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.

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.

A case-control study on environmental and biological risk factors for renal calculi persisting in a coastal Union Territory, India.

BACKGROUND AND OBJECTIVES: Renal stone disease is a common disorder of the urinary tract and also a significant problem because of incidence, recurrence, and severe consequences. The complex pathogenetic mechanisms of renal stone formation involve both biologic and environmental risk factors. The present study was performed to identify the role of these parameters among renal stone patients and normal individuals from a coastal union territory region in South India. METHODS: The authors conducted a case-control study of renal stone disease among outpatient department patients more than 30 years of age using systematic random sampling procedure with 100 study participants (50 subjects for each group). A questionnaire to explore some relevant history as well as to note general examination findings was used along with a house visit to collect a sample of water. Analysis was undertaken using appropriate statistical techniques. RESULTS: The study showed statistically significant association for renal stones with female sex, illiteracy, body mass index (BMI) (>25 kg/m2), sodium (>50 mg/L), water consumption (<1.5 L/day), water source being borewell, consuming soft drink, sedentary work, and family history of renal stones. The adjusted odds ratios (ORs) were significantly higher for consuming soft drink (OR: 8.19; 95% confidence interval: 1.99-33.69), sedentary work (10.01; 1.27-78.91), and water consumption < 1.5 L/day (7.73; 2.24-26.69). INTERPRETATION AND CONCLUSIONS: We conclude that in this part of India, female gender, illiteracy, high BMI, high sodium in drinking water, inadequate water consumption, borewell drinking water, soft-drink consumption, sedentary work, and family history of renal stones can lead to a significant increase in the risk of renal stone disease.

A descriptive cross-sectional study on menstrual hygiene and perceived reproductive morbidity among adolescent girls in a union territory, India.

INTRODUCTION: Menstruation is a milestone event in a girl's life and the beginning of reproductive life. Lack of knowledge and poor sanitary practices during menstruation has been associated with serious ill-health ranging from genital tract infections, urinary tract infections, and bad odor. AIM: This study aims to explore the knowledge, attitude, and practices about menstrual hygiene and perceived reproductive morbidity among adolescent school girls in Puducherry. MATERIALS AND METHODS: A school based cross-sectional study was conducted from June 2015 to July 2015 in Puducherry among 242 adolescent school girls in the age group of 12-18 years using multistage random sampling technique. Data were collected using a predesigned pretested, structured proforma by personal interview method after having informed written consent. RESULTS: The mean age for menarche was 12.99 ± 0.9 years; 51.7% of respondents were not aware of menstruation before attaining menarche; 71.5% and 61.2% were not known about the cause and source of the menstrual bleeding, respectively; 78.1% used only sanitary pads whereas 21.9% used both old clothes and sanitary pads as the absorbents. Unsatisfactory cleaning of the external genitalia was practiced by 12% of respondents. Higher prevalence of dysmenorrhea (82.2%) was mentioned by the respondents; 25.2% reported excessive genital discharge. Statistically significant association was found between perceived reproductive morbidity and poor menstrual hygiene practices. About 88.4% of the study population reported any one of the reproductive morbidity, and only 37.4% sought for medical treatment from a health facility. CONCLUSION: The present study has underscored the necessity of adolescent girls to have adequate and precise knowledge about menstruation before menarche. Proper menstrual hygiene practices which could be imparted through appropriate interventions at earlier stages of life can prevent the girls and women from suffering reproductive morbidities.

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.

