the end of intensive phase of treatment, observed to be a reasonable alternative to culture conversion in predicting a successful outcome. These parameters may potentially take up key positions as stratification factors for future trials contemplating on shorter TB regimens

Prevalence of disability in Tamil Nadu, India.

BACKGROUND Information on disability is essential for the government to formulate policies, allocate adequate resources and implement appropriate programmes. We aimed to estimate the prevalence of disability and describe the types of disability by gender, age and geographical regions in Tamil Nadu, India. METHODS We analysed the 2011 Census cross-sectional survey data of Tamil Nadu. Age-adjusted disability rates and disability rates per 100 000 population were calculated. RESULTS There were 1 179 963 disabled individuals in Tamil Nadu in 2011, a disability rate of 1635 per 100 000 population. Disability in movement, hearing and sight individually accounted for 24%, 19% and 11% of the total disability, respectively. Sixteen districts had disability rates above the state average. As age advanced, disability rates increased; the highest disability rate of 2533 per 100 000 was among people aged 60 years and above. The disability rates were higher in males compared to females (1819 v. 1451 per 100 000). Rural areas had higher disability areas compared to urban (1670 v. 1599 per 100 000). Currently married, working populations and literate populations had lower disability rates. Disability rate in the Scheduled Castes was higher at 1763 per 100 000 compared to the Scheduled Tribes and other social groups. Multiple disability was high in the age groups 0-19 years and 60 years and above. CONCLUSION Physical or mental disability was observed in 1.6% of the population of Tamil Nadu. Research is warranted to identify underlying causes and interventions to reduce the burden of disability in the state

Indicators to ensure treatment initiation of all diagnosed sputum positive pulmonary tuberculosis patients under tuberculosis control programme in India

Background: Pretreatment loss to follow-up (PTLFU) is used as performance indicator of Revised National Tuberculosis Control Programme (RNTCP) of India. Objective: To document the PTLFU, identify additional indicators and examine documentation of all the diagnosed sputum positive pulmonary tuberculosis (PTB) patients under RNTCP. Methodology: Tuberculosis (TB) laboratory, referral for treatment registers, and referral forms were perused for information on sputum positive PTB patients diagnosed from January to June 2014, in 3 TB Units in Chennai. Results: PTLFU was 24% (572 out of 2361). However, in pursuance with the principle of ensuring that all diagnosed patients must be started on treatment following referral, it was inflated to 44% (1046 out of 2361). Conclusion: The existing PTLFU indicator does not reflect the proportion of treatment initiation of all diagnosed smear-positive PTB patients. We propose additional indicators for monitoring referral and treatment initiation of all diagnosed sputum positive PTB patients