Prabhdeep Kaur

High prevalence of tobacco use, alcohol use and overweight in a rural population in Tamil Nadu, India

BACKGROUND Cardiovascular diseases are one of the leading causes of death in India. There is high prevalence of cardiovascular risk factors in urban Tamil Nadu. There are limited data on the prevalence of behavioral risk factors and overweight in rural Tamil Nadu. AIM We estimated prevalence of behavioral risk factors, overweight and central obesity in a rural population in Tamil Nadu, India. SETTING AND DESIGN We conducted a cross-sectional survey in 11 villages in Kancheepuram/Thiruvallur districts, Tamil Nadu. MATERIALS AND METHODS Study population included 10,500 subjects aged 25-64 years. We collected data on behavioral risk factors and anthropometric measurements. Body mass index (BMI) was categorized using the classification recommended for Asians. Central obesity was defined as waist circumference ≥90 cm for men and ≥80 cm for women. We computed proportions for all risk factors and used trend chi-square to examine trend. RESULTS Among the 10,500 subjects, 4927 (47%) were males. Among males, 1852 (37.6%) were current smokers and 3073 (62.4%) were current alcohol users. Among females, 840 (15.1%) were smokeless tobacco users. BMI was ≥23.0 kg/m 2 for 1618 (32.8%) males and 2126 (38.2%) females. 867 (17.6%) males and 1323 (23.7%) females were centrally obese. Most commonly used edible oil was palm oil followed by sunflower oil and groundnut oil. CONCLUSION We observed high prevalence of tobacco use, alcohol use and central obesity in the rural population in Tamil Nadu. There is need for health promotion programs to encourage adoption of healthy lifestyle and policy interventions to create enabling environment.

Persistent arthralgia among Chikungunya patients and associated risk factors in Chennai, South India

CONTEXT Chikungunya (CHIK) fever is viral disease characterized by joint pain for prolonged duration in various settings. However, there are no reports of long-term follow-up of the CHIK patients from India. AIMS We conducted a cohort study to describe the clinical manifestations, incidence of persistent arthralgia, and the associated risk factors among patients with CHIK identified during an outbreak in a suburb of Chennai, India. MATERIALS AND METHODS We conducted a retrospective cum prospective cohort study in Gowripet, Avadi, Chennai. We included all adult CHIK case patients identified during the outbreak. We conducted a nested case-control study to identify the risk factors for persistent arthralgia defined as a CHIK case experiencing arthralgia for more than 15 days from the date of onset of illness. We included all 81 patients and 81 randomly selected controls. RESULTS All 403 case patients had joint pain. Approximately 40% suffered joint pain for up to 1 month and 7% had it beyond 1 year. The most commonly affected types of joints were knee (96%), wrist (80%), and ankle (77%) joints. Regarding the number of types of joints affected, 36% had six types of joints, 23% had five types of joints, and 14% had three types of joints affected. The overall incidence of persistent arthralgia was 80%. High-grade fever, involvement of four or more types of joints, and joint swelling were significantly associated with persistent arthralgia. CONCLUSIONS High prevalence of persistent arthralgia indicates the need for appropriate treatment strategies to reduce the severity and duration of joint pain.

Prevalence of Behavioral Risk Factors, Overweight and Hypertension in the Urban Slums of North 24 Parganas District, West Bengal, India, 2010

Globally, 1 billion people live in slums. There are few reports of high prevalence of noncommunicable disease (NCD) risk factors among the urban poor. The prevalence of NCD risk factors in the slums in North 24 Parganas, West Bengal, India was estimated. Cross-sectional survey in 24 slums selected using cluster sampling method was conducted. Questionnaire for behavioral risk factors was used and anthropometric and blood pressure measurements were done. The study population included 1052 participants aged 25-64 years, 528 (50%) were males. Among males, 206 (39%) were current smokers and 154 (29%) were current alcohol users. Central obesity was prevalent among 32.8% males and 56.1% females and 115 (10.9%) had body mass index ≥27.5 kg/m 2 . Hypertension was prevalent among 35% males and 33% females. We observed high prevalence of NCD risk factors among urban slum dwellers that need to be addressed with health promotion programs and strengthening of primary health care system.

Challenges and limitations of maintenance hemodialysis in urban South India.

