Psychiatric morbidity among elderly in Chandigarh.

OBJECTIVE: To find out the prevalence of Psychiatric Morbidity Among Elderly in the age-group of 65 years and above. METHODOLOGY: This community based study was conducted by house to house visit after selecting a sample by stratified random technique from the 47 sectors in urban areas and 27 villages in Chandigarh. A total of 250 households in urban and 50 households in rural areas were covered which consisted of 362 elderly (313 urban and 49 rural) who were enrolled and psychiatric morbidity was assessed by using R Kellner & B F Shaffield (1979) scale. RESULTS: All study subjects had at least one symptom related to psychiatric morbidity. Over two-third elderly were having somatic (72.1%) and depression (68.2%) related symptoms of anger - hostility, cognition and anxiety. Paranoid and psychotic symptoms were noticed among 6.9% and 6.6% of elderly, respectively. Anxiety, depression, somatic, cognitive symptoms were more prevalent in females while anger hostility was more common in males. Some of the common symptom from each of the 7 groups were : Anxiety : Nervousness (37.3%), Depression : Feeling tired lack of energy (57.2%), Somatic : Irritable (48.3%), Anger Hostility: Angry (55.8%), Cognitive : Poor memory (45.6%), Paranoid : Feeling that people do not like you (7.5%) and Psychotic : Strange experiences which other people do not have (4.4%). CONCLUSION: Prevalence of high morbidity related to psychiatric symptoms among elderly in Chandigarh, India highlights the significance and need to develop comprehensive mental health care program for elderly.

Impact of mass supplementation of vitamin A.

OBJECTIVE: To study the impact of mass supplementation of Vitamin A solution on morbidity due to diarrhea, Acute respiratory infection (ARI) and xerophthalmia. METHODS: The two rounds of age specific mass distribution of Vitamin A solution were undertaken during January 2000 and December 2000 respectively covering 27,642 (98.7%) and 31,762 (88.0%) children respectively out of total beneficiaries in two round of PPI in Chandigarh. A random sample of 276 children from intervention area and 252 children from control area in the age group of 1-5 yr were followed up on monthly basis for morbidity pattern for a period of nine mth. The morbidity pattern for intervention and control area children was compared to see the impact of mass supplementation of Vitamin A solution. RESULTS: The average annual episodes of diarrhea in intervention children were lower (3.9 per yr) as compared to control children (5.2 per yr) although difference was not statistically significant (P>0.05) except in initial month. The average annual episodes of ARI in intervention children were lower (5.1 per yr) as compared to Control children (6.0 per yr) although difference was not significant (P>0.05) except in initial first mth. There was significant decline in vitamin A deficiency (VAD) as no case of Bitot's spot was found in intervention children as compared to control children where the prevalence of Bitot's spot ranged from 4.3-5.08% during different visits. The mortality rate was found to be higher in control children with a death rate of 8 per 1000 children during the study period as compared to intervention children where no death was recorded. CONCLUSION: It is concluded that mass supplementation of vitamin A led to significant reduction in xerophthalmia and decline in mortality in the intervention area as compared to control area.

Validity of verbal autopsy in determining causes of adult deaths.

A verbal autopsy (VA) questionnaire, which had an open-ended description of the deceased's illness followed by a series of close-ended questions on specific symptoms and signs, was used by three trained field workers to interview relatives of the deceased who had died in a Chandigarh hospital in previous year. The sensitivity and specificity of the cause of death assigned by physician from the verbal autopsy was calculated against the cause of death derived from the hospital records. Of the 262 verbal autopsies, 60% were males and 23% belonged to rural area. Specificity of VA cause of death was high (>95%) for all broad cause groups except cardiovascular (79%) diseases. Sensitivity was highest for injuries (85%) and it was in the range of 60% to 65% for circulatory diseases, neoplasms, and infectious diseases. Sensitivity was low (20% to 40%) for respiratory, digestive and endocrine diseases. Cause specific proportionate mortality for major cause groups by the VA were statistically similar to the causes of deaths derived from the hospital records (p>0.05). Therefore, VA can be used for determining causes of adult deaths.

Improving environmental conditions of a slum in Chandigarh by an awareness campaign.

