6 results on '"Guggilla, Rama K."'
Search Results
2. Effectiveness of a scalable group-based education and monitoring program, delivered by health workers, to improve control of hypertension in rural India: A cluster randomised controlled trial.
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Gamage, Dilan Giguruwa, Riddell, Michaela A., Joshi, Rohina, Thankappan, Kavumpurathu R., Chow, Clara K., Oldenburg, Brian, Evans, Roger G., Mahal, Ajay S., Kalyanram, Kartik, Kartik, Kamakshi, Suresh, Oduru, Thomas, Nihal, Mini, Gomathyamma K., Maulik, Pallab K., Srikanth, Velandai K., Arabshahi, Simin, Varma, Ravi P., Guggilla, Rama K., D'Esposito, Fabrizio, and Sathish, Thirunavukkarasu
- Subjects
EPIDEMIOLOGICAL transition ,MEDICAL personnel ,CLINICAL trial registries ,BLOOD pressure ,HYPERTENSION ,ANTIHYPERTENSIVE agents - Abstract
Background: New methods are required to manage hypertension in resource-poor settings. We hypothesised that a community health worker (CHW)-led group-based education and monitoring intervention would improve control of blood pressure (BP).Methods and Findings: We conducted a baseline community-based survey followed by a cluster randomised controlled trial of people with hypertension in 3 rural regions of South India, each at differing stages of epidemiological transition. Participants with hypertension, defined as BP ≥ 140/90 mm Hg or taking antihypertensive medication, were advised to visit a doctor. In each region, villages were randomly assigned to intervention or usual care (UC) in a 1:2 ratio. In intervention clusters, trained CHWs delivered a group-based intervention to people with hypertension. The program, conducted fortnightly for 3 months, included monitoring of BP, education about hypertension, and support for healthy lifestyle change. Outcomes were assessed approximately 2 months after completion of the intervention. The primary outcome was control of BP (BP < 140/90 mm Hg), analysed using mixed effects regression, clustered by village within region and adjusted for baseline control of hypertension (using intention-to-treat principles). Of 2,382 potentially eligible people, 637 from 5 intervention clusters and 1,097 from 10 UC clusters were recruited between November 2015 and April 2016, with follow-up occurring in 459 in the intervention group and 1,012 in UC. Mean age was 56.9 years (SD 13.7). Baseline BP was similar between groups. Control of BP improved from baseline to follow-up more in the intervention group (from 227 [49.5%] to 320 [69.7%] individuals) than in the UC group (from 528 [52.2%] to 624 [61.7%] individuals) (odds ratio [OR] 1.6, 95% CI 1.2-2.1; P = 0.001). In secondary outcome analyses, there was a greater decline in systolic BP in the intervention than UC group (-5.0 mm Hg, 95% CI -7.1 to -3.0; P < 0.001) and a greater decline in diastolic BP (-2.1 mm Hg, 95% CI -3.6 to -0.6; P < 0.006), but no detectable difference in the use of BP-lowering medications between groups (OR 1.2, 95% CI 0.8-1.9; P = 0.34). Similar results were found when using imputation analyses that included those lost to follow-up. Limitations include a relatively short follow-up period and use of outcome assessors who were not blinded to the group allocation.Conclusions: While the durability of the effect is uncertain, this trial provides evidence that a low-cost program using CHWs to deliver an education and monitoring intervention is effective in controlling BP and is potentially scalable in resource-poor settings globally.Trial Registration: The trial was registered with the Clinical Trials Registry-India (CTRI/2016/02/006678). [ABSTRACT FROM AUTHOR]- Published
- 2020
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3. Additive association of knowledge and awareness on control of hypertension: a cross-sectional survey in rural India.