Maintenance hemodialysis is a treatment modality available to few patients reaching end‐stage renal disease in India. However, the morbidity and outcome of such treatment remains largely unknown. A retrospective cohort of patients commencing hemodialysis in a secondary care institution in India between January 1, 2002 and December 31, 2004 was studied. Patient demographics, cardiac status, access, hospitalizations, and emergency room visits were assessed and outcomes determined. During the study period, 95 patients (66 males, 29 females) commenced maintenance hemodialysis. The underlying cause of chronic kidney disease was diabetic nephropathy in 66.3% of patients. Cumulative follow‐up was 676+9.1 patient months. The mean serum creatinine (+SD) at initiation of dialysis was 8.39+3.28 mg%. Thirty‐six percent of patients had a functioning arteriovenous fistula at commencement of dialysis, while the remaining 64% of patients required temporary access. The mean number of comorbidities was 1.9+1.0/patient; diastolic dysfunction was deemed to be present in 20.4% of the patients. The hospitalization rate was 3.9/patient year; the number of visits to the emergency room was 4.9/patient year. Cardiac pathology was the most common cause leading to hospitalization and emergency room visits. Diabetic patients were older and had higher cardiac morbidity (p<0.01). The outcome was as follows: 39% transferred to other units; 27% died; 9% switched to CAPD; 8% lost to follow‐up; 1% transplantation: Kaplan‐Meier survival analysis showed a median survival of 410 days. Patients commencing hemodialysis in an urban dialysis center in South India are predominantly male and have significant comorbidity including diabetes and cardiac disease. Outcome is generally poor. Hence, a huge opportunity for improvement exists.

Non-communicable disease comorbidities and risk factors among tuberculosis patients, Meghalaya, India

We did cross-sectional study to estimate the prevalence of tobacco, alcohol use, hypertension and diabetes among tuberculosis (TB) patients in comparison to the non-TB patients in East Garo Hills District, Meghalaya, India. We surveyed 110 TB patients attending outpatient TB clinic and 110 age/sex matched non-TB subjects from the general outpatient department as comparison group. Prevalence of ever smoking was 74.5% and 55.4%; alcohol consumption 31.0% and 22.3%; hypertension 24.5% and 17.3%; diabetes 7.5%, 4.5% among TB patients and non-TB subjects, respectively. NCD and TB programmes need integration in the primary care for screening, counselling and treatment of NCD comorbidities.

Rickettsial disease outbreaks in India: A review

Rickettsial infections are caused by bacteria of the Rickettsiae family. Several reports in the past decade indicated the presence of disease in various parts of India. We reviewed the rickettsial outbreaks to describe the epidemiology, clinical features, laboratory investigations, entomological investigations, risk factors and treatment. We searched the literature about rickettsial diseases outbreaks in India using web databases. We included research papers about the investigation of rickettsial disease outbreaks during 2000-2011. We included 11 outbreaks from seven Indian states of which four were in a community setting rest were hospital based. There were more than 900 cases and forty two deaths with case fatality ratios 5%-17%. The clinical manifestations were fever, eschar, headache, myalgia, cough and lymphadenopathy. The laboratory diagnosis in 9 outbreaks was based on Weil Felix test either singly (n = 5) or in combination with Micro-immunofluorescence (n = 2) or ELISA (n = 2). Only IgM ELISA was used in 2 outbreaks. Only one of the outbreaks was due to Indian Tick Typhus while the remaining 10 were due to Scrub Typhus. Risk factor and entomological investigations were conducted in few studies. The review of rickettsial outbreaks in the last decade indicates its continued presence in several parts of the India. We recommend use of uniform case definition, capacity building for laboratory confirmation and entomology surveys. Doctors practicing in areas prone to these diseases need to be sensitized to have high index of suspicion while evaluating patients with fever and community should be educated to seek early treatment.

