Socioeconomic and Geographical Inequities in Burden and Treatment seeking Behavior for Hypertension among Women in the Reproductive Age (15-45 years) Group in India: Findings from a Nationally Representative Survey.

BACKGROUND: Socioeconomic disparity changed healthcare seeking and management cascade of hypertension due to inequity in hypertension care cascade pathway. OBJECTIVES: The inequities in burden and treatment-seeking behavior of hypertension among reproductive age group women were studied from National Family Health Survey-4 (NFHS-4) data. MATERIALS AND METHODS: We analyzed the data from NFHS-4 of women of reproductive age group between 15 and 49 years among the selected households contributing to 699,686 women. Socioeconomic inequities were assessed by expenditure quintile. Inequities in burden and treatment-seeking behavior were reported using the concentration curve and concentration index. RESULTS: The prevalence of hypertension in India was 15% (95% confidence interval: 14.9%-15.4%). One-third (32%) of the hypertensive population received treatment and only 28% of the women had controlled blood pressure. Wealth and education-based inequalities were more in high wealth index. The inequity in screening and awareness was in the northern and northeastern regions. CONCLUSION: There was inequity in the overall hypertension care cascade pathway with more inequity in the northern and northeastern region.

Men's involvement in women's reproductive health: A community-based mixed-method study.

BACKGROUND: Female dominion in family planning has underestimated men's participation in female reproductive health. OBJECTIVE: To assess male's involvement in female reproductive health with regard to safe motherhood and family planning and to explore the factors influencing the participation of males in reproductive and sexual health. METHODS: A community-based, mixed-method study was conducted from May 2018 to January 2019 in urban Puducherry. All eligible couples with at least one child were included. Two-stage random sampling with a sample size of 373 was considered. Data were collected separately among spouses using epi-collect 5 and analyzed using the SPSS software version 23. Qualitative data were obtained using free-listing and pile-sorting techniques, analyzed in Anthropac software. RESULTS: 39.9% had planned their pregnancy. Only 33.5% of couples had decided together with the place of delivery. 76.7% of wives wish to involve their husbands in family planning. 88.2% of wives and 89.8% of husbands chose tubectomy as the preferred method of permanent contraception. Both husband and wife were involved in child rearing among 60.3% of participants. The changing dynamics of society, health-care provider initiative, and literacy level favored males' involvement in females' reproductive health. CONCLUSION: Men were involved in planning the pregnancy, supporting their spouse by accompanying for antenatal checkups, discussing with their partners about the complications faced during pregnancy. Health care facility-related factors and faith were perceived as hindering factors for males' involvement in reproductive health by either gender.

Magnitude and Determinants of Patients at Risk of Developing Obstructive Sleep Apnea in a Non-Communicable Disease Clinic.

Background and Objective: Obstructive sleep apnea (OSA) is a common chronic disorder worldwide, which can adversely affect the cardiovascular system among non-communicable disease (NCD) patients. It is underdiagnosed-or rather not diagnosed-in primary care settings due to the costly diagnostic techniques involved. This study aimed to assess the number of study participants at risk of developing OSA and to assess and quantify the risk factors associated with this disorder. Materials and Methods: A cross-sectional study was performed in an NCD clinic of a rural health training center, Karikalampakkam, Puducherry of South India from August 2018 to October 2018. A Modified Berlin Questionnaire (MBQ) was used to screen the study participants at risk for OSA. Four-hundred-and-seventy-three people aged 18 years and above were included in the study, using systematic random sampling. Respondents' socio-demographic and morbidity characteristics, as well as clinical and anthropometric parameters including body weight, height, blood pressure, neck, hip and waist circumference were collected. Data was captured using Epicollect5 and analyzed using SPSS version 20.0. Results: One-fourth (25.8%) of the respondents were at high risk of developing OSA. In terms of gender, 27.9% of the men and 23.8% of the women were at high risk for OSA. In univariate analyses, the risk of developing OSA was significantly associated with a history of diabetes mellitus, hypertension, dyslipidemia and gastro-esophageal reflux disease, weight, body mass index, neck, waist and hip circumference, waist-hip ratio, and systolic and diastolic blood pressure. Multivariate logistic regression analysis showed that a history of dyslipidemia (aOR, 95% CI = 2.34, 1.22-4.48), body mass index (aOR, 95% CI = 1.15, 1.06-1.22) and waist circumference (aOR, 95% CI = 1.10, 1.07-1.14) emerged as significant predictors of risk for OSA. Conclusions: A considerable proportion of NCD patients with easily detectable attributes are at risk of developing OSA, but still remain undiagnosed at a primary health care setting. The results obtained using MBQ in this study were comparable to studies performed using polysomnography. Dyslipidemia, body mass index and waist circumference were independent risk factors for predicting a risk of developing OSA. Prospective studies are needed to confirm whether a reduction in these risk factors could reduce the risk for OSA.

