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   2018| April-June  | Volume 62 | Issue 2  
    Online since June 14, 2018

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Menstrual hygiene management in India: The concerns
Rabindra Nath Sinha, Bobby Paul
April-June 2018, 62(2):71-74
DOI:10.4103/ijph.IJPH_135_18  PMID:29923527
  9,792 1,259 -
A study on prevalence of depression and associated risk factors among elderly in a rural block of Tamil Nadu
M Buvneshkumar, KR John, M Logaraj
April-June 2018, 62(2):89-94
DOI:10.4103/ijph.IJPH_33_17  PMID:29923530
Background: Depression among elderly is an important public health problem responsible for considerable morbidity and disability. Causes of depression are multifactorial and often preventable. As there was dearth of community studies in Tamil Nadu, the present study was undertaken. Objectives: The objective of this study is to estimate the prevalence of depression and to assess the factors which are associated with depression among elderly. Methods: A cross-sectional study was done from July 2014 to July 2015 among elderly in Kattankulathur block with a sample size of 690 by cluster sampling method. House-to-house interview was conducted using a predesigned, pre-tested questionnaire, and depression was assessed using geriatric depression scale-30. Data were analyzed using SPSS version 20 (Trial). The statistical tests used were proportions, Chi-square test. P<0.05 was considered to be statistically significant. Results: The overall prevalence of depression was 35.5% (95% confidence interval: 31.9%–39.0%). Sociodemographic factors such as female sex, nuclear family, being widowed, unemployed status, low socioeconomic status, financially dependent, medical factors such as cardiac disease, visual impairment, arthritis, anemia, life events such as conflicts in family, death of the family member or close relative, and illness of self/family member were significantly associated with depression (P < 0.05). Conclusions: More strength of association for depression was seen with low socioeconomic status, nuclear family, low-intensity work, conflicts in the family, death of family members using multiple logistic regression. These findings show the need for proper care by the family members and counseling for the elderly which are of much importance in preventing depression.
  5,782 963 -
Prevalence of osteoarthritis of knee joint among adult population in a rural area of Kanchipuram District, Tamil Nadu
Jayaseelan Venkatachalam, Murugan Natesan, Muthurajesh Eswaran, Abel K Samuel Johnson, V Bharath, Zile Singh
April-June 2018, 62(2):117-122
DOI:10.4103/ijph.IJPH_344_16  PMID:29923535
Background: Osteoarthritis (OA) is one of the most common degenerative disorders among the elderly population; although aging is the most important cause, research has shown that it is a complex disease with many etiologies. It is not an inevitable part of aging but rather the result of a combination of factors, many of which can be modified or prevented. Objective: The objective of this study was to assess the burden and determinants of OA knee among the adult population. Methods: A community-based, cross-sectional study among 1986 adult persons living in a rural area in Kanchipuram district, Tamil Nadu, South India, was interviewed and examined from January 2014 to December 2014. Data collection was done by the postgraduates, trained health workers under the supervision of principal investigator. Written and informed consent was obtained before data collection. OA was diagnosed using the criteria laid down by the American College of Rheumatology, and it was validated and tested in the study area. Results: A total of 1986 adult respondents were interviewed out of which 27.1% had OA of knee. Age more than 50 years, female gender, tobacco usage, illiteracy, lower socioeconomic class, positive family history of OA, diabetes, and hypertension were found to be associated with OA knee (P < 0.05). Conclusion: The burden of osteoarthritis knee was high in this region. Hence, effective preventive strategy has to be taken to minimize this burden.
  4,562 583 -
Quality of life among geriatric population: A cross-sectional study in a rural area of Sepahijala District, Tripura
Nabarun Karmakar, Anjan Datta, Kaushik Nag, Kaushik Tripura
April-June 2018, 62(2):95-99
DOI:10.4103/ijph.IJPH_121_17  PMID:29923531
Background: Quality of life (QOL) among elderly is an important area of concern which reflects the health status and well-being of this vulnerable population. Objectives: The objective of this study is to find out different domains of QOL and its association with sociodemographic factors among geriatric population. Methods: A community-based cross-sectional study was done among 76 persons aged 60 years and above from August 2016 to October 2016 in rural areas of Madhupur, Sepahijala district, Tripura. The World Health Organization QOL-BREF scale was used and analysis was done using SPSS version 20.0 statistical software. P < 0.05 was considered as statistically significant. Results: The mean QOL score was maximum in social health domain (67.32 ± 15.30), followed by environmental health (51.64 ± 10.11), lowest was in psychological domain (44.29 ± 11.50). Better physical health domain score was found among participants <70 years age. Psychological health was better among Hindu and persons from nuclear family and higher socioeconomic class, whereas male, illiterate, and businessman had better social relationship. Environmental domain score was significantly better among primary educated, businessman, and higher socioeconomic class people. Conclusion: The present study revealed social relationship domain had higher mean QOL score in comparison to other domains, but contrastingly psychological domain was affected worst in “old age group.” Further research can be done to explore the factors affecting psychological domain.