High prevalence of household pesticides and their unsafe use in rural South India

ObjectiveTo estimate the prevalence of usage, unsafe practices and risk perception regarding household pesticides in a rural community of Tamil Nadu, India.Materials and MethodsIn a cross-sectional survey we used a pre-tested questionnaire and trained interviewers to collect information on household pesticide use for the past 6 months from any adult member of randomly selected households.ResultsOut of 143 households, 95% used at least one household pesticide (95% CI: 93.5–99.5) and 94% used at least one household pesticide specifically for mosquito control. The most commonly used pesticides were mosquito coils (75%), mosquito liquid vaporizers (36%), ant-killing powder (24%) and moth/naphthalene balls (18%). The major non-chemical methods of pest control were rat traps (12%) and mosquito bed nets (7.5%). Out of the mosquito coil users, 61% kept the windows and doors closed while the coil was burning. Out of the moth ball users, 88% left them in the place of use till they fully vaporized. Nearly half of the users did not know that household pesticides were harmful to their health and the health of their children.ConclusionsThe use of household pesticides was highly prevalent in this rural community. The prevalence of unsafe practices while handling them was also high. We recommend that the users of household pesticides be educated about the health hazards and about safe practices and non-chemical methods of pest control be promoted.

Seven years of the field epidemiology training programme (FETP) at Chennai, Tamil Nadu, India: an internal evaluation

BackgroundDuring 2001–2007, the National Institute of Epidemiology (NIE), Chennai, Tamil Nadu, India admitted 80 trainees in its two-year Field Epidemiology Training Programme (FETP). We evaluated the first seven years of the programme to identify strengths and weaknesses.MethodsWe identified core components of the programme and broke them down into input, process, output and outcome. We developed critical indicators to reflect the logic model. We reviewed documents including fieldwork reports, abstracts listed in proceedings and papers published in Medline-indexed journals. We conducted an anonymous online survey of the graduates to collect information on self-perceived competencies, learning activities, field assignments, supervision, curriculum, relevance to career goals, strengths and weaknesses.ResultsOf the 80 students recruited during 2001–2007, 69 (86%) acquired seven core competencies (epidemiology, surveillance, outbreaks, research, human subjects protection, communication and management) and graduated through completion of at least six field assignments. The faculty-to-student ratio ranged between 0.4 and 0.12 (expected: 0.25). The curriculum was continuously adapted with all resources available on-line. Fieldwork led to the production of 158 scientific communications presented at international meetings and to 29 manuscripts accepted in indexed, peer-reviewed journals. The online survey showed that while most graduates acquired competencies, unmet needs persisted in laboratory sciences, data analysis tools and faculty-to-student ratio.ConclusionsNIE adapted the international FETP model to India. However, further efforts are required to scale up the programme and to develop career tracks for field epidemiologists in the country.

Low coverage of Janani Suraksha Yojana among mothers in 24-Parganas (South) of West Bengal in 2009

Janani Suraksha Yojana (JSY), a maternity protection scheme, aims to reduce maternal and infant mortality and to promote institutional delivery in India. It was started in 2005. Under JSY, pregnant mothers of poor, scheduled caste and tribes shall get financial benefits of INR 500 (USD 10.7) after completing three antenatal care visits; INR 150 (USD 3.2) to INR 350 (USD 6.4) for transport to government or accredited private healthcare institution; and INR 500 (USD 10.7) for opting institutional delivery. We evaluated JSY in South 24-Parganas district of West Bengal.

Statistical issues in studying the relative importance of body mass index, waist circumference, waist hip ratio and waist stature ratio to predict type 2 diabetes

Systematic and appropriate statistical analysis is needed to examine the relative performance of anthropometrical indices, viz. body mass index (BMI), waist circumference (WC), waist hip ratio (WHR) and waist stature ratio (WSR) for predicting type 2 diabetes. Using information on socio-demographic, anthropometric and biochemical variables from 2148 males, we examined collinearity and non-linearity among the predictors before studying the association between anthropometric indices and type 2 diabetes. The variable involving in collinearity was removed from further analysis, and the relative importance of BMI, WC and WHR was examined by logistic regression analysis. To avoid non-interpretable odds ratios (ORs), cut point theory is used. Optimal cut points are derived and tested for significance. Multivariable fractional polynomial (MFP) algorithm is applied to reconcile non-linearity. As expected, WSR and WC were collinear with WHR and BMI. Since WSR was jointly as well as independently collinear, it was dropped from further analysis. The OR for WHR could not be interpreted meaningfully. Cut point theory was adopted. Deciles emerged as the optimal cut point. MFP recognized non-linearity effects on the outcome. Multicollinearity among the anthropometric indices was examined. Optimal cut points were identified and used to study the relative ORs. On the basis of the results of analysis, MFP is recommended to accommodate non-linearity among the predictors. WHR is relatively more important and significant than WC and BMI.