Zile Singh

Study of childhood obesity among school children aged 6 to 12 years in union territory of puducherry.

Objective: To study the prevalence of obesity and overweight among school children in Puducherry. To identify any variation as per age, gender, place of residence and type of school. Setting and design: Secondary data analysis of a school-based cross sectional study in all the four regions of Puducherry. Materials and Methods: Children between 6 and 12 yrs were sampled using multistage random sampling with population proportionate to size from 30 clusters. Anthropometric data (BMI) was analyzed using CDC growth charts. Data was analyzed using SPSS, BMI (CDC) calculator, CI calculator and OR calculator. Results: The prevalence of overweight (≥85th percentile) among children was 4.41% and prevalence of obesity (>95th percentile) was 2.12%. Mahe region had the highest prevalence of overweight (8.66%) and obesity (4.69%). Female children from private schools and urban areas were at greater risk of being overweight and obese. Conclusions: Childhood obesity is a problem in Puducherry and requires timely intervention for its control.

Diabetes prevalence and its risk factors in rural area of Tamil Nadu.

Objective: To estimate the usefulness of the Indian diabetes risk score for detecting undiagnosed diabetes in the rural area of Tamil Nadu. Materials and Methods: The present study was conducted in the field practice area of rural health centers (Chunampett and Annechikuppam, Tamil Nadu), covering a population of 35000 from February to March 2008 by using a predesigned and pretested protocol to find out the prevalence and the risk of diabetes mellitus in general population by using Indian diabetes risk score. Results: 1936 respondents comprising 1167 (60.27%) females and 769 (39.73%) males were studied. Majority 1203 (62.50%) were Hindus. 1220 (63.%) had studied up to higher secondary. 1200 (62%) belonged to lower and lower-middle socio-economic class. A large number of the subjects 948 (50%) were below 35 years of age. Most of the respondents 1411 (73%) indulged in mild to moderate physical activity. 1715 (87.91%) had no family history of diabetes mellitus. 750 (39.64%) individuals were in the overweight category (>25 BMI). Out of these overweight persons, 64% had high diabetic risk score. It is observed that chances of high diabetic score increase with the increase in BMI. Prevalence of diabetes in studied population was 5.99%; out of these, 56% known cases of diabetes mellitus had high (>60) IDRS. Co-relation between BMI and IDRS shows that, if BMI increases from less than 18.50 to more than 30, chances of high risk for developing diabetes mellitus also significantly increase. Conclusions: This study estimates the usefulness of simplified Indian diabetes risk score for identifying undiagnosed high risk diabetic subjects in India. This simplified diabetes risk score has categorized the risk factors based on their severity. Use of the IDRS can make mass screening for undiagnosed diabetes in India more cost effective.

Diabetes prevalence and its risk factors in urban Pondicherry

The present study was conducted in the Urban Health centre, Muthialpet, Pondicherry covering a population of 40000 from July to October 2007 by using a predesigned and pretested proforma to find out the risk of diabetes in general population by using Indian Diabetes Risk Score. A total of 616 respondents were studied comprising 325(53%) females and 290(47%) males. Majority 518(85%) were Hindus. Of them, 380 (62 %) had studied up to higher secondary and above, 539 (87%) belonged to upper middle and upper socioeconomic class. A large number of the subjects 422(68%) were above 35 years of age. Most of the respondents 558(90.50%) indulged in mild to moderate physical activity. Again, 422 (68.50%) had no family history of diabetes mellitus, 315 (51%) individuals were in the overweight category (>25 BMI), and 261 (83%) of high Diabetic Risk Score individuals were overweight. It is observed that chances of high diabetic score increase with the increase in BMI. Prevalence of diabetes in the studied population were 51 (8.27%), out of that 39 (76%) had high (>60) IDRS score. The relationship between BMI and IDRS shows that if BMI increases from under weight (<18.50) to obesity (>30) chances of risk for diabetes also increases significantly.

Determinants of patient's adherence to hypertension medications in a rural population of Kancheepuram District in Tamil Nadu, South India

Context: Non-communicable diseases, no longer a disease of the rich, impose a great threat in the developing nations due to demographic and epidemiological transition. This increasing burden of non-communicable diseases and their risk factors is worrisome. Adherence to hypertension (HT) medication is very important for improving the quality of life and preventing complications of HT. Aim: To study the factors determining adherence to HT medication. Settings and Design: A community-based cross-sectional study was conducted in a rural area of Kancheepuram district, Tamil Nadu, with a total population of around 16,005. Materials and Methods: This study was carried out over a period of 6 months (February-July) using a pre-structured and validated questionnaire. All eligible participants were selected by house-to-house survey and individuals not available on three consecutive visits were excluded from the study. The questionnaire included information on demographic characteristics, lifestyle habits, adherence to HT medication, blood pressure, and body mass index (BMI). Caste was classified based on Tamil Nadu Public Service commission. Statistical Analysis: Data were entered in MS Excel and analyzed in SPSS version 16. P value <0.05 was considered statistically significant. Ethical Consideration: Informed verbal consent was obtained prior to data collection. The patients adherence to HT medication was assessed using the Morisky 4-Item Self-Report Measure of Medication-taking Behavior [MMAS-4]. Results: We studied 473 hypertensive patients of which 226 were males and 247 were females. The prevalence of adherence was 24.1% (n = 114) in the study population. Respondents with regular physical activity, non-smokers and non-alcoholics were more adherent to HT medication as compared with respondents with sedentary lifestyle, smoking and alcohol intake (P < 0.005). Based on health belief model, the respondents who perceived high susceptibility, severity, benefit had better adherence compared with moderate and low susceptibility, severity, benefit.

