Distribution and Determinants of Chronic Kidney Disease of Unknown Etiology: A Brief Overview.

Globally, 33187000 DALYs and 956000 deaths are attributed to chronic kidney disease (CKD) every year. Diabetes and hypertension are the two most common causes of CKD. Another category of CKD without any known common causes, chronic kidney disease of unknown etiology (CKDu) is also increasingly reported from different regions of the world such as Central America, Sri Lanka, and India. They are predominately observed in agricultural communities where crops such as sugarcane and coconut are commonly cultivated. Young adults and males are at higher risk of developing CKDu. It mainly affects individuals belonging to lower socioeconomic status. Exposure to silica, arsenic, and fluoride might be associated with increased prevalence of CKDu. The role of heat stress in contributing to CKD through dehydration is unclear but cannot be ruled out. Mycotoxins such as aflatoxins and ochratoxins are also found to be associated with CKDu in some settings. Several studies have reported that CKDu has a significant positive association with pesticides used in agriculture such as HCH, Endosulfan, Alachlor, and Pendimethalin. There is also a possible role of infections by Hantavirus and Leptospirosis in acute febrile phase of CKDu. However, there is no conclusive evidence from studies conducted on CKDu regarding its causes and risk factors. Therefore, large-scale studies with better methodology need to be conducted to study the etiology and pathogenesis of CKDu in various settings.

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.

Efficacy of behavior change communication using mobile calls on glycemic control among Type 2 diabetic patients in an urban area of Pondicherry, South India: A randomized controlled trial.

CONTEXT: Lifestyle modifications play a major role in controlling blood glucose levels among diabetes mellitus for the prevention of its complications. Mobile phones can be used as an efficient tool for improving the healthy lifestyle through health education. AIMS: The aim of the study is to measure the efficacy of behavior change communication using mobile calls in controlling blood sugar levels, increasing medication adherence, healthy diet, and physical activity among diabetic patients. SETTINGS AND DESIGN: A randomized controlled trial was conducted in an urban area of Pondicherry between 50 (25 per arm) type 2 diabetes patients. SUBJECTS AND METHODS: All participants were interviewed using a structured questionnaire. Fasting blood glucose (FBG) was measured. Single-time health education was given to both groups. The intervention group received a mobile phone calls reminders thrice weekly for 2 months. Changes in FBG, diet, physical activities, and adherence to medications were assessed after 2 months. STATISTICAL ANALYSIS USED: Means and proportions were calculated. Chi-square test and paired t-test were used to calculate the P value. RESULTS: FBG increased significantly in the control group by 25.6 mg/dl (P = 0.03), whereas it was only 6.5 mg/dl in the intervention group (P = 0.56). Adherence to medications was increased significantly in both interventions (+21%) and control (+19%) groups. Number of fruits intake days per week (+1, P = 0.01) and fruits serving per day (+0.5, P = 0.00) have increased significantly in the intervention group. Recreational physical activity was increased in the intervention group but not statistically significant. CONCLUSION: Our study findings suggest that mobile phone calls might help to improve glycemic control. It also suggests that it could improve the adherence to medications and intake of fruits. In the future, studies with large sample size and longer intervention need to be conducted.

Efficacy of Health Education using Facebook to Promote Healthy Lifestyle among Medical Students in Puducherry, India: A Non-Randomized Controlled Trial.

INTRODUCTION: Increasing burden of overweight and obesity among young adults is mainly due to unhealthy lifestyle especially with respect to diet and physical activity. At the same time, younger generations are spending more time with social network sites. Therefore, this study was intended to explore the role of social networking sites in promoting healthy lifestyle. AIM: To measure the efficacy of health education using social networking sites in promoting healthy lifestyle among medical students in Puducherry, India. MATERIALS AND METHODS: A non-randomized controlled trial was conducted in a private medical college located in Puducherry. The study participants were overweight/obese individuals with (intervention arm) and without Facebook account (control arm). Following a baseline survey, both the groups received health education from dietician and physical trainer using Audiovisual (AV) aids. Intervention group received health education through Facebook in the forms of messages, pictures and videos for six weeks. Then, follow up survey was done to assess the change in dietary pattern, physical activity and body weight. Data of those who attended baseline, intervention and follow up surveys (23- control and 22- intervention) were analysed. Means and proportions were calculated. Paired t-test and Chi-square test were used to calculate the p-value. The p-value<0.05 was considered as statistically significant. RESULTS: Mean number of days of junk food intake per week was reduced in both control and intervention groups from 2.91 days/week and 3.27 days/week at baseline to 2.65 days/week to two days/week at follow up respectively. A significant decrease in the Body Mass Index (BMI) (p<0.05) was found among the control group (baseline: 25.57, follow up: 25.15). No significant changes were found with respect to physical activity and intake of fruits and vegetables. CONCLUSION: Except for the decrease in junk food intake, use of Facebook as an effective tool to promote healthy lifestyle could not be proved with confidence.

