Abraham Joseph

Suicides in young people in rural southern India

Different rates of suicide have been reported in India. In Vellore, southern India, we have noted that the rates of suicides are several fold higher than those reported anywhere in the world, especially in young women. The department of community health at the Christian Medical College, Vellore, has obtained data prospectively on births, deaths, and morbidity in a population of 108?000. We used the verbal autopsy method to assign cause of death. The mortality rates were analysed for 10 years, from 1992 to 2001, for the age-group 10-19 years. Suicides accounted for about a quarter of all deaths in young men and between 50% and 75% of all deaths in young women. The average suicide rate for young women was 148 per 100?000, and for young men 58 per 100?000. We believe that our findings are reliable. The system of surveillance is well established and the verbal autopsy method has been validated. These very high rates of suicide need urgent intervention.

Evaluation of suicide rates in rural India using verbal autopsies, 1994-9

Suicide rates have increased in many developing countries.1 But the reported rates are misleading because population counts are unreliable, and identifying suicides is problematic because of inefficient civil registration systems, non-reporting of deaths, variable standards in certifying death, and suicides legal and social consequences. Suicide rates were between 8.1 and 58.3/100 000 population for different parts of India.2 Police records, which under-report, were used to calculate these rates. We used verbal autopsies in the 85 villages of the Kaniyambadi region of southern India (area 127 km2; population 108 873 in 1999) to calculate mean age and sex specific suicide rates for the period 1994-9. A community health worker (a resident of the village), health aide, community nurse, and doctor reached a consensus on the cause of death. …

Solar disinfection of water for diarrhoeal prevention in southern India

Aims: To evaluate the efficacy and acceptability of solar irradiation in the prevention of diarrhoeal morbidity in children under 5 years of age, in an urban slum in Vellore, Tamil Nadu. Methods: A total of 100 children were assigned to receive drinking water that had been subjected to solar disinfection in polyethylene terephthalate bottles. One hundred age and sex matched controls were also selected. Both groups were followed by weekly home visits for a period of six months for any diarrhoeal morbidity. At the end of the follow up period, the acceptability of the intervention was assessed by interviews, questionnaires, and focus group discussions. Results: There was significant reduction in the incidence, duration, and severity of diarrhoea in children receiving solar disinfected water, despite 86% of the children drinking water other than that treated by the intervention. The incidence of diarrhoea in the intervention group was 1.7 per child-year, and among controls 2.7 per child-year, with an incidence rate ratio of 0.64 (95% CI −0.48 to 0.86). The risk of diarrhoea was reduced by 40% by using solar disinfection. In qualitative evaluation of acceptability, most women felt that solar disinfection was a feasible and sustainable method of disinfecting water. Conclusions: Solar disinfection of water is an inexpensive, effective, and acceptable method of increasing water safety in a resource limited environment, and can significantly decrease diarrhoeal morbidity in children.

Reproductive tract infections among young married women in Tamil Nadu, India.

CONTEXT Women often suffer silently with reproductive tract infections (RTIs). Studies of the prevalence of these infections in South Asia have been hindered by low participation rates, and little is known about rates among the youngest married women. METHODS A community-based cross-sectional study of RTIs was conducted in 1996-1997 among married women 16-22 years of age in Tamil Nadu, India. The women were questioned about symptoms, received pelvic and speculum examinations and provided samples for laboratory tests. Qualitative and quantitative data on treatment-seeking behavior were collected. RESULTS Fifty-three percent of women reported gynecologic symptoms, 38% had laboratory findings of RTIs and 14% had clinically diagnosed pelvic inflammatory disease or cervicitis. According to laboratory diagnoses, 15% had sexually transmitted infections and 28% had endogenous infections. Multivariate analysis found that women who worked as agricultural laborers had an elevated likelihood of having a sexually transmitted infection (odds ratio, 2.4), as did those married five or more years (2.1). Two-thirds of symptomatic women had not sought any treatment; the reasons cited were absence of a female provider in the nearby health care center, lack of privacy, distance from home, cost and a perception that their symptoms were normal. CONCLUSIONS Young married women in this rural Indian community have a high prevalence of RTIs but seldom seek treatment. Education and outreach are needed to reduce the stigma, embarrassment and lack of knowledge related to RTIs. The low social status of women, especially young women, appears to be a significant influence on their low rates of treatment for these conditions.

Hearing impairment and otitis media in a rural primary school in South India

In order to determine the prevalence of hearing impairment and otitis media in rural primary school children, a pilot study of 284 children aged 6-10 years was performed. These children were screened by otoscopy, pure tone audiometry and tympanometry. The overall prevalence of otological abnormalities (excluding wax) was 21.5%. Hearing impairment was detected in 34 children (11.9%). Conductive hearing impairment was predominant (10.9%). Otitis media was diagnosed in 17.6% of children. While 91.2% of children with hearing impairment had associated middle ear disease, only 53.4% of those with middle ear disease were detected as have hearing impairment. The importance of including tympanometry as part of the screening protocol is highlighted.

