Prevalence of psychological morbidity and its correlates among school-going adolescents of urban Puducherry, India.

Background Experiencing poor mental health during adolescence predisposes an individual to psychiatric morbid conditions in adulthood. We estimated the prevalence of psychological morbidity and its associated factors, among school-going adolescents in higher secondary schools of urban Puducherry. Methods We did this cross-sectional study among adolescents studying in classes 11 and 12 from selected schools of urban Puducherry, including one government and three private schools. Study tools used were the General Health Questionnaire-12 and Perceived Stress Scale-10 to assess psychological morbidity and perceived psychological stress in adolescents, respectively. Risk factors in academic, environmental, personal and health-related domains were captured using a structured questionnaire. Study questionnaires were self-administered by the participants in classrooms. Bivariate and multivariate analyses were done to identify risk factors for psychological morbidity. Results Of the 820 adolescents surveyed, the prevalence of psychological morbidity was 25.4% (95% CI 22.4- 28.5). Academic factors such as reporting peer pressure for academic performance and lack of extracurricular activities at school were associated with psychological morbidity. Among health-related factors, adolescents who reported having difficulty in coping with pubertal changes, being worried about their physical appearance, reporting substance abuse and experiencing sleep disturbances had greater chances of having screened with psychological morbidity. Of note, adolescents with psychological stress had 2.5 times higher chances of having psychological morbidity. Conclusions We estimated that 1 in 4 school-going adolescents in urban Puducherry suffered psychological morbidity. Reducing the academic burden and advocating health promotion through a life skills approach may improve mental wellness in Indian adolescents.

Prevalence and correlates of elder abuse: A cross-sectional, community-based study from rural Puducherry.

Background: Elder abuse is a neglected problem and needs to be addressed to improve the quality of life (QoL) of the elderly. We aimed to study the correlates of elder abuse in rural Puducherry. Methods: We conducted a cross-sectional, communitybased study among all the elderly people (60 years and above), from one of the four villages of a rural primary health centre in Puducherry. Participants were contacted at their homes. After obtaining consent, data were collected using (i) a structured, pre-tested questionnaire on sociodemographic details; (ii) elder abuse using the Hwalek-Sengstock Elder Abuse Screening Test; and (iii) QoL using WHO QoL-BREF. Multivariable logistic regression was used to identify predictors of elder abuse. Results: Of the 243 elderly individuals studied, 63% were women. The prevalence of elder abuse was 50.2%. On multivariable analysis, elderly with higher education status were found to have lower odds for suffering from abuse (primary education odds ratio [OR] 0.39 [0.18-0.84]; middle school OR 0.35 [0.14-0.86]; high school OR 0.08 [0.01-0.4]) compared to those with no formal education and those above 80 years of age were found to have higher odds for abuse (OR 3.02 [1.1-7.9]) compared to those <80 years, after adjusting for confounders such as sex, socioeconomic status, marital status and living arrangement. Conclusion: Half the elderly in our sample suffered from abuse. The higher age group and absence of formal education emerged as independent predictors of elder abuse.

Clustering of cardiovascular disease risk factors - Syndemic approach: Is sit a time to shift toward integrated noncommunicable disease clinic?

