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An optimum evidence base is necessary for the effective control of HIV/AIDS in India, as the lack of an adequate evidence base on critical issues leads to controversy and hurdles. To assess the trends in the HIV/AIDS evidence base for India, a PubMed literature search for publications from India in 2002 and 2003 on HIV/AIDS was done, and abstracts from India in one major international HIV/AIDS conference in 2002, and presentations at one major HIV/AIDS conference in India in 2003 were reviewed. The PubMed search revealed 145 papers with abstracts on HIV/AIDS from India during this period, which was 1.4% of the worldwide HIV/AIDS publications. Of these 145 publications, 124 (85.5%) were based on original research and, of these, 27.4% were in the basic sciences, 62.9% in the clinical sciences, and 9.7% in the public health sciences; 53.2% of the original research papers were published in journals with impact factors ranging from 0 to 1. Many vital issues for HIV control, such as validation of the methods used to assess HIV burden in the population, large-scale impact assessment of HIV prevention programmes, cost-effectiveness of HIV interventions, and critical evidence-to-policy issues, were not covered. Of the 8824 abstracts accepted for presentation at the XIV International AIDS Conference 2002 at Barcelona, 8% were from India--a fair representation given that India has about 10% of the world's HIV burden. However, the utility of this information is severely limited with the majority of it not getting translated into detailed papers in the peer-reviewed literature for widespread scrutiny and use. The views expressed by many experts at the Fourth International Conference on AIDS India 2003 at Chennai were impressive, but the presentation and discussion on original research data from India were sparse. From these various sources, it is estimated that the available evidence base for HIV/AIDS control in India is suboptimal. Using certain assumptions, it is estimated that to provide an adequate evidence base for the control of HIV/AIDS in India, quality original HIV/AIDS research in India would have to double in the basic and clinical sciences, and increase by more than 5 times for the public health sciences. Enhancingthis evidence base to an optimum level would require optimizing its demand, systematically planning its supply locally in India and creating an environment suitable for its development. To effectively control HIV/AIDS in India, strategic planning is needed to develop an evidence base that covers all critical areas where information is needed. Formation of a Society for HIV/AIDS Research in India by involving all the major stakeholders could help build up momentum towards establishing a comprehensive, relevant, dynamic and long-term evidence base that provides rigorous and timely information needed for HIV/AIDS control.
Rotaviruses cause an estimated 140 million cases of gastroenteritis and 800,000 deaths in children between the ages of 6 months to 2 yr in developing countries. In India, one of every 250 children or about 100-150,000 children die of rotavirus diarrhoea each year. The prevalence of rotavirus diarrhoea in India has been found to vary from 5-71 per cent in hospitalized children <5 yr of age with acute gastroenteritis. The seasonal variation of rotavirus diarrhoea in India varies in different geographical regions with high incidence in winter months at low relative humidity in north India. The distinctive features of rotavirus infection in India include the occurrence of severe disease at an early age and common neonatal rotavirus infections which are often asymptomatic. Rotavirus shows genetic and antigenic diversity in terms of subgroup, electropherotypes and G and P serotypes/genotypes. There are a few studies in terms of prevalence of different antigenic and genetic variants from various regions of India. In most studies on subgroup distribution from India a higher prevalence of subgroup II was reported compared to subgroup I. Electropherotyping has also demonstrated that a number of multiple electropherotypes co-circulate at one time in a particular community leading to extensive genomic variation and the appearance of new strains which may become the predominant electropherotype during the peak season. The most common G types reported from India are G1 and G2 and P types are P[4] and P[8]. A significant number of children also have mixed rotavirus infections. G9 strains are also quite commonly seen in Indian children. In addition P6 strains of probable bovine origin have been reported from India. A novel neonatal strain P type 11 human rotavirus (116 E) was isolated from neonates in Delhi, the VP4 of which was closely related to the bovine serotype G10P[11] strain B223 and VP7 was closely related to the human serotype G9 strain. Another neonatal strain G10P[11] was reported from Bangalore. G10P[11] strains also have a high prevalence in calves with diarrhoea, in India. The occurrence of these unusual rotavirus strains which are natural reassortants of human and bovine rotaviruses, suggests that reassortment may be an important mechanism for generation of rotavirus strains of newborns. This is catalyzed by the age old traditions of calves and humans living in the same household and socio-economic conditions in India. The diversity of rotavirus strains and the high prevalence of mixed infections in India are unique features of rotavirus epidemiology in India and emphasizes that vaccines should be formulated against a broad range of strains. Another important aspect is that vaccines in India should also target G9 strains. Since neonates acquiring rotavirus infection are protected against severe diarrhoea, neonatal rotavirus strains can be effective potential vaccine candidates and vaccines based on these neonatal strains are being indigenously developed in India.
