Papers by VENKATA GUDLAVALLETI
International Journal of Environmental Research and Public Health, 2021
This analysis of surveys from six low- and middle-income countries (LMICs) aimed to (i) estimate ... more This analysis of surveys from six low- and middle-income countries (LMICs) aimed to (i) estimate the prevalence of disability among older adults and (ii) compare experiences and participation in key life areas among older people with and without disabilities which may show vulnerability during the COVID-19 pandemic. Data were analysed from district-level or national surveys in Cameroon, Guatemala, Haiti, India, Nepal and the Maldives, which across the six databases totalled 3499 participants aged 60 years and above including 691 people with disabilities. Disability was common among adults 60+, ranging from 9.7% (8.0–11.8) in Nepal to 39.2% in India (95% CI 34.1–44.5%). Mobility was the most commonly reported functional difficulty. In each setting, older people with disabilities were significantly less likely to be working and reported greater participation restrictions and environmental barriers in key life areas compared to people in the same age categories without disabilities (p ...
British Journal of Ophthalmology, 2021
IntroductionIn its recent World Report on Vision, the WHO called for an updated approach to monit... more IntroductionIn its recent World Report on Vision, the WHO called for an updated approach to monitor eye health as part of universal health coverage (UHC). This project sought to develop a consensus among eye health experts from all world regions to produce a menu of indicators for countries to monitor eye health within UHC.MethodsWe reviewed the literature to create a long-list of indicators aligned to the conceptual framework for monitoring outlined in WHO’s World Report on Vision. We recruited a panel of 72 global eye health experts (40% women) to participate in a two-round, online prioritisation exercise. Two-hundred indicators were presented in Round 1 and participants prioritised each on a 4-point Likert scale. The highest-ranked 95 were presented in Round 2 and were (1) scored against four criteria (feasible, actionable, reliable and internationally comparable) and (2) ranked according to their suitability as a ‘core’ indicator for collection by all countries. The top 30 indic...
Tropical Medicine and Health, 2019
Background: Blindness and visual impairment from diabetic retinopathy (DR) are avoidable through ... more Background: Blindness and visual impairment from diabetic retinopathy (DR) are avoidable through early detection and timely treatment. The Western Province of Sri Lanka has the highest prevalence of diabetes mellitus (DM) (18.6%) in the country. A situational analysis identified a significant gap in DR screening services (DRSS) uptake in this region. Barriers that hinder people with DM (PwDM) from attending DRSS are poorly understood. The purpose of this study is to understand the factors which influence the uptake of DRSS and follow-up to inform health promotion strategies and improve the uptake of these services. Methods: Eleven focus group discussions (FGDs) were conducted with PwDM who presented to medical, general eye and vitreoretinal services in three public sector institutions (two tertiary and one secondary level) in the Western Province between October 2016 and March 2017. We enrolled six groups (four Sinhala speaking, two Tamil) of women and five groups (three Sinhala and two Tamil) of men representing ethnicity and gender. We performed a thematic analysis and described the main themes and subthemes using the socio-ecological model as a framework. Results: We identified lack of knowledge of both the condition and the need for screening as key barriers to access DRSS. Socio-cultural factors in the family environment, economic reasons and institutional factors were also important barriers. Additional reasons include long waiting time at eye clinics and poor referrals exacerbated by the lack of a systematic DRSS. In addition, attitudes to DRSS such as fear of discomfort from the procedure and the need for accompaniment following mydriasis were also deterrents to follow-up screening. Conclusion: This study has shown that there are interrelated user, family, and institutional factors which affect the uptake of DRSS. Understanding how DR is conceptualised by PwDM in this region is essential to refine strategies to improve access to DRSS. Strategies to improve knowledge need to be more culturally acceptable and relevant to PwDM and their families, with increased availability of DRSS at convenient locations may increase timely uptake of screening.
