Healthcare and public health: Delhi
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2014> 2017: decline in donations
Banks Run By Delhi Govt And Corporations Also Didn’t Run Crucial HIV And Hepatitis Tests
Blood donated voluntarily in Delhi went down from 55% of total collection to 45% between 2014 and 2017. This was determined by CAG in an audit of 68 blood banks in the capital for the period up to March 2017. Most blood banks, the audit showed, rely on replacement blood — blood given by a patient’s relative or friend in lieu of blood used from the hospital stock — which carries a relatively higher risk of infection.
Lok Nayak Hospital’s blood bank, for example, collected 56,245 units of blood in 2014-17. Of this, only 6% came from voluntary donors against the target of 90% set by the National Aids Control Organisation. The hospital told CAG last June that after the scrapping of the blood bank van a year and a half ago, blood donation camps could not be organised.
Deen Dayal Upadhyay Hospital, which managed 55% collection through voluntary donors, claimed the shortfall was due to lack of education and awareness and religious or health issues among the public. Guru Tegh Bahadur Hospital, which recorded the highest of 72%, said it couldn’t meet the target of 90% due to shortage of manpower, equipment, counsellors and social workers.
The audit report, however, pointed out that irrespective of the blood collected, none of the blood banks run by the state government or municipal corporations had run the Nucleic Acid Amplification Test (NAT) capable of detecting anomalies such as HIV and Hepatitis B and C in the "least window period". They relied instead on Elisa III test, which cannot detect infections transmitted in the immediate past, say a week or a month before donation. “Patients often arrange for professional donors. Such donors tend to conceal medical history, and if the screening system isn’t foolproof, infections can be transmitted,” said a doctor, who asserted NAT is a must.
CAG reported that Delhi government decided in November 2009 to introduce NAT screening, initially by outsourcing tests to four major blood banks and attaching the smaller blood banks to this quartet, but the plan was not adequately followed up. “None of blood banks under Delhi government and MCD hospitals have NAT screening facility as of March 2017 whereas five out of nine blood banks under government of India and 17 out of 39 private blood banks were using NAT for screening blood,” the CAG report said.
In 2014-17, the five blood banks at Lok Nayak, GTB, DDU, Sanjay Gandhi Memorial and Swami Dayanand hospitals prepared 4.47 lakh units of blood and its components of which 15% was discarded for reasons from expiry of shelf life to lack of storage facility and clotting. The audit observed that the hospitals did not establish quantitative norms for holding the blood and blood components allowing the transfer of excess blood and components to other blood banks to minimise wastage.
All blood banks in Delhi enrolled for the blood locator app launched by the National Blood Transfusion Council in June 2015, but the CAG audit showed that 32 had not updated any information, thus defeating the purpose of providing real-time information to the end user. Doctors say that many patients die due to lack of timely blood transfusion and the government needed to standardise the system to ensure such discrepancies do not hamper the supply of the life-saving product.
Breast cancer on rise, exercise can cut risk
Durgesh Nandan Jha TNN
The Times of India 2013/08/14
New Delhi: Breast cancer continues to keep its grip on the capital with more city women falling prey to the disease every passing year. Indian Council of Medical Research’s latest data shows an increase of 0.6 percent over the worrisome figure of 26.5 percent recorded previously.
Dr P K Julka, who heads the Delhi Cancer Registry, said the trend reflects how awareness is still missing on prevention and management of the disease. “Obesity is a major cause for breast cancer in post-menopausal women. It leads to excessive production of female hormones,” he said. Julka added that healthy diet and regular exercise can go a long way in preventing incidence of breast cancer.
According to the latest data collected from 168 major government hospitals, 250 private hospitals and municipal bodies, Delhi recorded 15,244 cancer cases in 2009. Among them, 8,122 (53.3%) were men and 7,122 (46.7%) were women. “In both men and women, the number of new cancers was more in the middle age group (35-64 years). In children, cancer cases were more in boys (5.7%) compared to girls (3.2%),” added Julka, professor of radiation oncology at AIIMS. He said that cervical cancer cases have, however, gone down significantly as part of a general trend “owing to awareness, better genital hygiene and HPV vaccination”.
As far as tobacco-related cancers are concerned, incidence is high among men. Two in every five cases of cancer among men in Delhi is due to tobacco. Mortality rate was recorded at 10.6 per 1,00,000 men and 9.4 per 1,00,000 women. “Most cancer patients diagnosed in initial stages can be saved. But due to lack of awareness and regular health screening practices, patients come to us late,” Dr G K Rath, chief of BRA Institute Rotary Cancer Hospital, said.