BACKGROUND: The concurrent occurrence of many noncommunicable disease (NCD) risk factors is common, and it can play a synergistic role in occurrence of NCDs. OBJECTIVES: This study aimed to identify the magnitude of clustering of NCD risk factors, patterns of risk factors emerged in clustering, and variations in clustering of risk factors based on socioeconomic factors. METHODS: A cross-sectional survey was undertaken in an urban area of Puducherry among 2399 adults during 2014-2015. Sociodemographic and behavioral risk factors were assessed through a validated STEPS survey tool. Individuals with three or more risk factors were classified to have clustering of NCD risk factors. Socioeconomic positions in relation to clustering were identified through Chi-square analysis followed by multiple logistic regression where clustering at family and area was adjusted through multilevel modeling techniques. RESULTS: Of the 2399 adults, 1741 (73%) had clustering of NCD risk factors. Inadequate consumption of fruits and vegetables, high salt intake, and high waist circumference are the three predominant risk factors across all subgroups. Adults belonging to Christian religion (adjusted odds ratio [adjOR]: 2.8, 95% confidence interval [CI]: 1.5-5.2), aged 35 years and over (adjOR: 2.0, 95% CI: 1.4-6.0), and illiterates (adjOR: 1.8, 95% CI: 1.1-5.5) are more likely to have clustered NCD risk factors compared to others. CONCLUSIONS: Clustering of NCD risk factors is highly prevalent in this region and mainly driven by dietary practices and obesity measures. There is an urgent need to reorient the health system toward integrated approach with mandated inclusion of nutritionist in NCD health service delivery.

Epidemiology of mental disability using Indian Disability Evaluation Assessment Scale among general population in an urban area of Puducherry, India.

BACKGROUND: There is paucity of information on epidemiology of mental disability in India. OBJECTIVE: The objective of this study was to assess mental disability, and to study the association between sociodemographic and comorbid chronic conditions with mental disability. MATERIALS AND METHODS: This community-based cross-sectional study was conducted among ≥5 years age group in an urban area attached to a Tertiary Care Medical Institute in Puducherry, India. Mental disability was assessed using Indian Disability Evaluation and Assessment Scale. Chronic morbid conditions and other associated factors were collected using pretested questionnaire. STATISTICAL ANALYSIS: Univariate and multiple logistic regression analysis. RESULTS: About 2537 subjects were covered with a response rate of 94.1%. Overall, the prevalence of mental disability was found to be 7.1% (181/2537). Among them, majority had mild mental disability (151, 83.4%), followed by moderate (21, 11.6%), severe (8, 4.4%), and profound (1, 0.6%) mental disability. Univariate analysis showed that age group status, marital status, education level, occupation, family type, religion, hypertension, joint pain, backache, current smoking, current alcohol use, and conflicts were associated with mental disability (P < 0.05). Multiple logistic regression analysis showed that male gender (adjusted odds ratio [AOR] =2.064), widowed status (AOR = 27.022), separated/divorced status (AOR = 16.674), currently married status (AOR = 18.487), being illiterate (AOR = 4.352), having 1st-10th standard education (AOR = 2.531), being in an unskilled (AOR = 0.287) or semiskilled/skilled occupation (AOR = 0.025), belonging to a nuclear family (AOR = 1.816), and absence of family conflicts (AOR = 0.259) were significantly associated with mental disability compared to their counterparts. CONCLUSION: Mental disability is more common in this area. Males, lesser education level, skilled or unskilled occupation, nuclear family, and conflicts were associated with mental disability after adjusting other variables. Multicentric cross-sectional analytical studies will explore the mental disability burden and its associated factors at regional or country level.

Impact of attendance in a daycare centre on depression among elderly in rural Puducherry: A pre- & post-intervention study.

BACKGROUND & OBJECTIVES: Depression is higher in the elderly and in the rural areas in India. There is a need for interventions to reduce depression among the elderly and improve their quality of life (QOL). This study was conducted to assess the impact of attendance at a community-based daycare centre in rural Puducherry, India, on depression, cognitive impairment (CI) and QOL of the elderly. METHODS: This was a before and after intervention study with a daycare centre set up in the village Thondamanatham in Puducherry, India, between January 2013 and January 2014. Socializing activities were held at the centre with psychological counselling. Depression was measured using Geriatric Depression Scale (GDS, short form), CI using the Hindi Mini-Mental Status Examination and QOL using WHO QOL BREF. RESULTS: There were 99 males and 164 females; of whom 42.2 per cent attended the daycare centre at least once a month. Significantly higher proportions of elderly had depression among those with lower frequency of attendance at the daycare centre. Irrespective of the pre-intervention status, attendance at the daycare centre reduced the probability of depression by about 51 per cent. There was an improvement in the WHO QOL scores in the social domain among those who attended more than once a month. INTERPRETATION & CONCLUSIONS: GDS scores decreased and WHO QOL scores increased with increasing attendance at the daycare centre. Thus, the intervention was found to be effective in reducing depression and improving QOL of the elderly.

