Harshal Salve

Prevalence of knee osteoarthritis amongst perimenopausal women in an urban resettlement colony in South Delhi

A community-based cross-sectional study was carried out in an urban resettlement colony in South Delhi to study the prevalence of knee osteoarthritis in women aged ≥40 years and treatment seeking behavior of women suffering from osteoarthritis. Osteoarthritis was diagnosed by using clinical criteria given by American College of Rheumatology for diagnosis of Idiopathic Osteoarthritis of knee joints. A total 260 women were interviewed out of which 123 (47.3%) women were found to be suffering from knee osteoarthritis. Prevalence of osteoarthritis found to be increased with age. Less than half of those with osteoarthritis underwent treatment. With this high prevalence of osteoarthritis, there is need to spread awareness about the disease, its prevention, and rehabilitation in the community.

Perception and attitude towards mental illness in an urban community in South Delhi - A community based study

Background: Mental illness have been largely ignored or neglected because of a communitys perception and attached social stigma. Materials and Methods: A community based cross-sectional study was conducted in an urban community in South Delhi to study perception and attitude of the community about towards mental illness. An adult member in household selected by systematic random sampling was interviewed using semi-structured interview schedule for perception about mental illness and 34 item Opinion about Mental Illness for Chinese Community (OMICC) scale Results: A total of 100 adults were interviewed. Mean age of the participants was 35.8 (SD: 12.6) years. Living without tension and satisfaction in routine life were identified as indicators of healthy mental status. Change in the behavior was perceived as the most common symptom of mental illness. Although mental stress was identified as the most common cause of mental illness, 25% attributed it to evil spirits. Keeping surroundings friendly and sharing problems with others were identified as - important preventive measures against mental illness. Mental illness was perceived as treatable; 12% preferred treatment from Tantric/Ojha. Community showed negative attitude for stereotyping, restrictiveness, and pessimistic prediction domains of OMICC scale with mean score of 4.5 (SD: 0.2), 3.9 (SD: 0.9), and 3.8 (SD: 0.4), respectively, with no statistically significant difference across age, sex, and literacy. Conclusion: Study observed lack of awareness regarding bio-medical concept of mental illness with socially restrictive, stereotyping, pessimistic, and non-stigmatizing attitude toward mental illness in the capital city.

Prevalence of psychiatric morbidity at Mobile Health Clinic in an urban community in North India

OBJECTIVE The objective was to estimate the prevalence of psychiatric morbidity amongst patients attending Mobile Health Clinic (MHC) in an urban community in South Delhi. METHODS Adult subjects were recruited by systematic random sampling at outpatient MHC. Primary Care Evaluation of Mental Disorder Patient Health Questionnaire (PHQ) was used for screening, and Mini International Neuropsychiatric Interview (M.I.N.I.) was used for the confirmation of diagnosis of psychiatric disorder of all PHQ-positive and 20% of PHQ-negative patients. Association of selected sociodemographic factors with psychiatric morbidity was also assessed. RESULTS In total, 350 subjects were recruited, out of which 92 (26.3%) [95% confidence interval (CI) 21.7-31.0] were found to be PHQ positive. M.I.N.I. was administered to 141 subjects (92 PHQ positives and 52 PHQ negatives). Total estimated magnitude of psychiatric morbidity by M.I.N.I. was 25.4% (95% CI 20.9-29.9). Depression (15.7%) was observed to be the most common psychiatric disorder followed by generalized anxiety disorder (11.1%) and phobic disorders (10.1%). Suicidal ideation was reported by 37 (10.6%) patients. Literate status [odds ratio (OR)=0.43] and duration of migration >20 years to study area (OR=1.27) were found to be significantly associated with psychiatric morbidity. CONCLUSION In resource-poor country like India, high psychiatric morbidity at MHC justifies the use of MHC for providing outreach mental health services in difficult areas.

