Pruthu Thekkur

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.

Self-care practices among diabetes patients registered in a chronic disease clinic in Puducherry, South India

Background: In management of diabetes, self-care plays an important role in prevention of complications. This study aims to find the proportion of diabetic patients following the recommended self-care practices in an urban area of Puducherry. Materials and Methods: Consecutive eligible patients registered in chronic disease clinic were interviewed using Summary of Diabetes Self Care Activities Score (SDSCA) questionnaire. Self-care practices were evaluated in domains of diet, physical activity, foot-care, adherence to medications and blood glucose monitoring. All domains were scored from the range of 0 to 7. Results: Totally 162 diabetic patients were interviewed. The mean (SD) age of participants was 57 (11.1) yrs. Among all domains, adherence to medication was the highest (95.6 %) followed by avoidance of selected food items (99.4%). Almost 78% of patients had their blood sugar checked at least once in the last three months. Only half of them (50.6%) had followed at least 20 minutes of leisure time physical activity. Except washing of foot (83.3%) all other foot care practices were less commonly (35-57%) followed. Conclusion: The study shows that higher level of compliance to self-care practices in terms of taking drugs and diet but self-care in other domains such as foot care is alarmingly low.

Age and Sex Differences in Sputum Smear Microscopy Results for Acid Fast Bacilli in a Tertiary Care Centre, South India

Background and Objectives. Low counts are more difficult to find in microscopic sputum examination and thus are more likely to be missed. In this study, we aimed to estimate the proportion of low-count grading and assessing any age and gender differences in sputum smear grading in a low HIV prevalence setting. Materials and Methods. From the tuberculosis laboratory register information on sputum positivity including the grading of smears, age and gender were extracted for January 2011–December 2011. Smears were examined using Ziehl-Neelsen technique and graded as per the Program Guidelines. Positive smears were classified into low grade positive smears (scanty and 1

Mobile Phone Usage and Willingness to Receive Health-Related Information Among Patients Attending a Chronic Disease Clinic in Rural Puducherry, India.

Global increase in mobile phone usage provides an opportunity in transforming health care delivery for improving the management of noncommunicable diseases (NCDs).1 Before planning mHealth interventions, it is useful to know the capacity and willingness of the target population.2 Therefore we aimed to assess mobile phone availability and knowledge regarding operation of mobile phones and assess willingness to receive health-related information.

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.

Alarmingly high level of alcohol use among fishermen: A community based survey from a coastal area of south India

INTRODUCTION Though studies from western world have reported high prevalence of alcohol use among fishermen, there is lack of information from developing world. Hence this study was carried out among fishermen in a coastal area of southern India to 1) determine the prevalence of alcohol use among fishermen 2) describe the pattern of alcohol use 3) identify factors associated with alcohol use. METHODS A community based cross-sectional study was carried out among fishermen in a coastal village of Puducherry, India. House to hose survey was conducted, fishermen aged above 18 years and involved in catching fish at least once in last three months, were included. Data on age, marital status, education, monthly income, duration in fishing occupation, owning a boat or wager, frequency of fishing per month/week, number of hours spent in sea, alcohol use in past one year, age at initiation, type of alcohol drink and presence of alcohol users in family. RESULTS In total, 304 participants were interviewed. Mean (SD) age of the participants was 41 (11) and 82% were involved in fishing for more than 10 years. Of 304 participants, 241 (79%) reported alcohol use in past one year. Of 241 participants who used alcohol, 89% reported alcohol consumption during fishing activity. In multivariate analysis, alcohol use in other family members was independently associated with alcohol use (aRR 21.4; 95% CI 6.8-67.4). CONCLUSION Very high prevalence of alcohol use is seen among fishermen. Of those who consume alcohol, nine out of ten use during fishing activities.

Attack rate and household secondary attack rate of acute conjunctivitis during an outbreak in South India: A community-based survey

Introduction: Knowledge on epidemiology of the disease in the contemporary world will help to develop appropriate strategies to curtail the transmission during an outbreak. This study was carried out during an outbreak of conjunctivitis in selected areas of Puducherry, South India, to assess the attack rate of conjunctivitis, identify factors associated with developing conjunctivitis and calculate household secondary attack rate (HSAR) of conjunctivitis and its correlates. Methodology: During December 2014, a community-based survey was conducted in a selected urban and rural area in Puducherry, South India. Simple random sampling was used to select primary sampling units and systematic sampling to select households. All individuals in the selected households were studied. A questionnaire was used to obtain data on sociodemographic characteristics, conjunctivitis during September-November, 2014, and number of household contacts who developed conjunctivitis within 7 days of index case. The attack rate and HSAR of conjunctivitis was expressed as percentage. Multivariate logistic regression was used to find factors independently associated with developing conjunctivitis and also 100% HSAR. Results: Of 3193 study participants from 772 households, 509 (15.9%, 95% confidence interval 14.7-17.2%) had an attack of conjunctivitis during the reference period. Of the 772 households, 218 (28.2%) had at least one case of conjunctivitis. Of 218 households, 33 (15.1%) households had 100% HSAR. Lower age, not being unemployed, low socioeconomic status, and residing in rural area were independently associated with developing conjunctivitis. Index case being male and living in a household with ≥5 members were independently associated with 100% HSAR. Conclusion: In the outbreak under study, more than one-fourth of households had at least one case of conjunctivitis and about one in every six individuals had an attack of conjunctivitis.

Active screening for tuberculosis among slum dwellers in selected urban slums of Puducherry, South India

295 Annals of Tropical Medicine and Public Health | Jul-Aug 2016 | Vol 9 | Issue 4 Dear Sir, The World Health Organization’s (WHO’s) “End TB Strategy” advocates for active case finding activities to have 90% tuberculosis (TB) case detection by 2030. [1] WHO recommends for active screening among household TB contacts, health care workers, people with diabetes, migrants and prisoners, and people in urban slums based on systematic review.[2,3] The review also recommends for local evidence on active screening in the recommended groups to enable policymakers to develop country specific active screening guidelines. [3,4] With an estimated 1 million missing TB cases in India, there is a need for determining yield, feasibility, and cost effectiveness of active case finding activities among the recommended high‐risk groups.[5] In this study, we aimed to assess the feasibility and yield of active screening among urban slum dwellers.

Comparing Adherence in Cardiac Clinic Versus General Outpatient Clinic: Few Concerns and Way Forward.

Dear Sir, We read the article titled “antihypertensive medications adherence among Nigerian hypertensive subjects in a specialist clinic compared to a general outpatient clinic.”[1] The study discusses the role of special clinic on adherence to medication among hypertensive patients. Adherence to medication has impact on treatment outcomes and the prevention of complications. As per rule of halves, only 12.5% of hypertensive patients are treated adequately, there are lacunae in diagnosing and treating hypertensive patients due to inefficiencies in the health system. Even among those 12.5% of hypertensive patients, patient-level factors play an important role in the adherence to the advice of healthcare providers. Hence, there is a need to assess patient’s adherence to medication and its associated factors to plan for targeted interventions toward individuals with poor adherence. There is an advocacy toward setting up special clinics for non-communicable diseases, and many developing countries have adopted this strategy. Since this study compares patient-level outcomes on adherence in special clinic versus general outpatient clinic, the study results will be of great use to policymakers in deciding on appropriate intervention. However, we have to take into account few issues before considering the study findings.