Burden of Pulmonary Tuberculosis among Tribal Population: A Cross-sectional Study in Tribal Areas of Maharashtra, India.

BACKGROUND: It is very important to identify and treat infectious pulmonary tuberculosis (PTB) patients at the earliest to save the life of the patients and to prevent the transmission of infectious agent to others. As per Global Tuberculosis (TB) Report 2017, an estimated 28 lakh new TB cases occur and 4.23 lakh people die due to TB annually. Due to the poor health services and lack of awareness, particularly vulnerable tribal groups are vulnerable or at risk to many diseases including TB. METHODOLOGY: A community-based cross-sectional study was conducted to determine the burden of pulmonary TB (PTB) among adult tribal population of Maharashtra. House-to-house visit was conducted to identify the presumptive TB cases and sputum microscopy and chest X-ray were done to confirm the diagnosis. RESULTS: In the survey, 6898 tribal adults were interviewed from 8 tribal clusters, and among them, 144 (2.1%) presumptive TB cases were identified. The most common symptom among the presumptive TB cases was cough for >2 weeks (93.1%). The prevalence of PTB in the study area estimated is 261per lakh tribal population per year. CONCLUSION: The current study shows that the estimated burden of PTB among tribal population is within the wide variation of prevalence reported from other studies in different tribal communities (133-3294 per lakh population) in India. The current study provides vital information on the burden of TB among the tribal population of Maharashtra which can be used as a baseline data for future epidemiological studies.

Development of a semi-quantitative tear film based method for public screening of diabetes mellitus.

Diabetes mellitus (DM) is a major health care burden associated with significant morbidity and serious impact on the quality of life. Estimating blood glucose levels is the currently employed method for screening for DM. Due to the invasive nature of access to blood glucose; new methods are being suggested that depend upon different targets than blood or another biochemical pathway altogether. But these are not cost effective and have inherent limitations related to public screening. We hypothesize a simple, non invasive and cheap paper strip method to estimate tear film glucose levels for screening purposes at community level. We also discuss the ideal properties of such a paper strip and the process of validation the technique should undergo before being employed for mass usage.

Observer variation in quantitative assessment of retinal shortening with ultrasound in patients of total rhegmatogenous retinal detachment.

Purpose: To evaluate the interobserver variation in the assessment of retinal length to choroidal length ratio (RCR) as a marker for proliferative vitreoretinopathy (PVR) in cases of rhegmatogenous retinal detachment (RRD). Methods: This was a double-masked, prospective study at a tertiary center. Ultrasound was used to calculate RCR in 50 eyes with total RRD by two observers. Both observers were trained after the first round of calculations, and all the calculations were repeated as before. Difference between the RCR values was stratified into four categories (<0.01, 0.01-0.05, 0.06-0.1, and >0.1) for descriptive analysis. A difference of 0.05 was set as the maximal limit for defining interobserver agreement. Correlation between RCR and interobserver difference was assessed. Results: The mean interobserver difference in RCR values was found to be 0.06 ± 0.0 (P = 0.41) and was reduced to 0.04 ± 0.02 (P = 0.81) following training. The interobserver difference was <0.1 in 82% of the cases before training and in 98% of cases after training. The worst interobserver agreement was noted in cases with RCR < 0.8, and there was a good negative correlation between RCR and interobserver difference (r = -0.6, P ≤ 0.001). Conclusion: There is good interobserver agreement in assessing RCR with ultrasound in eyes with RRD, which improves further with training. RCR needs careful assessment in eyes with very low RCR. This technique may be useful in prognostication of surgical outcomes in cases with advanced PVR.

Factors Associated with Physical Inactivity among Adult Urban Population of Puducherry, India: A Population Based Cross-sectional Study.

INTRODUCTION: Physical inactivity is the fourth leading cause of death worldwide. Increase in physical activity decreases the incidence of cardiovascular diseases, Type 2 diabetes, stroke, and improves psychological wellbeing. AIM: To study the level of physical inactivity among the adult population in an urban area of Puducherry in India and its associated risk factors. MATERIALS AND METHODS: This cross-sectional study was conducted among 569 adult participants from an urban area of Pondicherry. The level of physical inactivity was measured by using WHO standard Global Physical Activity Questionnaire (GPAQ). RESULTS: Overall prevalence of physical inactivity in our study was 49.7% (CI: 45.6-53.8). Among the physically active people, contribution of physical activity by work was 77.4%, leisure time activities were 11.6% and transport time was 11%. Both men and women were equally inactive {Physically inactive among women was 50% (CI:44.1-55.9)} and {Physically inactive among men was 49.5% (CI:43.8-55.2)}. Prevalence of physical inactivity was increasing with increasing age. Non tobacco users were two times more active than tobacco users {Adjusted Odds Ratio: 2.183 (1.175- 4.057)}. Employed were more active as compared to retired {Adjusted Odds Ratio: 0.412 (0.171-0.991)}, students {Adjusted Odds Ratio: 0.456 (0.196-1.060)}, house wives {Adjusted Odds Ratio: 0.757 (0.509-1.127)} and unemployed {Adjusted Odds Ratio: 0.538 (0.271-1.068)}. Non alcoholics were only 0.34 times as active as alcoholics. CONCLUSION: Level of physical activity was found to be insufficient among adult urban population of Puducherry. Working adult population found to be active, that too due to their work pattern. There is a need to promote leisure time and travelling time physical activity.

