Sanjeev Nair

• MD, DNB, DTCD
• Professor (Additional) at Government Medical College Thrissur

Background Montreal cognitive assessment (MoCA) is a tool that is widely accepted across the world to measure mild cognitive impairment (MCI). The original cut-off score of MoCA falsely screens a large population of Indians as having MCI. Objective The aim of this study was to develop the normative data for MoCA for the older population of Kerala,...

Background Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-base...

Background Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important follow...

Background Global evaluations of the progress towards the WHO End TB Strategy 2020 interim milestones on mortality (35% reduction) and incidence (20% reduction) have not been age specific. We aimed to assess global, regional, and national-level burdens of and trends in tuberculosis and its risk factors across five separate age groups, from 1990 to...

Background: Global evaluations of the progress towards the WHO End TB Strategy 2020 interim milestones on mortality (35% reduction) and incidence (20% reduction) have not been age specific. We aimed to assess global, regional, and national-level burdens of and trends in tuberculosis and its risk factors across five separate age groups, from 1990 to...

Background Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of D...

Background Following rapid urbanization in Kerala, the urban population grew faster with different health needs, widening the socioeconomic and health inequity. The urban primary health centers were formed, and with the introduction of decentralized governance, the primary and secondary health-care facilities in the urban region were transferred to...

Background Vitamin D deficiency has been declared a public health problem for both adults and children worldwide. Asthma and related allergic disorders are leading causes of morbidity in children. The objective of this study was to estimate Vitamin D levels in children suffering from asthma and allergic rhinitis in North Kerala. Objectives (1) To...

In recent years, nucleic-acid amplification tests (NAATs), which are highly specific and sensitive, have helped to transform the TB diagnostic landscape. According to the WHO 2021 Guidelines on Diagnostics, the NAATs used in TB diagnosis at the point of care (POC) include Xpert MTB/RIF a cartridge-based test manufactured by Cepheid, and Truenat a c...

Background: Globally, household air pollution (HAP) is a major environmental hazard that affects respiratory health. However, few studies have examined associations between HAP and lung function decline and respiratory disease and mortality. Methods: We used data from the Prospective Urban and Rural Epidemiology study and examined adults residin...

Setting: In alignment with the UN Sustainable Development Goals (SDGs), Kerala State in India aims to end the HIV/AIDS epidemic, using its strong background in local governance to implement the National AIDS Control Programme (NACP). Objective: To examine the role of local governments in the implementation of NACP in tune with SDGs. Design: We...

BACKGROUND: The state of Kerala, India, has experienced several unprecedented events in the past few years. The current study was an attempt to explore perceptions of stakeholders on how the decentralised system helped during the Nipah virus (NiV) outbreaks and COVID-19 pandemic in Kerala. METHODS: This study used a qualitative descriptive approach...

The southern Indian state of Kerala has implemented ‘Kerala Tuberculosis Elimination Mission’ as ‘People’s Movement against TB’ under the stewardship of local governments (LGs). The state has been certified by the Government of India for being on track to attain the UN Sustainable Development Goals related to TB elimination. To document the role o...

Abstract Background: To achieve the goals of the end tuberculosis (TB) strategy, strategies for management of TB infection (TBI) have to be expanded. The first step to devise policies is to understand the distribution and determinants of TBI in the community. The objectives of the study were to estimate the prevalence of TBI using Interferon Gamma...

Background More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehens...

Background: Extrapulmonary Tuberculosis (EPTB) accounts for 15%-53% of all TB cases. In recent years, cartridge-based nucleic acid amplification test (CBNAAT) has emerged as an important diagnostic tool since the diagnostic yield is higher. We conducted this study to evaluate the diagnostic yield of CBNAAT in EPTB. Methods: One hundred and four...

Background: The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territor...

Background Household air pollution (HAP) from cooking with solid fuels has been associated with adverse respiratory effects, but most studies use surveys of fuel use to define HAP exposure, rather than on actual air pollution exposure measurements. Objective To examine associations between household and personal fine particulate matter (PM2.5) and...

Objective We undertook a prescription-based study to identify the provider and institution-level factors related to achieving guideline-recommended control of hypertension and diabetes mellitus in Kerala, India. Methods This cross-sectional study in primary and secondary care hospitals in Kerala included both public and private institutions. One p...