Is rule of halves still an occurrence in South India: Findings from community-based survey in a selected urban area of Puducherry.

BACKGROUND: The objective of the present study was to assess the applicability of the rule of halves in an urban population of Puducherry, South India. We also aimed to find the correlates associated with undiagnosed hypertension to facilitate targeted screening. METHODOLOGY: We derive our observation from a community-based cross-sectional study conducted using the World Health Organization STEPwise approach to surveillance in urban slum of Puducherry during 2014-15. Blood pressure (BP) was measured for all the study subjects (n = 2399), and the subjects were classified as hypertensive using Joint National Committee 8 criteria, systolic BP (SBP) ≥140 mm Hg and/or diastolic BP (DBP) ≥90 mmHg and/or known hypertensives and/or treatment with antihypertensive drugs. Controlled hypertension was defined as SBP <140 mmHg and DBP <90 mmHg. RESULTS: Of 2399, 799 (33.3%; 95% confidence interval [CI]: 31.4%-35.2%) adults were found to have raised BP by any means (known and unknown hypertensives). Of the 799, 367 (15.3%; 95%CI: 13.9%-16.8%) of study participants were known hypertensives. Of the known hypertensives, 74.7% (274/367) were put on treatment (drugs and or lifestyle modification), and 80% (218/274) were on regular treatment. Higher proportions of men were found to have undiagnosed hypertension compared to women (26.1 vs. 19.8%, P < 0.001). Similarly, adult from below poverty line (23.8 vs. 20%, P < 0.001), unskilled laborer (26.6 vs. 20%, P < 0.001), and literacy less than middle school (12.3 vs. 23%, P < 0.001) had more undiagnosed hypertension. CONCLUSION: In the selected urban area of Puducherry around one-third of the adult populations are having hypertension, including the 54% of undiagnosed hypertension. Adults from the vulnerable subgroups such as lower level of literacy, below poverty line, and unskilled work are found to have higher proportions of undiagnosed hypertension.

Student-centred learning in Community Medicine: An experience from Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry.

BACKGROUND: Student-centred learning (SCL) places the student at the centre of policies, practices and decision-making in the teaching-learning process. SCL methodology also advocates active involvement of students in the curriculum planning, selection of teaching-learning methods and assessment process. We planned an education innovation project to assess the perception of fifth semester undergraduate medical students towards implementation of an SCL methodology. METHODS: The study was done among 87 fifth semester undergraduate medical students (batch of 2010-11) in the noncommunicable disease epidemiology section of Community Medicine at the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry. The students divided themselves into seven groups and developed the learning objectives, selected teaching-learning methods and assessment process for each session. The facilitators had 3-5 rounds of interaction with each group before the session. Qualitative analysis of feedback collected from students and external faculty after each session was done. The effect of implementing the SCL methodology was assessed by the reaction level of Kirkpatrick's training evaluation model by using a rating scale Results. Of the 87 eligible students, 73 (83.9%) returned the forms for evaluation. All seven groups were able to formulate the learning objectives. Most of the groups had used PowerPoint slides and videos as a teaching-learning tool. Innovative assessment methods such as crosswords and 'chocopati' were used by some groups. In general, the perception of students was favourable towards SCL compared to conventional methods and they felt that this methodology should be adopted more often. Time management and organization of sessions were the main problems encountered by the students. The mean (SD) score for the items 'sessions were useful', 'sessions were enjoyable' and 'sessions improved my knowledge' were 6.2 (1.8), 7.1 (1.8) and 6.3 (1.9), respectively. CONCLUSION: The majority of students found the sessions on innovative teaching-learning and assessment techniques enjoyable, useful and informative. The sessions showed that students took an active part in curriculum planning, execution and evaluation.

