Madhavi Bhargava

Can social interventions prevent tuberculosis?: the Papworth experiment (1918-1943) revisited.

RATIONALE There is consensus on the need to address social determinants of tuberculosis (TB) to achieve TB control, but evidence based on interventions is lacking. OBJECTIVES We reanalyzed data from the sociomedical experiment performed at the Papworth Village Settlement in England, where the impact of stable employment and adequate housing and nutrition on the incidence of TB infection and disease in children living with parents with active TB was documented during 1918-1943. METHODS Information on 315 children of patients, who lived at Papworth, was abstracted from a published monograph. Overall and age-specific occurrence of TB infection, disease, and deaths among children born in the settlement (village-born cohort) were compared with those of children born outside and admitted later (admitted cohort) to Papworth. MEASUREMENTS AND MAIN RESULTS The annual risks of infection in the village-born and admitted cohorts were 20 and 24%, respectively. Of 24 children who developed TB disease, only one was village-born. Among children 5 years of age or less, there was zero incidence of TB in the village-born, compared with five cases (1,217/100,000 person-years) among children born outside Papworth. In the admitted cohort, among children 13 years of age and older, the incidence of TB before admission to Papworth was 5,263/100,000 person-years, whereas it was 341/100,000 person-years while living in Papworth. CONCLUSIONS At Papworth social interventions including adequate nutrition did not reduce TB transmission but did reduce the incidence of TB disease in children living with parents with active TB. These results are relevant today for prevention of TB in children of patients with active TB, particularly with multidrug-resistant TB in high-burden settings.

World Water Day, 2016; Better Water, Better Jobs for the Unorganized Sector

As a part of the curriculum for the undergraduate students, the Department of Community Medicine, Yenepoya Medical College, Mangalore, conducted a program that focused on the water issues for workers at construction sites.[1] This was to sensitize the students toward the health in the unorganized sector. A “role play” by the students was followed by a demonstration of inexpensive and sustainable methods of water treatment before consuming as well as hand‐washing practices. The program concluded with an interactive session with the workers and contractors and an informal observation of workplace facilities.

Salt reduction strategy at population level

World is facing a huge burden of noncommunicable diseases such as hypertension, ischemic health diseases, and stroke. Moreover, the developing countries have had a relatively speedy rise of the problem, with noncommunicable diseases occurring at much lower age as compared to the developed world. The World Health Organization, therefore, recommends reduction in salt intake at population level to <5 g/day. Not all researchers and public health physicians agree to it, leading to conflicting information for a primary care physician. This evidence based summary documents this polarization of the recommendations regarding salt reduction and acknowledges the ongoing challenge primary care physicians face when following such evidence based guidelines.

Use of International physical activity questionnaire-short form for assessment of physical activity of children

The authors used International Physical Activity Questionnaire‐Short Form‐A (IPAQ‐SF) to assess physical activity and calculate metabolic equivalent for participants belonging to the age group 10–15 years. However, the IPAQ Guidelines for data processing and analysis clearly indicate that the instrument should be used for ages ranging from 15 to 59 years and that “until further development and testing is undertaken, the use of IPAQ for older and younger age groups is not recommended.”[2]

Patient and health system delays among adult smear-positive tuberculosis patients at medical colleges of Puducherry in South India: A comment

Sir, I read with interest the article on delays at patient and health system level among smear-positive tuberculosis by Purty et al.[1] The authors have pointed out the extent of delays in the diagnosis and treatment in sputum positive patients. The fact that 40.7% patients were earning international normalized ratio ≤2000/month and another 35.2% did not have steady income source is very significant. It definitely reinforces the importance of addressing social determinants in any tuberculosis control program.[2] Further considering the prevalence of multidrug-resistant tuberculosis (MDR-TB) in India, as 3% in new cases and 12%–17% in retreatment cases,[3] the implications on transmission of MDR-TB in the community are worrisome. This calls for the strengthening of airborne infection control in India, which is far from ideal.[4]

Overweight and Obesity in School Children of a Hill State in North India: Is the Dichotomy Urban-Rural or Socio-Economic? Results from a Cross-Sectional Survey

