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Mandal S, Rajiva A, Kloog I, Menon JS, Lane KJ, Amini H, Walia GK, Dixit S, Nori-Sarma A, Dutta A, Sharma P, Jaganathan S, Madhipatla KK, Wellenius GA, de Bont J, Venkataraman C, Prabhakaran D, Prabhakaran P, Ljungman P, Schwartz J. Nationwide estimation of daily ambient PM 2.5 from 2008 to 2020 at 1 km 2 in India using an ensemble approach. PNAS Nexus 2024; 3:pgae088. [PMID: 38456174 PMCID: PMC10919890 DOI: 10.1093/pnasnexus/pgae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/16/2024] [Indexed: 03/09/2024]
Abstract
High-resolution assessment of historical levels is essential for assessing the health effects of ambient air pollution in the large Indian population. The diversity of geography, weather patterns, and progressive urbanization, combined with a sparse ground monitoring network makes it challenging to accurately capture the spatiotemporal patterns of ambient fine particulate matter (PM2.5) pollution in India. We developed a model for daily average ambient PM2.5 between 2008 and 2020 based on monitoring data, meteorology, land use, satellite observations, and emissions inventories. Daily average predictions at each 1 km × 1 km grid from each learner were ensembled using a Gaussian process regression with anisotropic smoothing over spatial coordinates, and regression calibration was used to account for exposure error. Cross-validating by leaving monitors out, the ensemble model had an R2 of 0.86 at the daily level in the validation data and outperformed each component learner (by 5-18%). Annual average levels in different zones ranged between 39.7 μg/m3 (interquartile range: 29.8-46.8) in 2008 and 30.4 μg/m3 (interquartile range: 22.7-37.2) in 2020, with a cross-validated (CV)-R2 of 0.94 at the annual level. Overall mean absolute daily errors (MAE) across the 13 years were between 14.4 and 25.4 μg/m3. We obtained high spatial accuracy with spatial R2 greater than 90% and spatial MAE ranging between 7.3-16.5 μg/m3 with relatively better performance in urban areas at low and moderate elevation. We have developed an important validated resource for studying PM2.5 at a very fine spatiotemporal resolution, which allows us to study the health effects of PM2.5 across India and to identify areas with exceedingly high levels.
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Affiliation(s)
- Siddhartha Mandal
- Centre for Chronic Disease Control, New Delhi 110016, India
- Public Health Foundation of India, New Delhi 110017, India
| | - Ajit Rajiva
- Public Health Foundation of India, New Delhi 110017, India
| | - Itai Kloog
- Department of Environmental, Geoinformatics and Urban Planning Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Jyothi S Menon
- Public Health Foundation of India, New Delhi 110017, India
| | - Kevin J Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Heresh Amini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Gagandeep K Walia
- Centre for Chronic Disease Control, New Delhi 110016, India
- Public Health Foundation of India, New Delhi 110017, India
| | - Shweta Dixit
- Public Health Foundation of India, New Delhi 110017, India
| | - Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Anubrati Dutta
- Centre for Chronic Disease Control, New Delhi 110016, India
- Public Health Foundation of India, New Delhi 110017, India
| | - Praggya Sharma
- Centre for Chronic Disease Control, New Delhi 110016, India
| | - Suganthi Jaganathan
- Centre for Chronic Disease Control, New Delhi 110016, India
- Public Health Foundation of India, New Delhi 110017, India
- Institute of Environmental Medicine, Karolinska Institute, Stockholm 17177, Sweden
| | - Kishore K Madhipatla
- Center for Atmospheric Particle Sciences, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Jeroen de Bont
- Institute of Environmental Medicine, Karolinska Institute, Stockholm 17177, Sweden
| | - Chandra Venkataraman
- Department of Chemical Engineering, Indian Institute of Technology Bombay, Mumbai 400076, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi 110016, India
- Public Health Foundation of India, New Delhi 110017, India
| | - Poornima Prabhakaran
- Centre for Chronic Disease Control, New Delhi 110016, India
- Public Health Foundation of India, New Delhi 110017, India
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institute, Stockholm 17177, Sweden
- Department of Cardiology, Danderyd Hospital, Stockholm 18257, Sweden
| | - Joel Schwartz
- Department of Environmental Health, Harvard TH Chan School of Public Health, Harvard University, Boston, MA 02115, USA
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de Bont J, Nori-Sarma A, Stafoggia M, Banerjee T, Ingole V, Jaganathan S, Mandal S, Rajiva A, Krishna B, Kloog I, Lane K, Mall RK, Tiwari A, Wei Y, Wellenius GA, Prabhakaran D, Schwartz J, Prabhakaran P, Ljungman P. Impact of heatwaves on all-cause mortality in India: A comprehensive multi-city study. Environ Int 2024; 184:108461. [PMID: 38340402 DOI: 10.1016/j.envint.2024.108461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/12/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Heatwaves are expected to increase with climate change, posing a significant threat to population health. In India, with the world's largest population, heatwaves occur annually but have not been comprehensively studied. Accordingly, we evaluated the association between heatwaves and all-cause mortality and quantifying the attributable mortality fraction in India. METHODS We obtained all-cause mortality counts for ten cities in India (2008-2019) and estimated daily mean temperatures from satellite data. Our main extreme heatwave was defined as two-consecutive days with an intensity above the 97th annual percentile. We estimated city-specific heatwave associations through generalised additive Poisson regression models, and meta-analysed the associations. We reported effects as the percentage change in daily mortality, with 95% confidence intervals (CI), comparing heatwave vs non-heatwave days. We further evaluated heatwaves using different percentiles (95th, 97th, 99th) for one, two, three and five-consecutive days. We also evaluated the influence of heatwave duration, intensity and timing in the summer season on heatwave mortality, and estimated the number of heatwave-related deaths. FINDINGS Among ∼ 3.6 million deaths, we observed that temperatures above 97th percentile for 2-consecutive days was associated with a 14.7 % (95 %CI, 10.3; 19.3) increase in daily mortality. Alternative heatwave definitions with higher percentiles and longer duration resulted in stronger relative risks. Furthermore, we observed stronger associations between heatwaves and mortality with higher heatwave intensity. We estimated that around 1116 deaths annually (95 %CI, 861; 1361) were attributed to heatwaves. Shorter and less intense definitions of heatwaves resulted in a higher estimated burden of heatwave-related deaths. CONCLUSIONS We found strong evidence of heatwave impacts on daily mortality. Longer and more intense heatwaves were linked to an increased mortality risk, however, resulted in a lower burden of heatwave-related deaths. Both definitions and the burden associated with each heatwave definition should be incorporated into planning and decision-making processes for policymakers.
