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.

Prevalence of osteoarthritis of knee joint among adult population in a rural area of Kanchipuram District, Tamil Nadu.

BACKGROUND: Osteoarthritis (OA) is one of the most common degenerative disorders among the elderly population; although aging is the most important cause, research has shown that it is a complex disease with many etiologies. It is not an inevitable part of aging but rather the result of a combination of factors, many of which can be modified or prevented. OBJECTIVE: The objective of this study was to assess the burden and determinants of OA knee among the adult population. METHODS: A community-based, cross-sectional study among 1986 adult persons living in a rural area in Kanchipuram district, Tamil Nadu, South India, was interviewed and examined from January 2014 to December 2014. Data collection was done by the postgraduates, trained health workers under the supervision of principal investigator. Written and informed consent was obtained before data collection. OA was diagnosed using the criteria laid down by the American College of Rheumatology, and it was validated and tested in the study area. RESULTS:: A total of 1986 adult respondents were interviewed out of which 27.1% had OA of knee. Age more than 50 years, female gender, tobacco usage, illiteracy, lower socioeconomic class, positive family history of OA, diabetes, and hypertension were found to be associated with OA knee (P < 0.05). CONCLUSION: The burden of osteoarthritis knee was high in this region. Hence, effective preventive strategy has to be taken to minimize this burden.

Visual impairment among 10-14-year school children in Puducherry: A cross-sectional study.

INTRODUCTION: According to the 2010 estimates by the World Health Organization, nearly 285 million (4.24% of total population) people of all ages worldwide are visually impaired. Almost 18.9 million children under 15 years of age are visually impaired globally. In developing countries, 7%-31% of childhood blindness and visual impairment is avoidable. MATERIALS AND METHODS: The study was conducted as a cross-sectional study among 1884 school students in Puducherry, in the age group of 10-14 years. A child with presenting maximum vision ≤6/12 Snellen equivalent in the better eye is considered visually impaired. Data were entered in Microsoft Excel 2013 and analyzed using the statistical software SPSS version 21.0. Chi-square test was applied for testing difference in proportion and a P < 0.05 was considered statistically significant. RESULTS: The overall prevalence of visual impairment (vision ≤6/12) among the study participants was 6.37% (95% confidence interval = 5.27-7.47). The prevalence of visual impairment increased with age and it was found to be high among male students (6.6%) when compared to female students (6%). Presenting vision of 6/6 was observed in 79.8% of the children while with pinhole correction, the proportion increased to 94.6%. CONCLUSION: The prevalence of visual impairment in our study population was found to be 6.37% and the prevalence was even higher among children who belonged to schools of urban region or private schools. Children with a positive family history of spectacle use were more likely to have visual impairment.

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.

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.

Effectiveness of Mind Mapping Technique in Information Retrieval Among Medical College Students in Puducherry-A Pilot Study.

BACKGROUND: The traditional teaching learning methods involve a one way process of transmission of knowledge leaving the students lacking behind in creative abilities. Medical schools need to change their teaching strategies to keep the interest of students and empower them for future self- learning and critical thinking. OBJECTIVE: To assess the impact of mind mapping technique in information retrieval among medical college students in Puducherry. METHODS: A pilot study was conducted using experimental study design among sixth semester MBBS students (n = 64) at a medical college in Puducherry, India. One group (n = 32) followed the text reading method and another group (n = 32) followed the mind mapping technique to learn the same passage given to them. The knowledge about the topic was assessed using a pre designed questionnaire at baseline, day 0 and day 7. The knowledge gain is the primary outcome variable and is compared between two groups. The feedback regarding the teaching methods was obtained from the participants. RESULTS: Mean knowledge score in the text group was lesser than the mind map group at baseline (2.6 Vs 3.5; p = 0.08). On Day 0, the mean score in text group was slightly lesser than the mind map group (8.7 Vs 9.0; p = 0.26). On Day 7, the mean score in mind map group is significantly more than the text group (8.9 Vs 8.5; p = 0.03). CONCLUSION: The mind mapping technique is an innovative and effective method in remembering things better than the routine way of reading texts.

Unmet Needs of Family Planning Among Women: A Cross-Sectional Study in a Rural Area of Kanchipuram District, Tamil Nadu, South India.