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.

Prevalence of Hypertension Among School Children in a Rural Area of Tamil Nadu.

A cross-sectional study was conducted to measure the prevalence of hypertension among 310 rural school children in Tamil Nadu. The prevalence of hypertension and pre-hypertension was 10% and 14.2%, respectively. Prevalence was significantly higher among and private school students. We recommend that children should be screened for hypertension for early diagnosis and prevention of complications.

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 patient's 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.

Burden, distribution and impact of domestic accidents in a semi-urban area of coastal Tamil Nadu, India.

The objectives of this study are to determine the prevalence of domestic accidents, describe the factors associated with domestic accidents and assess the medical and economical consequences of domestic accidents. Community-based cross-sectional study was conducted in a semi-urban area of Tamil Nadu during February 2013. A total of 3947 study participants were interviewed using a structured questionnaire. Study variables included were socio-demography, housing conditions, epidemiological factors, medical and economical consequences of domestic accidents. Means and proportions were calculated. The prevalence of domestic accidents was 12.7%. Out of 500 domestic accidents, falls (54.4%) was the most common type of domestic accident. Females and the respondents in age group of 21-40 years were more commonly affected. About 60% of victims received treatment. Mean duration of hospital stay, mean amount of money spent for treatment and mean number of days away from routine work for falls category were 16 days, US$25 and 8 days, respectively, which are higher than other types of accidents. The burden and impact of domestic accidents was high. Therefore, in order to prevent and control domestic accidents, promotion of house safety measures and creation of awareness among the community using IEC programmes have to be undertaken.

ASHAs involvement in newborn care: a feasibility study.

We assessed the feasibility of involvement of Accredited Social Health Activist (ASHA) in newborn care. All the ASHAs (n = 33) of PHC Dayalpur, Faridabad district of Haryana were trained for one day which was followed by two refresher trainings. The mean (SD) knowledge score (out of 11) of ASHAs were 6.45 (2.44), 6.50 (2.01), 7.45 (1.36) and 7.15 (1.27) at pre-training, immediately after training, and after three and six months, respectively. Four fifth (83%) of the newborns born at home were weighed within 3 days of birth. About half (44%) of ASHAs weighed the neonates within ± 250 grams of the weight recorded by the author. We conclude that ASHAs could be involved in providing care for newborn. However, such efforts should ensure a stronger focus on skill development and practical experience.

Variability of soil-water quality due to Tsunami-2004 in the coastal belt of Nagapattinam district, Tamilnadu.

In this study, the Tsunami-caused deterioration of soil and groundwater quality in the agricultural fields of coastal Nagapattinam district of Tamilnadu state in India is presented by analyzing their salinity and sodicity parameters. To accomplish this, three sets of soil samples up to a depth of 30 cm from the land surface were collected for the first six months of the year 2005 from 28 locations and the ground water samples were monitored from seven existing dug wells and hand pumps covering the study region at intervals of 3 months. The EC and pH values of both the soil and ground water samples were estimated and the spatial and temporal variability mappings of these parameters were performed using the geostatistical analysis module of ArcGIS((R)). It was observed that the spherical semivariogram fitted well with the data set of both EC and pH and the generated kriged maps explained the spatial and temporal variability under different ranges of EC and pH values. Further, the recorded EC and pH data of soil and ground water during pre-Tsunami periods were compared with the collected data and generated variability soil maps of EC and pH of the post-Tsunami period. It was revealed from this analysis that the soil quality six months after the Tsunami was nearing the pre-Tsunami scenario (EC< 1.5 dS m(-1); pH<8), whereas the quality of ground water remained highly saline and unfit for irrigation and drinking. These observations were compared with the ground scenarios of the study region and possible causes for such changes and the remedial measures for taking up regular agricultural practices are also discussed.