Krishnapillai Vijayakumar

Domestic and Environmental Factors of Chikungunya-affected Families in Thiruvananthapuram (Rural) District of Kerala, India.

Background: The world is experiencing a pandemic of chikungunya which has swept across Indian Ocean and the Indian subcontinent. Kerala the southernmost state of India was affected by the chikungunya epidemic twice, first in 2006 and then in 2007. Kerala has got geography and climate which are highly favorable for the breeding of Aedes albopictus, the suspected vector. Aim: The aim of the study was to highlight the various domestic and environmental factors of the families affected by chikungunya in 2007 in Thiruvananthapuram district (rural) of Kerala. Settings and design:This is a cross-sectional survey conducted in Thiruvananthapuram (rural) district during November 2007. Settings and design: This is a cross-sectional survey conducted in Thiruvananthapuram (rural) district during November 2007 Materials and Methods: Samples were selected from field area under three Primary Health Centers.These areas represent the three terrains of the district namely the highland, midland, and lowland. The sample size was estimated to be 134 houses from each study area.The field area of health workers was selected as clusters and six subcenters from each primary health center were randomly selected (lot method). Results and Conclusions: The proportion of population affected by chikungunya fever is 39.9% (38.9-40.9%). The investigators observed water holding containers in the peri-domestic area of 95.6% of the houses. According to regression (binary logistic) analysis, the area of residence [adjusted odds ratio (OR) = 8.01 (6.06-14.60)], residing in a non-remote area [adjusted OR=0.25 (0.16-0.38)], perceived mosquito menace [adjusted OR=3.07 (2.31-4.64)], and containers/tires outside the house [adjusted OR=5.61 (2.74-27.58)] were the independent predictors of the occurrence of chikungunya in households.

Gender difference in blood pressure, blood sugar, and cholesterol in young adults with comparable routine physical exertion

Context: Gender differences in the risk of developing non-communicable diseases (NCD) are a matter of debate. The susceptibility of a woman to NCD should be evaluated taking into consideration the social factors that limit the physical activity among women. It will be interesting to note what will happen if women are allowed to take part in physical exercise to the extent of men. Aims: To find out the gender difference in the pattern of the clinical and biochemical indices related to NCD in young adults with comparable daily physical activity. Settings and Design: This is an institution-based cross-sectional study and the setting was Lekshmibhai National College for Physical Education (LNCPE), Thiruvananthapuram, Kerala, India. Materials and Methods: The study participants were students who were regularly involved in more than three hours of physical exercise daily at least for the previous one year. The information on socio-demography, anthropometry, and blood pressure was recorded. Blood samples were taken for laboratory examination. Results: Out of 150 students registered, 126 (84%) in the age group of 17 to 25 years who fulfilled the eligibility criteria were studied. Fifty-five (43.7%) of them were women. Systolic blood pressure, fasting blood sugar, and low-density lipoprotein were found significantly lower in women. No significant difference was noted in the case of diastolic blood pressure and total cholesterol. Conclusion: Gender differences exist for NCD risk factors among young adults with comparable physical activity and physical exertion seems to be more protective for females.

Predictors of depression among patients with diabetes mellitus in Southern India

OBJECTIVE Diabetes mellitus and depression are major public health problems and are significantly linked with each other. This research study intends to assess for undiagnosed depression and its predictors among adult diabetic patients. METHODS A cross-sectional study was done among 100 patients with type 2 diabetes mellitus attending the diabetic clinic of a tertiary care hospital. Depression was assessed using Patient Health Questionnaire-9 (PHQ-9). Chi-square test was performed and odds ratios (OR) with 95% confidence interval (95% CI) were obtained. Mann Whitney U and Pearson correlation tests were done. Logistic regression was carried out to determine the predictors of depression and adjusted odds ratios with 95% confidence intervals were obtained. RESULTS The prevalence of depression was 49% (95% CI 39.1-58.9%). The predictors of depression were female gender, elevated fasting blood sugar (FBS) level, physical disability and lack of physicians advice about lifestyle modifications. FBS values were significantly higher in depressed individuals as compared to the non-depressed (p value 0.002). A positive correlation (r=0.38, p value 0.01) was obtained between PHQ-9 scores and the FBS values of the diabetic subjects. CONCLUSIONS Subjects with diabetes are highly prone for comorbid depression. Physicians should be sensitive towards the need for assessing for possible depression and its risk factors in diabetic patients.

Comparative performance of the probable case definitions of dengue by WHO (2009) and the WHO-SEAR expert group (2011).

Abstract Background The primary objective of this study was to find the performance of the 2009 probable case definition of dengue and compare it with the definition given by the WHO-SEAR expert group in 2011. Methods A cross-sectional study was conducted in Thiruvananthapuram district of Kerala, which is hyperendemic for dengue. A consecutive series of 851 participants defined by the selection criteria were recruited from the primary, secondary, and tertiary health care settings. Sensitivity, specificity, predictive values, and likelihood ratios of the clinical case definitions were calculated using reverse transcriptase-polymerized chain reaction (RT-PCR) as gold standard in case of fever less than or equal to 5 days and serology (IgM positivity) for fever >5 days. Diagnostic odds ratio (DOR) was also calculated as a single indicator of performance of the case definition. Results The 2009 World Health Organization (WHO) case definition had a sensitivity of 76·4% (69·6–82·1) and negative predictive value of 87·5%. The 2011 WHO-SEAR expert group case definition had a higher sensitivity of 87·9% (82·2–91·9) but lower negative predictive value of 86·6%. The three independent criteria which were significantly associated with dengue were thrombocytopenia less than 150 000 (OR 2·80), leukopenia (OR 2·28), and absence of backache (OR 2·68). The performance of 2009 case definition was better (DOR 2·4) than the 2011 WHO-SEAR expert group case definition. This was further enhanced when thrombocytopenia was specified as platelet count less than 150 000 (DOR2·7). When ‘no backahe’ was added as an additional criteria, the performance of both definitions improved. Conclusions The 2009 WHO case definition has better discriminatory power than the 2011 WHO-SEAR expert group case definition. The performance of 2009 WHO case definition is enhanced by specifying thrombocytopenia as platelet count less than 150 000. The inclusion of ‘no backache’ further improves the discriminatory power. This may be more useful in primary care settings, to rule out dengue.

