Marie Gilbert Majella

High Tobacco Use among Presumptive Tuberculosis Patients, South India: Time to Integrate Control of Two Epidemics

Objectives Tobacco is an important risk factor for tuberculosis (TB) infection and TB disease. Identifying tobacco users and providing tobacco cessation services is expected to reduce the burden of TB. We assessed tobacco use among presumptive TB patients attending a tertiary hospital and their willingness to attend tobacco cessation services. Methods A cross-sectional study was conducted among presumptive TB patients attending a designated microscopy center of a tertiary hospital in South India. All presumptive TB patients aged ≥ 18 years attending the designated microscopy center were interviewed using a semistructured interview schedule. Data on presumptive TB patients age, sex, tobacco use and forms of tobacco, attempts to quit tobacco since 1 year, and willingness to attend a smoking cessation clinic in tertiary hospital were captured. History of use of tobacco in the past 1 month was considered as “tobacco use.”. Results A total of 424 presumptive TB patients aged ≥ 18 years were interviewed. Tobacco use in the past 1 month was reported by 176 (41.5%, 95% confidence interval: 36.9–46.3%) presumptive TB patients. In total, 78 (18%) presumptive TB patients were eventually diagnosed with smear-positive pulmonary TB, of them 63 (80%) were tobacco users. Presumptive TB patients aged ≥ 30 years, male sex, and < 10 years of education were significantly associated with tobacco use. Of 176, a majority of 132 (75%) used some form of smoking. Of a total of 132 smokers, 70 (53%) were willing to avail of tobacco cessation services. Conclusion Tobacco use among presumptive TB patients was high. Considering the high willingness to quit among smokers, proven brief interventions to help quit smoking can be tried.

Failure to achieve goal blood pressure and its associated factors among hypertensive patients registered in a primary health centre in South India

Introduction: Uncontrolled blood pressure (BP) among hypertensive patients leads to life-threatening complications, hospitalization, and premature mortality. Knowledge on the burden of uncontrolled BP and its correlates will help in devising strategies to achieve goal BP. We aimed to determine the proportion who have not achieved goal BP and its associated factors among hypertensive patients in a Primary Health Centre (PHC). Materials and Methods: A facility-based cross-sectional analytical study was conducted among the hypertensive patients attending chronic disease clinic of PHC at Ramanathapuram, Puducherry. BP was measured and goal BP was defined based on Joint National Committee-8 criteria. The interview was conducted using semi-structured questionnaire capturing sociodemographic details, behavioral characteristics, physical activity with the International Physical Activity Questionnaire (IPAQ), medication adherence with Morisky Medication adherence scale-8 (MMAS-8), and stress with perceived stress scale. The data were entered and analyzed using EpiData software. The proportion “not achieved goal BP” was expressed as percentage and association were measured using prevalence ratios (PRs) with 95% confidence interval (CI). Results: Of total 259 hypertensives studied, 140 (54.1%) were aged above 60 years, and 161 (62.2%) were females. Overall, 63 (24.3%) participants had not achieved goal BP. On univariate analysis, individuals aged 45–59 years (PR-2.1 [95% CI: 1.4–3.4]), being male (PR-1.6 [95% CI: 1.1–2.4]) and employed (PR-2.0 [95% CI: 1.1–3.5]) were associated with not achieving goal BP. Conclusion: One-fourth of patients treated for hypertension in PHC failed to achieve goal BP. Considering the consequences of uncontrolled BP, cost-effective, context-specific interventions at the primary health-care level are needed.

What diseases do ‘Siddha’ practitioners treat? Morbidity profile of adult outpatients attending traditional medicine health facilities in a district of South India

