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Indian State With Highest Diabetes Rate

Delhi Has Maximum Diabetes Patients In Country: Study

Delhi Has Maximum Diabetes Patients In Country: Study

According to the study – “Diabetes on the Rise in India” – Delhi is leading the diabetes pack, followed by Mumbai, Ahmedabad, Bengaluru, Chennai. The study has also found that if change of lifestyle and food habits are not made, 125 million Indians are likely to become patients of diabetes by 2035. India fares poorly “Besides the cost burden imposed by the disease, the impact on quality of life and productivity of individuals is particularly severe, especially in later years. Recently World Health Organisation (WHO) released findings that placed India among the top three countries with the highest number of diabetes cases,’’ noted the study. According to the study, about 42.5 per cent of Delhi population suffers from diabetes, while in Mumbai and estimated 38.5 per cent of the total population is in the grip of the disease. In Ahmedabad 36 per cent people are diabetic, in Bangalore 26.5 per cent while in Chennai the percentage is estimated to be 24.5 per cent. In Hyderabad and Kolkata, the number of diabetes patients is estimated at 22.6 per cent and 19.7 per cent of the total population respectively. Even in rural areas, people are increasingly becoming patients of diabetes. “Timely screening and early identification of the disease can help the victim take immediate steps and improve the quality of life. To enable this, ASSOCHAM and its members, under CSR activities, are organising a series of free medical camps in Delhi, where comprehensive check-up, counselling, diet plan and information on diabetes management is being made available to participants,’’ said a release issued by ASSOCHAM. Speaking about the study, D.S. Rawat, secretary general, ASSOCHAM, said: “Diabetes today is one of the biggest health threats to our country and immediate steps Continue reading >>

'disturbingly High' Rates Of Diabetes In India: Study

'disturbingly High' Rates Of Diabetes In India: Study

'Disturbingly high' rates of diabetes in India: Study An Indian nurse collects a blood sample from a policeman using a glucometer at a free diabetic health check-up camp on World Health Day in Hyderabad on April 7, 2016. PHOTO: AFP MIAMI (AFP) - India is facing an epidemic of diabetes and high blood pressure, often called "silent killers" because they lead to heart disease, said a report Monday (Jan 29) involving more than 1.3 million people. The rate of diabetes in India is over six per cent, while around one quarter of people have high blood pressure, said the first nationally representative figures on the topic, published in the Journal of the American Medical Association (Jama) Internal Medicine. The rates of diabetes and hypertension were particularly high among middle-aged and elderly people. While these rates are lower than the United States and China, experts say a combination of widespread tobacco use, genetic susceptibility to diabetes and a lack of access to quality medical care are to blame. "In middle-age to older adults across all geographic settings and socioeconomic groups in the country, the prevalence of both diabetes and hypertension were disturbingly high," said an accompanying editorial by Alka Kanaya of the University of California, San Francisco. Overall, prevalence of diabetes was 6.1 per cent among women and 6.5 per cent among men. For hypertension, it was 20 per cent among women and 24.5 per cent among men. Young adults also had unexpectedly high rates of hypertension - the rate was 12 per cent among those aged 18 to 25. "Hypertension was higher among adults under 45 than previously estimated and was higher than in Central and Eastern Europe, the region previously estimated to have the highest rates for young adults," said the report. Whether Continue reading >>

State Has Lowest Prevalence Of Diabetes In Country

State Has Lowest Prevalence Of Diabetes In Country

New Delhi: A pan-India survey on the burden of diabetes has shown that Meghalaya has the lowest prevalence of the disease. ICMR’s (Indian Council of Medical Research) India Diabetes Study, a door-to-door survey of males and females above 20 years of age is the first national study by the government to determine the exact national prevalence of diabetes and pre-diabetes in India by calculating state-wise prevalence. Discussing the findings on the occasion of World Health Day (whose theme this year is diabetes control), ICMR chief, Soumya Swaminathan said, “We have found wide regional variations in the prevalence of diabetes and pre-diabetes in India. Meghalaya has the lowest diabetes prevalence at 4.5 per cent, while Chandigarh has the highest at 13.6 per cent, followed by Punjab at 9.8 per cent. Pre-diabetes prevalence is also the highest for Chandigarh at 14.6 per cent and the lowest for Mizoram at 5.8 per cent.” Findings show Punjab as the most obese and hypertensive on account of its prosperity and consumption patterns. Punjab has the highest prevalence of both generalised and abdominal obesity at 40.5 and 57.2 per cent, respectively. Four in every 10 (44 per cent) people in Punjab reported hypertension, the highest in India. India has 60 million diabetics among its population of 1.3 billion (estimated national prevalence 7.8 per cent), and is next only to China. Half of diabetics in India don’t know their status, making treatment that much more difficult. Untreated diabetes can cause blindness, loss of foot, renal and heart diseases. Women from Meghalaya leanest Earlier, Health Ministry studies had showed that Punjabis are the most obese people in the country while men from Tripura and women from Meghalaya are the leanest. According to figures women everywhe Continue reading >>

