S Ganesh Kumar

Antimicrobial resistance in India: A review

Antimicrobial resistance is an important concern for the public health authorities at global level. However, in developing countries like India, recent hospital and some community based data showed increase in burden of antimicrobial resistance. Research related to antimicrobial use, determinants and development of antimicrobial resistance, regional variation and interventional strategies according to the existing health care situation in each country is a big challenge. This paper discusses the situational analysis of antimicrobial resistance with respect to its problem, determinants and challenges ahead with strategies required in future to reduce the burden in India. Recent data from Google search, Medline and other sources were collected which was reviewed and analyzed by the authors. Hospital based studies showed higher and varied spectrum of resistance in different regions while there are limited number of community based studies at country level. There exists lacunae in the structure and functioning of public health care delivery system with regard to quantification of the problem and various determining factors related to antimicrobial resistance. There is an urgent need to develop and strengthen antimicrobial policy, standard treatment guidelines, national plan for containment of AMR and research related to public health aspects of AMR at community and hospital level in India.

Mapping the pattern and trends of extrapulmonary tuberculosis

Background and Objectives: There has been a rapid expansion of the directly observed treatment short-term (DOTS) under the revised national tuberculosis control program throughout India in the last decade. Few reports exist detailing individual DOTS centers’ experiences with regard to extrapulmonary tuberculosis (EPTB) in a medical college hospital setting. Materials and Methods: This is a retrospective, record-based study of patients with the diagnosis of EPTB, in all age groups. Data on all consecutive EPTB cases diagnosed at the K. S. Hegde Medical College and Hospital, Deralakatte, Mangalore from 1 January 2005 to 31 December 2011 at the DOTS centre attached to this hospital were collected, analyzed by Mantel-Haenszel Chi square for linear trend and described in proportion or percentages. Results: Among 1267 cases registered for treatment of all forms of tuberculosis, 528 (41.67%) had EPTB. Around half of the cases of EPTB (269, 51%) were among adult age groups and the majority of cases (342, 64.77%) received Category-I treatment. Pleural TB was the commonest type of EPTB (n = 148, 28.03%), followed by lymph node TB (n = 131, 24.81%). Involvement of lymph nodes was the commonest manifestation among the less than 14 years’ age group (27, 58.7%), while involvement of pleura was more common among > 65 years’ age group (23, 45.1%). The difference in the occurrence of EPTB by site between males and females is statistically significant with a P value of <0.005. There is a significant increase in the number of cases of tuberculosis affecting bones and joints, and other forms of tuberculosis over the years. Conclusion: The burden of EPTB is more among the productive age group. Increase in the trend of bone and joint tuberculosis, and other rare forms of EPTB is a point of concern highlighting the importance of strengthening the services towards this group.

Health and environmental sanitation in India: Issues for prioritizing control strategies

Environmental sanitation is a major public health issue in India. Recent interventional studies on environmental sanitation in India highlighted the importance of prioritizing control strategies. Research related to the appropriate cost-effective intervention strategies and their implementation in Indian context is a big challenge. This paper discusses various intervention strategies related to environmental sanitation in India and emphasizes to prioritize it according to the need of country.

Malnutrition among under-five children in India and strategies for control.

Malnutrition among under-five children is an important concern for the health authorities in India. The aim of the present review was to assess the burden of under-nutrition and over-nutrition, its determinants and strategies required to tackle malnutrition among under-five children in India. Recent data were collected from Google search, Medline, and others. The information retrieved was reviewed and analyzed for discrepancies. Existing evidence shows that the prevalence of under-nutrition among under-five children was high and varied widely (under-weight: 39-75%, stunting: 15.4-74%, wasting: 10.6-42.3%) depending on the assessment methodology adopted. Studies on assessment of over-nutrition status among under-five children were limited. Distribution of various types of risk factors and its influence on nutrition status of children in a given set up should be analyzed for planning the control measures. Strengthening public health interventions for mild malnutrition cases and vulnerable groups, effective implementation and evaluation of the strategies at regional level, research on overweight, obesity and its etiological factors and steps for improving socioeconomic development are the prerequisites for tackling malnutrition among under-five children in India.