Background Siddha system is a complementary system of medicine popular in South India. Information on common morbidities for which people seek care in Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) systems and especially in Siddha hospitals is very limited. This knowledge will help in prioritizing diseases and developing standard treatment guidelines. Objective(s) The present study was designed with the aim to describe the morbidity profile of the adult patients attending Siddha Out Patient Department (OPD) at Government Hospitals in Erode district of Tamil Nadu. Materials and methods A facility-based cross-sectional descriptive study was conducted among adult (15–59 years) patients, who attended Siddha Hospital OPDs during February, 2014. Two block level health facilities were randomly selected from ten block hospitals offering Siddha services in Erode district of Tamil Nadu. Information on socio-demographic characteristics like age, gender and education was captured using a pre-tested proforma. Diagnosis was done by treating Siddha practitioners as per reporting format. Data were single entered and analyzed using EpiData software. Results Of the total 1786 patients who attended the Siddha OPD, 1720 (96%) completed the interviews. Mean (Standard Deviation) age of participants was 41 (11) years and 913 (53%) were females; 20% had no formal education. Of 1720 participants, arthritis (21%), neuritis (10%), fungal diseases (7%) were the top three morbidities, with arthritis and neuritis being most common morbidities in both males and females. Conclusion Arthritis, neuritis and fungal diseases were the most common morbidities, for which patients sought care in Siddha hospitals. These morbidities can be considered for preparing standard treatment guidelines under the national programme.

Overweight and obesity among elderly in an urban slum of Puducherry: A facility-based descriptive study

Background: Overweight and obesity are important addendum to the pool of risk factors for noncommunicable disease (NCD) among the elderly. Objectives: The objectives of this study were to find (1) the proportion of overweight and obesity and (2) the distribution of overweight and obesity based on sociodemographic characteristics and four major risk factors for NCDs (smoking, alcohol consumption, unhealthy diet, and physical inactivity) among the elderly attending the out-patient department/NCD clinic of a Urban Health and Training Centre (UHTC). Materials and Methods: This facility-based descriptive study was conducted among 181 elderly attending one UHTC, in Puducherry during June and July 2015. A pretested interview schedule was used to obtain information on sociodemographic details and history of NCD risk factors after obtaining verbal informed consent. Anthropometric measurements were taken as per standard procedures prescribed by the World Health Organization. Body mass index (BMI) was calculated and classified using BMI classification for the Asian population. Results: Among the elderly, 18% were overweight and 51% were obese. The proportion of obesity was more among females than males. Obesity was found to be decreasing with increase in age. Overweight and obesity were found to be significantly inversely related to chronic disease status. Overweight and obesity were proportionately more among elderly who were consuming alcohol and doing less physical activity than prescribes. However, the proportion of overweight/obees elderly with no tobacco use and not having unhealthy diet was found to be more than their counterpart. Conclusion: Overweight and obesity are important public health problems in the study population. Hence, interventions should be implemented targeting elderly as well as the adult to decrease the obesity and overweight among the elderly.

How much do persons with diabetes in a rural area of South India know about diabetes management? A step toward person-centered care

Introduction: The burden of diabetes mellitus is increasing worldwide, more so in developing countries. Optimal diabetes care depends on adherence to management protocol, which can be brought about by shared decision-making. Patients knowledge on life-threatening complications and preventive strategies for the same is a prerequisite for shared decision-making. Hence, this study was carried out among diabetes patients to assess the level of knowledge on different aspects of diabetes management. Methodology: A facility-based cross-sectional study was conducted among patients registered and seeking care from a Rural Primary Health Centre in Puducherry, South India. All the individuals with diabetes were included in the study. Trained MBBS interns interviewed the patients after obtaining informed consent. A semi-structured interview schedule was used to capture information on sociodemographic profile, disease characteristics, knowledge on different aspects of diabetes management, and prevention of diabetic complications. Data were entered and analyzed using EpiData software. Knowledge on each item was expressed as percentages. Results: Of the total 172 participants, 58% were females, 63% were aged between 31 and 60 years. About half of the participants had diabetes for more than 5 years. Of the total, about 83% knew that there is a need for lifelong treatment. About 51%, 44%, 21%, and 9% were aware that diabetes can cause complications to eye, renal, foot, and heart, respectively. Of the total, about 74%, 78%, 17%, 15%, 35%, and 56% knew the correct frequency for monitoring of blood sugars, blood pressure, renal function, lipid profile, fundus, and foot, respectively. Conclusion: This study shows that knowledge on few components of diabetes management is still limited, and there is a need to impart knowledge through health education to patients. Adequate knowledge on diabetes management principles is important for implementing patient-centered care in primary care setting.