An intervention project, in the form of an environmental awareness campaign was conducted in a slum of Chandigarh with a population of about 40,000, from December 1998-April 1999. The activities enforced during this campaign included focus group discussions with general public and mothers, household visit by medical students, distribution of literature, use of mass media by involving local residents, primary child care workers, teachers and school children. Evaluation of this campaign was carried out in May 1999 and compared with the baseline data obtained from a survey done in 1997. The study revealed that the method of storing water in covered buckets and utensils had improved significantly from 14.3% and 4.7% in the baseline survey to 35.2% (P < 0.001) and 16.2% (P < 0.01) respectively. Refuse disposal in the community bin and own bin had significantly improved to 22.2% (P < 0.001) and 19% (P < 0.01) from 8.4% and 11.2% respectively in the baseline survey. 51.2% of the residents using own bins disposed the refuse finally into the community bin. The use of community latrines had significantly increased among males (50.0%), females (47.7%) and children (41.2%) after intervention as compared to 32.8%, 32.5% and 16.7% respectively as found in the baseline survey (P < 0.001) and similarly open defaecation had significantly reduced among them. Further the study shows that the awareness regarding diarrhoea as hazard of unsafe water had improved significantly from 28.7% in baseline survey to 55.6% after intervention (P < 0.001). Knowledge of the residents regarding hazards of refuse disposal in the open and open defaecation had also improved significantly. Simple environmental awareness campaign can change the knowledge and behavioural practices of slum dwellers and could be a model for launching similar projects in other slums of India and other developing countries.

Evaluation of cold chain system in Chandigarh during PPI campaign 2001-2002.

OBJECTIVE: To evaluate the maintenance of cold chain system (CCS) in intensified pulse polio immunization (IPPI) programme, during December 2001 and January 2002 in Union Territory (UT) Chandigarh. MATERIALS & METHODS: A Cross sectional time bound study was conducted in seven centres, where OPV vials were stored prior to IPPI and 20 IPPI Booths in UT, Chandigarh. Booths were selected by stratified random sampling technique. The status of cold chain equipments was assessed at headquarter of IPPI, 6 regional (distribution) centres, 20 IPPI posts and 5 house to house teams. RESULTS: The cold chain sickness rate was found to be 9.7% in January, 2002. There were reports of breakdown of cold chain maintenance due to defective plugs and sockets, faults in thermostat, leakage of gas. But all vaccine samples picked up randomly were reported potent, as per the test reports provided by Central Research Institute (CRI), Kasauli during the period of study. OBSERVATION & DISCUSSION: Temperature charting and cold chain maintenance was found satisfactory, but necessity of improvement, specially regarding the handling of vaccines by the female health worker. Lids of vaccine carriers not closed tightly, frequent opening of lids during immunization, direct exposure of vaccine to atmospheric temperature, keeping the vaccine vial in hand or pocket. More emphasis is to be given on maintenance of cold chain system in orientation training programme of all Health functionaries before the Intensified Pulse Polio Immunization (IPPI) programme.

Social and functional status of older persons in a north Indian community.

With increase in life expectancy, the geriatric population is growing in developing countries. The Union Territory of Chandigarh has a population of about 0.9 million with nearly 90% in urban and 10% in rural areas. This cross-sectional, descriptive study was conducted in Chandigarh over a period of one year; 1998-99 among 362 subjects 65 years or more of age covering a population of 7937 family members in 1882 houses. The sampling was done by random sampling technique covering urban and rural population. The proportion of older persons in Chandigarh comprised 5.47% of the population. Most of the respondents were living with their spouses. More than one-fifth of urban and two third of rural older persons were illiterate. About 86% were living with their families and only 3.6% were living alone. Major modes of recreation were visiting religious places by two-thirds followed by going to parks and gardens by nearly one-fourth. Among 203 older persons having living partners in the study, one in every fifth older persons had indulged in sexual intercourse in the past six months. Nearly 2% of older persons needed assistance (partial or full) in activities of daily living like bathing, dressing, toileting, feeding, continence etc. The study also observed rural and urban variation in the use of aids and appliances by older persons. On the basis of very few having functional limitations, there is a need to include components of recreational facilities, activities of daily living, and not just assistance and aids and appliances, while developing a comprehensive geriatric health care programme in developing countries.