Viral hepatitis is a major public health problem in India, which is hyperendemic for HAV and HEV. Seroprevalence studies reveal that 90%-100% of the population acquires anti-HAV antibody and becomes immune by adolescence. Many epidemics of HEV have been reported from India. HAV related liver disease is uncommon in India and occurs mainly in children. HEV is also the major cause of sporadic adult acute viral hepatitis and ALF. Pregnant women and patients with CLD constitute the high risk groups to contract HEV infection, and HEV-induced mortality among them is substantial, which underlines the need for preventive measures for such groups. Children with HAV and HEV coinfection are prone to develop ALF. India has intermediate HBV endemicity, with a carrier frequency of 2%-4%. HBV is the major cause of CLD and HCC. Chronic HBV infection in India is acquired in childhood, presumably before 5 years of age, through horizontal transmission. Vertical transmission of HBV in India is considered to be infrequent. Inclusion of HBV vaccination in the expanded programme of immunization is essential to reduce the HBV carrier frequency and disease burden. HBV genotypes A and D are prevalent in India, which are similar to the HBV genotypes in the West. HCV infection in India has a population prevalence of around 1%, and occurs predominantly through transfusion and the use of unsterile glass syringes. HCV genotypes 3 and 2 are prevalent in 60%-80% of the population and they respond well to a combination of interferon and ribavirin. About 10%-15% of CLD and HCC are associated with HCV infection in India. HCV infection is also a major cause of post-transfusion hepatitis. HDV infection is infrequent in India and is present about 5%-10% of patients with HBV-related liver disease. HCC appears to be less common in India than would be expected from the prevalence rates of HBV and HCV. The high disease burden of viral hepatitis and related CLD in India, calls for the setting up of a hepatitis registry and formulation of government-supported prevention and control strategies.
Hemoglobinopathies are important inherited disorders with considerable high prevalence in Asia. Hemoglobin Q-India is a hemoglobinopathy that was first identified in India. Hb Q-India is caused by the mutation GAC --> CAC at codon 64 of the alpha-1 globin gene. The correlation between this hemoglobinopathy and thalassemia was reported. Although primary structure of disorder Hb Q-India is well documented, the secondary and tertiary structures, which can help explain the pathogenesis of the Hb Q-India disorder is not known. In this study, amino acid sequence of human alpha globin was searched using ExPASY and used for further mutation to Hb Q-India disorder. The derived sequences, alpha globin chains in both normal and Hb Q-India disorder, were used for further investigation for secondary and tertiary structures. Modeling of these proteins for secondary and tertiary structures was done using the NNPREDICT server and CPHmodels 2.0 Server, respectively. In this study, the secondary and tertiary structures of human alpha globin chains of normal and hemoglobin Q-India disorder are calculated and presented. Based on this information, the main difference between the predicted alpha globin secondary structures of normal and Hb Q-India is an extra helix in the Hb Q-India. The predicted tertiary structure also supports this finding. The results from this study can be good data for further study on Hb Q-India disorder, which can bring to the further understanding on this hemoglobinopathy.
