Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. FINDINGS: In 2016, there were 27·08 million (95% uncertainty interval [UI] 24·30-30·30 million) new cases of TBI and 0·93 million (0·78-1·16 million) new cases of SCI, with age-standardised incidence rates of 369 (331-412) per 100 000 population for TBI and 13 (11-16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55·50 million (53·40-57·62 million) and of SCI was 27·04 million (24·98-30·15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8·4% (95% UI 7·7 to 9·2), whereas that of SCI did not change significantly (-0·2% [-2·1 to 2·7]). Age-standardised incidence rates increased by 3·6% (1·8 to 5·5) for TBI, but did not change significantly for SCI (-3·6% [-7·4 to 4·0]). TBI caused 8·1 million (95% UI 6·0-10·4 million) YLDs and SCI caused 9·5 million (6·7-12·4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82-141) per 100 000 for TBI and 130 (90-170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. INTERPRETATION: TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments

Health behaviours & problems among young people in India: Cause for concern & call for action

The young people in the age group of 10-24 yr in India constitutes one of the precious resources of India characterized by growth and development and is a phase of vulnerability often influenced by several intrinsic and extrinsic factors that affect their health and safety. Nearly 10-30 per cent of young people suffer from health impacting behaviours and conditions that need urgent attention of policy makers and public health professionals. Nutritional disorders (both malnutrition and over-nutrition), tobacco use, harmful alcohol use, other substance use, high risk sexual behaviours, stress, common mental disorders, and injuries (road traffic injuries, suicides, violence of different types) specifically affect this population and have long lasting impact. Multiple behaviours and conditions often coexist in the same individual adding a cumulative risk for their poor health. Many of these being precursors and determinants of non communicable diseases (NCDs) including mental and neurological disorders and injuries place a heavy burden on Indian society in terms of mortality, morbidity, disability and socio-economic losses. Many health policies and programmes have focused on prioritized individual health problems and integrated (both vertical and horizontal) coordinated approaches are found lacking. Healthy life-style and health promotion policies and programmes that are central for health of youth, driven by robust population-based studies are required in India which will also address the growing tide of NCDs and injuries

Epilepsy in India I: Epidemiology and public health

Of the 70 million persons with epilepsy (PWE) worldwide, nearly 12 million PWE are expected to reside in India; which contributes to nearly one-sixth of the global burden. This paper (first of the two part series) provides an in-depth understanding of the epidemiological aspects of epilepsy in India for developing effective public health prevention and control programs. The overall prevalence (3.0-11.9 per 1,000 population) and incidence (0.2-0.6 per 1,000 population per year) data from recent studies in India on general population are comparable to the rates of high-income countries (HICs) despite marked variations in population characteristics and study methodologies. There is a differential distribution of epilepsy among various sociodemographic and economic groups with higher rates reported for the male gender, rural population, and low socioeconomic status. A changing pattern in the age-specific occurrence of epilepsy with preponderance towards the older age group is noticed due to sociodemographic and epidemiological transition. Neuroinfections, neurocysticercosis (NCC), and neurotrauma along with birth injuries have emerged as major risk factors for secondary epilepsy. Despite its varied etiology (unknown and known), majority of the epilepsy are manageable in nature. This paper emphasizes the need for focused and targeted programs based on a life-course perspective and calls for a stronger public health approach based on equity for prevention, control, and management of epilepsy in India

Epilepsy in India II: Impact, burden, and need for a multisectoral public health response

Epilepsy is a common neurological disorder whose consequences are influenced socially and culturally, especially in India. This review (second of the two part series) was carried out to understand the social impact and economic burden to develop comprehensive program for control and prevention of epilepsy. Epilepsy is known to have adverse effect on education, employment, marriage, and other essential social opportunities. Economic burden associated with epilepsy is very high with treatment and travel costs emerging as an important contributing factor. A vicious cycle between economic burden and poor disease outcome is clear. There is no significant change in the perception, stigma, and discrimination of epilepsy across the country despite improvement in educational and social parameters over the time. The huge treatment gap and poor quality of life is further worsened by the associated comorbidities and conditions. Thus, a multidisciplinary response is needed to address the burden and impact of epilepsy which calls for an integrated and multipronged approach for epilepsy care, prevention, and rehabilitation. Service delivery, capacity building, integration into the existing program, mobilizing public support, and increasing public awareness will be the hallmarks of such an integrated approach in a public health model

