Yadlapalli S. Kusuma

Migration and immunization: determinants of childhood immunization uptake among socioeconomically disadvantaged migrants in Delhi, India.

Objective  To determine the coverage of childhood immunization appropriate for age among socioeconomically disadvantaged rural–urban migrants living in Delhi and to identify the determinants of full immunization uptake among these migrant children.

Blood pressure levels among cross-cultural populations of Visakhapatnam district, Andhra Pradesh, India.

Background : Elevated blood pressure is a leading cause of morbidity and mortality throughout the world, as a major contributor to cardiovascular diseases. Blood pressure tends to vary cross-culturally and studies to address the influence of acculturization/modernization on blood pressure are limited from India, particularly from Andhra Pradesh. Aim : To provide information on blood pressure levels and variability across population groups from the State of Andhra Pradesh, India, and to examine the influence of acculturization/modernization on blood pressure levels. Subjects and methods : The blood pressure levels among 1316 individuals (646 men and 670 women) belonging to two tribal (Khondh and Valmiki) and two caste groups (Wadabalija and Settibalija) from rural and urban areas from Andhra Pradesh were collected. Analysis of covariance (ANCOVA) was used to examine the effect of age and sex, and population differences. Results : The distribution of blood pressure showed significant variability among these population groups. Higher levels of blood pressure were noticed in an acculturizing tribe, the Valmiki, than among the Khondh, a traditional tribal population. The results indicate that age had significant effect on both systolic and diastolic blood pressure levels. Also, the systolic blood pressure was relatively more sensitive than diastolic blood pressure to the effect of age. The sex did not contribute significantly to the variability of blood pressure. Conclusions : The study revealed significant population differences in the variability of blood pressure, with higher levels among acculturizing tribal population than the non-acculturizing group. But no significant variation was noticed between rural and urban slum dwellers. Age had a significant effect on blood pressure levels.

Perceptions on hypertension among migrants in Delhi, India: a qualitative study

BackgroundThe developing countries are experiencing epidemiological transition and hypertension has emerged as a major threat to health in these countries. Understanding peoples perceptions is important for any prevention and control activities and lay explanatory models (EMs) provide an opportunity to gain insights into the peoples perceptions. This qualitative study is taken up with an objective of understanding EMs of neo- and settled-migrants regarding hypertension.MethodsQualitative methods with grounded theory approach were used to elicit EMs of hypertension held by neo- and settled-migrants. In-depth interviews with key-informants and focus group discussions with community members were conducted. The data were subjected to thorough reading and analysed by segregating the text under different themes.ResultsHypertension has been perceived as a common and serious problem in the community. Lay conceptions have identified hypertension as symptomatic with ambiguity over perceived symptoms. City life has been perceived as a major predisposing factor for developing hypertension. City life has been corroborated with pollution and adulteration of food, stress, high fat diet along with physical inactivity and certain attitudes. The concepts of hypertension were interconnected and linked to their day-to-day living in the city. Inadequacy of awareness has been acknowledged and there was a felt need for awareness campaigns and screening programmes in the community. The EMs of hypertension among the neo- and settled-migrants and men and women were broadly similar. However, there were slight variations by gender and migration status in the perceived pathways to hypertension.ConclusionHypertension has been perceived as a common and serious problem in the community. Hypertension has been perceived as symptomatic; however, ambiguity prevails over perceived symptoms. Awareness and knowledge about hypertension and its consequences are inadequate in these communities. The felt need for awareness campaigns and mass screening programmes has emerged from the community and it provides enabling environment to successfully carry out public health interventions, by addressing the existing gaps, for prevention and control of hypertension and other cardiovascular diseases.

Migration and access to maternal healthcare: determinants of adequate antenatal care and institutional delivery among socio-economically disadvantaged migrants in Delhi, India.

To identify the determinants of adequate antenatal care (ANC) utilisation and institutional deliveries among socio‐economically disadvantaged migrants living in Delhi, India.

Migration and hypertension: a cross-sectional study among neo-migrants and settled-migrants in Delhi, India.

Understanding the blood pressure (BP) distribution within populations is fundamental to an understanding of the etiology of cardiovascular diseases and to develop effective preventive strategies. This study focuses on whether the BP levels and hypertension prevalence differ between neo-migrants and settled-migrants in the city of Delhi. Data on BP, anthropometry, social variables, and demographic variables were collected from a cross-sectional sample of 226 settled-migrants and 227 neo-migrants. Men possessed significantly higher BP levels than women. Settled-migrants possessed higher BP levels, except diastolic BP in males. The prevalence of hypertension ranges from 15% (neo-migrant women) to 25% (settled-migrant men), with no significant gender differences. Group differences were significant for men. Hypertension was more prevalent in older settled-migrants and younger neo-migrants. Recent migration was found to be a significant contributor to hypertension prevalence. Age contributed significantly to BP variation in both groups except in neo-migrant men. Pulse rate also contributed to systolic BP among neo-migrant women and settled-migrant men. Thus, urban residence and migration to urban areas can be a leading cause of increased prevalence of hypertension. Neo-migrants were subjected to more lifestyle insults and the stress generated during the adjustment process may be contributing to rise of BP even at younger ages.

Prevalence of hypertension in Indian tribes: a systematic review and meta-analysis of observational studies.

