Salig Ram Mazta

Morbidity pattern and health-seeking behavior of aged population residing in Shimla hills of north India: A cross-sectional study

Background: Population aging is a global phenomenon. In India, the size of the elderly population is growing fast. Many older adults have multiple medical conditions. Understanding elderly health problems and health-seeking behavior is prerequisite for proving comprehensive geriatric care to them. Objectives: To assess the morbidity pattern and study the health-seeking behavior of the elderly people of Shimla district in Himachal Pradesh. Materials and Methods: A total of 400 elderly people aged 60 years and above were selected from urban and rural areas of Shimla hills in North India by simple random sampling. Statistical software Epi info software version 3.2 was used for analyzing data. Descriptive statistics were used to describe sociodemographic and morbidity variables. Results: The most common morbidity identified among them were musculoskeletal problems (55.0%) followed by hypertension (40.5%). Two third were seeking treatment for their health problems. Among older persons not seeking treatment for their medical condition, most considered these morbidities as an age-related phenomenon. Many perceived that the health services were too far. Conclusion: The high morbidity load among elderly in the present study stresses for efforts to provide better health care to them and thus ensure that they remain active members of our society. Residence emerged out to be most significant determinant of healthcare-seeking behavior. Policy makers must focus on rural elderly and their beliefs which prevent them from seeking healthcare.

Prevalence of cognitive impairment and related factors among elderly: A population-based study

Background: Older persons are at a risk of developing cognitive impairment, which is often considered a precursor to more serious conditions, such as dementia, depression or even Alzheimers disease. Mini Mental State Exam (MMSE), a cognitive screening tests rated on a 30-point scale is most widely used to study cognitive measures. Aims and Objectives: The aim of our study was to determine the prevalence of cognitive impairment among older adults, to describe the pattern of cognitive impairment in rural and urban elderly population and to investigate the influence of socio-demographic and other variables on it. Materials and Methods: A cross-sectional study was carried out between January 2010 and July 2010, in urban and rural areas of Shimla district of Himachal Pradesh. Four hundred elderly people were included in the study. Cognitive levels were assessed with the MMSE scale (cut-off score 23). Data were analysed with SPSS 17.0 software for windows. Results: The prevalence of cognitive impairment was 3.5%. It was higher in rural (2.3%) than in urban population (1.3%), with a rural/urban prevalence ratio (PR) of 1.8 (95%CI 0.6-5.7). In the logistic regression model, old-old, illiterate and widowed showed a higher probability of cognitive impairment. It was not associated with use of alcohol, cigarette smoking or under nutrition. Conclusion: Knowing the prevalence rate of cognitive impairment in elderly, together with the associated factors may inform policy makers and aid in designing better geriatric friendly health services. When planning elderly health services priority should be given to the elderly who are old-old, widowed and those who are illiterate.

Functional status and its predictor among elderly population in a hilly state of North India

Background: Functional status can be conceptualized as an individuals ability to manage activities related to personal self-care and self-maintenance. Functional status assessment is fundamental aspect of geriatric examination. This assessment helps clinicians and policymakers to design and implement interventions that help elderly to live safely and independently. Aims and Objectives: The primary aim was to assess the prevalence of limitation in activities of daily living (ADL) and instrumental ADL (IADL) among elderly population. The secondary aim was to identify the factors that predict IADL limitation among them. Materials and Methods: A total of 400 community dwelling elderly persons residing in Shimla hills of North India were interviewed using valid and reliable functional assessment scales namely Katz ADL and Lawton and Brody IADL. Statistical procedures for the analyses included descriptive statistics and logistic regression. Results: The prevalence of ADL and IADL activity limitation was 5.5% (22/400) and 21.8% (87/400), respectively. The results of logistic regression analysis revealed that advancing age (70 years and above), poor self-rated health and ailments namely musculoskeletal problems and cataract significantly predict functional limitation. Conclusions and Recommendation: Elderly having musculoskeletal problems should be provided with rehabilitative support in the community settings. Cataract surgeries patients should be identified and operated upon so as to improve visual functioning and thus their functional ability. Further, cities, towns, and rural areas should be made age-friendly.

