Hypertension in urban slums of southern India: Burden, awareness, health seeking, control and risk factor profile.

INTRODUCTION: Hypertension is the leading risk factor for global disease burden. Inequalities in health among urban poor and non-poor is a matter of concern. The current study was done to estimate the prevalence of hypertension and to describe the health seeking and risk factor profile of people with hypertension in the urban slums of Kochi, Kerala, India. METHODS: Blood pressure of 5980 adults from 20 randomly selected slums were measured by door to door survey by trained nurses as a part of baseline assessment for a cluster randomised controlled trial. RESULTS: Prevalence of hypertension was found to be 34.8% (95% CI 33.5-34.9). Among those with hypertension, 66.9% were aware of their hypertensive status, of which 75.8% were initiated on treatment for hypertension. Proportion of hypertensive in the population who had their blood pressure under control was 24.5%. Among hypertensive, 53% were obese, 25.1% had diabetes mellitus, 14% had history of hospitalisation for high blood pressure. Of them, 60.3% had a per capita salt consumption above 8 g/day and 47.5% of them reported sitting for more than 8 h on a usual day. Mean monthly out of pocket expenditure for treatment of hypertension was $9(Median $8, IQR $16). CONCLUSION: One in three adults in urban slums of Kochi had hypertension. High rates of obesity, salt intake, physical inactivity prevails among the people with hypertension. Awareness, treatment initiation and control rate of hypertension are lower in urban slums as compared to non-slum urban areas. Slums require additional attention to ensure equitable and universal access to hypertension control.

Effectiveness of a community-based education and peer support led by women's self-help groups in improving the control of hypertension in urban slums of Kerala, India: a cluster randomised controlled pragmatic trial.

BACKGROUND: With less than 20% of people with hypertension achieving their target blood pressure (BP) goals, uncontrolled hypertension remains a major public health problem in India. We conducted a study to assess the effectiveness of a community-based education and peer support programme led by women's self-help group (SHG) members in reducing the mean systolic BP among people with hypertension in urban slums of Kochi city, Kerala, India. METHODS: A cluster randomised controlled pragmatic trial was conducted where 20 slums were randomised to either the intervention or the control arms. In each slum, participants who had elevated BP (>140/90) or were on antihypertensive medications were recruited. The intervention was delivered through women's SHG members (1 per 20-30 households) who provided (1) assistance in daily hypertension management, (2) social and emotional support to encourage healthy behaviours and (3) referral to the primary healthcare system. Those in the control arm received standard of care. The primary outcome was change in mean systolic BP (SBP) after 6 months. RESULTS: A total of 1952 participants were recruited-968 in the intervention arm and 984 in the control arm. Mean SBP was reduced by 6.26 mm Hg (SE 0.69) in the intervention arm compared with 2.16 mm Hg (SE 0.70) in the control arm; the net difference being 4.09 (95% CI 2.15 to 4.09), p<0.001. CONCLUSION: This women's SHG members led community intervention was effective in reducing SBP among people with hypertension compared with those who received usual care, over 6 months in urban slums of Kerala, India. TRIAL REGISTRATION NUMBER: CTRI/2019/12/022252.

Seroconversion and side effects after COVID vaccination among persons with type 2 diabetes in urban, rural, and tribal areas in Kerala, India.