Childhood Experiences of Physical, Emotional and Sexual Abuse among College Students in South India.

OBJECTIVES: To document the prevalence of physical, emotional and sexual abuse during childhood among college students. METHODS: The study was conducted among college students of Puducherry, South India. Stratified random sampling was done to select colleges. Data were gathered using the adapted 'Ministry of Women and Child Development Questionnaire on Child Abuse for Young adults'. RESULTS: A total of 936 college students completed the questionnaire. Mean ± SD age of the participants was 19.2 ± 1.1 years. Half (48%) of the participants reported being mocked because of their physical appearance. In all, 56% (524/936) of the participants reported that they were beaten during their childhood, of which 13.4% (70/524) required medical treatment. Around 10% reported someone exposing his/her private parts to them, while in 6.4% of the cases, the perpetrator forced the study participants to expose their private parts. CONCLUSIONS: Emotional, physical and sexual abuse is common in childhood and demands prompt interventions at the familial, community and political levels.

Active Screening for Pulmonary Tuberculosis Among Jail Inmates: A Mixed Method Study From Puducherry, South India.

BACKGROUND: Sustainable Development Goal 3 (SDG) aims to end the epidemic of TB by 2030. To achieve this goal, active screening should be initiated in the target populations. These target populations are those without access to proper healthcare like jail inmates. With pulmonary tuberculosis (PTB) being cosmopolitan in India, passive case finding alone cannot suffice to achieve the above-mentioned goal. Thus, active case finding (ACF) becomes the need of the hour. So, we aimed to conduct a mixed methods study that has a quantitative component, i.e., to actively screen the prison inmates for PTB, and a qualitative component, i.e., to know the perceptions of jail inmates towards PTB and the stigmas associated with it. METHODOLOGY: This was a mixed-method study conducted in the Central Jail, Puducherry. The quantitative component involved a facility-based cross-sectional study design and the qualitative component involved a focused group discussion (FGD). Participants were screened for PTB and diabetes mellitus (DM) and their anthropometry (weight, height, body mass index {BMI}, waist-to-hip ratio {WHR}) was noted. Presumptive cases were identified as those with symptoms of cough for more than two weeks with or without other concomitant symptoms. They were subjected to cartridge-based nucleic acid amplification test (CB-NAAT) assay. Data were entered in MS Excel 2017 and analyzed using SPSS version 16 (Armonk, NY: IBM Corp). For the qualitative exercise, purposive sampling with maximum variation technique was done to enroll a diverse subset of population for the FGD. Iterative analysis of the content was performed by the team to generate codes and themes. RESULTS: Out of all the 187 inmates screened, 10.7% were symptomatic. On CB-NAAT examination of the symptomatic inmates, none turned positive. The inmates with presumptive TB were older by age and had a higher proportion of illiteracy and existing co-morbidity (p≤0.05). While random blood sugar (RBS) levels of >140 mg/dL were recorded in 19.7% of inmates, RBS levels of >200 mg/dL considered diagnostic were noted in 5.34% of inmates. A total of 2.67% of the inmates were newly diagnosed with diabetes mellitus. The further management of the newly diagnosed inmates was taken over by the medical supervision team of the Central Jail. From the FGD, thematic manual content analysis was performed. A total of 24 codes were generated. After merging similar codes and removing duplications, the remaining 16 codes were grouped into six broad themes. Conclusions were drawn by interpretation of these themes. CONCLUSION: ACF is important as it is associated with early detection and treatment. It must be done periodically. During the FGD, we came across negative ideologies and stigmas associated with PTB among jail inmates. We used the same platform to clear those ideologies and recommend frequent health education exercises even in socially ostracized communities like jail inmates.