  3,045 591 -
Diabetes self care activities among adults 20 years and above residing in a resettlement colony in East Delhi
Anu Mohandas, SK Bhasin, Madhu Upadhyay, SV Madhu
April-June 2018, 62(2):104-110
DOI:10.4103/ijph.IJPH_249_17  PMID:29923533
Background: Self-care activities are the cornerstone of diabetes care that ensures patients participation to achieve optimal glycemic control and to prevent complications. Objective: The aim of this study is to find the level of self-care activities among diabetics aged ≥20 years residing in a resettlement colony in East Delhi and its association with sociodemographic factors, disease, and treatment profile. Methods: Using cross-sectional survey, 168 known diabetic patients were selected from Nand Nagri, a resettlement colony in East Delhi. Data were collected using Hindi translation of revised version-Summary of Diabetic Self Care Activities along with a pretested semi-open-ended questionnaire. Self-care was assessed on six parameters as follows: (a) general diet, (b) specific diet, (c) exercise, (d) blood sugar testing, (e) foot-care, and (f) smoking. The study period was from November 2014 to April 2016. Results: Nearly 35.1% of respondents belonged to 60–69 years age group. About 52.4% of respondents were female. Fifty-two diabetics (31%) reported having practised diet control on all 7 days in the past 1 week. Nearly 39.3% of patients did not perform any physical activity. The blood test was not practised by 92.3% of respondents. Foot-care was practised by only 19% of patients. There was a significant association between general diet among diabetics with family support (P = 0.020), place of diagnosis (P = 0.033), and treatment funds (P = 0.017). The exercise score among diabetics who were below the poverty line was higher than those above poverty line (P = 0.029). Younger age (P = 0.005) and treatment with insulin (P = 0.008) were positively associated with blood glucose testing. The foot-care practice was better in patients aware of complications and foot-care practices (P < 0.001). Conclusion: Self-care activities among diabetic patients were very poor. Self-management educational programs at hospitals along with information, education, and communication activities at the community level and one-to-one counseling are recommended.
  2,649 524 -
Block-wise comprehensive health index in Gadchiroli: A tribal district in Maharashtra
Prakash Prabhakarrao Doke
April-June 2018, 62(2):75-81
DOI:10.4103/ijph.IJPH_247_16  PMID:29923528
Background: The National Health Mission expects bottom-up approach for preparing Project Implementation Plan and also expects special attention toward tribal areas. Some district-level health information is available from national health surveys, but subdistrict-level information is mostly not available. Gadchiroli is the farthest district from the state capital. There are 12 blocks in the district. It is a notified tribal district having 8.61%–81.50% tribal population in different blocks and block-wise urbanization varies from 0.00% to 37.10%. Objectives: The objective was to assess community health status at block level in Gadchiroli district and then develop comprehensive health index for ranking the blocks. Methods: The author has used available secondary data sources including Census, Survey of Cause of Death scheme, health management information system, Directorate of Economics and Statistics, and Maharashtra Medical Council. Ten indicators were selected after discussion with public health specialists to evolve comprehensive health index. Blocks having best statistic in each indicator were given 100 marks and other blocks were given proportionate marks. Thus, the highest possible score for any block was 1000. Results: The range of block-wise score was from 424 to 781. The highest scoring block was Gadchiroli and was an outlier. The comprehensive score was having correlation with urbanization, r = 0.63 (95% confidence limits, 0.09–0.88). After principal component analysis, the extracted three components were responsible for most of the variations. Conclusions: Reasonably reliable and valid block-wise data are available to carry out community health assessment and develop comprehensive health index. The index is useful for comparison among blocks.
