Bijit Biswas

Potential of mid-upper arm circumference to replace body mass index as a screening tool for assessment of nutritional status: A study among a rural elderly population in eastern India

Background: Malnutrition in the form of undernutrition or overnutrition has reached epidemic proportions globally in all age groups assessment of which often becomes very difficult among the elderly since many of them cannot even stand for accurate measurement of their height and weight. n nAims and Objectives: The aim of this study is to assess and to find the optimum cutoff of mid-upper arm circumference (MUAC) to predict overweight/obesity using receiver operating characteristic (ROC) curves. n nMaterials and Methods: A community-based cross-sectional study was conducted in May 2017–August 2017 among 335 elderly, in two villages, West Bengal. Height, weight, and MUAC were measured for each subject. ROC curve analysis was used to estimate the cutoff values of MUAC. n nResults: Mean (standard deviation) age of the participants was 67.40 (6.19) years. More than half were overweight and 14 (4.2%) were obese. MUAC and body mass index (BMI) had strong significant positive correlation (r = 0.79). On ROC for MUAC to have overweight/obesity (BMI ≥25 kg/m2), area under curve was 0.9133 which signifies MUAC as a excellent screening and predictive tool. With Youden’s method as well with closest to top-left method, optimum cutoff of MUAC was found to be 21.75 cm. At this cutoff, an elderly individual will have BMI ≥25 kg/m2 with a sensitivity of 87.30% and specificity of 78.49%. n nConclusion: Our study suggests that MUAC has potential for surveillance of overweight/obesity and has a predictive tool to identify elderly who will need further assessment of obesity and its associated comorbidities.

Knowledge of the caregivers of thalassemic children regarding thalassemia: A cross-sectional study in a tertiary care health facility of eastern India

Background: Caregivers knowledge regarding thalassemia is one of the vital areas in the prevention of the disease. Studies related to caregivers knowledge and its sociodemographic predictors are very few in number which is helpful in designing interventions across different study settings. Objectives: the study aimed to find out the knowledge level of caregivers of thalassemic children and its sociodemographic determinants. Materials and Methods: It was a cross-sectional observational study conducted in a thalassemia day care unit of Eastern India. The study included 328 caregivers of thalassemic children attending thalassemia day care unit during May 2015–April 2016. Data were analyzed using Statistical Package for the Social Sciences (SPSS) (version 16). Results: Out of 328 caregivers only 47.6% knew about genetic etiology of the disease, while only 52.4% and 50.9% knew about premarital counseling and antenatal screening, respectively. Regarding treatment of the disease, 75.9% knew that both blood transfusion and iron chelation are the treatment of thalassemia, while only 19.2% and 2.7% of them had knowledge regarding splenectomy and bone marrow transplantation, respectively. Only 52.7% had satisfactory knowledge regarding the disease. In multivariable model, caregivers educational level (adjusted odds ratio, AOR-3.13 [1.87–5.25]), working status (AOR-2.18 [1.23–3.86]), place of residence (AOR-2.05 [1.19–3.52]), and socioeconomic class (AOR-2.11 [1.25–3.58]) were significant predictors of their knowledge. Conclusion: Caregivers knowledge regarding thalassemia was not at all satisfactory. Regular counseling of caregivers should be done addressing the knowledge lacunaes among them.

Importance of giving health education regarding lifestyle modification and perceived barriers: focus group discussion among community health workers of slum of Kolkata, India

Background: Considering the poor health literacy and high prevalence of risk factors of NCDs in the slums, health education remains prime intervention. Indeed, successful intervention requires programmes tailored not only to local needs and available resources but also the way it is implemented in the community. The objective was to assess the knowledge of NCDs and NCD care, identify the barriers that impede community level workers from providing services pertained to achieve and maintain healthy living among the community. Methods: It was a qualitative study (FGD) conducted on 30 November 2017 among community level workers of Urban Health Unit and Training Centre (UHU and TC), Chetla, Kolkata. A thematic qualitative analysis was conducted to identify significant themes in the data. Results: It was found that everyone was aware of Non-communicable Diseases. In terms of physical activity, lack of time, whereas in tobacco, it had become a habit from the young age, poor knowledge about healthy diet were the main challenges in adopting the healthy lifestyle. Health education to create awareness is crucial in tackling NCDs. Conclusions: The study revealed that the community workers were aware of the importance of health education and poor awareness regarding healthy lifestyle among people was the main challenge. By delivering holistic interventions that address multiple lifestyle risks and incorporate relapse prevention strategies, health trainers could potentially have a significant impact on control of NCDs.

Unmet need of family planning among married women of reproductive age: A clinic-based study in rural Bengal

Background: Fecund married women who currently do not practice any family planning (FP) methods are considered to have unmet need for FP. In spite of a longstanding and robust family welfare program in India, the key health indicators like birth rate or maternal mortality ratio are still far from satisfactory for which mitigating unmet need plays a crucial factor. n nObjectives: The objective of this study is to assess the unmet need for FP and its determinants among married women of reproductive age group. n nMaterials and Methods: It was a clinic-based descriptive study conducted among 104 married women of reproductive age group (15–49 years) attending the outpatient Department of Anandangar Primary Health Center, in the rural field practice area of All India Institute of Hygiene and Public Health, Kolkata. Data were collected 2 days a week with the help of a pre-tested structured interview schedule from women who attended the clinic and consented to participate during the 1 month study period (September 2016). n nResults: The mean age of the subjects was 32.4 years, and unmet need was found to be 34.6%. In univariate logistic regression analysis, significant association was found with religion odds ratios (OR) 3.75 (confidence interval [CI] 1.36–10.31), socioeconomic status (as measured by modified B.G Prasad scale 2016) OR 2.51 (CI 1.08–5.75), and who had at least one male child OR 3.73 (CI 1.50–9.23). In multivariable logistic regression, significant association was found with religion OR (CI) 14.22 (3.45–58.60) and socioeconomic status OR (CI) 2.93 (1.06–8.06). n nConclusion: Proper counselling by healthcare providers to rectify the misconceptions associated with contraceptive use may reduce their unmet need and increase the acceptance rate of contraceptives.

