Shobhit Garg

Potential of mid-upper arm circumference to replace body mass index as a screening tool for assessment of nutritional status: A study among a rural elderly population in eastern India

Background: Malnutrition in the form of undernutrition or overnutrition has reached epidemic proportions globally in all age groups assessment of which often becomes very difficult among the elderly since many of them cannot even stand for accurate measurement of their height and weight. Aims and Objectives: The aim of this study is to assess and to find the optimum cutoff of mid-upper arm circumference (MUAC) to predict overweight/obesity using receiver operating characteristic (ROC) curves. Materials and Methods: A community-based cross-sectional study was conducted in May 2017–August 2017 among 335 elderly, in two villages, West Bengal. Height, weight, and MUAC were measured for each subject. ROC curve analysis was used to estimate the cutoff values of MUAC. Results: Mean (standard deviation) age of the participants was 67.40 (6.19) years. More than half were overweight and 14 (4.2%) were obese. MUAC and body mass index (BMI) had strong significant positive correlation (r = 0.79). On ROC for MUAC to have overweight/obesity (BMI ≥25 kg/m2), area under curve was 0.9133 which signifies MUAC as a excellent screening and predictive tool. With Youden’s method as well with closest to top-left method, optimum cutoff of MUAC was found to be 21.75 cm. At this cutoff, an elderly individual will have BMI ≥25 kg/m2 with a sensitivity of 87.30% and specificity of 78.49%. Conclusion: Our study suggests that MUAC has potential for surveillance of overweight/obesity and has a predictive tool to identify elderly who will need further assessment of obesity and its associated comorbidities.

Importance of giving health education regarding lifestyle modification and perceived barriers: focus group discussion among community health workers of slum of Kolkata, India

Background: Considering the poor health literacy and high prevalence of risk factors of NCDs in the slums, health education remains prime intervention. Indeed, successful intervention requires programmes tailored not only to local needs and available resources but also the way it is implemented in the community. The objective was to assess the knowledge of NCDs and NCD care, identify the barriers that impede community level workers from providing services pertained to achieve and maintain healthy living among the community. Methods: It was a qualitative study (FGD) conducted on 30 November 2017 among community level workers of Urban Health Unit and Training Centre (UHU and TC), Chetla, Kolkata. A thematic qualitative analysis was conducted to identify significant themes in the data. Results: It was found that everyone was aware of Non-communicable Diseases. In terms of physical activity, lack of time, whereas in tobacco, it had become a habit from the young age, poor knowledge about healthy diet were the main challenges in adopting the healthy lifestyle. Health education to create awareness is crucial in tackling NCDs. Conclusions: The study revealed that the community workers were aware of the importance of health education and poor awareness regarding healthy lifestyle among people was the main challenge. By delivering holistic interventions that address multiple lifestyle risks and incorporate relapse prevention strategies, health trainers could potentially have a significant impact on control of NCDs.

Unmet need of family planning among married women of reproductive age: A clinic-based study in rural Bengal

Background: Fecund married women who currently do not practice any family planning (FP) methods are considered to have unmet need for FP. In spite of a longstanding and robust family welfare program in India, the key health indicators like birth rate or maternal mortality ratio are still far from satisfactory for which mitigating unmet need plays a crucial factor. Objectives: The objective of this study is to assess the unmet need for FP and its determinants among married women of reproductive age group. Materials and Methods: It was a clinic-based descriptive study conducted among 104 married women of reproductive age group (15–49 years) attending the outpatient Department of Anandangar Primary Health Center, in the rural field practice area of All India Institute of Hygiene and Public Health, Kolkata. Data were collected 2 days a week with the help of a pre-tested structured interview schedule from women who attended the clinic and consented to participate during the 1 month study period (September 2016). Results: The mean age of the subjects was 32.4 years, and unmet need was found to be 34.6%. In univariate logistic regression analysis, significant association was found with religion odds ratios (OR) 3.75 (confidence interval [CI] 1.36–10.31), socioeconomic status (as measured by modified B.G Prasad scale 2016) OR 2.51 (CI 1.08–5.75), and who had at least one male child OR 3.73 (CI 1.50–9.23). In multivariable logistic regression, significant association was found with religion OR (CI) 14.22 (3.45–58.60) and socioeconomic status OR (CI) 2.93 (1.06–8.06). Conclusion: Proper counselling by healthcare providers to rectify the misconceptions associated with contraceptive use may reduce their unmet need and increase the acceptance rate of contraceptives.

Assessment of self-care activities: A study among type 2 diabetic patients in a rural area of West Bengal

Background: Diabetes care is complex. Diabetes self-care activities are behaviors undertaken by people to successfully manage diabetes on their own. In populous and developing country like India where resources are limited, and treatment costs are on the rise, emphasizing on the self-care management may lead to improved outcomes in treatment and expenditure. Objectives: To assess self-care activities and associated factors among type 2 diabetic patients. Materials and Methods: A clinic-based cross-sectional study was conducted in Primary Health Centre in Singur among 195 patients (males 45 [23.1%], females 150 [76.9%]) who were interviewed with the help of a pretested schedule. Descriptive statistics, univariate logistic regression, and multivariable logistic regression were used to analyze the data. Results: Among the six domains of self-care activities, drug intake compliance was as high as 72.3% while correct diet intake and foot care were as low as 35.4% and 37.4%, respectively. Overall satisfactory self-care activities were among only 25.6% diabetic patients while adequate advice related to self-care activities was given to 38.5% patients. Longer duration (odds ratio [OR] - 3.1, confidence interval [CI] - 1.7-7.4), adequate advised (OR - 2.9, CI - 1.3-6.9), no diabetes distress (OR - 2.9, CI - 1.2-7.4), and glycemic control (OR - 4.0, CI - 1.8-9.3) were significant predictors of satisfactory self-care activities. Final model can predict the 34.5% of variance of self-care activities. Final model can predict 74.4% of the outcome accurately. Conclusion: Both self-care advises and activities should be an integral part of the control of the disease through high-quality health education and promotion programs guided by health personnel at all levels.