Estimation of tuberculosis incidence at subnational level using three methods to monitor progress towards ending TB in India, 2015-2020.

OBJECTIVES: We verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India. DESIGN: A community-based survey, analysis of programme data and anti-TB drug sales and utilisation data. SETTING: National TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status. PARTICIPANTS: Each district was divided into survey units (SU) and one village/ward was randomly selected from each SU. All household members in the selected village were interviewed. Sputum from participants with a history of anti-TB therapy (ATT), those currently experiencing chest symptoms or on ATT were tested using Xpert/Rif/TrueNat. The survey continued until 30 Mycobacterium tuberculosis cases were identified in a district. OUTCOME MEASURES: We calculated a direct estimate of TB incidence based on incident cases identified in the survey. We calculated an under-reporting factor by matching these cases within the TB notification system. The TB notification adjusted for this factor was the estimate by the indirect method. We also calculated TB incidence from drug sale data in the private sector and drug utilisation data in the public sector. We compared the three estimates of TB incidence in 2020 with TB incidence in 2015. RESULTS: The estimated direct incidence ranged from 19 (Purba Medinipur, West Bengal) to 1457 (Jaintia Hills, Meghalaya) per 100 000 population. Indirect estimates of incidence ranged between 19 (Diu, Dadra and Nagar Haveli) and 788 (Dumka, Jharkhand) per 100 000 population. The incidence using drug sale data ranged from 19 per 100 000 population in Diu, Dadra and Nagar Haveli to 651 per 100 000 population in Centenary, Maharashtra. CONCLUSION: TB incidence in 1 state, 2 UTs and 35 districts had declined by at least 20% since 2015. Two districts in India were declared TB free in 2020.

Designing and Evaluating a Personalized, Human-Centered Dietary Decision Support System for Use Among People With Diabetes in an Indian Setting: Protocol for a Quasi-Experimental Study.

BACKGROUND: Human-centered dietary decision support systems are fundamental to diabetes management, and they address the limitations of existing diet management systems. OBJECTIVE: The objective of the proposed study is to evaluate the use of an interactive, telephone-linked, personalized, human-centered decision support system for facilitating the delivery of personalized nutrition care for patients with diabetes. METHODS: A quasi-experimental trial was conducted between the period of June and December 2018. Study participants were recruited from Community Health Center, Dharamshala, Kangra (urban population), and Model Rural Health Unit, Haroli Block, Una (rural population). Eligible participants included adults aged ≥30 years with controlled or uncontrolled diabetes, those who agreed to participate in the study, those who were available for follow-up interviews, and those with a telephone or computer at home. Diabetic status was determined via a physician's diagnosis. Individuals with mental or physical challenges that affected their ability to use an electronic diet record, those who were not available for a telephone follow-up, and those who were involved in other protocols related to dietary assessments were excluded. The study participants were randomized into the following two groups: the intervention group (telephone-linked dietary decision support system) and the control group (paper-based diet record). Study participants in the intervention group recorded their daily dietary intake by using a telephone-linked, personalized, human-centered dietary decision support system and received personalized feedback and diet education via SMS text messaging. Study participants in the control group were provided with only a paper-based diet record for documenting their daily dietary intake. Follow-up visits were conducted at 3 and 6 months from the baseline in both groups. Differences in diabetes knowledge, attitudes, and practices will be measured across groups. RESULTS: The collection of baseline data from 800 study participants in both the intervention (n=400) and control groups (n=400), which were stratified by urban (control group: n=200; intervention group: n=200) and rural settings (control group: n=200; intervention group: n=200), has been completed. Follow-up data collection for months 3 and 6 is ongoing and is expected to be completed by October 2019. CONCLUSIONS: We anticipate that the intervention group will show significant changes in nutrition knowledge, attitudes, and practices; satisfaction with care; and overall diabetes management. We also expect to see urban-rural differences across the groups. The uniqueness of our nutrient data capture process is demonstrated by its cultural and contextually relevant features-diet capture in both English and Hindi, diet conversion into caloric components, sustained diet data collection and participant adherence through telephone-linked care, and auto-generated reminders. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13635.

