Rajvir Bhalwar

Prevalence and Determinants of Hypertension in a Rural Community

BACKGROUND There are few epidemiological studies on prevalence of hypertension and its determinants in rural population. This cross sectional study was done to determine the same in a rural community. METHODS A random sample of 406 people (218 men and 188 women) of 30 years and above was selected from a rural area. The pre tested proforma was used to collect the data by trained doctors. RESULT Prevalence of smoking and tobacco use was 16%, alcohol intake 9.4 %, daily salt intake (≥ 5 gram) 34.2%, daily saturated fat intake (≥ 10 % of daily energy intake) 47 .0 % and physical inactivity (work and leisure) as 18.5%. Body Mass Index (BMI) was ≥ 25 in 18 % and ≥ 30 in 3.2% men and women. Prevalence of truncal obesity (Waist Hip Ratio: men ≥ 0.9; women ≥ 0.8) was 8.5% with higher incidence in men. Prevalence of abdominal obesity (men ≥ 102 cms; women ≥ 88 cms) was found in 15.7 % with higher incidence in men. Differences in prevalence of risk factors between men and women were statistically significant in case of smoking, alcohol consumption and abdominal obesity. 18.5% men and women were suffering from systolic hypertension (≥ 140 mg Hg) and 15 % from diastolic hypertension (≥ 90 mg Hg). Prevalence of risk factors for hypertension was significantly more among subjects suffering from systolic and diastolic hypertension than normotensive subjects. CONCLUSION Prevalence of systolic hypertension in rural community was 18.5 % and of diastolic hypertension 15% with higher prevalence in the age group of 60 years and above, in case of men and women. There was a significant linear trend in prevalence of systolic hypertension with respect to age group in men whereas it was not significant in case of women.

Community Based Study of AIDS Awareness and Attitudes among School and College-going Teenagers from Rural Background

A community based, cross-sectional, analytical study was undertaken among children aged 13 to 19 years, who were currently studying in high school, intermediate or graduate classes, in a rural area of Maharashtra. A sample of 151 girls and 162 boys formed the material for this study. Data was collected by well qualified, centrally trained interviewers, using a pre-tested instrument, administered by personal interview technique. The study indicated that the general awareness about AIDS was very high, with more than 90% of the respondents having heard of AIDS and also identifying it as an important health problem in our country. However, less than 50% knew correctly about the etiology of AIDS, or the difference between HIV and AIDS. Similarly, a very high proportion of the subjects knew about the modes of transmission, though a much lesser proportion had the knowledge about the role of improperly sterilised syringes and needles. Similarly, a general lack of awareness about other sexually transmitted diseases was noticed. Lacunae in knowledge also existed as regards knowledge about high risk groups, like commercial sex workers (CSWs), intravenous drug users (IVDUs), truck drivers and professional blood donors. A very large majority of the subjects had a very positive and healthy attitude about sex, and did not accept pre or extra marital sex, as well as, were desirous of obtaining AIDS education as a part of school / college curriculum. Based on the findings of the study, certain recommendations on AIDS education in the reference population have been submitted.

Study of Disorders of Visual Acuity among Adolescent School Children in Pune.

BACKGROUND Disorders of visual acuity are known to affect the learning abilities of school children. Various authors have reported varying prevalence in India and abroad. METHODS A rapid, community based survey was conducted to assess the prevalence of disorders of visual acuity among adolescent school children in three schools in Pune Cantonment. A sample of 236 children studying in six sections were examined after random selection by a two stage sampling technique ensuring representation to each of the classes. Visual acuity was assessed for all the children available in the selected section on the date of survey. A questionnaire based study of the knowledge and attitude of the parents of the 50 affected children was also conducted. RESULT 50 children (25 males and 25 females) were found to have errors of refraction, resulting in prevalence rate of 21.19% with confidence intervals of 15.97% to 26.40%. CONCLUSION The study highlights significantly high prevalence of uncorrected errors of visual acuity among adolescent school children as well as the need for instituting IEC activities aimed at improving the general lack of appreciation of the seriousness of the problem by the parents and consequent neglect of urgent corrective measures.

Epidemiological Differentials of Hepatitis B Carrier State in the Army : A Community Based Sero-epidemiological Study.

BACKGROUND Most available studies on seroprevalence of Hepatitis B in the Armed Forces and also at the national level are based on hospital patients and blood donors. Hence, there was a perceived need to undertake a seroepidemiological study on an adequately large and representative random sample of the general cross section of Army personnel, with a view to obtain the exact picture of the frequency and distribution of HBV in the Army. METHODS A community based cross sectional study with random samples from four groups were drawn, viz recruits from the Army Medical Corps (AMC) and other Arms and Services; AMC personnel and personnel from other Arms and Services who had served for more than 10 years. A structured pretested questionnaire was administered to all participants and blood samples were drawn aseptically subsequently, with separation of serum and testing by ELISA technique for HBsAg. Multivariate analysis using multiple logistic regression procedure was done after appropriate data entry. RESULTS The overall seroprevalence was 7.9% (95%CI = 6.5% to 9.26%). The differential seroprevalence in the four groups being 7.72%, 7.92%, 8.28% and 7.75% respectively. There was statistically no significant difference as regards the seroprevalence levels [p > 0.05]. As regards serving medical personnel, the seroprevalence was observed to be higher among personnel involved in direct nursing care. On multiple logistic regression analysis, two risk factors emerged as independent and significant predictors of hepatitis B positivity. These were history of sexual exposure with commercial sex workers (CSWs) (OR = 3.06, p < 0.01) and history of having taken injections from civil sources (OR = 1.92, p < 0.001). CONCLUSION The relatively high level of seroprevalence among recruits has led to certain recommendations on testing and further studies in specific groups, based on the findings of the study.