Pattern of non-fatal injuries in road traffic crashes in a hilly area: A study from Shimla, North India

Research Question: What are the various injuries in road traffic crash cases? Objectives: To study various non-fatal injuries in road traffic crash cases. Study Design: Hospital based Descriptive study. Study Population: The study population comprised of 401 consecutive cases of non- fatal injuries involved in road traffic crashes and reported at Indira Gandhi Medical College hospital, Shimla. Study Period: 1st June 2005 to 31st May 2006. Study Variables: Demographic characteristics of the victims, pattern of injuries and hospital stay of the victims. Types of crashes, time, day and month of crashes, vehicles involved in crashes, use of protective gear etc. Statistical Analysis: Percentages, Proportions. Results: 73% of the injured victims were young between 20-49yrs, male to female ratio being 5.3:1. Employees (34.7%) and occupants of transport vehicles (45.9%) constituted the maximum number of the victims. Major injuries (fractures and abd. injuries) were reported in 53.4% of the victims and fractures of lower limb were the commonest of the injuries (26.3%). Use of seat-belt was found to be alarmingly low (14.3%) amongst the four- wheeler users and its non-use was found to be significantly associated with the major injuries. Helmet was used by 36 cases (66.7%) out of total of 54 users of motorized two-wheelers at the time of crash. Human error was the most reported cause of crash (82%) and the most common mode of crash was skidding and/rolling down (55%).23.1% of the drivers were reported to have consumed alcohol at the time of crash.

Prevalence of cigarette smoking and its predictors among school going adolescents of North India

Background: Cigarettes smoking is a common mode of consuming tobacco in India. This habit usually starts in adolescence and tracks across the life course. Interventions like building decision making skills and resisting negative influences are effective in reducing the initiation and level of tobacco use. Aims and Objectives: The purpose of this study was to assess the prevalence of adolescent current cigarette smoking behavior and to investigate the individual and social factors, which influence them both to and not to smoke. Methodology: A cross-sectional study was carried out among school going adolescents in Shimla town of North India. After obtaining their written informed consent, a questionnaire was administered. Results: The overall prevalence of current cigarette smoking was 11.8%. The binary logistic regression model revealed that parents’ and peers’ smoking behavior influence adolescent smoking behavior. Individual self-harm tendency also significantly predicted cigarette smoking behavior. Parental active participation in keeping a track of their childrens free time activities predicted to protect adolescents from taking this habit. Conclusion: Our research lends support to the need for intervention on restricting adolescents from taking up this habit and becoming another tobacco industries’ addicted customer. Parents who smoke should quit this habit, which will not only restore their own health, but also protect their children. All parents should be counseled to carefully observe their childrens free time activities.

Prevalence and predictors of the dual burden of malnutrition among adolescents in North India

Background: Dual burden of malnutrition comprising of both under nutrition and over nutrition constitutes an important public health problem among Indian adolescents. Objective: The objective of this study is to determine the prevalence of dual burden of malnutrition (underweight and overweight/obesity) among adolescents and to understand the role of dietary habits and physical activity in this regard. Methodology: A cross-sectional survey was conducted in Shimla district of North India. A total of 720 adolescents aged 14-19 years were selected to participate in the study. Data were collected on sociodemographic status, physical activity, dietary intake, and anthropometry. Statistical analysis was done using Epi info software for windows (version 6.0, Centre for Disease Control, Atlanta, USA). Results: A total of 298 (41.3%) of the adolescents were suffering from dual burden of malnutrition. The binary logistic regression revealed a statistically significant positive association of overweight/obesity with frequent fast food consumption (odds ratio [OR] = 4.45, confidence interval [CI] = 2.42-8.18). Individuals consuming less salt in the diet had lower odds of being overweight/obese (OR = 0.47, CI = 0.25-0.87). Similarly, individuals frequently consuming fruits in the diet had lesser odds of being underweight (OR = 0.61, CI = 0.42-0.86). Conclusion: The high prevalence of the dual burden of malnutrition in this study stresses the need for policy makers in India to adapt the current adolescent program so as to focus on both ends of the nutrition spectrum.

Evaluation of health safety of direct biomedical waste handlers in a Government Medical College, Himachal Pradesh

Hospital waste management is a crucial environmental issue of public health concern due to hazardous and infectious character of the waste. Hospital waste is produced when activities pertaining to the care of patients are carried out in the various settings of health care. The waste generated has a leeway to cause harm to the human beings and the environment. The waste generated is called the biomedical waste and includes soiled cotton, bandages, hypodermic needles, syringes and tubings. Such waste constitutes 15-25% of the total waste generated. The remaining is general waste like wrapper of drugs, waste paper, card board and left over food etc.

