Research carried out by Global Antibiotic Research and Development Partnership, a non-profit health organisation, has revealed that a significant number of multidrug-resistant infections in low- and middle-income countries, including India, are not being treated appropriately, because of large gaps in access.
| Photo Credit: Reuters

Only 7.8% of patients with drug-resistant infections in India received an appropriate antibiotic, a study of eight nations published in The Lancet Infectious Diseases journal has revealed. Lack of access to appropriate treatment for such serious infections increases morbidity and mortality, besides driving up health care costs and prolonging hospitalisation.

Research carried out by Global Antibiotic Research and Development Partnership (GARDP), a non-profit health organisation, has revealed that a significant number of multidrug-resistant infections in low- and middle-income countries (LMICs), including India, are not being treated appropriately, because of large gaps in access.

The study looked at which antibiotics were available to treat nearly 1.5 million cases of carbapenem-resistant Gram-negative (CRGN) infections across eight geographically diverse and populous LMICs — Bangladesh, Brazil, Egypt, India, Kenya, Mexico, Pakistan and South Africa. India’s 7.8% measures are against an average of 6.9% across all eight countries.

The study was undertaken to establish the barriers along the treatment pathway from initial presentation at the health facility to laboratory diagnostic testing to antibiotic access.

Two key parameters

The researchers defined and estimated two key parameters — the need for treatment or total number of resistant bacterial infections; the number of individuals potentially initiated on appropriate treatment, specifically focusing on CRGN infections. Researchers used The Lancet’s “Global Burden of Antimicrobial Resistance” (GRAM) study and IQVIA data for 2019 to arrive at the numbers.

“We were looking at three aspects,” explains Jennifer Cohn, GARDP’s Global Access Director and senior author of the study. “These were: To evaluate the access to antibiotics gap; create better data that will be an imperative to better define the cascade of care; and look at strong programmes or innovations that enabled better antibiotics stewardship in nations.” While the study only focused on eight countries, including India, she said there was a good reason to believe that the findings from this study also apply to other LMICs.

“We all know that high-end antibiotics are extensively overused and misused in countries like India, contributing significantly to resistance against these life-saving drugs. But this paper reminds us of an equally alarming issue — lack of access to these same antibiotics,” says Abdul Ghafur, infectious diseases specialist and founder, AMR Declaration Trust.

“In 2019, India had nearly 10 lakh carbapenem-resistant gram-negative infections, yet less than 1 lakh patients received appropriate treatment. The modelling suggests that around 3.5 lakh deaths occurred due to these infections. So we are caught in a paradox — irrational overuse on one end, and insufficient access on the other,” he added.

“To address this dual crisis, we must act on both fronts: preserve existing antibiotics through responsible use and ensure access to those who genuinely need them,” Dr. Ghafur further suggested. In the paper, authored by Anant Mishra et al, the recommendations are to set in place regulatory guardrails that will not only control antibiotics use, but also make sure that the access gap is bridged by nations and institutions. They also call for more research to better understand the barriers in accessing care, diagnoses and appropriate treatment.

Rohith G, Vignesh Hariharan and Sharmila Kumari Pinjala at The Hammer kettlebell academy in Kolathur. Photo: Srinivasa Ramanujam. Shot On OnePlus #FramesofIndia

A training session is in the works on the second floor of Kolathur’s The Hammer Fitness gym, on a particularly hot April morning.

Kettlebell coach Vignesh Hariharan is at work, teaching 55-year-old Sharmila Kumari Pinjala the proper method to lift and sustain a weight for a solid period of time. Sharmila, currently a zumba and Pilates instructor based out of Bengaluru, first heard the word ‘kettlebell’ only five years ago when one of her students suggested she introduce it in her dance-cum-fitness sessions.

“I have always been scared of weights. Though I am into fitness, I have never been a gym person. I was sceptical because I didn’t know if I would be able to lift even more than two kilograms,” she laughs, reminiscing about a time before her attempt to take on a certification course in kettlebell lifting.

Today, she is beaming with joy as her first tryst with any sport has resulted in a gold medal part of the OALC (one-arm long cycle) 30-minute category and a bronze in the OALC 10-minute category at the recently-held 12^th GSIF Kettlebell National Championship in Goa. Winning a rich tally of medals, the nine-member Tamil Nadu team displayed their prowess at the event that showcased top kettlebell players across the nation.

