Hypovitaminosis D, Dyslipidemia, and Thyroid Dysfunction among Adolescents and Their Associations with Blood Pressure in a Northeastern City of India.

BACKGROUND: Blood pressure (BP) is associated with serum levels of Vitamin D3, lipid profile, and thyroid hormones among adults. However, limited information is available regarding such associations in adolescents. OBJECTIVES: The objectives of this study were to estimate the prevalence of Vitamin D3 deficiency, dyslipidemia, and thyroid dysfunction among secondary school students of Agartala and to determine their associations with BP. METHODOLOGY: This cross-sectional study was conducted from April 1, 2018, to December 31, 2018, among 1000 secondary-level school students of Agartala municipal corporation area, chosen by multistage sampling ensuring proportionate representation. RESULTS: The prevalence of Vitamin D3 deficiency, thyroid dysfunction, and dyslipidemia was found to be 79.4%, 62.8%, and 37.5%, respectively. Among the respondents, 58.1% had raised BP, 16.7% were overweight, 5.3% were obese, and 48.3% had high waist-hip ratio (WHR). Among them, 70.97% of the fatty participants, 82.27% with high body mass index (BMI), and 69.05% with either low or normal WHR had significantly raised BP (P < 0.05). Out of total, 58.26% of the participants with normal serum D3 level, 59.95% with either euthyroid or hyperthyroid status, and 62.13% with dyslipidemia had raised BP, though these were not significant (P > 0.05). Binary logistic regression model has identified higher BMI, higher body fat content, high WHR, habit of consuming extra salt, and fast food on a regular basis as significant determinants of raised BP in this population (P < 0.05). CONCLUSION: Hypovitaminosis D, thyroid dysfunction, and dyslipidemia are prevalent among adolescents of Northeast India, but they did not emerge as significant determinants of BP in this population.

Cataract and Associated Factors Among OPD Attendees in a Teaching Institute of North East India: A Baseline Observation.

BACKGROUND: In India 66% of blindness among individuals aged 50 yrs and above is attributable to cataract. Cataract has multiple etiologies and many of them are modifiable. But data regarding burden and correlates of cataract among OPD attendees in Northeast India are insufficient. OBJECTIVES: To estimate the proportion of cataract among the attendees of ophthalmology OPD of a teaching hospital of Northeast India and to study the factors associated with it. METHODS: This hospital based cross-sectional study was conducted during 7th February to 6th March 2020, using a pre-tested structured interview schedule, among 330 adults attending ophthalmology OPD of Agartala Government Medical College, chosen by consecutive sampling. RESULT: Proportion of cataract among the attendees was 36.7% and it was 51.5% among the subjects aged ≥50 years. Age, family type, literacy, diabetes mellitus and hypertension had significant associations with cataract (P < 0.05). Logistic regression model has identified age ≥ 50 yrs (OR: 5.57, 95% CI: 2.98-10.43) and illiteracy (OR: 2.67, 95% CI: 1.55-4.59) as the significant predictors for developing cataract (P < 0.05) in the study population. CONCLUSION: Proportion of cataract among OPD attendees is 36.7%, which is higher than the community prevalence of cataract in Tripura. Promoting literacy, reducing family size, blood sugar and blood pressure may bring down the proportion of cataract in this population.

Teenage pregnancies, practices, and utilization of RCH services by the tribal and nontribal population of West and South Tripura districts: A mixed method study.