BACKGROUND: Systematic assessment of recent health research output from India, and its relation with the estimated disease burden, is not available. This information would help understand the areas in health research that need improvement in India to enhance the health of India's population. METHODS: The health research output from India during 2002, which was accessible in the public domain, was assessed by searching PubMed and other internet health literature databases, and was related to the disease burden suggested by the Global Burden of Disease Study. The main outcome measures were number of health papers with abstracts in basic, clinical and public health sciences; quality-adjusted research output based on the impact factors of journals in which the papers were published; classification of papers in disease/condition categories and comparison of research output with the estimated disease burden in each category. Comparison of the health papers from India during 2002 included in PubMed was done with those from Australia during one quarter of 2002. RESULTS: Of the 4876 health papers from India in 2002 in PubMed, 48.4%, 47.1% and 4.4% were in basic, clinical and public health sciences, respectively. Of the 4495 papers based on original research, only 3.3% were in public health. Quality-adjusted original research output was highest for non-communicable diseases (62% of total). Of the total quality-adjusted original research output, the proportions in injuries (0.7%), cardiovascular diseases (3.6%), respiratory infections (0.2%), diarrhoeal diseases (1.9%), perinatal conditions (0.4%), childhood cluster diseases (0.5%), unipolar major depression (0%), and HIV/AIDS (1.5%) were substantially lower than their proportional contribution to the disease burden in India. Human resources, health policy, health economics, and impact assessment of interventions were particularly poorly represented in public health research. The Australia-India ratio for quality-adjusted health research output per unit gross domestic product was 20 and for public health research output was 31. CONCLUSIONS: Good-quality public health research output from India is grossly inadequate, and strategic planning to improve it is necessary if substantial enhancement of population health were to be made possible. There is inordinately low relative research output in several diseases/conditions that cause major disease burden in India.
BACKGROUND: To eliminate avoidable blindness in India, appropriate national planning is necessary, which should be based on current and reliable data. A national survey done in 1986-89 reported that 1.5% of the Indian population (12 million people) was blind with a presenting visual acuity of < 6/60 in the better eye. The original goal of the National Programme for Control of Blindness was to reduce this prevalence to 0.3% by 2000. We have recently reported the prevalence of blindness in the population of Andhra Pradesh to be 1.66% with a presenting visual acuity of < 6/60 in the better eye as the sole criterion and 1.84% with a presenting visual acuity of < 6/60 orcentral visual field < 20 degrees in the better eye. We used these population-based data to estimate blindness in India in 2000 and project the possible scenarios of blindness through 2020 with different emphases of the blindness control policy in India. METHODS: Recent population-based data on the age-, sex- and cause-specific blindness rates from the Andhra Pradesh Eye Disease Study for the entire age range were applied to the population distribution of India to estimate the number of blind persons in 2000. The age-, sex- and cause-specific rates of blindness were then applied to the estimated age, sex and urban-rural population distribution of India in 2010 and 2020 to project the number of persons blind (from various causes) and the blind person-years that would be suffered under varying degrees of emphasis in the policy to control blindness due to particular diseases. For these projections, blindness was defined as a presenting distance visual acuity of < 6/60 or central visual field < 200 in the better eye. RESULTS: The number of blind persons in India in 2000 was estimated to be 18.7 million (95% confidence interval [CI]: 15.2-22.3), of which 9.5 million were cataract-related and 3 million refractive error-related. If there is no change in the current trend of blindness, the number of blind persons in India would increase to 24.1 million (95% CI: 19.7-28.4) in 2010, and to 31.6 million (95% Cl: 26.4-36.9) in 2020. If effective strategies are put in place to eliminate 95% of blindness due to cataract by 2020, blindness in 15.6 million persons would be prevented who would otherwise be blind in 2020 if the current trend continues, and 78 million blind person-years would be prevented in these persons. Similarly, if effective strategies are also implemented to eliminate 95% of the refractive error blindness by 2020, another 4.2 million persons would be prevented from being blind in 2020, and 82 million blind person-years would be prevented. In addition, if strategies to prevent 90% of the preventable blindness due to corneal disease and glaucoma are successful by 2020, blindness in an additional 3.6 million persons in 2020 and 29 million blind person-years would be prevented. CONCLUSION: The planning of blindness control in India should take into account recent population-based data for the entire age range, which suggest that the number of blind persons in India is currently over 18 million. This estimate is 50% more than the figure of 12 million from a decade ago that is still quoted widely in the blindness control policy documents. If avoidable blindness is to be substantially reduced in India by 2020, effective strategies against blindness due to cataract and refractive error are needed urgently as both these conditions are relatively easy to treat. Also, strategies against preventable corneal and glaucoma blindness need to be strengthened soon for them to show an impact over the next two decades.
