Varalakshmi Chandrasekaran

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.

Quality of life among persons with physical disability in Udupi Taluk: A cross sectional study

Background: Disability is not just a health problem or attribute of individuals, but it reflects the problems individuals experience in their interaction with society and physical movements. Disabled persons remain neglected part of society and they also experience various barriers due to restriction of participation. Objectives: The aim was to assess the quality of life (QOL) of physically disabled persons, the impact of physical disability on activities of daily living (ADL) and to study the awareness about laws and facilities available for disabled persons. Materials and Methods: A cross-sectional community based study was conducted among 130 physical disabled persons who were selected using convenience sampling technique. The WHO BREF scale was used to assess QOL, while assessment of ADL was done using Barthel Index. Socio-demographic assessment was done using Udai Pareek scale. SPSS version 15.0 was used to analyze data. Categorical variables were expressed as frequencies and percentages. As per guidelines physical, psychological, social, and environmental domain scores for WHO BREF scale were calculated. Results: Among the study participants, 36.2% had a disability from birth that is, congenital. The second common cause of disability was found to be postpolio residual paralysis as it was found among 26.2% respondents. Other causes found were stroke/paralysis and accidents, in 19.2% and 18.5% respondents, respectively. Activities such as transfer, mobility, and stair climbing showed greater impact of physical disability. It was found that 11.5% respondents required help in one of the ADL. QOL score was found to be low under the psychological domain reflecting on negative feelings, bodily image, appearance, spirituality, and self-esteem of respondents. Conclusion: Physical disability had affected social participation as well as marriage of the respondents. However, it was found that very few of them are aware about facilities provided under persons with disability act.

Occupational stress and health-related quality of life among public sector bank employees: A cross-sectional study in Mysore, Karnataka, India

Background: Occupational morbidities have been estimated to cause an economic loss up to 10–20% of the gross national product of a country. It is an important cause of occupational morbidity and decreased quality of life (QOL) for the workers. Aim: The aim of the present study is to assess the level of occupational stress and its association with the QOL among the public sector bank employees. Materials and Methods: The present study was conducted among employees of public sector banks in Mysore district, Karnataka, India. A cross-sectional study design was used for the study. Job stress was measured by using occupational stress index (OSI) scale questionnaire and health-related QOL was measured using the short form 12 (SF-12) questionnaire. The sample size estimated for the study was 526 and cluster random sampling technique was used. Chi-square test was used to find the association between the study variables and level of stress. Multiple linear regression model was used to find the determinants of health-related QOL among the study subjects. Results: The total number of the study subjects was 546 out of which 57% were males and 43% were females. The proportion of study subjects reporting to be current smokers was 4.2% and almost all study subjects reported occasional alcohol consumption. The mean physical component summary (PCS) score and mental component summary (MCS) using the original United States standardization were 47.90 and 48.30, respectively. The individuals with mild stress scored higher in both PCS and MCS than the individuals who had moderate to severe stress levels. There was significant association of health related quality of life with the age of the respondent,presence of at least one morbidity and level of stress with health-related QOL. Conclusion: This study has shown an association of occupational stress with the QOL. There is a need for interventions aimed at mitigating the occupational stress among employees of the banking sector.

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.

Prevalence of anemia among tribal women of reproductive age in Udupi Taluk, Karnataka

Context: Anaemia is a major public health problem in India. Many studies have emphasized on prevalence of anaemia among general population. This study has focussed to address the prevalence of anaemia among the tribal population in Udupi taluk. Anaemia among women in the reproductive age group is one of the causes for maternal morbidity and mortality in India. Aim: To estimate the prevalence of anemia among tribal women (aged 15 to 49 years). Settings and Design: A Community based cross sectional study was conducted among tribal women aged 14-49 years in Udupi taluk, Udupi district, Karnataka. Methods and Material: A cross sectional study during July 2012 to August 2012 was conducted. A sample size of 170 was calculated taking into consideration a relative error of 15% and the prevalence of anemia in Karnataka as 51% (as per the NFHS-3). Statistical analysis used: Univariate and multivariate analysis was used to analyse the data using SPSS 15. Results: The study sample had a mean hemoglobin value of 11.3 g/dL with 95% CI of (11 – 11.6), with a standard deviation of 2g/dL. The study reveals that in the sample of tribal women in the age group of 15-49 years, the prevalence of anemia was 55.9%. Among the subjects, 6 (3.5%) were severely anemic, 33 (19.4%) were moderately anemic and 56 (32.9%) were mildly anemic. Conclusions: This study calls for an appropriate action and intervention in this tribal population to treat and prevent anaemia.

