M. Athar Ansari

Lifestyle and gallstone disease: scope for primary prevention.

Objective: To study the antecedent risk factors in the causation of gallstone disease in a hospital-based case control study. Materials and Methods: Cases (n = 150) from all age groups and both sexes with sonographically proven gallstones were recruited over a duration of 3 months from the surgical wards of a tertiary care teaching hospital. Modes of presentation were also noted among cases. Age- and sex-matched controls (n = 150) were chosen from among ward inmates admitted for other reasons. Univariate and multivariate logistic regression analyses were performed for selected sociodemographic, dietary, and lifestyle-related variables. Results: Females had a higher prevalence of gallstone disease than males (P < 0.01). Among males, the geriatric age group (<60 years) was relatively more susceptible (28%). Prepubertal age group was least afflicted (3.3%). Univariate analysis revealed multiparity, high fat, refined sugar, and low fiber intakes to be significantly associated with gallstones. Sedentary habits, recent stress, and hypertension were also among the significant lifestyle-related factors. High body mass index and waist hip ratios, again representing unhealthy lifestyles, were the significant anthropometric covariates. However, only three of these, viz., physical inactivity, high saturated fats, and high waist hip ratio emerged as significant predictors on stepwise logistic regression analysis (P < 0.05). Conclusion: Gallstone disease is frequent among females and elderly males. Significant predictor variables are abdominal adiposity, inadequate physical activity, and high intake of saturated fats; thus representing high risk lifestyles and yet amenable to primary prevention.

Routine immunization coverage in underserved children of Aligarh (India): an effort with UNICEF

The aims of the study were to find out the routine immunization coverage in under-five children; and to impart correct health education regarding the importance of complete immunization. This hospital- and outreach-session-based cross-sectional study was carried out by the interview method in two underserved areas of Aligarh city. Two thousand five hundred and thirty-one under-five children and their mothers or family members were included in the population sample. Statistical analysis was done by proportions and chi-square test. In Shahjamal area, a maximum 86.5 percent of children were immunized with DPT, OPV (86.5%) first doses followed by BCG (84.9%). DPT and OPV second and third doses were given in 64.5 percent and 54.8 percent respectively. Measles and DPT booster coverage was low at 39.0 percent and 11.4 percent respectively. Similarly, in Bhojpura, 99 percent of children received DPT and OPV first doses followed by BCG (94.1%). DPT and OPV second and third doses were given in 67.7 percent and 47.4 percent of children respectively. Measles and DPT booster coverage was low as 31.9 percent and 6.7 percent respectively. The results reveal high coverage of DPT1, OPV1, BCG, DPT2 and OPV2 in both areas. Immunization services need to be strengthened beyond infancy.

Cultural determinants: Addressing barriers to holistic diabetes care

Background: Cultural beliefs and traditional practices nearly affect all aspects of diabetes care. Therefore, understanding its broader cultural context can serve as important background information for effective care for diabetes. Materials and Methods: We conducted this study to explore the cultural determinants in diabetes care and to propose a broad theoretical framework for cultural assessment in persons with diabetes. Explanatory Model Interview Catalog interviews of 25 diabetes persons were conducted. Results: We found that perception about diabetes is influenced by tradition, customs and ethos. Diabetes does not show early signs and therefore symptoms are usually ignored until they interfere with their day-to-day living. Following dietary advice was the most difficult part of diabetes care due to varied cultural barriers. Due to cultural reasons, diabetes is still not assigned due priority by the family. Health illiteracy and cost of care were important barriers for seeking care. Diabetics taking conventional treatment often used complementary treatment, which may be hazardous. Language was also considered a barrier for effective diabetes care. Females struggle more for receiving appropriate care for their diabetes due to social and cultural factors. Conclusion: Cultural assessment needs to be done at various stages - initial assessment, identification of cultural issues in care, planning for culturally relevant intervention and evaluation. This calls for focused elements relevant to the presenting problem, necessary intervention, and participatory evaluation. Cultural values, beliefs, customs, and family patterns may be used as clues for planning diabetes care. Such interventions are likely to bear significant impact on diabetes care in times to come.