Knowledge, attitude and practices regarding work related hazards among salt workers in Marakkanam, Tamil Nadu

Background: The salt pan workers are exposed to severe health hazards like extreme heat, intense manual labour, direct contact with salt, sunlight glare from salt crystals. This paper describes their knowledge, attitude and practices (KAP) regarding their work related hazards as well as availability and use of personal protective equipments (PPEs).Methods: A community based cross sectional study was conducted in 4 randomly selected villages among the 10 salt worker villages in Marakkanam, Tamil Nadu. A house to house survey of the selected villages enrolled 331 salt workers. The data was collected using a pre designed and pre tested questionnaire.Results: Majority of salt worker (78.5%) reported of being aware of one or more hazards like physical stress (70.7%), direct sunlight (38.7%) and glare from salt crystals (16%) in salt work that resulted in musculoskeletal problems, ophthalmic problems, headache and giddiness. 87% of the salt workers were aware of one or the other personal protective equipments. However, only less than 10% were using the conventional PPEs. The reasons for not using PPE were mainly inconvenience in using and PPE not provided by the employer.Conclusions: Most of the study population is aware of the hazards as well as one or the other methods of protective equipment but actual use of PPE is very low because of non-availability and perception of inconvenience in using them. There is a large gap between awareness and practice regarding PPE usage among these salt workers.

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.

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.

Patient and health system delay among new pulmonary tuberculosis patients diagnosed at medical college hospitals in Puducherry, India.

Background: Early diagnosis of the disease and prompt initiation of treatment are essential for an effective tuberculosis (TB) control program. The delay in the diagnosis and treatment may worsen the disease, increases the risk of death and enhances tuberculosis transmission in the community. This study was done to assess the extent of various delays and their determinants among TB patients. Methods: A cross-sectional study including retrospective medical record review and patient interviews was conducted during the year 2010 in and around union territory of Puducherry in India. A structured questionnaire used in the WHO multi-country study to estimate the diagnostic and treatment delay in TB was used to interview the patients. Average estimates and proportions were calculated for continuous and categorical variables respectively. Unadjusted odds ratios (OR) were calculated. Level of significance was determined at 95% confidence level (P value <0.05) and all tests applied were two-sided. Results: A total of 138 new sputum smear positive TB patients were included in the study. The mean age of participants was 41.8 years ± 17.3 years (range 15-87 years). Majority (67.4%) of the patients were male and married (68.8%). Majority (86%) of the patients were literate. The median patient delay, health system delay and total delay was 36 days, 28.5 days and 81 days respectively. The place of residence (OR = 0.39, 95% CI = 0.18-0.87) and family size (OR = 0.45, 95% CI = 0.21-0.97) were found as the determinants of various delays for TB patients. Conclusion: Patient and health care system delay for TB patients is long. There is need to improve the referral mechanism to ensure an early initiation of treatment for TB patients diagnosed a tertiary care hospitals.

Prevalence of diagnosed diabetes in an urban area of Puducherry, India: Time for preventive action.

BACKGROUND: Epidemiological studies in India have shown that the prevalence of diabetes in the population is at least twice the number of persons diagnosed with diabetes residing in the given area. Similarly, community-based prevalence figures are unavailable in Puducherry,. AIMS: The aim of this study was to estimate the number of persons diagnosed with diabetes mellitus in Puducherry. SETTING AND DESIGN: This study was conducted in the service area of the Urban Health Centre (UHC), Pondicherry Institute of Medical Sciences (PIMS), Puducherry with retrospective data from family records. METHODS: The diagnosis of diabetes was retrospectively documented by reviewing all family folders of 2667 families (Population 11,835) for the period of 1/1/2003 to 31/12/2006. The data was verified by home visits from January until March, 2007. The case definition used, was a resident diagnosed with diabetes by a medical doctor and who was on antidiabetes treatment for at least the past six months. RESULTS: We found 643 individuals who had been diagnosed with diabetes. The prevalence of known diabetes was estimated to be 5.6% (5.31% in males and 6.1% in females). The age-sex specific prevalence was estimated using the 2001 Census data. There are about 48,876 known diabetics living in Puducherry. CONCLUSIONS: (1) Community-based health surveillance data comprise a useful tool to measure the prevalence of diagnosed cases of diabetes mellitus within the Indian context; 2) Diabetes mellitus is an important public health priority requiring urgent preventive action as there are about 97,752 persons in Puducherry who have either been diagnosed with diabetes or remain undiagnosed for the disease.