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   2019| October  | Volume 44 | Issue 5  
    Online since October 15, 2019

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Nutritional assessment of tribal women in Kainatty, Wayanad: A cross-sectional study
Sreelakshmi Mohandas, K Amritesh, Harsha Lais, Sanjeev Vasudevan, S Ajithakumari
October 2019, 44(5):50-53
DOI:10.4103/ijcm.IJCM_39_19  PMID:31728091
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.
  9,822 85 -
Assessment of health facilities for airborne infection control practices and adherence to national airborne infection control guidelines: A study from Kerala, Southern India
Arun Raj, Devraj Ramakrishnan, Carmel Regeela Mainu Thekkeveettil Thomas, Amrita Das Mavila, Midhun Rajiv, Rakesh Purushothama Bhat Suseela
October 2019, 44(5):23-26
DOI:10.4103/ijcm.IJCM_25_19  PMID:31728084
Introduction: Nosocomial transmission of airborne infections, such as H1N1, drug-resistant tuberculosis, and Nipah virus disease, has been reported recently and has been linked to the limited airborne infection control strategies. The objective of the current study was to assess the health facilities for airborne infection control (AIC) practices and adherence to the National AIC (NAIC) guidelines, 2010. Materials and Methods: A cross-sectional study was conducted in 25 public and 25 private hospitals selected from five randomly selected districts in the state of Kerala. A checklist with 62 components was developed based on the NAIC guidelines. Frequencies, percentages, and mean with standard deviation were used to summarize facility risk assessment and compliance to guidelines. Results: Most of the facilities had infection control committees 35 (70%). Annual infection control trainings were held for staff in 21 (42%) facilities. Twenty (40%) facilities were not familiar with NAIC guidelines. Counseling on cough etiquette at registration was practiced in 5 (10%) institutions. Cross ventilation was present in outpatient departments in 27 (54%) institutions. Sputum was disposed properly in 43 (86%) institutions. N95 masks were available in high-risk settings in 7 (14%) health facilities. Conclusion: There exist deficiencies in adherence to all components of NAIC guidelines including administrative, environmental, and use of personal protective equipment in both government and private hospitals in the state.
  1,550 115 -
Prevalence and factors of urinary incontinence among postmenopausal women attending the obstetrics and gynecology outpatient service in a tertiary health care center in Kochi, Kerala
Aathira Kizhakkeveetil Ajith, Amritha Rekha, Sucharitha Duttagupta, Vinita Murali, Devraj Ramakrishnan, Vijayakumar Krishnapillai
October 2019, 44(5):30-33
DOI:10.4103/ijcm.IJCM_29_19  PMID:31728086
Introduction: Urinary incontinence has an immense impact on the social and mental health, and the quality of life of a person. Women neither come forward seeking medical consultation nor do they discuss about their incontinence openly, and the condition remains underestimated in the society. Hence, this study was undertaken to assess the type of urinary incontinence in postmenopausal women visiting obstetrics and gynecology (OBG) outpatient in a tertiary health care sector and to determine the risk factors of urinary incontinence. Materials and Methods: All postmenopausal women of age 45–90 years visiting the OBG Department of Amrita Institute of Medical Sciences in the months of May and June 2018 were assessed for urinary incontinence. QUID questionnaire - a six item urinary incontinence diagnostic questionnaire to diagnose and differentiate stress, urge and mixed incontinence - was used. Results: The prevalence of urinary incontinence was 26.47%, stress urinary incontinence contributing 13.9%, mixed urinary incontinence 7.2%, and urge urinary incontinence 5.4%. Chronic cough, recurrent urinary tract infections (UTI), and prolonged duration of labor were independent risk factors associated with urinary incontinence in postmenopausal women. Conclusion: Stress incontinence was found to be the major type of urinary incontinence in the postmenopausal women. Those having history of chronic cough, prolonged duration of labor, and recurrent UTI should be screened regularly for urinary incontinence.
