The Impact of COVID-19 Pandemic on the Developing Nations: Emerging Mental Health Challenges and Interventions

The world is facing an unprecedented challenge of the 21st century in the form of COVID-19 outbreak. People across the culture, race, ethnicity, socio-economic background are being affected by the rippling effects of this pandemic. The aim of this narrative review is to briefly describe the impact of the pandemic on mental health, the vicious cycle of social issues and psychological health caused and aggravated by the Covid-19 pandemic. We also aim to highlight certain interventions to overcome the mental health challenges posed by the pandemic. For this purpose, a thorough search of all databases was done to gather articles relevant to the objective of this narrative review. Keywords were used in combination and separately to identify the articles on the various psychosocial issues caused by the pandemic. Published articles in various databases like Scopus, Web of Science, Pubmed etc., related to psychosocial effects due to COVID-19 were searched and summarized to justify and support the objective of this paper. The coming months will reveal the extent of damage this pandemic has caused to the socio-economic and health sectors across the globe. It is crucial to recognize the psychosocial impact of this pandemic and necessitate the measures to overcome them by mobilizing the resources we have at hand.

Assessing the burden of Covid-19 in the slums of Bangalore city: Results of Rapid Community Survey

Background: Karnataka, more so Bangalore, reported an increase in number of COVID-19 cases in early April 2021. Objective: To assess the burden of COVID-19 in the slums of Bengaluru city. Materials and Methods: A cross-sectional multi centre community-based study was done in the 2nd and 3rd week of April 2021 in 24 different slums in Bangalore city. WHO cluster random sampling technique was followed. Swabs for RTPCR test and 4 ml of venous blood was collected from 728 subjects more than 18 years of age. Results: A total of 51 (7%) subjects were positive for COVID-19 through RT-PCR. Majority 33 (56.9%) were in the age group of 18-44 years. 148 (20.3%) subjects were sero-positive on blood examination and 18-44 years was the (59.4%) preponderant age group. Overall seropositivity was 20.3% (95%CI; 17.4-23.2) and RT-PCR positivity is 7% (95%CI; 5.2-8.8%) among the subjects surveyed. In the inner core area of Bangalore, seropositivity was 24.2% (95%CI; 21.0 – 27.3) and RT-PCR positivity was 8% (95%CI; 6.1-9.9). Two doses of COVID-19 vaccine were taken only by 1.55% subjects during the study period. Conclusion: The study showed that one in 5 subjects were sero-positive to SARS-CoV-2 and one in 15 individuals had active COVID-19 infection.

Non-communicable disease surveillance in India using Geographical Information System-An experience from Punjab

"Geographic information system (GIS) collects various kinds of data based on the geographic relationship across space." Data in GIS is stored to visualize, analyze, and interpret geographic data to learn about an area, an ongoing project, site planning, business, health economics and health-related surveys and information. GIS has evolved from ancient disease maps to 3D digital maps and continues to grow even today. The visual-spatial mapping of the data has given us an insight into different diseases ranging from diarrhea, pneumonia to non-communicable diseases like diabetes mellitus, hypertension, cardiovascular diseases, or risk factors like obesity, being overweight, etc. All in a while, this information has highlighted health-related issues and knowledge about these in a contemporary manner worldwide. Researchers, scientists, and administrators use GIS for research project planning, execution, and disease management. Cases of diseases in a specific area or region, the number of hospitals, roads, waterways, and health catchment areas are examples of spatially referenced data that can be captured and easily presented using GIS. Currently, we are facing an epidemic of non-communicable diseases, and a powerful tool like GIS can be used efficiently in such a situation. GIS can provide a powerful and robust framework for effectively monitoring and identifying the leading cause behind such diseases. GIS, which provides a spatial viewpoint regarding the disease spectrum, pattern, and distribution, is of particular importance in this area and helps better understand disease transmission dynamics and spatial determinants. The use of GIS in public health will be a practical approach for surveillance, monitoring, planning, optimization, and service delivery of health resources to the people at large. The GIS platform can link environmental and spatial information with the disease itself, which makes it an asset in disease control progression all over the globe.

Adverse events associated with COVID-19 vaccination among health care professionals of Himachal Pradesh- a Rapid Survey.

