Unnikrishnan Bhaskaran

Adherence to Antiretroviral Therapy Among People Living with HIV

Background: Acquired immune deficiency syndrome (AIDS) is now considered as a manageable chronic illness. There has been a dramatic reduction in human immunodeficiency virus (HIV) related morbidity and mortality due to antiretroviral therapy. A high level of adherence (>95%) is required for antiretroviral therapy to be effective. There are many barriers to adherence in both developed and developing countries. Aim: The aim of our study was to determine adherence levels and factors influencing adherence to antiretroviral therapy among people living with HIV. Materials and Methods: Using a cross-sectional study design, 116 HIV positive patients receiving antiretroviral therapy for at least 1 year were interviewed using a semi structured questionnaire. The collected data was analyzed using Statistical Product and Service Solutions (SPSS) version 11.5. Chi-square test was done. A P value of < 0.05 was considered statistically significant. Results: Of 116 participants, 63.7% reported adherence ≥ 95%. Mean adherence index was 91.25%. Financial constraints, forgetting to take medication, lack of family care, depression, alcohol use, social stigma and side effects to antiretroviral therapy were barriers for adherence in our study. Conclusion: Adherence to antiretroviral therapy in south India is suboptimal. Intensive adherence counseling should be provided to all patients before initiation ofantiretroviral therapy. Health care providers must identify possible barriers to adherence at the earliest and provide appropriate solutions.

Knowledge of First Aid Skills Among Students of a Medical College in Mangalore City of South India

Background: The adequate knowledge required for handling an emergency without hospital setting at the site of the accident or emergency may not be sufficient as most medical schools do not have formal first aid training in the teaching curriculum. Aim: The aim of this study is to assess the level of knowledge of medical students in providing first aid care. Subjects and Methods: This cross-sectional study was conducted during May 2011 among 152 medical students. Data was collected using a self-administered questionnaire. Based on the scores obtained in each condition requiring first aid, the overall knowledge was graded as good, moderate and poor. Results: Only 11.2% (17/152) of the total student participants had previous exposure to first aid training. Good knowledge about first aid was observed in 13.8% (21/152), moderate knowledge in 68.4% (104/152) and poor knowledge in 17.8% (27/152) participants. Analysis of knowledge about first aid management in select conditions found that 21% (32/152) had poor knowledge regarding first aid management for shock and for gastro esophageal reflux disease and 20.4% (31/152) for epistaxis and foreign body in eyes. All students felt that first aid skills need to be taught from the school level onwards and all of them were willing to enroll in any formal first aid training sessions. Conclusion: The level of knowledge about first aid was not good among majority of the students. The study also identified the key areas in which first aid knowledge was lacking. There is thus a need for formal first aid training to be introduced in the medical curriculum.

Diabetic peripheral neuropathy and its determinants among patients attending a tertiary health care centre in Mangalore, India

Background The burden of diabetes mellitus (DM) is on the rise especially in developing countries like India. Due to its chronic nature DM tends to cause many debilitating complications and diabetic peripheral neuropathy (DPN) is one of them. The aim of this study is to determine the prevalence of DPN among patients attending a tertiary care hospital and to identify the determinants associated with it. Design and methods A cross sectional study was conducted in Government Wenlock Hospital, Mangalore (India), during January-February 2014. A total of 208 patients with >5 year duration of DM were asked to respond to the patient history version of Michigan Neuropathy Screening Instrument (MNSI) and examinations were conducted after obtaining consent from them. The statistical analysis was done in terms of descriptive statistics and association between variables was tested using logistic regression test. Results The prevalence of DPN using the MNSI history version and MNSI examination were found to be 18.3% and 32.2% respectively. The major determinants associated with DPN were found to be male gender (OR: 2.7, CI: 1.4-5.1, P=0.001), smoking (OR: 5.8, CI: 1.9-17.3, P=0.001) and age >40 years (OR: 2.7, CI: 1.2-5.8, P=0.011). Conclusions The burden of undetected DPN was found to be higher among diabetics, with an especially higher prevalence among males, smokers and those with long standing diabetes mellitus. Interventions in the form of early detection through routine screening, smoking cessation and regular follow up examinations would go a long way in reducing the burden of disability among diabetics and improve their quality of life significantly. Significance for public health The findings of the current research hold importance since diabetes is one of the leading causes of morbidity and mortality across the world. Due to its chronic nature and effects of hyperglycaemia, diabetes tends to be associated with many comorbidities, like peripheral neuropathy, nephropathy, retinopathy etc. The presence of diabetic peripheral neuropathy leads to a reduced quality of life among diabetic patients due to the trauma and consequent gangrenes andamputation. The concept of secondary prevention can be applied to the prevention of diabetic peripheral neuropathy using easy to apply screening tools and thus help in early diagnosis and treatment to reduce the burden of this debilitating illness.