  1,365 71 -
Prevalence and pattern of antibiotic self-medication practice in an urban population of Kerala, India: A cross-sectional study
Aparna Rajendran, Kiran George Kulirankal, PS Rakesh, Sobha George
October 2019, 44(5):42-45
DOI:10.4103/ijcm.IJCM_33_19  PMID:31728089
Background: Self-medication involves the use of medicinal products by a consumer to treat self-recognized disorders or symptoms or intermittent or continued use of a medication prescribed by a physician for chronic or recurring diseases or symptoms. Practicing self-medication for antibiotics is a major factor fueling the emergence of drug resistance. This study would help health-care providers in creating public awareness on the dangers of antibiotic abuse. Objectives: The aim of the study was to assess the prevalence and pattern of antibiotic self-medication in an urban population of Kerala. Materials and Methods: A community-based cross-sectional study was carried out in Thrippunithura municipality, Kerala. Data were collected from 755 adults by face-to-face interview using a questionnaire after obtaining consent. Data were entered in Excel and were analyzed using SPSS. Results: The percentage of respondents who practiced antibiotic self-medication was 3.31%. Males (4.1%), graduates (3.8%), and skilled workers (8.5%) were found to practice antibiotic self-medication. Majority took self-medication for sore throat (25%). Azithromycin (39%) was the major antibiotic used. Among the respondents, 36% used doctor's previous prescription to get antibiotics. The reason for antibiotic self-medication reported by majority was convenience (41%). Conclusion: Health education must be given to graduates and professionals, highlighting the problems due to antibiotic self-medication. With danger of antibiotic resistance developing, this is a major threat that has to be addressed urgently.
  1,157 114 -
Prevalence and determinants of somatization and anxiety among adult women in an urban population in Kerala
Arjun Rajendra Babu, Aswathy Sreedevi, Alexander John, Vijayakumar Krishnapillai
October 2019, 44(5):66-69
DOI:10.4103/ijcm.IJCM_55_19  PMID:31728095
Background: Common mental disorders (CMDs) such as somatization and anxiety are prevalent in general practice. These are twice more common in women. Objectives: The objective of this study is to estimate the prevalence and determinants of somatization and anxiety among adult women in an urban population of Kochi. Materials and Methods: A cross-sectional study was conducted among 1210 adult women of Kochi in 2016–2017. The Patient Health Questionnaire-15; the Generalized Anxiety Disorder-7 questionnaire; the Hurt, Insult, Threaten, and Scream tool; and a semi-structured questionnaire were used to estimate the prevalence of somatization and anxiety. Descriptive statistics and univariate and multivariate analysis were done for factors associated with CMDs. Results: Most of the respondents were married (77.7%), with a mean age of 45.24 ± 15.59. In the current study, 40.8% (95% confidence interval [CI] =38.09–43.62) had somatization and 23.9% (95% CI = 21.57–26.37) had anxiety disorders. In the final logistic regression model, hypertension, perception of illness, positive family history of mental illness, and arthritis were the four determinants common to somatization and anxiety. Menstrual problems (odds ratio [OR] =3.19; 95% CI = 1.12–5.9), cardiac illness (OR = 2.31; 95% CI = 1.08–4.9), and history of major surgeries (OR = 1.62; 95% CI = 1.14–2.41) were independent determinants of somatization. The status of being single (OR = 1.71; 95% CI = 1.25–2.32), adverse life circumstances (OR = 5.85; 95% CI = 3.98–8.6), diabetes (OR = 2.04; 95% CI = 1.25–3.34), sleep problems (OR = 1.64; 95% CI = 1.77–2.91), and history of drug use (OR = 4.89; 95% CI = 1.92–12.46) were independent determinants of anxiety. Conclusion: Mental health services for urban women deserve immediate attention as the prevalence of somatization and anxiety is high. Hence, it is important to screen for somatization and anxiety among women with noncommunicable diseases.
