Treatment of substance use disorders through the government health facilities: Developments in the “Drug De-addiction Programme” of Ministry of Health and Family Welfare, Government of India
TL;DR: Monitoring and evaluation exercises carried out show that the existing model of inpatient treatment and of shared responsibility between central and state governments is partially successful, and the establishment of drug treatment clinics on pilot basis with a focus on outpatient treatment and direct support from the DDAP is showing encouraging results.
Abstract: Substance use disorder (SUD) is a major problem worldwide, including in India, and contributes significantly to morbidity and mortality. The Ministry of Social Justice and Empowerment, Government of India, addresses the prevention and rehabilitation aspect of substance use through the establishment of “rehabilitation centers” run by nongovernmental organizations. The Drug De-addiction Programme (DDAP) was initiated in 1988 under the Ministry of Health and Family Welfare, Government of India, and was mandated with provision of treatment for SUDs. Through the DDAP, de-addiction centers (DACs) have been established in government hospitals by providing a one-time financial grant by the central government, with the recurring expenses to be borne by the state governments. In addition, some premier institutions as well as DACs from Northeastern region are provided annual recurring grants for their functioning. Capacity building has been a major focus area of DDAP in which nonspecialist medical officers working in government hospitals have been trained, and various training materials have been developed. Another major area of work is the development of “drug abuse monitoring system” to track the pattern of drug use and profile among individuals seeking treatment in the DACs. Monitoring and evaluation exercises carried out show that the existing model of inpatient treatment and of shared responsibility between central and state governments is partially successful. The establishment of drug treatment clinics on pilot basis with a focus on outpatient treatment and direct support from the DDAP for staff as well as for medicines is showing encouraging results.
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TL;DR: The increase in health loss from diabetes since 1990 in India is the highest among major non-communicable diseases and the relative rate of increase highest in several less developed low ETL states, and policy action is needed urgently to control this potentially explosive public health situation.
326 citations
TL;DR: The increasing prevalence and that of several major risk factors in every part of India, especially the highest increase in the prevalence of ischaemic heart disease in the less developed low ETL states, indicates the need for urgent policy and health system response appropriate for the situation in each state.
322 citations
TL;DR: Examination of disease-specific out-of-pocket expenditure (OOPE), catastrophic health expenditure (CHE) and distress health financing in India finds that risk-pooling and social security mechanisms based on contributions from both households as well as the central and state governments can reduce the financial burden of diseases and avert households from distress health finance.
Abstract: Background Rising non-communicable diseases (NCDs) coupled with increasing injuries have resulted in a significant increase in health spending in India. While out-of-pocket expenditure remains the major source of health care financing in India (two-thirds of the total health spending), the financial burden varies enormously across diseases and by the economic well-being of the households. Though prior studies have examined the variation in disease pattern, little is known about the financial risk to the families by type of diseases in India. In this context, the present study examines disease-specific out-of-pocket expenditure (OOPE), catastrophic health expenditure (CHE) and distress health financing. Methods and materials Unit data from the 71st round of the National Sample Survey Organization (2014) was used for this study. OOPE is defined as health spending on hospitalization net of reimbursement, and CHE is defined as household health spending exceeding 10% of household consumption expenditure. Distress health financing is defined as a situation when a household has to borrow money or sell their property/assets or when it gets contributions from friends/relatives to meet its health care expenses. OOPE was estimated for 16 selected diseases and across three broad categories- communicable diseases, NCDs and injuries. Multivariate logistic regression was used to understand the determinants of distress financing and CHE. Results Mean OOPE on hospitalization was INR 19,210 and was the highest for cancer (INR 57,232) followed by heart diseases (INR 40,947). About 28% of the households incurred CHE and faced distress financing. Among all the diseases, cancer caused the highest CHE (79%) and distress financing (43%). More than one-third of the inpatients reported distressed financing for heart diseases, neurological disorders, genito urinary problems, musculoskeletal diseases, gastro-intestinal problems and injuries. The likelihood of incurring distress financing was 3.2 times higher for those hospitalized for cancer (OR 3.23; 95% CI: 2.62-3.99) and 2.6 times for tuberculosis patients (OR 2.61; 95% CI: 2.06-3.31). A large proportion of households who had reported distress financing also incurred CHE. Recommendations Free treatment for cancer and heart diseases is recommended for the vulnerable sections of the society. Risk-pooling and social security mechanisms based on contributions from both households as well as the central and state governments can reduce the financial burden of diseases and avert households from distress health financing.
