Ramachandra Kamath

Secondhand smoke exposures in indoor public places in seven Asian countries.

Exposure to secondhand smoke (SHS) is a major threat to public health. Asian countries having the highest smoking prevalence are seriously affected by SHS. The objective of the study was to measure SHS levels in hospitality venues in seven Asian countries and to compare the SHS exposure to the levels in Western countries. The study was carried out in four types of related hospitality venues (restaurant, café, bar/club and entertainment) in China, India, Japan, Korea, Malaysia, Pakistan and Sri Lanka. Real-time measurement of particulate matter of <2.5microm aerodynamic diameter (PM(2.5)) was made during business hour using a handheld laser operated monitor. A total of 168 venues were measured in seven countries. The average indoor PM(2.5) level was 137microg/m(3), ranging from 46microg/m(3) in Malaysia to 207microg/m(3) in India. Bar/club had the highest PM(2.5) level of 191microg/m(3) and restaurants had the lowest PM(2.5) level of 92microg/m(3). The average indoor PM(2.5) level in smoking venues was 156micro/m(3), which was 3.6 times higher than non-smoking venues (43microg/m(3)). Indoor PM(2.5) levels were significantly associated with country, type of venue, smoking density and air exchange rate (p<0.05). In the seven Asian countries, PM(2.5) levels were high due to SHS in public places. The current levels are comparable to the levels in Western countries before the adoption of smoke-free policy. Since Asian country has high prevalence of SHS in public places, there is an urgent need for comprehensive smoke-free regulation in Asian countries.

Studying risk factors associated with human leptospirosis.

Background: Leptospirosis is one of the most under diagnosed and underreported disease in both developed and developing countries including India. It is established that environmental conditions and occupational habit of the individuals put them at risk of acquiring disease, which varies from community to community. Various seroprevalence studies across the world have documented emerging situation of this neglected tropical disease, but limited have probed to identify the risk factors, especially in India. Objectives: The objective of this study was to identify the environmental and occupational risk factors associated with the disease in Udupi District. Materials and Methods: This population-based case-control study was carried out in Udupi, a District in Southern India from April 2012 until August 2012. Udupi is considered to be endemic for Leptospirosis and reported 116 confirmed cases in the year 2011. Seventy of 116 laboratory confirmed cases and 140 sex matched neighborhood healthy controls participated in the study. A predesigned, semi-structured and validated questionnaire was used for data collection through house to house visit and observations were noted about environmental conditions. Univariate analysis followed by multivariate analysis (back ward conditional logistic regression) was performed by using STATA version 9.2 (StataCorp, College Station, TX, USA) to identify potential risk factors. Results: Occupational factors such as outdoor activities (matched odds ratio [OR] of 3.95, 95% confidence interval [CI]: 1.19-13.0), presence of cut or wound at body parts during work (matched OR: 4.88, CI: 1.83-13.02) and environmental factors such as contact with rodents through using the food materials ate by rat (matched OR: 4.29, CI: 1.45-12.73) and contact with soil or water contaminated with urine of rat (matched OR: 4.58, CI: 1.43-14.67) were the risk factors identified to be associated with disease. Conclusion: Leptospirosis is still considered as neglected disease in the district. Early diagnosis and prompt treatment of cases can save many lives. However, there is a need of integrated rodent control measures with great effort to increase awareness and education among subjects in controlling the disease.

HIV-TB coinfection: Clinico-epidemiological determinants at an antiretroviral therapy center in Southern India.

Background: HIV–TB (tuberculosis) coinfection has emerged as a major public health threat. Given the multifactorial enabling environment in a resource-constrained setting like India, the consequences are of epidemic proportions. Aims: This study was aimed at identifying the clinical and epidemiological determinants underlying HIV–TB coinfection. Settings and Design: A retrospective review of patient records was done from the antiretroviral therapy center (ART) center at a district hospital in southern India between May and August 2012. Materials and Methods: Secondary data of 684 patients on ART as well as pre-ART were collected between July 2008 and June 2012 and were analyzed. Statistical Analysis: Descriptive analysis, χ2, and Wilcoxon signed rank tests were used with SPSS version 15.0 to draw significant statistical inferences. Results: HIV–TB coinfection was diagnosed in 18.9% with higher prevalence among males (75.3%), in the sexually active age group 31-45 years (61.3%), with less than primary education (44.15%), who were married (56.1%), laborers (42.4%), from rural backgrounds (88.2%), and having low income-earning capacity (94.4%). Transmission was predominantly through the heterosexual route. The key entry point was the integrated counseling and testing center (ICTC) (47.4%). Pulmonary tuberculosis (58.8%) was predominantly found followed by extrapulmonary tuberculosis (38.2%) and both in 3.1%. A favorable outcome was observed in 69.3% of coinfected patients with 89.2% on ART and 97.2% currently on DOTS therapy. The Wilcoxon signed-rank test found significant association between rises in CD4 counts after the 6th-month follow up (P < 0.05). Coinfected patients had a case fatality rate of 25%. Conclusions: The prevalence of HIV–TB coinfection recorded in this sample was 18.86%. ICTC implemented by NACO emerged as an effective entry point, while Revised National Tuberculosis Control Program referred 1.6% (n = 11) of the patients to the ART center. Coinfection is associated with lower CD4 counts than those with HIV alone, which could translate into increased morbidity and progression of HIV to AIDS.