Universal health coverage for India by 2022: a utopia or reality?

It is the obligation of the state to provide free and universal access to quality health-care services to its citizens. India continues to be among the countries of the world that have a high burden of diseases. The various health program and policies in the past have not been able to achieve the desired goals and objectives. 65th World Health Assembly in Geneva identified universal health coverage (UHC) as the key imperative for all countries to consolidate the public health advances. Accordingly, Planning Commission of India constituted a high level expert group (HLEG) on UHC in October 2010. HLEG submitted its report in Nov 2011 to Planning Commission on UHC for India by 2022. The recommendations for the provision of UHC pertain to the critical areas such as health financing, health infrastructure, health services norms, skilled human resources, access to medicines and vaccines, management and institutional reforms, and community participation. India faces enormous challenges to achieve UHC by 2022 such as high disease prevalence, issues of gender equality, unregulated and fragmented health-care delivery system, non-availability of adequate skilled human resource, vast social determinants of health, inadequate finances, lack of inter-sectoral co-ordination and various political pull and push of different forces, and interests. These challenges can be met by a paradigm shift in health policies and programs in favor of vulnerable population groups, restructuring of public health cadres, reorientation of undergraduate medical education, more emphasis on public health research, and extensive education campaigns. There are still areas of concern in fulfilling the objectives of achieving UHC by 2022 regarding financing model for health-care delivery, entitlement package, cost of health-care interventions and declining state budgets. However, the Governments commitment to provide adequate finances, recent bold social policy initiatives and enactments such as food security bill, enhanced participation by civil society in all health matters, major initiative by some states such as Tamil Nadu to improve health, water, and sanitation services are good enough reasons for hope that UHC can be achieved by 2022. However, in the absence of sustained financial support, strong political will and leadership, dedicated involvement of all stakeholders and community participation, attainment of UHC by 2022 will remain a Utopia.

Mobile Phone Usage and its Health Effects Among Adults in a Semi-Urban Area of Southern India.

INTRODUCTION Worldwide, mobile phone usage has been increased dramatically which could affect the health of the people. India has the second largest number of mobile phone users. However there are only few studies conducted in India to assess its effects on health. AIM To determine the prevalence and pattern of mobile phone usage and to assess the relationship between certain selected health problems and mobile phone usage among adults. SETTINGS AND DESIGN Community-based cross-sectional study was conducted in Kottakuppam, a town panchayat in Villupuram district of Coastal Tamil Nadu, Southern India. It is a semi-urban area with a population of about 16,000. Majority of the residents are Muslim by religion and belong to different socio economic status. MATERIALS AND METHODS The study was approved by the Institutional Ethics Committee. A total of 2121 study participants were interviewed by the pre-final medical students through house-to-house survey using a pretested structured questionnaire. The questionnaire included the variables such as socio demographic profile, mobile phone usage and pattern, selected health problems, perceived benefits and threats and blood pressure. Selected health problems included headache, earache, neck pain, tinnitus, painful fingers, restlessness, morning tiredness, tingling fingers, fatigue, eye symptoms, sleep disturbance and hypertension. STATISTICAL ANALYSIS USED Only 2054 were included for data analysis using SPSS 17 version. Proportions were calculated. Chi-square test was used to measure the p-value. The p-value < 0.05 was considered as statistically significant. RESULTS The prevalence of mobile phone usage was 70%. Calling facility (94.2%) was used more than the SMS (67.6%). Health problems like headache, earache, tinnitus, painful fingers and restlessness etc., were found to be positively associated with mobile phone usage. There was negative association between hypertension and mobile phone usage. CONCLUSION The prevalence of mobile phone usage was high. There was significant association between selected health problems and mobile phone usage. In future, higher studies are required to confirm our findings.

Aging: The triumph of humanity-are we prepared to face the challenge?