BACKGROUND: Global contraceptive usage was 63.3 % in 2010 which was 9 % more than that in 1990. NFHS-III 2005-2006 revealed that the contraceptive prevalence rate was 56 % while in the past decade it was 48 %. In India, female sterilization is the most commonly preferred method of contraception accounting for 76 %, while in Tamil Nadu it was 90 %. Thus, this study aims at measuring the prevalence of unmet needs of family planning and its determinants in a rural area of Kancheepuram district, Tamil Nadu. MATERIALS AND METHODS: The study was carried out as a community-based cross-sectional study in Chunambed panchayat, a rural area in Kanchipuram District, Tamil Nadu, India, among 505 women of age group 15-49 years. Cluster random sampling was done to select the households to include in the study. In every household, all the available and eligible women were explained about the study and recruited after obtaining informed consent. STATISTICAL ANALYSIS: Chi-square test was applied for finding the difference in proportion, and p value <0.05 was considered statistically significant. RESULTS: The prevalence of unmet need for family planning in our study population was nearly 31 %; it was even more for younger age groups and for the women whose family size was less. 51.7 % of the participants were currently using a contraceptive measure and very few of their partners used contraception. Government health facilities were the major source of contraceptive service and majority of our participants were well aware about the various contraceptive methods. CONCLUSION: Unmet needs of family planning were high in our study population, and the knowledge about the contraceptive use and family planning was found to be fairly adequate.

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.

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.

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.

Study of morbidity pattern among salt workers in marakkanam, Tamil Nadu, India.

BACKGROUND: Salt workers are exposed to occupational hazards like contact with salt crystals and brine, physical stress, sunlight and glare due to sunlight reflected by salt crystals. Very few studies have documented the morbidity among the salt workers. AIM: To assess the morbidity pattern among salt workers in Marakkanam, Tamil Nadu, India. MATERIALS AND METHODS: A community based cross-sectional study was undertaken in 4 randomly selected salt worker villages. Three hundred thirty one salt workers were reached by a house-to-house survey during April 2010 to March 2011. Demographic data was collected; clinical examination was conducted using a predesigned and pretested questionnaire. A pilot study was conducted to estimate the prevalence of morbidity before initiating the study. The data was analyzed using SPSS Version 11.5. Chi-square test and odds ratios (OR) with 95% confidence intervals (CI) were calculated to determine the association of morbidity levels with various factors. RESULTS: Of the 331 salt workers in the study, 58% were females, mean age was 41.9 ± 10.8 y. Eighty seven percent salt workers had some or other morbidity. The observed morbidities include clinical pallor (44.4%), ocular morbidities including cataract, pterygium, conjunctivitis, pingecula and corneal ulcer (42%), caries teeth (41.7%), hypertension (23.3%), underweight (19.3%), goiter (19%), obesity (14.8%) and dermal conditions including dermatitis, thickening of palm and sole, tinea unguum, follicultitis (9.1%). The presence of morbidity did not show any significant association with increase in age, gender, duration of employment or the type of salt work involved with. However, the lower the education level, the higher is the morbidity level among salt workers (OR = 5.23, 95% CI= 2.07 to 13.21). CONCLUSION: Morbidity among salt workers is high. Intervention programs are needed to alleviate the health problems in the salt workers.

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.

Universal health coverage for India by 2022: a utopia or reality?

It is the obligation of the state to provide free and universal access to quality health-care services to its citizens. India continues to be among the countries of the world that have a high burden of diseases. The various health program and policies in the past have not been able to achieve the desired goals and objectives. 65(th) World Health Assembly in Geneva identified universal health coverage (UHC) as the key imperative for all countries to consolidate the public health advances. Accordingly, Planning Commission of India constituted a high level expert group (HLEG) on UHC in October 2010. HLEG submitted its report in Nov 2011 to Planning Commission on UHC for India by 2022. The recommendations for the provision of UHC pertain to the critical areas such as health financing, health infrastructure, health services norms, skilled human resources, access to medicines and vaccines, management and institutional reforms, and community participation. India faces enormous challenges to achieve UHC by 2022 such as high disease prevalence, issues of gender equality, unregulated and fragmented health-care delivery system, non-availability of adequate skilled human resource, vast social determinants of health, inadequate finances, lack of inter-sectoral co-ordination and various political pull and push of different forces, and interests. These challenges can be met by a paradigm shift in health policies and programs in favor of vulnerable population groups, restructuring of public health cadres, reorientation of undergraduate medical education, more emphasis on public health research, and extensive education campaigns. There are still areas of concern in fulfilling the objectives of achieving UHC by 2022 regarding financing model for health-care delivery, entitlement package, cost of health-care interventions and declining state budgets. However, the Government's commitment to provide adequate finances, recent bold social policy initiatives and enactments such as food security bill, enhanced participation by civil society in all health matters, major initiative by some states such as Tamil Nadu to improve health, water, and sanitation services are good enough reasons for hope that UHC can be achieved by 2022. However, in the absence of sustained financial support, strong political will and leadership, dedicated involvement of all stakeholders and community participation, attainment of UHC by 2022 will remain a Utopia.