Feasibility of a mobile based Continuing Medical Education (CME) program for recent updates in the medical colleges of Himachal Pradesh, India.

BACKGROUND: Mobile based messaging system provides a platform to communicate to health care professionals of medical colleges for an updated knowledge in Revised National Tuberculosis Control Program (RNTCP) in the state of Himachal Pradesh. MATERIAL AND METHODS: Pragmatic trial under routine programmatic conditions was planned in which an automated messaging system was developed along with development of message banks tailored for medical faculty (total 335) with respect to their discipline. RESULTS: Message banks were developed by the research team by referencing the relevant training modules and guidelines under RNTCP. Two message banks consisted of relevant message lines were developed; one was for case notification, revised presumptive definition, and revised diagnostic methods and general information and another one was for INDEX-TB guidelines. Different combinations -input system - of message lines were decided and designed for both message banks. Input system was kept for one-month cycle with delivery of messages on fixed day and at fixed time (usually at 19:00h on a selected day) to ensure sustained interest and effective reading time for messages. CONCLUSION: Mobile based medical education program to the medical faculties proved to be feasible and useful to keep them updated about recent changes in the RNTCP.

Delineating the factors associated with recurrence of tuberculosis in programmatic settings of rural health block, Himachal Pradesh, India.

BACKGROUND: Tuberculosis (TB) recurrence observed to be an important event in its treatment and has future implications under national TB control efforts. The present study was carried out to assess the recurrence rate along with its risk factors among patients undergoing treatment for TB under Revised National TB Control Program (RNTCP). MATERIAL AND METHODS: Total 204 patients in health block of district Una, Himachal Pradesh were studied using pretested structured interviewer-administered questionnaire. Along with univariate a non-hierarchal multi-way frequency analysis (MFA) was done to study the one and multi-way effects between the discrete variables included in a hypothesized model. The variables were under-nutrition, pulmonary TB, injecting drug use (IDU), multi-drug resistant (MDR) TB, and past TB (recurrent cases). RESULTS: Total 29 cases (14.2%) had recurrence (17.7/100,000 population) with significantly high fraction for alternate residence (Recurrent: 50.0%, Non-recurrent: 47.4%; p = 0.001), Multi-drug resistance (MDR) TB (Recurrent: 13.8%, Non-recurrent: 2.3%; p = 0.003), and sputum negative patients (Recurrent: 51.7%, Non-recurrent: 14.5%; p = 0.000). Non-recurrent cases had significantly high fraction for sputum positive cases (Recurrent: 48.3%, Non-recurrent: 72.1%; p = 0.011), and extra-pulmonary TB (Recurrent: 00.0%, Non-recurrent: 13.4%; p = 0.036). MFA observed all significant one-way effects. Significant two-way effects were IDU and pulmonary TB (p = 0.001), MDR and past TB (p = 0.004), IDU and past TB (p = 0.019), and IDU and MDR-TB (p = 0.039). CONCLUSION: Proportion of TB recurrence was expected with a significant difference between the history of change of residence, MDR-TB, pulmonary and extra-pulmonary nature of the disease. Hypothesized model observed with a significant association of IDU, pulmonary TB, MDR-TB and past TB.

Effectiveness of randomized control trial of mobile phone messages on control of fasting blood glucose in patients with type-2 diabetes mellitus in a Northern State of India.