Deliveries: institutional, non-institutional births
2001-19; 2020- Feb 21
Surge in births at home in city due to Covid
The latest birth registration data of municipal bodies has revealed that in the past few months, the consistent trend of institutional deliveries going up – less than 10% non-institutional births were registered in 2019 – got reversed because of Covid, reports Paras Singh. As against a progressive rise in institutional deliveries over the past two decades, 35% to 42.5% births at home have been recorded in areas under three municipal corporations in the past few months.
Why surge in births at home is a worry
The new corporation portal on birth and death certificates automatically divides the birth certificates into categories of home and hospital/institutional deliveries, and experts have been surprised by what that has shown. During the past one week in south Delhi, 3,658 births have been registered by the south corporation, of which over 42% (1565 cases) were deliveries at home. Similarly, during the past two months, 23,780 births have been registered in the four zones of the south corporation, out of which 8,258 cases were of home births – around 35% women gave birth at home while 56% opted for institutional deliveries. Across the six administrative zones of the north corporation, the home delivery rate in the month of February has been even higher at 42.5% with 4,763 out of 11,202 cases being non-institutional deliveries.
A senior official from a mother and child welfare centre run by the corporations said that the increase in non-institutional deliveries is cause for worry since the increase in institutional births was the key factor behind overall reduction in maternal and newborn mortality rates. According to Delhi’s annual birth and death vital statistics reports, the percentage of institutional births in 2001 was 62.11%, which rose to 73.72% in 2005; 78.51% in 2010; and 84.41% in 2015. The hospital/institutional deliveries constituted 89.1% births in 2017 and 91.15% in 2019.
Delhi-specific studies on home deliveries state that fear of surgical procedures, unfamiliarity with hospital surroundings, financial reasons and loss of wages have traditionally been some of the reasons that drove women to choose home deliveries.
Dr Suneeta Mittal, former head of gynaecology department at AIIMS, said that the financial reasons have been tackled through various government schemes. “The Covid pandemic and its after-effects may be the main reason behind this rise in home delivery cases as there was a sudden 20% decline in institutional deliveries when the lockdown was imposed. The hospitals were tackling rising corona cases while people too were scared to come to the hospitals. There has also been a drop in outstation patients due to restrictions on movement,” she added.
A senior municipal doctor said that they too had to create dedicated teams, which visited the homes in case of complicated deliveries during the lockdown and later part of the pandemic.
Dengue and Delhi
Durgesh Nandan Jha TNN
Dengue cloud over capital
The Times of India 2013/08/13
Dengue fever is the viral disease which is caused by the bite of the Aedes aegypt i mosquito. The total number of dengue cases reported in Jan-August 2013 at 41 is more than the count reported in corresponding figures for the previous two years. Delhi reported only 10 dengue cases in 2012, but in 2011, 38 cases were reported till August 10.
The data received also shows that a majority of patients diagnosed with dengue are below 40 years of age.
“The incidence of mosquito breeding has increased alarmingly in the last two weeks due to continuous rains and stagnation of fresh water,” said a senior municipal corporation official. He said 53 cases of malaria and four cases of chikungunya have been reported so far this year. Dr N K Yadav, the municipal health officer, added dengue breeding checkers are visiting all households to make residents aware of best practices.
“The symptoms are common for all viral illnesses. But dengue is characterized by high fever, pain in the eyes, rashes, nausea and vomiting. In some cases, there could be severe drop in platelet count and bleeding from the nose or gums which is reflective of the severity of the case,” said Dr Romel Tickoo, senior consultant internal medicine at Max Hospital, Saket. He said that certain painkillers are known to cause sudden decrease in platelet count and so they must be avoided.
Incidence of dengue: 2010-mid 15
The Times of India, Sep 01 2015
After 5 yrs, dengue cases cross 800 mark
Corporation officials have said the total number of cases has crossed 830 till August 2015, the highest for the period 2010-15. In all, 937 cases were re ported till August 2010.
Among those affected are a Palestinian diplomat and his two sons. Sources said Abd Elrazeg Abu Jazer, first secretary in Palestine embassy, was admitted to a private hospital in Chanakyapuri on August 26 while his two sons, Ashraf (23) and Amzad (16), were hospitalized on August 28.
Salvatore Girone, one of the two Italian marines facing murder charges, is also reported to be down with dengue. “The Italian defence ministry has sent two military doctors to India to monitor their health,“ a source said.