BMC pregnancy and childbirth, Jan 12, 2018
Cohort studies have public health importance as they effectively provide evidence on determinants... more Cohort studies have public health importance as they effectively provide evidence on determinants of health from a life course perspective. Researchers often confront the poor follow-up rates as a major challenge in the successful conduct of cohort studies. We are currently recruiting in a birth cohort study, titled as "Maternal Antecedents of Adiposity and Studying the Transgenerational role of Hyperglycemia and Insulin" (MAASTHI) in a public hospital; with the aim of assessing maternal glycemic levels on the risk of adverse fetal outcomes. Nested within the ongoing cohort, the proposed trial aims to evaluate the effectiveness of two interventions in improving the follow-up in the cohort study in a public hospital. A randomized trial of 795 pregnant women, with 265 women each in three arms observed through pregnancy, until their baby is 14 weeks old. The comparator group receives a standard leaflet, with details on the importance of glucose testing and regular follow up i...
World journal of diabetes, Jan 15, 2018
To perform a meta-analysis of the association of obesity with hypertension and type 2 diabetes me... more To perform a meta-analysis of the association of obesity with hypertension and type 2 diabetes mellitus (T2DM) in India among adults. To conduct meta-analysis, we performed comprehensive, electronic literature search in the PubMed, CINAHL Plus, and Google Scholar. We restricted the analysis to studies with documentation of some measure of obesity namely; body mass index, waist-hip ratio, waist circumference and diagnosis of hypertension or diagnosis of T2DM. By obtaining summary estimates of all included studies, the meta-analysis was performed using both RevMan version 5 and "metan" command STATA version 11. Heterogeneity was measured by statistic. Funnel plot analysis has been done to assess the study publication bias. Of the 956 studies screened, 18 met the eligibility criteria. The pooled odds ratio between obesity and hypertension was 3.82 (95%CI: 3.39 to 4.25). The heterogeneity around this estimate (I2 statistic) was 0%, indicating low variability. The pooled odds r...
JMIR Research Protocols, 2016
Background: Evidence from high income countries shows mothers who are supplemented with folic aci... more Background: Evidence from high income countries shows mothers who are supplemented with folic acid in their periconceptional period and early pregnancy have significantly reduced adverse outcomes like birth defects. However, in India there is a paucity of data on association of birth defects and folic acid supplementation. We identified a few important questions to be answered using separate scientific methods and then planned to triangulate the information. Objective: In this paper, we describe the protocol of our study that aims to determine the association of folic acid and pregnancy outcomes like neural tube defects (NTDs) and orofacial clefts (OFCs). We decided to fill the gaps in knowledge from India to determine public health consequences of folic acid deficiency and factors influencing dietary and periconceptional consumption of folic acid. Methods: The proposed study will be carried out in five stages and will examine the questions related to folic acid deficiency across selected locations in South and North India. The study will be carried out over a period of 4 years through the hierarchical evidence-based approach. At first a systematic review was conducted to pool the current birth prevalence of NTDs and orofacial clefts OFCs in India. To investigate the population prevalence, we plan to use the key informant method to determine prevalence of NTDs and OFCs. To determine the normal serum estimates of folic acid, iron, and vitamin B12 among Indian women (15-35 years), we will conduct a population-based, cross-sectional study. We will further strengthen the evidence of association between OFCs and folic acid by conducting a hospital-based, case-control study across three locations of India. Lastly, using qualitative methods we will understand community and health workers perspective on factors that decide the intake of folic acid supplements. Results: This study will provide evidence on the community prevalence of birth defects and prevalence folic acid and vitamin B12 deficiency in the community. The case-control study will help understand the association of folic acid deficiency with OFCs.
International Journal of Stroke, 2015
Background The aim of this pilot study was to determine the feasibility of a multicenter, randomi... more Background The aim of this pilot study was to determine the feasibility of a multicenter, randomized, controlled trial in India of a family-led, trained caregiver-delivered, home-based rehabilitation intervention vs. routine care. Methods A prospective, randomized (within seven-days of hospital admission), blinded outcome assessor, controlled trial of structured home-based rehabilitation delivered by trained and protocol-guided family caregivers (intervention) vs. routine care alone (control) was conducted in patients with residual disability. Key feasibility measures were recruitment, acceptance and adherence to assessment procedures, and follow-up of participants over six-months. CTRI/2014/10/005133. Results A total of 104 patients from the stroke unit at Christian Medical College, Ludhiana were recruited over nine-months. Recruitment was feasible and accepted by patients and their carers. Important observations were made regarding potential unblinding of the participants, contami...