Limited availability of randomized control trial warranted the conduct of a present study to demonstrate the effectiveness of mobile phone-based short message services (SMSs) on reduction in mean fasting blood glucose (FBG) in patients with type-2 diabetes mellitus. A total of 955 patients were recruited from primary and secondary health-care facilities and randomized to intervention (479) and control (476) group. Messages were delivered to patients for 12 months tailoring to their recent FBG values. SMS included information to maintain the desired FBG levels and next due date for FBG assessment. Patients were statistically similar for their age, socioeconomic status, smoking, and alcohol use. After the intervention, an average FBG declined from 163.7 to 152.8 mg/dl (P = 0.019) in intervention and from 150.5 to 149.2 mg/dl (P = 0.859) in control group. Adjusted for the baseline FBG, the intervention was found to be significantly effective (odds ratio: 1.7; 95 confidence interval: 1.2-2.6).

Plasma levels of Rifampicin and Pyrazinamide with pre and post meal administration in tuberculosis patients.

CONTEXT: Various factors affect plasma concentrations of antitubercular drugs in different populations so dosing schedule should be adjusted after therapeutic drug monitoring. AIMS: To study variability in plasma concentrations of Rifampicin and Pyrazinamide with pre and post-meal administration of drugs in tuberculosis patients. METHODS AND MATERIAL: 52 patients of pulmonary tuberculosis, divided in to two groups, pre and post-meal through systemic randomization. After taking pre-dose sample, drugs were administered according to the group. Samples were withdrawn at 2, 4, 6, and 10h after drug administration. Analysis of samples was done using HPLC. RESULTS: Mean±1SD of Cmax of Rifampicin was 7.75±2.82µg/ml, mean±1SD of AUC0-10 was 42.17±17.25µgh/ml, adjusted Tmax was 4.25h. In pre-meal samples, the corresponding values were 7.75±2.88µg/ml, 42.83±18.47µgh/ml, 3.76h and in post-meal samples 8.03±2.30µg/ml, 41.56±16.46µgh/ml and 4.75h. Mean±1SD of Cmax levels of Pyrazinamide was 54.49±21.86µg/ml, mean±1SD of AUC0-10 was 337.94±124.28µgh/ml and adjusted Tmax was 3.49h. In pre-meal samples the corresponding values were 52.00±19.13µg/ml, 329.96±112.11µgh/ml, 3.23h, and in post-meal samples 57.43±23.61µg/ml, 345.58±136.99µgh/ml, 3.54h. CONCLUSION: There is huge variability in the plasma levels of Rifampicin and Pyrazinamide in population of this sub-himalayan region.

Building Evidence for Coverage of Fully Vaccinated Children of 12-23 Months of Age across Districts of North India, 2015.

CONTEXT: Unprecedented low coverage (63%) of fully vaccinated (FV) children in the recent round of national survey district level household (HH) and facility survey 4 (DLHS-4) propelled health system of Himachal Pradesh for an independent rapid assessment of FV coverage. AIM: The aim of the study was to assess the FV coverage among 12-23-month old children in the state. SETTINGS AND DESIGN: A community-based survey with an interviewer-administered questionnaire was carried out in all 12 districts of Himachal Pradesh from September 2015 to January 2016. SUBJECT AND METHODS: WHO 30 × 7 cluster technique was used. STATISTICAL ANALYSIS USED: Chi-square and unpaired Student's t-test along with 95% confidence intervals. RESULTS: A total of 2492 children across 35,551 HHs (2.4% of state share) were surveyed with FV coverage of 98.1% (95% confidence interval [CI]: 97.5-98.6) and 86% (95% CI: 84.6-87.3) based on history and card, respectively. CONCLUSIONS: The reported FV coverage in the current study was observed too high in the state as reported in earlier round of the national surveys (except DLHS-4).

Prevalence of Autism Spectrum Disorder among Rural, Urban, and Tribal Children (1-10 Years of Age).