Assessment of mental health status among adolescents in Puducherry, India - A mixed method study.

Context: Adolescence is a crucial period during which biological and psychosocial changes occur in an individual. The prevalence of mental disorders among Indian adolescents was 7.3%. Early recognition and intervention will help to have favorable outcomes. Aims: To determine and compare the prevalence and risk factors associated with mental health illness among urban and rural adolescents in Puducherry. Methods and Material: An explanatory mixed-method design wherein the quantitative phase (an analytical cross-sectional study) was followed by qualitative phase (focus group discussion). Adolescents aged 13-17 years attending Government schools in urban and rural Puducherry were selected by stratified random sampling. Mental health status was screened using a validated Youth Report Measures for Children and Adolescents - SDQ and students with higher score were considered to be at risk of mental health illness. Results: Among 329 adolescent, 25.5% are found to be at risk of mental health illness. The mean total score and sub-domain scores of hyperactivity and emotional symptoms were found to be significantly higher in urban when compared to rural. Among those at risk of mental health illness, significant difference between urban and rural area was seen with respect to variables like family monthly income and parent's occupation. Behaviour change and deterioration in academic performance were the most common presentation as perceived by the teachers. Conclusions: One fourth of the adolescents were found to be at risk of mental health illness, so periodic screening could be done at schools, for early identification and proper treatment of mental disorders.

Sensitizing the medical undergraduates to qualitative research: In the context of experiential learning debriefings.

BACKGROUND: The role of medical undergraduates is limited while interacting with the community related to issues involving human behavior. Since qualitative research seeks to build a holistic understanding of social phenomena, we designed this project to expose them to the basics of qualitative research in a real-world setting of experiential learning. The aim of this study is to sensitize the medical undergraduates to the basics of qualitative research and able to apply it in the context of experiential learning in the community. MATERIALS AND METHODS: In this current educational intervention, a structured teaching program was designed and applied for the first time, to our students to effectively sensitize them to qualitative research in a natural community setting, intended to provide them a solid base for experiential learning. A batch of students (n = 50) was selected by convenient sampling method who had their clinical postings with us. At first, a "session planning guide" was drawn on the plan of conduction of this program. We followed the "facilitators reference manual by research consortium on educational outcomes and poverty (RECOUP) for our teaching sessions. The framework of our study was executed in the following sequence: sensitization of the learners, exposure to structured quality experience, systematic debriefing sessions with evaluation of learner experiences, and the process and outcome feedbacks from the learners. The students were monitored by trained facilitators. The various study tools used in the structured teaching program included, the teaching sessions using the RECOUP manual, didactic lectures and short group interactive sessions to teach qualitative research and photographs and video clips to facilitate the sessions, mock demonstrations and role plays on interviewing techniques, use of case vignettes on the theme "perception of psychosis" for interviewing the community, structured debriefing guide, and various self-reflective exercises. Learners' perspective of community perception, debriefing sessions, and self-reflective responses were transcribed, and manual content analysis was done to identify the codes and interpret the results. RESULTS: Majority could appreciate the uniqueness of qualitative research over the quantitative counterpart. They could enumerate the attributes of a good qualitative researcher. The debriefing exercises made them summarize their experiences and the self-reflective exercises enabled them to identify their abilities and critique their ideas. It was a different experience to our learners as they could identify themselves with the sentiments of the community. To them, the facilitating points were the interviewing skills and confidence gained in facing the community. However, they felt time constraint for exploring the sensitive issues during the fixed posting schedule. CONCLUSIONS: The experience of learning beyond the boundaries of a classroom setting sensitized them to various community perceptions and reactions. The students perceived the qualitative methods well and could apply the lessons learnt in the facility. They also felt that this learning exposure gave them community orientation and confidence in dealing with community issues.