This year, two dengue deaths have been officially reported in Delhi. According to South Delhi Municipal Corporation, which compiles the report for all civic bodies, the victims, both from north Delhi, are three-year-old Shivam from Inderpuri and 37-yearold Mamta Rani from Narela.The death of a 10-year-old girl in the first week of August has been designated as a suspected dengue case.
“The dengue situation in Delhi is bad. The emergency and the medicine department are flooded with dengue patients. Many people are also seeking admission in panic against the doctor's advice,“ said a senior doctor at Safdarjung Hospital.
North Delhi has the highest case count at 352. South Delhi has 220 cases while east Delhi has posted the lowest count at 73 cases. A total of 115 cases have been reported from areas outside the corporation areas while 30 cases have come from UP and eight from Haryana.
Number of cases of dengue in Delhi, year-wise, 2015-19
2015- mid- 2019
Dengue under check, experts advise caution New Delhi: Longer spell of rains and timely action from the authorities concerned have kept the vector-borne diseases under check this year. Compared to previous years, the capital has reported significantly lower number of malaria, dengue and chikungunya cases as on August 24, 2019. Scientists, however, warn against complacency because the peak season for mosquito-borne diseases is about to start.
“This year, the number of cases of mosquito-borne diseases has been lower than usual due to multiple factors. Firstly, the rainy season has been longer, which has limited the scope of mosquitoes breeding outdoors. Frequent outbreaks of dengue and chikungunya have also made a large section of population immune to the strain of the virus in circulation. And most importantly, the civic bodies, the state government and the centre have displayed competitive approach towards creating more awareness about measures to prevent the spread of these diseases among the public,” said a senior scientist from National Institute of Malaria Research (NIMR). As per the municipal data, the city has reported 75 dengue cases as on August 24 this year. During the corresponding period, 78 cases of dengue were reported in 2018, 435 in 2017, 311 in 2016 and 530 cases were reported in 2015. The incidence of malaria and chikungunya has also been significantly lower with 131 and 21 cases reported, respectively, as on August 24 this year.
Scientists say that chances of dengue or chikungunya rising to epidemic proportions is significantly lower this year. “Mosquito breeding usually picks up once the rain stops. We are going to witness increase in breeding over the next few weeks, and that may lead to increase in the number of patients. However, given the preparations and awareness level among public this year, I am confident that the number will remain lesser than before,” said a health officer.
Beginning September1, the Delhi government has started a campaign wherein people are being urged to spend 10 minutes at 10 am every Sunday to check their houses for any breeding ground of mosquitoes. Kejriwal will launch the campaign by checking his own house for 10 minutes at 10 am on Sunday. The campaign will continue for 10 weeks.
Appealing to the Delhi residents to join the campaign, Kejriwal said: “Every Sunday, we should ensure that flower pots, air coolers and other places are free of stagnant water”. “Mosquitoes that spread dengue can’t fly beyond 200 metres. So, if we keep our premises clean, chances of us getting affected by the deadly diseases become less,” he added.
The union health ministry had also launched a similar campaign to sensitise and mobilise people on measures for prevention and control of vector-borne diseases in July. The ministry constituted 286 ward-wise teams with 20-25 members in each team to visit residential areas, schools, hospitals and markets, and sensitise people on prevention and control of such diseases. The teams included officers of the municipal corporations, along with the officers from the central and the state governments.
Hospitals: Government vs private
The Times of India, Jul 09 2015
On an average, a hospital admission would be more than three times as costly in a private hospital than in a gov ernment facility.
In some cases, like eye diseases, private hospitals can cost up to 6.5 times more than government ones, and for an obstetrics or neonatal case, seven times. Childbirth costs eight-and-a-half times more in private hospitals. These findings are part of a latest National Sample Survey Organization survey report.
“People go to private hospitals as government ones are few and under so much pressure,“ says Amit Sengupta of People's Health Movement. In rural areas, about 58% of all hospitaliza tion cases go to private facilities. This is up from about 56% in 1995-96. In urban areas, 68% cases go to private hospitals, up from 57% twenty years ago, the report says.
About 86% of the rural and 82% of urban population isn't covered by any health expenditure support, whether government funded or private insurance covered. This means that high hospitalization costs would substantially affect a family's budget in a majority of cases as incomes are not very high.
The report found that the main source of meeting hospitalization expenses was savings from income. In rural areas, a quarter of households borrowed money to meet hospital-related expenditure. The source of borrowing was not found out. In urban areas too, over 18% people had to borrow to meet hospitalization costs.
