Anil Goswami

Prevalence of celiac disease in the northern part of India: A community based study

Background and Aim:  While celiac disease is estimated to affect about 1% of the worlds population, it is thought to be uncommon not only in India but in Asia also. There is a lack of studies on the prevalence of celiac disease from Asian nations. The aim of the present study was to estimate the prevalence of celiac disease in the community.

Prevalence of Irritable Bowel Syndrome: A Community Based Study From Northern India

BACKGROUND/AIMS The prevalence of irritable bowel syndrome (IBS) varies from 4% to 20% in different Asian nations. Prevalence of IBS in native North Indian community is not known. METHODS Between November 2008 to December 2009, we estimated the prevalence of IBS in a rural community of Ballabgarh block, located in Haryana state. A structured questionnaire based on Rome III module was used to collect symptoms related to IBS from all the participants in a door to door survey. A Rome III criterion was used for diagnosis of IBS. IBS was further classified based on predominance of symptoms as constipation predominant, diarrhea predominant, mixed and unspecified based on Rome III module. RESULTS There were 4,767 participants (mean age 34.6 ± 10.8, males 50%). Overall, 555 (11.6%; 95% CI, 10.7-12.5) had constipation, 542 (11.4%; 95% CI, 10.5-12.3) diarrhea and 823 (17.3%; 95% CI, 16.2-18.4) abdominal pain. The overall prevalence of IBS was 4% (95% CI, 3.5-4.6). The prevalence of constipation predominant IBS was 0.3% (95% CI, 0.16-0.49), diarrhea predominant IBS 1.5% (95% CI, 1.18-1.90), mixed IBS 1.7% (95% CI, 1.35-2.11) and unsubtyped IBS 0.5% (95% CI, 0.32-0.75). The prevalence of IBS was significantly higher in females compared with males (4.8% vs 3.2%, P = 0.008). However, there was no significant difference between males and females in the prevalence of different subtypes of IBS. The prevalence increased with age. CONCLUSIONS The prevalence of IBS in a North Indian community is 4%. IBS poses a significant burden on the rural adults.

Community Perception and Client Satisfaction about the Primary Health Care Services in an Urban Resettlement Colony of New Delhi.

Research Question: This study attempts to assess the community perception and client satisfaction of primary health care services provided by mobile health clinics. Objectives: To assess the awareness of the community about mobile health clinic services and its utilization in an urban area and to assess the client satisfaction of those who have utilized the services. Study Design: A cross-sectional community-based study. Setting: Dr. Ambedkar Nagar, urban resettlement colony of New Delhi. Study Period: July 2006 and September 2006. Participants: For exit interviews, patients who have utilized the mobile health clinic; for community interviews, an adult member present in the family. Materials and Methods: For the community survey, two blocks were randomly chosen and the interview was carried out by house visits. For exit interviews, patients were selected randomly from those attending the mobile health clinic. Statistical Analysis: Descriptive statistical analysis. Results and Conclusions: A total of 377 interviews were conducted (295 community interviews and 82 exit interviews). It was seen that 82% were aware of the mobile health clinic but more than two-thirds preferred private practitioners; reasons given were that they have more trust in private practitioners, convenient timings, and less waiting time. Approximately two-thirds to three-fourths of the clients were satisfied with the mobile health clinic services. Client satisfaction is an important measure of the quality of health care and needs to be addressed in order to improve the utilization of primary health care services in urban areas.

Prevalence of dental caries among adults and elderly in an urban resettlement colony of New Delhi

BACKGROUND Dental caries remains the most important dental health problem in developing countries. In India the prevalence of dental caries is reported to be about 50-60%. Most of the Indian studies have been carried out in school children and very few in adults. This study aimed to estimate the prevalence of dental caries in the adult population (aged 35-44 years) and in the elderly (60 years and above) in an urban resettlement colony in New Delhi. METHODOLOGY A community-based cross-sectional study was carried out in Dakshinpuri, New Delhi, from January to February 2007. A local adaptation of the WHO questionnaire was used. Oral examination was done and dentition status was recorded by trained investigators and according to the standard procedures. RESULTS A total of 452 participants were enrolled in the study. The prevalence of dental caries in the 35-44 years age-group was 82.4% and it was 91.9% in those > or =60 years. The DMF index was 5.7 +/- 4.7 in the 35-44 years age-group and 13.8 +/- 9.6 in the > or =60 years age-group. Of the participants, 27.9% were currently using tobacco. A statistically significant association was found between tobacco consumption and dental caries ( P = 0.026). The awareness about good and bad dental practices was found to be low among the study participants. One-fifth of the individuals with dental problems relied on home remedies. CONCLUSION The prevalence of dental caries among adults is high in this population. There is a need to generate awareness about oral health and the prevention of dental caries and to institute measures for the provision of dental care services at the primary level.