INTRODUCTION: Studies on autism spectrum disorders (ASDs) have largely focused on children in specific settings. The current scenario of research in ASDs is limited largely to clinic-based case reports, case series, and retrospective chart reviews. The present study is the first population-based prevalence study conducted across rural, urban, and tribal populations in India. MATERIALS AND METHODS: A cross-sectional two-phase study was conducted covering children in the age group of 1-10 years of age across geographical regions representing rural, urban, and tribal populations. The first phase (screening phase) involved administration of the Hindi version of the Indian Scale for Assessment of Autism. Those identified as suspected of ASD and 10% of all classified as nonsuspects for autism were also evaluated by the clinical team in second phase (evaluation phase). RESULTS: Forty-three children out of a total of 28,070 children in rural, urban, and tribal area in the age group of 1-10 years were diagnosed as cases of ASD yielding a prevalence of 0.15% (95% confidence interval [CI] =0.15-0.25). Logistic regression analysis showed a two times significantly higher risk of diagnosing ASD in rural area as compared to tribal (odds ratio [OR]; 95% CI = 2.17 [1.04-4.52], P = 0.04). Male sex and upper socioeconomic group of head of family/father had a higher risk of getting diagnosed as autism as compared to lower socioeconomic group (OR; 95% CI - 3.23; 0.24-44.28, P = 0.38). CONCLUSIONS: Estimation of true prevalence of ASD in India is going to improve policies on developmental disabilities.

Malnutrition as a cause of mental retardation: A population-based study from Sub-Himalayan India.

BACKGROUND: Mental retardation is one of the most common disabilities of childhood. The research on childhood malnutrition and its relationship with cognitive functioning suggests that malnutrition alone does not cause mental retardation. OBJECTIVE: To identify the relation between malnutrition and cognition among children from a Sub-Himalayan state in North India. MATERIALS AND METHODS: A two-phase cross-sectional study was conducted in the rural, urban, and slum area of district Kangra. A 30-cluster sampling technique was used to screen a population of children 1-10 years of age from five randomly selected panchayats (village government units) of district Kangra. The screening was based on a modified version of the ten questions screen, adapted to the local population. In the first phase, a door-to-door survey was done to identify suspects of mental retardation. In the second phase, the children found positive in the first phase were called for clinical examination to confirm mental retardation. Anthropometric assessment of all study children was done by measuring weight and height. The nutritional assessment was done by categorizing them according to Waterlow classification for malnutrition. RESULTS: Out of the total 5300 children, 1.7% were diagnosed as mentally retarded. No positive association was reported with different types of malnutrition and mental retardation. A weakly positive association existed between nutritional status and mental retardation (correlation coefficient-0.04). Children who were both wasted and stunted had the highest risk (odds ratio, 95% confidence interval - 5.57, 2.29-10.36) of mental retardation as compared to normal. CONCLUSION: Malnutrition may be one of the causes but certainly not the only cause of mental retardation. Other causes may be contributing more significantly toward it.

Prevalence of mental retardation in urban and rural populations of the goiter zone in Northwest India.

BACKGROUND: The existence of an endemic goiter belt along the southern slopes of the Himalayas has been known for a long time. Prevalence of neonatal hypothyroidism is high and there has been little work on the prevalence of mental retardation in this part of India. OBJECTIVE: The study was conducted with the aim to know the prevalence of mental retardation in the urban and rural populations of Himachal Pradesh, India and to generate a hypothesis on the differential distribution (geographical) of mental retardation. METHODS: This cross-sectional study was conducted in the rural and urban areas of the district of Kangra, Himachal Pradesh, India among children of 1-10 years of age. In the first phase, the children in the age group of 1-10 years were screened for mental retardation using the Ten Questions Screen, whereas in the second phase the suspects were evaluated clinically. RESULTS: The prevalence of mental retardation was found to be 1.71% in the study population with higher prevalence (3.3%) in the 73-120 months age group. The prevalence was higher among the males in all study populations [rural: 1.9%, urban (nonslum): 1.6%, and urban slum: 7.14%). The prevalence was similar among the urban (nonslum) (1.75%) and rural (1.11%) populations, whereas it was higher (4%) in the urban slum population. A prevalence of 2% was seen in families from the lower middle class and 1.8% among families from the lower class in the rural population, whereas a prevalence of 2% was seen among lower middle class families of urban (nonslum) areas. CONCLUSION: The prevalence of mental retardation was higher in our study than in other parts of the country. The study concludes with the hypothesis that the prevalence of mental retardation is differentially distributed geographically with socioeconomic factors being important predictors.