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Affiliation(s)
- Jeroen de Bont
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Amruta Nori-Sarma
- Center for Climate and Health, Boston University School of Public Health, Boston, MA, United States
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service /ASL Roma 1, Rome, Italy
| | - Tirthankar Banerjee
- Institute of Environment and Sustainable Development, Banaras Hindu University, Varanasi, India
| | - Vijendra Ingole
- Office for National Statistics, Wales, Newport, United Kingdom
| | - Suganthi Jaganathan
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Chronic Disease Control, New Delhi, India; Ashoka University, Sonipat, India
| | - Siddhartha Mandal
- Centre for Chronic Disease Control, New Delhi, India; Ashoka University, Sonipat, India
| | - Ajit Rajiva
- Centre for Chronic Disease Control, New Delhi, India; Ashoka University, Sonipat, India
| | | | - Itai Kloog
- Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kevin Lane
- Center for Climate and Health, Boston University School of Public Health, Boston, MA, United States
| | - Rajesh K Mall
- DST-Mahamana Center of Excellence in Climate Change Research, Institute of Environment and Sustainable Futures Collaborative, New Delhi, India
| | | | - Yaguang Wei
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gregory A Wellenius
- Center for Climate and Health, Boston University School of Public Health, Boston, MA, United States
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India; Ashoka University, Sonipat, India
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Poornima Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India; Ashoka University, Sonipat, India
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
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Mandal S, Jaganathan S, Kondal D, Schwartz JD, Tandon N, Mohan V, Prabhakaran D, Narayan KMV. PM 2.5 exposure, glycemic markers and incidence of type 2 diabetes in two large Indian cities. BMJ Open Diabetes Res Care 2023; 11:e003333. [PMID: 37797962 PMCID: PMC10565186 DOI: 10.1136/bmjdrc-2023-003333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/29/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Exposure to fine particulate matter has been associated with several cardiovascular and cardiometabolic diseases. However, such evidence mostly originates from low-pollution settings or cross-sectional studies, thus necessitating evidence from regions with high air pollution levels, such as India, where the burden of non-communicable diseases is high. RESEARCH DESIGN AND METHODS We studied the associations between ambient PM2.5 levels and fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and incident type 2 diabetes mellitus (T2DM) among 12 064 participants in an adult cohort from urban Chennai and Delhi, India. A meta-analytic approach was used to combine estimates, obtained from mixed-effects models and proportional hazards models, from the two cities. RESULTS We observed that 10 μg/m3 differences in monthly average exposure to PM2.5 was associated with a 0.40 mg/dL increase in FPG (95% CI 0.22 to 0.58) and 0.021 unit increase in HbA1c (95% CI 0.009 to 0.032). Further, 10 μg/m3 differences in annual average PM2.5 was associated with 1.22 (95% CI 1.09 to 1.36) times increased risk of incident T2DM, with non-linear exposure response. CONCLUSIONS We observed evidence of temporal association between PM2.5 exposure, and higher FPG and incident T2DM in two urban environments in India, thus highlighting the potential for population-based mitigation policies to reduce the growing burden of diabetes.