  2,466 479 -
A cohort study on risk factors for preterm births in rural Gujarat
Poonam Trivedi, Deepak Saxena, Tapasvi Puwar, Shital Savaliya, Parthasarathi Ganguly
April-June 2018, 62(2):111-116
DOI:10.4103/ijph.IJPH_337_16  PMID:29923534
Background: Prematurity is one of the leading causes of neonatal and under-five mortalities globally and also in India. It is an important determinant of short- and long-term morbidities in infants and children. Unfortunately, risk factors of majority of preterm births (PTBs) remain unexplained which calls for appropriate action. There is a dearth of community-based research on PTB and its risk factors, especially in high burden countries like India. Objectives: The objective of the study was to explore different risk factors for PTB. Methods: A cohort of 1977 antenatal mothers was enrolled at household level by trained field investigators and was followed up in four districts of Gujarat, India, to document the outcome of pregnancy. Pretested and structured questionnaires were used to collect information. A hierarchical regression model was used to analyze the risk factors for PTB. Results: Proportion of PTB was 9% among the enrolled cohort. Risk factors which were found to be significant on applying the hierarchical model were periodontal disease, long sleep duration, and sex during any trimester. Conclusions: The study suggests an urgent need for strengthening of existing guidelines for effective, evidence-based, and culturally appropriate interventions for prevention of PTB. Maintenance of good oral hygiene should find a place in routine recommendations for pregnant women, and antenatal examinations should include screening for oral hygiene also.
  2,313 541 -
Assessment of drug prescribing pattern using world health organization indicators in a tertiary care teaching hospital
Sartaj Hussain, Suraj Singh Yadav, Kamal Kumar Sawlani, Sanjay Khattri
April-June 2018, 62(2):156-158
DOI:10.4103/ijph.IJPH_429_16  PMID:29923544
This cross-sectional study was carried out to assess drug prescribing pattern at a tertiary care teaching medical institute. One thousand prescriptions were randomly collected and analyzed using the world health organization prescribing indicators. The average number of drugs per prescription was 2.91. The percentage of drugs prescribed by generic name, from the essential drug list (National) and as fixed dose combinations (FDCs) was 10.05%, 22.57%, and 49.22%, respectively. The total percentage of encounters with antibiotics, injectables, and FDCs was 19.70%, 2.20%, and 73.60%, respectively. The most common group of drug prescribed was gastrointestinal tract drugs (26.38%) followed by Vitamins and Minerals (23.12%), cardiovascular system drugs (11.56%) and antimicrobials (9.63%). The prescribing practices were not appropriate as they consist of polypharmacy, lesser prescription by generic name, and overprescription of FDCs. There is a need for improvement in the standards of prescribing patterns in many aspects.
  1,884 429 -
India epidemic intelligence service: Advocating for a unique mentor-based epidemiology training program
Jai Prakash Narain
April-June 2018, 62(2):143-145
DOI:10.4103/ijph.IJPH_336_17  PMID:29923540
To strengthen epidemiological capacity in the country, the Government of India in 2012 initiated a unique, competency-based training in epidemiology. Modeled along the United States Epidemic Intelligence Service (EIS), this 2-year mentor-driven and practical-oriented program, based on “learning by doing,” is being implemented by the National Centre for Disease Control in Delhi, in close collaboration with the US Centers for Disease Control and Prevention, Atlanta. In its 4th year now, many lessons learned so far are being used to expand the program, without compromising on the technical quality. Many including the trainees who have completed the program speak highly of the epidemiological skills imparted in real time and feel that if the India EIS program is “regionalized” and expanded rapidly, it could in due course transform public health in the country.
  2,074 175 -
Is obesity a problem among school children?
Rajesh Kunwar, Sukhmeet Minhas, Vipra Mangla
April-June 2018, 62(2):153-155
DOI:10.4103/ijph.IJPH_430_16  PMID:29923543
Reduction of premature mortality due to noncommunicable diseases through prevention and control forms the core issue of target 3.4 of sustainable development goals. Childhood obesity is an important public health challenge today. The current study was carried out in a large military station of North East India to find out prevalence of obesity among schoolchildren using World Health Organization body mass index-for-age charts for boys and girls. A total of 793 schoolchildren comprising of 328 girls and 465 boys between the age groups of 6 and 19 years were included. The prevalence of overweight and obesity among girls was 9.76% and 1.22%; and among boys, it was 10.97% and 3.23%, respectively. Overweight and obesity were more common among boys as compared to girls under the age of 13 years but trend changed afterwards. Lower prevalence of overweight and obesity found in our study could be because of availability of healthful environment in schools.