Suicide an emerging public health problem: evidence from rural Haryana, India.

Analysis of annual mortality data for year 2002-2009 of twenty eight villages in Ballabgarh block of rural Haryana was carried out to calculate suicide rates per 100,000 population. In addition, informal discussions were carried out amongst health providers to understand their perceptions regarding suicides. In a period of 8 years, out of total 4552 deaths, 163 (3.5%) deaths were attributed to suicides giving a suicide rate of 24.4/100,000 population (95% CI 24.1- 24.7). Mean years of productive life lost for males and females were estimated to be 44.4 (SD 1.1) years and 39.9 (SD 1.4) years respectively. Poisoning (41.1%) was the most common mode of suicide followed by hanging (36.8%) and burns (14.7%). Health workers also perceived suicide as major problem in the community and marital conflict was identified as major cause for suicides. There is need to address the complex issue of suicide by public- health approach at the community level.

Prevalence of chronic kidney diseases and its determinants among perimenopausal women in a rural area of North India: A community-based study

The burden of noncommunicable diseases is rising in India. A high prevalence of lifestyle-related diseases in perimenopausal women in the community makes them vulnerable to chronic kidney diseases (CKD). A cross-sectional community-based study was carried out among women >35 years of age in the village of Ballabgarh, Haryana (north India). Eligible women were selected by the probability proportionate to size sampling method. Estimation of glomerular filtration rate (GFR) was carried out by using the age- and body surface area (BSA)-adjusted Cockcroft–Gault (CG) and modification of diet in renal disease (MDRD) equations. Association of risk factors such as obesity, hyperlipidemia, hypertension, and diabetes mellitus with CKD was also assessed using multivariate logistic regression analysis. A total of 455 women were studied. The prevalence of low GFR (<60 mL/min/1.73 m2) by the CG/BSA equations and MDRD equation was found to be 18.2% (95% confidence interval 14.6, 21.8) and 5.9% (95% confidence interval 3.7, 8.1), respectively. Obesity (odds ratio 15.5) (P = 0.002), hyperlipidemia (odds ratio: 2.5) (P = 0.017), and age (P < 0.001) were significantly associated with reduced GFR on multivariate logistic regression analysis. This study observed a high prevalence of CKD and its risk factors among perimenopausal women in a rural community in north India. The study highlights the need of a multipronged, community-based intervention strategy that includes a high-risk screening approach and awareness generation about CKD and its risk factors in the community.

Improving access to institutional delivery through Janani Shishu Suraksha Karyakram: Evidence from rural Haryana, North India

Background: In India, Janani Shishu Suraksha Karyakaram (JSSK) was launched in the year 2011 to assure cashless institutional delivery to pregnant women, including free transport and diet. Objective: To assess the impact of JSSK on institutional delivery. Materials and Methods: A record review was done at the primary health care facility in Faridabad district of Haryana from August 2010 to March 2013. Focus group discussion/ informal interviews were carried out to get an insight about various factors determining use / non-use of health facilities for delivery. Results: Institutional delivery increased by almost 2.7 times (197 Vs 537) after launch of JSSK (p < 0.001). For institutional deliveries, the most important facilitator as well as barrier was identified as ambulance service under JSSK and pressure by elders in the family respectively. Conclusions: JSSK scheme had a positive impact on institutional deliveries. It should be supported with targeted intervention designed to facilitate appropriate decision-making at family level in order to address barriers to institutional delivery.

