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Nath A, Mathur P, Sudarshan K, Kaur Rajput G, Mascarenhas L, Arora RS, Seth R, Kumar Dixit S, Chinnaswamy G, Banipal RPS, Bhutia TW, Kumar Bodal V, Budukh A, Kumar Chaudhary N, Vijay C, Shikha Das D, Gundeti S, Harris C, Hazarika M, Natha Jondhale S, Gunaseelan K, Khamo V, Konjengbam R, Kumar A, Saroj Kumar DM, Majumdar G, Malik S, Mandal S, Najmi AM, Mohan Kumar C, Kumar Pandey A, Pandya S, Pareek P, Pautu JL, Surya Rao V, Ramesh C, Rawal M, Radhakrishnan N, Radhakrishnan V, Shah A, Singh S, Singh V, Singh P, Sundriyal D, Swaminathan R, Avinash T, Priya Kumari T, Tawsik S, Tiwari L. An assessment of childhood cancer care services in India - gaps, challenges and the way forward. Lancet Reg Health Southeast Asia 2023; 16:100235. [PMID: 37694177 PMCID: PMC10485780 DOI: 10.1016/j.lansea.2023.100235] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/03/2023] [Accepted: 05/25/2023] [Indexed: 09/12/2023]
Abstract
Background Childhood cancers are emerging as an essential concern in India where there is lack of a specific programme component or policy to address childhood cancer control. There is limited information on the status and quality of childhood cancer care services in India. This paper describes the childhood cancer care services available at secondary and tertiary-level hospitals in India through a cross sectional study design. Methods The survey was conducted in 137 tertiary-level and 92 secondary-level hospitals in 26 states and 4 Union Territories (UTs), ensuring a uniform representation of public and private care hospitals. The study tool collected data on the organisational infrastructure, type of oncology services, health workforce, equipment, treatment and referral protocols, and treatment guidelines. Descriptive statistics was used to primarily present the health service status and data on childhood cancer care services in proportions and mean. Findings A dedicated pediatric oncology department was available in 41.6% of the public, 48.6% of private, and 64% Non Government Organization (NGO) managed tertiary-level hospitals. In 36 (39%) of the 92 hospitals providing secondary care, childhood cancer care was provided. The availability of bone (41.5%) and positron emission tomography (PET) scans (25.9%) was lower in public tertiary hospitals, whereas histopathology, computerised tomography (CT scan), and magnetic resonance imaging (MRI) were lower in public secondary hospitals than private and NGO managed hospitals for the corresponding level of care. Most tertiary hospitals had the required supportive care facilities except for play therapy and hospice care. Less than 50% of the public tertiary hospitals had stocks of the four categories of cancer-treating drugs and essential infrastructure for radiotherapy and chemotherapy. Most secondary-level hospitals not treating childhood cancer had referral linkages with tertiary hospitals. Interpretation The situational analysis of childhood cancer care services in India showed the concentration of availability of childhood cancer care services at the tertiary level of health care. There were gaps in the availability of specialised pediatric oncology care in all the tertiary hospitals. The availability of childhood cancer care services was higher in private and NGO-managed hospitals than in public hospitals. Integration of childhood cancer as a part of the national cancer control response should be taken up as a matter of priority. The need of the hour is to formulate a childhood cancer policy that will enable timely access to care universally. Funding World Health Organization, India provided funding and technical support.
