Treat every TB case and trace all close contacts

Health Care, Heart Care Foundation of India, Medicine No Comments

Testing for latent TB should be performed in asymptomatic individuals

New Delhi, 20th February 2018: Tuberculosis (TB) is a major public health problem in India with the country having the largest number of TB cases in the world. Over a quarter of the global TB and multidrug-resistant TB (MDR-TB) burden is in India. Statistics from USAID indicate that in 2016, 2.79 million people became ill from TB, and 435,000 died from it.

Testing for latent TB should be performed in asymptomatic individuals. High-priority groups for evaluation include close contacts of TB patients.

Close contact is defined as individuals with at least four hours of contact per week. This includes those living in the same household or frequent visitors to the house or contacts at work or school.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “The risk of developing active disease is very high in the years following exposure and new infection. It is imperative to evaluate close contacts first and expand the contact investigation to casual contacts if evidence of transmission is found. Casual contact is defined as individuals with less than four hours of contact per week. This may include health care workers and/or contacts at work or school. Evidence of transmission is defined by a secondary active case or positive Mantoux test. In general, source cases with positive sputum smear are more contagious. Casual contacts of smear-negative patients are usually not evaluated unless they are immunocompromised.”

If the first test is negative, close contacts of patients with active pulmonary TB should undergo a second test eight weeks later. The risk of disease in the first two years following infection is age dependent.

Adding further, Dr Aggarwal, who is also Vice President of CMAAO, said, “Health care workers should undergo pre-exposure baseline testing prior to employment, followed by subsequent annual testing. Conversion of a Mantoux from negative to positive indicates new infection. Approximately half of the lifetime risk of reactivation occurs in the first one to two years following infection, and thus, it is important to target those who convert their Mantoux for treatment. A two-step Mantoux protocol should be followed (ie, if the first Mantoux is negative, then a second Mantoux is performed within one to four weeks). For the Mantoux, conversion is defined as a new positive test (with an increase of ≥10 mm) in the size of the Mantoux reaction compared with the previous two years.”

The decline of risk with increasing age reflects greater innate and acquired immunity: Infants (ages ≤1 year): 50 percent; Children (ages 1 to 2 years): 12 to 25 percent; Children (ages 2 to 5 years): 5 percent; Children (ages 5 to 10 years): 2 percent and Age >10 years: 1 to 2 percent.

The purpose of notification of Tb is the trace the close and casual contacts.

Union Budget 2018: a budget for the poor and not-so-much for the common man

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Preventive health and health insurance given major push

New Delhi, 1st February 2018: The Union Budget 2018 presented at the Lok Sabha seems to a pro-poor budget with many reforms and initiatives being directed towards their welfare. The focus has been on universal health coverage and affordable healthcare, two aspects which must be pertinently addressed—and seem to have been addressed at length this year.

The three facets of the healthcare budget this year have been enhancing the quality of medical education, covering all poor households under the Jeevan Bima Yojana, and promotion of preventive healthcare.

Contributions have been invited from the private sector organizations to realize the concept of health and wellness centres.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “This budget is directed more towards the poorer sections of the society. It remains to be seen what benefit the Aam Janata will accrue. The Flagship ‘National health protection scheme’ launched to cover 10 crore poor and vulnerable families (meaning 50 crore beneficiaries) by providing Rs 5 lakh per family per year for secondary and tertiary care hospitalization is a good move. This will be the world’s largest government funded national health programme. The National health policy 2017 envisioned ‘health and wellness centres’ as foundation of India’s health. This budget then aims to set up 1.5 lakh wellness centres with the hope of bringing health care closer to the homes of the people. The fact that comprehensive health care including NCDs and maternal and health services fall under this gambit is encouraging. These centres will also provide free essential drugs and diagnostic tests, a need of the hour.”

Apart from this, Rs 600 crore has been allocated to provide nutritional support to all TB patients @ Rs 500/month for the duration of their treatment. Cess in health and education has been increased from 3% to 4% and there is also a Mediclaim relief of Rs 50, 000 for senior citizens.

Adding further, Dr Aggarwal, who is also the Vice President of CMAAO, said, “The push for health coverage and insurance has been big. It is hoped that many more people will fall under the insured category this year onwards. At least one medical college for every 3 parliamentary constituencies and at least one government medical college in each state of the country is a positive step towards addressing the shortage of doctors in the country.”

Some other provisions are as follows.

To make villages ODF, the government is launching ‘Galvanizing organic bio agro resources dhan – Govardhan’ for the management and conversion of cattle dung and solid waste in farms to compost fertilizer and bio gas and bio CNG.

The Government will work to cover all poor households, households, including SC/ST households, under various bima yojanas in a mission mode.

Lack of sleep can affect eating and weight in children

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Parents should set an example for children by following a healthy lifestyle

New Delhi, 27 January 2018: As per a recent study, poor quality of sleep in a child can affect his/her eating habits and weight. Over time, this can also lead to childhood obesity, which can further put them at a greater risk of developing obesity-related cancers in adulthood. As per the study, shorter sleep duration, measured in hours, was associated with a higher BMI z-score (body mass index adjusted for age and sex). Each extra hour of sleep was associated with 0.13 reduction in BMI z-score and reduction in waist circumference of 1.29 cm.

Statistics indicate that India has the second highest number of obese children in the world after China. About 14.4 million kids in the country have excess weight. Globally, over two billion children and adults suffer from health problems related to being overweight or obese, and an increasing percentage of people die from these health conditions.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “Childhood obesity is a condition where excess body fat negatively affects a child’s health or well-being. As methods to determine body fat directly are difficult, the diagnosis of obesity is often based on BMI. The prevalence of childhood obesity is increasing in India and is being recognized as a serious public health concern. Unhealthy diet (eating foods high in fats, sugar and salt -junk food, processed food) and a sedentary lifestyle contribute significantly to this escalating epidemic. Also, TV, internet, computer and mobile games have taken precedence over outdoor sports with children becoming more sedentary. Childhood obesity is well-recognized as a precursor to obesity in adulthood. Most obese children grow up to be obese adults.”

Obese children and adolescents are more prone to bone and joint problems, sleep apnea, and social and psychological problems such as stigmatization and poor self-esteem.

Adding further, Dr Aggarwal, who is also Group Editor of IJCP, said, “Habits such as eating healthy and engaging in regular physical activity must be inculcated right from a young age. Parents should serve as role models for their children and set the right example by following a healthy lifestyle themselves. Schools can help in shaping the lives of students and have a very important role to play in the battle against childhood obesity. Healthy habits in childhood lay a foundation for a healthier adulthood.”

Here are some tips that parents can follow at home to tackle obesity and overweight in children.

  • Encourage healthy eating habits even at a very young age.
  • Try making favorite dishes healthier. Few changes can make even snacks healthier.
  • Avoid tempting children with calorie-rich food. It is okay to treat them but in moderation and by limiting high-fat and high-sugar or salty snacks.
  • Make kids understand the importance of being physically active.
  • Lead by example. Indulge in at least 60 minutes of moderate to intense physical activity every day.
  • Reduce sedentary time. While reading is a good option, too much of screen time is not. Make regular sleep time and good sleep a priority.
  • Replace screen time with the outdoors and fun activities to keep children engaged.

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