Self-directed learning readiness among fifth semester MBBS students in a teaching institution of South India.

BACKGROUND: Lifelong learning is a skill that must be acquired by medical graduates and proposes that students take the responsibility for learning process. The present study was carried out to measure readiness for self-directed learning among fifth semester MBBS studentsin a tertiary care teaching hospital. METHODS: Readiness assessment was carried out among 87 fifth semester MBBS students using Fishers' 40-item self-directed learning readiness score (SDLRS) instrument after taking informed written consent. A total of 40 items were classified into three domains: Self-management (9 items), desire for learning (16 items) and self-control (15 items). Institute scientific society and ethical committee clearance was obtained. The data were entered and analyzed using IBM-SPSS version 21. Chi-square test was used to elicit relationship between readiness assessment and gender, presence of a physician in family and area of residence. RESULTS: Out of 87 students, 64 (73.5%) students consented to be assessed for readiness toward self-directed learning. The mean SDLRS score was 140.4 ± 24.4, with 19 students (30%) scoring more than 150 indicating high readiness.The mean scores in the three domains of self-management, desire for learning and self-control were 38.8 ± 9.8, 47.3 ± 6.9 and 54.3 ± 10.4, respectively. Males had a higher readiness for self-directed learning than females (P = 0.045). DISCUSSION: Self-directed learning scores were lower among our MBBS students than reported elsewhere in the literature.

Assessment of village water and sanitation committee in a district of Tamil Nadu, India.

A descriptive study was conducted among 75 members of five Village Water and Sanitation Committees (VWSCs) and 15 local residents in Tamil Nadu, India to assess committee's formation and decision making process. There were 64% females and rest were males, all aged between 20 years and 45 years. A total of 50.7% of them passed 12 th standard and 29.3% belonged to self-help groups. Although, all of them were aware about presence of guidelines, none of them knew its contents. About 20% opined that meetings were not being conducted regularly. All members said that they had problems in attending meeting regularly, take decisions if at least 10 (67%) members are present and fund was not adequate for 1 year period. One-third of local residents did not know the committee formation process and none of them aware about guidelines. Formation and decision making process of VWSC should be improved to tackle the sanitation problem.

Molecular characterization of Giardia intestinalis assemblages in children among the rural and urban population of Pondicherry, India.

Introduction: Giardiasis is one of the greatest public parasitic infections causing diarrheal and also known to be associated with high morbidity and mortality, among the children's particularly in developing countries with less cleanliness practices. Thus, studying genomic variety of Giardia intestinalis aids to improve our perspective related to the variability in the genome of the parasite. Materials and Methods: In this cross-sectional study, 1006 stool samples were collected from the rural (n = 500) and urban settings (n = 506) from the children (<15 years) with and without symptoms and were screened for the presence of G. intestinalis by polymerase chain reaction (PCR) targeting triosephosphate isomerase gene. Further, all PCR-positive amplicons were subjected to restriction fragment length polymorphism using RsaI restriction enzyme. Results: Of the total 1006 stool samples, 500 samples from rural screened by PCR 108 (21%) were found to be positive for assemblage A, 116 (23.2%) belong to assemblage B, and 5 (1%) were mixed assemblages (A + B). Whereas in urban, of the 506 samples screened by PCR, 92 (18.1%) were found to be positive for assemblage A, 93 (18.3%) assemblage B, and 10 (1.9%) were mixed assemblages (A + B). No significant difference was found between the G. intestinalis assemblages with clinical details of symptomatic and asymptomatic in children. Conclusions: This signifies the first study inspection in our location to shed lights and delivers some preliminary data on assemblages and subassemblages. The results suggest that anthroponotic transmission could be a foremost transmission path for giardiasis among the study population.