Agreement between international classification of disease (ICD) and cause of death and associated conditions (CODAC) for the ascertainment of cause of stillbirth (SB) in the rural areas of north India.

International Classification of Diseases-10 th version (ICD-10) has been used to ascertain the cause of death but its use for stillbirths (SBs) is limited. Cause of Death and Associated Conditions (CODAC) as a detailed system expected to provide the exact cause of SB, so a community-based study was planned to study the level of agreement between ICD-10 and CODAC for ascertaining the cause of SB. A verbal autopsy (VA) tool was used to collect the information and then the cause of each SB was assigned using ICD-10 and CODAC separately. Each tool was used for 87 SBs and found that prolonged singleton labor, maternal pregnancy induced hypertension (PIH), and central nervous system (CNS) related congenital malformations were considered the top three causes. There was a significant agreement between ICD-10 and CODAC but the latter offers a scope to delineate the causes more precisely due to its hierarchal nature.

Socio demography of mental retardation: A community-based study from a goitre zone in rural sub-Himalayan India.

INTRODUCTION: Mental retardation is one of the most common disabilities of childhood which can be prevented by timely identification of the causative agent and an adequate management accordingly. District Kangra lies in the sub-Himalayan belt and forms a part of the 2400 km long goitre belt along the southern slopes of the Himalayas. OBJECTIVE: To study the prevalence of mental retardation among children (1-10) years of age. MATERIALS AND METHODS: A two-phase cross-sectional study was conducted in the rural area of district Kangra. A 30-cluster sampling technique was used to screen a population of children 1-10 years of age from five randomly selected panchayats (village government units) of district Kangra. The screening was based on a modified version of the ten questions screen, adapted to the local population. In the first phase a door to door survey was done to identify suspects of mental retardation. In the second phase, the children found positive in the first phase were called for examination by the pediatrician to confirm mental retardation. RESULTS: A total of 2420 children were screened in the first phase of which 95 tested positive. About 52 of these children were found to be mentally retarded in the second phase giving a prevalence of 2.15%. The 69% of these children belonged to the lower middle class and 28.3% belonged to middle class families using the Uday Parekh scale for assessment of the socio-economic status. CONCLUSION: Prevalence of mental retardation is high in district Kangra of Himachal Pradesh in comparison to other states of India. This could be attributed to the good primary health care in Himachal Pradesh where institutional deliveries are about 70%. This may have led to better survival of children with congenital disorders and those that suffer perinatal trauma.

Hypertension and diabetes as risk factors for dementia: A secondary post-hoc analysis from north-west India.

INTRODUCTION: A relation between midlife risk factors (hypertension and diabetes) and dementia has been studied in past and an association has been documented, in spite of some studies pointing to the contrary. MATERIALS AND METHODS: The study was based on post-hoc analysis of data obtained from a study conducted on an elderly population (60 years and above) from selected geographical areas (migrant, urban, rural and tribal) of the Himachal Pradesh state in North-West India. RESULTS: Analysis of variance revealed an effect of risk factors on cognitive scores; however, post hoc Tukey's honest significant difference (HSD) test revealed that only hypertensives' demonstrated higher chances of scoring lower on cognitive measures. DISCUSSION: The possibility that hypertension and diabetes affect dementia needs further evaluation, more so in Indian context.

Level of literacy and dementia: A secondary post-hoc analysis from North-West India.