Chandigarh Set To Become Diabetes Capital, Finds Study Conducted By Icmr

Chandigarh Set To Become Diabetes Capital, Finds Study Conducted By Icmr

Chandigarh » Community WORLD HEALTH DAYPunjab most obese, hypertensive, finds study conducted by Indian Council of Medical Research New Delhi, April 8 A pan-India survey on the burden of diabetes has shown that Chandigarh is on course to becoming the country’s diabetes capital while Punjab is a close second. Punjab has emerged the national leader in obesity, hypertension and dyslipidemia, all risk factors for major non-communicable diseases. ICMR’s (Indian Council of Medical Research) India Diabetes Study, a door-to-door survey of men and women above 20 years of age is the first national study by the government to determine the exact national prevalence of diabetes and pre-diabetes in India by calculating state-wise prevalence. Discussing the findings on World Health Day (whose theme this year is diabetes control) today, ICMR chief Soumya Swaminathan said: “We have found wide regional variations in the prevalence of diabetes and pre-diabetes in India. Meghalaya has the lowest diabetes prevalence at 4.5%, while Chandigarh has the highest at 13.6%, followed by Punjab at 9.8%. Pre-diabetes prevalence is also the highest for Chandigarh at 14.6 per cent and the lowest for Mizoram at 5.8%.” Results are currently available for 15 states with the ICMR set to cover the remaining 13 states soon. In every state, the sample size was 4,000 (2,800 rural plus 1,200 urban). Findings show Punjab as the most obese and hypertensive on account of its prosperity and consumption patterns. Punjab has the highest prevalence of both generalised and abdominal obesity at 40.5 and 57.2%, respectively. Four in every 10 (44%) people in Punjab reported hypertension, the highest in India. Even for dyslipimedia (high fats in bloodstream), Punjab has the highest prevalence (92.3%) among the 15 Continue reading >>

Nearly 50% Of Diabetics Identified In 14 Indian States Unaware Of Their Condition

Nearly 50% Of Diabetics Identified In 14 Indian States Unaware Of Their Condition

A large community-based study involving over 57,000 adults from 14 States and a Union Territory (Chandigarh) in the country has revealed that the average prevalence of diabetes in these States stands at 7.3%. The prevalence varied from 4.3% of the population in the case of Bihar, to 10.4% in Tamil Nadu; Chandigarh was found to have a prevalence of 13.6%. The study also showed that the economically more developed States had a higher prevalence than economically less developed States. The overall prevalence of diabetes was lower in the northeast States compared with other States. The prevalence of pre-diabetes in all the 14 States and Chandigarh was found to be 10.3%. It varied from 6% (Mizoram) to 14.7% (Tripura). This high prevalence implies the existence of a huge number of people who could develop the disease in the near future. More than 47% studied were unaware of having diabetes until they tested. The prevalence was higher in urban areas (11.2%) compared to rural areas (5.2%). With 5.9%, the northeast States registered lesser prevalence compared with other States studied (8.3%). While people with better socio-economic status in rural areas had a higher prevalence of the disease, in the relatively more affluent States such as Tamil Nadu and Gujarat, the reverse was was found to be true. Epidemiological shift “We are seeing an epidemiological transition. Awareness is high among the rich and they are taking care of themselves, while diabetes is hitting the poorer people in these States,” says Dr. V. Mohan from Dr. Mohan’s Diabetes Specialities Centre, Chennai and one of the authors of the paper. The Phase I of the study included Tamil Nadu, Chandigarh, Jharkhand, and Maharashtra (2008-2010) and Phase II included Andhra Pradesh, Bihar, Gujarat, Karnataka, and Pun Continue reading >>