Public–private implementation of integrated emergency response services: Case study of GVK Emergency Management and Research Institute in Karnataka, India

© 2017 Elsevier Inc. Background Emergency medical services are important to the functioning of health systems, but these services tend to be neglected in low- and middle-income countries, such as India. In recent years, several models of pre-hospital emergency medical services have emerged in India. Research on these models holds important lessons for existing and future emergency medical service programs in low- and middle-income countries. Our objective was to provide a comprehensive description of the organizational structure and service delivery model of a public–private partnership in the southern Indian state of Karnataka, GVK Emergency Management and Research Institute, with a particular focus on its operations in Bengaluru. Methods A case study methodology was used to explore systematically the organizational model of GVK Emergency Management and Research Institute in Karnataka. Qualitative data were collected through an in-person site visit to GVK Emergency Management and Research Institute headquarters in Bengaluru in July 2013. Three sources were used: in-depth, semistructured interviews, document review, and nonparticipant observation. Data were analyzed according to the health system “building blocks” proposed by the World Health Organization. Results The organization follows a standardized model across the states and union territories where they have contractual arrangements, including Karnataka. Processes for fleet maintenance, information systems/information technology and training, and deployment were well structured at the organizational level. The public–private partnership appears pro-poor in orientation; however, further demand-side research is required on the perspective of patients. Conclusion Our study reveals a functional structure at the organizational level, which provides a key service at no cost to users. Detailed analyses of this nature can help inform global efforts for the development and strengthening of emergency medical services systems

Evidence-Based Road Safety Practice in India: Assessment of the Adequacy of Publicly Available Data in Meeting Requirements for Comprehensive Road Safety Data Systems

Objective: To assess the availability and coverage of publicly available road safety data at the national and state levels in India. Methods: We reviewed the 2 publicly accessible data sources in India for the availability of data related to traffic injuries and deaths: (1) the National Crime Records Bureau (NCRB) and (2) the Ministry of Road Transport and Highways (MORTH). Using the World Health Organization (WHO) manual for the comprehensive assessment of road safety data, we developed a checklist of indicators required for comprehensive road safety assessment. These indicators were then used to assess the availability of road safety data in India using the NCRB and MORTH data. We assessed the availability of data on outcomes and exposures indicators (i.e., number of crashes, injuries, deaths, timing of deaths, gender and age distribution of injuries and deaths), safety performance indicators (i.e., with reference to select risk factors of speeding, alcohol, and helmet use), and cost indicators (i.e., medical costs, material costs, intervention costs, productivity costs, time costs, and losses to quality of life). Results: Information on outcome indicators was the most comprehensive in terms of availability. Both NCRB and MORTH databases had data for most of the need areas specified by the WHO under outcomes and exposure indicators. Regarding outcome and exposure indicators, data were available for 81 and 91 percent of specified need areas at the national level from NCRB and MORTH databases, respectively. At the state level, data on outcome and exposure indicators were available for only 54 percent of need areas from either of the 2 sources. There were no data on safety performance indicators in the NCRB database. From the MORTH database, data availability on safety performance indicators was 60 percent at both national and state levels. Data availability on costs and process indicators was found to be below 20 percent at the national and state levels. Conclusion: Overall, there is an urgent need to improve the publicly available road safety data in India. This will enhance monitoring of the burden of traffic injuries and deaths, enable sound interpretation of national road safety data, and allow the formulation effective road safety policies

The burden attributable to headache disorders in India: estimates from a community-based study in Karnataka State