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Ragavan RS, Joshi R, Evans RG, Riddell MA, Thankappan KR, Chow CK, Oldenburg B, Mahal AS, Kalyanram K, Kartik K, Suresh O, Thomas N, Mini GK, Srikanth VK, Maulik PK, Alim M, Guggilla RK, Busingye D, and Thrift AG
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- Awareness, Blood Pressure, Cross-Sectional Studies, Female, Health Knowledge, Attitudes, Practice, Humans, India epidemiology, Male, Middle Aged, Prevalence, Risk Factors, Rural Population, Hypertension epidemiology
- Abstract
Objective: To determine whether there is an interaction between knowledge about hypertension and awareness of hypertension on the treatment and control of hypertension in three regions of South India at different stages of epidemiological transition (see Video, Supplemental Digital Content 1, http://links.lww.com/HJH/B426)., Methods: Using a cross-sectional design, we randomly selected villages within each of rural Trivandrum, West Godavari, and Chittoor. Sampling was stratified by age group and sex. We measured blood pressure and administered a questionnaire to determine knowledge and awareness of hypertension. Logistic regression was used to assess associations of awareness and knowledge about hypertension with its treatment and control in participants with hypertension, while examining for statistical interaction., Results: Among a total of 11 657 participants (50% male; median age 45 years), 3455 had hypertension. In analyses adjusted for age and sex, both knowledge score [adjusted odds ratio (aOR) 1.14 [95% confidence interval (CI) 1.12--1.17)] and awareness [aOR 104 (95% CI 82--134)] were associated with treatment for hypertension. Similarly, both knowledge score [aOR 1.10; 95% CI (1.08--1.12)] and awareness [aOR 13.4; 95% CI (10.7--16.7)], were positively associated with control of blood pressure in those with hypertension, independent of age and sex. There was an interaction between knowledge and awareness on both treatment and control of hypertension (P of attributable proportion <0.001 for each)., Conclusion: Health education to improve knowledge about hypertension and screening programs to improve awareness of hypertension may act in an additive fashion to improve management of hypertension in rural Indian populations.
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- 2021
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4. Hypertension in Rural India: The Contribution of Socioeconomic Position.
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Thrift AG, Ragavan RS, Riddell MA, Joshi R, Thankappan KR, Chow C, Oldenburg B, Mahal AS, Kalyanram K, Kartik K, Suresh O, Mini GK, Ismail J, Gamage DG, Hasan A, Srikanth VK, Thomas N, Maulik PK, Guggilla RK, and Evans RG
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- Adolescent, Adult, Aged, Blood Pressure, Cross-Sectional Studies, Educational Status, Female, Health Surveys, Humans, Hypertension diagnosis, Hypertension physiopathology, Hypertension prevention & control, Income, India epidemiology, Male, Middle Aged, Prevalence, Risk Assessment, Risk Factors, Young Adult, Hypertension epidemiology, Rural Health, Social Class, Social Determinants of Health
- Abstract
Background Various indicators of socioeconomic position (SEP) may have opposing effects on the risk of hypertension in disadvantaged settings. For example, high income may reflect sedentary employment, whereas greater education may promote healthy lifestyle choices. We assessed whether education modifies the association between income and hypertension in 3 regions of South India at different stages of epidemiological transition. Methods and Results Using a cross-sectional design, we randomly selected villages within each of rural Trivandrum, West Godavari, and Rishi Valley. Sampling was stratified by age group and sex. We measured blood pressure and anthropometry and administered a questionnaire to identify lifestyle factors and SEP, including education, literacy, and income. Logistic regression was used to assess associations between various components of SEP and hypertension, and interaction analyses were used to determine whether educational attainment modified the association between income and hypertension. Trivandrum, the region of highest SEP, had the greatest prevalence of hypertension, whereas Rishi Valley, the lowest SEP region, had the least. Overall, greater income was associated with greater risk of hypertension. In interaction analyses, there was no evidence that educational attainment modified the association between income and hypertension. Conclusions Education is widely considered to ameliorate the risk of hypertension in high-income countries. Why this effect is absent in rural India merits investigation.