Diabetes Is India's Fastest Growing Disease: 72 Million Cases Recorded In 2017, Figure Expected To Nearly Double By 2025

Diabetes Is India's Fastest Growing Disease: 72 Million Cases Recorded In 2017, Figure Expected To Nearly Double By 2025

Diabetes is India's fastest growing disease: 72 million cases recorded in 2017, figure expected to nearly double by 2025 India IndiaSpend Apr 17, 2018 16:10:11 IST Mumbai:Indias economic development has brought higher incomesand a large helping of diabetes. As salaries have increased, and all socio-economic groups have experienced a rise in living standards, diabetesa condition caused by the bodys inability to regulate insulin levels, which can lead to tissue damage and organ failurebecame the countrys fastest growing disease burden over 16 years to 2016. India currently represents 49 percent of the worlds diabetes burden, with an estimated 72 million cases in 2017, a figure expected to almost double to 134 million by 2025. This presents a serious public health challenge to a country facing a future of high population growth and a government attempting to provide free health insurance to half a billion people. Diabetes prevalence has increased by 64 percent across India over the quarter-century, according to a November 2017 report by the Indian Council for Medical Research, Institute for Health Metrics and Evaluation, both research institutes, and the Public Health Foundation of India, an advocacy. In 1990, Indias per capita income was $380 (Rs 24,867), rising 340 percent to $1,670 (Rs 1,09,000) in 2016, as per data from the World Bank . Over the same period, the number of diabetes cases increased by more than 123 p ercent. Amongst the wealthiest quintilethe surveyed group were divided into five equal groups according to wealth2.9 percent of women and 2.7 percent of men reported they had diabetes when asked in the National Family Health Survey (NFHS) 2015-16 . These rates are almost triple those found in the lowest quintile (0.8 percent for women and 1.0 percent for me Continue reading >>

High Rates Of Diabetes, Hypertension Found In India

High Rates Of Diabetes, Hypertension Found In India

High rates of diabetes, hypertension found in India January 29, 2018, Harvard T.H. Chan School of Public Health Rates of diabetes and hypertension are high among middle-aged and elderly people across all geographic measures and sociodemographic groups in India, according to the first nationally representative study of those conditions in the country. The study, led by researchers at Harvard T.H. Chan School of Public Health, also found unexpectedly high rates of hypertension among young adults. "Understanding how diabetes and hypertension prevalence varies within a country as large as India is essential for targeting of prevention, screening, and treatment services," said lead author Pascal Geldsetzer, a doctoral student in the Department of Global Health and Population. The study appears online January 29, 2018 in JAMA Internal Medicine. India, home to more than a sixth of the world's population, is in the midst of a rapid epidemiological transition. Rates of noncommunicable diseases have risen in recent decades and are likely to continue as India's population ages and urbanizes. Meanwhile, many areas of India still face substantial burdens of infectious diseases and poor maternal and child health . The researchers wanted to find out how the prevalence of diabetes and hypertension in India varied by state, rural vs. urban location, and by sociodemographic characteristics such as education and household wealth. They used health data collected from 1,320,555 adults across India between 2012 and 2014, which included plasma glucose and blood pressure measurements. The findings showed that diabetes and hypertension were prevalent across all geographies and sociodemographic groups. Overall, prevalence of diabetes was 6.1% among women and 6.5% among men; for hypertension, 20 Continue reading >>

