Subitha Lakshminarayanan

Diarrheal diseases among children in India: Current scenario and future perspectives

Diarrhea is the third leading cause of childhood mortality in India, and is responsible for 13% of all deaths/year in children under 5 years of age. Information on diarrheal diseases, its determinants and preventive and control strategies need to be reviewed for better planning and organization of health services. This study reviewed literature on diarrheal disease control among under-five children in India from literature published in PubMed, Google search engine and other databases on the internet. Data were described in terms of disease burden in India, determinants, management and intervention strategies, preventive strategies, and role of public health and scope for future action. This review calls for a comprehensive diarrheal disease control strategy, through improved case management, addressing social determinants of health and research in the field of cost-effective interventions to reduce the burden of diarrhea among children in India. With < almost one year left to reach the 2015 Millennium Development Goal on reducing child mortality, progress on control of diarrheal diseases must be accelerated.

Role of government in public health: Current scenario in India and future scope

The new agenda for Public Health in India includes the epidemiological transition, demographical transition, environmental changes and social determinants of health. Based on the principles outlined at Alma-Ata in 1978, there is an urgent call for revitalizing primary health care in order to meet these challenges. The role of the government in influencing population health is not limited within the health sector but also by various sectors outside the health systems. This article is a literature review of the existing government machinery for public health needs in India, its success, limitations and future scope. Health system strengthening, human resource development and capacity building and regulation in public health are important areas within the health sector. Contribution to health of a population also derives from social determinants of health like living conditions, nutrition, safe drinking water, sanitation, education, early child development and social security measures. Population stabilization, gender mainstreaming and empowerment, reducing the impact of climate change and disasters on health, improving community participation and governance issues are other important areas for action. Making public health a shared value across the various sectors is a politically challenging strategy, but such collective action is crucial.

Comparison of different criteria for diagnosis of gestational diabetes mellitus.

Introduction: The International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria for gestational diabetes mellitus (GDM) has been adopted by most associations across the world including the American Diabetes Association and World Health Organization (WHO). We conducted a study comparing the IADPSG and previous WHO criteria and their effects on neonatal birth weight. Methods: The study was carried out in Obstetrics and Gynaecology Department of a tertiary care institute in South India in collaboration with Endocrinology Department. Thousand two hundred and thirty-one antenatal cases with at least one risk factor for GDM and gestational age of more than 24 weeks were included in the study. Both criteria were compared on the basis of 75 g oral glucose tolerance test results. Results: The prevalence of GDM using IADPSG and previous WHO criteria were 12.6% and 12.4%, respectively. The prevalence of GDM was 9.9% when both criteria had to be satisfied. Both GDM criteria groups did not differ in neonatal birth weight and macrosomia rate. However, there was a significant increase in lower segment cesarean section in IADPSG criteria group. Elevated fasting plasma glucose alone picked up only one GDM in the previous WHO criteria group. Conclusions: A single 2 h plasma glucose is both easy to perform and economical. A revised WHO criterion using a 2 h threshold of ≥140 mg % can be adopted as a one-step screening and diagnostic procedure for GDM in our country.

Effectiveness of physical activity promotion in blood pressure and blood sugar reduction: A community–based intervention study in rural south India

Context: Physical activity of moderate intensity for 30 minutes a day, on most days substantially reduces the risk of many chronic diseases. Aim: To assess the effect of regular physical activity on blood pressure and blood sugar levels in a rural Indian community Settings and Design: This community-based study was carried out in Periakattupalayam and Rangareddipalayam in south India, with 485 subjects, aged 20 to 49 years. Materials and Methods: The study was done in five phases: Awareness campaign, baseline assessment of participants, intervention phase (10 weeks), interim, and final assessment. Physical activity of moderate intensity (brisk walking for 30 minutes on four days / week) was promoted by forming 30 small walking groups, in a home-based setting, with professional supervision. Village leaders and Self-Help Group members were the resource people for the promotion of physical activity. Statistical Analysis: Analysis was done by using paired ‘t’ test; the ‘Intention-to-Treat’ approach was utilized for the interpretation of the findings of the study. Results: Of the 485 subjects, 265 (54.6%) complied with walking on more than four days / week, while 156 (32.2%) walked on one to four days / week, and 64 (13.2%) dropped out during the intervention period. This study has shown that a 10-week intervention to promote physical activity was effective in significantly decreasing the populations BP by 1.56 / 0.74 mm Hg, fasting blood sugar levels by 2.82 mg%, body weight by 0.17 kg, and BMI by 0.06 kg / m2. Conclusions: This study has proved the functional feasibility of enabling people to undertake physical activity in a rural Indian community, and the effectiveness of using physical activity, to significantly reduce the populations mean BP and blood sugar levels.

Factors affecting compliance to management of diabetes in Urban Health Center of a tertiary care teaching hospital of south India

Aim: To Study the Factors affecting compliance to diabetes management and study risk factors and complications of type II diabetes. Settings and Design: Primary health center, Descriptive study. Materials and Methods: A descriptive study of previously diagnosed diabetics (n = 135) attending the chronic disease clinic of Urban Health Center, Jawaharlal Institute of Postgraduate Medical Education and Research (JIUHC) was carried out during October 2011 to December 2011. Data were collected by personal interview on demographic parameters, duration of diabetes, number of doses missed in the last 15 days, co-morbidities, knowledge and practice of dietary modification, physical activity, self-care, family support, awareness about risk factors and complications of diabetes. Statistical Analysis Used: The findings were expressed in terms of proportions. Chi-square test was used to study the association between socio-demographic factors and compliance. Results: Majority of patients were in the age group of 50-59, of which 80% were females. Compliance (defined as not missing more than two doses in the last 15 days) to oral hypoglycemic agents was found in 103 (76%; 68.5-82.9). Dietary modifications was practiced by 110 (81.4%; 74.2-87.3) and 37% (29.2-45.4) practice physical activity. Annual eye check-up was carried out by 43.7%, renal function test by 46.6% and foot care by 54%. Knowledge regarding risk factors (66%; 42.7-59.4) and complications (79%; 71.8-85.4) was comparatively better than knowledge about self-care. Conclusions: Three-fourth of patients were compliant to medications and diet, but less than half follows modifications in physical activity and other self-care practices. Hence, it is essential to educate and motivate people in primary health-care level about self-care and life-style modifications.