Determinants of pre-eclampsia: A case-control study in a district hospital in South India

Objective: The objective was to study the determinants of pre-eclampsia among pregnant women admitted for delivery in a district hospital. Materials and Methods: A case-control study was conducted at District Lady Goschen Hospital, Dakshina Kannada district, Karnataka, South India. The group of pregnant women with pre-eclampsia comprised those with hypertension after the 20th week of gestation with associated proteinuria, and controls were pregnant women not diagnosed with pre-eclampsia. A total of 100 cases and 100 controls were selected for the year 2006. Study variables included mother′s age, parity, body mass index, history of chronic hypertension, history of diabetes, history of renal disease, family history of hypertension, and history of pre-eclampsia in earlier pregnancy. Statistical Analysis: Chi-square test, and crude and adjusted odds ratio with 95% confidence intervals were used for statistical analysis. Results: Significant risk factors identified in univariate analysis included prepregnancy body mass index (BMI > 25) (OR = 11.27), history of chronic hypertension (OR = 8.65), history of diabetes (OR = 11.0), history of renal disease (OR = 7.98), family history of hypertension (OR = 5.4), history of pre-eclampsia in earlier pregnancy (OR = 9.63), and multiple pregnancy (OR = 4.85). Multiple logistic regression analysis revealed that the prepregnancy BMI of >25 (OR = 7.56), history of chronic hypertension (OR = 6.69), history of diabetes (OR = 8.66), history of renal disease (OR = 5.6), family history of hypertension (OR = 5.48), and multiple pregnancy (OR = 5.73) are the significant risk factors of pre-eclampsia. Conclusion: Pregnant women at risk of pre-eclampsia should be identified and high-quality antenatal care should be given in order to minimize the complications of pre-eclampsia both for the mother and the fetus.

Epidemiology of Accidents in Tile Factories of Mangalore City in Karnataka

Background: Occupational accidents are a major point of concern in industries. The academic community should take the first step to address the long-neglected concerns of occupational safety. Objective: To assess the prevalence and pattern of occupational accidents. Materials and Methods: A record-based, cross-sectional study was done in three tile factories of Mangalore city, in Karnataka. A total of 416 workers were analyzed for the year 2004, and data regarding age, sex, job duration, type and nature of injury, body parts involved, and time of injury were collected in a prestructured proforma. Statistical Analysis: Proportions, Chi-square test, Univariate and Multivariate analysis. Results: The overall prevalence rate of accidents was found to be 18.5%. It was found that almost around 86% of the accidents had affected the limbs (upper limb 24.7%, lower limb 61%), around half (52%) of the injuries were contributed by superficial injuries, 40% of accidents were due to stepping/striking against objects and while handling. Hand tools and machinery in motion contributed to around 20% of the accidents. Accidents were more common among the younger age group and less-experienced workers. Multiple logistic regression analyses revealed that the age group of 30-39 years had an independent significant association with accidents (OR = 0.21, P = 0.04). Conclusion: Accidents in tile industries are an important occupational health problem in this area of the country. There is a need for proper safety training of the workers.

Prevalence of acute respiratory infection among under-five children in urban and rural areas of puducherry, India

Introduction: The incidence of Acute respiratory infections (ARI) is high among under-five children, especially in developing countries. However, the data on ARI from rural and urban areas in India are scarce. Objective: To estimate the prevalence of ARI and selected associated factors among under-five children. Materials and Methods: A community-based cross-sectional study was conducted in urban and rural areas of Puducherry, India. Data were collected from 509 parents of under-five children regarding ARI incidence along with socio-demographic and selected associated factors. Results: Overall prevalence of ARI was observed to be 59.1%, with prevalence in urban and rural areas being 63.7% and 53.7%, respectively. Bivariate analysis indicated that overcrowding, place of residence, and mothers education were significantly associated with ARI. Multiple logistic regression analysis suggested that presence of overcrowding (adjusted odds ratio [AOR] = 1.492), urban residence (AOR = 2.329), and second birth order (AOR = 0.371) were significant predictors of ARI. Conclusion: The prevalence of ARI is high, particularly in urban areas. Improvement of living conditions may help in reduction of burden of ARI in the community.