A profile of patients attending an Anti Retroviral Therapy (ART) centre at a tertiary care hospital in South India.

Background An estimated 2.5 million Indians are currently living with HIV. In 2004, the Indian government began providing free antiretroviral therapy (ART), through ART centers. This was conducted to assess the socio-demographic and clinical profile, opportunistic infection and treatment pattern of ART center attendees. Method

Profile of cervical cancer patients attending Tertiary Care Hospitals of Mangalore, Karnataka: A 4 year retrospective study

Objectives: To describe the sociodemographic characteristics and clinical profile of women presenting with cervical carcinoma and to identify factors associated with the timing of presentation and prognosis. Materials and Methods: A record-based descriptive study was carried out from 1st February to 31st March 2014 at Tertiary Care Hospitals of Mangalore. The study population included women who were diagnosed with cervical carcinoma from January 1, 2010 to December 31, 2013. A pretested data extraction sheet aimed at collecting information from the inpatient records was used as the study instrument. The collected data were entered and analyzed using SPSS version 16.0. Results: A total of 227 patients were included in the study. Mean (Standard Deviation) age of diagnosis of cervical cancer was found to be 55 ± 11 years. Majority of the women were Hindus (88.5%) and 51.0% of the women had occupational activities out of which manual labor was the most common. Forty-eight percent of the patients presented in the late stages. Squamous cell carcinoma was found to be the most common histological type. It was also observed that a slightly higher proportion of women with an age >49 years presented in late stages of the disease (n = 70, 48.6%) compared to women <49 years of age (n = 28, 46.7%); however, the difference was not statistically significant (P = 0.800). Conclusions: Our study found out a higher proportion of late presentation by the patients. It emphasizes the need for the development and implementation of an efficient screening cum prevention program for cervical cancer and to continue active research in the domains of identifying all possible risk factors and steps to mitigate them.

A systematic review of community-based health insurance programs in South Asia

BACKGROUND Community-based health insurance (CBHI) has been evolving as an effective means of healthcare financing in many countries of South Asia. A systematic review in this context would give a comprehensive report of the performance of these schemes in terms of improving the health-seeking behaviour of the beneficiaries enrolled for the schemes. METHODS Important databases like PubMed, Elsevier, SocINDEX (EBSCO), Cochrane Reviews, Medline and Scopus were reviewed along with relevant portals-Google Scholar, www.who.int/, www.worldbank.org and www.cochrane.org-and specific journals and discussion series with published literature in the areas of community health insurance and health microfinance. RESULTS The review finally chronicles 20 CBHI schemes from published and unpublished literature from the countries comprising South Asia. These schemes have been reviewed in terms of their enrolment process, entry point and the extent to which they have contributed to the healthcare-seeking behaviour. CONCLUSION The CBHI schemes can also serve as an alternative healthcare financing mechanism where fee-for-service and user fees have not made any impact. There have been very few studies that have tried to carry out an impact evaluation of the CBHI schemes on the target population, and more and more such studies can be a scope for further research. Copyright

Caregiver Burden among Adults Caring for People Living with HIV/AIDS (PLWHA) in Southern India.

INTRODUCTION In India, family caregivers provide bulk of care to People Living With HIV/AIDS (PLWHA). Caregiver burden refers to the physical, emotional and financial hardships associated with providing care to a diseased individual. Attending to the needs of PLWHA can place a significant burden on family members. This may adversely affect their Quality of Life (QOL). AIM The main aim of our study was to assess the caregiver burden and QOL among the family members of PLWHA in Southern India. We also determined the impact of caregiver burden on QOL. MATERIALS AND METHODS This facility based cross-sectional study was carried out at Kasturba Medical College (KMC) Mangalore. The study was conducted over a period of 18 months starting from October 2013. A total of 360 caregivers participated in our study. The data were collected by face-to-face interview. Caregiver burden was assessed using the Zarit Burden scale & WHOQOL-BREF scale was used to assess the QOL of caregivers. The collected data was entered and analysed using SPSS version 11.5. A p-value of less than 0.05 was considered statistically significant. RESULTS The mean age of caregivers was 36.09± 10.18 years. Most of the caregivers were females 279 (77.5%). Majority of caregivers 184 (51.1%) belonged to Middle/Lower Middle socioeconomic class (Kuppuswamy class III). Majority of PLWHA 155 (43.1%) had Stage 2 disease. Mean CD4 count of the patients was 405.2± 240 cells/μL. In our study 88(24.4%) caregivers had moderate to severe burden and 36(10%) had very severe burden. Physical domain of QOL showed maximum score of 60.28±13.08, while a minimum score of 51.88 ± 14.20 was seen in social domain. With increase in caregiver burden, the mean QOL scores decreased which was statistically significant. CONCLUSION Our study highlights the need to counsel the caregivers on how to deal with PLWHA in the family. Family care plays a major role in the general wellbeing of PLWHA. Majority of national HIV programmes all over the world focus mainly on PLWHA. National programmes should immediately address the mental health issues of caregivers thereby reducing caregiver burden. More studies on this topic have to be conducted in developing countries.