  1,896 293 -
Assessing Nepal's health policies and programs from a human rights perspective
Shiva Raj Adhikari, Sanjaya Aryal
April-June 2018, 62(2):123-127
DOI:10.4103/ijph.IJPH_308_16  PMID:29923536
Background: The right to health is a fundamental part of human rights. Ensuring right to health is not straightforward; there are several challenges. Factors such as capacity of right holders and duty-bearers and practices of providing and utilizing services among others determine to ensure health rights for the whole population. Objective: The objective of this paper is to analyze whether the health policies and programs follow a human rights-based approach (HRBA) and assess the situation of rights to health among the poor and vulnerable population. Methods: The study assessed domestic instruments against human rights policies and analyzed the implementation status of the policies and programs. An analytical case study method is used by utilizing qualitative and quantitative data. Results: Around 90% medicines are available in the facilities; however, 22% of health worker posts are vacant. Persistence of unequal distribution of health facilities, high out-of-pocket payment, and cultural and language barriers does not ensure accessibility of health services. Acceptability of health-care services in terms of utilization rate and client satisfaction is improved after introduction of new policy. Nepal has made significant progress in improving maternal mortality ratio, infant/child mortality, immunization rates, and life expectancy at birth. Conclusions: Although a progressive realization of the right to health is being achieved, more efforts are still needed to follow HRBA so as to achieve quality and equity in health-care services.
  1,841 167 -
Assessment of implementation status of Cigarettes and Other Tobacco Products Act (COTPA) and its awareness among residents in a block of Haryana
Ramashankar Rath, Anand Krishnan, Baridalyne Nongkynrih, Puneet Misra
April-June 2018, 62(2):100-103
DOI:10.4103/ijph.IJPH_126_17  PMID:29923532
Background: Legislative route is one of the known method to control behaviour of population. Cigarette and Other Tobacco Products Act is one of the laws enacted to control the use of tobacco in India lunched in the year 2003. Objective: The objective of this study was to find compliance of COTPA among tobacco stores and to find the knowledge of people regarding COTPA. Methods: All selected communities were studied by community audit. All stores selling tobacco products were assessed for its compliance to COTPA. Thirty participants from selected communities with in the age range of 18- 65 years were selected and interviewed for knowledge regarding COTPA. Results: A total of 218 stores were found to be selling tobacco. None of the stores were fully compliant to all COTPA clauses. Stores in rural areas were found to be more non-complaint than urban areas. 41% of stores were selling tobacco to minors, 10% were within 100 yards of schools.8% of schools have tobacco advertisement on façade and 24% displayed tobacco products openly. Around half of the participants (n-552) had heard about COTPA whereas only 4% were aware of all 4 provisions of COTPA. Conclusion: Although more than a decade passed since the law was enacted poor compliance and knowledge was found among participants.
  1,495 319 -
Dynamics in child undernutrition in Bangladesh: Evidence from nationally representative surveys between 1997 and 2014
Md Masud Hasan, Ali Quazi, Alice Marion Richardson
April-June 2018, 62(2):82-88
DOI:10.4103/ijph.IJPH_153_17  PMID:29923529
Background: Bangladesh has been struggling to reduce the prevalence of childhood undernutrition, which impedes physical and mental capability and accelerates morbidity and mortality. Objectives: The objective of the paper is to examine the changes over time in the association between potential covariates and nutritional status of Bangladeshi children. Methods: The study combined and analyzed data from six waves of Demographic and Health Surveys between 1997 and 2014. Multivariable binary logistic regression models have been fitted to data from individual waves. Overall association has been investigated using forest plots, and meta-regression has been utilized to assess the pace of change in the association over time. Results: Parental education and place of residence showed a consistent association with nutritional status of children. Children from parents with no little education were more likely to be undernourished than those from parents with secondary or higher level of education (odds ratio [OR] in 1997 = 3.34, 95% confidence interval [CI] = 2.65–4.22, OR in 2004 = 1.93, 95% CI = 1.58–2.37). On the other hand, gaps in the association of wealth and childhood nutrition have been widening consistently so that in 2014 children from households from the lowest 40% wealth category were 2.66 times (OR = 2.66, 95% CI = 2.13–3.33) as likely as to be undernourished than those from upper 20%. Conclusions: The findings have policy implications in terms of developing programs directed to mothers with a relatively poor socioeconomic background. A specific example would be providing nutritional education in relation to importance of childhood nutrition or cheaper nutritious food.