Advances in medicine have increased the life expectancy resulting in an increase in the geriatric population all over the world, and their proportion will only continue to rise in the coming years. It is known that the elderly bear a significant burden of morbidity, which is why health systems globally spearheaded by the WHO are waking up to the need for better geriatric health services. This includes India, whose health system continues to grapple with the health challenges of communicable and noncommunicable diseases. This article enumerates the various government policies and programs, constitutional and legal provisions available for the care of the elderly, and concludes that they are grossly inadequate to deal with the various physical, psychological, and emotional needs of the aging population. Mainstreaming of geriatric health to address the health needs of the elderly at all levels of health care, both in the public and the private sectors, giving due importance to multidimensional rehabilitative services and terminal care, involving NGOs and voluntary organizations, and stepping up social security in old age are the recommended measures for improving geriatric health in India.

A multicenter cross-sectional study of mental and physical health depression in MHD patients

Depression is ranked fourth among the disabling diseases affecting people worldwide and is the most common psychological problem in patients with End Stage Renal Disease (ESRD). The aim of this study is to assess the physical and emotional health status of renal dialysis patients, based on the SF-36 scale in relation to their economic status. Sixty maintenance hemodialysis patients, with a mean age of 40±13 years were included in this cross-sectional study using the SF-36 scale. It comprises 36 questions regarding physical and mental functions, body pain, vitality, etc. An SF-36 score of 50 or less was considered as moderate to severe depression and 51–100 as mild depression to good health. 56.81% of the patients who are below poverty line under dialysis had moderate to severe depression with regard to their health status. A physical health score of up to 50 was seen in 63.63% of patients below poverty line 63.63% (P= 0.16). A mental health score of 0–50 was observed in 61.63% of the cohort studied (P = 0.22). Among the patient with diabetes (28.33%) 55.56% had depression. Dialysis duration was directly associated with deteriorating physical health status and inversely proportional to their mental health status (P<0.05). There are problems in other regular activities due to depressed physical and mental health. The factors that were identified in this study that influence depression such as poverty status, increasing age, vintage and frequency of dialysis and treatment with erythropoietin dosage should be addressed and treated accordingly to improve the quality of life. Improving self-esteem with fruitful employment opportunities, concerted rehabilitation by professionals and easing of economic burden by private–public partnership is an achievable goal.

Prevalence of Underweight and its Risk Factors among Under Five Children in a Rural Area of Kancheepuram District in Tamil Nadu, India

Background: India is contributing to around 20% of world total under five children deaths. Major cause of under five children deaths is malnutrition and multiple factors are involved in determining the nutritional status of the children. Therefore the objective of the study is to measure the prevalence of underweight and to study the selected factors associated with underweight among children under five years of age residing in a rural area. Methods: A community based cross sectional study was conducted. We have interviewed 563 parents/guardians of under five children using a structured questionnaire consisting of socio- demographic factors, natal history, feeding practices etc. The weight (in kg) was measured using Bathroom weighing scale (> 1 year of age) and infant weighing scale and grading was done as per Indian Academy of Paediatrics (IAP) classification.Results: The prevalence of underweight among under five children was 52.9%. Around 7% of children were severely malnourished. The prevalence of underweight among children under the age of one year was 62.4%. Females (62.6%) were more malnourished than males (44.0%). Children belonging to higher socio-economic status (40.0%) were less malnourished than lower socioeconomic status (47.2%). Conclusion: The burden of underweight was very high and some important risk factors for underweight were age, females and lower socio-economic status. Therefore, any interventions to prevent and solve the problem of

Respiratory morbidity among welders in the shipbuilding industry, Goa

Context: Welding is pivotal in shipbuilding. The fumes and gases involved in welding may cause respiratory morbidity. Aim: To study the prevalence of respiratory morbidity (RM) among welders vis à vis among nonwelders and its association with certain relevant factors. Settings and Design: A cross-sectional study of 276 welders and 276 nonwelders was conducted in the shipbuilding industry. Materials and Methods: An interviewer-administered questionnaire was followed by spirometric examination. Statistical Analysis: Odds ratio and its 95% CI and two-way ANOVA. Results: Prevalence of RM was found to be significantly higher among welders compared to nonwelders (who were comparable in age, duration of employment (DOE) and smoking habits,) with odds ratio (OR) of 1.78 (95% confidence interval (CI):1.20-2.63). Obstructive type of RM was predominant in both welders (26% (n = 73)) and nonwelders (17% (n = 49)) with welders being at a significantly higher risk (OR = 1.66 (95%: 1.10-2.49)). RM was commoner after the 40 years of age or after 20 years of employment in both groups. Smoking was associated with RM among welders (OR = 1.48, 95% CI: 1.24-1.75) as well as nonwelders (OR = 2.83, 95% CI: 2.26-3.54). Work-related respiratory symptoms (WRRS) was not found to be related to RM (OR = 1.69, 95% CI: 1.00-2.84). Consistent use of personal protective equipment (PPE) was protective against RM in welders (OR = 0.33, 95% CI: 0.28-0.37). Conclusion: Welders had a greater burden of RM and this was related to increasing age, DOE, smoking and inconsistent use of PPE. WRRS were not indicative of RM.