Geographical Information System-Aided Noise Pollution Mapping of Urban Puducherry, South India.

Context: Noise pollution and its influence on environmental and quality of human life are a major concern and hot topic of scientific research in the twenty-first century. Aims: Spatial analysis of noise pollution in urban Puducherry, South India. Settings and Design: Cross-sectional study conducted in 36 locations of urban Puducherry. Methods and Material: Noise measurements were taken using a calibrated NOR 132 digital sound level meter using the prescribed parameters set by the Central Pollution Control Board. Geo coordinates were taken using Garmin Oregon 550 GPS. Noise measurements were classified according to the Bureau of Indian Standards for town planning into five zones. Statistical Analysis Used: Noise pollution map of urban Puducherry for three time points of the day was generated using ArcGIS Desktop v10.3 with Geo-statistical module and Inverse Distance method. Results: Seventeen percent of the sites are high noise sources (80-90 dB), two thirds (65%) of the study sites fall into concentrated average noise zones (70-80 dB), and less than one fifth (18%) of the study sites are in relatively quiet zones across different measurement time slots. Conclusions: Long-term strategy for noise control should be incorporated in the development of new townships and other infrastructures in accordance with the noise control norms. Implications for future research include monitoring noise pollution levels in rural areas and health effects of noise pollution in bystanders and drivers.

High Prevalence of Prehypertension and its Association with Modifiable Risk Factors: Findings of Household STEPS Survey from Urban Puducherry, South India.

BACKGROUND: Prehypertension increases the likelihood of hypertension, cardiovascular diseases, and renal failure, and it is amenable to control if it is detected early. The burden of prehypertension prevalent in the community is not much explored. This study aimed to estimate the prevalence and to identify the socio-behavioral and dietary factors related to prehypertension in South India. METHODS: A community-based cross-sectional study was carried out where data related to socio-demographic status, substance use, dietary patterns, physical activity, and associated comorbidities were assessed using the WHO STEPwise survey tool. Adults aged >=18 years who were not previously diagnosed and treated for hypertension were assessed for prehypertension. Prevalence of prehypertension is reported as percentage with 95% CI. Association was reported as adjusted prevalence ratio obtained through multivariable log binomial regression adjusted for potential confounders. RESULTS: Among 2399 participants, 2213 underwent screening. Among 2213 adults, 810 (36.6%, 95% CI: 34.6-38.6%) were in the prehypertension range. The adjusted prevalence for prehypertension was 36.2% among males and 37.2% among females, respectively. Being in the age group of 45-54 years aPR-1.36, body mass index (BMI) >23 Kg/m2 aPR-1.25, consumption of more than 6 grams of salt per day aPR-1.15 times were more likely to be associated with prehypertension. The comorbid conditions such as diabetes are less likely to be associated with prehypertension aPR-0.54 (0.41-0.72). CONCLUSIONS: This community-based surveillance showed 36% of prehypertension among adults which would have been missed if we were to follow the routine cares such as opportunistic and high-risk-based screening. Since prehypertension increases the risk for various end organ failures, there is an impending need to focus on screening and promote healthy lifestyles.

Coverage of and compliance to iron supplementation under the National Iron Plus Initiative among reproductive age-group women in urban Puducherry - a cross-sectional study.