Background: Headache disorders are common worldwide, causing pain and disability. India appears to have a very high prevalence of migraine, and of other headache disorders in line with global averages. Our objective was to estimate the burdens attributable to these disorders in order to inform health policy. Methods: In a door-to-door survey, biologically unrelated adults (18–65 years) were randomly sampled from urban and rural areas of Bangalore and interviewed by trained researchers. The validated structured questionnaire enquired into several aspects of burden. Results: Of 2,329 participants (non-participation rate 7.4 %), 1,488 (63.9 %; 621 male, 867 female) reported headache in the preceding year. Symptom burden was high. Migraine (1-year prevalence 25.2 %) occurred on average on 28 days/ year but, in 38.0 % of cases (ie, 9.6 % of adults), on ≥3 days/month (≥10 % of days). All causes of headache on ≥15 days/ month (prevalence 3.0 %) occurred on a mean of 245 days/year. Both these and migraine were rated severe in intensity. Participants with headache lost 4.3 % of productive time; those with migraine lost 5.8 % (equating to 1.5 % fromthe adult population). Lost paid worktime accounted for 40 % of this, probably detracting directly from GDP. We estimated population-level disability attributable to migraine using the disability weight from GBD2010 for the ictal state (0.433). Mean disability per person with migraine was 1.8 %, reducing the functional capacity of the entire adult population by 0.46 %. Fewer than one quarter of participants with headache had engaged with health-care services for headache in the last year. Actual expenditure on headache care was greatest among those with headache on ≥15 days/month (especially probable medication-overuse headache), but otherwise not high. Expressed willingness to pay for effective treatment for headache was higher, signalling dissatisfaction with current treatments. Conclusions: In Karnataka State, southern India, prevalent headache disorders, especially migraine, give rise to commensurately heavy burdens. Limited access to health care fails to alleviate these. Structured headache services, with their basis in primary care, are the most efficient, effective, affordable and equitable solution. They could be implemented within the health-care infrastructure of India and are likely to be cost-saving. This solution requires political will, itself dependent on awareness. Keywords: Headache disorders, Migraine, Tension-type headache, Medication-overuse headache, Burden, Health policy, Willingness to pay, India, South-East Asia, Global campaign against headach

Headache disorders and public ill-health in India: Prevalence estimates in Karnataka State

Background: Primary headache disorders are among the commonest disorders, affecting people in all countries. India appears to be no exception, although reliable epidemiological data on headache in this highly populous country are not available. Such information is needed for health-policy purposes. Our aim was to estimate the prevalence of each of the headache disorders of public-health importance, and examine their sociodemographic associations, in urban and rural populations of Karnataka, south India. Methods: In a door-to-door survey, 2,329 biologically unrelated adults (aged 18–65 years) were randomly sampled from urban (n = 1,226) and rural (n = 1,103) areas in and around Bangalore and interviewed by trained researchers using a pilot-tested, validated, structured questionnaire. ICHD-II diagnostic criteria were applied. Results: The observed 1-year prevalence of any headache was 63.9 %, with a female preponderance of 4:3. The age-standardised 1 year prevalence of migraine was 25.2 %; prevalence was higher among females than males (OR: 2.1 [1.7-2.6]) and among those from rural areas than urban (OR = 1.5 [1.3-1.8]). The age-standardized 1 year prevalence of TTH was 35.1 %, higher among younger people. The estimated prevalence of all headache on ≥15 days/ month was 3.0 %; that of pMOH was 1.2 %, five-times greater among females than males and with a rural preponderance. Conclusions: There is a very high 1 year prevalence of migraine in south India (the mean global prevalence is estimated at 14.7 %). Explanations probably lie in cultural, lifestyle and/or environmental factors, although the observed associations with female gender and rural dwelling are usual. Levels of TTH, pMOH and other headache on ≥15 days/month are similar to global averages, while the very strong association of pMOH with female gender requires explanation. Until another study is conducted in the north of the country, these are the best data available for health policy in a population of over 1.2 billion people. Keywords: Headache disorders; Migraine; Tension-type headache; Medication-overuse headache; Epidemiology; Population-based study; Prevalence; Health policy; Global Campaign against Headach

The burden attributable to headache disorders in India: estimates from a community-based study in Karnataka State