Effectiveness of community-based depression intervention programme (ComDIP) to manage women with depression in primary care- randomised control trial

BACKGROUND In low and middle income countries where mental health resources are limited, community based depression intervention models, which can be implemented through the existing health system, are extremely relevant. OBJECTIVE To test the effectiveness of Community based Depression Intervention Programme (ComDIP), newly developed by us, to reduce severity of depression in women, compared to the treatment as usual (TAU). METHODS An RCT (Trial registration Number: CTRI/2011/08/001978, Clinical Trials Registry -India) was conducted in a primary care setting in Trivandrum, Kerala, South India. Health workers screened 422 women, aged 18-60 years, using PHQ-9. Sixty women with HAM-D (Hamilton Depression Rating scale) score above 19 were randomized to receive either ComDIP or TAU. Primary care physicians and health workers together implemented ComDIP which had psycho-social intervention and drug treatment. Those in TAU arm were referred to available mental health services. Primary outcome was measured at 8 weeks, by HAM-D. RESULTS At baseline and 8 weeks, mean (SD) HAM-D scores were 29.2 (5.8) and 12.2 (9.3) respectively among women in ComDIP; and 28.6 (5.1) and 21.7 (12.4) respectively among those in TAU (p = 0.02, effect size = 0.82). CONCLUSIONS ComDIP, implemented through existing health system is an effective public health programme to manage women with depression in primary care.

Prevalence of undernutrition among tribal preschool children in Wayanad district of Kerala

Background: Nutritional status especially that of preschool children is a sensitive indicator of health and nutritional status of a community. Aim: To estimate the prevalence of undernutrition among tribal preschool children and to assess the factors associated with variation in nutritional status. Methods: A cross-sectional survey was conducted among 438 tribal preschool children in 10 clusters of Wayanad district of Kerala. Height, weight, mid-arm circumference and hemoglobin level were measured. Children more than two standard deviations (SDs) below the standard median of World Health Organization Multi Centric Growth Reference Study were considered underweight (weight-for-age), stunted (height-for-age) and wasted (weight-for-height) respectively. Qualitative variables such as prevalence of underweight, stunting and wasting were summarized using percentages. Mean (SD) was used, to summarize, quantitative variables such as height and weight. Generalized estimating equation models were constructed to assess associations. Adjusted models included social factors and child morbidities. Results: More than half of the children say 58.7% (257/438) had deficits in at least one of the three anthropometric indicators. The prevalence of underweight, stunting and wasting was 39% (171/438), 38% (167/438) and 20.5% (90/438) respectively. The prevalence of anemia was 95.7% (419/438). Bivariate analysis showed significant associations between undernutrition and educational status of parents, tribe to which the child belonged, diarrheal episode and low birth weight. In adjusted analysis, lower educational status of mother (adjusted odds ratio 1.9, 95% confidence intervals 1.2-3) and an episode of diarrhea (1.8, 1.03-3.2) independently predicted undernutrition in a tribal preschool child. Conclusion: Undernutrition in the form of stunting, wasting and underweight is very high among the tribal preschool children. There is an urgent need to improve health care services to the tribal population and tribal children.

Reliability and validity of PHQ-9 when administered by health workers for depression screening among women in primary care

BACKGROUND Depression is twice more prevalent among women but remains unidentified in primary care. OBJECTIVE We aimed to estimate the reliability and validity of PHQ-9, when administered by health workers, a cadre of public health staff, posted in primary health centres. We translated PHQ-9 to Malayalam, a language spoken by 30 million people in Kerala, India. Health workers administered PHQ-9 to women (n = 238) aged 18-60 years in a high prevalent primary care setting. Mini International Neuropsychiatric Interview (MINI) was administered by the psychiatrist on the same day to diagnose depressive disorder. Two health workers administered PHQ-9, independently, in a subset of 21 women. RESULTS The internal consistency reliability (Cronbachs alpha 0.89) and inter-rater reliability (intra class correlation coefficient, 0.94; 95% CI, 0.86-0.95) were high. On ROC analysis, area under curve was 0.92 (95% CI 0.88-0.96). For a cut-off score of ≥9, PHQ-9 had a sensitivity of 82.5%, (95% CI, 72.4-92.6), specificity of 90.1% (95% CI, 84.5-95.6%), positive predictive value of 73.4% (95% CI, 62.4-84.4%) and negative predictive value of 93.9% (95% CI, 90.2-97.6%). The accuracy was 88.2% (84.0-92.4%) and positive likelihood ratio was 8.3. Factor analysis supported a single factor, with eigen value above 1, with high loading for all items (0.73-0.79), except item related to appetite (0.58). This explained 62% of variance in the data. Prevalence of MINI diagnosed depressive disorders was 25%. CONCLUSION When administered by health workers, PHQ-9 has good reliability and at cut off score ≥9, it has good validity to identify depression in primary care.