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Affiliation(s)
| | | | - Dimple Kondal
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, New Delhi, Delhi, India
| | - Joel D Schwartz
- Harvard T H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, New Delhi, Delhi, India
| | - K M Venkat Narayan
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Johnson LCM, Nikhare K, Jaganathan S, Ali MK, Venkat Narayan KM, Prabhakaran D, Tandon N, Singh K. Stakeholder Perspectives regarding the Acceptability and Sustainability of a Multi-component Diabetes Care Strategy in South Asia: a longitudinal qualitative analysis. Glob Implement Res Appl 2022; 2:350-360. [PMID: 37745272 PMCID: PMC10516368 DOI: 10.1007/s43477-022-00060-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/29/2022] [Indexed: 09/26/2023]
Affiliation(s)
- Leslie C. M. Johnson
- Emory School of Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA
| | | | | | - Mohammed K. Ali
- Emory School of Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA
- Rollins School of Public Health, Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - KM Venkat Narayan
- Rollins School of Public Health, Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Gurugram, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Nikhil Tandon
- All India Institute of Medical Sciences, Department of Endocrinology & Metabolism, New Delhi, India
| | - Kavita Singh
- Public Health Foundation of India, Gurugram, India
- Centre for Chronic Disease Control, New Delhi, India
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de Bont J, Jaganathan S, Dahlquist M, Persson Å, Stafoggia M, Ljungman P. Ambient air pollution and cardiovascular diseases: An umbrella review of systematic reviews and meta-analyses. J Intern Med 2022; 291:779-800. [PMID: 35138681 PMCID: PMC9310863 DOI: 10.1111/joim.13467] [Citation(s) in RCA: 101] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The available evidence on the effects of ambient air pollution on cardiovascular diseases (CVDs) has increased substantially. In this umbrella review, we summarized the current epidemiological evidence from systematic reviews and meta-analyses linking ambient air pollution and CVDs, with a focus on geographical differences and vulnerable subpopulations. We performed a search strategy through multiple databases including articles between 2010 and 31 January 2021. We performed a quality assessment and evaluated the strength of evidence. Of the 56 included reviews, the most studied outcomes were stroke (22 reviews), all-cause CVD mortality, and morbidity (19). The strongest evidence was found between higher short- and long-term ambient air pollution exposure and all-cause CVD mortality and morbidity, stroke, blood pressure, and ischemic heart diseases (IHD). Short-term exposures to particulate matter <2.5 μm (PM2.5 ), <10 μm (PM10 ), and nitrogen oxides (NOx ) were consistently associated with increased risks of hypertension and triggering of myocardial infarction (MI), and stroke (fatal and nonfatal). Long-term exposures of PM2.5 were largely associated with increased risk of atherosclerosis, incident MI, hypertension, and incident stroke and stroke mortality. Few reviews evaluated other CVD outcomes including arrhythmias, atrial fibrillation, or heart failure but they generally reported positive statistical associations. Stronger associations were found in Asian countries and vulnerable subpopulations, especially among the elderly, cardiac patients, and people with higher weight status. Consistent with experimental data, this comprehensive umbrella review found strong evidence that higher levels of ambient air pollution increase the risk of CVDs, especially all-cause CVD mortality, stroke, and IHD. These results emphasize the importance of reducing the alarming levels of air pollution across the globe, especially in Asia, and among vulnerable subpopulations.
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Affiliation(s)
- Jeroen de Bont
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Suganthi Jaganathan
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Environmental Health, Public Health Foundation of India, Delhi-NCR, India.,Centre for Chronic Disease Control, New Delhi, India
| | - Marcus Dahlquist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Persson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital, Danderyd, Sweden
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Singh K, Kaushik A, Johnson L, Jaganathan S, Jarhyan P, Deepa M, Kong S, Venkateshmurthy NS, Kondal D, Mohan S, Anjana RM, Ali MK, Tandon N, Narayan KMV, Mohan V, Eggleston K, Prabhakaran D. Patient experiences and perceptions of chronic disease care during the COVID-19 pandemic in India: a qualitative study. BMJ Open 2021; 11:e048926. [PMID: 34145019 PMCID: PMC8214993 DOI: 10.1136/bmjopen-2021-048926] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE People with chronic conditions are known to be vulnerable to the COVID-19 pandemic. This study aims to describe patients' lived experiences, challenges faced by people with chronic conditions, their coping strategies, and the social and economic impacts of the COVID-19 pandemic. DESIGN, SETTING AND PARTICIPANTS We conducted a qualitative study using a syndemic framework to understand the patients' experiences of chronic disease care, challenges faced during the lockdown, their coping strategies and mitigators during the COVID-19 pandemic in the context of socioecological and biological factors. A diverse sample of 41 participants with chronic conditions (hypertension, diabetes, stroke and cardiovascular diseases) from four sites (Delhi, Haryana, Vizag and Chennai) in India participated in semistructured interviews. All interviews were audio recorded, transcribed, translated, anonymised and coded using MAXQDA software. We used the framework method to qualitatively analyse the COVID-19 pandemic impacts on health, social and economic well-being. RESULTS Participant experiences during the COVID-19 pandemic were categorised into four themes: challenges faced during the lockdown, experiences of the participants diagnosed with COVID-19, preventive measures taken and lessons learnt during the COVID-19 pandemic. A subgroup of participants faced difficulties in accessing healthcare while a few reported using teleconsultations. Most participants reported adverse economic impact of the pandemic which led to higher reporting of anxiety and stress. Participants who tested COVID-19 positive reported experiencing discrimination and stigma from neighbours. All participants reported taking essential preventive measures. CONCLUSION People with chronic conditions experienced a confluence (reciprocal effect) of COVID-19 pandemic and chronic diseases in the context of difficulty in accessing healthcare, sedentary lifestyle and increased stress and anxiety. Patients' lived experiences during the pandemic provide important insights to inform effective transition to a mixed realm of online consultations and 'distanced' physical clinic visits.