Introduction In India there is an increasing trend in hypertension prevalence among the general population. Studies have shown that tribal populations in India are also experiencing this burden. Objective The aim was to estimate the pooled prevalence of primary hypertension among adult tribal populations of India. Methods A systematic search was conducted in MEDLINE, IndMed, Web of Science, Google Scholar and major journals for studies published between 1981 and 2011. Two authors independently reviewed the studies, did quality assessment and extracted data in pre-coded spread-sheets. Pooled estimates of prevalence of hypertension were calculated using DerSimonian-Laird random effects model. Subgroup and sensitivity analyses and meta-regression were performed. Results Twenty studies or 53 subpopulations with 64 674 subjects were included in final review. The pooled estimate of hypertension prevalence was 16.1% (95% CI: 13.5, 19.2). There was significant heterogeneity among the studies (I2 = 99% and Q = 4624.0, df  = 53, p<0.001). Subgroup analyses showed that year of study, acculturation status, special features, and BP measurement techniques significantly influenced prevalence, but after meta-regression analyses, ‘decade of study’ remained the only covariate that significantly and independently influenced prevalence (R2 = 0.57, Q = 119.2, df  = 49, p value <0.001). Conclusion An increasing trend was found in the prevalence of hypertension in adult tribal populations across three decades. Although acculturation was probably the underlying agent that caused this increase, other unmeasured factors that need further research were also important. Concerned policy makers should focus on the changing health needs of tribal communities.

Group- and Sex-Specific Effects of Age, Body Composition and Pulse Rate on Blood Pressure Variability in Some Cross-Cultural Populations of Visakhapatnam District; South India

Background Hypertension is becoming a major public health problem in developing countries. Blood pressure tends to vary cross-culturally and is influenced by various factors including age, body composition and pulse rate. This paper reports the influence of age, body composition and pulse rate on blood pressure variability. Design The data were collected from 1316 individuals (646 men and 670 women) belonging to two tribes (Khondh and Valmiki) inhabiting hilly tribal area and two castes (Wadabalija and Settibalija) from both rural and urban areas from Visakhapatnam district, Andhra Pradesh, India. Results There are considerable ethnic differences in blood pressure and body composition variables. Age contributes significantly to the variance in blood pressure in these populations. However the influence of age is less pronounced in Khondh, a primitive/unacculturized tribe, while age exerts a profound effect on blood pressure variability in Valmiki, an acculturizing tribe. Further, the effect of age is more pronounced on systolic than on diastolic pressure and it contributes more to the blood pressure of women than men. The subcutaneous fatness measures (sum of three trunk skin fold thicknesses and sum of three extremities skin fold thicknesses) are significant predictors of both systolic and diastolic blood pressure in Khondh, Valmiki and Wadabalija, while body mass index (BMI) is an important predictor of both systolic and diastolic blood pressure in Settibalija. Pulse rate is often found to influence blood pressure of women. Conclusion The age-associated variability of blood pressure confirms the proposition that variability is high in adverse environment, when modernization/acculturization is taken to represent environmental adversity. Apart from the influence of age, body composition/adiposity contributes significantly to the blood pressure variability.

The Association of Tobacco Smoking and Blood Pressure in Some Low Socioeconomic Groups from Andhra Pradesh, India

AbstractObjective: To investigate the relationship of tobacco smoking with blood pressure (BP). Methods: The study is based on a cross-sectional sample of 1316 adult men and women of six low socioeconomic groups belonging to four different ethnic groups from Visakhapatnam district of Andhra Pradesh, India. Data pertaining to BP, smoking habit and anthropometry were collected from men and women aged ≥20 years, after obtaining their informed consent. Results: The smoking habit is more prevalent in men compared with women. In general, female smokers and male non-smokers had higher BP levels in various groups. After adjusting the BP for age and body mass index, smoking does not yield a significant effect on BP. In general, the prevalence of hypertension is higher among female smokers and male non-smokers. Conclusion: The negative association in the present populations, as in many studies, may be explained by the phenomena of rebound and adaptation.

Asymmetry of finger ridge countsamong four tribal populations of Andhra Pradesh, India

The asymmetry among the four tribal populations Dulia, Kotia, Manne Dora and Manzai Mali is reported. The mean directional asymmetry (MDA) and mean absolute asymmetry (MAA) were measured for homologous fingers. The asymmetry follows a decreasing trend in radio-ulnar direction with higher mean values in thumb and index finger. The individual variation is also higher in these fingers. Neither sexual nor population differences are consistent. Jantzs Square root of A2 (another measure to assess asymmetry) for total finger ridge count and absolute finger ridge count does not indicate any significant sexual or ethnic differences. The results suggest that the underlying mechanisms influencing the level of asymmetry may be similar for all groups, and that certain dermatoglyphic areas like the thumb are more vulnerable to developmental/environmental stress, that cause asymmetry at the developmental stage.

Migrants' perceptions on barriers to treatment seeking for hypertension: a qualitative study from Delhi, India.

Abstract This study reports the perceptions on treatment seeking behaviour and perceived barriers to treatment for hypertension among the socio-economically disadvantaged migrants in Delhi, India. In-depth interviews with key informants and focus group discussions with community members were conducted. Treatment seeking for hypertension was not adequate. Several patient-and provider-related issues have emerged as barriers in treatment seeking and adherence. The perceived barriers and needs are to be considered by individual practitioners and the public health care systems to bring them into the fold of health care to tackle the problem of hypertension.