Sanjay Pattanshetty

Self-medication patterns among medical students in South India

BACKGROUND Self-medication results in wastage of resources, increases resistance of pathogens and generally causes serious health hazards such as adverse drug reactions, prolonged suffering and drug dependence. This study was undertaken to determine the reasons for self-medication and the pattern of self-medication among medical students. METHOD This cross-sectional descriptive study was conducted at the K.S. Hegde Medical Academy, Mangalore. The participants were medical students from first to final year. Medical students were selected through convenience sampling. The data was collected using a pre-tested semi-structured questionnaire. The data was analysed using SPSS version 16 and the results expressed as proportions. RESULTS A total of 200 students, 121 (60.5%) female and 79 (39.5%) male, were included in the study. Of the medical students surveyed, self-medication was reported among 92%. The respondents who used self-medication found it to be time- saving in providing relief from minor ailments. The most common ailments for which self-medication were used were: the common cold (69%), fever (63%) and headache (60%). The students consulted their textbooks (39%) and seniors or classmates (38%) for the medications. Antipyretics (71%), analgesics (65%), antihistamines (37%) and antibiotics (34%) were the most common self- medicated drugs. Of the respondents, 33% were unaware of the adverse effects of the medication and 5% had experienced adverse reactions. The majority (64%) of students advised medications to others, more often to family and friends. CONCLUSION The prevalence of self-medication among medical students is high, facilitated by the easy availability of drugs and information from textbooks or seniors. A significant number of students are unaware of the adverse effects of the medication that they themselves take and suggest to others. Therefore, potential problems of self-medication should be emphasised to the students.

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.

A study on knowledge, attitude and practice of contraception among college students in Sikkim, India

OBJECTIVE To assess the knowledge, attitude and practice of contraception among the college students. MATERIALS AND METHODS A cross sectional study was conducted in the Government College, Gangtok, Sikkim, during the month of April 2009 to evaluate the knowledge, attitude and practice of contraception among 156 students enrolled in the first year bachelor course. Descriptive statistics was used for data analysis. RESULTS 98% (153/156) of the students had knowledge about family planning and 86% (134/156) of them had heard about contraceptives. Most of them knew about condoms (85%) and contraceptive pills (40%) but knowledge about permanent methods and Cu-T was poor (average 12%). Most students thought contraceptives were to be used to prevent unwanted pregnancy (35%) and for birth spacing (30%). 11% of students had used some form of contraceptive in the past and 7% were currently users. The most commonly used contraceptives were condoms, followed by combined use of OCP and condom. CONCLUSION The study highlights the need to motivate the youth for effective and appropriate use of contraceptives when required and arrest the trend towards unwanted pregnancy.

Mass drug administration to eliminate lymphatic filariasis in Southern India

Background Lymphatic filariasis is an important public health problem in India. Inspite of National filarial control programme (NFCP) being in place for lymphatic filariasis (LF) elimination,several important issues need to be addressed. There is uncertainty about the coverage and compliance to treatment in order to achieve elimination. Method A community based cross-sectional study was conducted as per the National Vector Borne Disease Control Programme (NVBDCP) directions. The study included survey of 200 households of Dakshina Kannada District, South India where the Mass drug administration (MDA) program was conducted. The main objective of the study was to assess the coverage and compliance to MDA. Results Out of the total 1050 eligible people, 876 (83%) received the DEC tablets; so, the coverage was 83%. Among those who received the tablets, only 777 (88.7%) received the adequate dose and only 670 (76.8%) people actually consumed the tablets. Hence, compliance rate was only 76.8%. Conclusion The planning and implementation of MDA programme needs to be strengthened by efficient micro planning, inter sectoral co-ordination and motivating the community to participate in the MDA programme

A study on emergency contraceptive practice among nursing staff in Sikkim, India-A cross sectional study

Background Improved knowledge about emergency contraception (EC) may decrease the unplanned pregnancy rate, unsafe abortion and save many lives. This study aims to assess the knowledge, attitude and practice of EC amongst the nursing staff in Sikkim.

