articles by Pankaj K Singh
To address the public health challenge posed by Dengue in Uttarakhand, the health department, Utt... more To address the public health challenge posed by Dengue in Uttarakhand, the health department, Uttarakhand state government designed and implemented a comprehensive, multi-sectoral, integrated approach for bridging the gaps in containment of anticipated dengue outbreaks during the whole transmission period in vulnerable areas. A well-crafted strategy aimed to implent a containment action plan by timely identification of early Hot-Spots, containment strategy execution by proper micro-planning in a multi-sectoral, integrated approach. The containment action plans were issued from District Magistrate's of respective districts. The surveillance system early identified hotspots of dengue in vulnerable areas and multi-sectoral teams responded to the hotspots to neutralize any occurrence of outbreak/epidemic of dengue. Inspite of anticipated increase in dengue cases in year 2023, the incidence of dengue cases was reduced to less than half in comparison of previous high transmission year i.e. 2019. The dengue mega campaign containment strategy implementation resulted in successful control of incidence of dengue cases in expected high transmission period of dengue in Uttarakhand state.
Indian Journal of Forensic and Community Medicine
Indian Journal of Forensic and Community Medicine
Tuberculosis (TB) poses a significant public health challenge in Uttarakhand, India. To address t... more Tuberculosis (TB) poses a significant public health challenge in Uttarakhand, India. To address this, the state has implemented strategic measures aimed at increasing the presumptive TB case examination rate. Key initiatives include the deployment of 40 additional molecular diagnostic machines, facilitated by the Corporate Social Responsibility (CSR), ensuring comprehensive coverage and enhancing field-level testing capabilities. The proactive procurement of molecular diagnostic chips and consumables at the state level has ensured an uninterrupted supply, bolstering testing capacity across all blocks. Additionally, regular fortnightly reviews and monitoring at the block level have been instituted to set targets, involve local leadership, and foster continuous improvement. These combined efforts have significantly improved the diagnostic capacity and operational efficiency of TB control measures in Uttarakhand, demonstrating the state's commitment to effective TB management and eventual elimination.
Climate change presents significant risks to human health, with healthcare facilities increasingl... more Climate change presents significant risks to human health, with healthcare facilities increasingly vulnerable to extreme weather, floods, droughts, and climate-sensitive diseases. This study examines the development of Green and Climate-Resilient Healthcare Facilities in Rudraprayag, Uttarakhand, through multi-sectoral collaboration. Key interventions include energy audits, LED lighting, solar panel installation, and rainwater harvesting, aimed at enhancing sustainability and resilience. The initiative demonstrates the importance of proactive adaptation measures and sustainable practices in healthcare infrastructure, providing a model for other regions to ensure continuous, high-quality care amid escalating climate threats. This approach underscores the critical need for innovation, collaboration, and commitment in building climate-resilient health systems.
Indian Journal of Forensic and Community Medicine, 2023
Under the aegis of Pradhan Mantri TB Mukt Bharat Abhiyan, a Corporate Social Responsibility (CSR)... more Under the aegis of Pradhan Mantri TB Mukt Bharat Abhiyan, a Corporate Social Responsibility (CSR)–NGO Mix model demonstrated the improved treatment success rates among tuberculosis (TB) patients in Haridwar district, Uttarakhand. The initiative, launched by the Government of India, addresses the bidirectional relationship between undernutrition and TB, emphasizing the need for holistic support beyond medical interventions. The Nikshay Mitras, acting as companions, not only provide nutritional assistance but also contribute to reduce the stigma associated with TB and offer comprehensive support, including job opportunities. Uttarakhand has actively implemented the initiative, with various support models, including individual Nikshay Mitra, NGOs, and Corporate Sectors contributing through CSR support. The editorial focuses on the impact of CSR initiatives on TB treatment success rates, presenting data from Haridwar district. The unique CSR-NGO model, showcased a significant improvement in the treatment success rate, reaching 94% for a cohort of 304 TB patients. No mortality or loss to follow-up was reported, highlighting the effectiveness of this collaborative approach. The success in Haridwar district demonstrates the positive outcomes of engaging NikshayMitra, blending corporate support, NGO facilitation, and government oversight.
Keywords: Nikshay Mitra, Pradhan Mantri TB Mukt Bharat Abhiyan, CSR-NGO model, Nutritional support.