Utilization of maternal health-care services by tribal women in Kerala

Background: The coverage of maternal care services among the tribal women in Kerala is better as compared to other states in India. Aim: This study was done to identify the factors contributing to better coverage of maternal care services among the tribal women in Kerala and to study the reasons for remaining differences that exists in utilization of services between tribal and non-tribal pregnant women. Settings and Design: This was a descriptive cum qualitative study conducted in Thariode Gramapanchayat in the Wayanad district of Kerala. Materials and Methods: Among all women who had registered their pregnancies in the 5 sub-centres under CHC Thariode and had delivered between September 2009 and October 2010, equal numbers of tribal and non-tribal ante-natal women, 35 each were interviewed in-depth using a semi-structured questionnaire. Statistical Analysis Used: Quantitative data was analysed using SPSS Version 16.0. Content analysis was done for qualitative data. Results: The determinants of utilization in tribal women were general awareness, affordability, accessibility and quality of services along with motivation by health workers. Among tribal antenatal women, 85% utilized maternal health care facilities fully compared to 100% among non-tribal women. Lower levels of education and lack of transport facilities were prime factors contributing to under utilization by tribal women. Conclusions: Affordable, accessible and good quality of services in the public health system in Kerala and motivation by health workers were important contributing factors for better utilization of maternal care services.

Prevalence and pattern of occupational injuries at workplace among welders in coastal south India

Background: Injuries among welders are an important health issue in metal industries at global level. The study aimed to assess the prevalence and pattern of injuries and its possible associated risk factors among welders. Materials and Methods: A cross-sectional study was conducted among 209 welders in metal industries of Puducherry, coastal south India. Data regarding all types of injuries during the past 1 year were collected by administering a pre-designed questionnaire. The various risk factors associated with injuries that include age, training before induction, experience, job duration, tobacco chewing, alcohol use and use of protective measures were assessed using standard questionnaire. The data was analyzed by univariate and multiple logistic regression analysis. Results: Majority of subjects were aged between 20 and 40 years (160, 76.6%) and educated below 10th standard (181, 86.6%). Mean number of injury was found to be 10.74 (SD = 5.74) in the preceding year. All of them had more than 2 injuries and 44% (92) of them had more than 10 injuries. All of them had abrasions and more than three fourths of them had each of lacerations, foreign body in the eye, flash burns and contusions. Multiple logistic regression analysis showed that age less than 30 years (OR = 5.19), tobacco use (OR = 2.56), alcohol use (OR = 3.96) and institutional training (OR = 0.10) were the predictors associated with more than 10 injuries among welders. Conclusion: Injury among welders is an important health problem in this area. Strategies for strengthening institutional training for younger age groups may help in decreasing the burden of injuries.

Assessment of village water and sanitation committee in a district of Tamil Nadu, India.

A descriptive study was conducted among 75 members of five Village Water and Sanitation Committees (VWSCs) and 15 local residents in Tamil Nadu, India to assess committees formation and decision making process. There were 64% females and rest were males, all aged between 20 years and 45 years. A total of 50.7% of them passed 12 th standard and 29.3% belonged to self-help groups. Although, all of them were aware about presence of guidelines, none of them knew its contents. About 20% opined that meetings were not being conducted regularly. All members said that they had problems in attending meeting regularly, take decisions if at least 10 (67%) members are present and fund was not adequate for 1 year period. One-third of local residents did not know the committee formation process and none of them aware about guidelines. Formation and decision making process of VWSC should be improved to tackle the sanitation problem.