  1,137 66 -
A comparative study assessing sleep duration and associated factors among adolescents studying in different types of schools in an urban area of Kerala, India
Geethu Mathew, Aby Dany Varghese, Anoop Ivan Benjamin
October 2019, 44(5):10-13
DOI:10.4103/ijcm.IJCM_19_19  PMID:31728081
Background: Sleep is essential for optimizing physical, cognitive, and emotional functioning of adolescents. Adolescents are one of the most sleep-deprived age groups in the society. Objectives: To assess sleep duration and associated factors among adolescent children studying in different types of schools in an urban area of Kerala. Methodology: This cross-sectional study was conducted in Pathanamthitta district, Kerala, from January to December 2017. All adolescent children studying in high school and higher secondary classes were included using stratified random sampling. Study tool included a questionnaire which collected sociodemographic information, sleep duration, and schedule. Results: In this study, 657 students were enrolled. The mean age of the participants was 15.09 ± 1.33 years. 201 students (30.6%) were from government school, 242 (36.8%) from aided, and 214 (32.6%) were from private school. The mean sleep duration among the students was 7.2 ± 1.26 h. Sleep duration was found to be inadequate in 60% of the children. The sleep duration was found to be longer during weekends compared to weekdays. Nearly 92% of students take a daytime nap of >1 h during weekends. Private school students had inadequate sleep duration, late bedtime, and early wake-up time compared to other students. Higher age, class, education of parents, family income, distance travelled to school, and female gender were the other factors associated with inadequate sleep among adolescents. Conclusion: Inadequate sleep duration and difference in sleep schedule during weekends were observed among adolescents, especially among private school students. Primary prevention approach aimed at spreading adequate awareness regarding the importance of sleep among students, parents, and teachers should be practiced.
  1,045 112 -
Antifungal efficacy of spice extracts against Candida albicans: An in vitro study
Pooja Latti, Subramaniam Ramanarayanan, GM Prashant
October 2019, 44(5):77-80
DOI:10.4103/ijcm.IJCM_140_19  PMID:31728098
Background: Candida species are normal commensals and are isolated intra-orally in 17%–75% of healthy individuals and all debilitated people. Eradication of candidiasis is complicated by the emergence of Candida strains that are resistant to the currently used antifungal agents. Plants as remedies are gaining popularity in developed countries. Although many plants have already been investigated against Candida albicans, the search is still to find a long-term prevention or cure for oral candidiasis. Objectives: The objective of this study was (1) to evaluate the antifungal activity of black pepper, bay leaf, cinnamon, and cumin against C. albicans and (2) to determine the minimum inhibitory concentration (MIC) of spice extracts against C. albicans. Materials and Methods: Spices obtained from the local market were dried and powdered. Solvent extracts were obtained by maceration with methanol followed by filtration and evaporation. The antifungal efficacy was assessed using cup-plate diffusion method followed by the determination of MIC by serial tube dilution technique. Statistical analysis was done using one-way analysis of variance followed by Tukey's post hoc test. P < 0.05 was considered as statistically significant. Results: All the extracts evaluated showed variable degree of inhibition zones against C. albicans with cinnamon showing the highest inhibition (49.3 ± 0.52) mm and also with least MIC against C. albicans (<0.05 mg/ml). Conclusion: These results exhibit the antifungal activity of the spice extracts against C. albicans, which may be useful in the treatment of oral candidiasis.
  1,051 53 -
HIV related stigma and discrimination among people living with HIV/AIDS in Ernakulam District: A qualitative study
Leyanna Susan George
October 2019, 44(5):34-37
DOI:10.4103/ijcm.IJCM_30_19  PMID:31728087
Introduction: Human immunodeficiency virus (HIV)-related stigma refers to the negative beliefs, feelings, and attitudes, while discrimination is the unfair and unjust treatment of people living with HIV/acquired immunodeficiency syndrome (PLHA). Their manifestations are context-specific and have varied impacts. Objectives: (1) To determine the different contexts in which PLHA face stigma and discrimination. (2) To study the impact of stigma and discrimination on the health of the PLHA. Methodology: A qualitative study was conducted among PLHA at the office of the network for positives. Fourteen key informant interviews were conducted on PLHA and the peer counselors to determine the contexts in which they faced stigma and discrimination. To understand its impact on health, two Focus Group Discussions were carried out separately for male and female PLHA. The data were collected using a semi-structured interview guide and were audio recorded. They were then transcribed, manually coded, thematically analyzed, and triangulated. Results: The themes that arose showed that stigma and discrimination were context-specific and were experienced in different levels such as an individual, family, community, health-care system, and media. They experienced violence in addition to the loss of shelter and economic support. Stigma and discrimination was found to have a negative impact on the health of the PLHA. It was a major hindrance to health-care utilization resulting in worsening of health conditions and indirectly contributed to the spread of diseases. Conclusion: PLHA experience different forms of stigma and discrimination which have an adverse impact on their health. Behavior change communication initiatives for the community are required.
