Ashok Kumar Bhardwaj

Is Dementia Differentially Distributed? A Study on the Prevalence of Dementia in Migrant, Urban, Rural, and Tribal Elderly Population of Himalayan Region in Northern India

Background: Throughout the world, a large number of surveys have been carried out to find the prevalence of dementia with variable results. Aims: This study was to generate data on the prevalence of dementia and to generate a hypothesis on the differential distribution across populations. Materials and Methods: Four settings identified for the purpose of this study included a migrant, urban, rural, and tribal. The study was conducted in two phases: 1) A screening phase and 2) a clinical phase, on 2,000 individuals above 60 years of age. To complete the required sample of 2,000 elderly individuals, 500 individuals were approached from each site. Nobody refused to participate. Results: A total of 32/2,000 (1.6%) elderly individuals were classified as demented. No case of dementia was reported from tribal population. A look at sex differential reveals that majority (21/32; 66%) of individuals identified as demented were females. As age advanced scores on cognitive screen decreased with elders above 80 years of age showing lowest scores. Out of 32, 18 (56%) of patients classified as demented were more than 80 years of age. Conclusion: The findings of this study are in agreement with previous studies which point towards differential distribution of dementia across populations.

Rapid Assessment for Coexistence of Vitamin B12 and Iron Deficiency Anemia among Adolescent Males and Females in Northern Himalayan State of India

Coexistence of folic acid and vitamin B12 deficiency has been observed among adolescents with iron deficiency anemia, but limited evidence is available from India. So, a rapid assessment was done to study the prevalence of iron, folic acid, and vitamin B12 deficiency among adolescent males and females in northern Himalayan state in India. Methods. Total 885 (female: 60.9%) adolescents (11 to 19 completed years) were surveyed from 30-cluster village from two community development blocks of Himachal Pradesh. Serum ferritin, folic acid, and vitamin B12 were estimated among randomly selected 100 male and 100 female adolescents. Results. Under-nutrition (BMI < 18.5 kg/m2) was observed among 68.9% of adolescents (male: 67.1%; female: 70.7; P = 0.29). Anemia was observed to be prevalent among 87.2% males and 96.7% females (P = 0.00). Mild form of anemia was observed to be the most common (53.9%) form followed by moderate (29.7%) anemia. Strikingly, it was found that all the adolescents were deficient in vitamin B12 and none of the adolescents was observed to be deficient in folic acid. Conclusion. Among both male and female adolescents anemia with vitamin B12 deficiency was observed to be a significant public health problem. Folic acid deficiency was not observed as a problem among surveyed adolescents.

Factors influencing early health facility contact and low default rate among new sputum smear positive tuberculosis patients, India.

Early case identification and prompt treatment of new sputum smear positive case are important to reduce the spread of tuberculosis (TB). Present study was planned to study the associated factors for duration to contact the health facility since appearance of symptoms and treatment default. Methodology. It was prospective cohort study of TB patients already registered for treatment in randomly selected TB units (TUs) in Himachal Pradesh, India. Relative risk (RR) was calculated as risk estimate to find out the explanatory variables for early contact and default. Results. Total 1607 patients were recruited and 25 (1.5%) defaulted treatment. Patients from nuclear family (aRR: 1.37; 1.09–1.73), ashamed of TB (aRR: 1.32; 1.03–1.70), wishing to disclose disease status (aRR: 1.79; 1.43–2.24), but aware of curable nature (aRR: 1.67; 1.17–2.39) and preventable (aRR: 1.35; 1.07–1.70) nature of disease, contacted health facility early since appearance of symptoms. Conclusion. Better awareness and less misconceptions about disease influences the early contact of health facility and low default rate in North India.

Development of a cognitive screening instrument for tribal elderly population of Himalayan region in northern India

Introduction: Cognitive impairment, characteristic of dementia, is measured objectively by standard neuropsychological (cognitive) tests. Given the diversity of culture and language in India, it is difficult to use a single modified version of MMSE uniformly to Indian population. In this article, we report methods on the development of a cognitive screening instrument suitable for the tribal (Bharmour) elderly (60 years and above) population of Himachal Pradesh, India. Materials and Methods: We used a systematic, item-by-item, process for development of a modified version of MMSE suitable for elderly tribal population. Results: The modifications made in the English version of MMSE and the pretesting and pilot testing thereof resulted in the development of Bharmouri version of cognitive scale. Discussion: The study shows that effective modifications can be made to existing tests that require reading and writing; and that culturally sensitive modifications can be made to render the test meaningful and relevant, while still tapping the appropriate cognitive domains.