Aging: the triumph of humanity-are we prepared to face the challenge?

Advances in medicine have increased the life expectancy resulting in an increase in the geriatric population all over the world, and their proportion will only continue to rise in the coming years. It is known that the elderly bear a significant burden of morbidity, which is why health systems globally spearheaded by the WHO are waking up to the need for better geriatric health services. This includes India, whose health system continues to grapple with the health challenges of communicable and noncommunicable diseases. This article enumerates the various government policies and programs, constitutional and legal provisions available for the care of the elderly, and concludes that they are grossly inadequate to deal with the various physical, psychological, and emotional needs of the aging population. Mainstreaming of geriatric health to address the health needs of the elderly at all levels of health care, both in the public and the private sectors, giving due importance to multidimensional rehabilitative services and terminal care, involving NGOs and voluntary organizations, and stepping up social security in old age are the recommended measures for improving geriatric health in India.

Respiratory morbidity among welders in the shipbuilding industry, Goa.

CONTEXT: Welding is pivotal in shipbuilding. The fumes and gases involved in welding may cause respiratory morbidity. AIM: To study the prevalence of respiratory morbidity (RM) among welders vis à vis among nonwelders and its association with certain relevant factors. SETTINGS AND DESIGN: A cross-sectional study of 276 welders and 276 nonwelders was conducted in the shipbuilding industry. MATERIALS AND METHODS: An interviewer-administered questionnaire was followed by spirometric examination. STATISTICAL ANALYSIS: Odds ratio and its 95% CI and two-way ANOVA. RESULTS: Prevalence of RM was found to be significantly higher among welders compared to nonwelders (who were comparable in age, duration of employment (DOE) and smoking habits,) with odds ratio (OR) of 1.78 (95% confidence interval (CI):1.20-2.63). Obstructive type of RM was predominant in both welders (26% (n = 73)) and nonwelders (17% (n = 49)) with welders being at a significantly higher risk (OR = 1.66 (95%: 1.10-2.49)). RM was commoner after the 40 years of age or after 20 years of employment in both groups. Smoking was associated with RM among welders (OR = 1.48, 95% CI: 1.24-1.75) as well as nonwelders (OR = 2.83, 95% CI: 2.26-3.54). Work-related respiratory symptoms (WRRS) was not found to be related to RM (OR = 1.69, 95% CI: 1.00-2.84). Consistent use of personal protective equipment (PPE) was protective against RM in welders (OR = 0.33, 95% CI: 0.28-0.37). CONCLUSION: Welders had a greater burden of RM and this was related to increasing age, DOE, smoking and inconsistent use of PPE. WRRS were not indicative of RM.

Study of childhood obesity among school children aged 6 to 12 years in union territory of puducherry.

OBJECTIVE: To study the prevalence of obesity and overweight among school children in Puducherry. To identify any variation as per age, gender, place of residence and type of school. SETTING AND DESIGN: Secondary data analysis of a school-based cross sectional study in all the four regions of Puducherry. MATERIALS AND METHODS: Children between 6 and 12 yrs were sampled using multistage random sampling with population proportionate to size from 30 clusters. Anthropometric data (BMI) was analyzed using CDC growth charts. Data was analyzed using SPSS, BMI (CDC) calculator, CI calculator and OR calculator. RESULTS: The prevalence of overweight (≥85(th) percentile) among children was 4.41% and prevalence of obesity (>95(th) percentile) was 2.12%. Mahe region had the highest prevalence of overweight (8.66%) and obesity (4.69%). Female children from private schools and urban areas were at greater risk of being overweight and obese. CONCLUSIONS: Childhood obesity is a problem in Puducherry and requires timely intervention for its control.