Financial burden of stroke on family and caregiver in India: a literature review

As life expectancy increases, India will face enormous socioeconomic burden to meet the costs of integrated rehabilitation of subjects with stroke. Caring for stroke patients leads to caregiver (CG) strain and financial burden. The CG burden is perceived differently in the Indian background depending on the society and culture. Caregiving stress has the potential to hamper rehabilitation of the patients and is of vital importance both as a research topic and the focus of clinical care. Cost and burden of informal care giving are high rural Indian community. Financial stress was prominent and common among the socioeconomically weaker division. The financial costs associated with family caregiving were a significant factor in caregiving burden, both for the male and female caregivers. Despite the high financial burden, limited recent studies have focused on costs associated with stroke in the India. Establishing total stroke-related costs is essential to evaluate and support the health economic research on stroke systems of care. Stroke care giving studies may help to better understand care giving impact, and also to find the most effective interventions to improve the quality of life of stroke patients and their caregivers, reduce the burden and depression of caregivers. Policies and programs to alleviate the financial burden and to provide social and financial support for these family caregivers are equally important for both family caregivers and their care receivers.

Design and Development of Domestic Solar Dryer with Comparative Analysis of Nutritional Aspect of Dried Raisins

Solar dryer technology is simple and can be implemented by households and small communities due to its simplicity. The suitable design of the absorber/collector is very vital for any solar drying system as the collector efficiency plays a key role in determining the overall system drying efficiency. To study the practical applicability of a developed solar dryer, grapes were dried in the drying chamber of a designed and developed solar dryer and for comparison, in open sunlight. Faster drying was noted for the grapes dried in the unit. The study on nutritional aspects indicated that solar drying process retained the major nutritional components like total sugars, total proteins and total lipids in raisins. The comparison between the solar dried raisins and open sun dried ones showed a higher ash content of 2.71% with solar dried ones and 1.95% in case of open sun dried raisins. The quantity of MUFA content was also affected by the varying drying practices implemented with 10.95% and 7.12% MUFA in solar dried and open sun dried raisins respectively. The drying technique also affects the bacterial load on raisins as observed in our current study with negligible bacterial growth on on solar dried raisins compared to open dried ones

Relationship between Thyroid Profile with Reproductive Hormones and Semen Quality

Semen quality is associated with various factors. The objective of the study was to investigate the impact of hypothyroidism and hyperthyroidism on human semen quality and reproductive hormones level if any. A total of 351 subjects were enrolled. They were subjected to assess the status of thyroid as well as reproductive hormones and semen quality. The subjects were grouped on the basis of thyroid hormone profile as, hypothyroid, hyperthyroid and normal thyroid hormone profile with respect to semen quality and reproductive hormones level.  Semen volume, sperm count and viability was non-significant statistically in both hypothyroid and hyperthyroid subjects with respect to subjects with normal thyroid profile. Whereas, percent fast progressive Sperm was significantly lower in hypothyroid subjects, while non-motile sperm was significantly higher in hypothyroid subjects as compared to normal thyroid profile subjects. The data on reproductive hormones level indicated that FSH was higher and testosterone level was lower in both hypo and hyperthyroid subjects as compared to subjects with normal thyroid profile. Although the results were statistically non-significant. While LH level was also higher which was statistically significant in hypothyroid subjects with respect to subjects having normal thyroid profile. The data obtained suggest that impaired thyroid hormone has an impact on semen quality as well as reproductive hormone profile to some extent

Optimizing Village-Level Targeting of Active Case Detection to Support Visceral Leishmaniasis Elimination in India.

Background: India has made major progress in improving control of visceral leishmaniasis (VL) in recent years, in part through shortening the time infectious patients remain untreated. Active case detection decreases the time from VL onset to diagnosis and treatment, but requires substantial human resources. Targeting approaches are therefore essential to feasibility. Methods: We analyzed data from the Kala-azar Management Information System (KAMIS), using village-level VL cases over specific time intervals to predict risk in subsequent years. We also graphed the time between cases in villages and examined how these patterns track with village-level risk of additional cases across the range of cumulative village case-loads. Finally, we assessed the trade-off between ACD effort and yield. Results: In 2013, only 9.3% of all villages reported VL cases; this proportion shrank to 3.9% in 2019. Newly affected villages as a percentage of all affected villages decreased from 54.3% in 2014 to 23.5% in 2019, as more surveillance data accumulated and overall VL incidence declined. The risk of additional cases in a village increased with increasing cumulative incidence, reaching approximately 90% in villages with 12 cases and 100% in villages with 45 cases, but the vast majority of villages had small cumulative case numbers. The time-to-next-case decreased with increasing case-load. Using a 3-year window (2016-2018), a threshold of seven VL cases at the village level selects 329 villages and yields 23% of cases reported in 2019, while a threshold of three cases selects 1,241 villages and yields 46% of cases reported in 2019. Using a 6-year window increases both effort and yield. Conclusion: Decisions on targeting must consider the trade-off between number of villages targeted and yield and will depend upon the operational efficiencies of existing programs and the feasibility of specific ACD approaches. The maintenance of a sensitive, comprehensive VL surveillance system will be crucial to preventing future VL resurgence

Development and Evaluation of Active Case Detection Methods to Support Visceral Leishmaniasis Elimination in India.

As India moves toward the elimination of visceral leishmaniasis (VL) as a public health problem, comprehensive timely case detection has become increasingly important, in order to reduce the period of infectivity and control outbreaks. During the 2000s, localized research studies suggested that a large percentage of VL cases were never reported in government data. However, assessments conducted from 2013 to 2015 indicated that 85% or more of confirmed cases were eventually captured and reported in surveillance data, albeit with significant delays before diagnosis. Based on methods developed during these assessments, the CARE India team evolved new strategies for active case detection (ACD), applicable at large scale while being sufficiently effective in reducing time to diagnosis. Active case searches are triggered by the report of a confirmed VL case, and comprise two major search mechanisms: 1) case identification based on the index case's knowledge of other known VL cases and searches in nearby houses (snowballing); and 2) sustained contact over time with a range of private providers, both formal and informal. Simultaneously, house-to-house searches were conducted in 142 villages of 47 blocks during this period. We analyzed data from 5030 VL patients reported in Bihar from January 2018 through July 2019. Of these 3033 were detected passively and 1997 via ACD (15 (0.8%) via house-to-house and 1982 (99.2%) by light touch ACD methods). We constructed multinomial logistic regression models comparing time intervals to diagnosis (30-59, 60-89 and ≥90 days with =90 days compared to the referent of <30 days for ACD vs PCD were 0.88, 0.56 and 0.42 respectively. These ACD strategies not only reduce time to diagnosis, and thus risk of transmission, but also ensure that there is a double check on the proportion of cases actually getting captured. Such a process can supplement passive case detection efforts that must go on, possibly perpetually, even after elimination as a public health problem is achieved

Willingness to Pay for Insured Loans in Northern Ghana

Index insurance has been heralded as a potential solution to systemic risks faced by smallholder farmers in developing countries by covering risks such as drought, low crop yields, and low market prices. Despite its potential, demand has remained low in many early experiments and field trials. Little research has been done, however, on demand for insurance as it is coupled with other services such as loans. Here, willingness to pay for drought index insurance backed loans is investigated using contingent valuation methodology. Results demonstrate that on average the sample population has a willingness to pay high enough to sustain a market viable insured loan product without subsidization with 56% of the target population expressing a willingness to pay for an insured loan at the market price. Results also show a positive and significant WTP for individual policies and to avoid basis risk resulting from rainfall measurement