Diabetes In Kerala

Diabetes In Kerala

Kerala ─ Diabetes Capital of India Kerala is the diabetes capital of India with a prevalence of diabetes as high as 20% ─ double the national average of 8%. 1, 2 In a large multi-center study involving nearly 20,000 subjects, the prevalence of diabetes in Thiruvananthapuram was 17% compared to 15% in Hyderabad and New Delhi, 4% in Nagpur and 3% in Dibrugarh.(Table 004). 1, 2 Several studies from different parts of Kerala support the high prevalence of diabetes. One study from central Kerala reported a prevalence of diabetes at 20% and prediabetes at 11%.3 Another study from southern Kerala, showed a wide urban-rural gradient in age-standardized (30-64 years) prevalence of diabetes indicating an important role of lifestyle factors.4 The prevalence was 17% in urban, 10% in the midland, 7% in the highland, and 4% in the coastal regions.4 Other studies have shown a prevalence of 11-19% in men and 15-22% in women with rural Keralans having paradoxically higher rates of diabetes than urban dwellers (Kerala Paradox). This is in sharp contrast to national data that shows the prevalence of diabetes to be double in urban areas than rural areas.5, 6 The high literacy rate in this state does not seem to translate to health literacy. The high prevalence of diabetes is accompanied by poor detection. In one study, a surprising 11% (55% of all diabetes) were newly diagnosed.3 The control rates of diabetes are even poor, which could lead to an increase in the burden of cardiovascular disease (CVD)─the foremost killer of people with diabetes.7 Among those with diagnosed diabetes, 17% received no treatment, 15% were on diet alone, and 68% were on medications. Only 40% of people with diabetes had adequate control of blood sugar. The fasting blood glucose was 153 mg/dl and the mean gl Continue reading >>

Gujarat’s Sweet Toothache: Highest Incidence Of Diabetes In The County

Gujarat’s Sweet Toothache: Highest Incidence Of Diabetes In The County

That Gujarat pips all other states with the highest number of diabetes and hypertension cases as reported in the recent National Health Profile 2015 by Central Bureau of Health Intelligence under Ministry of Health and Family Welfare, rarely comes as a shock to people in a state known for its sweet tooth. The fact that there is a long festival season that stretches from Shravanin July-August to Holi in March with Janmashtami, Dusshera, Diwali and Uttarayan in between, makes the problem even more acute. Health experts attribute three primary reasons for the state recording the highest number of diabetes cases in the country: Gujaratis’ penchant for adding sugar to almost all food items over and above sweets that are also an integral part of the daily diet; the professional lifestyle of a population employed largely in business concerns leading to physical inactivity and thirdly obesity. “Sugar is added to almost all the food items in addition to sweets and desserts. Not only sugar, but a fatty laden diet with oil and ghee is another weakness among Gujaratis,” explained Dr Jaydip Oza, the state diabetes programme officer. As per the health profile report, the number of diabetic persons in Gujarat stands at 1,61,578 which is 20.5 per cent of the total 7,87,435 population screened. Along with diabetes, hypertension, too, has the highest number of cases reported from Gujarat. With 1,59,150, cases, hypertension also records an equal percentage of 20.2 per cent cases out of the total population screened. State authorities claim that Gujarat recording the highest number of diabetes cases could be the result of 100 per cent reporting to the central bureau under an online report launched by the health department. However, other studies have too confirmed a higher prevalence Continue reading >>

Diabetic Patients: Kerala Tops List Of Indian States

Diabetic Patients: Kerala Tops List Of Indian States

Diabetic patients: Kerala tops list of Indian states Diabetic patients: Kerala tops list of Indian states Kerala has the largest number of diabetes patients followed by Tamil Nadu and Punjab, according to endocrinologists and diabetologists in the state. A recent ICMR study in fifteen states had found a mean prevalence of 7.3 per cent. While 19.4% people have diabetes in Kerala, the corresponding figures in Chandigarh and Tamil Nadu are 13.6% and 10% respectively In the age group of 45 to 69 years nearly two third (67.7%) had either diabetes or pre-diabetes KOCHI: Kerala has the largest number of diabetes patients followed by Tamil Nadu and Punjab, according to endocrinologists and diabetologists in the state. While 19.4% people have diabetes in Kerala, the corresponding figures in Chandigarh and Tamil Nadu are 13.6% and 10% respectively, according to analysis of separate studies done by Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram and Indian Council of Medical Research . A recent ICMR study in fifteen states had found a mean prevalence of 7.3 per cent. Though diabetes was more common in urban areas, it was seen that in seven states with relatively higher economic status the disease was affecting the lower socioeconomic group. This is in contrast to the situation which prevailed earlier. However, Kerala was not part of the study. But a recently concluded study on 12,000 adults in Kerala by Sri Chitra showed that one in five adults had diabetes. Nearly six per cent people with diabetes could have the diseases under control. In Kerala, there is a high burden of pre-diabetes also which in addition to leading to diabetes also increases the risk for heart disease. In the age group of 45 to 69 years nearly two third (67.7%) had either Continue reading >>

