The status and socio-demographic predictors of geriatric malnutrition of rural Maharashtra of central India: A cross-sectional study

Introduction: The elderly population has a lot to give to society but various issues like malnutrition hinder their activities and affect their quality of life. Objective: The current study was proposed to assess the nutritional status of the elderly in rural Maharashtra of central India. Method: This cross-sectional study recruited 460 elderly individuals and was conducted in selected four villages of same district in central India for 5 months (Aug-Dec 2021). Stratified sampling method was used. This study used the MNA (Mini Nutritional Assessment) questionnaire and haemoglobin level to assess the nutritional status of the elderly. Univariate analysis and multivariate analysis were carried out using R software. Results: Out of 460 study subjects, 42 (9.13%) were malnourished and 286 (62.17%) were at risk of malnutrition. The study assessed 300 elderly for hemoglobin status and 129 (43%) were found anemic. The elderly who belonged to the age group 71-80 years had lesser odds of having satisfactory nutritional status (OR=0.53) while age group >80 was more prone to anemia (OR= 1.71). The odds of satisfactory nutritional status were higher for elderly who had education less than secondary school (OR=2.02) and for elderly those who had completed high secondary schooling (OR=4.94) and those who belonged to the nuclear family (OR=1.59). The study showed elderly who belonged to Open caste had lesser odds of having anemia (OR=0.68). Conclusion: The study found high prevalence of anaemia (43%) and at-risk malnutrition (62.17%) in the geriatric population. Policymakers should prioritise nutritional interventional policy, and stakeholders should promote the existing nutritional policies of this vulnerable group

Accuracy and Reliability of Pallor for Detecting Anaemia: A Hospital-Based Diagnostic Accuracy Study

Anaemia is a common disorder. Most health providers in resource poor settings rely on physical signs to diagnose anaemia. We aimed to determine the diagnostic accuracy of pallor for anaemia by using haemoglobin as the reference standard.In May 2007, we enrolled consecutive patients over 12 years of age, able to consent and willing to participate and who had a haemoglobin measurement taken within a day of assessment of clinical pallor from outpatient and medicine inpatient department of a teaching hospital. We did a blind and independent comparison of physical signs (examination of conjunctivae, tongue, palms and nailbed for pallor) and the reference standard (haemoglobin estimation by an electronic cell counter). Diagnostic accuracy was measured by calculating likelihood ratio values and 95% confidence intervals (CI) at different haemoglobin thresholds and area under the receiver operating characteristic curve. Two observers examined a subset of patients (n = 128) to determine the inter-observer agreement, calculated by kappa statistics. We studied 390 patients (mean age 40.1 [SD 17.08] years); of whom 48% were women. The haemoglobin was <7 g/dL in 8% (95% confidence interval, 5, 10) patients; <9 g/dL in 21% (17, 26) patients and <12 g/dL in 64% (60, 70) patients. Among patients with haemoglobin <7 g/dL, presence of severe tongue pallor yielded a LR of 9.87 (2.81, 34.6) and its absence yielded a LR of 0. The tongue pallor outperformed other pallor sites and was also the best discriminator of anaemia at haemoglobin thresholds of 7 g/dL and 9 g/dL (area under the receiver operating characteristic curves (ROC area  = 0.84 [0.77, 0.90] and 0.71[0.64, 0.76]) respectively. The agreement between the two observers for detection of anaemia was poor (kappa values  = 0.07 for conjunctival pallor and 0.20 for tongue pallor).Clinical assessment of pallor can rule out and modestly rule in severe anaemia

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Receiver Operating Characteristics (ROC) curves for all clinical sites for detection of anaemia at haemoglobin cutoff points (a) 7 g/dL and (b) 9 g/dL.

<p>Receiver Operating Characteristics (ROC) curves for all clinical sites for detection of anaemia at haemoglobin cutoff points (a) 7 g/dL and (b) 9 g/dL.</p

Interobserver variability in assessment of anaemia (n = 128).

<p>Interobserver variability in assessment of anaemia (n = 128).</p

Sample Study Profile, tongue pallor as index test and haemoglobin levels (less than 7 g/dL and 9 g/dL) as reference standards.

<p>Sample Study Profile, tongue pallor as index test and haemoglobin levels (less than 7 g/dL and 9 g/dL) as reference standards.</p

Vitalizing Community for Health Promotion Against Modifiable Risk Factors of Noncommunicable Diseases (V-CaN) in Rural Central India: Protocol for a Hybrid Type II Implementation Effectiveness Trial

BackgroundLow- and middle-income countries are facing the emerging burden of chronic noncommunicable diseases (NCDs). Apart from loss of human lives and premature deaths, NCDs result in huge costs for treatment to individuals and the health system. Although NCDs develop in later life, the risk factors begin at an early age. The key to the control of the global epidemic of NCDs is primary prevention based on comprehensive community-based programs. ObjectiveThis study aims to develop, implement, and evaluate the effect of a participatory health promotion initiative utilizing the existing mechanisms of Village Health Nutrition and Sanitation Committees (VHNSCs), women’s self-help groups (SHGs), and schools on modifiable risk factors for NCDs among young people aged 10-30 years. MethodsThe proposed type II hybrid effectiveness implementation cluster randomized field trial will be conducted in the catchment area of 4 primary health centers (PHCs) in Wardha district, India, comprising 100 villages with a population of 144,000. Each PHC will be randomly allocated to one of the 3 intervention arms or the control arm. The 3-intervention arm PHCs will utilize a unique strategy with either VHNSC or SHG members or school students as change agents for health action against common modifiable NCD risk factors. This study will be implemented in 3 phases from January 2022 to December 2024. First, the preparatory phase for baseline assessments includes anthropometry, behavioral and biochemical risk factors for NCDs, and participatory development of the health promotion intervention modules. Second, the implementation phase will focus on capacity building of the change agents and implementation of the participatory health promotion initiative. The implementation will include organization of community-based events, 6-monthly participatory assessment of change, and preparation of a sustainability and exit plan toward the end of this phase. Third, the evaluation phase will consist of studying the effectiveness of each intervention strategy in the reduction of risk factor prevalence at the population level. ResultsWe will assess 12,000 (3000 in each arm) randomly selected individuals for behavioral risk factors and 1600 (400 in each arm) individuals for biochemical risk factors during baseline as well as endline assessments. Difference in differences, ANOVA or multivariate analysis of covariance, and regression analysis will be performed to assess the effectiveness of the interventions. Qualitative methods such as focus group discussions and stories of change will be documented and analyzed using thematic framework analysis. The implementation outcomes will be reported using the PRISM (Practical Robust Implementation and Sustainability Model) RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The results are expected to be published by mid-2025. ConclusionsThis study will show the magnitude of risk factors for NCDs, its determinants, feasibility, effectiveness of community-based interventions, and health promotion models for NCD prevention. Trial RegistrationClinical Trials Registration India CTRI/2020/10/028700; https://ctri.nic.in/Clinicaltrials/showallp.php?mid1=47597&EncHid=&userName=V-CaN International Registered Report Identifier (IRRID)DERR1-10.2196/4245