An epidemiological study on empathy and its correlates: A cross-sectional assessment among medical students of a government medical college of India

Background: Empathy is a desirable quality in every clinician. It is a crucial determinant of patient–physician communication and relation. There are very few existent Indian studies on empathy of medical students and its correlates. Aim: The aim of the study was to assess empathy level of medical students and its correlates. Methodology: It was a cross-sectional, hospital-based, analytical observational study conducted from July to November 2017. In total, 249 undergraduate medical students of a medical college of Kolkata were interviewed with a structured schedule. The schedule comprised of the sociodemographic questionnaire, career satisfaction, future career choice, and Jefferson Scale of Empathy. Results: The mean empathy score was 98.5 ± 12.5. Third-semester students had higher empathy scores (102.4 ± 12.4) compared to fifth (97.2 ± 12.9) and seventh semester (95.0 ± 10.9) students. The difference between the mean scores of different semesters was statistically significant. Female students were more empathic than male students. In the multivariable linear regression model, sex, semester, residence, career satisfaction, future career choice, and current place of living were significant predictors of empathy scores. Conclusion: Empathy level of medical students of our study was quite low compared to other studies conducted outside India. Empathy eroded with semester, which supports earlier pieces of evidence in this regard.

Quantification of vulnerability to Type 2 diabetes: A study among shopkeepers in Kolkata

Context: Urban people are more prone to develop diabetes due to their sedentary lifestyle and high-calorie food intake. Shopkeepers with their long sitting hours, unhealthy food habits, and lack of regular physical activity are one of the high-risk groups for developing diabetes. Hence, it is necessary to detect this large pool of undiagnosed people with diabetes to offer them early treatment. Aims: The present study aimed at assessing people with a high risk of developing type 2 diabetes and its correlation with some known risk factors. Materials and Methods: The study was a cross-sectional community-based study conducted from May to July among 152 shopkeepers in a permanent market with a structured schedule. Statistical Analysis Used: Data were analyzed using appropriate statistical methods by SPSS software (version 16). Results: Thirty-five (23.02%) out of 152 shopkeepers were found having high blood sugar (>140 mg/dl). In univariate analysis, the study participants with higher age, perceived stress score, Indian Diabetic Risk Score (IDRS), body weight, centrally obese, and less physically active had shown significantly greater odds of having high blood sugar level. In multivariable model, PSS (adjusted odds ratio [AOR]-1.90), waist circumference (AOR-3.34), and physical activity (AOR-3.09) remained significantly adjusted with other significant variables in univariate analysis excepting IDRS. Sensitivity and specificity of IDRS were 68.6% and 65.8%, respectively, with diagnostic accuracy of 72.3% calculated using receiver operating characteristic curve. Conclusions: The study revealed that shopkeepers are indeed at high risk of developing diabetes. There is an urgent need for increasing awareness regarding diabetes among them.

Urinary incontinence, its risk factors, and quality of life: A study among women aged 50 years and above in a rural health facility of West Bengal

Context: Urinary incontinence (UI) is a chronic debilitating disease which is often under reported, but laid significant impact on ones quality of life (QoL) thus is of public health importance. Aims: The aim of this study is to find out proportion of rural women have UI, its associated risk factors and treatment-seeking behavior, QoL of affected women. Methods: This was a cross-sectional clinic-based study conducted from October 2016 to January 2017 among 177 women aged 50 years or above attending a rural health facility with a structured schedule. Data were analyzed using appropriate statistical methods by SPSS (version 16). Results: Forty-nine (27.7%) out of 177 women were found having UI. The most prevalent type of UI was stress UI (51.0%), followed by mixed UI (32.7%) and urge UI (16.3%). In bivariate analysis, study participants who were illiterate, having a history of prolonged labor, having a history of gynecological operation, normal vaginal deliveries (NVDs) (>3), diabetic, having chronic cough, having constipation, and having lower urinary tract symptoms (LUTS) had shown significantly greater odds of having UI. In multivariable illiteracy (adjusted odds ratio [AOR] - 2.41 [1.02–5.69]), NVDs (AOR - 3.37 [1.54–7.37]), a history of gynecological operation (AOR - 3.84 [1.16–12.66]), chronic cough (AOR - 2.69 [1.21–5.99]), LUTS (AOR - 2.63 [1.15–6.00]) remained significant adjusted with other significant variable in bivariate analysis. Those with mixed UI had 5.33 times higher odds having unfavorable QoL. Only 30.6% sought medical help. Treatment-seeking behavior shown negative correlation with QoL while fecal incontinence and LUTS shown possitive correlation. Conclusions: The study revealed that rural women are indeed at high risk of developing UI. Majority of them did not sought treatment for UI which is matter of concern. Generating awareness regarding UI may help to improve health-seeking behavior and QoL.