INTRODUCTION: A relation between literacy and dementia has been studied in past and an association has been documented. This is in spite of some studies pointing to the contrary. The current study was aimed at investigating the influence of level of literacy on dementia in a sample stratified by geography (Migrant, Urban, Rural and Tribal areas of sub-Himalayan state of Himachal Pradesh, India). MATERIALS AND METHODS: The study was based on post-hoc analysis of data obtained from a study conducted on elderly population (60 years and above) from selected geographical areas (Migrant, Urban, Rural and Tribal) of Himachal Pradesh state in North-west India. RESULTS: Analysis of variance revealed an effect of education on cognitive scores [F = 2.823, P =0.01], however, post-hoc Tukey's HSD test did not reveal any significant pairwise comparisons. DISCUSSION: The possibility that education effects dementia needs further evaluation, more so in Indian context.

Is dementia differentially distributed? A study on the prevalence of dementia in migrant, urban, rural, and tribal elderly population of himalayan region in northern India.

BACKGROUND: Throughout the world, a large number of surveys have been carried out to find the prevalence of dementia with variable results. AIMS: This study was to generate data on the prevalence of dementia and to generate a hypothesis on the differential distribution across populations. MATERIALS AND METHODS: Four settings identified for the purpose of this study included a migrant, urban, rural, and tribal. The study was conducted in two phases: 1) A screening phase and 2) a clinical phase, on 2,000 individuals above 60 years of age. To complete the required sample of 2,000 elderly individuals, 500 individuals were approached from each site. Nobody refused to participate. RESULTS: A total of 32/2,000 (1.6%) elderly individuals were classified as demented. No case of dementia was reported from tribal population. A look at sex differential reveals that majority (21/32; 66%) of individuals identified as demented were females. As age advanced scores on cognitive screen decreased with elders above 80 years of age showing lowest scores. Out of 32, 18 (56%) of patients classified as demented were more than 80 years of age. CONCLUSION: The findings of this study are in agreement with previous studies which point towards differential distribution of dementia across populations.

Factors influencing early health facility contact and low default rate among new sputum smear positive tuberculosis patients, India.

Early case identification and prompt treatment of new sputum smear positive case are important to reduce the spread of tuberculosis (TB). Present study was planned to study the associated factors for duration to contact the health facility since appearance of symptoms and treatment default. Methodology. It was prospective cohort study of TB patients already registered for treatment in randomly selected TB units (TUs) in Himachal Pradesh, India. Relative risk (RR) was calculated as risk estimate to find out the explanatory variables for early contact and default. Results. Total 1607 patients were recruited and 25 (1.5%) defaulted treatment. Patients from nuclear family (aRR: 1.37; 1.09-1.73), ashamed of TB (aRR: 1.32; 1.03-1.70), wishing to disclose disease status (aRR: 1.79; 1.43-2.24), but aware of curable nature (aRR: 1.67; 1.17-2.39) and preventable (aRR: 1.35; 1.07-1.70) nature of disease, contacted health facility early since appearance of symptoms. Conclusion. Better awareness and less misconceptions about disease influences the early contact of health facility and low default rate in North India.

Prevalence of Diabetes Mellitus and Its Risk Factors among Permanently Settled Tribal Individuals in Tribal and Urban Areas in Northern State of Sub-Himalayan Region of India.

Background. Effect of urban environment on the development of DM and its risk factors is studied with an ecological fallacy due to their study designs that formulate the background for the present study. Objective. To study the prevalence of DM and associated lifestyle related risk factors in traditional tribal individuals residing in tribal area and migrating persons of the same tribe to urban area of sub-Himalayan northern state of India. Methodology. Population based cross-sectional study. Results. A total of 8000 individuals (tribal: 4000; urban: 4000) were recruited. Overall, among urban tribes the prevalence of central obesity (59.0%), overweight (29.3%), stage 1 (22.8%) and stage 2 (5.3%) hypertension, and DM (fasting: 7.8%; OGTT: 8.5%) (P = 0.00) was significantly higher than the tribes of tribal area. Based on OGTT, the prevalence of DM was found to be 9.2% among central obese tribes of urban area and 6.7% of tribal area (P = 0.00). DM showed a significant high prevalence among urban tribes with prehypertension (urban: 8.3%; tribal: 2.9%; P = 0.00), and stage 1 (urban: 14.1%; tribal: 8.7%; P = 0.00) and stage 2 (urban: 17.5%; tribal: 13.9%; P = 0.59) hypertension. Conclusion. Urban environment showed a changing lifestyle and high prevalence of DM among tribal migrating urban tribes as compared to traditional tribes.