Review Diabetes Care In India

Review Diabetes Care In India

Abstract Diabetes has become a major health care problem in India with an estimated 66.8 million people suffering from the condition, representing the largest number of any country in the world. The rising burden of diabetes has greatly affected the health care sector and economy in India. The goal of health care experts in India is to transform India into a diabetes care capital in the world. An expert detailed review of the medical literature with an Asian Indian context was performed. Recent epidemiologic studies from India point to a great burden from diabetes. Diabetes control in India is far from ideal with a mean hemoglobin A1c of 9.0%—at least 2.0% higher than suggested by international bodies. Nearly half of people with diabetes remain undetected, accounting for complications at the time of diagnosis. Screening can differentiate an asymptomatic individual at high risk from one at low risk for diabetes. Despite the large number of people with diabetes in India, awareness is low and needs to be addressed. Other challenges include balancing the need for glycemic control with risk reduction due to overly tight control, especially in high-risk groups and taking into account health care professional expertise, attitudes, and perceptions. Pharmacologic care should be individualized with early consideration of combination therapy. Regular exercise, yoga, mindful eating, and stress management form a cornerstone in the management of diabetes. Considering the high cost incurred at various steps of screening, diagnosis, monitoring, and management, it is important to realize the cost-effective measures of diabetes care that are necessary to implement. Result-oriented organized programs involving patient education, as well as updating the medical fraternity on various deve Continue reading >>

Epidemiology Of Diabetes Mellitus

Epidemiology Of Diabetes Mellitus

Prevalence (per 1,000 inhabitants) of diabetes worldwide in 2000 - world average was 2.8%. no data ≤ 7.5 7.5–15 15–22.5 22.5–30 30–37.5 37.5–45 45–52.5 52.5–60 60–67.5 67.5–75 75–82.5 ≥ 82.5 Disability-adjusted life year for diabetes mellitus per 100,000 inhabitants in 2004 No data <100 100–200 200–300 300–400 400–500 500–600 600–700 700–800 800–900 900–1,000 1,000–1,500 >1,500 Globally, an estimated 422 million adults are living with diabetes mellitus, according to the latest 2016 data from the World Health Organization (WHO).[1] Diabetes prevalence is increasing rapidly; previous 2013 estimates from the International Diabetes Federation put the number at 381 million people having diabetes.[2] The number is projected to almost double by 2030.[3] Type 2 diabetes makes up about 85-90% of all cases.[4][5] Increases in the overall diabetes prevalence rates largely reflect an increase in risk factors for type 2, notably greater longevity and being overweight or obese.[1] Diabetes mellitus occurs throughout the world, but is more common (especially type 2) in the more developed countries. The greatest increase in prevalence is, however, occurring in low- and middle-income countries[1] including in Asia and Africa, where most patients will probably be found by 2030.[3] The increase in incidence in developing countries follows the trend of urbanization and lifestyle changes, including increasingly sedentary lifestyles, less physically demanding work and the global nutrition transition, marked by increased intake of foods that are high energy-dense but nutrient-poor (often high in sugar and saturated fats, sometimes referred to as the Western pattern diet).[1][3] The risk of getting type 2 diabetes has been widely found to be associat Continue reading >>

Sikkim Reports Highest Number Percent Of Diabetes, Hypertension As Per Npcdcs Screening

Sikkim Reports Highest Number Percent Of Diabetes, Hypertension As Per Npcdcs Screening