BACKGROUND: As per NFHS III, 4.5% of the teen aged women of Tripura were pregnant, 18.5% have begun childbearing, and 14% have given live births. OBJECTIVES: To estimate the prevalence of teenage pregnancies among tribal and nontribal population of West and South districts of Tripura, to study the social practice of care during these pregnancies, and to assess the utilization of RCH services by them. METHODS: A community-based mixed method study was conducted from 5th September 2014 to 4th September 2015 among 2108 tribal and nontribal women aged 15 to ≤18 years residing in the undivided West and South districts of Tripura chosen by multistage sampling. RESULT: Among the study women, 93.5% were married, 6.3% were unmarried, and 0.2% was either divorced or widowed. Out of total, 21.35% were pregnant and 57.92% had already delivered. ASHA services were received by 59.73% and 72.13% in West and South districts and by 68.09% and 63.69% of the tribal and nontribal, respectively. JSY registration was 53.99% and 83.43% in West and South districts and 71.56% and 66.91% among tribal and nontribal, respectively. Antenatal check-up was received by 96.26% and 90.79% in West and South districts and 89.39% and 97.66% among tribal and nontribal ever pregnant women, respectively. Home deliveries were higher among tribal and they had inadequate postnatal check-up. Practice of isolated confinement following childbirth was fewer and these rooms were unclean and ill-ventilated though normal clothing was used. Qualitative component revealed that underutilization of RCH services was mainly due to poor quality of services, ignorance, and economic constraints to reach health facility. CONCLUSION: Teenage pregnancy is prevalent in Tripura and more among tribal. Ignorance of the women and poor quality of RCH services at primary health care level are responsible for its underutilization.

Validation of Indian Diabetes Risk Score for Screening Prediabetes in West Tripura District of India.

BACKGROUND: Viswanathan Mohan and his team have developed "Indian Diabetes Risk Score" (IDRS) for identifying the Indians at risk for developing diabetes and prediabetes. Due to heterogeneity of Indian population, this risk score needs further validation in different parts across the country. OBJECTIVES: The objective is to estimate the sensitivity, specificity, positive, and negative predictive values of IDRS for screening prediabetes in West Tripura District. METHODOLOGY: It was a community-based cross-sectional study conducted in West Tripura district during January 1, 2018-December 31, 2019 among 325 self-declared nondiabetic individuals, selected by multistage sampling. Fasting blood sugar value was used as the gold standard to validate IDRS. Data were collected using a validated and pretested interview schedule. Data entry and analysis were performed in computer using SPSS-24. Receiver operating characteristic (ROC) curve was constructed to validate IDRS. RESULTS: Among the study individuals, 19% and 6.5% were identified as prediabetic and diabetics, respectively. Optimum sensitivity of 83.13% and specificity of 82.64%, with positive and negative predictive values 62.16% and 93.45%, respectively, were observed at an IDRS score of ≥60 for identifying prediabetes and diabetes in this study population. IDRS showed good accuracy with an area under ROC curve of 0.832 (95% confidence interval: 0.77-0.88). CONCLUSION: IDRS is found to be a valid tool for screening prediabetes at community level in West Tripura district of India.

Proportion of anaemia and factors associated with it among the attendees of the antenatal clinic in a teaching institute of northeast India.

BACKGROUND: Anaemia is an important cause of maternal morbidity and mortality in India. According to National Family Health Survey-4, the prevalence of anaemia among pregnant women in Tripura was 54.4%, but the proportion of anaemic women attending antenatal clinics is not known. OBJECTIVES: To find out the proportion of anaemia and associated factors among pregnant women attending antenatal clinic at Agartala Government Medical College. MATERIALS AND METHOD: This hospital-based cross-sectional study was conducted among 200 pregnant women attending the antenatal clinic of Agartala Government Medical College from 14th July to 7th August 2019 chosen by consecutive sampling. RESULTS: Majority (69.5%) of the women were aged either ≤ 25 years, 94.5% were Hindu, 37% belonged to scheduled caste community, 58.5% from a rural area, 28% belonged to BG Prasad's class II socioeconomic status and 52.5% had only primary education. The proportion of anaemia was found to be 60%. It was 63.3% among ≤ 25 years age group and 62.9% among those who studied up to primary level. Mean (SD) Hb level was 9.9 ± 0.6 g%. Among the anaemic, 57.5% were primigravida and 45% were carrying the third trimester of pregnancy. Only 1% of the study women reportedly consumed either 200 or more number of iron tablets. Age < 25 years, (OR = 1.824, 95% CI = 1.231-2.108, P = 0.003), holding BPL or similar ration cards (OR = 3.482, 95% CI = 1.201-5.371, P = 0.031) and getting at <18 years (OR = 4.482, 95% CI = 2.317-6.451, P = 0.003) were identified as the significant predictors of anaemia during pregnancy. CONCLUSION: The proportion of anaemia among attendees of the antenatal clinic was higher than the state prevalence of anaemia among pregnant women. Lower literacy, lower socioeconomic status, rural residence, etc., had significant associations with anaemia in this population.

