A pilot study to evaluate home-based screening for the common non-communicable diseases by a dedicated cadre of community health workers in a rural setting in India.

BACKGROUND: Population-based screening for the common non-communicable diseases (NCD) is recommended but is difficult to implement in the hard-to-reach areas of low resourced countries. The objective of our pilot study was to evaluate the feasibility and the efficacy of delivering NCD screening services at home by trained community health workers (CHWs). Men and women aged 30-60 years residing in rural areas of India were targeted for screening. METHODS: The CHWs made home visits to educate the participants about healthy lifestyles and symptoms of common cancers and counsel the tobacco/alcohol users to quit. They measured height, weight, blood pressure (BP) and random blood sugar for all and performed oral visual examination (OVE) to screen the tobacco/alcohol users for oral cancer. For cervical cancer screening, the women themselves provided self-collected vaginal samples that the CHWs delivered to the laboratory for high-risk Human Papillomavirus (HPV) detection. The women were not screened for breast cancer but were made aware of the common symptoms and the importance of early diagnosis. Further assessment of the screen-positive individuals and the women with breast symptoms was arranged at the nearest primary health center (PHC). RESULTS: The CHWs screened 1998 men and 4997 women from 20 villages within 6 months; the refusal rate was less than 10%. High BP and sugar were detected in 32.6% and 7.5% participants respectively; hypertension and diabetes were confirmed in 42.3% and 35% respectively among those undergoing follow-up. Obesity prevalence was only 2.4%. More than 50% men were tobacco chewers. Of the total participants, 2.6% were positive on OVE, though no oral cancer was detected among them. HPV test was positive in 8.6% women and they were triaged with visual inspection after application of acetic acid (VIA) test for treatment either by thermal ablation (same visit) or by loop excision. VIA was positive in 14% of the HPV-positive women and 56.5% of them received same day ablative treatment. The VIA-negative women were advised follow up after 1 year. No breast cancer was detected among the 0.6% women complaining of breast symptoms. CONCLUSIONS: Delivery of NCD screening services at home by trained CHWs is feasible and well-accepted by our study population.

Correlation of Thyroid Function Test with Severity of Liver Dysfunction in Cirrhosis of Liver.

AIMS AND OBJECTIVES: To evaluate the Thyroid functions in patients with cirrhosis of liver and to assess the severity of liver dysfunction in relation with interpretation of thyroid functions. MATERIAL AND METHODS: The present study was undertaken at Maharana Bhupal Govt. Hospital, attached to R.N.T. Medical College, Udaipur (Raj.). Study included total 50 patients admitted at Maharana Bhupal Govt. Hospital, attached to R.N.T. Medical College Udaipur (Raj.) with clinical, biochemical, and radiological evidence of cirrhosis of liver. All patients were subjected to medical examination as per the fixed Performa. OBSERVATIONS AND CONCLUSION: Prevalence of subclinical hypothyroidism with cirrhosis was 62%. 31 out of 50 patients had subclinical hypothyroidism. The study showed that prevalence of hypothyroidism in cirrhosis patients increases as the severity of cirrhosis increases and findings were statistically significant (p value 0.00).This study found association between serum T3 and severity of liver disease. As the severity of cirrhosis increases which is indicated by Child Pugh A to C, serum level of T3 reduces and findings were statistically significant (p value 0.00).All 50 patients of cirrhosis had their serum T4 level within normal limit and it does not change with severity of liver disease. This study found association between serum FT4 and severity of liver disease. As the severity of cirrhosis increases which is indicated by Child Pugh A to C, serum level of FT4 fall in low-normal or below normal value and findings were statistically significant (p value 0.00). This study found association between serum FT3 and severity of liver disease. As the severity of cirrhosis increases which is indicated by Child Pugh A to C, serum level of FT3 reduces. All patients of Child Pugh C had low FT3 level and the findings were statistically significant (p value 0.00). This study showed that serum bilirubin, prothombin time, INR, TSH level increases and serum albumin level, T3, FT3, and FT4 level reduces as the severity of cirrhosis increases.According to this study all cirrhotic patients should undergo thyroid function evaluation as these patients are definitely associated with development of hypothyroidism. There is significant inverse correlation between serum level of T3, FT3, and FT4 with severity of cirrhosis. These parameters can be used as markers to indicate the severity of cirrhosis.

Study of Knowledge, Attitudes, and Practices Toward Risk Factors and Early Detection of Noncommunicable Diseases Among Rural Women in India.

PURPOSE: In recognition of the growing burden of noncommunicable diseases (NCDs), including cancer, we assessed the knowledge, attitudes, and practices of rural women in low-resourced countries toward common NCDs and the barriers they face in receiving NCD early detection services. PATIENTS AND METHODS: The study was conducted in a rural block of India using the Rapid Assessment and Response Evaluation ethnographic assessment, which included in-depth interviews of key health officials; focus group discussions with women, men, teachers, and health workers from the block; and a knowledge, attitudes, and practices questionnaire survey. The home-based survey was conducted among 1,192 women selected from 50 villages of the block using a two-stage randomization process and stratified to 30- to 44-year and 45- to 60-year age-groups. RESULTS: Our study revealed low awareness among women with regard to tobacco as a risk factor; hypertension, diabetes, and cancer as major health threats; and the importance of their early detection. Only 4.8% of women reported to have ever consumed tobacco, and many others consumed smokeless tobacco without knowing that the preparations contained tobacco. Only 27.3% and 11.5% of women had any knowledge about breast and cervical cancer, respectively, and only a few could describe at least one common symptom of either cancer. Self-reported diagnosis of hypertension and diabetes was significantly lower than the reported national prevalence. Only 0.9% and 1.3% of women reported having had a breast examination or gynecologic checkup, respectively, in the past 5 years. Low female empowerment and misconceptions were major barriers. CONCLUSION: Barriers need to be addressed to improve uptake of NCD early detection services.