Health seeking behavior of lung cancer patients receiving treatment at a tertiary cancer institute: a study from North India

Background: The morbidity and mortality of lung cancer is directly related to its stage at diagnosis. Only 15% of lung cancers are detected at a stage amenable to curative resection and the overall five-year survival rate is merely 16%. Early diagnosis of lung cancer results in lower stages, less intensive treatment and improved survival as well as it is less costly. Objectives: The aim was to track treatment seeking behavior of lung cancer patients and to study the socio-demographic profile of these patients and their relationship with treatment seeking behavior. Materials and Methods: All the newly registered lung cancer patients >18 years who came for treatment at our institute during the study period ie from 1st September 2011 through April 2012. Data was analyzed using descriptive and inferential statistics. Results: Out of 91 patients included in the study, 73 (80.2 %) were males and 18 (19.8 %) were females. The mean age of the study population was 59.24 ± 10.53 years and the median age was 60 years. Commonest presenting symptoms were cough (72.5 %), dyspnoea (63.7%) and pain chest (61.5%). The mean duration of symptoms was 3.5 months. We found that 42.9% patients reported within one week of appearance of first symptoms, 19.7% between one week and one month and 37.4% after one month. As the age of patients increased the odds of seeking treatment before one month, decreased. On the other hand as the socio-economic status improved, the odds of seeking treatment earlier also decreased. A significant difference was found in married patients, who sought treatment earlier than those who were single/divorced or widowed (p=0.02). 50% patients thought it was a minor cough and cold which would get cured by itself or by minor treatment. 48% said that there was a delay in diagnosis and referral. Conclusion: The findings indicate an urgent need for public health awareness that targets increasing awareness and recognizing symptoms suggestive of lung cancer. Further strengthening of health facilities with the provision of infrastructure with recent diagnostic modalities and manpower is needed which may help to decrease the delay in diagnosis and hence early referral.

Validity of madras diabetes research foundation: Indian diabetes risk score for screening of diabetes mellitus among adult population of urban field practice area, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Introduction: IDRS is based on four simple parameters derived from known risk factors for diabetes; two modifiable risk factors (waist circumference and physical inactivity) and two non-modifiable risk factors (age and family history of diabetes), which may be amenable to intervention. The present study has been planned as the region specific validation is important before it can be used for screening in this part of the country. Aims: The aim of the present study was to validate MDRF-IDRS for screening of diabetes mellitus among adult population of urban field practice area, IGMC, Shimla, Himachal Pradesh, India. Methods: The present community based cross sectional study was conducted among 417 adults fulfilling the eligibility criteria using a two stage sampling design. Results: In the present study IDRS value ≥70 had an optimum sensitivity of 61.33% and specificity of 56.14% for detecting undiagnosed type 2 diabetes in the community. At an IDRS score of ≥70, the PPV was 23.47%, NPV as 86.88%, the diagnostic accuracy as 57.07%, LR for positive test as 1.398, LR for negative test as 0.69 and Youdens index as 0.17. However Youdens index was 0.19 at a cut of ≥60 i.e. higher than what was at ≥70. Higher IDRS scores increased the specificity but the sensitivity dramatically decreased. Conversely, lower IDRS values increased the sensitivity but the specificity drastically decreased. Area under the curve = 0.630 and a P value < 0.001. Conclusions: MDRF IDRS is user friendly screening tool but the criteria of including the parameter of physical activity for the calculation of the risk score needs to be clearly defined. In the present study the maximum sensitivity of 100% was seen at a cut off of ≥30. Hence we would recommend that all those in the medium and high risk group should be screened for type 2 Diabetes.

Indian public health standards in primary health centers and community health centers in Shimla District of Himachal Pradesh: A descriptive evaluation

Introduction: The health planners in India have visualized primary health centers (PHCs) and community health centers (CHCs) as the key healthcare delivery institutions in rural areas. These centers are supposed to have health manpower, infrastructure, and service delivery as per the Indian public health standards (IPHS) guidelines (2010). Materials and Methods: A cross-sectional study was conducted in seven CHCs and 12 PHCs, randomly selected from eight blocks of Shimla District and evaluated in terms of health manpower, infrastructure, and services from September 2011 to August 2012. Data was collected from the selected units using structured data collection instruments designed by the IPHS. Results: The health centers were assessed according to IPHS guidelines. Outpatient department services and referral services were provided in all the centers studied. No specialist doctor was posted at any of CHCs against a sanctioned strength of at least four (surgeon, physician, obstetrician, and pediatrician) per CHC. In 3 (42.8%) CHCs and 8 (75%) PHCs, no pharmacist was posted. Eight (75%) PHCs did not have any staff nurse posted. Three (42.8%) CHCs and 10 (83.3%) PHCs did not have a laboratory technician. In CHCs, separate labor room was available in 6 (85.7%) whereas a separate laboratory was available in all seven. Separate labor room and laboratory were available in four (25%) PHCs. Conclusions: IPHS guidelines are not being followed at PHC and CHC levels of the district. Health manpower shortage is the key bottleneck in service delivery. Political advocacy is needed to ensure sufficient health manpower availability to deliver quality healthcare.