Background: Chronic obstructive pulmonary disease (COPD) is the second leading cause of death in India. The objective of this study was to map COPD cases and its risk factors and to determine the association between them using geographic information system (GIS) in a semi-urban area of Trivandrum, South India. Materials and methods: This communi...

Introduction Health personnel in high-burden countries are at a greater risk of tuberculosis (TB) infection, due to continuous exposure to diagnosed and undiagnosed pulmonary TB cases. A scoping review is done to ascertain the prevalence and risk factors for latent TB infection (LTBI) among India's healthcare personnel. Materials and Methods A rev...

Introduction Use of polluting cooking fuels generates household air pollution (HAP) containing health-damaging levels of fine particulate matter (PM2.5). Many global epidemiological studies rely on categorical HAP exposure indicators, which are poor surrogates of measured PM2.5 levels. To quantitatively characterize HAP levels on a large scale, a m...

Background and objectives: Obstructive sleep apnea (OSA) during rapid eye movement (REM) stage of sleep is gaining importance in recent years. This study was done to determine the proportion of REM-related OSA and its associated polysomnographic features. Methods: One hundred forty-two patients were included in the study. REM-related OSA was def...

Background Final adult height is a useful proxy measure of childhood nutrition and disease burden. Tall stature has been previously associated with decreased risk of all-cause mortality, decreased risk of major cardiovascular events and an increased risk of cancer. However, these associations have primarily been derived from people of European and...

Black Carbon (BC) is an important component of household air pollution (HAP) in low- and middle-income countries (LMICs), but levels and drivers of exposure are poorly understood. As part of the Prospective Urban and Rural Epidemiological (PURE) study, we analyzed 48-hour BC measurements for 1187 individual and 2242 household samples from 88 commun...

Resistance to antimycobacterial agents consistently remains a major obstacle to end TB in India. Geographical prevalence data regarding drug-resistant evolutionary genetics of M. tuberculosis (MTB) remains sparse in India. Our objective was to determine the genotypic drug resistance mutation pattern for Rifampicin and Isoniazid of MTB isolates to g...

Background Tuberculosis is a major contributor to the global burden of disease, causing more than a million deaths annually. Given an emphasis on equity in access to diagnosis and treatment of tuberculosis in global health targets, evaluations of differences in tuberculosis burden by sex are crucial. We aimed to assess the levels and trends of the...

Purpose Peripheral blood routine examination results are often abnormal in Covid-19. This study aimed to determine whether absolute eosinophil count can be used as a marker to differentiate covid-19 from other short febrile illness Materials and Methods This was a single-center retrospective descriptive study which studied 1000 laboratory confirme...

Background Blood peripheral Eosinophil count in COPD patients is increasingly being considered as a biomarker in COPD and is now being included in major guidelines to guide treatment, particularly in the use of inhaled corticosteroids. Objective To estimate the peripheral blood Absolute Eosinophil Count (AEC) in COPD patients attending the Pulmona...

Background and objectives Asthma and depression are two highly prevalent chronic diseases in India and worldwide, imposing unacceptable social and economic burdens on the public health care system. Asthma has long been considered an illness in which mood and emotions contribute to poor control of symptoms. The contribution of psychiatric diseases e...

Background: Cognitive impairment in obstructive sleep apnea (OSA) is a widely unrecognized entity. Earlier studies have shown variable results for the prevalence of this entity. Hence, this study was done to determine the prevalence of cognitive impairment in patients diagnosed to have OSA and its association with the severity of OSA.Materials and...

Background: Approximately 2·8 billion people are exposed to household air pollution from cooking with polluting fuels. Few monitoring studies have systematically measured health-damaging air pollutant (ie, fine particulate matter [PM2·5] and black carbon) concentrations from a wide range of cooking fuels across diverse populations. This multinatio...

Background: Chronic obstructive pulmonary disease (COPD) is the second leading cause of mortality in India; however, there are no programs for COPD in India at primary care level. Kerala became the first state in India to implement a program at primary care for COPD, called the Step Wise Approach to Airway Syndrome program. Objective: The object...

Background Previous attempts to characterise the burden of chronic respiratory diseases have focused only on specific disease conditions, such as chronic obstructive pulmonary disease (COPD) or asthma. In this study, we aimed to characterise the burden of chronic respiratory diseases globally, providing a comprehensive and up-to-date analysis on ge...

