Thursday, 7 February 2019

Google Trends data maps trajectory, interest in swine flu highest in north, north-west India

With a prolonged and bitter winter, 6,601 cases of swine flu had been recorded across India by February 3 this year. Already, the number of cases this year is the fourth highest in the past eight years, the period for which year-wise data is available from the National Centre for Disease Control. The highest number of cases in the past eight years was registered in 2015, when a total of 42,592 cases were reported in the country, 6.5 times the cases reported so far this year. To be sure, more than 10 months are still left for 2019 to end. 

An HT analysis of Google Trends data for India has found that past outbreaks of the disease led to an increased interest on it in terms of Google searches. A further analysis of common search terms related to the disease this year shows that interest in it was concentrated in north and north-west India. However, the trends in statewise interest in the disease in Google search is not in keeping with the state-wise trend in number of reported cases of swine flu.

For example, between January 2014 and February 2019, the peak interest in search terms ‘swine flu’, ‘swine flu symptoms’, and ‘swine flu vaccine’ was observed in the February 15 to February 21 week of 2015, the year when maximum number of swine flu cases were reported.

Between 2016 and 2019, notable spikes in the same search terms have occurred in February and August 2017, October 2018, and January-February 2019. Comparison of year wise peaks shows that the highest peak was observed in 2017, followed by 2019 and 2018.

Among the three terms ‘swine flu’ is the most searched throughout. This year up to February 3, while interest in the term increased continuously until January 30, there was a spike on January 17, the day on which the news of BJP president Amit Shah getting admitted to AIIMS for treatment of swine flu broke.

A sub –region wise analysis shows that interest for ‘swine flu’ was concentrated in north India, after adjusting for search volumes, with the highest interest in Punjab. Punjab has recorded the eighth highest number of swine flu cases in the period, and 3rd highest number of deaths due to the disease this year. Rajasthan, which has recorded the highest number of swine flu cases and deaths in the same period, had the fifth highest interest in the search term.

Looking at just one search term may not reflect the true regional distribution of interest in the disease. People looking for information on the disease may also type in terms in addition to ‘swine flu’ in their search phrase. For example, one might search for ‘symptoms of swine flu’ or ‘best hospital to get treated for swine flu’, etc.

Google Trends data shows that the top five searches related to ‘swine flu’ were ‘swine flu symptoms’, ‘symptoms of swine flu’, ‘swine flu in hindi’, ‘swine flu symptoms hindi’, and ‘swine flu vaccine’.

The fastest rising search phrase for this period was ‘swine flu ke lakshan’, Hindi translation for ‘symptoms of swine flu’.

Interest in these search phrases is also concentrated in north and north-west India, with interest in Hindi search results through phrases like ‘swine flu in hindi’ and ‘swine flu ke lakshan’ concentrated in Rajasthan.
Source: Hindustan Times

Monday, 4 February 2019

Battling more than just a disease: on leprosy

The fight to end discrimination, stigma and prejudice against people afflicted with leprosy
rages on in India, which reported the highest number of new cases in the world in 2017.

Bindu Shajan Perappadan speaks to Vagavathali Narsappa, who was abandoned as a child
due to his medical condition, about the changing dialogue around leprosy
“Leprosy does not kill, but the social discrimination, isolation and disability associated with
the disease do not allow people to reach their potential, which is worse than death,” said
Vagavathali Narsappa, who works with the Association of People Affected by Leprosy
(APAL-India), a support group for leprosy patients.

The 55-year-old activist was abandoned by his parents at the age of nine when he was
diagnosed with the disease. Left to fend for himself on the streets, the disease quickly spread
to his fingers, which eventually had to be amputated.

“I met my wife at the leprosy hospital where we were both being treated. We have been
blessed with two girls... we now work for APAL to support people afflicted with leprosy,”
said Mr. Narsappa, who was recently in the Capital to participate in leprosy eradicationrelated

Timely treatment
One of the biggest challenges in the battle against leprosy is that one in every 10 new leprosy
patients is a child, he said, adding: “Unlike other diseases, leprosy does not have a
vaccination or a preventive pill... the fact that leprosy can cause childhood disabilities makes
awareness and timely treatment vital.”