BACKGROUND: Anaemia is a global health problem and an important cause of morbidity in all age groups, especially among women and children. Various programmes have been implemented to combat anaemia in India and National Iron Plus Initiative (NIPI) is the latest programme to be implemented. AIM: To ascertain the proportion of reproductive age women receiving iron supplementation under the NIPI and assess the compliance and factors hindering the implementation and compliance of the programme. MATERIALS AND METHODS: A cross-sectional study was conducted among women of reproductive age (15-49 years) during November 2017. The participants were interviewed at their household using a pre-tested semi-structured questionnaire to obtain information on socio-demographic details, whether they were receiving iron supplements and compliance to the programme. RESULTS: Out of 302 study participants, only 138 (45.7%) were found to be receiving the supplements under the NIPI. The major source of iron supplementation was various health facilities (69.4%). Of those not receiving the tablets, 96.3% were non-pregnant non-lactating women. The proportion of study participants receiving iron supplementation through house visits by auxiliary nurse mid-wives (ANMs) was only 1.45%. Of the 138 women receiving supplementation, 85 (61%) were compliant with their medication. Compliance also tended to be higher among pregnant and lactating women. The most important reasons for non-compliance were adverse effects and forgetfulness. The presence of regular house visits by ANMs had a significant association with reception of tablets [prevalence ratio (PR)-1.43]. Pregnant women had a significant association with both reception (PR-2.19) and compliance (PR-1.8) with iron supplementation. CONCLUSION: The current NIPI programme needs to be regularly evaluated to ensure its effective implementation. Importance should be given to non-pregnant non-lactating women to increase coverage among them.

Prevalence of intestinal parasites among rural and urban population in Puducherry, South India - A community-based study.

INTRODUCTION: Developing country, like India intestinal parasitic infections are still remaining as the most important health problem in public of concern. The infection remains the most leading cause of morbidity and mortality especially among the childrens. It is presumed that the prevalence is high in developing countries probably due to poor sanitary conditions and improper personal hygiene practice. AIM: The main aim of this study was carried to find out the prevalence of intestinal parasitic infection among rural and urban population of Puducherry, India. MATERIALS AND METHODS: This is a cross-sectional descriptive study carried out between the period September 2016 to December 2018. Random sampling was adopted to collect stool samples from urban and rural population in Puducherry. A door to door survey was done. Stool samples were collected from rural setting (n = 500) and urban setting (n = 506) and transport to the parasitology section, Dept. of Microbiology, JIPMER were subjected to routine stool investigations. The results were recorded, and data were presented in the form of frequency and distribution. Data entry was done in MS Excel and analysis was carried out in SPSS software version 22. RESULTS: Among the rural and urban population, 500 stool samples from the rural population showed nearly 40.4% intestinal parasites Giardia intestinalis (21.2%), Blastocystis spp (8.8%), Entamoeba spp (6.6%), hookworm (2.8%), Ascaris lumbricoides (1%), Hymenolepis nana (0%) and 506 stool samples from urban population showed 20.3% of intestinal parasites (Giardia intestinalis (10.4%), Blastocystis spp (3.7%), Entamoeba spp (3.3%), hookworm (1.7%), Hymenolepis nana (0.9%), Ascaris lumbricoides (0%). There was a noticeable male predominance pattern (31.4%) compared to female showing 29.1% positivity. The increase in the prevalence of intestinal parasites among rural population than the urban population was statistically significant. CONCLUSION: The stool samples collected from rural population showed high prevalence of intestinal parasite infestation when compared to urban population, hence necessary interventions like health education, awareness creation and medical intervention should be undertaken particularly among the rural population. In our study population, age group between 1-10 years are predominantly infected with these parasites.

High prevalence of anemia among postnatal mothers in Urban Puducherry: A community-based study.