Ceylon Medical Journal, 2018
Introduction Population-based data on visual impairment are required to estimate the need for ser... more Introduction Population-based data on visual impairment are required to estimate the need for services, evaluate service delivery and identify priorities that need to be addressed, as recommended in the World Health Organisation (W HO) Global Action Plan for Universal Eye Health. In the absence of national data for Sri Lanka, a nationwide survey was initiated. Objectives Determine the prevalence, distribution, magnitude and causes of blindness, visual impairment amongst adults aged 40 years in Sri Lanka; and to determine risk factors for blindness and visual impairment, and disability from the major causes. Methods The survey recruited a nationally representative sample of adults aged 40 years using proportionateto-population size methods and 18 years to estimate the prevalence of disability. All nine provinces and 25 districts of the country were included. 100 participants aged 40 years were enumerated in each of the randomly selected 68 clusters, giving a sample of 6800 persons. An examination site was set up in each cluster with space for interviews, anthropometry and clinical examination. Results Fieldwork took place over a year from 2013 to 2014. W ritten informed consent was obtained before the examination. Overall response rate was 86.1%. Companion articles in this issue highlight the prevalence and causes of blindness, visual impairment and disability and the role of socio-demographic factors in the prevalence estimates. Conclusions The findings from the survey can be extrapolated to the entire country as the sample was representative of the demographic characteristics of Sri Lanka. Data provides sufficient evidence for program
Ceylon Medical Journal, 2018
Introduction The following definition of functional low vision is used in surveys to estimate the... more Introduction The following definition of functional low vision is used in surveys to estimate the need for low vision services: corrected visual acuity in the better eye of less than 6/18 down to and including light perception from causes not amenable to treatment. However, such data for Sri Lanka is lacking. Objectives To determine the prevalence, causes and magnitude of functional low vision in a nationally representative sample of adults aged 40 years and above in Sri Lanka. Methods Distance visual acuity was measured using a LogMAR E chart. If the acuity was less than 3/60 in either eye, the ability to see hand movements, count fingers or perceive light was assessed. All underwent autorefraction followed by subjective refraction and measurement of best corrected acuity if indicated. Participants with a presenting acuity of <6/12 in the better eye were examined in details and a cause of visual loss was assigned. Analysis included those who fulfilled the definition of functional low vision. Results Among those examined, 59 participants fulfilled the definition of functional low vision: prevalence 1.02% (95% confidence interval 0.77-1.31%). The commonest causes were complications of cataract surgery (42.4%), and posterior segment conditions (30.5%) principally and age related macular degeneration (5 cases) and other retinal conditions (11 cases). Based on these estimates, 77,600 adults in Sri Lanka may benefit from low vision services. Conclusions The prevalence of functional low vision is slightly lower than the prevalence of blindness from all causes. Complications of cataract surgery are potentially avoidable causes.
Indian Journal of Ophthalmology, 2020
The Indian health infrastructure is struggling to handle the burgeoning number of people with dia... more The Indian health infrastructure is struggling to handle the burgeoning number of people with diabetes. Managing the complications of diabetes in an organized manner through the government health programs is still a distant reality. Here, we describe a program aimed at addressing the problem of diabetic retinopathy in rural areas of Tumkur district in Karnataka. By amalgamating telescreening and our own novel distributive care model, we were able to screen 85% of the registered diabetics in the Government noncommunicable disease clinics and treat 95% of those needing laser therapy. We also describe the importance of using electronic medical records in public health programs which not only increase the efficiency in screening for disease but help in increasing uptake of treatment by tracking defaulters.
Background In the last two decades, India has witnessed a substantial decrease in infant mortalit... more Background In the last two decades, India has witnessed a substantial decrease in infant mortality attrib-uted to infectious disease and malnutrition. However, the mortality attributed to birth defects remains constant. Studies on the prevalence of birth defects such as neural tube defects and orofacial clefts in India have reported inconsistent results. Therefore, we conducted a systematic review of observational studies to document the birth prevalence of neural tube defects and orofacial clefts. Methods A comprehensive literature search for observational studies was conducted in MEDLINE and EMBASE databases using key MeSH terms (neural tube defects OR cleft lip OR cleft palate AND Prevalence AND India). Two reviewers independently reviewed the retrieved studies, and studies satisfying the eligibility were included. The quality of included studies was assessed using selected criteria from STROBE statement. Results
The Lancet Healthy Longevity, 2022
Summary Background We undertook a Grand Challenges in Global Eye Health prioritisation exercise t... more Summary Background We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. Findings Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. Interpretation This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges. Funding The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission. Translations For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section.