Psychiatric morbidity at secondary level health facility in Ballabgarh, Haryana

Background: There is dearth of information about psychiatric morbidity at secondary level health facility in India. Aim: To study psychiatric morbidity amongst patients attending psychiatry clinic in secondary level health facility. Settings and Design: Present study is based on hospital record review of psychiatry clinic at secondary care hospital in Ballabgarh, Haryana. Materials and Methods: Service record of psychiatry clinic at civil hospital Ballabgarh was reviewed. Diagnosis of psychiatric morbidity was done according to DSM IV and ICD 10 classification. Statistical Analysis: Descriptive analysis of data was carried out. Results: A total of 724 (0.7%) new OPD patients consulted psychiatry clinic. Common Mental Disorders comprising of mood disorders, neurotic stress –related and somatoform disorders were the most commonly diagnosed disorders (60.5%) amongst reported psychiatric morbidity in the hospital. Conclusion: Substantial burden of psychiatry morbidity highlights necessity of psychiatry clinic at secondary care hospital in India.

Work-related neck pain among desk job workers of tertiary care hospital in New Delhi, India: Burden and determinants

Background: Work-related Neck Pain (WRNP) is a leading cause of disability and absenteeism. There is dearth of information about burden and determinants of WRNP in health facility setting in India. Materials and Methods: A cross-sectional study was carried out at tertiary care hospital in New Delhi. All Group C desk job workers involved in the administrative work were included in the study. Participants were screened for WRNP by using pretested semi-structured questionnaire. Detailed information on probable risk factors was collected among patients with WRNP. Neck examination by trained investigator was done. Work place assessment was done by using observation check-list using the recommendations of the ISO Standard (Ergonomic requirements for office work with visual display terminals). Crude and adjusted odds ratio was calculated with 95% confidence interval to understand the determinants of WRNP. Results: In total, 441 participants were included in the study. Of them, 58% were males. Majority of participants aged between31-50 years. One-year prevalence of neck pain and WRNP was reported as 43.3%, (95% CI 38.7%-47.9%) and 28.3%, (95% CI 24.3%-32.7%) respectively. On multivariate analysis, female gender (OR-2.0 95% CI) and poor perception of breaks during working hours (OR-2.4 95% CI), along with work place related factors such as posture (OR-5.4 95% CI) and height of the screen (<10 cms) (OR-2.6) were identified as independent determinants of WRNP. Conclusion: High one-year prevalence of WRNP was reported among desk job workers. Burden of WRNP was reported more among females as compared to males. Most common factor identified was Computer use for more than 4-6 hours was most important predictor of WRNP followed by work related factors such as height of screen and posture are associated with WRNP.

Pre-treatment practices among patients attending an Animal Bite Management clinic at a primary health centre in Haryana, North India

A cross-sectional study was carried out at the Animal Bite Management (ABM) clinic in a primary health centre in the Faridabad district of Haryana. Information about socio-demographic characteristics, animal bite exposure and pre-treatment practices was obtained. Clinical examination determined the severity of the bite. All 619 patients who reported to the ABM clinic during January 2011 to December 2012 were included. Out of the total, 38% had applied chilli-oil paste, and 4% antiseptics to the wound as pre-treatment; only 30.6% had washed the wound with water. There was a direct association between traditional pre-treatment practices and delay in seeking treatment for animal bites which was statistically significant (P = 0.01). Health education of the general population with culturally appropriate Information, Education and Communication material is therefore a necessary strategy to reduce delay in seeking appropriate treatment.

Impact of ambient air temperature on human health in India

Abstract A systematic search was carried out in the databases of Pubmed, Indmed and Mausam for articles on the effect of ambient temperature on health. Relevant data were extracted using a standard data abstraction form by two authors independently. The overall effects of ambient air temperature are reported as odds ratio (OR) and 95% confidence intervals (CIs) on mortality. Of 812 records identified, only seven were included in the final review as per pre-defined criteria. An increase in the all-cause mortality rate of 41% are reported during a heat wave in India. Risk ratios for all-cause mortality was in the range of 1.7–2.1. The dose-response relationship of ambient temperature and all-cause mortality and cardiovascular diseases are been reported. Current evidence on the effect of ambient temperature and health is sufficient to initiate an integrated response from policy makers, climate scientists and public health practitioners in India. Continued advocacy and generation of more robust evidence is needed.