The healthcare sector all over the world suffers from an “information asymmetry“, Sengupta says. This means that patients have practically no information or competence to know about costs or make a choice about treatment. Doctors and hospitals have all the information and competence. This invariably leads to inefficiencies, escalated costs and even malpractice, he says.
The Times of India, Jul 09 2015
Durgesh Nandan Jha
Shortage of beds for children at the city's government-run hospitals proved tragic when a newborn denied admission at Kalawati Saran and Ram Manohar Lohia (RML) hospitals died. While government hospitals turn away dozens of children due to unavailability of beds or equipment every day , even those who get admitted are at risk of hospital-acquired infections and poor sanitation in the crowded wards. When this reporter visited the paediatric emergency unit at RML Hospital on Wednesday , it was swarming with people. Families were eating lunch on patients' beds. “The attendants do not have clean water to drink.They stay in inhuman conditions for their children,“ said an attendant.
At Kalawati Saran Hospital, one of Asia's biggest health facilities for children, doctors said they always have 5-6 patients for every four beds. During monsoon, when infections are more common, the ratio goes up to two patients to a bed.
“The paediatric emergency and ICU at our hospital has more than 20 beds. But there are less than five ventilators.MRI and echocardiogram tests are not available. Those who can pay are asked to get these tests done outside, the others are sent to G B Pant and RML hospitals,“ said a senior doctor.
The hospital also faces acute shortage of nurses. The rule is to have two nurses for each newborn but at Kalawati and most other public hospitals there's just one for 10 patients.
“Most of the caring of a newborn is done by attendants,“ said Suman Singh, whose son was being treated at RML Hospital. In some cases, attendants are even asked to manage handheld resuscitation devices like ambu-bags. Any technical error--overuse, discontinuity or improper mask seal--can cause a fall in oxygen levels and respiratory failure.
RML has a nursery for children born there and a paediatric emergency block for newborns and infants admitted with different medical conditions from outside.“When the child who died was brought to the hospital, there was no bed available in the newborn ICU (NICU). We could not admit it in the general ward because it does not have ventilator facility or warmers, which are needed to regulate temperature.Newborns can die of hypothermia in an air-conditioned room,“ a doctor at RML said.
“This child's case was highlighted because he was taken to various hospitals in a CATS ambulance. Many poor parents bring their newborns in an autorickshaw or a private vehicle. No one knows how many such children who are refused admission survive,“ said Dr Ajay Gambhir, president of National Neonatology Forum.He said most private nursing homes that deliver babies don't have facilities or medical expertise to take care of ill children. “They refer them to the big hospitals without making enquiries about the availability of beds.“
Lok Nayak Hospital has 50 NICU beds, half of which are for in-house patients. Dr Sidharth Ramji, director and professor of the hospital's neonatology unit, said, “We need to upgrade existing infrastructure in public hospitals and also utilize the facilities under private sector.Some NICU beds in private hospitals can be reserved under the EWS category .”
The Times of India, Aug 06 2015
Govt fails to fill EWS beds in pvt hospitals
Latest data shows one out of every three beds reserved for the poor are lying vacant even as patients queue outside government-run medical institutions to seek treatment. Some of the hospitals have not admitted a single patient under the EWS category.
The rule says that any poor patient can visit private hospitals directly for admission under EWS quota or state-run hospitals can refer their patients, if required.
The real-time update on availability of beds on the state health department's website is useless for a poor patient who have no access to internet or the confidence to fight with authorities.
Private hospitals have been found indulging in malpractices, such as denying the poor treatment citing lack of documentation or discouraging them in the name of high costs of medicines or consumables which they ought to give for free.
Delhi children have weaker lungs than EU’s/ 2018
Even as the Centre claims that there is no direct link between diseases and air pollution, the Delhi-based Hazard Centre and some independent researchers have released a study highlighting how severe pollution levels at 15 locations along eight arterial roads and two Ring Roads are affecting lives.
The study also found that, on average, lung function among a majority of the over 300 children and young adults tested is far lower than the normal values for European children. The study was conducted with a network of lowcost air monitors between October and November 2017. It found that there is a base pollution load across Delhi of about 300µg/m3 for PM10 and 200µg/m3 for PM2.5, which is three times higher than the national standard.
“There was an overall spike in pollution levels to above 600µg/m3 for PM2.5 on November 8, and a smaller increase up to 500µg/m3 on November 12, and both were much higher than the one on Diwali on October 19,” the study found. In fact, at Guru Tegh Bahadur Nagar on Ring Road, one of the low-cost monitors recorded a spike of 2,000µg/m3 in January 2018, but experts said that it could also be an anomaly.
