Respiratory tract infection: Current pattern of pathogens involved and related antibiotic resistance observed at a tertiary health care institute of Rajasthan

Background: Antibiotic resistance is one of the contributing factors responsible for increased morbidity and mortality. Objectives: The study was designed to assess the current pattern of involved pathogens in respiratory tract infections with relevant antibiotic sensitivity and resistance to improve patient outcomes. Methodology: The study was conducted for 6 months and positive cultured sample reports of respiratory secretions in the form of sputum, tracheal secretion, bronchial aspirate, and pus were included in the study. Pathogens involved and antibiotic sensitivity, resistance were observed for respiratory secretion and pus separately. Results: A total 129 samples including 83 respiratory secretion samples and 46 pus samples cultures were found positive for organisms and included in the study. Among respiratory secretion cultures, Pseudomonas were most common organism (60%) followed by E. Coli, Klebsiella, Acinetobacter, Staphylococcus aureus, Citrobector, and Candida. Among pus cultures, Staphylococcus was the most common organism (23.90%) followed by E.Coli, Klebsiella, Pseudomonas, Citrobactor, Coagulase negative staphylococcus, Proteus. These pathogens were resistant to many first-line antibiotics. Conclusion: Antibiotic resistance to first-line antibiotics has emerged as alarming situation and contributes to morbidity and mortality. The current pattern of involved pathogen and antibiogram may help to decide appropriate empirical treatment

Prevalence of self-reported reproductive tract infections/sexually transmitted infections symptoms and treatment seeking behavior among the married tribal women in Udaipur, Rajasthan

Background: Indian tribes are culturally distinct communities, with unique traditions and practices. Lack of awareness and “culture of silence” about reproductive health issues among women in rural areas contributes to high burden of reproductive tract infections/sexually tract infections. Rural tribal women also suffer from ignorance, poverty and lack of access to quality health care, which makes them more vulnerable to RTIs/STIs.Methods: It was a community based cross sectional study conducted among 200 tribal women living in rural Udaipur, Rajasthan. The study was conducted from May 2019 to November 2019. A predesigned, pretested and structured questionnaire was used to take the interview of eligible women. Questionnaire included questions about sociodemographic profile, questions to assess the knowledge regarding RTIs and history of occurrence of any RTI symptom in the past six months and; questions to assess the treatment seeking behaviour for RTI symptoms.Results: Most of the participants were 26-35 years old.About 37% gave the history of experiencing RTI symptoms, vaginal discharge being the most common (46%) symptom. Regarding the treatment, most (34%) of the females took treatment from government hospital, followed by 26% of women who bought the medicines direct from pharmacy (over the counter), about 16% consulted a private practitioner. Prevalence was found to be significantly higher in less educated, belonging to lower socioeconomic status and among non-users of contraceptive methods.Conclusions: Health education and active participation of stakeholders in the reproductive health programs is essential to strengthen the ongoing schemes about improving reproductive health of tribal women

A perspective on Master of Public Health (MPH) Graduates in India: Current role and way head

The public health sector of any country deals on the forefront and utilizes the multidisciplinary approach. In India the Masters of Public Health graduates are trained in unstandardized manner and lack a regulatory body. The gap created in serving the unserved can easily be fulfilled by utilization of this workforce in systematic manner, The emerging competition in the field, undervalued sector in terms of monitory benefits, poor demand and limited training institutions for MPH graduates along with the contribution of MPH during COVID 19 pandemic has been emphasized in the article. The perception of those working in the field has been highlighted with the way ahead of MPH program in India

Prevalence and pattern of anemia in the second and third trimester pregnancy in Western Rajasthan

Background: Anemia in pregnancy is related to maternal-fetal morbidity and mortality. In developing countries like India it is important to study prevalence and pattern of anemia in pregnancy especially in the region with higher maternal mortality rate like western Rajasthan. The main objective was to study the prevalence and pattern of anemia in second and third trimester pregnant females in western Rajasthan.Methods: In this cross sectional study females with second and third trimester pregnancy were evaluated for presence of anemia with its morphological type and severity.Results: 17,552 second and third trimester pregnant females were evaluated and prevalence of anemia was found 48.4%. The percentages of mild, moderate and severe anemia were 35.1%, 51.3% and 13.4% respectively. Most common morphological type was microcytic hypochromic anemia (51%) followed by normocytic normochromic anemia (32%), dimorphic anemia (13%) and macrocytic anemia (4%).  Conclusions: There is high prevalence of anemia in pregnant females. This warrants the need of proper prophylaxis and early diagnosis of anemia in pregnancy to minimize the maternal-fetal morbidity and mortality

A study of cytological pattern of cervical papanicolaou smears in western Rajasthan, India