BACKGROUND: Anemia is a common problem across all life stages and ages with a higher burden among women. The postnatal period is an often-neglected period for the provision of effective care to the mothers. Anemia burden is also high during this period, which leads to many morbidities and poor quality of life. METHODS: A community-based cross-sectional study was done in the field practice area of two Urban Primary Health Centres (PHCs) in Puducherry between March 2015 and February 2016. A total of 227 postnatal mothers were selected by simple random sampling from the list of mothers delivered from the field practice area. House visit was done within 4 weeks of completion of their postnatal period. Socio-demographic details and third-trimester hemoglobin levels were collected using a pretested questionnaire. Hemoglobin level during post-partum was measured using Sahli's Hemoglobinometer. Paired t-test is done to assess the difference in hemoglobin antepartum and post-partum. Multiple Logistic Regression is done to identify factors associated with postpartum anemia. RESULTS: The mean (SD) hemoglobin during postpartum was 10.95 (1.1) gm% ranging from 7.4 gm% to 13.8 gm%. The prevalence of anemia among postnatal mothers is 76.2% (n = 173, 95% CI: 70.4%-81.4%). Around 26% (59) had mild anemia, 49.8% (113) had moderate anemia and 0.4% (1) had severe anemia. One-fourth of the mothers who had a normal hemoglobin level in their third trimester had developed anemia in the postnatal period. There was a significant difference in mean hemoglobin during postpartum and that of third trimester (10.95 vs 10.69 gm%, t = 3.4, df 226, P = 0.001). Birth order of two or more is significantly associated with postpartum anemia (aOR 2.2, 95% CI: 1.07-4.39). CONCLUSIONS: The prevalence of anemia among postnatal mothers is high. Routine hemoglobin estimation, advice on consumption of iron-rich foods and Iron and Folic Acid (IFA) supplementation have to be provided to postnatal mothers to improve this situation.

Association of non-allopathic drugs and dietary factors with chronic kidney disease: A matched case-control study in South India.

BACKGROUND: The multifactorial etiology of chronic kidney disease (CKD) is known to vary with geographical region. Although diabetes and hypertension are the major known contributors for CKD, the role of other risk factors relevant to India needs to be explored. This study was done to find out the role of dietary factors and nonallopathic drugs in CKD. MATERIALS AND METHODS: A hospital-based individual pair-matched case-control study was conducted in a tertiary care center in South India. The sample included 80 incident cases of CKD matched with 80 controls. Factors assessed in the study include sociodemographic factors, medical history, dietary factors, nonallopathic drugs, substance use, and other possible confounders. Univariate analysis was performed using McNemar's test and multivariate analysis was done using conditional logistic regression. RESULTS: On multivariate analysis, lifetime exposure to nonallopathic drugs increased risk of CKD by approximately five times [odds ratio (OR): 5.15, confidence interval (CI): 1.27-20.87] and chicken intake (two to three times a month to once a week) had an increased risk by approximately four times (OR = 4.23, CI: 1.13-15.80). Fish intake at a frequency of two to three times or more reduced the risk of CKD by 94% (OR = 0.06, CI: 0.01-0.43). CONCLUSION: Chicken intake and lifetime exposure to nonallopathic drugs could increase risk for CKD in South India. Increased fish intake was found to be protective for CKD.

Prevalence and Correlates of Common Mental Disorders among the Rural Elderly in Puducherry, South India: A Cross-sectional Community-based Study.

BACKGROUND: Demographic transition has led to rethinking of strategies that are in place to address health issues of the elderly. A study was done to estimate the prevalence and correlates of common mental disorders (CMDs) among the rural elderly in Puducherry. This would help prioritize and plan opportunistic screening for CMDs among the elderly at the primary care level. MATERIALS AND METHODS: A cross-sectional community-based study was conducted among all the elderly, n = 243 (60 years and above), from one of the four villages catered by a rural health center in Puducherry. Data were collected at home from subjects using a questionnaire on (1) sociodemographic details and (2) CMDs using the general health questionnaire-12 (GHQ-12). Multivariable logistic regression was used to identify independent correlates of CMDs. RESULTS: A total of 243 subjects were studied. Women constituted 63% of the study subjects. The univariable analysis showed that the odds of having CMDs was higher among women (odds ratio [OR] =1.76 [1.03-2.97]), widowed elderly (OR = 2.44 [1.46-4.11]), and among those with a per capita per month income less than USD 19.6 (USD 19.6 to USD 9.9: OR: 4.02 [1.22-13.22]; less than USD 9.9: OR: 3.67 [1.008-13.34]). Elderly with an education of upper primary level (OR: 0.37 [0.33-0.15]) and above (OR: 0.22 [0.22-0.06]) had lower odds of having CMDs compared to those with no formal education. On multiple logistic regression analysis, after adjusting for other confounders, widowed elderly were found to have 2.1 times the odds of having MDs as opposed to elderly with living spouse (OR: 2.107 [CI: 1.09-4.06]). CONCLUSIONS: Fifty-one percent of the elderly in our sample suffered from CMD. Widowhood emerged as the single independent predictor of CMDs in this study population.