  986 58 -
Impact of Swachh Bharat Abhiyan on residents of Cochin corporation
Amrita Das Mavila, Paul T Francis
October 2019, 44(5):19-22
DOI:10.4103/ijcm.IJCM_24_19  PMID:31728083
Context: Environmental sanitation is a major public health issue in India. Sustainable Development Goal 6 envisages the accessibility of safe water and sanitation throughout the world. Swachh Bharat Abhiyan (SBA), a national cleanliness campaign established by the Government of India in 2014, has six main objectives. It has crossed the half-way point of its intended implementation course. Aims: This study aims to assess the impact of SBA on the sanitation of Cochin Corporation and to identify factors associated with awareness and practice of SBA. Settings and Design: A cross-sectional study among residents of Cochin Corporation. Materials and Methods: Semi-structured questionnaire was used to measure awareness, practice, and impact of SBA. Three divisions were selected purposively. A score was assigned for knowledge and impact assessment questions and was classified into three categories. Statistical Analysis Used: Descriptive statistics using frequencies and percentages were done. Chi-square test was used to test differences between proportions. Results: Thirty percent had no awareness regarding SBA and 42% had minimal awareness regarding the program and its objectives. Only 24% responded that SBA had a good impact on the overall sanitation of the community. The impact of SBA was significantly associated with socioeconomic status. The study revealed the major sanitary concern of the community to be the disposal of solid waste. Conclusion: The SBA did not have a significant impact on Cochin population due to existing good sanitation. Solid waste disposal is still a concern of the community. As far as, Kerala is concerned, it appears that the primary focus of SBA should be on Municipal Solid Waste Management.
  845 113 -
From neglect to equity vis-a-vis noncommunicable diseases and neglected tropical diseases
Vijayakumar Krishnapillai, Aswathy Sreedevi, Devraj Ramakrishnan
October 2019, 44(5):1-2
DOI:10.4103/ijcm.IJCM_304_19  PMID:31728078
  808 128 -
Emergence of fluconazole-resistant candida infections in diabetic foot ulcers: Implications for public health
Chankramath S Arun, Priyanka Raju, Vivek Lakshmanan, Anil Kumar, Arun Bal, Harish Kumar
October 2019, 44(5):74-76
DOI:10.4103/ijcm.IJCM_111_19  PMID:31728097
Background: It is well documented in the literature that fungal infections are common in diabetic foot ulcers (DFUs). This has led to an overuse of antifungal agents, namely fluconazole, with a consequent risk of emergence of resistance to this drug. Previous studies have shown a 3.9% prevalence of fluconazole resistance in DFU, but limited data exist regarding the change in resistance pattern over the last decade. Objectives: Our aim was to study the prevalence of resistance to fluconazole in patients with DFU and culture-proven fungal infections. Materials and Methods: We retrospectively studied 1438 patients with type 2 diabetes and nonhealing foot ulcers who had fungal cultures performed during the course of their treatment. The data were collected for all patients who presented to our foot clinic over a period of 18 months. Results: The prevalence of positive fungal culture was 17.38% (250/1438). 151/200 positive cultures belonged to Candida species. Resistance to fluconazole was observed in 9.3% (17/200). The most common organism with resistance to fluconazole was Candida auris (10/17). Conclusions: High prevalence of fluconazole resistance is a potential cause of concern, and the rational use of this drug is important in the community. The above results could have an impact on public health, as fluconazole is one of the safest and effective oral antifungal agents available. The spread of resistance could have implications for its use in other situations including systemic fungal infections.