Cognitive Impairment Among Older Adults With Diabetes Mellitus in Puducherry: A Community-Based Cross-Sectional Study.

Background Cognitive impairment is a global public health problem in the elderly population. There is increasing evidence that diabetes mellitus predisposes to cognitive impairment. Early diagnosis and management of cognitive impairment can delay the onset of dementia, thereby improving self-care and quality of life of diabetic patients. This study intends to assess cognitive impairment, and the factors influencing cognitive impairment among older adults with diabetes mellitus in Puducherry. Methods A community-based cross-sectional study was conducted in field practice areas of a Government Medical College in Puducherry between April and June 2019. After obtaining ethical approval, 240 registered diabetic patients aged 55 years and above were randomly selected. Data on demographic profile and clinical variables were collected using a semi-structured questionnaire. Cognitive function was assessed using the Hindi Mental State Examination (HMSE) tool, and participants who scored below 26 were considered to have cognitive impairment. Results Among 240 participants, 67.9% were aged 60 years and above, 62.5% were females, and 83.8% were unemployed. The proportion of cognitive impairment among older adults with diabetes was 30.0% (95% confidence interval (CI): 24.5-36.03). The mean ± standard deviation of the HMSE Score was 26.13 ± 3.8, and the median score was 27. Female gender (P= 0.02, adjusted prevalence ratio (aPR) = 5.31, 95% CI: 1.34-21), widowhood status (P= 0.005, aPR= 2.71, 95% CI: 1.34-5.46), illiteracy (P<0.001, aPR= 3.55, 95% CI: 1.78-7.07), and presence of probable symptomatic hypoglycemia (P=0.02, aPR= 2.18, 95% CI: 1.13-4.20) were significant predictors of cognitive impairment in the study population by multivariate analysis. Conclusion Almost one-third of older adults with diabetes were found to be at risk of cognitive impairment. Older diabetic patients with identified risk factors may be prioritized for a screening of cognitive impairment at the primary care level.

Prevalence and Determinants of Peripheral Neuropathy Among Adult Type II Diabetes Mellitus Patients Attending a Non-communicable Disease Clinic in Rural South India.

Background Diabetic peripheral neuropathy (DPN) is one of the most common microvascular complications of diabetes. Almost half of the diabetic patients develop foot ulcer as a complication of DPN during their lifetime. The aim was to estimate the prevalence and identify the risk factors of diabetic peripheral neuropathy among adult diabetes mellitus (DM) patients. Methods A cross-sectional study was conducted among 421 type 2 DM patients attending Non-Communicable Disease (NCD) clinic in rural Puducherry through systematic random sampling. The study instruments used for data collection were a pre-tested semi-structured questionnaire, Michigan Neuropathy Screening Instrument (MNSI), Morisky Green Levine Scale (MGLS), physical measurements and recent laboratory results. The data was captured using Epicollect5 and analyzed using SPSS version 20. Results The prevalence of DPN was 31.1% (95% confidence interval (CI): 27.1%-35.1%). The mean age, duration of diabetes, and duration of foot symptoms were 57.91±10.61, 7.00±6.23, 5.56±5.26 years. Smoking (adjusted odds ratio (AOR) 3.14; 95% CI 1.73-5.69), mean duration of diabetes>5years (AOR 2.74; 95% CI 1.71-4.40), hyperglycemic status(>200mg/dl) (AOR 2.24; 95% CI 1.08-4.64) and unemployment (AOR 2.05; 95% CI 1.11-3.76) were found to be statistically significant determinants of DPN on binary logistic regression analysis. Conclusions A considerable proportion of diabetics are at risk of developing DPN among rural DM patients. More diligent screening in a primary health care setting and addressing the modifiable risk factors like smoking, obesity, physical inactivity, and uncontrolled hyperglycemia will delay or hamper DPN development among diabetic patients.