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Affiliation(s)
- Kavita Singh
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
- Clinical Research, Centre for Chronic Disease Control, New Delhi, India
| | - Aprajita Kaushik
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
- Clinical Research, Centre for Chronic Disease Control, New Delhi, India
| | - Leslie Johnson
- School of Medicine, Emory University, Atlanta, Georgia, USA
| | | | - Prashant Jarhyan
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - Mohan Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Sandra Kong
- Shorenstein Asia-Pacific Research Center, Stanford University, Stanford, California, USA
| | - Nikhil Srinivasapura Venkateshmurthy
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
- Clinical Research, Centre for Chronic Disease Control, New Delhi, India
| | - Dimple Kondal
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
- Clinical Research, Centre for Chronic Disease Control, New Delhi, India
| | - Sailesh Mohan
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
- Clinical Research, Centre for Chronic Disease Control, New Delhi, India
| | - Ranjit Mohan Anjana
- Department of Epidemiology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Mohammed K Ali
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Nikhil Tandon
- Departement of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - K M Venkat Narayan
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Viswanathan Mohan
- Department of Epidemiology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Karen Eggleston
- Shorenstein Asia-Pacific Research Center, Stanford University, Stanford, California, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
- Clinical Research, Centre for Chronic Disease Control, New Delhi, India
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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7
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Singh K, Kondal D, Mohan S, Jaganathan S, Deepa M, Venkateshmurthy NS, Jarhyan P, Anjana RM, Narayan KMV, Mohan V, Tandon N, Ali MK, Prabhakaran D, Eggleston K. Health, psychosocial, and economic impacts of the COVID-19 pandemic on people with chronic conditions in India: a mixed methods study. BMC Public Health 2021; 21:685. [PMID: 33832478 PMCID: PMC8027966 DOI: 10.1186/s12889-021-10708-w] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/24/2021] [Indexed: 02/07/2023] Open
Abstract
Background People with chronic conditions are disproportionately prone to be affected by the COVID-19 pandemic but there are limited data documenting this. We aimed to assess the health, psychosocial and economic impacts of the COVID-19 pandemic on people with chronic conditions in India. Methods Between July 29, to September 12, 2020, we telephonically surveyed adults (n = 2335) with chronic conditions across four sites in India. Data on participants’ demographic, socio-economic status, comorbidities, access to health care, treatment satisfaction, self-care behaviors, employment, and income were collected using pre-tested questionnaires. We performed multivariable logistic regression analysis to examine the factors associated with difficulty in accessing medicines and worsening of diabetes or hypertension symptoms. Further, a diverse sample of 40 participants completed qualitative interviews that focused on eliciting patient’s experiences during the COVID-19 lockdowns and data analyzed using thematic analysis. Results One thousand seven hundred thirty-four individuals completed the survey (response rate = 74%). The mean (SD) age of respondents was 57.8 years (11.3) and 50% were men. During the COVID-19 lockdowns in India, 83% of participants reported difficulty in accessing healthcare, 17% faced difficulties in accessing medicines, 59% reported loss of income, 38% lost jobs, and 28% reduced fruit and vegetable consumption. In the final-adjusted regression model, rural residence (OR, 95%CI: 4.01,2.90–5.53), having diabetes (2.42, 1.81–3.25) and hypertension (1.70,1.27–2.27), and loss of income (2.30,1.62–3.26) were significantly associated with difficulty in accessing medicines. Further, difficulties in accessing medicines (3.67,2.52–5.35), and job loss (1.90,1.25–2.89) were associated with worsening of diabetes or hypertension symptoms. Qualitative data suggest most participants experienced psychosocial distress due to loss of job or income and had difficulties in accessing in-patient services. Conclusion People with chronic conditions, particularly among poor, rural, and marginalized populations, have experienced difficulties in accessing healthcare and been severely affected both socially and financially by the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10708-w.
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Affiliation(s)
- Kavita Singh
- Public Health Foundation of India, Plot number 47, Sector 44, Gurugram, New Delhi, Haryana, 122002, India. .,Centre for Chronic Disease Control, New Delhi, India.