  873 42 -
Prevalence of depression among students of a dental tertiary care center in Kerala
Dhanya Raghunathan, Devraj Ramakrishnan, KV Iris Valsan, Suchitra Ambika
October 2019, 44(5):14-18
DOI:10.4103/ijcm.IJCM_23_19  PMID:31728082
Introduction: According to the World Health Organization, more than 300 million people were estimated to suffer from depression in 2017. Many studies have observed that medical personnel have a higher level of depression, but studies among dentists are scarce. Early diagnosis will help in controlling the morbidity and mortality due to depression. Hence, this study was undertaken to estimate the prevalence of depression among students of Government Dental College (GDC), Thiruvananthapuram, the capital city of the state of Kerala, India. Materials and Methods: A cross-sectional study was conducted at GDC, Thiruvananthapuram, for a period of 3 months from September to December 2017, using the Patient Health Questionnaire-9 (PHQ-9) and a pro forma comprising 37 questions. Students having PHQ scores >9 were considered to have depression. The questionnaire was administered on 364 students comprising undergraduate students, paradental students, house surgeons, and postgraduates. Separate sessions were arranged for each group and four reminders were given. Results: The prevalence of depression was estimated as 26.9% (95% confidence interval: 22.4–31.8). Being married, having high and average level of course satisfaction, and having close friends were found to act as independent protective factors, whereas female gender and breakups in relationships were found to be independent risk factors. Conclusion: It is high time we provide supportive programs and implement preventive measures to help professional students, especially those who are at higher risk of mental ill-health. Further studies need to be conducted to explore the academic reasons for depression.
  787 96 -
Barriers to healthy lifestyle among college-going students in a selected college in Bengaluru Urban district
Chitra Tomy, Farah Naaz Fathima, Savan Sara Mathew, Avita Rose Johnson
October 2019, 44(5):54-56
DOI:10.4103/ijcm.IJCM_44_19  PMID:31728092
Context: Cardiovascular diseases (CVDs) are influenced by factors acting at all stages of life. Healthy lifestyle practices among adolescents and youth are crucial in preventing CVDs in the later years. Many barriers prevent young people from practicing healthy lifestyles. Aims: The aim of this study is to identify barriers to healthy lifestyle among college-going students in Bengaluru Urban District. Settings and Design: A cross-sectional study was conducted among 722 students aged 15–25 years, in a degree college in Bengaluru Urban district. Subjects and Methods: A structured interview schedule with good internal consistency (Cronbach's alpha = 0.887), consisting of 50 questions scored on a 5-point Likert scale with five domains (diet, physical activity, tobacco use, alcohol consumption, and stress) was administered. The total score was classified into high-, moderate-, and low-barrier categories using percentiles. The barrier score for each domain and for each individual question was computed by multiplying the weight of the responses by their frequencies. Statistical Analysis Used: Barriers to healthy lifestyle and its association with sociodemographic variables were analyzed using inferential statistics such as t-test and ANOVA. Significant factors were entered into a multiple linear regression model. Results: The domain of stress emerged as the topmost barrier followed by diet. The main factors responsible for stress among college students were examinations (74.9%), long hours of the study (71.1%), and lack of time (69.6%). Conclusions: Barriers to healthy lifestyle are common among adolescents and youth. The topmost barriers identified were stress- and diet-related barriers.
  767 68 -
Transgenerational preventive practices of diabetes mellitus type II patients attending a tertiary care hospital in Cochin, India
Paul T Francis
October 2019, 44(5):7-9
DOI:10.4103/ijcm.IJCM_17_19  PMID:31728080
Introduction: The incidence and prevalence of diabetes mellitus type II (DM type II) has been increasing relentlessly over the past few decades despite amassing a great body of evidence regarding its causation and prevention. Objective: To determine the practices of DM type II patients to prevent the disease in their children. Methodology: This is a mixed-methods study at a tertiary care teaching hospital. DM type II patients attending the department of endocrinology and its urban health center were the study participants. Data were collected using an investigator-administered questionnaire and in-depth interviews. A total of 137 patients were included in the quantitative part, and 16 in-depth interviews were conducted. Quantitative data were analyzed by SPSS software, and qualitative data were analyzed manually. Results: Nearly 62% of the patients had a family history of DM type II, 62% of the patients were aware of the genetic risk of the disease, and 26% of the patients had tried some form of preventive measure. Most of them advised their children to be careful about diet and exercise, but did not implement any specific or sustained behavioral change. The main reason was that the patients were not aware of the importance of the hereditary nature of the disease. Other reasons were children were grown up, were living separately, or did not appreciate the seriousness of the risk. Conclusion: There is a need to educate the patients about the hereditary risk of developing DM type II to empower them to implement preventive practices in their households.