Identifying and Addressing Factors Contributing to Pretreatment Loss to Follow-Up of Tuberculosis Patients Referred for Treatment from Medical Colleges in Pondicherry: An Implementation Research.

BACKGROUND: In India, there is no feedback regarding 34% of tuberculosis (TB) patients diagnosed and referred from medical colleges for treatment to peripheral health institutions (PHIs). OBJECTIVES: The aim of this study is to measure the effectiveness of the new intervention package, developed based on qualitative study in reducing pretreatment loss to follow-up (PTLFU) of all TB patients diagnosed and referred for treatment from medical colleges to PHIs. MATERIALS AND METHODS: An intervention was developed based on the findings of in depth-interviews conducted among different stakeholders such as TB patients who did/did not report, service providers working in four medical colleges in Pondicherry. Intervention consisting of phone calls, home visits, etc., was implemented for a period of 6 months. The baseline and endline proportion of TB patients for whom feedback received was determined from the available records (Revised National TB Control Program State Task Force Quarterly reports). RESULTS: Patient's ignorance, lack of faith in healthcare system, side effects and social stigma, unpleasant experience in hospitals, poor accessibility to directly observed treatment, short-course centers, drugs shortage, poor coordination between program and hospital staff were the risk factors for PTLFU. At baseline, the proportions of feedback received about TB patients referred for treatment from medical colleges to PHIs was 46%. After the initiation of interventions, it increased to 61% and 66% in the first and second quarters of 2017, respectively. CONCLUSION: Risk factors for PTLFU were multi-factorial related to both patient and health system. Simple, feasible interventions such as phone calls and home visits to TB patients were effective in reducing PTLFU.

Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India.

BACKGROUND: The average expenditure incurred by patients in low- and middle-income countries towards diagnosis and treatment of TB ranges from $55 to $8198. This out-of-pocket expenditure leads to impoverishment of households. One of the three main targets of the End TB Strategy (2016-2035) is that no TB-affected household suffers catastrophic costs due to TB. Study setting was free care under national tuberculosis program (NTP), Puducherry district, India. OBJECTIVES: The objectives of the study were among the newly diagnosed and previously treated tuberculosis (TB) patients, to (a) estimate patient costs during diagnosis and intensive phase of treatment, (b) determine the proportion of households experiencing catastrophic costs, and (c) explore coping strategies. METHODS: An explanatory mixed methods design comprising both quantitative cost description and qualitative descriptive component was used. Catastrophic cost was defined as total TB care costs exceeding 20% of annual household income. RESULTS: Of 102 TB patients included, two-thirds (69%) were male, 6% were HIV positive, and 45% reported at least one episode of hospitalization for TB care. The median (IQR) total cost of TB care was US$195 (52.1, 492.9) with a direct cost of US$65.3 (22.3, 156.5) and indirect cost of US$50.2 (0.9, 295.1). Overall, 32.4% of households experienced catastrophic costs due to TB care, significantly higher in patients with HIV coinfection (p = 0.009) and hospitalization (p = 0.009). Pledging jewels and borrowing money were major coping strategies. Cash assistance was the expected remedy from the patient perspective. CONCLUSION: Despite free TB care under NTP, more than a third incurred catastrophic costs towards TB care.

A descriptive cross-sectional study on menstrual hygiene and perceived reproductive morbidity among adolescent girls in a union territory, India.