It is now widely accepted that (i) modern humans, Homo sapiens sapiens, evolved in Africa, (ii) migrated out of Africa and replaced archaic humans in other parts of the world, and (iii) one of the first waves of out-of-Africa migration came into India. India, therefore, served as a major corridor for dispersal of modern humans. By studying variation at DNA level in contemporary human populations of India, we have provided evidence that mitochondrial DNA haplotypes based on RFLPs are strikingly similar across ethnic groups of India, consistent with the hypothesis that a small number of females entered India during the initial process of the peopling of India. We have also provided evidence that there may have been dispersal of humans from India to southeast Asia. In conjunction with haplotype data, nucleotide sequence data of a hypervariable segment (HVS-1) of the mitochondrial genome indicate that the ancestors of the present austro-asiatic tribal populations may have been the most ancient inhabitants of India. Based on Y-chromosomal RFLP and STRP data, we have also been able to trace footprints of human movements from west and central Asia into India.
PURPOSE: To assess what impact attention to quality of cataract surgery and postoperative follow up can have on cataract blindness in India, and to estimate the number of surgeries needed to eliminate cataract blindness in India. METHODS: In a population-based sample of 5268 persons in two rural areas in the state of Andhra Pradesh, India, data on the visual outcome of cataract surgery were obtained on 129 eyes of 106 persons operated previously. These were compared with the visual outcome of cataract surgery performed during 1999 in 2394 eyes of 2213 persons at two new rural eye centres set up in these areas that pay particular attention to the quality of eye care. Blindness in an eye was defined as presenting distance visual acuity less than 6/60, and in a person as this acuity level in the better eye. These data were extrapolated to India. RESULTS: In the population-based sample, of the 129 operated eyes, 51 (39.5%) were blind after surgery, which included 41 (31.8%) from cataract surgery-related causes. Of the 106 persons in the population sample who had had cataract surgery in one or both eyes, 26 (24.5%) were still blind. In contrast, for the cataract surgery at the two rural eye centres paying attention to quality, 3.1% of the eyes and 1.8% of the persons were blind soon after surgery, but these figures could increase 2.6 times over the lifetime of these persons. The 3.5 million cataract surgeries in India in 2000 are estimated to result in 0.32 million persons having blindness averted over their lifetime. To eliminate cataract blindness in India, an estimated 9 million good-quality cataract surgeries are needed every year during 2001-2005, increasing to over 14 million surgeries needed every year during 2016-2020 on persons most likely to go blind from cataract. CONCLUSIONS: The number of persons in whom blindness is being averted due to cataract surgery in India is currently a very small fraction of the number blind from cataract. If adequate attention is given to the quality of eye care, for the current number of cataract surgeries in India it should be possible to increase by threefold the number in whom blindness can be averted with cataract surgery. In addition to improving quality, the annual number of cataract surgeries has to be at least threefold the current number during 2006-2010 if cataract blindness in India is to be eliminated.
Since the first case of the human immunodeficiency virus (HIV) infection was documented in India in 1986, there has been an explosive increase in HIV transmission. In this review we describe the chronology of the HIV epidemic in India, preliminary information about the clinical presentation of the acquired immunodeficiency syndrome (AIDS), the biological and behavioral aspects of HIV transmission in the Indian setting, and projections regarding the future of the HIV epidemic in India. Using recent data obtained by searching the computerized literature and published abstracts, conference proceedings, and publications from the government of India, we show that India is experiencing a major epidemic of HIV transmission in high-risk populations of commercial sex workers, sexually transmitted disease clinic patients, intravenous drug users, and commercial blood donors. There is also evidence of recent spread of the epidemic from these high-risk groups to other risk groups in India, and from urban centers to rural populations. It is estimated that 1.6 million people are currently infected with HIV in India. At the present rate of transmission, India will have the largest number of HIV-infected individuals of any country in the world by the end of this decade, with more than 5 million infected individuals. Because limited data are available, comprehensive and well-designed epidemiologic surveys are urgently needed to adequately characterize the HIV epidemic in India and to help implement targeted and effective educational and prevention-oriented programs.