Caregiver burden among caregivers of mentally ill individuals and their coping mechanisms

Background: During a given year, almost 30% of the people around the world are affected by mentally ill health. In India, it accounts for about 20%. Caregivers face a lot of strain, ill health, and disrupted family life, with literature suggesting an increasing concern about their ability to cope up. The needs of caregivers of the mentally ill are given low priority in the current health-care setting in India. Aim: The aim of the study was to assess the burden of caregivers of mentally ill individuals and their coping mechanisms. Methods: A cross-sectional study was employed with a quantitative approach. A convenient sample of 320 caregivers was taken from two private tertiary care centers and one public secondary care center in Udupi taluk. This study was conducted using the Burden Assessment Schedule (BAS) and Brief Cope Scale (BCS). Statistical analysis was done on categorical variables, and they were expressed as frequencies and percentages. Continuous variables were measured using mean and standard deviation. Univariate and multivariate analysis using binomial logistic regression was done. SPSS version 15 was used to analyze the data. Results: According to BAS, severe burden accounted for 40.9% and moderate for 59.1%. The highest amount of burden was seen in the areas of physical and mental health, spouse related, and in areas of external support. The BCS showed that the most frequently used coping styles were practicing religion, active coping, and planning. Conclusion: This study concluded that caregivers of the mentally ill individuals do undergo a lot of burden. Hence, there is a need to develop strategies that can help them such as providing them with a support structure as well as counseling services.

Comparative Analysis of Cost of Biomedical Waste Management Across Varying Bed Strengths in Rural India

Abstract Background: The quantum of waste generated from medical care and activities is a global matter of concern. Improper management of biomedical waste has a grave health impact on the community, health care professionals and the environment. It is mandatory by law that every medical organization that generates waste should have a system, process and resources in place for segregating biomedical waste within the organization for proper disposal. The present articles deals with understanding the various costs associated in biomedical waste management process which will help the health care organization to prioritize their spending and focus on areas that require spending to achieve compliance in process of biomedical waste management. Material and methods: Descriptive cross sectional study was carried out, to study the compliance of biomedical waste management at three different hospitals with respect to Bio-Medical Waste (Management & Handling) Rules, 2011. A retrospective study was conducted to analyze cost data for a 1-year time period. Cost involved in BMW management was analyzed and classified as capital and recurring costs. The study was undertaken in Udupi taluk, taluk comprises of 11 hospitals (1 Government and 10 private hospitals), the hospitals were selected using convenient sampling as taking permission to conduct the study was difficult. Only three hospitals permitted to carry out the study. Results: Compliance was found to be better in accredited hospital than non-accredited hospital. This could be attributed to strict adherence to standard operating procedures and Regular training of staff. Cost involved in BMW management was analyzed as capital and recurring costs. Since most of the hospital outsource final disposal, Capital costs are significantly less compared to recurring costs. Among the recurring costs, maximum expenditure is on Consumables like color- coded bags. Cost per bed per day for handling BMW was calculated and it was found to be higher in smaller hospitals. Conclusion: Cost of biomedical waste management forms a significant part of hospital expenses. We analyzed both the capital costs and the operating costs and it was found that operating costs had a bigger impact on the hospital bottom line. The costs were found to be higher in the smaller hospitals. The larger hospital would be procuring items in higher volumes, which would enable them to bargain for a lower cost. If the government or the common biomedical waste management facility can provide color- coded bags to hospitals at a uniform pricing irrespective of the bed strength, it would enable them to bring down the operating costs significantly.

The link between HIV/AIDS and violence among young adults: A study in Udupi, Karnataka

Background: Violence is a major public health problem which affects the community and threatens the life of people. Objectives: To estimate the prevalence and different forms of violence among HIV positive young adults taking antiretroviral therapy (ART) in Udupi district. Materials and Methods: A cross-sectional study was carried out among HIV positive young adults (18-35 years) who were aware of their status. The participants were selected from ART Centre of Udupi district adopting convenience sampling. Data were collected from 200 young HIV positive young adults using a predesigned, pre-tested self-administered questionnaire. Results: The overall prevalence of domestic violence was 14.5% and was found to be more among females (17.6%) as compared to males (6.9%). This difference was statistically significant among gender with a P-value Conclusion: Physical and sexual violence was found to be more in female HIV positive patients as compared to males. The presence of violence among HIV positive young adults especially among the females demands for the concerted efforts at combating underlying factors leading to violence among this vulnerable group of HIV positive young adults.