| | - Dimple Kondal
- Public Health Foundation of India, Plot number 47, Sector 44, Gurugram, New Delhi, Haryana, 122002, India
| | - Sailesh Mohan
- Public Health Foundation of India, Plot number 47, Sector 44, Gurugram, New Delhi, Haryana, 122002, India.,Centre for Chronic Disease Control, New Delhi, India.,Deakin University, Melbourne, Australia
| | | | - Mohan Deepa
- Madras Diabetes Research Foundation, Chennai, India
| | - Nikhil Srinivasapura Venkateshmurthy
- Public Health Foundation of India, Plot number 47, Sector 44, Gurugram, New Delhi, Haryana, 122002, India.,Centre for Chronic Disease Control, New Delhi, India
| | - Prashant Jarhyan
- Public Health Foundation of India, Plot number 47, Sector 44, Gurugram, New Delhi, Haryana, 122002, India
| | | | | | | | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Dorairaj Prabhakaran
- Public Health Foundation of India, Plot number 47, Sector 44, Gurugram, New Delhi, Haryana, 122002, India.,Centre for Chronic Disease Control, New Delhi, India.,London School of Hygiene and Tropical Medicine, London, UK
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8
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Prabhakaran P, Jaganathan S, Walia GK, Wellenius GA, Mandal S, Kumar K, Kloog I, Lane K, Nori-Sarma A, Rosenqvist M, Dahlquist M, Reddy KS, Schwartz J, Prabhakaran D, Ljungman PLS. Building capacity for air pollution epidemiology in India. Environ Epidemiol 2020; 4:e117. [PMID: 33134770 PMCID: PMC7553192 DOI: 10.1097/ee9.0000000000000117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/28/2020] [Indexed: 11/26/2022] Open
Abstract
Air pollution represents a major public health threat in India affecting 19% of the world's population at extreme levels. Despite this, research in India lags behind in large part due to a lack of comprehensive air pollution exposure assessment that can be used in conjunction with health data to investigate health effects. Our vision is to provide a consortium to rapidly expand the evidence base of the multiple effects of ambient air pollution. We intend to leapfrog current limitations of exposure assessment by developing a machine-learned satellite-informed spatiotemporal model to estimate daily levels of ambient fine particulate matter measuring less than 2.5 µm (PM2.5) at a fine spatial scale across all of India. To catalyze health effects research on an unprecedented scale, we will make the output from this model publicly available. In addition, we will also apply these PM2.5 estimates to study the health outcomes of greatest public health importance in India, including cardiovascular diseases, chronic obstructive pulmonary disease, pregnancy (and birth) outcomes, and cognitive development and/or decline. Thus, our efforts will directly generate actionable new evidence on the myriad effects of air pollution on health that can inform policy decisions, while providing a comprehensive and publicly available resource for future studies on both exposure and health effects. In this commentary, we discuss the motivation, rationale, and vision for our consortium and a path forward for reducing the enormous burden of disease from air pollution in India.
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Affiliation(s)
| | | | | | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | | | - Kishore Kumar
- Centre for Chronic Disease Control, New Delhi, India
| | - Itai Kloog
- Ben-Gurion University of the Negev, Beersheba, Israel
| | - Kevin Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Amruta Nori-Sarma
- Center for Environmental Health and Technology, Brown University School of Public Health, Providence, Rhode Island
| | - Marten Rosenqvist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Dahlquist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Delhi-NCR, India
- Centre for Chronic Disease Control, New Delhi, India
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Petter L S Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
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Walia GK, Mandal S, Jaganathan S, Jaacks LM, Sieber NL, Dhillon PK, Krishna B, Magsumbol MS, Madhipatla KK, Kondal D, Cash RA, Reddy KS, Schwartz J, Prabhakaran D. Leveraging Existing Cohorts to Study Health Effects of Air Pollution on Cardiometabolic Disorders: India Global Environmental and Occupational Health Hub. Environ Health Insights 2020; 14:1178630220915688. [PMID: 32341651 PMCID: PMC7171984 DOI: 10.1177/1178630220915688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/06/2020] [Indexed: 06/11/2023]
Abstract
Air pollution is a growing public health concern in developing countries and poses a huge epidemiological burden. Despite the growing awareness of ill effects of air pollution, the evidence linking air pollution and health effects is sparse. This requires environmental exposure scientist and public health researchers to work more cohesively to generate evidence on health impacts of air pollution in developing countries for policy advocacy. In the Global Environmental and Occupational Health (GEOHealth) Program, we aim to build exposure assessment model to estimate ambient air pollution exposure at a very fine resolution which can be linked with health outcomes leveraging well-phenotyped cohorts which have information on geolocation of households of study participants. We aim to address how air pollution interacts with meteorological and weather parameters and other aspects of the urban environment, occupational classification, and socioeconomic status, to affect cardiometabolic risk factors and disease outcomes. This will help us generate evidence for cardiovascular health impacts of ambient air pollution in India needed for necessary policy advocacy. The other exploratory aims are to explore mediatory role of the epigenetic mechanisms (DNA methylation) and vitamin D exposure in determining the association between air pollution exposure and cardiovascular health outcomes. Other components of the GEOHealth program include building capacity and strengthening the skills of public health researchers in India through variety of training programs and international collaborations. This will help generate research capacity to address environmental and occupational health research questions in India. The expertise that we bring together in GEOHealth hub are public health, clinical epidemiology, environmental exposure science, statistical modeling, and policy advocacy.
