Sonali Sarkar

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.

Effectiveness of foot care education among people with type 2 diabetes in rural Puducherry, India.

Background: The burden of diabetes and its foot complications is increasing in India. Prevention of these complications through foot care education should be explored. The objective of our study was to assess the risk factors of poor diabetic foot care and to find the effectiveness of health education in improving foot care practice among diabetes patients. Materials and Methods: A structured pre-tested questionnaire was administered to the outpatients of a rural health center with type 2 diabetes. Awareness regarding diabetes, care of diabetes and foot care practice ware assessed and scored. Individual and group health education focusing on foot care was performed. Foot care practice was reassessed after 2 weeks of education. Results: Only 54% were aware that diabetes could lead to reduced foot sensation and foot ulcers. Nearly 53% and 41% of the patients had good diabetes awareness and good diabetes care respectively. Only 22% of the patients had their feet examined by a health worker or doctor. The patients with poor, satisfactory and good practice scores were 44.7%, 35.9% and 19.4% respectively. Low education status, old age and low awareness regarding diabetes were the risk factors for poor practice of foot care. Average score for practice of foot care improved from 5.90 ± 1.82 to 8.0 ± 1.30 after 2 weeks of health education. Practice related to toe space examination, foot inspection and foot wear inspection improved maximally. Conclusion: Foot care education for diabetics in a primary care setting improves their foot care practice and is likely to be effective in reducing the burden of diabetic foot ulcer.

Estimation of the Cardiovascular Risk Using World Health Organization/International Society of Hypertension (WHO/ISH) Risk Prediction Charts in a Rural Population of South India

BACKGROUND World Health Organization/International Society of Hypertension (WHO/ISH) charts have been employed to predict the risk of cardiovascular outcome in heterogeneous settings. The aim of this research is to assess the prevalence of Cardiovascular Disease (CVD) risk factors and to estimate the cardiovascular risk among adults aged >40 years, utilizing the risk charts alone, and by the addition of other parameters. METHODS A cross-sectional study was performed in two of the villages availing health services of a medical college. Overall 570 subjects completed the assessment. The desired information was obtained using a pre-tested questionnaire and participants were also subjected to anthropometric measurements and laboratory investigations. The WHO/ISH risk prediction charts for the South-East Asian region was used to assess the cardiovascular risk among the study participants. RESULTS The study covered 570 adults aged above 40 years. The mean age of the subjects was 54.2 (±11.1) years and 53.3% subjects were women. Seventeen percent of the participants had moderate to high risk for the occurrence of cardiovascular events by using WHO/ISH risk prediction charts. In addition, CVD risk factors like smoking, alcohol, low High-Density Lipoprotein (HDL) cholesterol were found in 32%, 53%, 56.3%, and 61.5% study participants, respectively. CONCLUSION Categorizing people as low (<10%)/moderate (10%-20%)/high (>20%) risk is one of the crucial steps to mitigate the magnitude of cardiovascular fatal/non-fatal outcome. This cross-sectional study indicates that there is a high burden of CVD risk in the rural Pondicherry as assessed by WHO/ISH risk prediction charts. Use of WHO/ISH charts is easy and inexpensive screening tool in predicting the cardiovascular event.

Use of Portfolio-based Learning and Assessment in Community-based Field Curriculum

Portfolio-based learning is recognized in medical education. It helps students to assess themselves as per the key learning objectives and outcomes expected out of them. The faculty could also get feedback regarding individual students progress toward learning outcomes and facilitate the students achieve the same. This article addresses the process of portfolio development and assesses from students feedbacks, if portfolio-based learning is an improvement over record-based study in community-based field studies. The results of this study shows that involving students in framing objectives, developing a mechanism for self-introspection and self-assessment by the students and a mechanism by which faculty can monitor each students progress toward the defined objectives can significantly enhance the learnability of the students.

Validation of the Tamil version of short form Geriatric Depression Scale-15

Background: Local language screening instruments can be helpful in early assessment of depression in the elderly in the community and primary care population. This study describes the validation of a Tamil version of Geriatric Depression Scale (short form 15 [GDS-15] item) in a rural population. Materials and Methods: A Tamil version of GDS-15 was developed using standardized procedures. The questionnaire was applied in a sample of elderly (aged 60 years and above) from a village in South India. All the participants were also assessed for depression by a clinical interview by a psychiatrist. Results: A total of 242 participants were enrolled, 64.9% of them being females. The mean score on GDS-15 was 7.4 (±3.4), while the point prevalence of depression was 6.2% by clinical interview. The area under the receiver-operator curve was 0.659. The optimal cut-off for the GDS in this sample was found at 7/8 with sensitivity and specificity being 80% and 47.6%, respectively. Conclusion: The Tamil version of GDS-15 can be a useful screening instrument for assessment of depression in the elderly population.