Rates and factors associated with suicide in Kaniyambadi Block, Tamil Nadu, South India, 2000-2002.

Background: Inefficient civil registration systems, non-report of deaths, variable standards in certifying death and the legal and social consequences of suicide are major obstacles to investigating suicide in the developing world. Objective: The aim of this study was to prospectively determine the suicide rate in Kaniyambadi Block, Tamil Nadu, South India, for the years 2000–2002 using verbal autopsies. Method: The setting for the study was a comprehensive community health programme in a development block in rural South India. The main outcome measure was death by suicide, diagnosed by a detailed verbal autopsy and census, and birth and death data to identify the population base. Results: The average suicide rate was 92.1 per 100,000. The ratio of male to female suicides was 1: 0.66. The age-specific suicide rate for men increased with age while that for women showed two peaks: 15–24 years and over 65 years of age. Hanging (49%) and poisoning with organo-phosphorus compounds (40.5%) were the commonest methods of committing suicide. Acute and/or chronic stress was elicited for nearly all subjects. More men suffered from chronic stress while more women had acute precipitating events (X2 4.58; p < 0.04). People less than 44 years of age had more acute precipitating events before death while older subjects reported more chronic stress (X2=17.38; p < 0.001). Conclusion: The study replicates findings of an earlier study from the area. The suicide rate documented in this study is very high and is a major public health concern. There is a need for sentinel centres in India and in developing countries to monitor trends and to develop innovative strategies to reduce deaths by suicide.

Chronic suppurative otitis media: prevalence and practices among rural South Indian children

In order to determine the prevalence of chronic suppurative otitis media (CSOM) in rural South Indian children, a cross-sectional survey was conducted among 914 children (484 boys and 430 girls) from four primary schools and 12 nurseries (balwadis; preschool), of adjacent villages of North Arcot District of Tamil Nadu state. The preschool children were aged 2-5 years, while the ages of the primary school children ranged from 6 to 10 years. The overall prevalence rate of CSOM was found to be 6%. The disease was equally prevalent in preschool children (5.7%) and primary school children (6.2%) (P = 0.94). Cholesteatomatous ear disease was observed in 1.2% of children, those of the older age group having a slightly higher prevalence rate (1.5%) than the younger age group (0.7%). Parental beliefs and existing practices with respect to the disease are also presented.

Establishment of the MAL-ED Birth Cohort Study Site in Vellore, Southern India

The Indian Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) site is in Vellore, Tamil Nadu, in south India and is coordinated by the Christian Medical College, Vellore, which has many years of experience in establishing and following cohorts. India is a diverse country, and no single area can be representative with regard to many health and socioeconomic indicators. The site in Vellore is an urban semiorganized settlement or slum. In the study site, the average family size is 5.7, adults who are gainfully employed are mostly unskilled laborers, and 51% of the population uses the field as their toilet facility. Previous studies from Vellore slums have reported stunting in well over a third of children, comparable to national estimates. The infant mortality rate is 38 per 1000 live births, with deaths due mainly to perinatal and infectious causes. Rigorous staff training, monitoring, supervision and refinement of tools have been essential to maintaining the quality of the significantly large quantity of data collected. Establishing a field clinic within the site has minimized inconvenience to participants and researchers and enabled better rapport with the community and better follow-up. These factors contribute to the wealth of information that will be generated from the MAL-ED multisite cohort, which will improve our understanding of enteric infections and its interactions with malnutrition and development of young children.

Measles vaccination before nine months.

Summary objective  To measure the protective effect of measles vaccine administered before 9 months of age and compare overall mortality of children vaccinated at 6–8 months and at 9–11 months.nsp;Non‐concurrent cohort study involving all 13 134 children born between 16 January 1986 and 31st December 1991 in Kaniyambadi block near Vellore who had not left the area by six months of age. Main outcome measures were risk of disease and death among the under‐five‐year‐olds according to age at measles immunization.ensp;Unimmunized children had a higher risk of developing measles compared to the immunized(P < 0.05). There was no significant difference in risk of measles among those vaccinated prior to and after nine months of age. Unvaccinated children were at significantly higher risk of death than vaccinated children (P < 0.001). There was no difference in risk of death between infants vaccinated between 6 and 8 months and those vaccinated between 9 and 11 months. There was no difference in the risk of death between boys and girls vaccinated between 6 and 8 months with standard‐titre Edmonston‐Zagreb vaccine.p; Administration of standard‐titre Edmonston‐Zagreb measles vaccine at 6–8 months is an effective and safe preventive measure for measles, especially where the age‐specific attack rate for childrenis high.

Does antenatal care influence postpartum health behaviour? Evidence from a community based crosssectional study in rural Tamil Nadu, South India

Objective To study the association between attendance to antenatal care and postpartum health behaviour among women in rural Tamil Nadu, South India.