Ravi Prakash Upadhyay

Hypertension in the elderly: Prevalence and health seeking behavior

Background: Non-communicable diseases (NCDs) are major contributors of morbidity and mortality in the elderly. Estimating the prevalence of hypertension and studying the health seeking behavior is important. Aim: This study was designed to estimate the prevalence of hypertension and understand the health seeking behavior among the elderly in rural Puducherry, south India. Materials and Methods: A total of 211 elderly from a rural community were selected by systematic random sampling. Blood pressure (BP) was measured. Socio-demographic characteristics and health seeking behavior were assessed by interviews. Results: Prevalence of hypertension among study participants was 40.5%. Prevalence of hypertension among elderly male subjects was 39.2% and in female subjects was 40.8%. About 62% (53 out of 85 hypertensives) were already aware of their hypertensive status. About 54.7% (29) were diagnosed at government health facilities either at primary health centers (PHCs) or a government hospital. Conclusion: Burden of hypertension among the elderly is high in rural areas. Strategies to detect and treat hypertension in the elderly have to be implemented early.

Determinants of Smoking Initiation and Susceptibility to Future Smoking among School-Going Adolescents in Lagos State, Nigeria

BACKGROUND It is projected that low and middle-income countries will bear a major burden of tobacco related morbidity and mortality, yet, only limited information is available on the determinants of smoking initiation among youth in Africa. This study aimed to assess the determinants of smoking initiation and susceptibility to future smoking among a population of high school school students in Lagos, Nigeria. MATERIALS AND METHODS Baseline data from an intervention study designed to assess the effect of an anti-smoking awareness program on the knowledge, attitudes and practices of adolescents was analyzed. The survey was carried out in six randomly selected public and private secondary schools in local government areas in Lagos state, Nigeria. A total of 973 students completed self-administered questionnaires on smoking initiation, health related knowledge and attitudes towards smoking, susceptibility to future smoking and other factors associated with smoking. RESULTS Of the respondents, 9.7% had initiated smoking tobacco products with the predominant form being cigarettes (7.3%). Males (OR: 2.77, 95%CI: 1.65-4.66) and those with more pro-smoking attitudes (OR: 1.44, 95%CI: 1.34-1.54) were more likely to have initiated smoking. Those with parents and friends who are smokers were 3.47 (95%CI: 1.50-8.05) and 2.26 (95%CI: 1.27-4.01) times more likely to have initiated smoking. Non-smoking students, in privately owned schools (OR: 5.08), with friends who smoke (5.09), with lower knowledge (OR: 0.87) and more pro-smoking attitudes (OR 1.13) were more susceptible to future smoking. In addition, respondents who had been sent to purchase cigarettes by an older adult (OR: 3.68) were also more susceptible to future smoking. CONCLUSIONS Being male and having parents who smoke are predictors of smoking initiation among these students. Consistent with findings in other countries, peers not only influence smoking initiation but also influence smoking susceptibility among youth in this African setting. Prevention programs designed to reduce tobacco use among in-school youth should take these factors into consideration. In line with the recommendations of article 16 of the WHO FCTC, efforts to enforce the ban on the sales of cigarettes to minors should be also emphasised.

High neonatal mortality rates in rural India: what options to explore?

The neonatal mortality rate in India is amongst the highest in the world and skewed towards rural areas. Nonavailability of trained manpower along with poor healthcare infrastructure is one of the major hurdles in ensuring quality neonatal care. We reviewed case studies and relevant literature from low and middle income countries and documented alternative strategies that have proved to be favourable in improving neonatal health. The authors reiterate the fact that recruiting and retaining trained manpower in rural areas by all means is essential to improve the quality of neonatal care services. Besides this, other strategies such as training of local rural healthcare providers and traditional midwives, promoting home-based newborn care, and creating community awareness and mobilization also hold enough potential to influence the neonatal health positively and efforts should be made to implement them on a larger scale. More research is demanded for innovations such as “m-health” and public-private partnerships as they have been shown to offer potential in terms of improving the standards of care. The above proposed strategy is likely to reduce morbidity among neonatal survivors as well.

Burden of diabetes mellitus and prediabetes in tribal population of India: a systematic review.

OBJECTIVE To estimate the burden of diabetes mellitus and pre-diabetes in tribal populations of India. METHODS The authors reviewed studies from 2000 to 2011 that documented the prevalence of diabetes mellitus in various tribal populations of India. The search was performed using electronic and manual methods. Meta-analysis of data on point prevalence was performed. RESULTS A total of seven studies were retrieved. The prevalence of diabetes mellitus ranged from 0.7% to 10.1%. The final estimate of diabetes prevalence obtained after pooling of data from individual studies, was 5.9% (95% CI; 3.1-9.5%). The prevalence for impaired fasting glucose (IFG) varied from 5.1% to 13.5% and impaired glucose tolerance (IGT), from 6.6% to 12.9%. CONCLUSION Chronic disease research in tribal populations is limited. The reported prevalence of IFG/IGT was higher than the prevalence of diabetes and this observation could be suggestive of a potential increase in diabetes in the coming years. Given that lifestyle changes have occurred in the tribal populations, there is a need to synthesize evidence(s) relating to diabetes and other chronic diseases in these marginalized populations and inform policy makers.

Why are there delays in seeking treatment for childhood diarrhoea in India

To examine the barriers and facilitating factors for seeking treatment for childhood diarrhoea and to determine the main causes for delay in seeking treatment.