Kyari, F; Murthy, GVS; Sivasubramaniam, S; Gilbert, CE; Abdull, MM; Entekume, G; Foster, A; , Nig... more Kyari, F; Murthy, GVS; Sivasubramaniam, S; Gilbert, CE; Abdull, MM; Entekume, G; Foster, A; , NigeriaNationalBlindnessandVisualImpairmentSurvey; (2008) Prevalence of Blindness and Visual Impairment in Nigeria: The National Blindness and Visual Impairment Survey. Investigative ophthalmology & visual science, 50 (5). pp. 2033-2039. ISSN 0146-0404 DOI: https://doi.org/10.1167/iovs.083133 Downloaded from: http://researchonline.lshtm.ac.uk/5314/ DOI: https://doi.org/10.1167/iovs.08-3133
What the data is: Qualitative (interview-based and ethnographic) data on health-seeking, health-c... more What the data is: Qualitative (interview-based and ethnographic) data on health-seeking, health-care and medical pluralism in rural areas of Andhra Pradesh, India. How and why collected: Collected as phase 1 of a multi-disciplinary, multi-phase proof-of-concept project (TRUMP), whose purpose was to create a pilot model for a mobile phone application for the self-management of chronic illness in rural India. Data collection for this first phase, used in this publication, combined semi-structured interviews with patients, with key informants (including informal medical practitioners who were the subject of this paper), group discussions, fieldwork conversations, and observations. Fieldwork took place from January to June 2014, under the direction of Prof. Peter Phillimore (Newcastle) and Dr G.V.S. Murthy (IIPH Hyderabad), organised and coordinated by Dr Papreen Nahar (Newcastle) working with Drs Kannuri and Mikkilineni (then both IIPH Hyderabad). Data processing: Data were transcribed...
Indian Journal of Ophthalmology, 2021
Purpose To determine whether the presence of age-related macular degeneration (AMD) decreases the... more Purpose To determine whether the presence of age-related macular degeneration (AMD) decreases the risk of diabetic retinopathy. Methods This was a retrospective, case-cohort study performed in patients with a systemic diagnosis of diabetes at a tertiary health care center from May 2011 to April 2020. A total of 43,153 patients (1,024 AMD patients and 42,129 non-AMD patients) were included in the analysis. A total of 1,024 age and diabetes mellitus (DM) duration-matched controls were chosen from the non-AMD group for risk factor analysis. The severity of diabetic retinopathy was compared between the patients with AMD and the patients without AMD. Results Out of the enrolled 43,153 diabetic patients, 26,906 were males and 16,247 were females. A total of 1,024 patients had AMD and 42,129 had no AMD. The mean age of the cohort was 58.60 ± 0.09 years. The overall prevalence of DR was noted to be 22.8% (9,825 out of 43,153 eyes). A significantly lower prevalence of diabetic retinopathy (DR) (23% in non-AMD, 11.4% in AMD, OR = -0.43, P < 0.001), non-proliferative diabetic retinopathy (NPDR) (12% in non-AMD, 8.2% in AMD, OR = -0.66, P < 0.001), and proliferative diabetic retinopathy (PDR) (11% in non-AMD, 3.2% in AMD, OR = -0.27, P < 0.001) was seen in the AMD patients. No significant difference was seen between the dry and wet AMD. On multivariate logistic regression analysis, the lower age, absence of AMD, and male gender were associated with a higher risk of PDR. Conclusion The presence of AMD was noted to statistically reduce the risk of DR. Our results may be useful in the field of resource allocation and awareness of DR.