Papers by Pankaj K Singh
The Kumbh Mela is a large religious mass gathering event organised in India. During April 01 to A... more The Kumbh Mela is a large religious mass gathering event organised in India. During April 01 to April 30, 2021, Kumbh Mela was organized in Haridwar, Uttarakhand, India in the amid of COVID-19 pandemic. To detect and respond to unusual health events, a special surveillance model was established during Kumbh Mela-2021, Haridwar. The Kumbh module of Integrated Health Information Platform (IHIP) is utilized for real time data capturing. An Emergency Operations Centre (EOC) established to monitor COVID-19 and other disease situations through IHIP. Capacity building of Rapid Response Teams (RRT) was conducted. The special surveillance monitored 24 diseases/ syndromes. Kumbh mela area was divided into 4 zones with total 75 health facilities. A total of 31021 cases were reported on IHIP, including 86% communicable diseases (CDs), 8% non-communicable diseases (NCDs) and 6% unusual syndrome. Among total CDs, 27% acute febrile illness (AFI), 25.3% acute respiratory illness (ARI), 19% water borne diseases (WBDs), 15% COVID-19 and 14% others encountered. Out of total NCDs, 67% trauma, 25% dog bite, 8% others. A total of 36 early warning signals generated and responded, of which 22% WBDs, 22% ARI, 17% COVID-19, 14% AFI, 11% unusual syndrome and 14% others. The special disease surveillance helped monitoring health event alerts and health condition alerts. EOC monitored early warning signals and facilitated early detection and quick response to public health threats. Acute febrile illnesses emerged as a leading cause of morbidity. Future Mass Gathering events like Kumbh Mela should include disease surveillance as part of planning and augment capacity to diagnose and management of acute febrile illness.
Background & objectives: Climate change is an emerging issue particularly in the context of vecto... more Background & objectives: Climate change is an emerging issue particularly in the context of vector-borne diseases. A study was undertaken in Nainital and Almora districts of Uttarakhand to provide evidences of changing climatic conditions, abundance of vectors, and knocking of malaria in hilly areas. Material and methods: Longitudinal data on temperature and relative humidity were procured from Tussar Silk Centre, Bhimtal, India as well as generated using HOBO device. Monthly density of malaria vectors, their positivity for sporozoite proteins of malaria parasite and fever surveys were conducted as per the standard procedures from 2010 to 2013. Epidemiological data were procured from the State Programme Officer of Uttarakhand state. Results: It was found that the temperature has increased since 1990 resulting in extension in windows of malaria transmission, temporal distribution as well as man hour density of Anopheles culicifacies and An. fluviatilis in hilly districts of Uttarakhand state. Both the vectors were found in high density up to a maximum man hour density of 110 (An. culicifacies) and 69 (An. fluviatilis) as compared to 32 and 33, respectively during 1998. The field collected vector species were also found positive for sporozoite proteins of malaria parasites in the month of October and November. Evidence of occurrence of malaria cases was also found in areas hitherto free from malaria. The findings reveal that Himalayan region needs attention to strengthen surveillance for malaria to identify emerging new foci of malaria transmission in view of climate change. Health education to communities about preventive measures to contain breeding of vectors and seeking timely treatment should be imparted so as to achieve the goal of malaria elimination in category-1 in the first instance.
2008 under IDSP at National Centre for Disease Control (NCDC), Delhi for providing supplemental i... more 2008 under IDSP at National Centre for Disease Control (NCDC), Delhi for providing supplemental information on early detection of outbreaks in India so that a timely and an appropriate action can be taken. Since then the system is working efficiently and has detected many outbreaks before the conventional system in their incipient stages and helped in their containments at early stages. Media scanning & verification cell is an "Early Warning System" (EWS) that gathers preliminary reports of public health significance on a real time basis and immediately disseminate the information to the users electronically for verification. This unique system monitors Global and National Media sources such as National and Regional print media, news on internet, websites, news channels and news shared by partners like Global Public Health Intelligence Network (GPHIN), Canada, WHO and other International and national agencies. Media scanning & verification cell is managed by trained Epidemiologists and Public Health Consultants working in Central Surveillance Unit of IDSP. The major part of work is manual with two rounds of screening by experts that fulfills issues regarding quality assurance.
Dengue has become a major Aedes borne disease globally, particularly in tropical and subtropical ... more Dengue has become a major Aedes borne disease globally, particularly in tropical and subtropical countries, including India. Dengue cases and deaths have been reported every year from this country with regular frequency and spatio-temporal expansion in the recent past. Uttarakhand, a mountainous state in northern India reported two dengue cases for the first time in 1996. Both cases were from Haldwani, a town below the foothills. Since then sporadic cases have been reported in subsequent years from a few localities. In 2019, a large dengue outbreak was reported from the hill state with 10 622 cases and eight deaths. Nearly all (96.54%) cases were reported from just four districts: Dehradun, Haridwar, Nainital and Udham Singh Nagar (US Nagar). A district-wise pattern of distribution indicates that these four districts were also major contributors of dengue cases during 2008-2020. However, Dehradun, Nainital, Haridwar and Tehri Garhwal saw the maximum deaths due to dengue. The disease affected both genders across all age groups. Dengue's seasonal trend indicates that the number of cases increases with monsoon, and starts to decline as temperatures begin to drop from the month of November. Currently, all 13 districts are endemic, with a few districts reporting most of the cases due to different epidemiological and ecological factors. This paper discusses in detail various variables like urbanization, decadal growth, Human Development Index (HDI), altitude, temperature, climate change and entomological aspects and their role in the physiographic dispersal of dengue in Uttarakhand.