INTRODUCTION: Menstruation is a milestone event in a girl's life and the beginning of reproductive life. Lack of knowledge and poor sanitary practices during menstruation has been associated with serious ill-health ranging from genital tract infections, urinary tract infections, and bad odor. AIM: This study aims to explore the knowledge, attitude, and practices about menstrual hygiene and perceived reproductive morbidity among adolescent school girls in Puducherry. MATERIALS AND METHODS: A school based cross-sectional study was conducted from June 2015 to July 2015 in Puducherry among 242 adolescent school girls in the age group of 12-18 years using multistage random sampling technique. Data were collected using a predesigned pretested, structured proforma by personal interview method after having informed written consent. RESULTS: The mean age for menarche was 12.99 ± 0.9 years; 51.7% of respondents were not aware of menstruation before attaining menarche; 71.5% and 61.2% were not known about the cause and source of the menstrual bleeding, respectively; 78.1% used only sanitary pads whereas 21.9% used both old clothes and sanitary pads as the absorbents. Unsatisfactory cleaning of the external genitalia was practiced by 12% of respondents. Higher prevalence of dysmenorrhea (82.2%) was mentioned by the respondents; 25.2% reported excessive genital discharge. Statistically significant association was found between perceived reproductive morbidity and poor menstrual hygiene practices. About 88.4% of the study population reported any one of the reproductive morbidity, and only 37.4% sought for medical treatment from a health facility. CONCLUSION: The present study has underscored the necessity of adolescent girls to have adequate and precise knowledge about menstruation before menarche. Proper menstrual hygiene practices which could be imparted through appropriate interventions at earlier stages of life can prevent the girls and women from suffering reproductive morbidities.

A case-control study on environmental and biological risk factors for renal calculi persisting in a coastal Union Territory, India.

BACKGROUND AND OBJECTIVES: Renal stone disease is a common disorder of the urinary tract and also a significant problem because of incidence, recurrence, and severe consequences. The complex pathogenetic mechanisms of renal stone formation involve both biologic and environmental risk factors. The present study was performed to identify the role of these parameters among renal stone patients and normal individuals from a coastal union territory region in South India. METHODS: The authors conducted a case-control study of renal stone disease among outpatient department patients more than 30 years of age using systematic random sampling procedure with 100 study participants (50 subjects for each group). A questionnaire to explore some relevant history as well as to note general examination findings was used along with a house visit to collect a sample of water. Analysis was undertaken using appropriate statistical techniques. RESULTS: The study showed statistically significant association for renal stones with female sex, illiteracy, body mass index (BMI) (>25 kg/m2), sodium (>50 mg/L), water consumption (<1.5 L/day), water source being borewell, consuming soft drink, sedentary work, and family history of renal stones. The adjusted odds ratios (ORs) were significantly higher for consuming soft drink (OR: 8.19; 95% confidence interval: 1.99-33.69), sedentary work (10.01; 1.27-78.91), and water consumption < 1.5 L/day (7.73; 2.24-26.69). INTERPRETATION AND CONCLUSIONS: We conclude that in this part of India, female gender, illiteracy, high BMI, high sodium in drinking water, inadequate water consumption, borewell drinking water, soft-drink consumption, sedentary work, and family history of renal stones can lead to a significant increase in the risk of renal stone disease.

Effect of mobile reminders on screening yield during opportunistic screening for type 2 diabetes mellitus in a primary health care setting: A randomized trial.