The locations monitored by the team included Holambi, Bhalswa, Wazirpur, Punjabi Bagh, GTB Nagar, Bahadurgarh, Seelampur, Seemapuri, Kalyanpuri, Patparganj, New Friends Colony, Tughlaqabad, Saket, Munirka and Ayanagar. These locations were chosen because they were close to schools or colleges and there were Delhi Pollution Control Committee, IMD or Central Pollution Control Board monitors that could be used as reference.
Experts said low-cost sensors estimate the pollution levels at the breathing height whereas high-volume air samplers of government agencies assess the pollution 5-6 metres above the ground. The low-cost devices yield data that are lower than the DPCC monitors, about the same as the IMD ones, and higher than the CPCB monitors. But the patterns are more or less the same, they found.
The team also carried out a quick health study at 11locations with 343 individuals below the age of 20 years who walk to school or college in the area. They found that 80% of the “peak flow” (how fast you can breathe out) values for children in Delhi fall below what is considered ‘normal’ for European children. “This may partly be due to demographic differences, but one would not expect such a large difference in the city with the highest per capita income in the nation,” a Hazard Centre expert said. Compared to those in west and east Delhi, those tested in the southern and northern peripheries had slightly better lung function results.
The data analysis also revealed that, across Delhi, there is a spike in the morning hours between 8am and 10am, a dip in the afternoons between 2pm and 4pm, and another spike in the evening hours between 7pm and 9pm. The pollution loads are highest in places like Bahadurgarh and Punjabi Bagh in the west, GTB Nagar and Wazirpur in the north, Kalyanpuri in the east, and New Friends Colony in the south — all of them being characterised by heavy traffic on arterial roads. The air is relatively the cleanest in Holambi and Bhalswa in far north. Saket, Tughlakabad, and Ayanagar in south have slightly higher pollution but the peaks are comparatively lower.
2014- Aug 2019
Malaria may soon be re-categorised as a ‘dangerous disease’ like tuberculosis, plague, small pox or leprosy in the capital. But the move is on the table not because the disease has acquired an epidemic proportion or a new dangerous strain has been found. Rather, through this step, South Delhi Municipal Corporation wants to improve the screening mechanism to eradicate the disease completely from the city.
Once the corporation, the coordinating civic body for implementing the National Malaria Eradication Programme in Delhi, empowers the commissioner to declare a disease as ‘dangerous’, it becomes obligatory for all medical practitioners, clinics and private hospitals to report and give information about all such patients arriving at their facilities, explained a senior public health official.
The municipal corporations have been asked to eradicate malaria from the city by 2022 and this move is expected to push the drive, the official said. “Under the eradication programme, Delhi falls in the first phase as the incidence is already low in the city. The whole country is to be declared malariafree by 2030,” he added.
Currently, the corporations only get the data related to the mosquito-borne diseases from 36 hospitals under the sentinel scheme. The obligatory reportage will improve mapping of malaria cases and discourage incomplete treatment, which leads to development of resistance against drugs. “As malaria is not considered risky, most cases do not get reported. Doctors give medicines for four-five days, which cures the symptoms but traces of the parasite stay in the liver. A full 14-day radical treatment has to be followed for its complete removal from the system,” another official said.
The civic data shows that Delhi reported just 201 cases of malaria in 2014, which rose to 359 in 2015, 454 in 2016 and 577 in 2017. Last year, 473 cases were reported while the count at the onset of this monsoon was around 83.
An analysis of one year’s mosquito breeding data from the three corporations reveals that peri-domestic containers — vase, flower pots, bird pots, tins, tyres and water fountains — account for the largest chunk of the mosquito breeding sites (38%). Domestic water storage containers — drums, buckets, jerry cans etc — come second at 33%. Desert coolers, used in Delhi in large numbers, and overhead tanks come at the third and fourth spots, respectively.
Eradication will still be a huge task, an official pointed out. The re-designation process is in the final stage of approval.“Once the commissioner approves it, the proposal will be placed in the House. As this is in alignment with the central policy, we expect the proposal to sail through,” he added.
Nine in 2019
See graphic :
Delhi’s Nine Medical colleges, as in 2019
2018, Sept: sharp decline vs. 2017, 2016 and 2015
9-Mth Figure Of 481 Lowest In 4 Yrs, Rain May Have Played Role Too
For the first time in four years, the number of dengue cases has remained below 1,000 as on September.