  700 112 -
Intimate partner violence among ever-married women treated for depression at a rural health center in Bengaluru Urban District
Savan Sara Mathew, Ramakrishna B Goud, Johnson Pradeep
October 2019, 44(5):70-73
DOI:10.4103/ijcm.IJCM_72_19  PMID:31728096
Background: Intimate partner violence (IPV) is a risk factor for depression among women. Spousal alcoholism and marital quality are associated with both depression and spousal abuse Knowledge about the factors contributing to IPV in depression will enable us to have interventions to address IPV in tandem with treating depression. Objectives: (1) To estimate the prevalence of IPV in women treated for depression in a rural community health-care facility in Bengaluru Urban District. (2) To assess the association between IPV and various other factors in women treated for depression in a rural community health care facility. Methodology: A cross-sectional study was conducted among ever-married women above 18 years, registered under mental health program in the mental health clinic in Mugalur, Karnataka, and currently on treatment for depression. The women who consented were interviewed using structured questionnaires – WHOQOL-BREF, standard of living index, Hamilton Depression Rating Scale, Index of Spouse Abuse, family interview for genetic studies for reported alcohol use, and marital quality scale. Results: The mean age of the study participants was 49.7 ± 13.2 years. The prevalence of physical IPV and non-physical IPV was found to be 18% and 7%, respectively. Marital quality was significantly lower among women who experienced IPV. Women with husbands who ever used alcohol were found to have six times more risk of experiencing physical IPV, odd ratio 6.193 (1.595, 24.047). Conclusion: Health education, involvement of self-help groups, and awareness programs are required to alleviate IPV.
  766 45 -
Relationship between dental caries experience and social capital among children – A pilot study
Yeturu Sravan Kumar, PS Rakesh, Pentapati Kalyana-Chakravarthy, S Vijay Kumar
October 2019, 44(5):3-6
DOI:10.4103/ijcm.IJCM_11_19  PMID:31728079
Background: The effect of larger and distal environmental and societal factors on oral health is established and the concept of social capital (SC) is gaining importance. Aim: The aim of the study is to evaluate the association of dental caries (DC) experience of children with parental social SC. Methods: A cross-sectional survey was conducted among 200 pairs of 5–12-year-old children and their parents of Kaloor (65th division), Kerala. A 30-item self-administered neighborhood SC Index questionnaire. DC of children was assessed as per the WHO guidelines. Results: The final analysis included 186 pairs of children and parents, out of which 54.8% were boys. The mean caries experience of children was 3.3 ± 3.7. A significantly higher proportion of parents rated their children as “poor oral health” in caries experienced group than caries-free group (P = 0.006). No other significant differences were found with total SC and demographic variables except for “frequency of having meal together.” Regression analysis showed that trust, control, and political domains were significant with carious status. On adjusting the confounders that were significant in bivariate analysis, only control domain of the SC remained significant. Conclusion: The social control domain (family members or neighbors actions that seek to correct deviant behavior) of SC was associated with caries experience of the children. Distal factors such as SC can influence the caries status of children.
  699 108 -
Health promoting schools in Kerala, India
Heljo Padamadan Joseph, Ramanarayanan Venkitachalam, Joe Joseph, Chandrashekar Janakiram
October 2019, 44(5):38-41
DOI:10.4103/ijcm.IJCM_31_19  PMID:31728088
Introduction: Health promoting school (HPS) is a holistic concept where health and learning coexist. The objective of this study was to assess the health promoting standards of schools in Kerala. Methodology: A cross-sectional study was designed in Kerala, India, with schools in Kerala as a study unit. A questionnaire which consisted of 37 items across eight domains of the HPS concept was developed and validated. The schools were then graded into compliant and not compliant categories based on scores obtained. Bivariate and multivariate analysis was also done. Results: Of 120 schools, 90.8% were compliant toward health education domain and only 8.3% were compliant with nutrition services. Majority of schools showed compliance with the other six domains. Average overall scores were 153 (58.8%) with the equal number of schools in both compliant and not compliant categories. There was a significant association between health education and physical education domain with respect to the type of school, i.e., privately managed had six times more chances of being compliant toward health education domain compared to government schools (odds ratio [OR] 6.05; 95% confidence interval [CI] 1.10–33.29). Hence, also private schools had two times more chance of being compliant toward physical education compared to government schools (OR 2.52; 95% CI 1.0 – 4.32). Physical education domain showed a significant association with respect to geographic region, i.e., the schools in North Kerala were found to be three times more compliant compared to South Kerala (OR 3.48; 95% CI 1.05–11.53). Conclusions: Despite the good health and social indicators in Kerala, there is a deficiency in schools promoting health of children. A coordinated effort by the government and the education system can convert existing schools into health promoting.