Background: The rolling out of the COVID -19 vaccination programme was accompanied by several doubts including the safety and occurrence of adverse effects after the vaccination. Methodology: A cross sectional study was conducted amongst the health care professionals working in the state of Himachal Pradesh to assess the frequency and types of side effects associated with the administration of Covid-19 vaccines using a semi structured questionnaire floated through a Google form. Result: Of the 187 responses received, after the 1st dose, 37.5% participants reported malaise, 31% myalgia, 36.4% low-grade fever, while 18.5% high-grade fever. Mild reactions at the injection site were reported by 37.5%, headache was reported by 3%, low back ache, drowsiness, giddiness and diarrhea were reported by about 3%. No reactions were reported by 18.5% of the participants. After the second dose, 51.8% did not report any adverse event, 17.1% reported malaise,15.2% reported low grade fever, 3% reported high grade fever, 20.1% reported mild reactions at the site of injection while 4.2% reported drowsiness, breathlessness on exertion, nausea, low back ache and diarrhea. Conclusion: The frequency of adverse events with COVID -19 vaccines is not higher than those observed with other commonly used vaccines.

An illustration of delays in Mucormycosis: A case Study

Background: Mucormycosis is an opportunistic fungal infection with a high fatality rate and is the third most common fungal infection that is invasive in nature, next to candidiasis and aspergillosis. It is attributed to the poor socio-economic status and triggered by the local trauma due to unhygienic setup or poor health care. The pathway of pathogenesis is not clearly understood in immunocompetent patients and therefore becomes a matter of great concern.Aim& Objective: To explore the pathway of mucormycosis in a case of post SARS-CoV-2 infection Settings and Design: Tertiary Care hospital of Jabalpur DistrictMethods and Material: Interview with the case and care taker and case file review.Results: We could conclude this as a case of rhino- orbital mucormycosis attributed to uncontrolled blood sugar during treatment of SARS-CoV-2 infection, three delays that have occurred during the disease progression like ignorance from health service provider, late diagnosis, non compliance to the advice given by health facility, poor oral and nasal hygiene and no use of distilled water in humidifier. Conclusions: The early diagnosis, prompt Treatment , surgical intervention , proper blood sugar monitoring and rational use of steroids are important steps of successful outcome of the disease.

Forecasting the Anti-Rabies Vaccine Demand at Jawaharlal Medical College and Hospital, Ajmer, Rajasthan: A Comparative Analysis based on Time Series Model

Background: In India, high mortality and morbidity rates of human rabies is observed. Hence, a structured surveillance system is yet to be put in place for public health discussion. At the tertiary care hospital and all public health centres, requirement of anti-rabies vaccine is needed in advance to predict the upcoming months coverage so that wastage of vaccine is minimum. Objective: To find a suitable model for forecasting the appropriate stock of anti-rabies vaccines to avoid shortage and over-supply at anti rabies clinic. Methods and Material: This was a record based cross sectional study, conducted at anti rabies clinic of Jawaharlal Nehru Medical College and Hospital, Ajmer. Data of used anti rabies vaccine was taken from immunization inventory during the period from 2017 to 2020. Time series analysis based on Holt-Winter and Box-Jenkins methods were carried out to predict the need of vaccine. Results: Study series was not stationary and stationarity was observed by taken difference in the observation between two consequent months. Residuals of the series were normally distributed and independent to each other. ARIMA(0, 1, 1) was the best model in comparison to Holt-Winter model for prediction because of low value of model selection criterion. The forecasted value for anti-rabies vaccine was done for the year 2021. Conclusions: The following study concluded that time series can be used as a tool to forecast anti-rabies vaccine coverage and will help the policy makers to formulate appropriate plans and strategies and improve the management of vaccination resources and inventory.

Does the social status of the elderly impact morbidities among them? – A cross sectional Study in a district of Gujarat

Background: The aging population is both medical & sociological problem for the country and they suffer with high rates of morbidity and mortality. So Social factors lay a significant impact on the health practices and this study will help us to understand and evaluate their health problems of elderly. Aims and Objective: 1. To assess the social status of elderly population. 2. To associate the findings with morbidities of elderly Methods: A cross sectional study was carried out in urban and rural area of Surendranagar district among 611 elderly, using a predesigned and pre tested questionnaire by directly questioning the subjects with oral and written consent. For selection of the area, in both areas, the sampling units were enumerated and samples were collected by using simple random sampling, data was entered and analyzed using MS excel 2007. Result: Nearly 60 % of the subjects were currently unemployed and the predominant family system was 3 generation family. Majority of the families in the urban areas were from social class 4, whereas in the rural areas were from social class 5. Having poor social score had a statistically significant association with presence of morbidity in elderly both areas. Conclusions: Majority of elderly in both urban and rural areas had a poor social status. Role of the family and social structure on the health of the elderly can be clearly established. However, support structure must be developed in our social system in a way that the destitute and dependent elderly are taken care of by either government system or social organizations like NGOs and old age home.