Burden Among Caregivers of Children Living with Human Immunodeficiency Virus in North India.

BACKGROUND: Due to wider access to and free antiretroviral therapy (ART) program, the number of children dying due to acquired immune deficiency syndrome (AIDS)-related causes has declined and the nature and duration of human immunodeficiency virus (HIV)/AIDS caregiving has also dramatically altered. The care of children living with HIV/AIDS (CLHA) places a significant additional burden on the caregivers. AIMS: This study was conducted to assess the perceived burden among caregivers of children living with HIV in North India. MATERIALS AND METHODS: A hospital-based cross-sectional study among 156 CLHA-caregiver dyads in North India was conducted from June 2010 to May 2011. Data were collected by using a pretested structured interview schedule. The caregiver burden was measured with a 36-item scale adapted from Burden Assessment Schedule of Schizophrenia Research Foundation (BASS). Child characteristics, caregiver characteristics, caregiving burden, the knowledge of caregivers, and issues related to health care, nutrition, education, and psychological aspects were studied. RESULTS: Caregivers had a mean age of 35.9 ± 10.2 years. Women accounted for over three-fourth (76.9%) of the caregivers. Nearly two-third of them (65.4%) reported as living with HIV. The mean caregiver burden score was 68.7 ± 2.9. A majority of the caregivers reported either low or moderate burden. Standardized percentage score was high in the domains of physical and mental health, external support, patients' behavior, and caregivers' strategy and seemed to be comparatively less in the other domains such as support of the patient and taking responsibility. CONCLUSIONS: Caring of children is a universal practice but there is a need of special care for children living with HIV. The majority of caregivers who were usually the mothers perceived the burden and need to be assisted in caring for the child. Stigma and discrimination with HIV infection further increased the burden as caregivers did not disclose the HIV status to any near and dear one.

Patient and health system delays among adult smear-positive tuberculosis patients diagnosed at medical colleges of Puducherry in south India.

Early diagnosis and prompt initiation of treatment are essential for an effective tuberculosis (TB) control program. This study was done to assess the extent of various delays among TB patients diagnosed at medical colleges of Puducherry. A cross-sectional study involving retrospective medical record review and prospective patient interviews was conducted in and around the union territory of Puducherry during the period 2009-10. Various delays and adjusted odds ratios (ORs) were calculated. Level of significance was determined at 95% confidence interval (CI) (P value <0.05) and all tests were two-sided. Among 216 new sputum smear-positive TB patients, 11.1% and 10.6% were smokers and alcohol users, respectively. The median patient delay, health system delay, and total delay was 37 days, 28 days, and 65 days respectively. Being a resident of Puducherry (OR = 0.39, 95% CI = 0.18-0.87) and family size of ≤5 (OR = 0.45, 95% CI = 0.21-0.97) were found as the determinants of patient delays and total delays, respectively.

Consent for audio-video recording of informed consent process in rural South India.

INTRODUCTION AND OBJECTIVES: In recent times, audio-video (A-V) recording of consent process for all the study subjects entering a clinical trial has been made mandatory. A-V recording of informed consent process is a big challenge due to confidentiality and the sociocultural environment in India. It is important to find out the acceptability for A-V recording of the consent process and reasons for refusal, if any to address this new challenge. MATERIALS AND METHODS: A descriptive survey was done among 150 residents of a rural community of South India. Acceptability for A-V recording of consent process was assessed among those who had given the informed written consent for participation in the study. An attempt to find the factors determining the refusal was also made. RESULTS: More than one-third (34%) of the study subjects refused to give consent for A-V recording of consent process. Not interested in recording or don't like to be recorded (39%) were the most common reasons to refuse for A-V recording of consent process. The refusal was higher among female and younger age-group adult subjects. Socioeconomic status was not found to be significantly associated with refusal to consent for A-V recording. CONCLUSION: Refusal for A-V recording of consent process is high in the South Indian rural population. Before any major clinical trial, particularly a field trial, an assessment of consent for A-V recording would be helpful in recruitment of study subjects.