Background: Cervical cancer is one of the most common cancers of Indian females. Western Rajasthan differs a lot from rest of India in respect of geographical conditions, environment, culture, population density etc. and it also has relatively lower literacy rate which is one of the risk factor for many diseases. The objective of this study was to estimate the prevalence of cervical cytological pattern in females of western Rajasthan by using conventional Papanicolaou (Pap) smears for the screening of inflammatory, premalignant and malignant lesions of the cervix.Methods: This cross sectional study was conducted at tertiary care institute of western Rajasthan for 1.5 year duration, on 1768 females who were screened by Pap smear examination. After staining with conventional Papanicolaou technique, all smears were classified as per Bethesda nomenclature.Results: Out of 1768 smears 1039 (58.7%) were abnormal Pap smears, 445 (25.1%) were normal Pap smears while 284 (16.1%) smears had inadequate sample material to be examined. Out of 1039 abnormal smears, 956 (92.01%) smears reported to have inflammatory/reactive changes whereas 26 (2.50%) had atrophic changes in Pap smear and abnormality in epithelial cell was reported in 57(5.49%) smears.Conclusions: Pap smear examination is an effective screening procedure to detect cervical cytological abnormalities. Routine cytological screening by Pap smear should be offered to all women above 19 years or within 3 years of sexual activity. It is recommended to improve the awareness about the disease amongst females and skills of health care personal about proper preparation of Pap smear

Demographic characters and factors favouring emergence of diabetes mellitus type two

Background: Diabetes mellitus (DM) is associated with high morbidity and mortality. It has various complications. Risk factor control is effective way of prevention. Current study was conducted to know demographic profile including risk factors related to diabetes mellitus in patients attending a tertiary health care institute of Rajasthan.Methods: This cross-sectional study was conducted for the duration of six months. In the study 623 diabetes mellitus type 2 patients were included and subjected to evaluation of various demographic parameters and risk factors like age, sex, economic status, area of residence, obesity, hypertension (HTN), lack of exercise, smoking, dyslipidemia and positive family history.Results: Mean age of diabetic population was 62 years. Male-female, urban-rural ratios were nearly 1:1 and 3:2 respectively. Nearly 7 % patients were found to be below poverty line (BPL). On risk factor evaluation of 623 diabetic patients it was found that 598 (96%) patients had lack of exercise, 406 (65.2%) patients had age more than 60 years, 394 (63.2%) patients had dyslipidemia, 210 (33.7%) patients were smoker as per the mentioned criteria, 144 (23.1%) patients were obese, 118 (19%) patients had HTN before emergence of DM and 90 (14.4%) patients had positive family history.Conclusions: High prevalence of risk factors in Indian community is alarming. Health education, promotion of exercise, favourable life style, dietary modification, cessation of smoking, screening programmes for early detection of derange blood pressure, blood sugar, lipid profile can be effective prevention strategies

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Global, regional, and national burden of HIV/AIDS, 1990–2021, and forecasts to 2050, for 204 countries and territories: the Global Burden of Disease Study 2021

BackgroundAs set out in Sustainable Development Goal 3.3, the target date for ending the HIV epidemic as a public health threat is 2030. Therefore, there is a crucial need to evaluate current epidemiological trends and monitor global progress towards HIV incidence and mortality reduction goals. In this analysis, we assess the current burden of HIV in 204 countries and territories and forecast HIV incidence, prevalence, and mortality up to 2050 to allow countries to plan for a sustained response with an increasing number of people living with HIV globally. MethodsWe used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 analytical framework to compute age-sex-specific HIV mortality, incidence, and prevalence estimates for 204 countries and territories (1990–2021). We aimed to analyse all available data sources, including data on the provision of HIV programmes reported to UNAIDS, published literature on mortality among people on antiretroviral therapy (ART) identified by a systematic review, household surveys, sentinel surveillance antenatal care clinic data, vital registration data, and country-level case report data. We calibrated a mechanistic simulation of HIV infection and natural history to available data to estimate HIV burden from 1990 to 2021 and generated forecasts to 2050 through projection of all simulation inputs into the future. Historical outcomes (1990–2021) were simulated at the 1000-draw level to support propagation of uncertainty and reporting of uncertainty intervals (UIs). Our approach to forecasting utilised the transmission rate as the basis for projection, along with new rate-of-change projections of ART coverage. Additionally, we introduced two new metrics to our reporting: prevalence of unsuppressed viraemia (PUV), which represents the proportion of the population without a suppressed level of HIV (viral load <1000 copies per mL), and period lifetime probability of HIV acquisition, which quantifies the hypothetical probability of acquiring HIV for a synthetic cohort, a simulated population that is aged from birth to death through the set of age-specific incidence rates of a given time period. FindingsGlobal new HIV infections decreased by 21·9% (95% UI 13·1–28·8) between 2010 and 2021, from 2·11 million (2·02–2·25) in 2010 to 1·65 million (1·48–1·82) in 2021. HIV-related deaths decreased by 39·7% (33·7–44·5), from 1·19 million (1·07–1·37) in 2010 to 718 000 (669 000–785 000) in 2021. The largest declines in both HIV incidence and mortality were in sub-Saharan Africa and south Asia. However, super-regions including central Europe, eastern Europe, and central Asia, and north Africa and the Middle East experienced increasing HIV incidence and mortality rates. The number of people living with HIV reached 40·0 million (38·0–42·4) in 2021, an increase from 29·5 million (28·1–31·0) in 2010. The lifetime probability of HIV acquisition remains highest in the sub-Saharan Africa super-region, where it declined from its 1995 peak of 21·8% (20·1–24·2) to 8·7% (7·5–10·7) in 2021. Four of the seven GBD super-regions had a lifetime probability of less than 1% in 2021. In 2021, sub-Saharan Africa had the highest PUV of 999·9 (857·4–1154·2) per 100 000 population, but this was a 64·5% (58·8–69·4) reduction in PUV from 2003 to 2021. In the same period, PUV increased in central Europe, eastern Europe, and central Asia by 116·1% (8·0–218·2). Our forecasts predict a continued global decline in HIV incidence and mortality, with the number of people living with HIV peaking at 44·4 million (40·7–49·8) by 2039, followed by a gradual decrease. In 2025, we projected 1·43 million (1·29–1·59) new HIV infections and 615 000 (567 000–680 000) HIV-related deaths, suggesting that the interim 2025 targets for reducing these figures are unlikely to be achieved. Furthermore, our forecasted results indicate that few countries will meet the 2030 target for reducing HIV incidence and HIV-related deaths by 90% from 2010 levels. InterpretationOur forecasts indicate that continuation of current levels of HIV control are not likely to attain ambitious incidence and mortality reduction targets by 2030, and more than 40 million people globally will continue to require lifelong ART for decades into the future. The global community will need to show sustained and substantive efforts to make the progress needed to reach and sustain the end of AIDS as a public threat. FundingThe Bill & Melinda Gates Foundation and the National Institute of Allergy and Infectious Diseases