Background: Headache disorders are common worldwide, causing pain and disability. India appears to have a very high prevalence of migraine, and of other headache disorders in line with global averages. Our objective was to estimate the burdens attributable to these disorders in order to inform health policy. Methods: In a door-to-door survey, biologically unrelated adults (18–65 years) were randomly sampled from urban and rural areas of Bangalore and interviewed by trained researchers. The validated structured questionnaire enquired into several aspects of burden. Results: Of 2,329 participants (non-participation rate 7.4 %), 1,488 (63.9 %; 621 male, 867 female) reported headache in the preceding year. Symptom burden was high. Migraine (1-year prevalence 25.2 %) occurred on average on 28 days/ year but, in 38.0 % of cases (ie, 9.6 % of adults), on ≥3 days/month (≥10 % of days). All causes of headache on ≥15 days/ month (prevalence 3.0 %) occurred on a mean of 245 days/year. Both these and migraine were rated severe in intensity. Participants with headache lost 4.3 % of productive time; those with migraine lost 5.8 % (equating to 1.5 % fromthe adult population). Lost paid worktime accounted for 40 % of this, probably detracting directly from GDP. We estimated population-level disability attributable to migraine using the disability weight from GBD2010 for the ictal state (0.433). Mean disability per person with migraine was 1.8 %, reducing the functional capacity of the entire adult population by 0.46 %. Fewer than one quarter of participants with headache had engaged with health-care services for headache in the last year. Actual expenditure on headache care was greatest among those with headache on ≥15 days/month (especially probable medication-overuse headache), but otherwise not high. Expressed willingness to pay for effective treatment for headache was higher, signalling dissatisfaction with current treatments. Conclusions: In Karnataka State, southern India, prevalent headache disorders, especially migraine, give rise to commensurately heavy burdens. Limited access to health care fails to alleviate these. Structured headache services, with their basis in primary care, are the most efficient, effective, affordable and equitable solution. They could be implemented within the health-care infrastructure of India and are likely to be cost-saving. This solution requires political will, itself dependent on awareness. Keywords: Headache disorders, Migraine, Tension-type headache, Medication-overuse headache, Burden, Health policy, Willingness to pay, India, South-East Asia, Global campaign against headach

Headache disorders and public ill-health in India: Prevalence estimates in Karnataka State

Background: Primary headache disorders are among the commonest disorders, affecting people in all countries. India appears to be no exception, although reliable epidemiological data on headache in this highly populous country are not available. Such information is needed for health-policy purposes. Our aim was to estimate the prevalence of each of the headache disorders of public-health importance, and examine their sociodemographic associations, in urban and rural populations of Karnataka, south India. Methods: In a door-to-door survey, 2,329 biologically unrelated adults (aged 18–65 years) were randomly sampled from urban (n = 1,226) and rural (n = 1,103) areas in and around Bangalore and interviewed by trained researchers using a pilot-tested, validated, structured questionnaire. ICHD-II diagnostic criteria were applied. Results: The observed 1-year prevalence of any headache was 63.9 %, with a female preponderance of 4:3. The age-standardised 1 year prevalence of migraine was 25.2 %; prevalence was higher among females than males (OR: 2.1 [1.7-2.6]) and among those from rural areas than urban (OR = 1.5 [1.3-1.8]). The age-standardized 1 year prevalence of TTH was 35.1 %, higher among younger people. The estimated prevalence of all headache on ≥15 days/ month was 3.0 %; that of pMOH was 1.2 %, five-times greater among females than males and with a rural preponderance. Conclusions: There is a very high 1 year prevalence of migraine in south India (the mean global prevalence is estimated at 14.7 %). Explanations probably lie in cultural, lifestyle and/or environmental factors, although the observed associations with female gender and rural dwelling are usual. Levels of TTH, pMOH and other headache on ≥15 days/month are similar to global averages, while the very strong association of pMOH with female gender requires explanation. Until another study is conducted in the north of the country, these are the best data available for health policy in a population of over 1.2 billion people. Keywords: Headache disorders; Migraine; Tension-type headache; Medication-overuse headache; Epidemiology; Population-based study; Prevalence; Health policy; Global Campaign against Headach