Level of awareness about tuberculosis in urban slums: Implications for advocacy and communication strategy planning in the National program

Background: Tuberculosis (TB) remains as an important public health problem in India. Awareness about the disease, its diagnosis, and treatment among public will help in controlling the killer disease. This study aims at arriving at an educational diagnosis about TB in an urban poor community. Materials and Methods: A cross-sectional study was conducted in an urban slum in South India using a structured, pretested questionnaire. Domains identified were knowledge about TB, symptoms, spread, diagnosis, treatment, and prevention of TB. Results: A total of 395 households were interviewed. Of them, 370 (94%) respondents had heard about TB. Regarding the symptoms of TB, 82% were aware that cough is a symptom of TB. Among the 79% of study subjects who reported any test to diagnose TB, sputum examination as a method of diagnosis was known to only 40%. However, 84% of the subjects were aware of the free treatment available for TB under National program. Conclusion: Level of awareness about TB among urban poor in a slum area is good. Knowledge about “free treatment” and “duration of treatment” has to be stressed during health education activities.

A Community-Based Study of Metabolic Syndrome and Its Components Among Women of Rural Community in Ballabgarh, Haryana

BACKGROUND The metabolic syndrome is an important cluster of coronary heart disease risk factors with common insulin resistance. Although the prevalence of metabolic syndrome is high among Asians, including Indians, no sizeable literature is available about the magnitude of metabolic syndrome in rural areas, especially in women. METHODS Blood pressure and anthropometric measurements were noted in 307 women, aged ≥20 years, selected through a multistage sampling technique. Blood samples were collected after overnight fasting and subjected to biochemical quantification such as fasting blood glucose, triglycerides, and high-density lipoprotein cholesterol (HDL-C). Data were analyzed using updated National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) definition by modifying the waist circumference cutoffs as per Asia-Pacific guidelines. RESULTS Overall metabolic syndrome was observed in 12.0% [95% confidence interval (CI); 8.5-16.8] of the rural women population. Women in the age group ≥60 years had the highest prevalence (27.8%), whereas those in the age group 20-39 years had the lowest prevalence (4.2%). At least one component of metabolic syndrome was present in nearly 95% of the study respondents; 41.6% had at least two, 12.0% had at least three, and 2.6% had at least four components of metabolic syndrome. None of the participants had all the five components. CONCLUSION The current prevalence of metabolic syndrome in women in rural communities of the selected area, although less than that in their urban counterparts, could be a serious problem in the future. It is incumbent on government agencies and the medical community to address this issue to prevent the consequences of its increased burden.

Postpartum depression in India: a systematic review and meta-analysis

Abstract Objective To provide an estimate of the burden of postpartum depression in Indian mothers and investigate some risk factors for the condition. Methods We searched PubMed®, Google Scholar and Embase® databases for articles published from year 2000 up to 31 March 2016 on the prevalence of postpartum depression in Indian mothers. The search used subject headings and keywords with no language restrictions. Quality was assessed via the Newcastle–Ottawa quality assessment scale. We performed the meta-analysis using a random effects model. Subgroup analysis and meta-regression was done for heterogeneity and the Egger test was used to assess publication bias. Findings Thirty-eight studies involving 20 043 women were analysed. Studies had a high degree of heterogeneity (I2 = 96.8%) and there was evidence of publication bias (Egger bias = 2.58; 95% confidence interval, CI: 0.83–4.33). The overall pooled estimate of the prevalence of postpartum depression was 22% (95% CI: 19–25). The pooled prevalence was 19% (95% CI: 17–22) when excluding 8 studies reporting postpartum depression within 2 weeks of delivery. Small, but non-significant differences in pooled prevalence were found by mother’s age, geographical location and study setting. Reported risk factors for postpartum depression included financial difficulties, presence of domestic violence, past history of psychiatric illness in mother, marital conflict, lack of support from husband and birth of a female baby. Conclusion The review shows a high prevalence of postpartum depression in Indian mothers. More resources need to be allocated for capacity-building in maternal mental health care in India.

The Role of Maternal Diet and Iron-folic Acid Supplements in Influencing Birth Weight: Evidence from India's National Family Health Survey

AIM To examine the role of maternal diet in determining low birth weight (LBW) in Indian infants. METHODS Data from the National Family Health Survey (2005-06) were used. Multivariate regression analysis was used to analyse the effect of maternal diet on infant birth weight. RESULTS Infants whose mothers consumed milk and curd daily [odds ratio (OR), 1.17; 95% confidence interval (CI), 1.06-1.29]; fruits daily (OR, 1.20; 95% CI, 1.07-1.36) or weekly (OR, 1.13; 95% CI, 1.02-1.24) had higher odds of not having a low birth weight baby. The daily consumption of pulses and beans (OR, 1.18; 95% CI, 1.02-1.36) increased the odds while weekly consumption of fish (OR, 0.79; 95% CI, 0.70-0.89) decreased the odds of not having a LBW infant. Intake of iron-folic acid supplements during pregnancy increased birth weight by 6.46 g per month. CONCLUSION Improved intake of micronutrient-rich foods can increase birth weight.

Does Utilization of Antenatal Care Result in an Institutional Delivery? Findings of a Record-Based Study in Urban Chandigarh

BACKGROUND Antenatal care is an important pillar of safe motherhood initiative and is essential to reduce maternal as well as neonatal morbidity and mortality. The study aimed to explore whether women availing antenatal care are more likely to go for an institutional delivery. METHODS The study area was an urban resettlement colony located in Chandigarh. The antenatal records, at Urban Health Clinic, from January 2010 to December 2010 were analyzed. The information on the place of delivery was collected by the health workers during routine post-natal care visits. RESULTS The records of 332 pregnant females were analyzed. Majority had an institutional delivery (75.9%). Women with higher education (i.e. more than secondary school) and those with first pregnancy preferred institutional delivery compared to those who were illiterate and multigravid respectively. CONCLUSION There is a need to understand the societal and familial dynamics that influence the choice of the place of delivery.