Locomotor problems among rural elderly population in a District of Aligarh, North India

Introduction: Locomotor functions decline with the age along with other physiological changes. This results in deterioration of the quality of life with decreased social and economic role in the society, as well as increased dependency, for the health care and other basic services. The demographic transition resulting in increased proportion of elderly may pose a burden to the health system. Objectives: To find the prevalence of locomotor problems among the elderly population, and related sociodemographic factors. Materials and Methods: The study was a community-based cross-sectional study done at field practice area of Rural Health Training Centre, JN Medical College, AMU, Aligarh, Uttar Pradesh, India. A sample of 225 was drawn from 1018 elderly population aged 60 years and above using systematic random sampling with probability proportionate to size. Sociodemographic characteristics were obtained using pretested and predesigned questionnaire. Locomotor problems were assessed using the criteria used by National Sample Survey Organization. Data were analyzed using SPSS version 20. Chi-square test was used to test relationship of locomotor problems with sociodemographic factors. P <0.05 was considered statistically significant. Results: The prevalence of locomotor problems among the elderly population was 25.8%. Locomotor problems were significantly associated with age, gender, and working status whereas no significant association with literacy status and marital status was observed. Conclusion: The study concluded that approximately one-fourth of the elderly population suffered from locomotor problems. The sociodemographic factors related to locomotor problems needs to be addressed properly to help them lead an independent and economically productive life.

Prevalence of risk factors for non-communicable diseases in Aligarh: a community based study

Background: Non-communicable diseases (NCD) are now recognized as major cause of morbidity and mortality. All countries, irrespective of their stage of economic development or demographic and epidemiological transition, face an increasing burden of non-communicable diseases (NCDs). The objective of the study was to estimate the prevalence of risk factors associated with non-communicable diseases. Methods: This is a community based cross sectional study conducted at field practice areas of the urban and rural health training centers, Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh. 640 study subject’s age group 18-65 years. Systematic random sampling and proportionate to population size method (PPS). SPSS version 13 and Chi-square was used to analyse the data. Results: The age group for the present study was chosen to be 18-65 years of age. The study population consisted of 340 females and 300 males. 27.1% belong to younger age group (18-25 years), whereas in urban areas majority (27.3%) belongs to 26-35 years age group. Also, the study group comprised of higher percentage of females (53%) compared to males (47%).129 (20.2%) subjects were found to be current smokers. Only 4 (1.3%) women were smokers. The prevalence of smokeless tobacco use which was found to be 21.6% (28.3% in males and 15.6% in females). The prevalence of current alcohol use in our study to be 10.3% in males and 0.6% in females. The overall prevalence of alcohol use was 5.2%. Alcohol use showed inverse relation with socioeconomic class, About 87% of the respondents did not have sufficient intake of fruits and vegetables. The physical inactivity during work was more in males (30.7%) compared to females (15.5%. Mean body weight, BMI and waist circumference showed significant changes with age in both sexes. Conclusions: It can be concluded from our study that the burden of risk factors for non-communicable diseases (NCDs) among the rural and urban areas of Aligarh is quite high.

Assessment of Secondary Sexual Development of Adolescent School Boys of Aligarh

Introduction: Adolescence comprises a period in the life cycle between childhood and adulthood. It is a period between 10 to 19 years. Biological, social and environmental factors influence the definitive onset and termination of adolescence. There is wide individual variation in pubescence and the rate of acquisition of pubertal changes. The rapid changes during the adolescence include increase in body dimensions, i.e. growth and progressive attainment of adult status, i.e. maturation. Objective: To study the secondary sexual development in adolescent school boys using Tanner staging. Materials and Method: A cross-sectional study was done covering 500 students between 10-19 years of age from rural and urban schools of district Aligarh. Students were interviewed and sexual maturity rating (SMR) was observed using Tanner stages. The data obtained were analysed using SPSS 20 and tested statistically. P value <0.05 was considered significant. Results: SMR-1 ranged from age 10-12 yrs, SMR-2 ranged from 11-14 yrs. SMR-3 started from age 12 yrs and ended gradually at 18 yrs. Similarly SMR-4 started from 14 yrs and SMR-5 at 15 yrs. Conclusion: Adolescent showed different maturity stages on same age. Though it is a vulnerable age group therefore it should be given priority in national health programs.

