Quality of life and its determinants in people living with human immunodeficiency virus infection in Puducherry, India

Context: With anti-retroviral therapy (ART) for human immunodeficiency virus infection (HIV) coming into picture, quality of life (QOL) has gained importance. Knowledge on the factors affecting QOL would be helpful in making important policy decisions and health care interventions. Aims: The aim of this study is to assess the quality of life of people living with HIV (PLWH) and to identify the factors influencing their QOL. Materials and Methods: The study was done among 200 PLWH attending a tertiary care hospital, and three Non Governmental Organizations at Puducherry, India, from November 2005 to May 2007. QOL was assessed using HIV specific World Health Organization Quality Of Life scale (WHOQOL-HIV) - BREF questionnaire which has six domains (physical, psychological, level of independence, social relationships, environment and spirituality/religiousness/personal belief). Social support and stigma were measured using "Multidimensional Scale of Perceived Social Support" and "HIV Stigma Scale," respectively, using Likert Scale. Factors influencing QOL were identified using backward stepwise multiple linear regression with the six domain scores as the dependent variables. Results: Male: Female ratio was 1:1 and 58% were in early stage of the disease (stage I/II). Psychological and SRPB (Spirituality Religiousness and Personal Beliefs) domains were the most affected domains. All the regression models were statistically significant (P<0.05). The determination coefficient was highest for the social relationship domain (57%) followed by the psychological domain (51%). Disease stage and perceived social support significantly influenced all the domains of WHOQOL. Younger age, female gender, rural background, shorter duration of HIV, non-intake of ART and greater HIV related stigma were the high risk factors of poor QOL. Conclusion: Interventions such as ART, family, vocational and peer counseling would address these modifiable factors influencing QOL, thereby improving the QOL of PLWH

Determinants of COVID-19 transmission in India: Issues and challenges

The recent increase in trend of COVID-19 cases in India is an important public health issue. Cases reported vary in calendar time in different states and regions. Case presentations, its determinants and mediators such as behavioral and social factors may be different across and within countries. Although agent, host and environmental factors play a major role, there are other influencing factors for transmission of infection. Appropriate cost-effective prevention strategies such as social distancing, use of face mask and its implementation in the Indian context is a big challenge. Recent data available on the public domain was reviewed on various issues and challenges related to determinants of COVID-19 and its transmission in the Indian context. This review emphasizes to further strengthen prevention of infection transmission strategies at regional and state level by a combination of multiple strategies and robust surveillance system

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

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

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

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

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

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