According to latest data released by the South Delhi Municipal Corporation (SDMC), which collates data on mosquito-borne diseases for all civic bodies, shows that a total of 481 people were affected by dengue as on September 29. In 2017, 2016 and 2015, the number of people affected by the disease stood at 1,807, 1,692 and 5,982 respectively during this period.
Neena Valecha, director of the National Institute of Malaria Research (NIMR) said delayed rains could be responsible for fewer cases so far this year. “We shouldn’t be complacent though. It is possible that there may be some increase in cases in the coming weeks,” she said, adding that overall incidence may still be much lower than previous years.
NIMR studied the dengue positive cases and found that predominant strain of dengue virus in circulation this year is type III. Dengue strains are of four types. Type I causes classic dengue fever, type II leads to haemorrhagic fever with shock, dengue III causes fever without shock and dengue IV causes fever without shock or profound shock. Valecha said prevalence of type III strain of virus could be behind less complications and no deaths this year.
In 2015, when Delhi witnessed an outbreak of dengue leading to over 15,000 cases and 60 recorded deaths due to the mosquito-borne diseases, the predominant strain of the dengue virus were type II and type IV that are most virulent.
Meanwhile, the corporation data shows the number of chikungunya and malaria are also significantly lower this year compared to last year. As on September 29, Delhi has reported 79 cases chikungunya which is transmitted by the same Aedes Aegypti mosquito and causes severe pain in joints along with fever. In 2016 and 2015, the number of chikungunya cases in Delhi stood at 338 and 2522 respectively.
Malaria cases haven’t gone down significantly though it is lesser than last year. As per data, 308 people have been affected by the mosquito-borne disease this year compared to 482 cases last year.
2018: '48% living in Delhi slum are overweight'
Nearly half of a group of healthy individuals living in a Delhi slum were found to be overweight while 17.2 per cent were obese, according to a survey.
Almost 64.9 per cent of 314 individuals who were assessed during a camp were found either over-weight or obese, which are important risk factors for heart and vascular diseases. Around 20.1 per cent reported use of tobacco products while 37.3 pc had high blood pressure.
Around 500 individuals were evaluated and examined for body mass index (BMI), obesity, blood pressure measurement, spot blood sugar, blood lipids and an electrocardiogram (ECG) was done at a recent camp by a team of doctors from Batra Hospital and Medical Research Centre (BHMRC) out of which the data was available for 314 individuals.
"Around 37.3 per cent of the persons had high blood pressure as per the current Indian definition of 140/90 mms Hg.
"Here it needs to be mentioned that the US definition has changed recently to above 130/80 mms Hg and going by that parameter, it would be an alarming figure of around 50 per cent," said Dr Upendra Kaul, Chairman and Dean Academics and Research at the Batra Hospital and Medical Research Center(BHMRC).
Analysis of the blood sugar levels taken at health camp revealed a disturbing pattern which warrants serious attention from healthcare workers. 66.1 per cent of the persons had blood sugar levels between 101-200 mg/dL(average 137 mgs/ dl) while 8.5 per cent had blood sugar levels above 200 mg/dL with only 11 per cent of them reporting a family history of diabetes.
Also, 14.5 pc had borderline high cholesterol levels (200-239 mg/dL) while 3.2 per cent of the evaluated individuals had high cholesterol levels, exceeding 240 mg/dL.
2004 and 2013: increased by 25%
Deaths due to preventable illnesses such as tuberculosis have been on the rise in Delhi, warned a new study which shows that government efforts to improve healthcare have been insufficient to combat the impact of poverty and inequalities in Delhi.
Researchers from Rutgers School of Public Health, New York University and Columbia University in the US found that between 2004 and 2013, amenable mortality increased by about 25% in Delhi, while the cities being compared with it experienced a decrease in amenable mortality by at least 25%.
Delhi was selected for the study because its statistics are medically certified and more complete than those of India as a whole.
Delhi's rates of amenable mortality were compared against those of Moscow, Sao Paulo and Shanghai, which are mega cities in similar large, middle-income countries with booming economies that likewise have been striving toward a goal of universal health coverage.
“Despite having the world's largest generic drug industry , thriving medical tourism, significant innovations in the delivery, financing and manufacturing of health care services and products, there is a basic failure to assure minimal standards of sanitation and public health,“ said Michael K Gusmano, a research scholar and associate proffessor at Rutgers.
With more than half of India's households lacking toilets and more than 200 million people with no access to safe drinking water, the World Health Organisation (WHO) estimates that 9 lakhIndians die annually from drinking contaminated water and breathing polluted air, researchers said.
