Developing Standard Treatment Workflows—way to universal healthcare in India

Primary healthcare caters to nearly 70% of the population in India and provides treatment for approximately 80–90% of common conditions. To achieve universal health coverage (UHC), the Indian healthcare system is gearing up by initiating several schemes such as National Health Protection Scheme, Ayushman Bharat, Nutrition Supplementation Schemes, and Inderdhanush Schemes. The healthcare delivery system is facing challenges such as irrational use of medicines, over- and under-diagnosis, high out-of-pocket expenditure, lack of targeted attention to preventive and promotive health services, and poor referral mechanisms. Healthcare providers are unable to keep pace with the volume of growing new scientific evidence and rising healthcare costs as the literature is not published at the same pace. In addition, there is a lack of common standard treatment guidelines, workflows, and reference manuals from the Government of India. Indian Council of Medical Research in collaboration with the National Health Authority, Govt. of India, and the WHO India country office has developed Standard Treatment Workflows (STWs) with the objective to be utilized at various levels of healthcare starting from primary to tertiary level care. A systematic approach was adopted to formulate the STWs. An advisory committee was constituted for planning and oversight of the process. Specialty experts' group for each specialty comprised of clinicians working at government and private medical colleges and hospitals. The expert groups prioritized the topics through extensive literature searches and meeting with different stakeholders. Then, the contents of each STW were finalized in the form of single-pager infographics. These STWs were further reviewed by an editorial committee before publication. Presently, 125 STWs pertaining to 23 specialties have been developed. It needs to be ensured that STWs are implemented effectively at all levels and ensure quality healthcare at an affordable cost as part of UHC

A study of concordance between adolescent self-report and parent-proxy report of health-related quality of life in school-going adolescents

Objectives: The purpose of the study was to determine the degree of concordance between the self-report and the parent's proxy report of health-related quality of life (HRQoL) in school-going adolescents using the World Health Organization Quality of Life (WHOQOL)-BREF instrument in India. Methods: Twenty schools were purposively selected out of the 1900 schools in Lucknow, India. About 5% adolescents (between 10-19 years) per school were randomly selected by lottery system. Subjects, whose parents consented for child's participation, completed the WHOQOL-BREF self-report and their parents filled the WHOQOL-BREF proxy-report for adolescent's HRQoL. Degree of concordance and association were assessed using Cohen's κ and Spearman's correlation, respectively. Results: Five hundred fifteen adolescents (mean age=14 years with a standard deviation of ±2 years; 48.2% females) were included. κ Statistic values ranged from fair to moderate for all facets and dimensions of HRQoL between adolescent and parent report (κ =0.31-0.58, P<.01). There were moderate to very strong correlations between adolescent self and parent proxy report (r=0.62-0.81, P<.01) which declined with age of adolescent. The mother's scores correlated best in psychological dimension (r=0.81-0.88, P<.01) while that of father correlated best in environment dimension (r=0.81-0.79, P<.01), irrespective of child's gender. Conclusion: Our study illustrated that fair to moderate agreement existed between parent proxy and subject's self-report for adolescent's HRQoL. That may be an indicator for suitability of parent's proxy report in certain dimensions, if a child is unavailable or unable to respond. However, further research may provide new insights into the determinants of concordance between subject self and parent proxy report of adolescent HRQoL

Determinants of health related quality of life in school-going adolescents in Northern India

Objective: To identify determinants of good Health Related Quality of Life (HRQoL) in school going adolescents. Methods: This Cross-sectional study was conducted in public and private schools in Lucknow, Northern India after obtaining institutional ethical clearance. Children aged 10 to 19 years were included after obtaining parental written informed consent. HRQoL was assessed using culturally appropriate WHOQOL-BREF version. Results: From 1900 schools in Lucknow, 10 public and 10 private schools were selected. Within schools, random selection of the subjects was done. Dropout rate was 7.2% (525/566). Mean age of participants was 14.04±2.09 years, of which 52.4% (275/525) were boys and 48.5% (255/525) were from private schools. Good HRQoL was a score =83, which corresponded to third quartile, and 33.7% and 16.6% of subjects, from private and public schools, respectively, fell in this category (p-value <0.0001). Determinants of good HRQoL on multivariate analysis were age <14 years (OR: 2.11, 95%CI 1.39-3.02, p<0.0001) and studying in private school (OR = 2.04, 95%CI 1.18-3.51, p<0.0001). Conclusions: Younger adolescent age and enrolment in private schools are determinants of good HRQoL in school-going adolescents. Further research is needed to identify measures to improve HRQoL among older adolescents and those studying in public schools

Incidence of community acquired pneumonia in children aged 2-59 months of age in Uttar Pradesh and Bihar, India, in 2016: An indirect estimation.

