V K Sashindran

By Rajneesh Thakur and Vangal Krishnaswamy Sashindran

Tuberculosis continues to be an epidemic disease worldwide especially in the developing countries. One of the main reasons behind the continuation of this epidemic is latent tuberculosis infection. Globally, 2–3 billion people have latent TB infection. Prevention of reactivation TB is now considered as one of the important strategies of TB prevention and is one of the main pillars for the WHO “End TB Strategy.” Biostatistical modeling has shown that protecting 8% of persons with latent tuberculosis every year can bring down the global incidence rate by 14 times by 2050 as compared to that in 2013 without any other intervention. One of the most effective strategies recommended by WHO has been Isoniazid preventive therapy for 6–9 months. Chemoprophylaxis for LTBI can prevent 60–90% of reactivation TB. Isoniazid preventive therapy is considered safe; however, it can occasionally result in significant adverse effects like hepatitis and rarely mortality. In conclusion, chemoprophylaxis of LTBI can be considered an important intervention being done to curb the epidemic of TB especially in high-risk group and reduce the morbidity and mortality associated with active TB disease.

Part of the book: Advances in HIV and AIDS Control

By Vangal Krishnaswamy Sashindran and Puja Dudeja

The global prevalence of obesity has doubled from 1990 to 2015. Worryingly, the increase is more in children than in adults. In just three decades, the number of school-going children and adolescents with obesity has increased by 10-fold, and the International Association for the Study of Obesity (IASO) and International Obesity Task Force (IOTF) reckon that 200 million school children worldwide are either overweight or obese. The prevalence of obesity among 5- to 19-year-old Indian children, ranged between 3.6 and 11.7%. It is predicted that by 2025 there will be 17 million obese children in India. Urbanisation is the single most important factor linked to obesity in India. Epigenetic, dietary, familial, psychosocial, parental education and parental occupation are other important factors. About 50% of obese children will become obese adults. The prevalence of hypertension, type 2 diabetes dyslipidaemia and non-alcoholic fatty liver disease in children is also increasing parallelly. Prevention of childhood obesity is vital because it is near impossible to get children to lose weight and maintain it. A healthy diet and an active lifestyle should start from the pre-conception time itself and be continued through all stages of childhood.

Part of the book: Public Health in Developing Countries

By Vangal K. Sashindran and Rajneesh Thakur

HIV/AIDS can cause malnutrition directly and also indirectly through opportunistic infections (OIs). Infectious diarrhoea and tuberculosis are the commonest OIs linked to malnutrition in HIV/AIDS. Environmental enteric dysfunction has now been identified to play a significant role in HIV-malnutrition. Food insecurity is bidirectionally associated with aggravation and perpetuation of HIV infection. Increasingly, drugs used in antiretroviral therapy have been recognised to lead malnutrition in many ways. Both HIV and malnutrition are most prevalent in the poorest areas of the world, and there is a convergence of etiological factors. Malnutrition depresses every aspect of immune function. Deficiency of key micronutrients like iron, folic acid, zinc, selenium and vitamins A, C and D also adversely affects immune function. Recent research has led to a greater understanding of these mechanisms. Immune dysfunction secondary to malnutrition is referred to as nutrition-associated immunodeficiency. Hence it is easy to surmise that malnutrition and HIV/AIDs are a deadly duo.

Part of the book: Nutrition and HIV/AIDS