2014: Daily death count rises; causes
The Times of India, Aug 28 2015
Deaths up sharply in Delhi govt report
Increasing antibiotic resistance causing Septicemia, TB mortality: Experts
Delhi saw 332 deaths daily in 2014 compared to 266 in the preceding year. Of this, 61.50% deaths took place in hospitals and the rest (38.50%) at home. The data is part of the annual report on registration of births and deaths in Delhi in 2014. Septicemia (8.92%) and tuberculosis (5.83%) were the biggest causes of death in hospitalized patients followed by diseases of pulmonary circulation and other forms of heart disease (4.07%) and shock (3.91%). Of the total deaths reported in 2014, 62.17% were male and 37.83% female.
In 2012 and 2013, the percentage of institutional deaths caused due to septicemia was 7.32% and 8.25%, respectively .Tuberculosis deaths for the corresponding period stood at 4.60% and 4.75%, respectively .
“Septicemia is a severe infection caused by a bacteria which leads to organ dysfunction. High death rates due to this condition may be explained by increasing antibiotic resistance. Many patients die because the infections are not treatable even with most high-end antibiotics,“ said Vishwajeeth Kumar, a public health activist.
A senior doctor at AIIMS said death due to tuberculosis is also related to antibiotic resistance. “While global trends show over 50% decline in deaths due to tuberculosis, the statistics released by the Delhi government is showing a significant jump over the past few years,“ he said. Cancer patients, diabetics, transplant patients and those suffering from rheumatoid arthritis, in particular, are dependent on antibiotics for survival, the doctor added. The latest data shows maximum deaths occurred in the 65-and-above age-group.
An official in Delhi government said that many people from other states come to Delhi for treatment. “We record all deaths that take place in Delhi hospitals. The patient may not necessarily be a local,“ he said.The official added that the causes of hospitalised deaths have been divided into 24 categories. “Septicemia is a generalized condition but a significant percentage of deaths are also taking place due to heart disease, respiratory problems and viral diseases. Mosquitoborne diseases account for less than 0.50 per cent of all institutional deaths,“ he said.
2014-15, state-wise ranking
The Times of India, Jun 25 2015
City lags behind Kerala, TN on health indicators
Delhi remains behind states like Kerala and Tamil Nadu in key health indicators, such as the infant mortality rate (IMR). The Eco nomic Survey report 2014-15 shows that 22 of every 1,000 children born in the city in 2013 the latest available data) died within a year of birth. The number of children dy ng within 29 days of birth--al so called neonatal mortality rate (NMR)-stood at 15 per 1,000 births for the correspond ing year, as per the civil regis tration system.
Dr V K Paul, professor and head of the pediatrics depart ment at AIIMS, said the figures reflected lack of infrastruc ture. “Kerala and Tamil Nadu fare much better in terms of IMR despite having a larger and more diverse population Tamil Nadu has tribal and coastal populations that are un educated,“ he said.
Dr Paul added that neonatal ICU facilities in Delhi need to be increased and mothers need to be made aware about the best practices. Dr Krishan Chugh chairman of the department of paediatrics at Sir Ganga Ram Hospital, said the institutional birth rate has gone up in Delhi “Deaths are still happening due to poor ante-natal care, and in some cases mothers reach hos pital for birth too late,“ he said.
The report shows that the percentage of gross state do mestic product (GSDP) spent on healthcare in Delhi has re duced from 1.05 in 2006-07 to 0.96 in 2014-15. In 2001, Delhi's IMR was 24 per 1,000 births. It re duced to 13 per 1,000 in 2004 and 2005 but has been on the rise ev er since. Delhi's NMR was 14 per 1,000 in 2001 and reduced to 9 per 1,000 in 2004 but has been increasing ever since.
Experts said conditions arising in the period immedi ately before and after birth cause maximum infant deaths followed by hypoxia, birth as phyxia and other respiratory conditions. “The government is promoting institutional childbirth but the infrastruc ture required for it remains poor. Infection rates are high in most maternity centres due to poor hygiene. The number of doctors and nurses is also not adequate,“ said an expert.
2016-17: Some important highlights
Stats Show Leap In Respiratory Disease Deaths
At a time when the polluted air is among the capital’s biggest concerns, the Delhi Government Statistical Handbook 2017 reveals data that is cause for more worry. In 2016, as many as 9,149 deaths were related to respiratory factors, according to the chief registrar of births and deaths. This figure represents a big jump over 2015, when 6,502 people had died of respiratory diseases. Doctors, of course, explain that the term ‘respiratory disease’ covers many illnesses that may not necessarily be related to pollution.