143 citations
01 Jan 2020
TL;DR: Where a negative impact was observed for the economy and human life, the environment got a positive one and India dealt and can potentially deal with these three factors during and post COVID-19 situation.
Abstract: India, which has the second-largest population in the world is suffering severely from COVID-19 disease. By May 18th, India investigated ∼1 lakh (0.1million) infected cases from COVID-19, and as of 11th July the cases equalled 8 lakhs. Social distancing and lockdown rules were employed in India, which however had an additional impact on the economy, human living, and environment. Where a negative impact was observed for the economy and human life, the environment got a positive one. How India dealt and can potentially deal with these three factors during and post COVID-19 situation has been discussed here.
139 citations
TL;DR: A Bats–Hosts–Reservoir–People transmission fractional-order COVID-19 model is analysed for simulating the potential transmission with the thought of individual response and control measures by the government and the effectiveness of preventive measures, predicting future outbreaks and potential control strategies of the disease are estimated.
Abstract: Since the first case of 2019 novel coronavirus disease (COVID-19) detected on 30 January, 2020, in India, the number of cases rapidly increased to 3819 cases including 106 deaths as of 5 April, 2020. Taking this into account, in the present work, we have analysed a Bats–Hosts–Reservoir–People transmission fractional-order COVID-19 model for simulating the potential transmission with the thought of individual response and control measures by the government. The real data available about number of infected cases from 14 March, 2000 to 26 March, 2020 is analysed and, accordingly, various parameters of the model are estimated or fitted. The Picard successive approximation technique and Banach’s fixed point theory have been used for verification of the existence and stability criteria of the model. Further, we conduct stability analysis for both disease-free and endemic equilibrium states. On the basis of sensitivity analysis and dynamics of the threshold parameter, we estimate the effectiveness of preventive measures, predicting future outbreaks and potential control strategies of the disease using the proposed model. Numerical computations are carried out utilising the iterative Laplace transform method and comparative study of different fractional differential operators is done. The impacts of various biological parameters on transmission dynamics of COVID-19 is investigated. Finally, we illustrate the obtained results graphically.
132 citations
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01 Jan 2003
11,232 citations
"Treatment of substance use disorder..." refers background in this paper
...[5] This scheme of the MoSJE is implemented by the nongovernmental organizations (NGOs), who run “Integrated Rehabilitation Centre for Addicts” for treatment and rehabilitation of people with SUD....
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...It should not be seen as an endorsement of this term by the authors) in each of the six premier hospitals/institutions in the country for providing inpatient treatment for patients with SUD....
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...[2] The global disease burden attributable to illicit drugs and alcohol use disorders was estimated to be 10.9% and 9.6% of disability-adjusted life years caused by mental illness and SUD....
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...6% of disability-adjusted life years caused by mental illness and SUD.[3] In India, the National Household Survey reported alcohol (21....
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TL;DR: The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) as discussed by the authors was used to estimate the burden of disease attributable to mental and substance use disorders in terms of disability-adjusted life years (DALYs), years of life lost to premature mortality (YLLs), and years lived with disability (YLDs).
4,753 citations
01 Jan 2007
TL;DR: The ability of hospital ventilation systems to filter Aspergillus and other fungi following a building implosion and the impact of bedside design and furnishing on nosocomial infections are investigated.
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961 citations
TL;DR: Routine and terminal disinfection with a germicide has been recommended to decrease the frequency and level of contamination of environmental surfaces and medical equipment in hospital rooms, and enhanced education, checklists, and methods to measure the effectiveness of room cleaning with immediate feedback to environmental services personnel has been found to improve cleaning and lead to a reduction in healthcare-associated infections.