Older patients are also vulnerable, with untreated ulcers often proving to be fatal. “The
government and various organisations working in this area are doing their bit but the stigma
attached to leprosy still remains... though people are more open to diagnosis and treatment
now,” said Mr. Narsappa.

While welcoming the passing of a Bill excluding leprosy as grounds for divorce, the activist
said that society’s mindset needs to change too.

“My dream and mission is to work towards zero disability, and for that to happen we need to
create awareness, remove misconceptions about leprosy, have early detection and voluntary
reporting. School curriculum should make children aware that early detection can prevent
disability. People afflicted with leprosy should be made partners in policy making,” said Mr.

Last-mile efforts in leprosy eradication will need enabling environments where people
afflicted by the disease feel comfortable in coming forward and seeking treatment, he said,
adding that till this happens eradicating leprosy “will remain a distant dream for India”.

World Leprosy Day
In India, World Leprosy Day is celebrated on January 30 to commemorate the death
anniversary of Mahatma Gandhi. The date was chosen by French humanitarian Raoul
Follereau as a tribute to the life of the Mahatma, who had compassion for people afflicted
with leprosy.

This year’s theme was ‘ending discrimination, stigma, and prejudice’.
Several reports have revealed that a majority of leprosy patients have experienced some form
of social stigma and discrimination and nearly 50% end up suffering from mental health
issues such as depression or anxiety.

Know the disease
Leprosy is a chronic infectious disease caused by Mycobacterium leprae
Leprosy is a major cause of physical disabilities. Timely detection and treatment of cases,
before nerve damage sets in, is the most effective way of preventing disabilities due to the

The year 2000 marked the elimination of leprosy as a public health problem at the global
level - a significant milestone in history. Elimination means the prevalence of less than one
case per 10,000 population, globally. The elimination target was also achieved by most of the
endemic countries at the national level by the end of 2005

Approximately 96% of leprosy cases are limited to 15 countries, which report more than
1,000 new cases annually

In the early 1980s, the World Health Organization introduced multidrug therapy (MDT),
which revolutionised treatment of leprosy

MDT offers multiple benefits: The infected person ceases to be infective after a single dose;
it is a complete treatment; and it reduces the risk of disabilities and consequent stigma.

Source: The Hindu

Thursday, 4 October 2018

Diabetes may increase cancer risk

Diabetes can increase the risk of developing a number of cancers, and may reduce the chances
of survival in cancer patients, a study has found.

Researchers from the Swedish National Diabetes Register (NDR) compared over 450,000
people with type 2 diabetes with more than 2 million matched controls over an average of 7

For the most common cancers, individuals with diabetes face a 20 per cent greater risk of
developing colorectal cancer and a five per cent higher risk of breast cancer compared with
their diabetes-free counterparts.

People with diabetes already diagnosed with cancer also fare worse, with a 25 per cent and 29
per cent higher chance of dying following a breast and prostate cancer diagnosis respectively
than their peers without diabetes.

More than 415 million people are living with diabetes worldwide — equivalent to 1 in 11 of
the adult population — and this figure is expected to rise to 642 million by 2040.
Previous research has suggested a link between type 2 diabetes and an increased risk of cancer.
However, the relationship between diabetes and cancer remains poorly understood due to
limitations of previous studies.

To provide more evidence, researchers examined the incidence of a number of cancers and
post-cancer mortality in 457,473 individuals with type 2 diabetes from the NDR between 1998
and 2014, compared to 2,287,365 controls from the general population over an average of 7
years follow up.

A total of 227,505 people developed cancer over the follow-up period. Diabetes was associated
with 11 out of the 12 specific types of cancer investigated in the study.

Scientists found that people with diabetes were 231 per cent more likely to be diagnosed with
liver cancer than those without a history of diabetes over the study period.

Diabetes was also clearly linked with higher risk of cancers of the liver, pancreas (119 per
cent), uterus (78 per cent), penis (56 per cent), kidney (45 per cent), gallbladder and bile ducts
(32 per cent), stomach (21 per cent), and bladder (20 per cent).