  1,406 261 -
HIV prevalence trend from HIV sentinel surveillance over a decade in India: An overview
Bhavna Sangal, Pradeep Kumar, Neeraj Dhingra
April-June 2018, 62(2):138-142
DOI:10.4103/ijph.IJPH_151_16  PMID:29923539
We aim to describe trends in antenatal HIV prevalence in India, at a national and regional level from consistent sentinel surveillance sites (2003–2015) among Antenatal Clinic (ANC) attendees. Data were analyzed from a total of 1,885,207 ANC attendees recruited at ANC sites. The consistent sites were grouped by years of initiation (Group 1: 2003–2005 and Group 2: 2006–2008) and according to six regions. Chi-square test for linear trend was applied to test the statistical significance of the trend. Nationally, at Group 1 sites, HIV prevalence was 0.93% in 2003, which declined to 0.36% in 2015 (P < 0.001). Similarly, at Group 2 sites, prevalence ranged from 0.25% to 0.23% during 2006–2015 (P > 0.05). The findings suggest that HIV is conclusively declining at old sites, nationally as well as in most of the other regions but increasing in the northern region. At newer sites, the conclusive declining trend is evident only in the southern region. National AIDS response must consider these variations to allow locally appropriate responses to the epidemic.
  1,266 216 -
A tool for quickly identifying gaps in diet of school children for nutritional educational interventions
Thomas V Chacko, Subhashini Ganesan
April-June 2018, 62(2):146-149
DOI:10.4103/ijph.IJPH_23_17  PMID:29923541
Compared to adults, assessment of dietary intake of school children has always been a great challenge in public health practice. Hence, this paper aims to share our experience in overcoming the problems in dietary assessment of large number of school children aged 6–17 years and the practicality of the tool for quickly identifying the broad gaps in the diet of individual Children for providing them dietary counseling. Based on the Indian Council of Medical Research/National Institute of Nutrition recommendations for balanced diet among school children, a simplified dietary gap assessment tool was developed to identify gross gaps in their diet and also a system of scoring it so as to measure effectiveness of the nutritional educational program. The simplified tool was effective in overcoming the challenge of making the children understand the concept of portion size by replacing it with inquiry of frequency of food intake in 'yes” or “no” terms and thereby making it easy to administer and is time efficient enough to enable a large number of students to be screened.
  1,120 250 -
Exposure to second hand smoke and its correlates in Northern State of India
Garima Bhatt, Sonu Goel, Suman Mor, Rakesh Gupta
April-June 2018, 62(2):128-132
DOI:10.4103/ijph.IJPH_442_16  PMID:29923537
Background: Second-hand smoke (SHS) has enormous adverse health impacts with grave health implications for the next generation. Section 4 of Indian legislation, Cigarettes and Other Tobacco Products Act, prohibits smoking at public places, thus protecting people from SHS. Objective: The objective of present study was to assess the exposure to SHS at home and working areas in Punjab, India. Methods: The present cross-sectional study was conducted from December 2015 to March 2016. A three-stage sampling technique was used for collecting data from three randomly selected districts representing three major regions of Punjab, India. A sample size of 510 individuals was divided equally into an urban and rural area with proportionate sampling on the basis of subsets of age groups and gender. The questionnaire based on tobacco questions for the survey, a subset of key questions from global adult tobacco survey was used. Results: At home, the odds of exposure to SHS exposure was higher (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 0.6–7.3) in urban area, females, low educational status, and nongovernment employee as compared to their counterparts. At workplace, (OR = 3.9 and 95% CI = 1.11–14.3) SHS exposure was higher in rural area, among males, primary and middle education and nongovernment or self-employed occupation. Conclusion: SHS exposure was low in Punjab, India especially in females as compared to other states of the country. The socio-economic disadvantaged groups and people with low education were more likely to experience exposure to SHS at workplace, which should be targeted to reduce tobacco consumption.
