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- Hossain, Sheikh Jamal, et al.
(author)
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Effect of a parenting and nutrition education programme on development and growth of children using a social safety-net platform in urban Bangladesh : a cluster randomized controlled trial
- 2024
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In: The Lancet Regional Health - Southeast Asia. - : Elsevier. - 2772-3682. ; 25
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Journal article (peer-reviewed)abstract
- BackgroundAlthough sustainable development goals mandate for quality early childhood development (ECD) interventions for children <8 years, little occurs for children <3 years, especially in urban settings in low-and-middle-income countries (LMICs). Our primary objective was to measure the effect of an ECD-focused parenting and nutrition education on children's development through home visits using a social safety net platform of urban Bangladesh.MethodsA cluster randomized controlled trial was conducted with mothers of children aged 6–16 months in 20 clusters across the Rangpur city, Bangladesh. The intervention group received fortnightly ECD-focused parenting and nutrition education at homes by local Community Health Workers (CHWs) for one year. Bayley-III was used to measure children's cognitive, language and motor development. Data were analyzed using intention to treat. ClinicalTrials.gov Identifier: NCT03753646.FindingsOut of 599 mother-child dyads, 56.6% mothers were aged ≤25 years old. After one year, the intervened children had higher cognitive [Effect size Cohen's d; 0.42 SD (95% CI: 0.58–0.25)], language (0.38 SD, 95% CI: 0.55–0.22) and motor (0.17 SD, 95% CI: 0.01–0.34) development. In the intervention group, mothers experienced less violence [Odds ratio; 0.6 (95% CI: 0.4–1.0)] and fathers engaged more (0.23 SD, CI: 0.39–0.06) in ECD activities with their children compared to the comparison group. Total home stimulation and mothers' knowledge on child care were also improved in the intervention. But the children's growth was not improved.InterpretationThis ECD programme improves the development of children of young mothers in urban settings using a social safety-net platform. The evidence may help in increasing ECD coverage in urban areas in LMICs.
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- Marklund, Matti, et al.
(author)
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Hypertension treatment capacity in India by increased workforce, greater task-sharing, and extended prescription period : a modelling study
- 2023
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In: The Lancet Regional Health - Southeast Asia. - : Elsevier. - 2772-3682. ; 10
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Journal article (peer-reviewed)abstract
- Background The worldwide control rate for hypertension is dismal. An inadequate number of physicians to treat patients with hypertension is one key obstacle. Innovative health system approaches such as delegation of basic tasks to non-physician health workers (task-sharing) might alleviate this problem. Massive scale up of population-wide hypertension management is especially important for low-and middle-income countries such as India. Methods Using constrained optimization models, we estimated the hypertension treatment capacity and salary costs of staff involved in hypertension care within the public health system of India and simulated the potential effects of (1) an increased workforce, (2) greater task-sharing among health workers, and (3) extended average prescription periods that reduce treatment visit frequency (e.g., quarterly instead of monthly).Findings Currently, only an estimated 8% (95% uncertainty interval 7%-10%) of -245 million adults with hypertension can be treated by physician-led services in the Indian public health system (assuming the current number of health workers, no greater task-sharing, and monthly visits for prescriptions). Without task-sharing and with continued monthly visits for prescriptions, the least costly workforce expansion to treat 70% of adults with hypertension would require -1.6 (1.0-2.5) million additional staff (all non-physicians), with -INR 200 billion (approximate to USD 2.7 billion) in additional annual salary costs. Implementing task-sharing among health workers (without increasing the overall time on hypertension care) or allowing a 3-month prescription period was estimated to allow the current workforce to treat -25% of patients. Joint implementation of task-sharing and a longer prescription period could treat -70% of patients with hypertension in India.Interpretation The combination of greater task-sharing and extended prescription periods could substantially increase the hypertension treatment capacity in India without any expansion of the current workforce in the public health system. By contrast, workforce expansion alone would require considerable, additional human and financial resources.
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- Ramadona, Aditya Lia, et al.
(author)
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Predicting the dengue cluster outbreak dynamics in Yogyakarta, Indonesia : a modelling study
- 2023
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In: The Lancet Regional Health - Southeast Asia. - : Elsevier. - 2772-3682. ; 15
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Journal article (peer-reviewed)abstract
- Background: Human mobility and climate conditions are recognised key drivers of dengue transmission, but their combined and individual role in the local spatiotemporal clustering of dengue cases is not well understood. This study investigated the effects of human mobility and weather conditions on dengue risk in an urban area in Yogyakarta, Indonesia.Methods: We established a Bayesian spatiotemporal model for neighbourhood outbreak prediction and evaluated the performances of two different approaches for constructing an adjacency matrix: one based on geographical proximity and the other based on human mobility patterns. We used population, weather conditions, and past dengue cases as predictors using a flexible distributed lag approach. The human mobility data were estimated based on proxies from social media. Unseen data from February 2017 to January 2020 were used to estimate the one-month ahead prediction accuracy of the model.Findings: When human mobility proxies were included in the spatial covariance structure, the model fit improved in terms of the log score (from 1.748 to 1.561) and the mean absolute error (from 0.676 to 0.522) based on the validation data. Additionally, showed only few observations outside the credible interval of predictions (1.48%) and weather conditions were not found to contribute additionally to the clustering of cases at this scale.Interpretation: The study shows that it is possible to make highly accurate predictions of the within-city cluster dynamics of dengue using mobility proxies from social media combined with disease surveillance data. These insights are important for proactive and timely outbreak management of dengue.