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- 2020
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5. Determinants of inhalant (whitener) use among street children in a South Indian city.
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Praveen D, Maulik PK, Raghavendra B, Khan M, Guggilla RK, and Bhatia P
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- Adolescent, Child, Child, Preschool, Cross-Sectional Studies, Female, Humans, India epidemiology, Inhalant Abuse epidemiology, Male, Surveys and Questionnaires, Homeless Youth legislation & jurisprudence, Inhalant Abuse etiology
- Abstract
A cross-sectional study was conducted in the year 2008 among 174 children in observation homes in Hyderabad, India, to estimate the distribution of inhalant (whitener) use among this population. Data were collected using an instrument developed for this purpose. About 61% of the children were boys and their mean age was 12.2 years (range 5-18 years). Whitener use was found in 35% of the children along with concurrent use of other substances. Peer pressure was the commonest cause reported for initiating substance use. The high prevalence is an important concern for the Indian policymakers given the large number of street children in Indian cities.
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- 2012
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6. Trends of public health research output from India during 2001-2008.
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Dandona L, Raban MZ, Guggilla RK, Bhatnagar A, and Dandona R
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- Humans, India, Program Development, PubMed, Bibliometrics, Biomedical Research statistics & numerical data, Biomedical Research trends, Public Health
- Abstract
Background: An understanding of how public health research output from India is changing in relation to the disease burden and public health priorities is required in order to inform relevant research development. We therefore studied the trends in the public health research output from India during 2001-2008 that was readily available in the public domain., Methods: The scope and type of the published research from India in 2007 that was included in the PubMed database was assessed and compared with a previous similar assessment for 2002. Papers were classified based on the review of abstracts and original public health research papers were assessed in detail. Impact factors for the journals were used to compute quality-adjusted research output. The websites of governmental organizations, academic and research institutions and international organizations were searched in order to identify and review reports on original public health research produced in India from 2001 to 2008. The reports were classified based on the topics covered and quality and their trends over time were assessed., Results: The number of original health research papers from India in PubMed doubled from 4494 in 2002 to 9066 in 2007. This included a 3.1-fold increase in public health research papers, but these comprised only 5% of the total papers in 2007. Within public health, the increase was lowest for the health system and policy category. Several major causes of disease burden in India continued to be underrepresented in the quality-adjusted public health research output in 2007. The number of papers evaluating population health interventions increased from 2002 to 2007, but there were none on the leading non-communicable causes of disease burden or on road traffic injuries. The number of identified original public health research reports increased by 64.7% from 204 in 2001-2004 to 336 in 2005-2008. The proportion of reports on reproductive and child health was very high but decreased slightly from 38.7% of the total in 2001-2004 to 31.5% in 2005-2008 (P = 0.09); those on the leading chronic non-communicable conditions and injuries increased from 6.4% to 13.4% (P = 0.01) but this was still much lower than their contribution to the disease burden. Health system/policy issues were the topic in 27.4% reports but health information issues were covered in a miniscule 0.6% reports. The proportion of reports that were evaluations increased slightly from 26% in 2001-2004 to 31.5% in 2005-2008, with this proportion being higher among the reports commissioned by international organizations (P < 0.001). The proportion of reports commissioned by Indian governmental organizations alone, or in collaboration with international organizations, doubled from 2001-2004 to 2005-2008 (P < 0.001). Only 25% of the total 540 reports had a quality score of adequate or better. The quality of reports produced by collaborations between Indian and international organizations was higher than those produced by Indian or international organizations alone (P < 0.001)., Conclusion: This is the first analysis from India that includes research reports in addition to published papers. It provides the most up-to-date understanding of public health research output from India. The increase in available public health research output and the increase in commissioning of this research by Indian governmental organizations are encouraging. However, the distribution of research topics and the quality of research reports continue to be unsatisfactory. It is necessary for health policy to address these continuing deficits in public health research in order to reduce the very large disease burden in India.
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- 2009
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