Objective. We wanted to study whether mobile reminders increased follow-up for definitive tests resulting in higher screening yield during opportunistic screening for diabetes. Methods. This was a facility-based parallel randomized controlled trial during routine outpatient department hours in a primary health care setting in Puducherry, India (2014). We offered random blood glucose testing to non-pregnant non-diabetes adults with age >30 years (667 total, 390 consented); eligible outpatients (random blood glucose ≥ 6.1 mmol/l, n = 268) were requested to follow-up for definitive tests (fasting and postprandial blood glucose). Eligible outpatients either received (intervention arm, n = 133) or did not receive mobile reminder (control arm, n = 135) to follow-up for definitive tests. We measured capillary blood glucose using a glucometer to make epidemiological diagnosis of diabetes. The trial was registered with Clinical Trial Registry of India (CTRI/2014/10/005138). Results. 85.7% of outpatients in intervention arm returned for definitive test when compared to 53.3% in control arm [Relative Risk = 1.61, (0.95 Confidence Interval - 1.35, 1.91)]. Screening yield in intervention and control arm was 18.6% and 10.2% respectively. Etiologic fraction was 45.2% and number needed to screen was 11.9. Conclusion. In countries like India, which is emerging as the diabetes capital of the world, considering the wide prevalent use of mobile phones, and real life resource limited settings in which this study was carried out, mobile reminders during opportunistic screening in primary health care setting improve screening yield of diabetes.

Smear Conversion, Treatment Outcomes and the Time of Default in Registered Tuberculosis Patients on RNTCP DOTS in Puducherry, Southern India.

BACKGROUND: Revised National Tuberculosis Control Programme (RNTCP) in India has achieved improved cure rates. OBJECTIVES: This study describes the achievements under RNTCP in terms of conversion rates, treatment outcomes and pattern of time of default in patients on directly observed short-course treatment for Tuberculosis in Puducherry, Southern India. SETTINGS: Retrospective cohort study; Tuberculosis Unit in District Tuberculosis Centre, Puducherry, India. MATERIALS AND METHODS: Cohort analysis of patients of registered at the Tuberculosis Unit during 1(st) and 2(nd) quarter of the year 2011. Details about sputum conversion, treatment outcome and time of default were obtained from the tuberculosis register. STATISTICAL ANALYSIS: Kaplan-Meier plots & log rank tests. RESULTS: RNTCP targets with respect to success rate (85.7%), death rate (2.7%) and failure rate (2.1%) in new cases have been achieved but the sputum conversion rate (88%) and default rate (5.9%) targets have not been achieved. The overall default rate for all registered TB patients was 7.4%; significantly higher in category II. In retreatment cases registered as treatment after default, the default rate was high (9%). The cumulative default rate; though similar in the initial two months of treatment; was consistently higher in category II as compared to that in category I. Nearly 40% of all defaulters interrupted treatment between the second and fourth month after treatment initiation. CONCLUSION: Defaulting from treatment is more common among the retreatment cases and usually occurs during the transition phase from intensive phase to continuation phase.

Prevalence of Diabetes Mellitus among Tuberculosis Patients in Urban Puducherry.

BACKGROUND: Diabetes and Tuberculosis often present together and complicate each other at many levels. A collaborative framework for care and control of diabetes and tuberculosis developed by World Health Organisation and International Union against Tuberculosis and Lung Diseases emphasizes routine bi-directional screening for the two diseases. AIMS: The study was to assess the prevalence of diabetes in tuberculosis patients currently on treatment. MATERIALS AND METHODS: This facility-based cross-sectional study was undertaken in four randomly selected peripheral health institutions providing directly observed treatment short-course, treatment for tuberculosis patients. All cases of tuberculosis, more than 18 years of age were screened for diabetes. Risk factors like age, sex, family history of diabetes, alcohol, smoking and obesity were assessed. RESULTS: The prevalence of diabetes in tuberculosis patients was found to be 29% (known diabetics - 20.7%, new Diabetes cases - 8.3%). Diabetes was significantly associated with older age, family history of diabetes, consumption of alcohol and sputum positivity. CONCLUSIONS: Screening patients with Tuberculosis for fasting blood sugar estimation will help in early detection of diabetes.

Effect of exercise intensity on lipid profile in sedentary obese adults.