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Affiliation(s)
| | | | | | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nancy L Sieber
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Bhargav Krishna
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Dimple Kondal
- Centre for Chronic Disease Control (CCDC), New Delhi, India
| | - Richard A Cash
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - D Prabhakaran
- Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control (CCDC), New Delhi, India
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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10
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Humphries C, Jaganathan S, Panniyammakal J, Singh S, Dorairaj P, Price M, Gill P, Greenfield S, Lilford R, Manaseki-Holland S. Investigating discharge communication for chronic disease patients in three hospitals in India. PLoS One 2020; 15:e0230438. [PMID: 32294091 PMCID: PMC7159187 DOI: 10.1371/journal.pone.0230438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/29/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Poor discharge communication is associated with negative health outcomes in high-income countries. However, quality of discharge communication has received little attention in India and many other low and middle-income countries. PRIMARY OBJECTIVE To investigate verbal and documented discharge communication for chronic non-communicable disease (NCD) patients. SECONDARY OBJECTIVE To explore the relationship between quality of discharge communication and health outcomes. METHODS DESIGN Prospective study. SETTING Three public hospitals in Himachal Pradesh and Kerala states, India. PARTICIPANTS 546 chronic NCD (chronic respiratory disease, cardiovascular disease or diabetes) patients. Piloted questionnaires were completed at admission, discharge and five and eighteen-week follow-up covering health status, discharge communication practices and health-seeking behaviour. Logistic regression was used to explore the relationship between quality of discharge communication and health outcomes. OUTCOME MEASURES PRIMARY Patient recall and experiences of verbal and documented discharge communication. SECONDARY Death, hospital readmission and self-reported deterioration of NCD/s. RESULTS All patients received discharge notes, predominantly on sheets of paper with basic pre-printed headings (71%) or no structure (19%); 31% of notes contained all the following information required for facilitating continuity of care: diagnosis, medication information, lifestyle advice, and follow-up instructions. Patient reports indicated notable variations in verbal information provided during discharge consultations; 50% received ongoing treatment/management information and 23% received lifestyle advice. Within 18 weeks of follow-up, 25 (5%) patients had died, 69 (13%) had been readmitted and 62 (11%) reported that their chronic NCD/s had deteriorated. Significant associations were found between low-quality documented discharge communication and death (AOR = 3.00; 95% CI 1.27,7.06) and low-quality verbal discharge communication and self-reported deterioration of chronic NCD/s (AOR = 0.46; 95% CI 0.25,0.83) within 18-weeks of follow-up. CONCLUSIONS Sub-optimal discharge practices may be compromising continuity and safety of chronic NCD patient care. Structured protocols, documents and training are required to improve discharge communication, healthcare integration and NCD management.
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Affiliation(s)
- Claire Humphries
- Institute of Applied Health Research, University of Birmingham, Birmingham, England, United Kingdom
| | - Suganthi Jaganathan
- Public Health Foundation of India, Delhi, India
- Centre for Chronic Disease Control, Delhi, India
| | - Jeemon Panniyammakal
- Public Health Foundation of India, Delhi, India
- Centre for Chronic Disease Control, Delhi, India
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India
| | - Sanjeev Singh
- Hospital Administration, Amrita Institute of Medical Sciences, Kochi, India
| | - Prabhakaran Dorairaj
- Public Health Foundation of India, Delhi, India
- Centre for Chronic Disease Control, Delhi, India
| | - Malcolm Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, England, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, England, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, England, United Kingdom
| | - Paramjit Gill
- Academic Unit of Primary Care, University of Warwick, Coventry, England, United Kingdom
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, England, United Kingdom
| | - Richard Lilford
- Centre for Applied Health Research and Delivery, University of Warwick, Coventry, England, United Kingdom
| | - Semira Manaseki-Holland
- Institute of Applied Health Research, University of Birmingham, Birmingham, England, United Kingdom
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Humphries C, Jaganathan S, Panniyammakal J, Singh SK, Goenka S, Dorairaj P, Gill P, Greenfield S, Lilford R, Manaseki-Holland S. Patient and healthcare provider knowledge, attitudes and barriers to handover and healthcare communication during chronic disease inpatient care in India: a qualitative exploratory study. BMJ Open 2019; 9:e028199. [PMID: 31719070 PMCID: PMC6858202 DOI: 10.1136/bmjopen-2018-028199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES 1) To investigate patient and healthcare provider (HCP) knowledge, attitudes and barriers to handover and healthcare communication during inpatient care. 2) To explore potential interventions for improving the storage and transfer of healthcare information. DESIGN Qualitative study comprising 41 semi-structured, individual interviews and a thematic analysis using the Framework Method with analyst triangulation. SETTING Three public hospitals in Himachal Pradesh and Kerala, India. PARTICIPANTS Participants included 20 male (n=10) and female (n=10) patients with chronic non-communicable disease (NCD) and 21 male (n=15) and female (n=6) HCPs. Purposive sampling was used to identify patients with chronic NCDs (cardiovascular disease, chronic respiratory disease, diabetes or hypertension) and HCPs. RESULTS Patient themes were (1) public healthcare service characteristics, (2) HCP to patient communication and (3) attitudes regarding medical information. HCP themes were (1) system factors, (2) information exchange practices and (3) quality improvement strategies. Both patients and HCPs recognised public healthcare constraints that increased pressure on hospitals and subsequently limited consultation times. Systemic issues reported by HCPs were a lack of formal handover systems, training and accessible hospital-based records. Healthcare management communication during admission was inconsistent and lacked patient-centredness, evidenced by varying reports of patient information received and some dissatisfaction with lifestyle advice. HCPs reported that the duty of writing discharge notes was passed from senior doctors to interns or nurses during busy periods. A nurse reported providing predominantly verbal discharge instructions to patients. Patient-held medical documents facilitated information exchange between HCPs, but doctors reported that they were not always transported. HCPs and patients expressed positive views towards the idea of introducing patient-held booklets to improve the organisation and transfer of medical documents. CONCLUSIONS Handover and healthcare communication during chronic NCD inpatient care is currently suboptimal. Structured information exchange systems and HCP training are required to improve continuity and safety of care during critical transitions such as referral and discharge. Our findings suggest that patient-held booklets may also assist in enhancing handover and patient-centred practices.