  724 76 -
Oral health status and treatment needs of 12-year-old school children among urban and rural areas of Raichur Taluk, Karnataka, India
Sudarshan Kumar Chinna, Arun Kumar Acharya, Rashmi Chinna
October 2019, 44(5):27-29
DOI:10.4103/ijcm.IJCM_28_19  PMID:31728085
Introduction: Oral health is an integral part of general health. Oral health status has a direct impact on general health, and conversely, general health influences oral health. Objectives: The objectives of the study were to assess oral health status and treatment needs of 12-year-old school children among urban and rural areas of Raichur Taluk, Karnataka, India. Materials and Methods: A cross-sectional study was conducted on 1240 school children in the age group of 12 years from urban (620) and rural (620) areas of Raichur Taluk, Karnataka, India. Oral health status was assessed using the World Oral Health assessment form 1997. Results: The prevalence of caries in urban and rural areas of school children was 63.5% and 64.5%, respectively. The mean decayed teeth, missing teeth, filled teeth, and decay, missing, filled teeth of school children in Raichur Taluk were 1.15 ± 1.20, 0.0, 0.03 ± 0.23, and 1.19 ± 1.21, respectively. Conclusion: This study highlights the need for preventive and curative oral health services and should be made integral to other health programs. Oral health promotion strategies need to be implemented to improve the oral health of primary school children. Health education should be given regarding the prevention of dental caries by maintaining good oral hygiene.
  700 56 -
Non-fatal home injuries among the elderly in Tamil Nadu, India
Alex Joseph, M Bagavandas
October 2019, 44(5):81-84
DOI:10.4103/ijcm.IJCM_141_19  PMID:31728099
Background: Injuries are considered as an emerging public health problem in India. Globally every year, injuries kill more than 5 million people, and by 2020, injuries will be the third-leading cause of death and disability worldwide. The study aimed to assess the prevalence and characteristics of nonfatal home injuries among the elderly in Tamil Nadu. Methodology: A cross-sectional analytical study was conducted among 1139 elderly (60 years and above), sampled from three districts of Tamil Nadu, India. Probability proportional to size sampling technique was used for sampling; a pretested questionnaire was used to collect the data. Results: Prevalence of nonfatal home injuries among elderly within the past 1 year was 14.6% (12.5–16.7 at 95% confidence interval), (n = 1003), among those injured, 94.5% were unintentionally injured and 5.5% were of intentional nature. When classified according to the types of injuries, majority of them had fall injuries (6.7%) followed by minor domestic injuries (5.4%), animal-related injury (0.2%), burn injuries (1.1%), road traffic injury (0.4%), and suicide attempt (0.8%). Majority of the respondents were in the age group of young-old, 60–69 years of age (84%), and there was more number of males (55%) in the study. Conclusion: The study reveals that nonfatal home injuries among elderly are an emerging public health problem, unintentional injuries contribute to the majority of the injuries, fall was the single largest contributor for all injuries among elderly.