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Affiliation(s)
- Anita Nath
- ICMR-National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bengaluru, Karnataka, India
| | - Prashant Mathur
- ICMR-National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bengaluru, Karnataka, India
| | - K.L. Sudarshan
- ICMR-National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bengaluru, Karnataka, India
| | - Gurpreet Kaur Rajput
- ICMR-National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bengaluru, Karnataka, India
| | - Leena Mascarenhas
- ICMR-National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bengaluru, Karnataka, India
| | | | - Rachna Seth
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Tseten W. Bhutia
- Sir Thutob Namgyal Memorial Referral Hospital, Gangtok, Sikkim, India
| | | | - Atul Budukh
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC), Homi Bhabha National Institute (HBNI), Mumbai, India
| | | | - C.R. Vijay
- Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | | | | | - Caleb Harris
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | | | | | - K. Gunaseelan
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | | | - Arun Kumar
- Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | | | | | - Shikha Malik
- All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | | | - Arshad Manzoor Najmi
- Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | | | | | - Shashank Pandya
- The Gujarat Cancer & Research Institute, Ahmedabad, Gujarat, India
| | - Puneet Pareek
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - V. Surya Rao
- Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
| | - C. Ramesh
- Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Manoj Rawal
- BPS Government Medical College for Women, Haryana, India
| | | | | | - Anand Shah
- The Gujarat Cancer & Research Institute, Ahmedabad, Gujarat, India
| | - S.B. Singh
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Varinder Singh
- Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India
| | | | - Deepak Sundriyal
- All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | | | - T. Avinash
- Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | | | - Sopai Tawsik
- Tomo Riba Institute of Health and Medical Sciences, Naharlagun, Arunachal Pradesh, India
| | - Lokesh Tiwari
- All India Institute of Medical Sciences, Patna, Bihar, India
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Jadaun AS, Dalpath SK, Trikha S, Upadhyay RP, Bhandari N, Punia JS, Rawal M, Martines JC, Bahl R, Agarwal R, Mazumder S. Government-led initiative increased the effective use of Kangaroo Mother Care in a region of North India. Acta Paediatr 2022. [PMID: 35665961 DOI: 10.1111/apa.16376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022]
Abstract
AIM To learn how to achieve high-quality, effective coverage of Kangaroo Mother Care (KMC), defined as 8 hours or more of skin-to-skin contact per day and exclusive breastfeeding in district Sonipat in North India, and to develop and evaluate an implementation model. METHODS We conducted implementation research using a mixed-methods approach, including formative research, followed by repeated, rapid cycles of implementation, evaluation and refinement until a model with the potential for high and effective coverage was reached. Evaluation of this model was conducted over a 12-month period. RESULTS Formative research findings informed the final implementation model. Programme learning was critical to achieve high coverage. The model included improving the identification of small babies, creating KMC wards, modification in hospitalisation criteria, private sector engagement and in-built programme learning to refine implementation progress. KMC was initiated in 87% of eligible babies. At discharge, 85% received skin-to-skin contact care, 60% effective KMC and 80% were exclusively breastfed. At home, 7-day post discharge, 81% received skin-to-skin care and 79% were exclusively breastfed in the previous 24 hours. CONCLUSION Achieving high KMC coverage is feasible in the study setting using a model responsive to the local context and led by the Government.
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Affiliation(s)
- Arun S. Jadaun
- Centre for Health Research and Development Society for Applied Studies New Delhi India
| | - Suresh K. Dalpath
- State Health Systems Resource Center, Haryana Panchkula Haryana India
| | - Sonia Trikha
- State Health Systems Resource Center, Haryana Panchkula Haryana India
| | - Ravi P. Upadhyay
- Centre for Health Research and Development Society for Applied Studies New Delhi India
| | - Nita Bhandari
- Centre for Health Research and Development Society for Applied Studies New Delhi India
| | - Jaswant Singh Punia
- Department of Health District Hospital, Government of Haryana Sonipat Haryana India
| | - Manoj Rawal
- Bhagat Phool Singh Government Medical College Sonipat Haryana India
| | - Jose Carlos Martines
- Department of Global Public Health and Primary Care Centre for Intervention Science in Maternal and Child Health University of Bergen Bergen Norway
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health World Health Organization Geneva Switzerland
| | - Ramesh Agarwal
- Department Pediatrics All India Institute of Medical Sciences New Delhi India
| | - Sarmila Mazumder
- Centre for Health Research and Development Society for Applied Studies New Delhi India
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Rawal M, Raikwar P, Nair NP, Thiyagarajan V, Lingam R. Demographic Profile and Genotypic Distribution of Rotavirus Gastroenteritis from Rural Haryana, India. Indian J Pediatr 2021; 88:47-52. [PMID: 33420973 DOI: 10.1007/s12098-020-03612-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To know the prevalence of rotavirus among hospitalized <5 y children, their demographic profile and genotypic distribution of rotavirus strain from tertiary care center of rural Haryana. METHODS An observational 3-year study done from June 2016 to June 2019 where children under 5 y of age hospitalized for acute gastroenteritis were enrolled. Various demographic, environmental, and clinical parameters were assessed. Stool samples were collected and sent to CMC, Vellore for rotavirus screening by enzyme immune assay (EIA) and RV-positive samples were genotyped using reverse transcription-polymerase chain reaction (RT-PCR). RESULTS Out of 444 stool sample screened, 107 were positive (24.1%) for rotavirus. RV positive cases seen mostly in 6-24 mo age group with moderate to severe dehydration at presentation and peaks in winter months (Dec - Feb). G3P[8] (35.24%) is the most prevalent genotype identified followed by G1P[8] (20.95%), G1P[6] (11.43%), G2P[4] (6.67%) and G12P[8] (2.86%). CONCLUSION Continuous surveillance is required to monitor the circulating genotypes in postvaccination phase and assess the effectiveness and impact of the vaccine.