Background: Persons with type 2 diabetes mellitus (T2DM) are at high-risk for COVID-19 infection and are a priority group for vaccination. Objectives: The objective of this study is to estimate the seroconversion and determine the side effects after COVID-19 vaccination among persons with T2DM in urban, rural, and tribal areas in Kerala. Methods: A cross-sectional study was conducted in urban, rural, and tribal field practice areas of a medical college in Central Kerala, among 396 persons with T2DM. The participants were selected by simple random sampling from the 200-250 diabetic patients visiting each health center. Qualitative and quantitative estimation of antibodies were done by WANTAI Ab enzyme-linked immunosorbent assay kit and Abbott SARS COV-2 IgG Quantitative assay, respectively. Results: The mean age of the respondents was 59.40 ± 12.25 years. A majority (65.5%) had received both doses of vaccine. About half (51.5%) experienced side effects after vaccination. Antibodies (IgG or IgM) were detected in 93.2% (95% confidence interval [CI] 90.2, 95.5) of participants. Those with a duration of diabetes ≥5 years, with a single dose of vaccine, were five times (adjusted odds ratio [aOR] - 5.23,95% CI 1.86, 14.66) and four times (aOR - 4.11, 95% CI 1.66, 10.13) more likely, respectively, to be seronegative. Those who took medication for diabetes were protected against a no antibody (aOR - 0.05, 95% CI 0.02, 0.148) response. The median antibody titer in a subset (150) of participants was 365.2 (90-1587) AU/ml. Past COVID infection was an independent determinant of high IgG titers (aOR - 4.95, 95% CI 1.50, 16.36). Conclusion: Reinforcing the importance of vaccination particularly among those with longer duration of diabetes is imperative.

Assessment of respiratory morbidity among bus drivers and conductors of the state road transport corporation, Kochi, Kerala.

INTRODUCTION: In 2012, 8% of the 2.3 million work-related deaths globally were from chronic respiratory diseases (CRDs). This study was undertaken to estimate the prevalence of respiratory morbidity among the drivers and conductors of the public road transport network in Kochi. METHODOLOGY: A cross-sectional study was carried out in the public bus stand (South), Kochi between September 2015 and 2017 among bus drivers and conductors. The interview was conducted among 300 bus drivers and conductors using a locally adapted version of ATS-DLD-78-A questionnaire. Lung function assessment was done using a Mini Wright peak flow meter and a portable spirometer. Data were tabulated using MS Excel and analyzed using SPSS v20. RESULTS: The prevalence of CRD among bus drivers and conductors was found to be 9.97% (95% CI 7.34-14.66) and chronic respiratory symptoms were found to be 19.2% (95% CI 14.58-23.82). On logistic regression, the independent predictors for the CRD were found to be working for more than 15 h/day (OR 2.815, 95% CI 1.26-6.28) and working for more than 4 days/week (OR 2.462, 95% CI 1.12-5.39). CONCLUSION: CRD exists as a public health problem affecting approximately one in ten bus drivers and conductors in Kochi city. Applying the logical principles of ergonomics by modifying duty hours may be considered.

Nutritional Assessment of Tribal Women in Kainatty, Wayanad: A Cross-Sectional Study.

INTRODUCTION: Women from a society reflect the culture that they are a part of and tribal women are the most disadvantaged considering the levels of illiteracy and ignorance. As per the National Family Health Survey 4 reports, in Kerala, undernutrition is particularly common among women from scheduled tribes, 20%. This study was done to assess the nutritional status and its associated factors among tribal women in the reproductive age group at Wayanad. MATERIALS AND METHODS: A hospital-based cross-sectional study was carried out during January 2017 at Amrita Kripa Charitable Hospital in Kainatty, Wayanad. The minimum calculated sample size was 186. Using systematic random sampling, every third tribal woman in the age group of 15-49 years attending the general outpatient department as patient or bystander was interviewed using a pretested semi-structured questionnaire and examined for height, weight, body mass index, and pallor. Data were analyzed using SPSS version 21. RESULTS: Data were collected from a total of 223 study participants; 53.8% of them were undernourished (<18.5 kg/m2) with 25% severe underweight and 3.1% and 2.7% preobese and obese women. Participants who were <30 years of age (0.001), those who used smokeless tobacco (0.008), and women from the Paniya tribe 0.001 had significantly higher odds of undernutrition. CONCLUSION: Almost one-fourth of the study participants were severely undernourished and 5.8% belonged to obese and preobese categories, thereby indicating the gravity of the nutritional difficulties among tribal women. A well-planned and coordinated effort is needed to address the scenario of malnutrition among tribal women.