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Affiliation(s)
- Claire Humphries
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Suganthi Jaganathan
- Centre for Chronic Disease Control, Gurgaon, Haryana, India
- Public Health Foundation of India, New Delhi, India
| | - Jeemon Panniyammakal
- Centre for Chronic Disease Control, Gurgaon, Haryana, India
- Public Health Foundation of India, New Delhi, India
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | | | - Shifalika Goenka
- Centre for Chronic Disease Control, Gurgaon, Haryana, India
- Public Health Foundation of India, New Delhi, India
| | - Prabhakaran Dorairaj
- Centre for Chronic Disease Control, Gurgaon, Haryana, India
- Public Health Foundation of India, New Delhi, India
| | - Paramjit Gill
- Academic Unit of Primary Care, University of Warwick, Coventry, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Richard Lilford
- Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
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Jaganathan S, Jaacks LM, Magsumbol M, Walia GK, Sieber NL, Shivasankar R, Dhillon PK, Hameed SS, Schwartz J, Prabhakaran D. Association of Long-Term Exposure to Fine Particulate Matter and Cardio-Metabolic Diseases in Low- and Middle-Income Countries: A Systematic Review. Int J Environ Res Public Health 2019; 16:E2541. [PMID: 31315297 PMCID: PMC6679147 DOI: 10.3390/ijerph16142541] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/24/2022]
Abstract
: Background: Numerous epidemiological studies indicated high levels of particulate matter less than2.5 μm diameter (PM2.5) as a major cardiovascular risk factor. Most of the studies have been conducted in high-income countries (HICs), where average levels of PM2.5 are far less compared to low- and middle- income countries (LMICs), and their socio-economic profile, disease burden, and PM speciation/composition are very different. We systematically reviewed the association of long-term exposure to PM2.5 and cardio-metabolic diseases (CMDs) in LMICs. METHODS Multiple databases were searched for English articles with date limits until March 2018. We included studies investigating the association of long-term exposure to PM2.5 (defined as an annual average/average measure for 3 more days of PM2.5 exposure) and CMDs, such as hospital admissions, prevalence, and deaths due to CMDs, conducted in LMICs as defined by World Bank. We excluded studies which employed exposure proxy measures, studies among specific occupational groups, and specific episodes of air pollution. RESULTS A total of 5567 unique articles were identified, of which only 17 articles were included for final review, and these studies were from Brazil, Bulgaria, China, India, and Mexico. Outcome assessed were hypertension, type 2 diabetes mellitus and insulin resistance, and cardiovascular disease (CVD)-related emergency room visits/admissions, death, and mortality. Largely a positive association between exposure to PM2.5 and CMDs was found, and CVD mortality with effect estimates ranging from 0.24% to 6.11% increased per 10 μg/m3 in PM2.5. CVD-related hospitalizations and emergency room visits increased by 0.3% to 19.6%. Risk factors like hypertension had an odds ratio of 1.14, and type 2 diabetes mellitus had an odds ratio ranging from 1.14-1.32. Diversity of exposure assessment and health outcomes limited the ability to perform a meta-analysis. CONCLUSION Limited evidence on the association of long-term exposure to PM2.5 and CMDs in the LMICs context warrants cohort studies to establish the association.
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Affiliation(s)
| | - Lindsay M. Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | | | | | - Nancy L. Sieber
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | | | | | | | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi 110016, India
- Public Health Foundation of India, Gurgaon 122002, India
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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13
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Humphries C, Jaganathan S, Panniyammakal J, Singh S, Goenka S, Dorairaj P, Gill P, Greenfield S, Lilford R, Manaseki-Holland S. Investigating clinical handover and healthcare communication for outpatients with chronic disease in India: A mixed-methods study. PLoS One 2018; 13:e0207511. [PMID: 30517130 PMCID: PMC6281223 DOI: 10.1371/journal.pone.0207511] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 11/01/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Research concentrating on continuity of care for chronic, non-communicable disease (NCD) patients in resource-constrained settings is currently limited and focusses on inpatients. Outpatient care requires attention as this is where NCD patients often seek treatment and optimal handover of information is essential. We investigated handover, healthcare communication and barriers to continuity of care for chronic NCD outpatients in India. We also explored potential interventions for improving storage and exchange of healthcare information. METHODS A mixed-methods design was used across five healthcare facilities in Kerala and Himachal Pradesh states. Questionnaires from 513 outpatients with cardiovascular disease, chronic respiratory disease, or diabetes covered the form and comprehensiveness of information exchange between healthcare professionals (HCPs) and between HCPs and patients. Semi-structured interviews with outpatients and HCPs explored handover, healthcare communication and intervention ideas. Barriers to continuity of care were identified through triangulation of all data sources. RESULTS Almost half (46%) of patients self-referred to hospital outpatient clinics (OPCs). Patient-held healthcare information was often poorly recorded on unstructured sheets of paper; 24% of OPC documents contained the following: diagnosis, medication, long-term care and follow-up information. Just 55% of patients recalled receiving verbal follow-up and medication instructions during OPC appointments. Qualitative themes included patient preference for hospital visits, system factors, inconsistent doctor-patient communication and attitudes towards medical documents. Barriers were hospital time constraints, inconsistent referral practices and absences of OPC medical record-keeping, structured patient-held medical documents and clinical handover training. Patients and HCPs were in favour of the introduction of patient-held booklets for storing and transporting medical documents. CONCLUSIONS Deficiencies in communicative practices are compromising the continuity of chronic NCD outpatient care. Targeted systems-based interventions are urgently required to improve information provision and exchange. Our findings indicate that well-designed patient-held booklets are likely to be an acceptable, affordable and effective part of the solution.