IntroductionCommunity Acquired Pneumonia (CAP) is the leading cause of mortality in children younger than five years of age in developing countries, including India. Hence, this prospective study was performed to estimate the incidence of CAP in children (2-59 months)in four districts of Northern India.MethodsA cross-sectional survey in rural Lucknow was conducted using cluster sampling technique to assess the proportion of CAP cases that were hospitalized in last 12 months (hospitalization fraction). Another prospective study was done to assess number of hospitalized CAP cases in same districts in 2016. For this, a surveillance network of hospitals that admitted children was established. Cases with WHO-defined CAP with less than 14 days of illness were eligible for inclusion. Informed written parental consent was obtained. A mathematical model was developed to estimate the incidence of CAP in each district, taking into account number of cases hospitalized in one year, assuming it to be equal to hospitalization fraction and using Lucknow district as reference, correcting for child-population per hospital for each district. Population census data of 2011 was taken as denominator.ResultsIn cross-sectional survey (February to May 2016), 3351 children (2-59 months) from 240 villages were included. Of these 24.58% (824/3351) children suffered from CAP in last 12 months and out of these 4% (33/824) children were hospitalized. Computed incidence of CAP per 1000 child-year for Lucknow was 86.50 (95%CI: 85.72-87.29); Etawah 177.01(95%CI: 175.44-178.58); Patna 207.78 (95%CI: 207.20-208.37) and Darbhanga 221.18 (95%CI: 220.40-221.97). Infants (2-11 months)had almost five to ten times higher incidence of CAP than those in 12-59 months age category.ConclusionsIncidence of CAP in Uttar Pradesh and Bihar is high, being much higher in infants. Hence there is an urgent need for introduction of preventive strategies, improving health seeking behavior and quality of care for CAP

Autopsy findings of pediatric COVID-19: a systematic review

Abstract Background Little is known how COVID-19 is affecting children. Autopsies help gain an understanding of the pathophysiology of new and developing diseases. Numerous post-mortem studies had been conducted in adults with COVID-19, but few in children. Thereby, this systematic review aims to investigate the autopsy findings from pediatric COVID-19 patients. Results There were a total of 15 patients from eight studies. COVID-19 mainly affects the heart and lungs. Pathology findings from the heart of COVID-19 pediatric patients include diffuse inflammatory infiltrate, myocarditis, cardiomyocyte necrosis, pericarditis, and interstitial edema. Histopathology abnormalities observed in the lungs are diffuse alveolar damage, cytopathic changes, thrombi in arterioles and septal capillaries, lung congestion, focal acute hemorrhage and edema, focal exudative changes, and mild pneumocyte hyperplasia. In addition, pathological findings from other organs, such as the liver, kidney, brain, bone marrow, lymph node, skin, spleen, muscle, colon, parotid gland, and adrenal of COVID-19 pediatric patients are also included in this review. Conclusion Cardiomyocyte necrosis, interstitial edema, lung congestion, and diffuse alveolar damage are the most significant pathologic findings of the heart and lung in pediatric COVID-19 patients. More studies are needed to elucidate the pathophysiology of SARS-CoV-2 in autopsy findings and to determine the exact cause of death since it could be related to COVID-19 or other comorbidities

Google map of hospitals network in three districts of North India.

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Association of chest x-ray abnormalities with PCV13, controlling for independent variables.

Association of chest x-ray abnormalities with PCV13, controlling for independent variables.</p

Comparison of sociodemographic and clinical variables among the children exposed or unexposed to PCV13 vaccination.

Comparison of sociodemographic and clinical variables among the children exposed or unexposed to PCV13 vaccination.</p

Flow diagram of hospitalized children (2–23 months) with community acquired pneumonia recruited from Darbhanga (1^st June 2017-30^th April 2021), Patna (1^st June 2018 to 30^th April 2021) and Lucknow (1^st June 2018 to 30^th April 2021).

Flow diagram of hospitalized children (2–23 months) with community acquired pneumonia recruited from Darbhanga (1st June 2017-30th April 2021), Patna (1st June 2018 to 30th April 2021) and Lucknow (1st June 2018 to 30th April 2021).</p

Comparison of sociodemographic and clinical variables among the cases of CAP with and without hospital mortality.

Comparison of sociodemographic and clinical variables among the cases of CAP with and without hospital mortality.</p