BACKGROUND: Exercise is a lifestyle change that has been recommended for lowering atherogenic index in adults. The intensity and duration of exercise to bring about a change in the lipid parameters are yet to be determined. Previous studies examining the effects of exercise intensity on lipid and lipoprotein levels have reported conflicting findings. Thus we aimed at determining the changes in lipid profile in sedentary obese adults influenced by different intensity of exercise. METHODOLOGY: Study included 51 obese adults with sedentary lifestyle. Participants performed exercise of moderate intensity (n=22) and high intermittent intensity (n=29) for a duration of 40min/day for 5 days/week and 20 min/day for 3 days/week respectively on bicycle ergometer for a period of 15 weeks. OUTCOME MEASURES: Pretesting and post testing included measurement of height, weight, blood pressure and lipid profile. STATISTICAL ANALYSIS: RESULTS were analysed using the Paired and Unpaired samples t-test. RESULTS: Postexercise revealed significant reduction in the LDL-C and diastolic blood pressure (p<0.05) with the high intensity exercise group.There was a significant difference in BMI, lipid profile and blood pressure in both the moderate and high intensity exercise group. CONCLUSION: This study suggests that exercise is "elixir" for a healthy life. High intermittent intensity can be considered for individuals who have time constraints and lead a sedentary life style and moderate intensity exercise advised for individuals who are willing to create time for their health benefits. A programmed protocol of exercise will help in reduction of lipid parameters.

Level of awareness about tuberculosis in urban slums: Implications for advocacy and communication strategy planning in the National program.

BACKGROUND: Tuberculosis (TB) remains as an important public health problem in India. Awareness about the disease, its diagnosis, and treatment among public will help in controlling the killer disease. This study aims at arriving at an educational diagnosis about TB in an urban poor community. MATERIALS AND METHODS: A cross-sectional study was conducted in an urban slum in South India using a structured, pretested questionnaire. Domains identified were knowledge about TB, symptoms, spread, diagnosis, treatment, and prevention of TB. RESULTS: A total of 395 households were interviewed. Of them, 370 (94%) respondents had heard about TB. Regarding the symptoms of TB, 82% were aware that cough is a symptom of TB. Among the 79% of study subjects who reported any test to diagnose TB, sputum examination as a method of diagnosis was known to only 40%. However, 84% of the subjects were aware of the free treatment available for TB under National program. CONCLUSION: Level of awareness about TB among urban poor in a slum area is good. Knowledge about "free treatment" and "duration of treatment" has to be stressed during health education activities.

Effect of iron and zinc deficiency on short term memory in children.

OBJECTIVE: To evaluate the effect of iron and zinc deficiency on short term memory of children in the age group of 6-11 years and to assess the response to supplementation therapy. DESIGN: Interventional study. SETTING: 100 children in the age group of 6-11 years (subdivided into 6-8 yr and 9-11 yr groups) from an urban corporation school. METHODS: After collection of demographic data, the study children underwent hematological assessment which included serum iron, serum zinc, and hemoglobin estimation. Based on the results, they were divided into Iron deficient, Zinc deficient, and Combined deficiency groups. Verbal and nonverbal memory assessment was done in all the children. INTERVENTION: Iron (2mg/kg bodyweight in two divided doses) and zinc (5mg once-a-day) supplementation for a period of 3 months for children in the deficient group. RESULTS: All children with iron and zinc deficiency in both the age groups had memory deficits. Combined deficiency in 9-11 years group showed severe degree of affectation in verbal (P<0.01) and non-verbal memory (P<0.01), and improved after supplementation (P = 0.05 and P< 0.01, respectively). In 6-8 years group, only non-verbal form of memory (P =0.02) was affected, which improved after supplementation. CONCLUSION: Iron and zinc deficiency is associated with memory deficits in children. There is a marked improvement in memory after supplementation. Post supplementation IQ scores do not show significant improvement in deficient groups in 6-8 year olds.