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Affiliation(s)
- Manoj Rawal
- Department of Pediatrics, B P S Govt. Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India
| | - Preeti Raikwar
- Department of Pediatrics, B P S Govt. Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India.
| | - Nayana P Nair
- The Wellcome Trust Research Laboratory, Christian Medical College, Vellore, Tamil Nadu, India
| | - Varunkumar Thiyagarajan
- The Wellcome Trust Research Laboratory, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ragavi Lingam
- The Wellcome Trust Research Laboratory, Christian Medical College, Vellore, Tamil Nadu, India
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Abstract
Abstract
Background
High confidence in vaccination programmes is crucial for maintaining high coverage rates. Across the European Union (EU), however, vaccine delays and refusals are contributing to declining immunisation rates in a number of countries and are leading to increases in disease outbreaks.
Methods
We assessed the overall state of confidence in vaccines among the public in all 28 EU member states and among general practitioners (GP) in ten EU member states, conducting the largest ever study on attitudes to vaccines and vaccination in the EU, eliciting the views of approximately 28,000 respondents across the 28 EU member states.
Results
We found that a number of member states (including France, Greece, Italy, and Slovenia) have become more confident in the safety of vaccines since 2015, but that the Czech Republic, Finland, Poland, and Sweden have become less confident. While GPs generally hold higher levels of vaccine confidence than the public, the survey found that 36% of GPs surveyed in Czech Republic and 25% in Slovakia do not agree that the MMR vaccine is safe and 29% and 19% respectively do not believe it is important. Countries whose GPs hold higher confidence in vaccines tend to have a larger proportion of the public expressing positive vaccination beliefs.
Conclusions
Even countries with well-established vaccination programmes and high levels of confidence are not immune to rising vaccine hesitancy. There is a need for continuous monitoring, preparedness and response plans to maintain and increase confidence in the importance, effectiveness and safety of vaccines, among both the public and health professionals.
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Affiliation(s)
- H Larson
- Vaccine Confidence Project, LSHTM and Imperial College, London, UK
| | - A de Figueiredo
- Vaccine Confidence Project, LSHTM and Imperial College, London, UK
| | - E Karafllakis
- Vaccine Confidence Project, LSHTM and Imperial College, London, UK
| | - M Rawal
- Vaccine Confidence Project, LSHTM and Imperial College, London, UK
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Rohilla S, Yadav R, Rawal M, Das K, Dhaulakhandi D. An unusual case of bilateral reversible blindness in a child: Crucial role of imaging. J Pediatr Neurol 2015. [DOI: 10.3233/jpn-2012-0512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Seema Rohilla
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Sciences, Pt. B.D. Sharma University of Health Sciences, Rohtak, India
| | - Rohtas Yadav
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Sciences, Pt. B.D. Sharma University of Health Sciences, Rohtak, India
| | - Manoj Rawal
- Department of Pediatrics, Post Graduate Institute of Medical Sciences, Pt. B.D. Sharma University of Health Sciences, Rohtak, India
| | - Kunal Das
- Department of Pediatrics, Post Graduate Institute of Medical Sciences, Pt. B.D. Sharma University of Health Sciences, Rohtak, India
| | - Dhara Dhaulakhandi
- Department of Biotechnology and Molecular Medicine, Post Graduate Institute of Medical Sciences, Pt. B.D. Sharma University of Health Sciences, Rohtak, India
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Rohilla S, Rawal M, Yadav R, Ahuja A, Nanda S, Dhaulakhandi D. Neurocysticercosis presenting as central diabetes insipidus in a boy. J Pediatr Neurol 2015. [DOI: 10.3233/jpn-2009-0295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Seema Rohilla
- Department of Radiodiagnosis & Imaging, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak, Haryana, India
| | - Manoj Rawal
- Department of Pediatrics, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak, Haryana, India
| | - Rohtas Yadav
- Department of Radiodiagnosis & Imaging, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak, Haryana, India
| | - Amit Ahuja
- Department of Radiodiagnosis & Imaging, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak, Haryana, India
| | - Sanjiv Nanda
- Department of Pediatrics, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak, Haryana, India
| | - Dhara Dhaulakhandi
- Department of Biotechnology & Molecular Medicine, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak, Haryana, India
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