Background Outbreaks of unexplained illness frequently remain under-investigated. In India, outbr... more Background Outbreaks of unexplained illness frequently remain under-investigated. In India, outbreaks of an acute neurological illness with high mortality among children occur annually in Muzaff arpur, the country's largest litchi cultivation region. In 2014, we aimed to investigate the cause and risk factors for this illness. In this hospital-based surveillance and nested age-matched case-control study, we did laboratory investigations to assess potential infectious and non-infectious causes of this acute neurological illness. Cases were children aged 15 years or younger who were admitted to two hospitals in Muzaff arpur with new-onset seizures or altered sensorium. Age-matched controls were residents of Muzaff arpur who were admitted to the same two hospitals for a non-neurologic illness within seven days of the date of admission of the case. Clinical specimens (blood, cerebrospinal fl uid, and urine) and environmental specimens (litchis) were tested for evidence of infectious pathogens, pesticides, toxic metals, and other non-infectious causes, including presence of hypoglycin A or methylenecyclopropylglycine (MCPG), naturally-occurring fruit-based toxins that cause hypoglycaemia and metabolic derangement. Matched and unmatched (controlling for age) bivariate analyses were done and risk factors for illness were expressed as matched odds ratios and odds ratios (unmatched analyses). Findings Between May 26, and July 17, 2014, 390 patients meeting the case defi nition were admitted to the two referral hospitals in Muzaff arpur, of whom 122 (31%) died. On admission, 204 (62%) of 327 had blood glucose concentration of 70 mg/dL or less. 104 cases were compared with 104 age-matched hospital controls. Litchi consumption (matched odds ratio [mOR] 9•6 [95% CI 3•6 -24]) and absence of an evening meal (2•2 [1•2-4•3]) in the 24 h preceding illness onset were associated with illness. The absence of an evening meal signifi cantly modifi ed the eff ect of eating litchis on illness (odds ratio [OR] 7•8 [95% CI 3•3-18•8], without evening meal; OR 3•6 [1•1-11•1] with an evening meal). Tests for infectious agents and pesticides were negative. Metabolites of hypoglycin A, MCPG, or both were detected in 48 [66%] of 73 urine specimens from case-patients and none from 15 controls; 72 (90%) of 80 case-patient specimens had abnormal plasma acylcarnitine profi les, consistent with severe disruption of fatty acid metabolism. In 36 litchi arils tested from Muzaff arpur, hypoglycin A concentrations ranged from 12•4 μg/g to 152•0 μg/g and MCPG ranged from 44•9 μg/g to 220•0 μg/g. Interpretation Our investigation suggests an outbreak of acute encephalopathy in Muzaff arpur associated with both hypoglycin A and MCPG toxicity. To prevent illness and reduce mortality in the region, we recommended minimising litchi consumption, ensuring receipt of an evening meal and implementing rapid glucose correction for suspected illness. A comprehensive investigative approach in Muzaff arpur led to timely public health recommendations, underscoring the importance of using systematic methods in other unexplained illness outbreaks.
Indian Journal of Community Health
Recent COVID-19 pandemic has highlighted the importance of increase in the ability of public heal... more Recent COVID-19 pandemic has highlighted the importance of increase in the ability of public health workforce to detect and respond to the public health threats. For timely implementation of an adequate response and mitigation measure, the standardized and sustainable capacity building programme for frontline public health workforce is the need of hour. National Center for Disease Control (NCDC), Ministry of Health and Family Welfare, in partnership with U.S. Centers for Disease Control and Prevention (CDC), developed a three-month in-service Basic Epidemiology Training programme. This is a tailor-made programme for frontline public health workforce to strengthen epidemiological skills. This training was a practical interactive approach to field epidemiology for three months on the job training for frontline public health workforce that addressed the critical skills needed to conduct surveillance effectively at the local level while focusing on improving disease detection, reporting...
Indian Journal of Community Health, Dec 31, 2022
Introduction Methodology Results Conclusion References Citation Tables / Figures
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articles by Pankaj K Singh
Keywords: Nikshay Mitra, Pradhan Mantri TB Mukt Bharat Abhiyan, CSR-NGO model, Nutritional support.
Papers by Pankaj K Singh