Breast Feeding Practices among Families of Armed Forces Personnel in a Large Cantonment

BACKGROUND There seems to be a gap in the available literature and scientific knowledge about breast-feeding practices among families of armed forces personnel in our country, which needs to be studied. METHODS A cross sectional epidemiological study design was undertaken on a randomly selected sample of 175 families of armed forces personnel staying in a large cantonment and having at least one child in the age group of 3-24 months. RESULT The study observed positive association between various breast feeding practices such as feeding colostrum, demand/scheduled feeding, exclusive breast feeding for 4-6 months, partial breast feeding for 6 - 18 months and various sociodemographic variables such as age, religion, socio-economic status of mother (military rank of husband), parity and place of residence of the mother (where childhood was spent). CONCLUSION Higher proportion of mothers feeding colostrum was observed because of better educational status of mothers and organized health education activities available to the families of armed forces personnel. Majority (89.14%) gave demand feed and only 10.86% gave scheduled feed. On the other hand a relatively smaller percentage (47.43% and 29.32%) followed the correct practice about duration of exclusive and partial breast-feeding respectively.

Investigation of an epidemic of malaria in a military station

At present, about 100 countries are considered malarious, almost half of which are in sub-Saharan Africa. Urban and periurban malaria are on the increase in South Asia and in many areas of Africa. Unfavourable ecological changes have greatly contributed to malaria epidemics.(1)

AN INTRODUCTION TO ESSENTIALS OF BIO-MEDICAL WASTE MANAGEMENT

The issue of biomedical waste management has assumed great significance in recent times particularly in view of the rapid upsurge of HIV infection. Government of India has made proper handling and disposal of this category of waste a statutory requirement with the publication of gazette notification no 460 dated 27 July 1998. The provisions are equally applicable to our service hospitals and hence there is a need for all the service medical, dental, nursing officers, other paramedical staff and safaiwalas to be well aware of the basic principles of handling, treatment and disposal of biomedical waste. The present article deals with such basic issues as definition, categories and principles of handling and disposal of biomedical waste.

HIV SEROPREVALENCE AMONG ADOLESCENTS AND YOUNG ADULT MALES IN INDIA: A LARGE COMMUNITY BASED EPIDEMIOLOGICAL STUDY

A large number of HIV seroprevalence studies have been conducted on the high-risk groups. However there seems to be a paucity of such studies undertaken in the general population. This study was directed towards the adolescents and young Indian male adults. A representative samples of 19,436 were tested, out of which nine were positive for HIV, thereby giving a HIV seroprevalence rate of 0.46 per 1000 with a clustering of the positive subjects towards the North East of India followed by the Southern states. Those from the North East were younger than those from the South. This calls for a targeted information, education and communication (IEC) programme aimed at the younger group in the East with known greater risk potential for intravenous drug abuse, and older adults in the South. The study also provides an insight for HIV/AIDS mapping and possible future direction of the epidemic in India.

A MATHEMATICAL MODEL FOR PREDICTING THE PERSISTENCE AND EFFICACY OF BACILLUS THURINGIENSIS VAR ISRAELENSIS IN RELATION TO WATER POLLUTION

In a simulated field trial, the bead formulation of Bacillus thuringiensis var israelensis (Bti) was found to be more persistent in moderately polluted as compared to highly polluted water. A mathematical model was built up to study the influence of time (independent variable) on larval reduction (dependent variable) in relation to degree of water pollution. Two predictive models for different grades of water pollution were developed, which estimated that the larval mortality in moderately polluted water was likely to decline by 3.79 as compared to 5.02 on an average, in highly polluted water with each passing day.

CLINICO-EPIDEMIOLOGICAL ALGORITHM FOR PREDICTING SYSTEMIC ARTERIAL HYPERTENSION AT HIGH ALTITUDE THROUGH MATHEMATICAL MODELLING

A population based hybrid design combining element of cohort and cross-sectional approach was used to develop a simple clinical algorithm to predict individual probability of developing hypertension (systolic BP > 140 mm Hg and/or diastolic BP > 90 mmHg). 3615 soldiers initially normotensive at the time of induction into high altitude, were studied by systematic random sampling. Multiple logistic regression analysis showed a high significant association between hypertension and age, body mass index (BMI), tobacco smoking and alcohol consumption. Using the constant/coefficient values obtained from the logistic model and the receiver operating characteristics (ROC) curve analysis, the following predictive rule was developed - To the age in years, add (BMIx 3.86); also add 5.53 if he is a smoker; and add 19.81 if he consumes alcohol. If the total exceeds 142, the individual is at high risk of developing hypertension. This algorithm carries a sensitivity of 68.2% and specificity of 78.5%.