Deteriorating human microbiome – An emerging global health challenge

The study of human microbiome and its relationship with health and disease is one of the most exciting areas of research in health all over the world, especially after the failure of human genome project to deliver its expected results. Our body is composed of 30 trillion human cells. But it is host to close to 100 trillion bacterial and fungal cells. 70 – 90% of all cells in our body are non human. They reside on every inch of our skin, in our nose, mouth, ears, in our oesophagus, stomach and most abundantly in our gut. They are not a random phenomenon but have co-evolved with us humans over millions of years. Collectively these bacteria weigh about 3 pounds. The more we read about research on microbiome or microbiota, the name given to all these friendly symbiotic partners, the more we get interested in their role in health and disease. According to Martin J. Blaser, director of the Human Microbiome Program, who has also served as the president of Infectious Disease Society of America, in his best seller ‘Missing Microbes' (1), “It is our microbiome that keeps us healthy and parts of it are disappearing. The reason for this disaster is all around us – overuse of antibiotics in humans and animals, caesarean sections and widespread use of sanitizers and antiseptics, to name just a few.”

Re-evaluating the need for universal iron supplementation in pregnant Indian women in the light of gestational age specific low hemoglobin prevalence

Background: Anemia prevalence among Indian pregnant women in 2015-16 was 50.4% and has not declined from 49.7% in 1998-99 despite the national policies on iron-folic acid supplementation. New gestational age-specific cut-offs (INTERGROWTH cut-off) for risk of low Hemoglobin (Hb) have been identified. Aims and objectives: Compare prevalences of low Hb based on WHO and INTERGROWTH cut-offs Methods: The prevalence of anemia/low Hb among pregnant women in trimesters 2 and 3 from NFHS-4 data were estimated using the current WHO recommendations and the INTERGROWTH cut-offs. Results: Prevalence of low Hb by the INTERGROWTH cut-off was 28.1%(95% CI:26.9-29.4) and 21.7%(95% CI:20.6-22.9) in trimesters 2 and 3. Anemia prevalence by WHO cut-off was much higher at 41.2%(95% CI:39.8-42.5) and 54.8%(95 CI:53.2-56.3) in trimesters 2 and 3. The prevalence of low-Hb was similar between ANC and no-ANC reported groups in both trimesters (26.1% and 28.9% in trimester-2; 20.1% and 22.4% in trimester-3). Conclusion: The prevalence of low-Hb with gestational age specific cut-offs is much lower compared to earlier estimates using WHO cut-off. The universal iron supplementation program for pregnant women in India need to be re-examined in this light and a tragetter Hb testing based supplementation may be more beneficial in reducing anemia prevalence.

Gall Bladder Calculus in reproductive age group females attending the ultrasound clinic at a tertiary care hospital: A comparative Cross-sectional study

Background: Pregnant females are at risk for cholelithiasis' progress, and the obstruction in the bile duct produced by gallstones is responsible for jaundice and abdominal pain. Objective: The objectives of the present study were to see the burden of gall stones, relation with parity, and trimester among reproductive age group females. Methodology: A cross-sectional study was conducted on 467 females of age between 15 to 45 years. The gall bladder was thoroughly examined by an ultrasound probe of frequency 2-5 MHz in all planes. Results: In most females who had gallstones, single (68.8 percent) gall stone was common as compared to multiple (31.2 percent). More nonpregnant women had gall bladder stones than pregnant women (p-value <0.005). Among the current nonpregnant group, the percentage of presence of gallbladder stones was greater in the female having parity of two or more (27.4 percent) than the females having parity of less than two (8.2 percent) with p-value <0.05. Conclusion: Since Gallstones can further complicate the situation in the form of gallbladder carcinoma, and females with higher parity have more chances of developing gallstones. Therefore, it becomes necessary to know the trimester of gallstone formation and its role in the progression of symptoms.