There was evidence that those with diabetes were at a reduced risk of prostate cancer (18 per
cent) compared to their peers without diabetes.

The absolute 5-year risk of developing cancer for the cancer sites highlighted in the study
ranged from 0.02 per cent for penis cancer to 1.45 per cent for prostate cancer for people with

In addition, for individuals with diabetes, mortality was higher for prostate (29 per cent higher),
breast (25 per cent), and colon (9 per cent) cancer compared to their diabetes-free counterparts.
The researchers emphasise that although the relative risk of cancer is increased after diabetes,
the absolute risk increase is low.

"Our findings do not suggest that everyone who has diabetes will go on to develop cancer in
later life," said Bjornsdottir, who led the study.

"With the number of people with type 2 diabetes doubling over the past 30 years our findings
underscore the importance of improving diabetes care," she said.

Source: The Tribune

Friday, 14 September 2018

New law is the most progressive globally’

The Mental Health Care Act enshrines equality for mentally ill people with those who have
physical health problems in all matters related to health care.

India’s Mental Health Care Act is one of the most progressive legislations on mental health
globally, and should be read as a bill of rights for people with mental disorders. Fundamentally,
the Act enshrines equality for mentally ill people with those who have physical health problems
in all matters related to health care. Conceptually, it transforms the focus of mental health
legislations from supposedly protecting society and families by relegating people with mental
disorders to second-class citizens, to emphasising the provision of affordable care, aligned with
the preferences and needs of the affected person, financed by the government, through the
primary care system.

Involuntary treatment and confinement in mental hospitals, which have historically been
associated with profound depravity and abuse of human rights and which have been robustly
contested by the Convention for the Rights of Persons with Disabilities, has been greatly reined
in with stringent procedures to ensure that these are restricted to the rarest of circumstances
with systemic supports to enable the right of the person to make his/ her own decision.
However, it is hard to imagine these visionary ideals finding their way into the grim realities
of the lived experiences of the tens of millions of Indians living with a mental disorder and the
countless more of their familymembers and friends who are also affected. The National Mental
Health Survey of India (2016), the largest exercise to count the numbers of people affected by
mental disorders, reported that one of every ten adults experiences a clinically significant
condition. Nearly 90% of these people have received no care at all in the past year.

The recent observation that some of the victims of the horrific series of lynchings in our country
were people with mental disorders is a tragic reminder of their vulnerability. Indeed, no other
health condition in this country has such astonishing levels of unmet needs for care. Scarcity
is the mother of invention, and this is so true of health care innovations in India, a country
where the majority of people get too little of the care that they desperately need, while a few
get as much care, never mind if it is actually needed, that they can pay for. And the care that
many receive, whether too little or too much, is often not aligned with scientific evidence. In
the case of mental disorders, for example, only a tiny fraction of the population will have access
to brief psychosocial interventions, one of the most effective classes of treatments in medicine.
As with so many other formidable challenges facing our people, the community has been at the
heart of innovative solutions. A variety of community actions have illustrated paths to mental
health care which is affordable, evidencebased, empowering and equitable. Prominent amongst
these are the use of community based workers to deliver mental health care.

The community health worker, including cadre such as the ASHA worker and the Auxiliary
Nurse Midwife, are the foundation of our public health care system. Indeed, they have played
a central role in the success of our public health programmes which substantially reduced
maternal and child mortality. Even as they are slowly, but surely, winning these age-old battles,
they present a unique human resource to be deployed to helping people with mental disorders
to recovery.

Over the past decade, some national health care programmes (such as for adolescent health)
and NGOs have begun to task community-based workers to provide low intensity psychosocial
interventions. Sangath, an NGO I co-founded in Goa in 1996, has pioneered the design of an
entire suite of psycho social interventions for delivery by persons from the local community
with no prior professional training in mental health. These interventions have targeted a range
of conditions, from autism in childhood, emotional and behavioural problems in adolescents,
depression, drinking problems and psychosis in adults, to dementia in older people. Through
rigorous public health trials, we have demonstrated, time and again, that such interventions are
not only effective but, importantly, highly desired by people who are affected by these
disorders. There is no longer any doubt about whether community health workers can be trained
and supervised to deliver clinically effective psychosocial interventions. The challenge before
us now is how to go beyond pilots and research studies and scale these innovations up in routine
health care.