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Affiliation(s)
- Claire Humphries
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Suganthi Jaganathan
- Public Health Foundation of India, New Delhi, Delhi, India
- Centre for Chronic Disease Control, New Delhi, Delhi, India
| | - Jeemon Panniyammakal
- Public Health Foundation of India, New Delhi, Delhi, India
- Centre for Chronic Disease Control, New Delhi, Delhi, India
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sanjeev Singh
- Hospital Administration, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Shifalika Goenka
- Public Health Foundation of India, New Delhi, Delhi, India
- Centre for Chronic Disease Control, New Delhi, Delhi, India
| | - Prabhakaran Dorairaj
- Public Health Foundation of India, New Delhi, Delhi, India
- Centre for Chronic Disease Control, New Delhi, Delhi, India
| | - Paramjit Gill
- Academic Unit of Primary Care, University of Warwick, Coventry, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Richard Lilford
- Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Semira Manaseki-Holland
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, United Kingdom
- * E-mail:
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14
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Unnikrishnan R, Jaganathan S, Wadhwani P, Bhalla S, Kumar P, Sinha S, Bhatla N, Venkatram P, Ghosh K, Mittal A, Prabhakaran D, Tandon N, Mohan V, Ram U. Gestational Diabetes Mellitus Training: A Well-grounded Approach for Safeguarding Two Generations. Indian J Endocrinol Metab 2017; 21:934-935. [PMID: 29285466 PMCID: PMC5729691 DOI: 10.4103/ijem.ijem_221_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ranjit Unnikrishnan
- Dr. Mohan's Diabetes Specialities Centre, Seethapathy Clinic and Hospital, Chennai, Tamil Nadu, India
| | | | - Pallavi Wadhwani
- Training Division, Public Health Foundation of India, New Delhi, India
| | - Sandeep Bhalla
- Training Division, Public Health Foundation of India, New Delhi, India
| | - Pushkar Kumar
- Training Division, Public Health Foundation of India, New Delhi, India
| | - Sourabh Sinha
- Training Division, Public Health Foundation of India, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Padmalatha Venkatram
- Department of Obstetrics and Gynecology, Rangadore Memorial Hospital, Bengaluru, Karnataka, India
| | | | - Ambrish Mittal
- Division of Endocrinology and Diabetes, Gurgaon, Haryana, India
| | | | - Nikhil Tandon
- Department ofEndocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre, Seethapathy Clinic and Hospital, Chennai, Tamil Nadu, India
| | - Uma Ram
- Department of Obstetrics and Gynecology, Seethapathy Clinic and Hospital, Chennai, Tamil Nadu, India
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Jaganathan S, Vahedi Tafreshi H, Shim E, Pourdeyhimi B. A study on compression-induced morphological changes of nonwoven fibrous materials. Colloids Surf A Physicochem Eng Asp 2009. [DOI: 10.1016/j.colsurfa.2008.12.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vahedi Tafreshi H, A Rahman M, Jaganathan S, Wang Q, Pourdeyhimi B. Analytical expressions for predicting permeability of bimodal fibrous porous media. Chem Eng Sci 2009. [DOI: 10.1016/j.ces.2008.11.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Jaganathan S, Vahedi Tafreshi H, Pourdeyhimi B. Modeling liquid porosimetry in modeled and imaged 3-D fibrous microstructures. J Colloid Interface Sci 2008; 326:166-75. [DOI: 10.1016/j.jcis.2008.07.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 07/01/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
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Jaganathan S, Vahedi Tafreshi H, Pourdeyhimi B. A realistic approach for modeling permeability of fibrous media: 3-D imaging coupled with CFD simulation. Chem Eng Sci 2008. [DOI: 10.1016/j.ces.2007.09.020] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jaganathan S, Vahedi Tafreshi H, Pourdeyhimi B. On the pressure drop prediction of filter media composed of fibers with bimodal diameter distributions. POWDER TECHNOL 2008. [DOI: 10.1016/j.powtec.2007.07.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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