Forecasting the effects of smoking prevalence scenarios on years of life lost and life expectancy from 2022 to 2050: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundSmoking is the leading behavioural risk factor for mortality globally, accounting for more than 175 million deaths and nearly 4·30 billion years of life lost (YLLs) from 1990 to 2021. The pace of decline in smoking prevalence has slowed in recent years for many countries, and although strategies have recently been proposed to achieve tobacco-free generations, none have been implemented to date. Assessing what could happen if current trends in smoking prevalence persist, and what could happen if additional smoking prevalence reductions occur, is important for communicating the effect of potential smoking policies. MethodsIn this analysis, we use the Institute for Health Metrics and Evaluation's Future Health Scenarios platform to forecast the effects of three smoking prevalence scenarios on all-cause and cause-specific YLLs and life expectancy at birth until 2050. YLLs were computed for each scenario using the Global Burden of Disease Study 2021 reference life table and forecasts of cause-specific mortality under each scenario. The reference scenario forecasts what could occur if past smoking prevalence and other risk factor trends continue, the Tobacco Smoking Elimination as of 2023 (Elimination-2023) scenario quantifies the maximum potential future health benefits from assuming zero percent smoking prevalence from 2023 onwards, whereas the Tobacco Smoking Elimination by 2050 (Elimination-2050) scenario provides estimates for countries considering policies to steadily reduce smoking prevalence to 5%. Together, these scenarios underscore the magnitude of health benefits that could be reached by 2050 if countries take decisive action to eliminate smoking. The 95% uncertainty interval (UI) of estimates is based on the 2·5th and 97·5th percentile of draws that were carried through the multistage computational framework. FindingsGlobal age-standardised smoking prevalence was estimated to be 28·5% (95% UI 27·9–29·1) among males and 5·96% (5·76–6·21) among females in 2022. In the reference scenario, smoking prevalence declined by 25·9% (25·2–26·6) among males, and 30·0% (26·1–32·1) among females from 2022 to 2050. Under this scenario, we forecast a cumulative 29·3 billion (95% UI 26·8–32·4) overall YLLs among males and 22·2 billion (20·1–24·6) YLLs among females over this period. Life expectancy at birth under this scenario would increase from 73·6 years (95% UI 72·8–74·4) in 2022 to 78·3 years (75·9–80·3) in 2050. Under our Elimination-2023 scenario, we forecast 2·04 billion (95% UI 1·90–2·21) fewer cumulative YLLs by 2050 compared with the reference scenario, and life expectancy at birth would increase to 77·6 years (95% UI 75·1–79·6) among males and 81·0 years (78·5–83·1) among females. Under our Elimination-2050 scenario, we forecast 735 million (675–808) and 141 million (131–154) cumulative YLLs would be avoided among males and females, respectively. Life expectancy in 2050 would increase to 77·1 years (95% UI 74·6–79·0) among males and 80·8 years (78·3–82·9) among females. InterpretationExisting tobacco policies must be maintained if smoking prevalence is to continue to decline as forecast by the reference scenario. In addition, substantial smoking-attributable burden can be avoided by accelerating the pace of smoking elimination. Implementation of new tobacco control policies are crucial in avoiding additional smoking-attributable burden in the coming decades and to ensure that the gains won over the past three decades are not lost. FundingBloomberg Philanthropies and the Bill & Melinda Gates Foundation.Bloomberg Philanthropies and the Bill & Melinda Gates Foundation