Mass supplementation of vitamin A linked to National Immunization Day.

OBJECTIVE: Main objectives were to assess the feasibility of linking vitamin A delivery with National Immunization Days (NIDs) and to see the impact on xerophthalmia. METHODS: An Intervention study of mass distribution of vitamin A solution was undertaken to control widespread xerophthalmia prevalent in children living in about 26 slums of Chandigarh in the year 2000. Two rounds of mass distribution of Vitamin A solution covering 27642 and 31762 children in 1-5 years of age in first and second rounds, respectively, were undertaken. The findings of second round and post evaluation after intervention are presented here. An additional team of two persons per pulse polio immunization (PPI) centre delivered age specific doses of vitamin A solution through 98 centres and operational problems were recorded. PPI staff provided the supervision and PPI tally sheets were used. RESULTS: The programme achieved a vitamin A coverage rate of 99% in first round and 88% in second round. Only two parents refused vitamin A solution. No side effect or cases of toxicity due to vitamin A were reported by health institutions in the area or in a stratified random sample of 101 children. There was a significant decline (13.4%) in xerophthalmia after two rounds of mass distribution (P < .001). The strategy to deliver vitamin A was successfully integrated into NID's and appeared to achieve a significant decline in xerophthalmia. CONCLUSION: Linking of vitamin A distribution with PPI could be a basis for launching similar initiatives in other areas of India and other countries where xerophthalmia is a public health problem.

Population based study of hypertension among the elderly in northern India.

The study was conducted in the urban and rural areas of Chandigarh during 1998-1999 among 362 elderly subjects above 65 y of age. The sample, selected by stratified random technique, covered a population of 7937 family members in 1882 houses. Methodology comprised of interviews, clinical examination and laboratory investigations such as ECG. The study revealed that 210 (58%) of the elderly were hypertensives. Of the hypertensives, only 39% are on medication. Fewer calories were consumed by the hypertensives. Further, 82.4% of the obese subjects were hypertensives as compared to 52.4% of the non-obese subjects (P<0.001). Only 56 subjects (27.6%) were both diabetic and hypertensive. One third of the elderly had some abnormality in ECG revealing associated coronary heart disease. Forty subjects (11.05%) had complications such as MI and stroke. The prevalence of complications was slightly higher (11.9%) in the hypertensives as compared to the non-hypertensives (9.9%). Thus health education campaigns should be started to increase awareness regarding the risk factors and bring about changes in lifestyle for the control of hypertension and reduction of its complications.

Measles outbreak in a Periurban area of Chandigarh: need for improving vaccine coverage and strengthening surveillance.

OBJECTIVE: An outbreak of measles was investigated in the periurban areas of Chandigarh Union Territory, during the months of December 1998 to February 1999. Mainly the children below 15 years of age were affected. The children of migrant labourers belonging to the neighbouring states of Uttar Pradesh and Bihar constituted the majority of population in the area under study. They belonged to lower socio economic status with low immunization coverage. METHODS: A total of 2968 houses were surveyed for epidemiological investigations in the areas of colony No. 5, Ramdarbar, Palsora and Pandit colony of Kajheri, covering a population of 14,601 and 7.3% (216/2968) of families were affected in the outbreak. RESULTS: Two hundred and eighty three cases of measles were reported with an attack rate of 4.5% and male to female ratio of (M:F) 5.3%:3.6%. Among the measles cases, 48.8% had received measles vaccination. The outbreak was investigated by detecting measles specific IgG/IgM antibodies either in acute or convalescent serum samples or both. Due to inadequate surveillance system and containment measures, the outbreak was in full swing during the winter months. Measles related complications were reported in 31.1% cases (i.e. diarrhoea in 15.2% and Pneumonia is 7.1%). CONCLUSION: Following smallpox and guinea worm eradication, WHO's next thrust, is on eradication of poliomyelitis and measles. Hence, strengthening of disease surveillance as well as vaccination policies are mandatory to achieve disease control in these areas.