HIV Status Disclosure Among People Living with HIV in the Era of Combination Antiretroviral Therapy (cART).

INTRODUCTION As patients with HIV live longer due to Combination Anti-Retroviral Therapy (cART) serostatus disclosure becomes an important issue. Disclosure can have both positive and negative outcomes. Disclosure of HIV status has been associated with better adherence to medication and reduction in levels of psychological distress. Stigma and disruption of family relationships are barriers for disclosure. Most studies regarding disclosure status have been conducted in West. There are many cultural differences in Indian society when compared to west. There is a dearth of research in the field of disclosure of HIV infection in India. AIM To determine the prevalence of HIV status disclosure among people living with HIV (PLHIV) in South India. MATERIALS AND METHODS This descriptive cross-sectional study was done in the hospital attached to Kasturba Medical College (KMC), Mangalore, India from May-June 2013. PLHIV of age more than 18 years were included. During the study period 111 consecutive patients who consented for the study were enrolled. STATISTICAL ANALYSIS Data was collected using a pre-tested interviewer administered semi structured questionnaire. Data collected was analysed using SPSS Version 11.5 statistical software. Descriptive statistics were done and the results are presented as proportions and mean. RESULTS The mean age of the study population was 44.86 ± 10.8 years. Majority of the study subjects were men 76 (68.4%). Out of 111 study subjects, 102 (91.9%) had disclosed their HIV status to at least one person while 9 (8.1%) had not disclosed their HIV status to anyone. Disclosure on doctors advice was the main reason for 56 (54.9%) participants to disclose their HIV status. The main reason for non-disclosure was fear of shame in family. CONCLUSION Disclosure rate was high in our study in the era of cART. Society must stop discriminating against PLHIV so that they can disclose their serostatus and gain access to care and treatment services without any fear of stigma. In our study the main reason for disclosure was doctors advice which clearly states the importance of the commitment of doctors in creating awareness among PLHIV about the need for voluntary disclosure.

Prevalence of musculoskeletal disorders among doctors in Mangalore: A cross-sectional survey

Context: Musculoskeletal disorders (MSDs) are a significant concern for health care professionals due to the nature of work that exposes them to injuries. Aims: The aim was to assess the prevalence of MSDs among doctors. Settings and Design: Cross-sectional survey among doctors working in Mangalore. Materials and Methods: Self-administered questionnaires distributed among medical specialties professionals of two major hospitals (Government Wenlock Hospital and Kasturba Medical College Hospital) of Mangalore. Statistical Analysis Used: Descriptive analysis and Chi-square test ( P Results: Lower back (25%), neck (20.21%), and knees (14.36%) were the common MSDs among doctors in different specialties. MSDs association with respect to age, gender, and work experiences were nonsignificant, except physical activity ( P = 0.042). Conclusions: About 58.5% doctors reported MSDs and lower back disorders were most common.

Fertility Desires and Intentions among People Living with HIV/AIDS (PLWHA) in Southern India.

INTRODUCTION The desire of people living with HIV/AIDS (PLWHA) to have children can have significant public health implications. Combination Antiretroviral Therapy (cART) has increased the life expectancy of PLWHA as a result of which they may consider child bearing. There are hardly any studies from India addressing the fertility desires among PLWHA. AIM This study was done to assess the fertility desires of PLWHA in Southern India. MATERIALS AND METHODS It was a cross-sectional study conducted among 230 HIV-positive men and women who presented to Kasturba Medical College (KMC), Mangalore, India. Study was conducted between October 2012 and October 2014. Statistical analysis was performed using SPSS software version 11.5. Chi-square test, Fishers exact test and student t-test was used to find out the association of various factors affecting fertility desire. A p-value of less than 0.05 was considered statistically significant. RESULTS The mean age of our study population was 36.3±5.5 years. The mean age of males was 37.3±6 years and for female 34.9±5 years. In our study 132 (57.4%) were males. Majority were literate 229 (99%). Majority of patients were employed 166 (72%). In our study 195 (84.7%) were on cART. Out of 230 PLWHA 39 (16.95%) were unmarried and 151(65.5%) married PLHIV were living with partners at the time of study. In our study 77 (33.5%) patients had fertility desire. Age, gender, marital status, number of children, partners fertility desire and HIV status of partner had an association with fertility desire. CONCLUSION Providing universal access to cART is the main aim of national programs. It is high time that these programs focus on fertility issues of PLWHA. Reproductive rights of PLWHA need to be respected. Physicians and HIV counselors should proactively discuss and address reproductive issues of PLWHA.