Level of tobacco dependence among tobacco users in an urban slum of Puducherry: A pilot study

Context: Successful tobacco quit by the tobacco users can avoid millions of premature death. However, the physical dependence on tobacco use results in frequent relapse most commonly due to withdrawal symptoms. Aims: The aim of this study was to study the level of tobacco dependence among tobacco users in an urban slum of Puducherry. Materials and Methods: This facility-based descriptive pilot study was conducted among patients aged 15 years or above attending an urban health and training center in an urban slum of Puducherry. A total of 90 consecutive current tobacco users were included after obtaining verbal informed consent and interviewed using a pretested questionnaire. The information on tobacco dependence was collected using Fagerstrom Addiction Scale for smokers and smokeless tobacco users separately. Results: Of the 90 current tobacco users, 95% were daily tobacco users. Of the current tobacco users, 48.8%, 45.6%, and 5.6% were smokers, smokeless tobacco users, and dual users, respectively. Majority of the smokers (61%) and most of the smokeless tobacco users (41%) had medium dependence for tobacco use. However, physical dependence was much higher among smokeless tobacco users (41.3%) than smokers (20.4%). Conclusion: Proportionately high physical dependence on tobacco is a concern in the study population. Community-based interventions are required to curb the problem; however, study with representative sample should be carried out before that.

Use of Mobile Phone in Healthcare: Readiness among Urban Population of Puducherry, India

Introduction: Use of mobile phones in planning of health care interventions is on the rise. Before planning of such interventions, it is essential to know about readiness among the target population. Objective(s): To identify the access to personal mobile phone, knowledge on usage in terms of making/receiving call/SMS and the willingness to use mobile phone as a medium for health communication among adults in an urban area of Puducherry, South India. Methodology: A community based cross-sectional study was conducted in two randomly selected areas out of the four in the urban field practice area of a medical college in Puducherry during July, 2014. Systematic random sampling was done to select 126 houses. All individuals above 18 years in those households were included. A pre-tested interview schedule was used to collect information. Association between socio-demographic factors and willingness to receive health tip through mobile phone was found using binary logistic regression. Results: Among 299 participants interviewed, 227 (75.9%) had personal mobile phones; 229 (76.6%), 128 (42.8%) and 131 (43.8%), were able to receive and make a call, read SMS, and text SMS respectively. Nearly 50% were willing to receive health information through mobile phones. Of these, 67.5% were willing to receive through call/SMS and 35.5% only through calls. On multivariate binary logistic analysis, individuals having personal mobile and younger age were found to be willing to receive health information through mobile phones. Conclusion: Three in every five individuals having personal mobile were willing to receive health information through mobile with most of them preferring call/SMS over only call.

Does audit improve diabetes care in a primary care setting? A management tool to address health system gaps

Introduction: Diabetes mellitus is one of the emerging epidemics. Regular clinical and biochemical monitoring of patients, adherence to treatment and counseling are cornerstones for prevention of complications. Clinical audits as a process of improving quality of patient care and outcomes by reviewing care against specific criteria and then reviewing the change can help in optimizing care. Objective: We aimed to audit the process of diabetes care using patient records and also to assess the effect of audit on process of care indicators among patients availing diabetes care from a rural health and training center in Puducherry, South India. Materials and Methods: A record based study was conducted to audit diabetes care among patients attending noncommunicable disease clinic in a rural health center of South India. Monitoring of blood pressure (BP), blood glucose, lipid profile and renal function test were considered for auditing in accordance with standard guidelines. Clinical audit cycle (CAC), a simple management tool was applied and re-audit was done after 1-year. Results: We reviewed 156 and 180 patients records during year-1 and year-2, respectively. In the audit year-1, out of 156 patients, 78 (50%), 70 (44.9%), 49 (31.4%) and 19 (12.2%) had got their BP, blood glucose, lipid profile and renal function tests done. Monitoring of blood glucose, BP, lipid profile and renal function improved significantly by 35%, 20.7%, 36.4% and 56.1% over 1-year. Conclusion: CAC improves process of diabetes care in a primary care setting with existing resources.