Feasibility of Development of a Cohort in a Rural Area of Sub-Himalayan Region of India to Assess the Emergence of Cardiovascular Diseases Risk Factors.

Introduction. Rural area of India is facing epidemiological transitions due to growth and development, warranting a longitudinal study to assess the development of CVDs risk factors. Objective. Feasibility of setting up a rural cohort for the assessment and development of biochemical risk factors for CVDs. Methodology. In Himachal Pradesh, house-to-house surveys were carried out in six villages for anthropometry and assessment of lipid profile. All the information was stored in specifically designed web-based software, which can be retrieved at any time. Results. A total of 2749 individuals of more than 20 years of age were recruited with a 14.3% refusal rate. According to Asian criteria, measured overweight and obesity (BMI > 27.5 kg/m(2)) were 44.9% and 10.5%, respectively. Obesity was significantly more (P = 0.01) among females (11.7%) as compared to males (8.4%). The prevalence of prehypertension and hypertension was observed to be 16.3% and 37.4%, respectively. Eighty percent of individuals had borderline (46.5%) to high (35.4%) level of triglycerides (TGs). Elevated total cholesterol (TC) and low density lipoprotein (LDL) level were observed among 30.0% and 11.0% individuals only. Conclusion. A high prevalence of biochemical risk factors for CVDs in a rural area urges establishment of an effective surveillance system.

Identifying risk for dementia across populations: A study on the prevalence of dementia in tribal elderly population of Himalayan region in Northern India.

INTRODUCTION: Studies have suggested that dementia is differentially distributed across populations with a lower prevalence in developing regions than the developed ones. A comparison in the prevalence of dementia across populations may provide an insight into its risk factors. Keeping this in view, a study was planned to evaluate the prevalence of dementia in tribal elderly population. MATERIALS AND METHODS: A cross-sectional comprehensive two-phase survey of all residents aged 60 years and older was conducted. Phase one involved screening of all individuals aged 60 and above with the help of a cognitive screen specifically developed for the tribal population. Phase two involved clinical examination of individuals who were suspected of dementia as per the developed cognitive screening test. RESULTS: The results revealed that no individual above 60 years of age in the studied population was diagnosed as a case of dementia. Thereby, pointing out at some unknown factors, which are responsible for prevention of dementia. DISCUSSION: The differences between the prevalence rate in this study and other studies in India appear to be a function of a valid regional difference. Environmental, phenotypic and genetic factors may contribute to regional and racial variations in dementia. Societies living in isolated hilly and tribal areas seem less predisposed to dementia, particularly age related neurodegenerative and vascular dementia, which are the most common causes for dementia in elderly. This may be because some environmental risk factors are much less prevalent in these settings.

Assessment of clinical profile of the patients treated at ayurvedic health facilities in north India.

Since a very long time, a significant number of patients have been seeking treatment at Complementary and Alternative Medicine health facilities, but the disease burden at these facilities has never been assessed and documented. Present cross-sectional study was carried out at Ayurvedic tertiary care hospital to document and to assess the rationale of disease reporting at Ayurvedic institutions of the northern state of India from January 2011 to October 2011. Almost half of the patients' morbidities were not classified at all into any of the disease categories. The common reported morbidities at study hospital were: Respiratory (10.5%), neuromuscular (9.5%), digestive (9.2%) and circulatory (9.1%) disorders. As the majority of diseases were unclassified, so mainstreaming of the effective disease surveillance would be required to understand the morbidity pattern and successful treatment practices at health facilities.