Prevalence of hypertension in the paediatric population in coastal South India.

Background: Hypertension in children and adolescents has become increasingly common. We sought to study the prevalence of hypertension among apparently healthy school children in Udupi Taluk, a rapidly developing coastal region in Karnataka in South India and correlate high blood pressures with age, gender and BMI. Method :A total of 2067 students (1055 boys and 1012 girls) between the ages of 5 – 16 years from rural schools in Udupi taluk were studied as part of school health services. Height (in cm) and weight (in kg) were recorded along with Blood Pressure measurements using the auscultatory method. Blood pressure was measured twice among children who were found to have a high reading (more than the 95th percentile) the first time. Using WHO charts for BMI for boys and girls, prevalence of overweight and obese children was determined. The evaluation of hypertension was based on the Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents. Results: Overall prevalence of hypertension in children was 2.2%. Prevalence of hypertension in female children was 2.4% and in males it was 2.1%. The proportion of hypertensives was found to the maximum in the 14-16 year age group. The prevalence of obesity among girls and boys was found to be 1.5% and 1.1% respectively. The prevalence of systolichypertension was found to be significantly higher (P=0.041) in obese children (12.5%) as compared to that in underweight children (1.4%). Conclusion: We found that higher BMI was associated with higher blood pressures. The results suggest that the prevalence of hypertension is mainly in the adolescent age group; therefore targeted screening in this group would be beneficial.

Nutritional status assessment of under -five beneficiaries of Integrated Child Development Services program in rural Karnataka

Background The prevalence of underweight children in India is among the highest in the world, and is nearly double that of Sub- Saharan Africa. The effect of malnutrition is high morbidit and mortality among young children. The objective of this study was to determine the nutritional status of children aged between 3-6 years registered in government sponsored maternal and child care Anganwadi centres in India. Method A cross-sectional study was conducted in 35 centres in 11 villages situated in the field practice area of Community Medicine Department of a Medical College situated in Southern India. Results Of the 585 children in the study, 46.5% of the children were aged between 36 to 48 months. Assessment of nutritional status using the ICDS growth chart revealed malnourishment to be present among 189 (32.3%) children, of whom 166 children were grade I malnourished and 23 children were grade II malnourished. Proportionally girls (46.2%) were more malnourished than boys (33.6%). No significant association was found between the nutritional status of children and their duration of stay in an Anganwadi centre (p-value=0.56).Conclusion The findings of this study indicate that malnutrition is still an important problem even among children attending Anganwadis. Further improvements in functioning of Integrated Child Development Services need to be made in order to address the problem of malnutrition

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.

Private practitioners approach to the diagnosis of Pulmonary Tuberculosis in Southern India

Background In India majority of patients with respiratory symptoms initially consult private doctor. Few studies have been performed on the role of private practitioners in TB control. The present study was planned to assess the private practitioners approach in the diagnosis of pulmonary tuberculosis. Method A Cross Sectional study was conducted between September 2008 and October 2009 in rural and urban area of Udupi taluk. The study population included all modern medicine general practitioners and all the specialists practicing Internal Medicine, Chest Medicine, and Pediatrics. The non response rate was 8%. About 15 practitioners who were not in the list were interviewed during field visits. So, the total number of practitioners interviewed was 116. Results The majority (67.4%) of general practitioners and physicians opted for sputum examination as the investigation of choice to diagnose pulmonary Tuberculosis. About 26.1% of general practitioners and physicians used both sputum and chest x-ray to diagnose pulmonary tuberculosis. About 6.5% used chest x-ray alone. However, about 58.3% of paediatricians preferred both sputum and chest x-ray to diagnose pulmonary tuberculosis. Conclusion Relying only on chest x-ray to diagnose pulmonary tuberculosis may lead to over-diagnosis, over-medication and un-necessary utilization of resources. There is a need to improve the awareness among private practitioners regarding the importance of sputum smear examination to diagnose pulmonary tuberculosis.