Sikkim reports highest number percent of diabetes, hypertension as per NPCDCS screening Joseph Alexander, New Delhi Saturday, October 12, 2013, 08:00 Hrs [IST] Belying the common notion that South Indian States reported maximum number of diabetes cases, Sikkim emerged as the State to have maximum percentage of suspected diabetic patients, if the ongoing screening for diabetes and hypertension by the Union government is any indication. According to the figures based on the screening so far done under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), screening for diabetes & hypertension among the population above 30 years of age has been initiated in 100 districts of 21 States. 3,81,12,537 persons have been screened for diabetes and 20,14,385 persons have been screened for hypertension till the end of August. The screening found that 6.32 per cent of the population having suspected of diabetes and 5.91 per cent as suspected of hypertension. Standing high above the national average, 13.67 per cent people among those screened had diabetes while 18.16 per cent of them have hypertension. Out of total 127,393 people screened, 17414 persons have suspected cases of diabetes while 32,225 have hypertension. Karnataka (9.36 per cent), Punjab (9.36 per cent), Gujarat (9.10 per cent) and Andhra Pradesh (7.42 per cent) reported high incidence after Sikkim in the case of diabetes. Madhya Pradesh with just 2.57 per cent reported the least number of cases. In the case of hypertension, Assam came second with 10.42 per cent of prevalence, after Sikkim. According to report published by International Diabetes Federation (IDF; 5th Edition, 2011), number of people with diabetes (20-79 years) in Urban setting of India are about Continue reading >>

Prevalence Of Diabetes And Prediabetes In 15 States Of India: Results From The Icmr-indiab Population-based Cross-sectional Study.

Prevalence Of Diabetes And Prediabetes In 15 States Of India: Results From The Icmr-indiab Population-based Cross-sectional Study.

Abstract BACKGROUND: Previous studies have not adequately captured the heterogeneous nature of the diabetes epidemic in India. The aim of the ongoing national Indian Council of Medical Research-INdia DIABetes study is to estimate the national prevalence of diabetes and prediabetes in India by estimating the prevalence by state. METHODS: We used a stratified multistage design to obtain a community-based sample of 57 117 individuals aged 20 years or older. The sample population represented 14 of India's 28 states (eight from the mainland and six from the northeast of the country) and one union territory. States were sampled in a phased manner: phase I included Tamil Nadu, Chandigarh, Jharkhand, and Maharashtra, sampled between Nov 17, 2008, and April 16, 2010; phase II included Andhra Pradesh, Bihar, Gujarat, Karnataka, and Punjab, sampled between Sept 24, 2012, and July 26, 2013; and the northeastern phase included Assam, Mizoram, Arunachal Pradesh, Tripura, Manipur, and Meghalaya, with sampling done between Jan 5, 2012, and July 3, 2015. Capillary oral glucose tolerance tests were used to diagnose diabetes and prediabetes in accordance with WHO criteria. Our methods did not allow us to differentiate between type 1 and type 2 diabetes. The prevalence of diabetes in different states was assessed in relation to socioeconomic status (SES) of individuals and the per-capita gross domestic product (GDP) of each state. We used multiple logistic regression analysis to examine the association of various factors with the prevalence of diabetes and prediabetes. FINDINGS: The overall prevalence of diabetes in all 15 states of India was 7·3% (95% CI 7·0-7·5). The prevalence of diabetes varied from 4·3% in Bihar (95% CI 3·7-5·0) to 10·0% (8·7-11·2) in Punjab and was higher in Continue reading >>

Prevalence Of Diabetes In India

Prevalence Of Diabetes In India

According to the World Health Organisation (WHO), diabetes is currently one of the biggest health concerns that the world is faced with. WHO defines diabetes as “a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces”. Insulin is a hormone that regulates blood sugar. A common effect of diabetes is Hyperglycemia or increased blood sugar. Diabetes causes some serious health issues including blindness, kidney failure, stroke and heart diseases. Type 1 diabetes occurs when the body produces insufficient quantities of insulin. It is usually detected more in children. Type 2 diabetes occurs when the body does not effectively use the insulin produced. This is very frequently due to lack of physical activity, obesity, or incorrect dietary habits. Gestational diabetes occurs among pregnant women. In about 90 percent of cases, it is Type 2 diabetes that people are suffering from. The occurrence of Type 2 diabetes or Diabetes Mellitus may be prevented or delayed by adopting a healthy lifestyle. Diabetes can be identified by telltale symptoms – frequent urination, unusual thirst, excessive fatigue and hunger, weight loss, and wounds that take long to heal. Type 2 diabetes, however, may remain unnoticed and patients may not display any signs for years. Prevalence of Diabetes in India According to statistics from the International Diabetes Federation (IDF), India has more diabetics than any other nation of the world. Current estimates peg the number of diabetics in the country at about 62 million – an increase of over 10 million from 2011 when estimates suggested that about 50.8 million people in the country were suffering from the disease. If you think the disease has already reac Continue reading >>

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