Childhood blindness and associated factors: An observational study at the district disability rehabilitation centre, West Tripura district, India.

Background: In India, about 50% of all childhood blindness is either preventable or treatable. Hence, controlling childhood blindness may be an effective way to reduce blindness in this country in the long run. Strategies to combat childhood blindness require accurate data regarding its magnitude, distribution, and determinants in a population. In this regard, district disability rehabilitation centres (DDRC) are working in India to diagnose and rehabilitate the subjects with blindness of various degrees. Objectives: The objectives of the study are to estimate the proportion of childhood blindness among the visually challenged subjects registered under the DDRC of West Tripura district, to find out the different ocular morbidities in this population and to study the factors associated with these disabilities. Materials and Methods: This facility-based cross-sectional study was conducted using secondary data from 2,260 visually challenged subjects enlisted in the DDRC of West Tripura district of India from June 1, 2018, to May 31, 2020. Results: The proportion of childhood blindness was found to be 3.89% (88) among the visually challenged subjects catered by the DDRC of West Tripura district. About 68.18% of the study subjects belonged to the lower socio-economic class as per BG Prasad's socio-economic classification, 39.77% subjects had 30% blindness and 15.90% subjects had 100% blindness. Among these 88 cases (134 eyes) of blindness, 20.14% were refractive error, 7.50% corneal opacities, 12.68% phthisis bulbi, 3.73% congenital cataract and pseudophakia, 2.98% congenital glaucoma, 23.88% congenital globe anomalies, 8.20% retinal diseases, 11.94% nystagmus and 8.95% were due to miscellaneous causes. Conclusion: Childhood blindness is still a public health problem in this part of India. Congenital globe anomalies were found to be the commonest cause followed by refractive errors.

Associations of obesity and serum leptin level with elevated blood pressure among urban secondary school students of a northeastern city of India: A baseline observation.

BACKGROUND: Elevated blood pressure has been found to be associated with body mass index (BMI) and serum leptin levels among adults. But there is a paucity of reports regarding such associations among adolescents. OBJECTIVES: To estimate the prevalence of prehypertension and hypertension and its associations with BMI and serum leptin levels among the secondary school going students of the Agartala Municipal Corporation area. MATERIALS AND METHODS: This school-based cross-sectional study was conducted from 1st April 2018 to 31st December 2018, among 1,000 students studying in different secondary level schools located in Agartala municipal corporation area chosen by multistage sampling ensuring proportionate representation in the sample. RESULT: Prevalence of prehypertension and hypertension were found to be 42.40% and 15.70%, respectively, 55.20% had normal, 22.80% had low, and 22.00% had high BMI. Serum leptin levels were found to be normal among 54.70% of the students, whereas, 36.70% had high and 8.60% had low levels, respectively. Logistic regression analysis has identified male sex (OR = 0.231, 95% CI = 0.172-0.310, P = 0.000) and high BMI (OR = 4.289, 95% CI = 2.857-6.440, P = 0.000) as the significant determinants of elevated blood pressure, but the effect of serum leptin level and family history of hypertension did not attain the level of statistical significance. CONCLUSION: Prevalence of prehypertension and hypertension among urban school-going adolescents were found to be 42.40% and 15.70%, respectively and were significantly associated with their sex and BMI and serum leptin level, but regression analysis failed to detect any significant effect of serum leptin level in determining the blood pressure of the study subjects.

Health-Care Waste Management in Public Sector of Tripura, North-East India: An Observational Study.