The Lancet Global Health, 2021
Eye health is essential to achieve the Sustainable Development Goals; vision needs to be reframed... more Eye health is essential to achieve the Sustainable Development Goals; vision needs to be reframed as a development issue There is extensive evidence showing that improving eye health contributes directly and indirectly to achieving many Sustainable Development Goals, including reducing poverty and improving work productivity, general and mental health, and education and equity. Improving eye health is a practical and cost-effective way of unlocking human potential. Eye health needs to be reframed as an enabling, cross-cutting issue within the sustainable development framework. Almost everyone will experience impaired vision or an eye condition during their lifetime and require eye care services; urgent action is necessary to meet the rapidly growing eye health need In 2020, 1•1 billion people had distance vision impairment or uncorrected presbyopia. By 2050, this figure is expected to rise to 1•8 billion. Most affected people live in low-income and middle-income countries (LMICs) with avoidable causes of vision impairment. During the life course, most people will experience vision impairment, even if just the need for reading glasses. Because of unmet needs and an ageing global population, eye health is a major public health and sustainable development concern which warrants urgent political action. Eye health is an essential component of universal health coverage; it must be included in planning, resourcing, and delivery of health care Universal health coverage is not universal without affordable, high quality, equitable eye care. In line with the WHO World report on vision, we urge countries to consider eye care as an essential service within universal health coverage. To deliver comprehensive services including promotion, prevention, treatment, and rehabilitation, eye care needs to be included in national strategic health plans and development policies, health financing structures, and health workforce planning. Coordinated intersectoral action is needed to systematically improve population eye health, also within healthy ageing initiatives, schools, and the workplace. Integration of eye health services with multiple relevant components of health service delivery and at all levels of the health system is of central importance.
British Journal of Ophthalmology, 2020
PurposeTo report 15-year incidence rate and associated risk factors of pterygium among people age... more PurposeTo report 15-year incidence rate and associated risk factors of pterygium among people aged 30 years and above at baseline in the rural clusters of longitudinal Andhra Pradesh Eye Disease Study (APEDS III).MethodsThe baseline APEDS I included 7771 participants of which 6447 (83%) were traced and 5395 (83.7%) were re-examined in APEDS III. To estimate the incidence of pterygium, we selected participants who were 30 years and above at baseline (4188), of which 2976 were traced and 2627 (88.3%) were examined, and based on inclusion criteria, 2290 participants were included in the study. The incidence rate of pterygium was defined as the proportion of people free of pterygium at baseline who had developed the condition at 15-year follow-up (range 13–17 years). Univariate and multivariable analyses for risk factors were undertaken.ResultsThe sex-adjusted incidence rate of pterygium was 25.2 per 100 person-years (95% CI 24.8 to 25.7) which was significantly higher for men than wome...
Reproductive Health, 2019
Background: Appropriate antenatal care improves pregnancy outcomes. Routine antenatal care is pro... more Background: Appropriate antenatal care improves pregnancy outcomes. Routine antenatal care is provided at primary care facilities in rural India and women at-risk of poor outcomes are referred to advanced centres in cities. The primary care facilities include Sub-health centres, Primary health centres, and Community health centres, in ascending order of level of obstetric care provided. The latter two should provide basic and comprehensive obstetric care, respectively, but they provide only partial services. In such scenario, the management and referrals during pregnancy are less understood. This study assessed rural providers' perspectives on management and referrals of antenatal women with high obstetric risk, or with complications. Methods: We surveyed 147 health care providers in primary level public health care from poor and better performing districts from two states. We assessed their knowledge, attitudes and practices regarding obstetric care, referral decisions and pre-referral treatments provided for commonly occurring obstetric high-risk conditions and complications. Results: Staff had sub-optimal knowledge of, and practices for, screening common high-risk conditions and assessing complications in pregnancy. Only 31% (47/147) mentioned screening for at least 10 of the 16 common high-risk conditions and early complications of pregnancy. Only 35% (17/49) of the staff at Primary health centres, and 51% (18/35) at Community health centres, mentioned that they managed these conditions and, the remaining staff referred most of such cases early in pregnancy. The staff mentioned inability to manage childbirth of women with high-risk conditions and complications. Thus in absence of efficient referral systems and communication, it was better for these women to receive antenatal care at the advanced centres (often far) where they should deliver. There were large gaps in knowledge of emergency treatment for obstetric complications in pregnancy and pre-referral first-aid. Staff generally were low on confidence and did not have adequate resources. Nurses had limited roles in decision making. Staff desired skill building, mentoring, moral support, and motivation from senior officers. Conclusion: The Indian health system should improve the provision of obstetric care by standardising services at each level of health care and increasing the focus on emergency treatment for complications, appropriate decision-making for referral, and improving referral communication and staff support.
Uploads
Papers by VENKATA GUDLAVALLETI