Background Most studies of long-term exposure to outdoor fine particulate matter (PM2·5) and cardiovascular disease are from high-income countries with relatively low PM2·5 concentrations. It is unclear whether risks are similar in low-income and middle-income countries (LMICs) and how outdoor PM2·5 contributes to the global burden of cardiovascula...

Background: Kerala is facing challenges in the secondary prevention efforts of non-communicable diseases (NCDs). In spite of being the top performer in health parameters among Indian states, the burden of NCDs, especially diabetes mellitus (diabetes) and hypertension, is higher in Kerala. This research endeavours to identify the role of quality of...

Context: Health-seeking behavior of patients with chronic obstructive pulmonary disease (COPD) and asthma and the diagnosis told to them by doctors before they reach tertiary care is not well documented. Aims: This study aimed at describing the health-seeking behavior of asthma and COPD patients before they present to a tertiary care hospital in...

Introduction: Switching from polluting (e.g. wood, crop waste, coal) to clean cooking fuels (e.g. gas, electricity) can reduce household air pollution (HAP) exposures and climate-forcing emissions. While studies have evaluated specific interventions and assessed fuel-switching in repeated cross-sectional surveys, the role of different multilevel f...

Introduction: Pneumonia Severity Index (PSI) and CURB-65 rule for community acquired pneumonia (CAP) have been developed to stratify patients based on mortality. Lack of a risk stratifying score like PSI or CURB-65 can lead to significant delay in starting treatment. This study was conducted to find out the ability of CURB-65 score and PSI to predi...

Background: The associations between the extent of forced expiratory volume in 1 s (FEV1) impairment and mortality, incident cardiovascular disease, and respiratory hospitalisations are unclear, and how these associations might vary across populations is unknown. Methods: In this international, community-based cohort study, we prospectively enro...

Background: Household air pollution (HAP) from solid fuel use for cooking affects 2.5 billion individuals globally and may contribute substantially to disease burden. However, few prospective studies have assessed the impact of HAP on mortality and cardiorespiratory disease. Objectives: Our goal was to evaluate associations between HAP and morta...

Introduction Engaging the private sector effectively has been considered as the single most important intervention required for Revised National TB Control Program (RNTCP) to achieve the overall goal of universal access and early detection. This study attempts to identify the barriers and facilitators in the involvement of private practioners in si...

Background: Chronic Obstructive Pulmonary Disease(COPD), pneumothorax and asthma are climate sensitive diseases contributing a significant proportion of the respiratory disease morbidity. Even when the monsoon rainfall is high, recent years have witnessed an increase in the average temperature in Kerala. The study aims to determine the trends in ho...

Background: Air pollution is a major planetary health risk, with India estimated to have some of the worst levels globally. To inform action at subnational levels in India, we estimated the exposure to air pollution and its impact on deaths, disease burden, and life expectancy in every state of India in 2017. Methods: We estimated exposure to ai...

This paper estimated mortality for 282 causesof death in 195 countries from 1980 to 2017, adding 18 causes to its estimates compared to GBD 2016. In 2017, the GBD study added numerous data sources, including 127 country-years of vital registration data and 502 country-years of cancer registry data.

Background: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used...

Background Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. He...

Background Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used...

BACKGROUND: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used...

Background: Pulmonary rehabilitation is a proven strategy in the management of COPD, it’s a neglected area in our part of world and there are very few studies on home based pulmonary rehabilitation in COPD in our scenario and hence we evaluated the effectiveness of such a strategy. Aim of the research work was to study the effectiveness of home bas...

Introduction There is lack of information on the proportion of new smear—positive pulmonary tuberculosis (PTB) patients treated with a 6-month thrice-weekly regimen under Revised National Tuberculosis Control Programme (RNTCP) who develop recurrent TB after successful treatment outcome. Objective To estimate TB recurrence among newly diagnosed PTB...

Study definitions. (DOCX)

Background 18% of the world’s population lives in India, and many states of India have populations similar to those of large countries. Action to effectively improve population health in India requires availability of reliable and comprehensive state-level estimates of disease burden and risk factors over time. Such comprehensive estimates have no...

With almost one-fifth of the world’s population living in India, the health status and the drivers of health loss are expected to vary between different parts of the country and between the states. Accordingly, effective efforts to improve population health in each state require systematic knowledge of the local health status and trends. While stat...