Sangath is currently embarking on a series of projects seeking to achieve these goals, by
embedding its proven interventions for delivery through existing community health workers
and counsellors of the public system, in partnership with state governments. In New Delhi, we
will train ASHA workers to deliver parent-mediated interventions for children with autism. In
Madhya Pradesh, we will design digital interventions to train and support ASHA workers to
deliver brief psychological therapies for depression. In Goa, we will train primary care based
counsellors and community based workers to reduce the burden of depression in the population.
Each of these models for scaling up could offer opportunities for wider adoption across the

No NGO can ever match the mandate, reach and resources of the state for taking health care to
India’s vast and diverse population. For this to happen, we will need a structural rethink in how
we plan and implement mental health care. The doctor and hospital-centric approach which
dominates must be balanced with a robust investment in community based care, as was done
with such great results for maternal and child health.

The recent decision to rebrand the primary health care sub-centre as a Health and Wellness
centre, with a mid-level provider trained in community health, offers a major new opportunity.
Coordination between mental health professionals, primary care providers and community
workers is essential to address the longterm nature of many mental disorders and the need for
integrating clinical and social care. Only then will the creativity and science, which harnesses
civil society’s talent and instinct to care, be able to play its rightful role in realising the vision
of the National Mental Health Care Act.

The author is the Pershing Square Professor of Global Health at Harvard Medical School and
is affiliated with the Public Health Foundation of India and Sangath.

Source: Hindustan Times

Tuesday, 21 August 2018

WHO highlights ways to reduce cancer risk?

Tobacco and alcohol consumption, unhealthy diet, and physical inactivity are some major

With cancer emerging as the second leading cause of death globally, the World Health
Organisation (WHO) has listed ways to reduce cancer risk.

It advised not to consume any form of tobacco, to make one’s home smoke-free, to enjoy a
healthy diet, to vaccinate children against Hepatitis B and HPV, to use sun protections, to be
physically active, to limit alcohol intake and take part in organised screening programmes,
adding that breastfeeding reduces a mother’s cancer risk.

TheWHO said consumption of tobacco and alcohol, unhealthy diet, and physical inactivity are
major factors that increases cancer risk worldwide and are also the four shared risk factors for
other non-communicable diseases.

“Some chronic infections are risk factors for cancer and have major relevance in low and
middle-income countries. Approximately 15% of cancers diagnosed in 2012 were attributed to
carcinogenic infections, including Helicobacter pylori, Human papillomavirus (HPV),
Hepatitis B virus, Hepatitis C virus, and Epstein-Barr virus. Hepatitis B and C viruses and some
types of HPV increase the risk for liver and cervical cancer, respectively. Infection with HIV
substantially increases the risk of cancers such as cervical cancer,” the WHO said.

Dr. Pawan Gupta, additional director, Surgical Oncology, Jaypee Hospital, Noida said: “Cancer
is the uncontrolled multiplication of cells. Cancer can spread from where it started to another
part of the body. The original cancer is called the primary tumour. The cancer in another part
of the body is called metastatic or secondary cancer. Metastatic cancer has the same type of
cancer cells as the primary cancer. The term metastatic cancer is usually used to describe solid
tumours that have spread to another part of the body.”

Doctors have warned that prevalence of cancer cases are on the rise in India. The Indian
Council of Medical Research stated that approximately 12 to 13 lakh new cases of cancer are
being diagnosed every year along with an existing 25 to 30 lakh cancer cases at any given time
in India.

“The saddest part is that a vast majority of them are being diagnosed in advanced stages. On
the contrary, majority of cancer cases are diagnosed in the early stages in developed countries,
including Europe and the U.S.A., thanks to their effective screening programmes. Awareness
in general population about the big ‘C’ also helps in early cancer diagnosis,” added Dr. Pawan.

Source: The Hindu