Non-communicable diseases as a major contributor to deaths in 12 tribal districts in India.

Background & objectives: Non-communicable diseases (NCDs) are the leading cause of death in India. Although studies have reported a high prevalence of NCD in tribal populations, there are limited data pertaining mortality due to NCDs. Therefore, in this study we estimated the proportion of deaths due to NCDs among 15 yr and older age group in tribal districts in India. Methods: We conducted a community-based survey in 12 districts (one per State) with more than 50 per cent tribal population. Data were collected using a verbal autopsy tool from the family member of the deceased. The estimated sample size was 452 deaths per district. We obtained the list of deaths for the reference period of one year and updated it during the survey. The cause of death was assigned using the International Classification of Diseases-10 classification and analyzed the proportions of causes of death. The age-standardized death rate (ASRD) was also estimated. Results: We surveyed 5292 deaths among those above 15 years of age. Overall, NCDs accounted for 66 per cent of the deaths, followed by infectious diseases (15%) and injuries (11%). Cardiovascular diseases were the leading cause of death in 10 of the 12 sites. In East Garo Hills (18%) and Lunglei (26%), neoplasms were the leading cause of death. ASRD due to NCD ranged from 426 in Kinnaur to 756 per 100,000 in East Garo Hills. Interpretation & conclusions: The findings of this community-based survey suggested that NCDs were the leading cause of death among the tribal populations in India. It is hence suggested that control of NCDs should be one of the public health priorities for tribal districts in India.

Preparedness of primary & secondary care health facilities for the management of non-communicable diseases in tribal population across 12 districts in India.

Background and objectives: Non-communicable diseases (NCDs) are highly prevalent in the tribal populations; however, there are limited data regarding health system preparedness to tackle NCDs among these populations. We estimated the availability of human resources, equipment, drugs, services and knowledge of doctors for NCD management in the selected tribal districts in India. Methods: A cross-sectional survey was conducted in 12 districts (one from each State) with at least 50 per cent tribal population in Andaman and Nicobar Islands, Himachal Pradesh, Madhya Pradesh, Odisha and eight northeastern States. Primary health centres (PHCs), community health centres (CHCs) and district/sub-district hospitals (DHs) were surveyed and data on screening and treatment services, human resources, equipment, drugs and information systems indicators were collected and analysed. The data were presented as proportions. Results: In the present study 177 facilities were surveyed, including 156 PHCs/CHCs and 21 DHs. DHs and the majority (82-96%) of the PHCs/CHCs provided outpatient treatment for diabetes and hypertension. Overall, 97 per cent of PHCs/CHCs had doctors, and 78 per cent had staff nurses. The availability of digital blood pressure monitors ranged from 35 to 43 per cent, and drugs were either not available or inadequate. Among 213 doctors, three-fourths knew the correct criteria for hypertension diagnosis, and a few correctly reported diabetes diagnosis criteria. Interpretation & conclusions: The results of this study suggest that the health system of the studied tribal districts was not adequately prepared to manage NCDs. The key challenges included inadequately trained workforce and a lack of equipment and drugs. It is suggested that capacity building and, procurement and distribution of equipment, drugs and information systems to track NCD patients should be the key focus areas of national programmes.

Oral itraconazole for the treatment of severe seborrhoeic dermatitis.

BACKGROUND: Seborrheic dermatitis (SD) is an inflammatory skin disorder in which colonies of Malassezia furfur have been found in affected areas. AIM: The aim of this study was to evaluate the efficacy of itraconazole in the treatment of severe SD. MATERIALS AND METHODS: Itraconazole was given to 30 patients of SD in a dose of 100 mg twice daily for 1 week followed by 200 mg/day for first 2 days of the following 2 months. The response was noted on day 15, 30, 60, and 90. The clinical response was graded as markedly effective, effective, or ineffective. RESULTS: Clinical improvement (evaluated as markedly effective or effective) was observed in 83.3% cases. CONCLUSION: The anti-inflammatory activity of oral itraconazole suggests that it should be the first-line therapy in severe SD.

Bacteriological study of aerobic isolates from plantar ulcers of paucibacillary leprosy patients.

BACKGROUND: Plantar ulcers commonly occur in leprosy patients, which usually recur and cause morbidity in such cases. AIMS: The aim of the study is to find out the bacteriological profile of these ulcers and to find out the antibiotic susceptibility of the isolates so that appropriate drugs may be chosen for treatment and for prevention of recurrence. MATERIALS AND METHODS: Fifty-six samples from recurrent plantar ulcers of paucibacillary leprosy patients (attending the outpatient department of Calcutta School of Tropical Medicine) were studied for the purpose. Proper sample collection, gram staining, inoculation on culture media, and final identification by biochemical methods were undertaken. Antibiotic susceptibility testing was done for appropriate choice of drugs. RESULTS: Mixed growth of bacteria was seen in 20 (36%) cases while single organism was isolated from the rest. Staphylococcus aureus is the predominant single isolate followed by E. coil, Proteus sp. and Pseudomonas sp. Chloramphenicol and gentamycin are the two drugs that have shown efficacy to the extent of 75 to 100% and 25 to 100% respectively in vitro studies. CONCLUSION: Bacteriological study of plantar ulcers of leprosy patients has revealed Staphylococcus aureus as the main pathogen. Treatment with chloramphenicol and gentamycin holds good prospect as per our study.