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Frequent exposure to suboptimal temperatures in vaccine cold-chain system in India: results of temperature monitoring in 10 states/Exposition frequente a des temperatures suboptimales dans la chaine du froid des vaccins en Inde: resultats du suivi des temperatures dans 10 etats/Exposicion frecuente a temperaturas suboptimas en el sistema de la cadena de frio para las vacunas en India: resultados de la monitorizacion de la temperatura en 10 estados. Objective To estimate the proportion of time the vaccines in the cold-chain system in India are exposed to temperatures of < 0 or > 8[degrees]C. Methods In each of 10 states, the largest district and the one most distant from the state capital were selected for study. Four boxes, each containing an electronic temperature recorder and two vials of diphtheria, pertussis and tetanus vaccine, were placed in the state or regional vaccine store for each study state. Two of these boxes were then shipped--one per facility--towards the two most peripheral health facilities where vaccine was stored in each study district. The boxes were shipped, handled and stored as if they were routine vaccine supplies. Findings In state, regional and district vaccine stores and peripheral health facilities, respectively, the temperatures in the boxes exceeded 8[degrees]C for 14.3%, 13.2%, 8.3% and 14.7% of their combined storage times and fell below 0[degrees]C for 1.5%, 0.2%, 0.6% and 10.5% of these times. The boxes also spent about 18% and 7% of their combined times in transit at < 0 and > 8[degrees]C, respectively. In shake tests conducted at the end of the study, two thirds of the vaccine vials in the boxes showed evidence of freezing. Conclusion While exposure to temperatures above 8[degrees]C occurred at every level of vaccine storage, exposure to subzero temperatures was only frequent during vaccine storage at peripheral facilities and vaccine transportation. Systematic efforts are needed to improve temperature monitoring in the cold-chain system in India. Objectif Estimer le pourcentage du temps d'exposition des vaccins a des temperatures inferieures a 0[degrees]C ou superieures a 8[degrees]C dans la chaine du froid en Inde. Methodes Dans chacun des 10 etats, le district le plus grand et le district le plus eloigne de la capitale de l'etat ont ete selectionnes pour cette etude. Quatre boites, contenant chacune un enregistreur de temperature electronique et deux flacons de vaccin contre la diphterie, la coqueluche et le tetanos, ont ete placees dans le depot des vaccins de la region ou de l'etat pour chaque etat etudie. Deux de ces boites--une par centre--ont ete ensuite expediees vers les deux centres de sante les plus peripheriques ou les vaccins sont stockes dans chaque district de l'etude. Les hostes ont ete expediees, manipulees et stockees comme des boites de vaccins habituelles. Resultats Dans les depots de vaccins de l'etat, de la region et du district et dans les centres de sante peripheriques, les temperatures a l'interieur des boites ont ete superieures a 8[degrees]C pour, respectivement, 14,3%, 13,2%, 8,3% et 14,7% de leurs temps de stockage combines et inferieures a 0[degrees]C pour, respectivement, 1,5%, 0,2%, 0,6% et 10,5% de ces durees. Les boites ont egalement passe environ 18% et 7% de leurs temps combines en transit a des temperatures inferieures a 0[degrees]C ou superieures a 8[degrees]C, respectivement. Dans les tests d'agitation menes a la fin de l'etude, deux tiers des flacons de vaccins dans les boites ont presente des signes de congelation. Conclusion Alors que l'exposition a des temperatures superieures a 8[degrees]C s'est produite a tous les niveaux du stockage des vaccins, l'exposition a des temperatures inferieures a 0[degrees]C n'a ete frequente que pendant le stockage des vaccins dans les centres de sante peripherique et au cours du transport des vaccins. Des efforts systematiques sont necessaires pour ameliorer le suivi et le controle des temperatures dans la chaine du froid en Inde. Objetivo Estimar la proporcion de tiempo que las vacunas estan expuestas a temperaturas inferiores a 0 o superiores a 8[degrees]C en el sistema de la cadena de frio en India. Metodos En cada uno de los 10 estados, se selecciono para el estudio el distrito mas extenso y el mas distante a la capital del estado. Cuatro cajas, cada una de las cuales contenia un dispositivo electronico de registro de la temperatura y dos viales de vacunas contra la difteria, tos ferina y tetanos se colocaron en el almacen de vacunas estatal o regional de cada uno de los estados del estudio. Dos de estas cajas se enviaron despues--una por cada centro--hacia los centros sanitarios mas perifericos, donde la vacuna se almaceno en cada distrito del estudio. Las caias se enviaron, manipularon y almacenaron como si se tratara de suministros de vacunas rutinarios Resultados En los almacenes de vacunas estatales, regionales y de distrito, asi como en los centros sanitarios perifericos, respectivamente, las temperaturas en el interior de las caias superaron los 8[degrees]C durante el 14,3%, 13,2%, 8,3% y 14,7% de los periodos de almacenamiento combinados y bajaron de O[degrees]C durante el 1,5%, 0,2%, 0,6% y 10,5% de dichos periodos. Las cajas tambien estuvieron por debajo de 0 y por encima de 8[degrees]C, respectivamente, alrededor del 18% y 7% del tiempo de los periodos combinados en transito. En las pruebas de agitacion realizadas al final del estudio, dos tercios de los viales de vacunas de las cajas mostraron evidencias de congelacion. Conclusion Aunque la exposicion a temperaturas superiores a 8[degrees]C se produjo a todos los niveles del almacenamiento de las vacunas, la exposicion a temperaturas bajo cero solo fue frecuente durante el almacenamiento en centros perifericos y el transporte. Es preciso realizar esfuerzos sistematicos para mejorar la monitorizacion y el control de la temperatura en el sistema de la cadena de frio en India., Introduction Childhood immunization is one of the most cost-effective health interventions. (1) Since most vaccines are sensitive to heat, an adequate cold-chain system often has to be created and maintained [...]

During 2003-2006, diphtheria rates in Hyderabad, India, were higher among persons 5-19 years of age, women, and Muslims than among other groups. Vaccine was efficacious among those who received [greater [...]

The India Hypertension Control Initiative (IHCI) is a multi‐partner initiative, implementing and scaling up a public health hypertension control program across India. A cohort of 21,895 adult hypertension patients in 24 IHCI sentinel site facilities in four Indian states (Punjab, Madhya Pradesh, Maharashtra, and Telangana), registered from January 2018 until June 2019 were assessed at baseline and then followed up for blood pressure (BP) control and antihypertensive medication use. Among all registrations, 11 274 (51%) of the patients returned for a follow‐up visit between July 2019 and September 2019. Among patients returning for follow‐up, 26.3% had BP controlled at registration, and 59.8% had BP controlled at follow‐up (p <.001). The absolute improvement in BP control was more than two times greater in primary care (48.1 percentage point increase) than secondary care facilities (22.9 percentage point increase). Most IHCI patients received prescriptions according to state‐specific treatment protocols. This study demonstrates that a scalable public health hypertension control program can yield substantial BP control improvements, especially in primary care settings. However, high loss to follow‐up limits population health impact; future efforts should focus on improving systems to increase the likelihood that patients will return to the clinic for routine hypertension care. [ABSTRACT FROM AUTHOR]