Introduction Overweight and obesity are a public health problem in India not only in adults but also in children. The authors sought to estimate the prevalence of overweight and obesity in school-going children of 6–17 years of age and examine its demographic and dietary correlates in context of their urban-rural status and socio-economic status. Methods In this cross-sectional survey height and weight were measured in 1266 school children in government and private schools of urban and rural areas. Dietary assessment was done using single day 24-hour dietary recall method. The data were analyzed using SPSS (IBM SPSS Statistics Version 19) and WHO AnthroPlus Software. Factorial ANOVA was used for testing interaction within and between subgroups for continuous variables and Chi-square test was used for categorical variables. Results It was found that the overall prevalence of overweight was 15.6% of which 5.4% were obese, with maximum prevalence in boys attending urban private schools. The mean caloric intake in the study population with 24-hour dietary recall method was 1558.2 kilocalories (SD: 428 kilocalories). Conclusion Overweight and obesity is a significant problem in school-going children. Higher socio-economic status continues to remain an important driver of this epidemic in the younger generation and affects demographic and dietary determinants of this problem.

Physical activity correlates of overweight and obesity in school-going children of Dehradun, Uttarakhand

Background: Physical activity is important for prevention of overweight and obesity in growing children. Objective: The present study aims to explore the association of overweight and obesity in school children of the district of Dehradun with physical activity, sports, and recreation at home and school. Materials and Methods: A cross-sectional survey of 1266 schoolchildren of select private and government schools in urban and rural areas was done. Results: Overall 15.6% of children were overweight, of which 5.4% were obese. Overweight and obesity were significantly associated with physical inactivity related to passive transport to school, missed opportunities for play during lunch breaks, lack of participation in household work, and excessive viewing of television. Conclusion: We found a significant association between the lack of physical activity and overweight and obesity. There is a need to enhance physical activity, sports, and recreational opportunities at school as well as home to prevent overweight and obesity in children. Family physicians should include counseling for this important and cheap modifiable risk factor in their family care practice.

Community diagnosis by a family survey: an exposure to primary care during medical undergraduate training

Villages constitute 70% of India’s population but most medical colleges are situated in urban areas for multiple reasons. Most doctors also prefer urban areas to rural because of low revenue, housing issues, insanitary environment and poor educational opportunities for their own children in country areas.[1] There are more than 400 medical colleges for undergraduate medical training in India with more than 52,000 students in total.[2] The total duration of training is five and a half years which includes a final internship to be certified as Bachelor of Medicine and Bachelor of Surgery (MBBS). There are in all three community medicine postings of total 12 weeks duration (225 h) spanning over the first, second and third parts of undergraduate medical training. The vision document of the Medical Council of India (MCI) proposes the introduction of new teaching elements that emphasise training at primary and secondary level with compulsory family medicine training.[3] Community exposure and community projects are one of the many examples of newly introduced ‘electives’ which aid flexible learning. Rural health services are far from being perfect in India. If the present curriculum of undergraduate medical training is utilised optimally we can train doctors who are keen on rural practice rather than push rural practice through coercive methods such as extending the course by one more year or banning doctors from settling outside India.[4] This can also include optimising the involvement of medical colleges through their regular curriculum. Community medicine departments can play an important role in doing so. The department of community medicine at Yenepoya Medical College, during the first MBBS family survey attachment, introduces the concept of community diagnosis to the students in a simple and practical manner. Community diagnosis is a quantitative and qualitative description of the health of citizens and the factors which influence their health. It identifies problems, proposes areas for improvement and stimulates action. The objectives of community diagnosis are to determine major health problems and needs, identify resources to deal with them, ensure community participation, and study the physical, biological and psychological environment of the family.[5] It generally involves comprehensive assessment of the health status of the community in terms of its social, cultural, physical and environmental conditions. But the important underlying idea is to reinforce the importance of seeing the individual patient in the context of his or her family and community. This brings practical understanding of several social and environmental determinants and their role in health and disease. This paper describes the 10 day attachment of a cohort of 25 students of 1st MBBS for community diagnosis by family survey in a village. The community diagnosis was done using only limited components appropriate for these students. The qualitative aspect of community diagnosis was covered during a separate focus group discussion. We describe the main activities performed by students during this family survey attachment. It paves the way for family adoption during the tenure of undergraduate medical training which can provide a platform for social engagement and accountability of the medical colleges.