BACKGROUND: Hospitals generate variety of waste which is hazardous to patients, health workers, community, and environment. Proper health-care waste management (HCWM) requires infrastructure, trained workforce, law and supervision. More than 80% of the population of Tripura depends on the public health-care system but the knowledge and practice of health-care workers regarding HCWM in the public sector of Tripura is not clear. OBJECTIVES: The objective was to assess the knowledge and practice of health-care workers regarding HCWM and to take an account of the existing HCWM facilities in the public sector of Tripura. STUDY DESIGN: This was a facility-based, cross-sectional study. MATERIALS AND METHODS: This study was conducted during 1st November 2015 to 16th October 2017 among 544 health-care workers working in thirty health institutions chosen by stratified random sampling. Data entry and analysis was performed using SPSS software version 15.0. RESULTS: Overall, 37.68% of the respondents had fair knowledge regarding HCWM, 8.27% received in-service training on HCWM, 66.17% were immunized against hepatitis B and > 90% of the respondents knew about segregation of waste at source but knowledge regarding the use of colored bins for this purpose varied widely across different categories of participants. Housekeeping staff were ignorant about most of these issues. The importance of disinfecting the waste before disposal was known to 83.63% of the workers. Proper HCWM was practiced by 39.15% and segregation of waste at source into colored bins was followed by 23.3% of the respondents. The study revealed both waste management facilities and display of waste management policy as poor. Technical qualification and in-service training were identified as the statistically significant determinants of knowledge and practice of HCWM (P < 0.05). CONCLUSION: HCWM scenario including knowledge of health-care workers in Tripura is lacking. Installing proper waste management facilities, raising technical qualification at recruitment and in-service training may improve the situation.

Determinants of child sex ratio in West and South Districts of Tripura, India.

BACKGROUND: Indian census 2011 has detected declined child sex ratio in the West and South districts of Tripura State. OBJECTIVES: To find out the sex ratio at birth and to identify the factors affecting child sex ratio in west and south districts of Tripura. METHODS: This community-based cross-sectional study combined with a qualitative component was conducted among 3438 couples chosen by multistage sampling. Quantitative data were collected by a structured interview schedule. Data were analyzed by computer using SPSS version 15.0. Chi-square test was applied for testing the significance of study findings and P < 0.05 was considered statistically significant. Qualitative data were collected by Focus Group Discussions and analyzed by qualitative free listing and pile sorting considering Smith's S value. RESULTS: Sex ratio at birth in West and South Tripura districts during 2013 was found to be 972 and 829 respectively. Son preference was higher among couples irrespective of their literacy, residence, occupation, family type and religion except Christianity. Expenditure at marriage, lesser contribution to parent's family and fears of adverse situations at in law's house after marriage etc. were causes for lesser daughter preference. Very few pregnant women underwent ultrasonography for sex determination of fetus. Girls had differential or delayed medical care and higher death rate. The desire for children was found to be limited after male births. CONCLUSIONS: Low daughter preference was mostly due to economic reasons and prolonged contraception following male birth. Literacy, occupation and residence of study subjects did not modify prevalent higher male preference.

A study to assess the emotional disorders with special reference to stress of medical students of agartala government medical college and govinda ballabh pant hospital.

BACKGROUND: Stress is very common psychological phenomena where medical students faced in day to day activities. Epidemiological studies have asserted that about 70-80% of the diseases may be related to stress. Research related to this stress especially among medical students is essential, considering their learning, role and responsibilities as a future physician and health intervention programs. OBJECTIVES: To estimate the prevalence of stress and identify stressors among medical students. MATERIALS AND METHODS: A Cross-sectional study was carried out among undergraduate medical students and self administered GHQ-12 and stressor questionnaire were used to collect information regarding stress. Binary logistic regression analysis was performed to calculate odds ratio (OR). RESULTS: Prevalence of stress was 94.52% and more common among females. 33.56% students felt constantly under strain and 25.34% had loss of sleep over worry. Majority of the students of all semesters had stress (P > 0.05) and stressors viz. 'competition for marks' (P = 0.005), 'frequent examination' (P = 0.001), 'difficulty in finding time for recreation' (P = 0.014) and 'being away from home' (P = 0.027) were predominantly experienced by the 1(st) year medical students. Multiple logistic regression analysis revealed the causal effect of main parameter on the GHQ caseness and students who found difficulties in following teaching language among the caseness had 81.59% higher chance of developing stress (OR = 8.159, CI = 1.228-54.213). CONCLUSION: The stress experience was more common due to academics and seen among all year of medical students. Strategy development for eliminating stressors is necessary for promoting healthy life.