Utilization of antenatal care services in periurban area of Aligarh

Background: Utilization of antenatal care (ANC) services is poor in the peri-urban areas, causing increased maternal morbidity and mortality. Objective: (i) To determine the current status of utilization of ANC services and (ii) to asses factors affecting utilization of ANC services. Materials and Methods: A community-based cross-sectional study was conducted in peri-urban field practice area of urban health training center, J N Medical College, Aligarh, India. The data were collected by home visit using a pretested, structured, semi-open questionnaire from 200 recently delivered women, who utilized ANC services. Data were tabulated and analyzed by using SPSS-20. Proportion, frequencies, and χ2-tests were used to interpret the data. Result: Full utilization of ANC services was found to be 59%. Home deliveries were 23% and all were conducted by untrained persons. Utilization of ANC services was significantly associated with education, socioeconomic status, parity, and age at marriage. Main reasons for inadequate (partial/no) utilization of ANC services were financial constrains (34.14%) and lack of awareness (30.48%), whereas for home deliveries it was tradition (23.91%) and financial constrains (21.74%). Conclusion: Utilization of ANC services was not satisfactory and home deliveries by untrained person were still present. Prevailing barriers to utilization of ANC services and institutional deliveries must be identified and taken into consideration in planning and policy making.

Health problems among the aged: a community based study from urban Aligarh, Uttar Pradesh, India

Background: Old age is associated with decline in physical, physiological & cognitive function affecting the quality of life of the elderly population. The robust increase in proportion of elderly has resulted in demographic burden in a developing country like India. To cope up with this burden appropriate & timely intervention is required based on the situational analysis of the health problems faced by the aged population. The objective was to study the prevalence of health problems among elderly population and to find out the relationship of health problems with gender. Methods: This community based observational cross- sectional study was done among 225 individuals aged 60 years & above residing at field practice area of Urban Health Training Centre, JN Medical College, AMU, Aligarh. The data was obtained through pretested & predesigned questionnaire by selecting individuals using systematic random sampling with PPS. Data was entered & analysed by SPSS 20. Test of proportions & Chi square test were applied. P value <0.05 was taken as significant. Results: The present study revealed that the most prevalent problem was cataract (78.2%), followed by depression (35.6%), refractive error (27.6%), locomotor problem (21.3%) and hearing loss (13.8%). The prevalence of hearing loss was significantly related to gender. Conclusions: The study shows that elderly suffers from various physical and mental health problems which shows the need of comprehensive health service to address these problems.

An epidemiological study of cataract among elderly population in Aligarh, Uttar Pradesh, India

Background: Cataract is one of the major causes of avoidable blindness in India. The burden of cataract among the elderly population needs to be assessed therefor, the study was planned to find the prevalence of cataract among the elderly population, and related socio-demographic factors. Methods: The study was a community-based cross-sectional study done at field practice area of rural health training centre and urban health training centre, J N Medical College, AMU, Aligarh, Uttar Pradesh, India. A sample of 550 was taken from the registered elderly population aged 60 years and above using systematic random sampling with PPS. Socio- demographic characteristics was obtained using pretested and predesigned questionnaire. Cataract was identified with the help of torch light examination of lens. Data was analysed using SPSS version 20. Tests of proportion (Wald’s method to calculate confidence interval) and chi-square test was used. P value <0.05 was considered as significant. Results: The prevalence of cataract in the study population was 72.1% (95% CI- 68.3%, 75.8%) which was significantly associated with age, marital status, type of family & working status. Conclusions: The study concluded that approx. three- fourth of elderly population had cataract which was significantly associated with various socio- demographic factors. Therefore, these factors need to be addressed to reduce the burden of cataract among elderly population.

Health seeking behaviour among post-menopausal women: a knowledge, attitude and practices study

Background: Ageing women suffer problems associated with senility along with that of the reproductive tract changes. Unless the woman is treated as a whole, her problem is actually not addressed. With this background, the present study was undertaken with the following objectives: to identify the major health problems of postmenopausal women, to determine the level of knowledge, attitude and practices of postmenopausal women in terms of seeking Health care facilities for their problems and to determine the utilization pattern and barriers to utilization of health care services by these women. Methods: It was a community based cross-sectional study conducted in the registered field practice areas of the Department of Community Medicine, Jawahar Lal Nehru Medical College and Hospital, Aligarh from June, 2012 to May, 2013. The study tools consisted of pre-tested and semi-structured proforma and standard Menopausal Rating scale (MRS) questionnaire. Results: Psychological symptoms were reported by 34.3%, somatological symptoms by 60.1% and urogenital symptoms by 59.6% of the study population. To deal with these problems, majority in urban areas said that a doctor should be consulted whereas majority in rural areas either said that they did not know what could be done or traditional or home-based measures should be resorted to. Conclusions: A large majority suffered from ill-health. Most rural women had no access to health services. Lack of knowledge and traditional practices were barriers to utilization of services.