Prevalence of autism spectrum disorder among rural, urban, and tribal children (1–10 Years of Age)

Introduction: Studies on autism spectrum disorders (ASDs) have largely focused on children in specific settings. The current scenario of research in ASDs is limited largely to clinic-based case reports, case series, and retrospective chart reviews. The present study is the first population-based prevalence study conducted across rural, urban, and tribal populations in India. Materials and Methods: A cross-sectional two-phase study was conducted covering children in the age group of 1–10 years of age across geographical regions representing rural, urban, and tribal populations. The first phase (screening phase) involved administration of the Hindi version of the Indian Scale for Assessment of Autism. Those identified as suspected of ASD and 10% of all classified as nonsuspects for autism were also evaluated by the clinical team in second phase (evaluation phase). Results: Forty-three children out of a total of 28,070 children in rural, urban, and tribal area in the age group of 1–10 years were diagnosed as cases of ASD yielding a prevalence of 0.15% (95% confidence interval [CI] =0.15–0.25). Logistic regression analysis showed a two times significantly higher risk of diagnosing ASD in rural area as compared to tribal (odds ratio [OR]; 95% CI = 2.17 [1.04–4.52], P = 0.04). Male sex and upper socioeconomic group of head of family/father had a higher risk of getting diagnosed as autism as compared to lower socioeconomic group (OR; 95% CI - 3.23; 0.24–44.28, P = 0.38). Conclusions: Estimation of true prevalence of ASD in India is going to improve policies on developmental disabilities.

Agreement between international classification of disease (ICD) and cause of death and associated conditions (CODAC) for the ascertainment of cause of stillbirth (SB) in the rural areas of north India.

International Classification of Diseases-10 th version (ICD-10) has been used to ascertain the cause of death but its use for stillbirths (SBs) is limited. Cause of Death and Associated Conditions (CODAC) as a detailed system expected to provide the exact cause of SB, so a community-based study was planned to study the level of agreement between ICD-10 and CODAC for ascertaining the cause of SB. A verbal autopsy (VA) tool was used to collect the information and then the cause of each SB was assigned using ICD-10 and CODAC separately. Each tool was used for 87 SBs and found that prolonged singleton labor, maternal pregnancy induced hypertension (PIH), and central nervous system (CNS) related congenital malformations were considered the top three causes. There was a significant agreement between ICD-10 and CODAC but the latter offers a scope to delineate the causes more precisely due to its hierarchal nature.

Community Based Assessment of Biochemical Risk Factors for Cardiovascular Diseases in Rural and Tribal Area of Himalayan Region, India

Context. Evident change in nutrition and lifestyle among individuals of urban and rural areas raises suspicion for similar change in tribal area population of India. Aim. To study the biochemical risk factor for CVDs in rural and tribal population of Sub-Himalayan state of India. Settings and Design. Cross-sectional study in rural (low altitude) and tribal (high altitude) area of Himachal Pradesh, India. Methodology. Blood lipid profile using standard laboratory methods. Statistical Analysis. Chi-square test and multiple linear regression analysis. Results. Total of 900 individuals were studied in both areas. As per Asian criteria, obesity (BMI 27.5–30.0 kg/m2) was observed to be significantly high (P = 0.00) as 13.7% in tribal area as compared to 5.5% in rural area. Normal level of TC (<200 mg/dL) and LDL (<130 mg/dL) was observed in the majority of the population of both areas, whereas, at risk level of HDL (<40 mg/dL) was present in half of the population of both rural and tribal areas. The prevalence of borderline to high level of TGs was observed to be 60.2% and 55.2% in rural and tribal (P = 0.10) area, respectively. Conclusion. Prevalent abnormal lipid profile in tribal area demands establishment of an effective surveillance system for development of chronic diseases.