For Vignesh Hariharan, who has been an integral part of the city’s kettlebell training circuit, this is a moment of reckoning. Vignesh came into popularity in 2019 when he was crowned World Champion in Australia, thus becoming the first person in South India to be awarded the title. “In the Goa event, we had a nine-year-old and a 55-year-old taking part. As a coach, that gave me great joy,” says Vignesh, who also participated in the event, clinching three gold medals in different categories.

‘Never give up’

For the uninitiated, the sport of kettlebell originated in Russia and is still practised by Russian army personnel to hone their physical and mental strength. In Russia, the sport is known as girevoy, and athletes are called gireviks. “It can be played from by a wide group of people, ranging from the age groups of eight to 80. But it will test your patience; that’s when the sport gets intense,” says Vignesh.

Rohith G, a 26-year-old clinical sports physiotherapist, knows a thing or two about this. In his recent outing at Goa, Rohith reached a breaking point when he got a deep cut in his left hand during the first five minutes of the competition. “I was just not able to hold the kettlebell. I was about to give up, but my team pushed me on from the sidelines.”

Rohith was at about 100 repetitions when he was mentally ready to quit but thanks to powerful words of encouragement, he pushed himself to reach 285 repetitions. “It is a cardio workout and helps build endurance. It keeps the heart healthy, but the most important aspect of kettlebell lifting is learning to never give up,” says Rohith, who regularly trains with his pink kettlebell, that weighs eight kilograms and costs around ₹4,500, at home. He then sends video footage to his coach.

His aim? “To win a gold in Asia and World Championship and then train more athletes.” He certainly looks up to his coach Vignesh, who has already produced four World Champions and five National Champions since the time the latter became a World Champion himself. This is despite the fact that a couple of years were lost in adapting to COVID-related lockdowns. He says, “Kettlebell lifting is picking up at a fast rate in the country now, with more awareness about the sport’s benefits to overall fitness and health. From here, up is the only way to go.”

Climate change is expanding the range of disease-carrying vectors like mosquitoes and ticks, increasing the global risk of infections that can cause encephalitis | Image used for representational purpose only
| Photo Credit: Getty Images/iStockphoto

UK-based Encephalitis International on Tuesday launched a global campaign titled ‘Preventing Future Encephalitis: Climate Change and Infectious Disease’ to promote the importance of vaccination against the rising threat of encephalitis and other vaccine-preventable diseases.

Climate change and encephalitis risk

Encephalitis is inflammation of the active tissues of the brain caused by an infection or an autoimmune response. In a release issued on Tuesday, Encephalitis International said the campaign aims to raise awareness about how climate change was exacerbating the risk of encephalitis in India and globally.

The UK-based health charity organisation said the warming planet was creating conditions favourable to the spread of infections that can lead to encephalitis.

Encephalitis affects over 1.5 million people globally each year – about three people every minute. Yet, nearly 77 per cent of the population remains unaware of the condition, leading to delays in diagnosis and treatment, the release said.

“As the earth warms, new and emerging infections, including those that cause Encephalitis, will continue to rise. The vectors that can spread infectious diseases like mosquitoes and ticks are moving to new communities and environments,” said Ava Easton, chief executive of Encephalitis International.

Easton added that changing human and animal interactions and the movement of disease-carrying vectors like mosquitoes into new areas are compounding the risk.

India among high-burden countries

Outbreaks of vaccine-preventable diseases, including measles, meningitis and encephalitis, are increasing globally, whereas diseases like diphtheria, once well-controlled, are also at risk of re-emerging.

“Vaccines have saved more than 150 million lives over the past five decades,” the release quoted World Health Organization (WHO)’s Director-General, Tedros Adhanom Ghebreyesus. “Outbreaks of vaccine-preventable diseases are increasing around the world, putting lives at risk and exposing countries to increased treatment costs,” he said.

Vaccination drive is vital

India’s Universal Immunisation Programme (UIP), one of the world’s largest, targets 27 million infants and 30 million pregnant women annually. It provides free vaccination against 12 diseases, including Japanese Encephalitis in endemic areas, the release said.

India reported 1,548 cases of Japanese encephalitis from 24 states and union territories in 2024, underscoring the scale of the challenge. Encephalitis International is hosting a global webinar on April 29 to explore the link between climate change and the rising burden of encephalitis, as well as strategies to boost vaccine coverage, especially in rural areas.

“A vaccinated world is a safer world – each shot is a step towards freedom from preventable diseases,” Netravathi M, professor, National Institute of Mental Health and Neuro Sciences (NIMHANS) Bengaluru, said, highlighting the long-term benefits of vaccination.