Tobacco and alcohol use in rural elderly Indian population.

Background: Tobacco and alcohol use are serious health problems. Studies focusing on problems associated with tobacco and alcohol use in the elderly are limited. Aim: To find out the prevalence of tobacco and alcohol use among rural elderly population. Methods: This cross-sectional study was conducted in the intensive field practice area of the Comprehensive Rural Health Services Project in Ballabgarh in Faridabad, Haryana, a rural field practice area of the Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi. The sample was selected using stratified random cluster sampling. The participants were ≥60 years of age at the time of interview. Data on tobacco and alcohol use pattern of 1117 elderly were collected during the interview. Results: The prevalence of smoking was 71.8% in men (n=490) and 41.4% in women (n=497). Among men smokers, 41.5% were light smokers (≤5 beedis/day), 42.9% were moderate smokers (6–20 beedis/day) and 15.6% were heavy smokers (>20 beedis/day). Among women smokers, 71.8% were light smokers, 23.8% were moderate smokers and 4.4% were heavy smokers. Regular alcohol intake was seen in 16.3% of the men compared with 0.8% of the women. Conclusion: The finding of a high prevalence of smoking and alcohol consumption among men in this rural population of India is of serious concern and therefore needs remedial measures.

High burden of dental caries in geriatric population of India: A systematic review

Oral health is an essential component of health throughout life. Poor oral health and untreated oral diseases can have a significant impact on the quality of life of the elderly. The objective of this study was to estimate the burden of dental caries among the elderly persons in India in the past two decades. A systematic review from available literature was carried out. Six community-based articles were included in this review. The selected studies were screened by using STROBE checklist for observational studies. All studies were found to contain the required essentials of observational studies. Weighted prevalence of dental caries experience was calculated. Trend was generated using Microsoft Excel program. The prevalence of dental caries experience ranged from 31.5 to 100%. Weighted prevalence of dental caries experience was 83.6% and 82.3% for 2000-2004 and 2005-2009, respectively. There is a high burden of dental caries in the elderly population. Treatment and restorative services need to be provided to alleviate this problem.

Cost of Ambulatory Care by Mobile Health Clinic Run by a Medical College in India for the Year 2008-09

BACKGROUND The feasibility of using mobile health clinics (MHCs) to deliver health services in urban poor areas has to be explored as the health needs of the residents are not sufficiently addressed by the existing primary health care delivery system in India. OBJECTIVE To estimate the cost of providing primary health care services and the out of pocket expenditure (OOPE) incurred, while utilizing these services provided through the MHC based Urban Health Program of a Medical College in North India for the year 2008-2009. MATERIALS AND METHODS A cross-sectional study to estimate OOPE was conducted among 330 subjects selected from patients attending the mobile health care facility. For estimation of provider cost, 5 steps process involving identification of cost centres, measurement of inputs, valuing of inputs, assigning of inputs to cost centers, and estimation of unit cost were carried out. RESULTS Total annual cost of providing services under Urban Health Program in the year 2008-2009 was Rs. 7,691,943 Unit cost of providing outpatient curative care, antenatal care, and immunization were Rs. 107.74/visit, Rs. 388/visit and Rs. 66.14 per immunization, respectively. The mean OOPE incurred was Rs. 29.50/visit, while utilizing outpatient curative services and Rs. 88.70/visit for antenatal services. CONCLUSION The MHC can be considered as a viable option to provide services to urban poor.