Scoring satisfaction among patients, attending ART Centre of a medical college in north-west India

Patient satisfaction is a measurable concept comprising multidimensional elements such as access to care, quality of the provider patient interpersonal relationship and affordability of care. This further influences the decisions to seek care and outcomes of diseases. Although stigma and discrimination are potential barriers to effective implementation of the antiretroviral therapy (ART) programme, higher satisfaction levels of patients are also crucial for treatment adherence. A hospital-based cross-sectional study was conducted at the ART centre of IG Medical College, Shimla from November 2008 through May 2009. Three hundred and eighty four consecutive adult (≥18 years) patients attending the ART centre and on ART who consented to participate in the study were enrolled. Of the 384 patients, 209 (54.4%) were males. Majority were in the age bracket of 25–44 years. About 61.6% of the patients were satisfied to the services being provided. Mean Patient Satisfaction Questionnaire (PSQ) scores were the highest for technical quality of care and lowest for financial aspects. About 69.4% of the patients were satisfied towards their care provider. Although a majority of the patients were satisfied, several areas of patient care need improvement.

Malnutrition as a cause of mental retardation: A population-based study from Sub-Himalayan India

Background: Mental retardation is one of the most common disabilities of childhood. The research on childhood malnutrition and its relationship with cognitive functioning suggests that malnutrition alone does not cause mental retardation. Objective: To identify the relation between malnutrition and cognition among children from a Sub-Himalayan state in North India. Materials and Methods: A two-phase cross-sectional study was conducted in the rural, urban, and slum area of district Kangra. A 30-cluster sampling technique was used to screen a population of children 1–10 years of age from five randomly selected panchayats (village government units) of district Kangra. The screening was based on a modified version of the ten questions screen, adapted to the local population. In the first phase, a door-to-door survey was done to identify suspects of mental retardation. In the second phase, the children found positive in the first phase were called for clinical examination to confirm mental retardation. Anthropometric assessment of all study children was done by measuring weight and height. The nutritional assessment was done by categorizing them according to Waterlow classification for malnutrition. Results: Out of the total 5300 children, 1.7% were diagnosed as mentally retarded. No positive association was reported with different types of malnutrition and mental retardation. A weakly positive association existed between nutritional status and mental retardation (correlation coefficient-0.04). Children who were both wasted and stunted had the highest risk (odds ratio, 95% confidence interval - 5.57, 2.29–10.36) of mental retardation as compared to normal. Conclusion: Malnutrition may be one of the causes but certainly not the only cause of mental retardation. Other causes may be contributing more significantly toward it.

Prevalence of mental retardation in urban and rural populations of the goiter zone in Northwest India

Background: The existence of an endemic goiter belt along the southern slopes of the Himalayas has been known for a long time. Prevalence of neonatal hypothyroidism is high and there has been little work on the prevalence of mental retardation in this part of India. Objective: The study was conducted with the aim to know the prevalence of mental retardation in the urban and rural populations of Himachal Pradesh, India and to generate a hypothesis on the differential distribution (geographical) of mental retardation. Methods: This cross-sectional study was conducted in the rural and urban areas of the district of Kangra, Himachal Pradesh, India among children of 1-10 years of age. In the first phase, the children in the age group of 1-10 years were screened for mental retardation using the Ten Questions Screen, whereas in the second phase the suspects were evaluated clinically. Results: The prevalence of mental retardation was found to be 1.71% in the study population with higher prevalence (3.3%) in the 73-120 months age group. The prevalence was higher among the males in all study populations [rural: 1.9%, urban (nonslum): 1.6%, and urban slum: 7.14%). The prevalence was similar among the urban (nonslum) (1.75%) and rural (1.11%) populations, whereas it was higher (4%) in the urban slum population. A prevalence of 2% was seen in families from the lower middle class and 1.8% among families from the lower class in the rural population, whereas a prevalence of 2% was seen among lower middle class families of urban (nonslum) areas. Conclusion: The prevalence of mental retardation was higher in our study than in other parts of the country. The study concludes with the hypothesis that the prevalence of mental retardation is differentially distributed geographically with socioeconomic factors being important predictors.