Background: Physical activity has a protective effect against cardiovascular disease (CVD) in high-income countries, where physical activity is mainly recreational, but it is not known if this is also observed in lower-income countries, where physical activity is mainly non-recreational. We examined whether different amounts and types of physical...

Background: Asthma is a chronic inflammatory airway disease in which various inflammatory cells play a pivotal role in pathogenesis. Based on the inflammatory cells count in the sputum, various inflammatory phenotypes are identified. The identification of asthma phenotypes has potential clinical significance, as natural history and treatment respon...

Background: Bidis are minimally regulated, inexpensive, hand-rolled tobacco products smoked in south Asia. We examined the effects of bidi smoking on baseline respiratory impairment, and prospectively collected data for all-cause mortality and cardiorespiratory events in men from this region. Methods: This substudy of the international, community-b...

Summary Background 18% of the world’s population lives in India, and many states of India have populations similar to those of large countries. Action to effectively improve population health in India requires availability of reliable and comprehensive state-level estimates of disease burden and risk factors over time. Such comprehensive estimates...

The importance of hand-washing in personal and public hygiene has evolved over the centuries. While the market with its countless number of soaps and hand-wash products for personal hygiene with the accompanying advertising has created a false sense of security, it is community hygiene implemented through public health measures that is really effec...

The prevalence of gestational diabetes is on the rise. Understanding the various outcomes of it is necessary to face this challenge. To study the frequency of occurrence of various maternal and fetal outcomes among gestational diabetes patients. This is a retrospective cohort study conducted in rural Kerala, a southern state of India. The study par...

Background: Though Directly Observed Treatment Short course (DOTS) is found effective in many controlled trials, few studies have examined its effectiveness under programmatic conditions. DOTS based Revised National TB Control Programme (RNTCP) was initiated in Ernakulam district of Kerala state in June 2000. It now covers all of India. It now see...

Context: Respiratory diseases are one of the leading causes of deaths world-wide. There are no published studies on the pattern and determinants of respiratory mortality from South India. Aims: The aim was to find out the pattern and determinants of respiratory mortality during July 1, 2002 to June 31, 2008 in Varkala, Thiruvananthapuram district,...

SETTING: Two tertiary care hospitals and 12 peripheral health institutions (PHIs) in Trivandrum, Kerala, India. OBJECTIVE: To determine factors associated with the prevalence of diabetes mellitus (DM) among tuberculosis (TB) patients and examine differences in the proportion of new DM cases among TB patients diagnosed at tertiary care centres and P...

objective To assess the feasibility, results and challenges of screening patients with diabetes mellitus (DM) for tuberculosis (TB) within the healthcare setting of six DM clinics in tertiary hospitals across India. method Agreement on how to screen, monitor and record the screening was reached in October 2011 at a national stakeholders’ meeting, a...

objective To assess feasibility and results of screening patients with tuberculosis (TB) for diabetes mellitus (DM) within the routine healthcare setting across the country at: eight tertiary care hospitals and more than 60 peripheral health institutions in eight tuberculosis units. methods Agreement on how to screen, monitor and record was reached...

Objective To assess feasibility and results of screening patients with tuberculosis (TB) for diabetes mellitus (DM) within the routine healthcare setting across the country at: eight tertiary care hospitals and more than 60 peripheral health institutions in eight tuberculosis units. Methods Agreement on how to screen, monitor and record was reached...

While diabetes mellitus (DM) is a known risk factor for tuberculosis, the prevalence among TB patients in India is unknown. Routine screening of TB patients for DM may be an opportunity for its early diagnosis and improved management and might improve TB treatment outcomes. We conducted a cross-sectional survey of TB patients registered from June-J...

To study the determinants of Tuberculosis (TB) in children between the age group of 0-14 years receiving treatment under Revised National TB Control Programme (RNTCP). A case (registered under RNTCP) control study was undertaken with 41 cases and 82 controls. Factors found to have significance according to binary logistic regression were low-birth...

Objectives: To determine the clinical and radiological profile and etiology of ILD patients in a tertiary care setting in South Kerala. Methods: Data were collected from patients diagnosed as ILD based on clinical, radiological and PFT findings, using a structured questionnaire. Results: Among the 70 patients, 30% belonged to the age group 51 to 60...