Prevalence and determinants of unmet need for family planning in a district of eastern region of Nepal.

OBJECTIVES: The unmet need for family planning is defined as the discrepancy between individual's contraceptive behaviors and their stated fertility preferences--The extent of which is very high in developing countries like Nepal. This study explores the unmet need and its determinants. METHODS: Among the teaching district of B.P. Koirala institute of Health Sciences, in the Eastern Region of Nepal, a district was selected randomly to conduct a cross-sectional study. A total of 1079 women were selected using systematic random sampling. We compared different demographic variables and sex-ration to unmet need by using means, percentage and applied chi-squared test where applicable. RESULT: The extent of unmet need is 25 percent with 9.5 percent for spacing and 15.5 percent for limiting. The mean age at marriage is 16(+/-3.2) years. A strong association of gender preferences towards male child and unmet need exist, which is highly significant. CONCLUSION: Unmet need is high despite extensive family planning program in Nepal. Mean age at marriage below legal age, low female education and gender discrimination are the factors responsible for unmet need.

Occurrence of aflatoxin in some of the food and feed in Nepal.

BACKGROUND: There are many contaminants like aflatoxin present in food products. Aflatoxin in comparison to many other contaminants is very toxic and also carcinogenic. There are reports of outbreak of aflatoxin toxicity in many parts of the world. AIM: To find out the level of aflatoxin in common food and feed. SETTING: The study was conducted in 16 districts of the Eastern region of Nepal. METHODS AND MATERIALS: Samples were collected from retailers and whole sellers from 1995 to 2003. Common food items that had high chances of infestation were collected. Food sample were taken to the laboratory to estimate the level of aflatoxin. The thin layer chromatography method was used to detect aflatoxin in the samples and comparison of fluorescence of sample spot with fluorescence of standard for estimation. RESULT: There were 832 samples for aflatoxin detection and estimation. One-third samples were found to be contaminated with aflatoxin. The highest percentage of contamination was found in peanut butter/vegetable oil (42.5%) and the lowest in areca nut (25%). Highest proportion of cornflakes samples were found to be contaminated with aflatoxin by more than the recommended value (30 ppb) and contamination in peanut was the lowest. CONCLUSION: People consume many common food items that contain aflatoxin. It is of high importance for the concerned department to give attention to this important public health issue. Even in small doses, continuous consumption can lead to many health problems. So it is of paramount importance to detect and control these contaminants in food items.

Validation of the Tamil version of short form Geriatric Depression Scale-15.

BACKGROUND: Local language screening instruments can be helpful in early assessment of depression in the elderly in the community and primary care population. This study describes the validation of a Tamil version of Geriatric Depression Scale (short form 15 [GDS-15] item) in a rural population. MATERIALS AND METHODS: A Tamil version of GDS-15 was developed using standardized procedures. The questionnaire was applied in a sample of elderly (aged 60 years and above) from a village in South India. All the participants were also assessed for depression by a clinical interview by a psychiatrist. RESULTS: A total of 242 participants were enrolled, 64.9% of them being females. The mean score on GDS-15 was 7.4 (±3.4), while the point prevalence of depression was 6.2% by clinical interview. The area under the receiver-operator curve was 0.659. The optimal cut-off for the GDS in this sample was found at 7/8 with sensitivity and specificity being 80% and 47.6%, respectively. CONCLUSION: The Tamil version of GDS-15 can be a useful screening instrument for assessment of depression in the elderly population.