Data show a consistent rise in deaths due to respiratory diseases between 2009 and 2011, going up from 5,328 to 8,590. There was a decline in 2012 to 7,513 and further to 5,986 in 2013 and 5,516 deaths in 2014. There has been a steady rise since then, with 6,502 deaths in 2015, rising to an all-time high of 9,149 in 2016.
Every year, TOI has reported how doctors have been warning that the worsening quality of air is triggering respiratory conditions such as chronic bronchitis, lung cancer and other infections. This year’s smog in November left even healthy people breathless, and many with respiratory problems or heart disease had to make their way to hospital.
Dr Arup Basu, head of respiratory medicine at Sir Ganga Ram Hospital, agreed that pollution was an aggravating factor leading to mortality in respiratory cases. He said that people with cardiac or neurological co-morbidities were more vulnerable to the adverse impact of pollution. “The elderly and the very young, say, below two years of age, are also at risk of suffering the adverse impact of pollution,” Dr Basu said, before adding, “Having said this, I would also like to point outthat thesteep rise in number of deaths categorised under respiratory diseases might be due to the fact that there is more awareness about and higher reporting about conditions falling under respiratory disease.”
Meanwhile, data on total deathsfrom allcausesin Delhi rose from 1,24,516 in 2015 to 1,41, 632 in 2016. The number of live births in 2015 was 3,74,012, which increased to 3,79,161in 2016. The data revealed a decline in infant mortality rate per 1,000 live births from 21.66 in 2014 and 23.25 in 2015 to 21.35 in 2016.
The statistics said there were 1,145 health institutions with 52,003 beds in Delhi as on December 31, 2016 compared with 1,131 institutions and 48,131 beds on December 31, 2015.
The handbook said that around 3.82 lakh senior citizens and 71,581 differently abled persons were given financial assistance during 2016-17, even as 1.66 lakh girls received monetary help under the Ladli scheme in the year.
This year’s smog in November left even healthy people breathless, and many with respiratory problems or heart disease had to make their way to hospital
2017: Healthcare facilities-issues and status
Healthcare facilities run by the three corporations- issues and status as in March 2017
2018: 1/5 adolescents underweight
While the problem of obesity among schoolchildren is much documented, equally worrying is the prevalence of low weight among those aged between 15 and 19 years and studying in Classes IX and XII. Screening of nearly 1,785 students — 950 from 12 government schools and 835 from 10 private schools in Delhi — has revealed that one in every five adolescents in Delhi is either underweight or severely underweight.
One of the reasons for this high number could be that government schoolchildren cannot afford nutritional food, while private school students deliberately avoid them owing to their unhealthy dietary habits, Rita Sapra, principal of the school of nursing at Sir Ganga Ram Hospital, who led the screening programme, told TOI.
Anyone who has a body mass index (BMI) — a measure of relative size based on the mass and height of an individual — which is less than or equal to 16.4 is considered severely underweight.
If children are in range of 16.5 to 17.5, they are considered underweight, Sapra added. She was shocked to find that a number of government and private school students fell in both categories. “Being underweight is linked to a host of complications, including poor physical stamina, low immunity, anaemia, protein calorie malnutrition and poor self-esteem, among others,” the nursing school principal pointed out.
Sapra and his team had set out to find the prevalence of obesity and awareness about diabetes among adolescents of Delhi, but they chanced upon the underweight data while analysing the results.
Results of the screening programme have been published in the latest issue of Current Medicine Research and Practice. It confirmed the trend of rising incidence of obesity among students. The study found that one in four students (23%) in private schools was either overweight or obese. In government schools, the number was one in eight children (12%).
Dr Anoop Misra, chairman, Fortis Centre for Diabetes (obesity and cholesterol), said: “Obesity among schoolchildren is certainly on the rise and several studies have shown that. But the number of students being underweight is surprising. If the study is correct, it is an alarming figure as low weight is linked to multiple problems, like poor stamina and vulnerability to infections. I cannot confirm the trend though.”
Misra added that even in well-to-do families, the consumption of carbohydraterich diet is common and people tend to miss out of micronutrients.
Clinical nutritionist Ishi Khosla said that prevalence of obesity and underweight among schoolchildren is high because of food sensitivity. “It leads to both inflammation and mal-absorption. If we guide them well, based on the student’s nutrition status, both can be corrected,” Khosla added.
Healthcare and public health: Delhi