Time to Switch to 'Rule of Three-Quarters' from 'Rule of Halves' in Hypertension? A Descriptive Study from Dakshina Kannada, South India.

Background 'Rule of halves' depicts the overall picture of hypertension that prevails in a community. This study was taken up to understand if the traditional 'rule of halves' of hypertension still prevails or is it time to shift to the proposed 'rule of three-quarters'. The objectives of the study were: to estimate (i) the prevalence of hypertension among adult residents of Madani Nagar rural community in the Dakshina Kannada district of Karnataka state in southern India, (ii) the proportion who are aware of their disease among hypertensive patients, (iii) the proportion who are on treatment among those who are aware of their disease, and (iv) the proportion having adequate blood pressure control among those on treatment. Materials and methods This was a cross-sectional study carried out in Madani Nagar, Dakshina Kannada from February to April 2020. Complete enumeration method was followed and all adults aged ≥ 18 years who consented were included in the study. Data collection was done using a pre-validated questionnaire and blood pressure was recorded as per World Health Organization guidelines. Results A total of 661 individuals were enrolled in the study. The prevalence of hypertension was 29.2%. Only 55.4% of hypertensive patients were aware that they had the disease, and among them, 96.3% were on treatment. Among those on treatment, 58.3% had adequate control of blood pressure. Conclusion The hypertension pattern of the community leans more towards the traditional 'rule of halves' of hypertension and it is still a long way ahead until the proposed 'rule of three-quarters' can be achieved.

Opportunistic screening for diabetes mellitus and hypertension in primary care settings in Karnataka, India: a few steps forward but still some way to go.

Background: Opportunistic screening for individuals aged ≥30 years at all levels of healthcare for early detection of diabetes mellitus (DM) and hypertension (HTN) is an integral strategy under the national program to control non-communicable diseases. There has been no systematic assessment of the screening process in primary care settings since its launch. The objective was to determine the number and proportion eligible for screening, number screened, diagnosed and treated for DM and HTN among persons aged ≥30 years in two selected primary health centres (PHCs) in Dakshina Kannada district, Karnataka, India during March-May 2019 and to explore the enablers and barriers in the implementation of screening from the perspective of the health care providers (HCPs) and beneficiaries . Methods: This was a sequential explanatory mixed-methods study with a quantitative (cohort design) and a descriptive qualitative component (in-depth interviews and focus group discussions) with HCPs and persons seeking care. Those that were not known DM/HTN and not screened for DM/HTN in one year were used to estimate persons eligible for screening. Results: Of 2697 persons, 512 (19%) were eligible for DM screening, 401 (78%) were screened; 88/401 (22%) were diagnosed and 67/88 (76%) were initiated on treatment. Of 2697, 337 (13%) were eligible for HTN screening, 327 (97%) were screened, 55 (17%) were diagnosed with HTN; of those diagnosed, 44/55 (80%) were initiated on treatment.  The documentation changes helped in identifying the eligible population. Patient willingness to undergo screening and recognition of relevance of screening were screening enablers.  Overworked staff, logistical and documentation issues, inadequate training were the barriers. Conclusion: Nearly 19% were eligible for DM screening and 13% were eligible for HTN screening. The yield of screening was high. We noted several enablers and barriers. The barriers require urgent attention to reduce the gaps in delivery and uptake of services.

Epidemiological profile and mapping geographical distribution of road traffic accidents reported to a tertiary care hospital, Mangaluru using quantum geographic information system (QGIS).

BACKGROUND: The worldwide annual average of road traffic accident (RTA) is approximately 7,00,000 and out of that 10% occur in India. It is estimated that in India, by 2020 RTA would have its fatal effect on about 5,50,000 people annually. This study was conducted to describe the epidemiological profile and spatial distribution of RTAs using quantum geographic information system (QGIS) software reported to a tertiary care hospital in Mangaluru. METHODS: It was a record based descriptive study conducted in a tertiary care hospital of Mangaluru. The complete enumeration of all RTAs reported to Yenepoya Medical College Hospital (YMCH) during January 2018 to June 2018 was followed. QGIS software was used to depict spatial distribution of the road traffic accident on open street map. RESULTS: A total of 180 cases of RTA was reported to the hospital during the study period, of which 86.1% were males. The mean age of the study participants was 33.99 years. The lower limb was the most common site of injury (48.3%) and fractures were the most common type of injury (55.6%). As per the type of RTA majority (55.6%) was motorbike accidents and drivers (47.8%) were the most common RTA victims. Predominantly RTAs occurred during evening hours of the day (40%). QGIS plotting revealed clustering of RTAs in Dakshina Kannada district, North Karnataka and neighboring districts of Kerala. CONCLUSION: QGIS can be used at the health care system level as an important tool to plan preventive measures and early intervention measures at the site of RTA.