Prevalence of Goiter in Rural Area of Belgaum District, Karnataka

Background: To determine the prevalence of goiter and to study the factors influencing goiter among people of the rural community in Karnataka state, a community based study. Setting and Study Design: A cross sectional study was carried out to find out the prevalence of goiter in a rural community of Belgaum district. The study was conducted by house-to-house survey for a period of one month. Materials and Methods: Two villages (Handiganur and Gundwad) were selected randomly from Belgaum and Raibag taluks of Belgaum district. All the family members in each household were examined for the presence of goiter using WHO criteria. Iodine content of the salt sample obtained from each household was estimated by using spot testing kits. Information regarding the determinants of goiter was collected and recorded in a pre tested proforma. Data collected was analyzed using SPSS statistical packages. Results: The prevalence of goiter among rural population was found to be 16.6%. Goiter of grade 1 was 15.7% and that of grade 2 was 0.9%. Prevalence among males and females were 7.2% and 21.8%, respectively. The prevalence of goiter was highest among adolescents. Estimation of iodine content in the salt sample revealed that 50% of samples had adequate iodine content (≥15 ppm). Multiple Logistic Regression Analysis revealed that females of the age group 10-49 years were independently associated with goiter. Conclusion: Prevalence of goiter was relatively high and therefore constituted a public health problem in this region.

Quality of life among persons with physical disability in Udupi Taluk: A cross sectional study

Background: Disability is not just a health problem or attribute of individuals, but it reflects the problems individuals experience in their interaction with society and physical movements. Disabled persons remain neglected part of society and they also experience various barriers due to restriction of participation. Objectives: The aim was to assess the quality of life (QOL) of physically disabled persons, the impact of physical disability on activities of daily living (ADL) and to study the awareness about laws and facilities available for disabled persons. Materials and Methods: A cross-sectional community based study was conducted among 130 physical disabled persons who were selected using convenience sampling technique. The WHO BREF scale was used to assess QOL, while assessment of ADL was done using Barthel Index. Socio-demographic assessment was done using Udai Pareek scale. SPSS version 15.0 was used to analyze data. Categorical variables were expressed as frequencies and percentages. As per guidelines physical, psychological, social, and environmental domain scores for WHO BREF scale were calculated. Results: Among the study participants, 36.2% had a disability from birth that is, congenital. The second common cause of disability was found to be postpolio residual paralysis as it was found among 26.2% respondents. Other causes found were stroke/paralysis and accidents, in 19.2% and 18.5% respondents, respectively. Activities such as transfer, mobility, and stair climbing showed greater impact of physical disability. It was found that 11.5% respondents required help in one of the ADL. QOL score was found to be low under the psychological domain reflecting on negative feelings, bodily image, appearance, spirituality, and self-esteem of respondents. Conclusion: Physical disability had affected social participation as well as marriage of the respondents. However, it was found that very few of them are aware about facilities provided under persons with disability act.

Occupational stress and health-related quality of life among public sector bank employees: A cross-sectional study in Mysore, Karnataka, India

Background: Occupational morbidities have been estimated to cause an economic loss up to 10–20% of the gross national product of a country. It is an important cause of occupational morbidity and decreased quality of life (QOL) for the workers. Aim: The aim of the present study is to assess the level of occupational stress and its association with the QOL among the public sector bank employees. Materials and Methods: The present study was conducted among employees of public sector banks in Mysore district, Karnataka, India. A cross-sectional study design was used for the study. Job stress was measured by using occupational stress index (OSI) scale questionnaire and health-related QOL was measured using the short form 12 (SF-12) questionnaire. The sample size estimated for the study was 526 and cluster random sampling technique was used. Chi-square test was used to find the association between the study variables and level of stress. Multiple linear regression model was used to find the determinants of health-related QOL among the study subjects. Results: The total number of the study subjects was 546 out of which 57% were males and 43% were females. The proportion of study subjects reporting to be current smokers was 4.2% and almost all study subjects reported occasional alcohol consumption. The mean physical component summary (PCS) score and mental component summary (MCS) using the original United States standardization were 47.90 and 48.30, respectively. The individuals with mild stress scored higher in both PCS and MCS than the individuals who had moderate to severe stress levels. There was significant association of health related quality of life with the age of the respondent,presence of at least one morbidity and level of stress with health-related QOL. Conclusion: This study has shown an association of occupational stress with the QOL. There is a need for interventions aimed at mitigating the occupational stress among employees of the banking sector.