  1,048 238 -
Obesity and serum uric acid in secondary school-age students of srinagarindra the princess mother school, Phayao, Thailand
Wanpen Suttikomin, Preeya Leelahagul, Suphawan Khamvang, Chamnong Chaimongkol, Nanticha Chaiwut
April-June 2018, 62(2):133-137
DOI:10.4103/ijph.IJPH_117_17  PMID:29923538
Background: Obesity and hyperuricemia are the precipitating factors of multiple disease processes. Studies on the relationship between obesity and hyperuricemia in Thai adolescents are limited. Objective: The objective is to investigate the gender differences in obesity and serum uric acid as well as the relationship between obesity and serum uric acid levels in secondary school-age students. Methods: A cross-sectional study conducted among 689 secondary school-age students; 313 boys and 376 girls. Body composition and fasting serum uric acid were assessed. This study defined hyperuricemia as serum uric acid >6 mg/dL in girls and >7 mg/dL in boys. Results: By body mass index (BMI) for age and percentage of body fat classification, the prevalences of obesity were 11.5% and 9.0%, respectively. Prevalence of obesity by BMI for age, 15.3% and percentage of body fat, 12.4% in boys were statistically significantly higher than those in girls, 8.2% and 6.1%, respectively. Boys in all age groups had statistically significantly higher serum uric acid levels than those in girls as well as serum uric acid levels at late adolescent period in both sexes were statistically significantly higher than those at early adolescent period. Conclusion: On multivariate analysis, the demographic factors studied showed that boys, late adolescence period, and excess body fat adolescents had higher prevalence of hyperuricemia in secondary school-age students who have their birthplace in 8 provinces of Northern Thailand. This indicated that early nutritional management and encourage obese adolescents to weight and serum uric acid reductions are important for the prevention of diet-related chronic diseases in their adult period.
  1,074 160 -
Omission of quality assurance during data entry in public health research from India: Is there an elephant in the room?
Nafis Faizi, Ajay M Kumar, Shahwar Kazmi
April-June 2018, 62(2):150-152
DOI:10.4103/ijph.IJPH_386_16  PMID:29923542
As the adage, “Garbage in, Garbage out” goes, data entry errors may lead to erroneous results and conclusions. Quality assurance during data entry is one of the most neglected components of research and is conspicuously missing in most of the reporting standards. In this study, we reviewed research studies published in Indian Journal of Public Health and Indian Journal of Community Medicine during 2014–2016 and determined the proportion of papers reporting on quality assurance during data entry. Of 110 papers, only 6 (5.5%) papers explicitly included a statement about data quality assurance, with two studies reported to have performed double entry and validation, considered the gold standard in quality-assurance of data entry. This is highly unacceptable. We hereby appeal to the community of researchers, peer reviewers, and journal editors in India to pay attention to this important aspect of research and make reporting of quality assurance of data entry mandatory in every published paper.
  863 356 -
Relationship between height and arm span of elderly persons in an urban colony of New Delhi
Anil Kumar Goswami, Mani Kalaivani, Sanjeev Kumar Gupta, Baridalyne Nongkynrih, Chandrakant S Pandav
April-June 2018, 62(2):159-162
DOI:10.4103/ijph.IJPH_378_16  PMID:29923545
Anthropometric changes take place with increasing age. Progressive loss of height makes it difficult to use height for calculation of body mass index in nutritional screening of elderly persons. There is a need to find other alternative methods which could be used as proxy measurements of height in them. To assess the relationship of height and arm span and among elderly persons. A community-based cross-sectional study was conducted among elderly persons in urban colony of Delhi. Height and arm span of persons aged 60 years and above (n = 711) were measured according to standard methods. Correlation between arm span and height was calculated. The mean arm span was seen to be more than the mean height in all age-groups and both sexes. There was a linear relationship between height and arm-span in all age-groups. There was a strong correlation between arm span and height in all age groups. Arm span could be used instead of height as an alternative in the conventional body mass index in elderly persons.
  960 157 -
Epidemiology and management for health care
Arun Kumar Aggarwal
April-June 2018, 62(2):163-164
  371 147 -