  695 48 -
Comparison of health-care utilization pattern and its correlates among the tribal and nontribal population of Kerala
Hisham Moosan, Antony Stanley, Aslesh Ottapura Prabhakaran, Krishnapillai Vijayakumar, AK Jayasree, Soumya Gopakumar
October 2019, 44(5):57-61
DOI:10.4103/ijcm.IJCM_46_19  PMID:31728093
Background: The isolation from mainstream development activities, together with poverty and inaccessibility to health facilities made the tribal communities specifically vulnerable to various health problems. Objectives: This study aimed to compare the utilization of antenatal care, immunization, and supplementary nutrition services by tribal and nontribal mothers and its correlates in the selected districts. Materials and Methods: The study was a comparative cross-sectional study. The study population comprised tribal and nontribal mothers utilizing antenatal care, immunization, and supplementary nutrition services. A multi-stage cluster sampling strategy was employed for the study. The Chi-square test was used to assess the association between antenatal care services utilization, utilization of immunization services, supplementary nutrition services utilization and sociodemographic variables, and other service characteristics. Results: Effective utilization of antenatal care services was not seen in 5.6% of tribal mothers. The incidence of low-birth weight (≤2500) was significantly more among tribal mothers (31%) when compared to nontribal mothers (15%). The proportion of tribal children receiving complete immunization without delay was 74%, and among nontribal children, it was 78%. Effective immunization coverage was significantly lower among children of tribal mothers with education below high school level. Receipt of take-home ration was reported by nearly 90% of tribal and nontribal mothers. 90% of tribal mothers felt that quality of take-home ration that they received was of good quality. Conclusions: The comparison of health-care utilization restricted to the domains of antenatal care, immunization services, and supplementary nutrition suggests that the tribal mothers and children had a relatively comparable utilization pattern in most of the indicators measured.
  644 70 -
Attitude of accredited social health activists towards creating awareness on oral cancer in rural community of Chikkaballapur district, Karnataka
KM Shwetha, K Ranganath, K Pushpanjali
October 2019, 44(5):46-49
DOI:10.4103/ijcm.IJCM_37_19  PMID:31728090
Background: Accredited social health activists (ASHAs) form a link between rural community and health system in India; hence, it is important to understand their attitude to render health services. Objectives: The objectives of the study were to develop a tool for measuring the attitude to create awareness on oral cancer (OC) using theory of reasoned action and planned behavior (TRA/PB) to the community and to assess the attitude of ASHAs about the same. Methodology: A culturally relevant self-administered questionnaire was developed based on TRA/PB which was subjected to validity and reliability and then pilot tested. The sample size was estimated to be 278. A cross-sectional research design was used to assess the attitude of ASHAs. Multistage sampling technique was carried out to include ASHAs from three of six taluks of Chikkaballapur district. Results: The content validity ratio of the items was in the range of 0.6–0.7, and Cronbach's alpha was 0.762. Exploratory factor analysis provided three factors with eigenvalue >1. The mean age of study participants was 31.8 years. The mean work experience was 5.7 years. The attitude of ASHAs was favorable (82.45%) as they believed that it was their responsibility to contribute in disease prevention (normative belief). Some had seen suffering of OC patients closely (behavioral beliefs) and few opted to follow their authority instructions (perceived behavioral control). Conclusion: The developed tool with good validity and reliability was used to assess the attitude of ASHAs. Their attitude was favorable to educate the community about OC and contribute in disease prevention.
  561 65 -
Impediments to optimal health-care utilization of a particularly vulnerable tribal group in Wayanad: A qualitative study
Hisham Moosan, Antony Stanley, Krishnapillai Vijayakumar, AK Jayasree, Tony Lawrence, A Veena
October 2019, 44(5):62-65
DOI:10.4103/ijcm.IJCM_48_19  PMID:31728094
Introduction: The pathways and mechanisms through which constraints that impede optimal utilization of the government health-care service provisions translate into health inequities among Particularly Vulnerable Tribal Groups seem to be an area that warrants research. Objective: The objective is to explore and understand the mechanisms/pathways through which various factors result in health care inequity among the Kattunayakan tribe in Wayanad. Materials and Methods: Designed as a qualitative case study, using observations and interviews with mothers, community members, and frontline health-care personnel, the study was conducted in a Kattunayakan hamlet in Wayanad. The data, in the form of digital audio recordings and field notes, were transcribed, coded, and analyzed using a thematic approach. Results and Discussion: Axes of inquiry like access to health-care institutions, acceptability of the services provided, hurdles faced by the tribes, the health-care personnel, and how the system responded to these issues were explored. Disregard for the identity and culture of the tribes, geographical barriers for utilization and providing health services, proactive efforts from government systems, collaborations with private and professional bodies are important factors that possibly influence health inequities among tribes. Conclusion: Acknowledgment of the sociocultural identity of the tribes, gaining their trust, proactive efforts from the government machinery, innovative context-specific programs, strategic partnerships and a departure from the “blame the victim” philosophy are key in the effort to provide services that meet the health-care needs of the tribes.
  422 46 -
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