Unintentional childhood injuries in urban Delhi: A community-based study

Background: Childhood injuries claim around a million lives around the world each year. A community-based study on childhood injuries would provide valuable information on the epidemiology of injuries. Objective: To assess the prevalence of unintentional childhood injuries in an urban locality and determine various sociodemo graphic factors associated with childhood injuries. Methods: The study was done in urban Delhi among 1,639 children aged less than 18 years. Information on injuries in the last one year was collected. Only those injury episodes where treatment was sought or the child was left disabled after the injury were included. Treatment seeking behavior and the impact of injury on the child and the household were also assessed. Results: Among 1,639 children, 102 children suffered 116 episodes of various types of injuries in the last one year. Prevalence of injuries was 7.1% (95% CI: 5.9-8.4). Mean age was 8.5 ± 5.1 years. Prevalence was more in boys (8.4%) than girls (5.1%). Accidental falls (37.1%), dog bites (25%), and road traffic injuries (18.9%) were the three most common modes of injury. Two-thirds of children with injuries were taken to the emergency facility for treatment while 40% resorted to home remedies. Treatment expenses in some families led to the need for borrowing money, additional employment by another family member, and selling of household assets. Conclusions: The prevalence of childhood injuries in the past one year was 7.1%. Maximum injuries occurred at home and were mostly accidental falls and dog bites. Childhood injuries caused loss of school attendance and financial burden to the family.

Burden of Hypertension and Diabetes among Urban Population Aged ≥ 60 years in South Delhi: A Community Based Study.

INTRODUCTION India is going through a demographic transition, and the number of elderly is expected to increase both in absolute numbers, as well as in proportion. The elderly are one of the most vulnerable and high-risk group in terms of health status in any society, and more so for non- communicable diseases. AIMS To estimate the prevalence of diabetes and hypertension among elderly persons and association with socio-demographic variables; & to assess the awareness, treatment and control status of those with diabetes and hypertension. MATERIALS AND METHODS A cross-sectional community based study was carried out in a resettlement colony of South-east Delhi in Dakshinpuri Extension, Dr. Ambedkar Nagar. Elderly persons aged 60 years and above were selected by cluster random sampling. Information about self-reported diseases, socio-demographic variables was collected; fasting blood sugar and blood pressure were measured. Prevalence of diabetes and hypertension were calculated and association was tested by Chi-square test. Multivariate logistic regression analysis was used. RESULTS A total of 710 elderly persons participated in the study. Diabetes was seen in 24.0% and 67% were hypertensive. Isolated hypertension was detected in 25.9%. No statistically significant difference by gender (p=0.11), age (p=0.16), education (p=0.31) and economic dependency (p=0.28), was seen in both diabetes and hypertension. Out of 167 persons with diabetes, 62.3% were on treatment and 33.6% were under control; while out of 477 hypertensives, 41% were under treatment and only one-third of them had their blood pressure under control. CONCLUSION This study highlighted a significant burden of non-communicable diseases amongst elderly persons in a low-middle class community in Delhi. It also showed the lack of awareness about their disease conditions and need for screening, diagnostic and treatment services at the primary level.

Prevalence of malnutrition, diarrhea, and acute respiratory infections among under-five children of Sugali tribe of Chittoor district, Andhra Pradesh, India

Introduction: Over a period, tribal population has migrated to cities in search of livelihood. Data on various health problems of the tribes are sparse. Sugalis constitute the third largest tribe in Andhra Pradesh and have settlements in urban areas. Objective: To estimate the prevalence of malnutrition, diarrhea, and acute respiratory infections (ARI) among under-five children of Sugali tribe living in Chittoor district of Andhra Pradesh state in South India. Materials and Methods: A community-based cross-sectional study was conducted in four community blocks/mandals in 2012. A total of 500 Sugali households with under-five were identified. Demographic details, episodes of diarrhea, and ARI among under-five children and treatment/care seeking behavior were collected from mothers/care givers by interview. Nutritional status was assessed using new WHO standards. Results: Of the total 669 children in these 500 households, 343 (51.3%) were girls and 326 (48.7%) were boys. In the last 1 month, 21.4% (18.4-24.6) reported diarrhea and 51.6% (47.7-55.3) reported ARI. The prevalence of underweight, wasting, and stunting among under-five children was 32.7% (29.1-36.4), 18.3% (15.3-21.4), and 38.3% (34.2-41.9), respectively. Majority (70%) sought treatment for illness in modern system of medicine and only few continued with the practice of herbs and traditional medicine. Discussion: Despite living in urban area, the tribal children had high prevalence of malnutrition, diarrhea, and ARI, though lower compared to other tribes in India possibly due to improved access to health care services. Efforts need to be strengthened for social inclusion of tribes into mainstream.