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.

Alcohol use and alcohol use disorder among male outpatients in a primary care setting in rural Puducherry

Context: Alcohol use contributes to considerable morbidity and mortality worldwide. Screening for alcohol use and alcohol use disorder (AUD) at the primary care level can help in reducing this burden. While several community studies have been conducted to estimate the AUD, there apparently are no studies on opportunistic screening in a primary care setting in India. Aims: The aim was to estimate the prevalence of alcohol use and AUD in a primary care setting. Settings and Design: A hospital-based cross-sectional study was conducted among adult male outpatients in a primary care setting in Puducherry, South India. Subjects and Methods: Male outpatients aged 18 and above were interviewed for alcohol use. Current alcohol users were screened for AUD using World Health Organization - AUD identification test (AUDIT) questionnaire, respectively. Statistical Analysis Used: Proportions were used to describe the study population and the main study findings. The Chi-square test was used to find out the association between sociodemographic factors and alcohol use. Results: Of 256 subjects studied, 39.8% were found to be current alcohol users and 10.9% had AUD (AUDIT score ≥8). The sociodemographic factors did not show any association with an alcohol use in the current setting. Conclusion: Based on the findings of the present study, four current alcohol users are to be screened to identify one patient with AUD. Screening at the primary health care level can help in identifying the risk group and thus help in reducing the morbidity and mortality due to alcohol use in the population.

Out of pocket expenditure among the households of a rural area in Puducherry, South India

Background: As a measure to reduce the out of pocket health spending in our country, the high level expert group on Universal Health Coverage recommends a National Health Package free of cost to all. Whether availability of services free of cost, will reduce out of pocket expenditure? Aim: To assess this, we studied the out of pocket health spending among the households of a Ramanathpuram, a village in Puducherry, where surplus health services are available free of cost. Settings and Design: An exploratory study was conducted in by 200 purposively selected households of Ramanathpuram, during the months of March-April 2012. Materials and Methods: Information was sought on socio-demographic details (age, gender, and income), expenditure incurred during OPD visits, follow up for chronic diseases, and hospitalization using a pretested questionnaire. Recall periods of 1 and 3 months were considered for OPD visits and hospitalizations, respectively. Results: Of the total 935 individuals from the 200 households included, 51.3% (480) were men and 455 (48.7%) were women. A total of 231 visits to health care facilities were recorded from 143 (71.5%) households, of which 153 (66.2%) were for acute illness and 68 (29.4%) for follow up of chronic diseases and 10 (4.3%) for hospitalization. The mean per visit expenditure for acute illness, chronic diseases, and hospitalization were INR72.7 ± 143.6, 135.7 ± 196.2, and 1340 ± 1192.9, respectively. Government facilities were availed for 175 (75.7%) visits. Majority of those who incurred health expenditure for acute illness (80.4%) and utilized the private sector for acute illness (78.4%) were from higher socioeconomic class (P = 0.001). Conclusion: Majority (58.1%) of the households did not incur health care expenditure. Public health care facilities were preferred (75.5%) for seeking care. Availability of services free of cost reduces out of pocket expenditure among non-hospitalized cases.

Existing blood transcriptional classifiers accurately discriminate active tuberculosis from latent infection in individuals from south India

Several studies have identified blood transcriptomic signatures that can distinguish active from latent Tuberculosis (TB). The purpose of this study was to assess how well these existing gene profiles classify TB disease in a South Indian population. RNA sequencing was performed on whole blood PAXgene samples collected from 28 TB patients and 16 latently TB infected (LTBI) subjects enrolled as part of an ongoing household contact study. Differential gene expression and clustering analyses were performed and compared with explicit predictive testing of TB and LTBI individuals based on established gene signatures. We observed strong predictive performance of TB disease states based on expression of known gene sets (ROC AUC 0.9007-0.9879). Together, our findings indicate that previously reported classifiers generated from different ethnic populations can accurately discriminate active TB from LTBI in South Indian patients. Future work should focus on converting existing gene signatures into a universal TB gene signature for diagnosis, monitoring TB treatment, and evaluating new drug regimens.

Kill tobacco before it kills you

products are less likely to raise the issue of harmful effects of tobacco consumption with their patients and lack credibility in providing tobacco cessation services.[8] Smokers and smokeless tobacco users who were advised to quit by a health-care provider were only 46.3% and 26.7%, respectively.[2] Health personnel who smoke are usually less likely to determine the smoking status of their patients, less inclined to advise against tobacco use, and tend to adopt a passive attitude toward providing tobacco cessation guidance. A brief intervention by a health-care professional can motivate their patient to change their behavior mainly because of the authority, respect, and position they enjoy in the society. Each one of us must use every opportunity as a “teachable moment” and make an attempt to convince to quit. Behavioral counseling for tobacco cessation consists of 5A’s: Ask, advise, assess, assist, and arrange for follow-up. Approach for a current tobacco user who has not considered quitting tobacco, use 5R’s: Relevance, risks, rewards, roadblocks, and repetition.