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.

Female literacy rate is a better predictor of birth rate and infant mortality rate in India

Background: Educated women are known to take informed reproductive and healthcare decisions. These result in population stabilization and better infant care reflected by lower birth rates and infant mortality rates (IMRs), respectively. Materials and Methods: Our objective was to study the relationship of male and female literacy rates with crude birth rates (CBRs) and IMRs of the states and union territories (UTs) of India. The data were analyzed using linear regression. CBR and IMR were taken as the dependent variables; while the overall literacy rates, male, and female literacy rates were the independent variables. Results: CBRs were inversely related to literacy rates (slope parameter = −0.402, P < 0.001). On multiple linear regression with male and female literacy rates, a significant inverse relationship emerged between female literacy rate and CBR (slope = −0.363, P < 0.001), while male literacy rate was not significantly related to CBR (P = 0.674). IMR of the states were also inversely related to their literacy rates (slope = −1.254, P < 0.001). Multiple linear regression revealed a significant inverse relationship between IMR and female literacy (slope = −0.816, P = 0.031), whereas male literacy rate was not significantly related (P = 0.630). Conclusion: Female literacy is relatively highly important for both population stabilization and better infant health.

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.

Experiences of HIV Positive Mothers From Rural South India during Intra-Natal Period

CONTEXT Tamil Nadu comes under group I high prevalence state, with less than 1% prevalence of HIV infection in antenatal women but above 5% prevalence in high risk group. One of the ways to control HIV/AIDS in India is through Prevention of Parent to Child Transmission (PPTCT), the success of which lies in identifying pregnant women with HIV infection. But due to the stigma against HIV/AIDS among health care providers, HIV positive patients face discrimination in the health sector. AIMS To explore the difficulties faced by rural HIV positive mothers during the intra-natal period. METHODS A descriptive qualitative study was conducted among HIV positive mothers, in Gingee block of Villupuram district, Tamil Nadu, India. All the mothers who tested positive between June 2006 and May 2010 were interviewed in-depth using an interview guide. RESULTS There were 21 HIV positive mothers during this period, 19 of whom gave consent. Majority of the mothers were <30 years of age from families belonging to lower socio-economic class. The discriminations faced from the health staff was avoidance of physical examination, rude behaviour like throwing of records on the face, discriminatory comments, unnecessary referrals and even refusal to provide intra-partum services. The negative attitude of the staff made a few mothers to deliver in some other institution without disclosing their HIV status. CONCLUSION Stigma among health care providers towards HIV positive pregnant women acts as a barrier for improving access to PPTCT services in India and it poses high risk to the mothers, babies and also the health care providers. There is a pressing need to improve access to quality PPTCT services especially during the intranatal period.

Diabetes in rural Pondicherry, India: a population-based studyof the incidence and risk factors

Background: For India, the ‘diabetes capital’ of the world, it is essential to know the incidence of type 2 diabetes mellitus (T2DM) and its key determinants. As two thirds of Indians live in rural areas, a study was undertaken to assess the incidence and risk factors of T2DM in rural Pondicherry, India. Methods: In a population-based cohort study initiated in 2007, a sample of 1223 adults > 25 years ofage from two villages of Pondicherry were selected using cluster random sampling. Data on risk factor exposure were collected using a structured questionnaire, anthropometric tests and fasting blood glucose assessment. During house visits, 1223 of 1403 invited subjects participated. Of these, 71 (5.8%) were found to have diabetes. In 2010–2011, 85% of the non-diabetics (979/1152) were followed up using the same protocol. We calculated the risk of T2DM per annum standardized by age and sex. Population estimates of the risk factors associated with T2DM were analysed using the Generalized Estimating Equation model and the Population Attributable Risk (PAR) for T2DM calculated. Results: During 2937 person-years (PY) of follow-up, 63 new cases of T2DM occurred, giving an incidence rate of 21.5/1000 PY. Almost one third (31.7%) of cases occurred in people aged below 40 years. The incidence was double among males (28.7/1000 PY; 95% confidence interval (CI): 21.0–38.7) compared with females (14.6/1000 PY; 95% CI: 9.4–21.7). Applying these rates to rural populations, it is estimated that each year 8.7 million people develop T2DM in rural India. Nearly half of the T2DM incidence was attributed to overweight/obesity and alcohol usage. Conclusion: T2DM incidence was 2% per year in adults in rural Pondicherry, India, with the rate increasing twice as fast in men. Increasing age, obesity, alcohol use and a family history of T2DM independently predicted the development of diabetes. As half of T2DM incidence was attributed to overweight/obesity and alcohol use, health promotion interventions focusing on maintaining an optimal weight and decreasing alcohol consumption may be effective in reducing the rise in T2DM cases.