Prevalence of goitre among school children in Belgaum district

ObjectiveA school survey was conducted to estimate the prevalence of goitre among schoolchildren in Belgaum district.MethodsA cross-sectional study was conducted in primary, middle and high schools of villages selected. All the children of the selected schools were examined for the presence of goitre and the salt samples obtained from their homes were tested for iodine content.ResultsOverall prevalence of goitre was 16.7%. Prevalence of palpable goitre was 16.4 % and visible goitre was very low (0.3%). Higher prevalence was found among females (21.1%) when compared to that of male children (12.8 %). Prevalence of goitre increased significantly with advancement of age until 16-yr. 72.1 % children were consuming rock salt and only 27.9 % were consuming powdered salt at their homes. Estimation of Iodine content in the salt samples showed that 68.7 % of the sample had inadequate iodine content. Prevalence of goitre was significantly high among children who consumed rock salt (16.2%) as compared to those who used powdered salt (11%)ConclusionStrict implementation of salt codization and marketing in rural area is desired. Also health education programme be showed.

Nutritional status assessment of school children in Bellary district, Karnataka

Background: Malnutrition continues to be a primary cause of ill-health and morality among children in developing countries. It is a major public health problem and accounts about half of the deaths worldwide. About 150 million children in developing countries are still malnourished and more than half of underweight children live in South East Asia region. The high levels of under-nutrition in south Asia pose major challenge for child development. There are other factors that affect the nutritional status of children. Aims and Objectives: To assess the Nutritional Status of School Children in Bellary district. Materials and Methods: A total 27,544 students from 169 schools were enrolled for the study. Sample size was calculated by taking 20% of total enrolled school children in Bellary district. Statistical Analysis: The body mass index, Z score and World Health Organization Multicenter Growth Reference Study growth charts was used for analysis. Results: The study population of 27,544 students comprised of which 13,519 (49.1%) male and 14,025 (50.9%) female. On the analysis, 4447 (16.1%) found to be undernourished. More male students were found to be undernourished 2237 (16.9%), but obesity was common in females 1723 (12.3%). Conclusions: The nutritional status of the students in our study has been found better than other studies, but there are cases of undernourished that need attention and there is a need to deal with obesity and overweight in the school in order to prevent the epidemic of noncommunicable diseases.

Determinants of enrolment and experiences of Rashtriya Swasthya Bima Yojana (RSBY) beneficiaries in Udupi district, India.

Background: Morbidities have emerged as major threats to livelihoods of the poor. An estimated 150 million have been reported as spending more than 40% of their income on their health needs. Aim: To identify the determinants of enrolment and experiences of Rashtriya Swasthya Bima Yojana (RSBY) beneficiaries in Udupi district, India. Materials and Methods: A cross-sectional study was carried out in Udupi district between March and August 2012. A mixed method approach using qualitative and quantitative methods was used. The study included all households who were eligible under the RSBY scheme recognized by the Planning Commission of India as below poverty line (BPL) households and participants recruited above 18 years of age. The sample included in the study was 316 households and took into account 95% confidence interval and 20% precision. Results: Education of the household head, marital status, household size and awareness of the cost of enrollment to RSBY were seen to be significantly associated with enrollment to RSBY ( P < 0.05). Logistic regression analysis of four variables which showed statistical significance including household size, marital status, education, and prior awareness about the cost of enrollment into RSBY showed that prior knowledge of the cost of enrollment into the scheme and household size of less than five were major determinants to enrolling for RSBY. On qualitative analysis, the majority of the scheme users reported that the enrolment under RSBY had benefitted them and they are willing to renew the scheme again in the next round of enrollment. Conclusions: The awareness on scheme details among those included in the present study was found to be low. Information and education campaigns could improve involvement of both the insurers as well as the local institutions offering care and possibly increase utilization rate of RSBY.

Assessment of environmental factors associated with dengue transmission in Udupi Taluk, Karnataka

Background: Dengue fever is a major public health problem in India. Dengue is a re-emerging arboviral disease in the World. Assessment of environmental factors in the rural and urban areas is extremely important to understand vectors, its transmission and vector breeding sites. Aim: The study was conducted to assess the environmental factors associated with dengue transmission and its protective factors. Settings and Design: A Community based cross sectional study was conducted in Udupi Taluk. Materials and Methods: The Study period was conducted during March 2012 to August 2012. Sample size was calculated by the formula of estimation of proportion (n = Z 2pq/ͺ2 ) at 95% significance level. Stratified multistage cluster sampling was used. A total of 500 households of Udupi Taluk were selected randomly for the study. Statistical Analysis Used: Data was analyzed using the SPSS version 15, Chicago, IL. Results are presented in proportions. P < 0.05 was considered to be significant. Results: Results showed that foremost risk factor for vector breading was abundance of coconut shells around houses (73%), containers without covers 50.8% (outdoor) and 20% (indoor). The P < 0.05 was significant for usage of mosquito coil or repellents, having a protective screen for windows, doors in living rooms and use of insecticide spray to reduce mosquito density in urban and rural areas. Conclusions: Health education, specific protection and source reduction need to be emphasized to control dengue fever in rural and urban areas.