Abstract: Affiliation: 1. Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina; and Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Received February 5, 2013; accepted February 10, 2013; electronically published April 9, 2013. 2013 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2013/3405-0001$15.00. DOI: 10.1086/670223 More than 20 years ago, Dr Robert Weinstein estimated that the source of pathogens causing a healthcare-associated infection in the intensive care unit was as follows: patients’ endogenous flora, 40%–60%; cross infection via the hands of personnel, 20%–40%; antibiotic-driven changes in flora, 20%–25%; and other (including contamination of the environment), 20%. Over the past decade, substantial scientific evidence has accumulated indicating that contamination of environmental surfaces in hospital rooms plays an important role in the transmission of several key healthcare-associated pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), Clostridium difficile, Acinetobacter, and norovirus (Table 1). All of these pathogens have been demonstrated to persist in the environment for hours to days (and, in some cases, months), to frequently contaminate the surface environment and medical equipment in the rooms of colonized or infected patients, to transiently colonize the hands of healthcare personnel (HCP), to be associated with person-to-person transmission via the hands of HCP, and to cause outbreaks in which environmental transmission was deemed to play a role. Furthermore, hospitalization in a room in which the previous patient had been colonized or infected with MRSA, VRE, C. difficile, multidrug-resistant Acinetobacter, or multidrugresistant Pseudomonas has been shown to be a risk factor for colonization or infection with the same pathogen for the next patient admitted to the room. Although pathogen transfer from a colonized or infected patient to a susceptible patient most commonly occurs via the hands of HCP, contaminated hospital surfaces and medical equipment (and, less commonly, water and air) can be directly or indirectly involved in the transmission pathways. These transmission pathways and methods to interrupt transmission have been diagramed. HCP have frequent contact with environmental surfaces in patients’ rooms, providing ample opportunity for contamination of gloves and/or hands. Importantly, hand contamination with MRSA has been demonstrated to occur with equal frequency when HCP have direct contact with a colonized or infected patient or through touching only contaminated surfaces. The most important risk factor for HCP hand and glove contamination with multidrug-resistant pathogens has been demonstrated to be positive environmental cultures. To decrease the frequency and level of contamination of environmental surfaces and medical equipment in hospital rooms, routine and terminal disinfection with a germicide has been recommended. Unfortunately, routine and terminal cleaning of room surfaces by environmental services personnel and medical equipment by nursing staff is frequently inadequate. Multiple studies have demonstrated that less than 50% of hospital room surfaces are adequately cleaned and disinfected when chemical germicides are used. Similarly, inadequate cleaning of portable medical equipment by nursing staff has also been demonstrated. The implementation of enhanced education, checklists, and methods to measure the effectiveness of room cleaning (eg, use of fluorescent dye) with immediate feedback to environmental services personnel has been found to improve cleaning and lead to a reduction in healthcare-associated infections. No-touch methods (eg, ultraviolet C [UV-C] light and hydrogen peroxide systems) have been developed to improve terminal room disinfection. UV-C light has been demonstrated to decrease the level of C. difficile spores on contaminated surfaces in patient rooms, while hydrogen peroxide systems used in rooms of patients colonized or infected with a multidrug-resistant organism has been shown to decrease the risk of a subsequent patient admitted to the room developing infection or colonization with any multidrug-resistant organism. This special issue of Infection Control and Hospital Epidemiology is focused on the epidemiology and prevention of healthcare-associated infections associated with the hospital environment and includes 21 papers. Although space precludes describing each individual paper here, this issue details
97 citations
01 Jan 2003
TL;DR: A key purpose of the manual is to enable hospital administrators clinic managers and healthcare professionals working in limited resource settings to develop their own uniform infection prevention policies and service delivery guidelines.
Abstract: A key purpose of the manual is to enable hospital administrators clinic managers and healthcare professionals working in limited resource settings to develop their own uniform infection prevention policies and service delivery guidelines. It is recognized however that the strategies priorities and proven methods of infection risk reduction described in this manual will need to be adapted to reflect the existing conditions in each country. Only through this process can much needed changes be implemented and patient care in hospitals and clinics improved.
86 citations