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- Selvavinayagam, Sivaprakasam T., et al.
(author)
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Clinical characteristics and novel mutations of omicron subvariant XBB in Tamil Nadu, India - a cohort study
- 2023
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In: The Lancet Regional Health - Southeast Asia. - : ELSEVIER. - 2772-3682. ; 19
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Journal article (peer-reviewed)abstract
- Background Despite the continued vaccination efforts, there had been a surge in breakthrough infections, and the emergence of the B.1.1.529 omicron variant of SARS-CoV-2 in India. There is a paucity of information globally on the role of newer XBB variants in community transmission. Here, we investigated the mutational patterns among hospitalised patients infected with the XBB omicron sub-variant, and checked if there was any association between the rise in the number of COVID-19 cases and the observed novel mutations in Tamil Nadu, India. Methods Nasopharyngeal and oropharyngeal swabs, collected from symptomatic and asymptomatic COVID-19 patients were subjected to real-time PCR followed by Next Generation Sequencing (NGS) to rule out the ambiguity of mutations in viruses isolated from the patients (n = 98). Using the phylogenetic association, the mutational patterns were used to corroborate clinico-demographic characteristics and disease severity among the patients. Findings Overall, we identified 43 mutations in the S gene across 98 sequences, of which two were novel mutations (A27S and T747I) that have not been reported previously with XBB sub-variants in the available literature. Additionally, the XBB sequences from our cohort had more mutations than omicron B.1.1.529. The phylogenetic analysis comprising six major branches clearly showed convergent evolution of XBB. Our data suggests that age, and underlying conditions (e.g., diabetes, hypertension, and cardiovascular disease) or secondary complications confers increased susceptibility to infection rather than vaccination status or prior exposure. Many vaccinated individuals showed evidence of a breakthrough infection, with XBB.3 being the predominant variant identified in the study population. Interpretation Our study indicates that the XBB variant is highly evasive from available vaccines and may be more transmissible, and potentially could emerge as the 'next' predominant variant, which likely could overwhelm the existing variants of SARS-CoV-2 omicron variants.Funding National Health Mission (India), SIDA SARC, VINNMER (Sweden), ORIP/NIH (USA).Copyright (c) 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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- Subramanian, S.V., et al.
(author)
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Should India adopt a country-specific growth reference to measure undernutrition among its children?
- 2023
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In: The Lancet Regional Health - Southeast Asia. - : Elsevier BV. - 2772-3682. ; 9
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Journal article (other academic/artistic)abstract
- The 2006 World Health Organization (WHO) growth standard—based on the Multi Growth Reference Study (MGRS)—is a universal standard for healthy height and weight of young children. The share of children that deviate substantially from this growth standard (i.e., fall below −2 standard deviations) defines three important indicators: stunting (low height-for-age), wasting (low weight-for-height), and underweight (low weight-for-age). These three indicators are most often used to assess prevalence of different forms of undernutrition in a population. The prevalence of stunting, wasting, and underweight based on the MGRS are used to set international (e.g., Sustainable Development Goals) and national (e.g., POSHAN Abhiyaan in India) targets and guide substantial allocation of resources for reducing child undernutrition.
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- Yajnik, Chittaranjan S., et al.
(author)
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Polygenic scores of diabetes-related traits in subgroups of type 2 diabetes in India: a cohort study
- 2023
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In: The Lancet Regional Health - Southeast Asia. - 2772-3682. ; 14
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Journal article (peer-reviewed)abstract
- BackgroundA machine-learning approach identified five subgroups of diabetes in Europeans which included severe autoimmune diabetes (SAID), severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD) and mild age-related diabetes (MARD) with partially distinct genetic aetiologies. We previously validated four of the non-autoimmune subgroups in people with young-onset type 2 diabetes (T2D) from the Indian WellGen study. Here, we aimed to apply European-derived centroids and genetic risk scores (GRSs) to the unselected (for age) WellGen to test their applicability and investigate the genetic aetiology of the Indian T2D subgroups.MethodsWe applied European derived centroids and GRSs to T2D participants of Indian ancestry (WellGen, n = 2217, 821 genotyped) and compared them with normal glucose tolerant controls (Pune Maternal Nutrition Study, n = 461).FindingsSIDD was the predominant subgroup followed by MOD, whereas SIRD and MARD were less frequent. Weighted-GRS for T2D, obesity and lipid-related traits associated with T2D. We replicated some of the previous associations of GRS for T2D, insulin secretion, and BMI with SIDD and MOD. Unique to Indian subgroups was the association of GRS for (a) proinsulin with MOD and MARD, (b) liver-lipids with SIDD, SIRD and MOD, and (c) opposite effect of beta-cell GRS with SIDD and MARD, obesity GRS with MARD compared to Europeans. Genetic variants of fucosyltransferases were associated with T2D and MOD in Indians but not Europeans.InterpretationThe similarities emphasise the applicability of some of the European-derived GRSs to T2D and its subgroups in India while the differences highlight the need for large-scale studies to identify aetiologies in diverse ancestries. The data provide robust evidence for genetically distinct aetiologies for the T2D subgroups and at least partly mirror those seen in Europeans.
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