An Exploratory Study on Quality of Life among Road Traffic Accident Victims in India

Background: Road traffic accidents are India’s sixth leading cause of mortality, with a substantial share of physical, psychosocial and economic losses in the productive age group. Objectives: To explore the victims’ and stakeholders’ perceptions on quality of life among road traffic accident victims in India. Methods: A qualitative study incorporating in-depth interviews among road traffic accident victims and key informant interviews among stakeholders was conducted from June to August 2019 (3 months) in Puducherry. Participants were selected using purposive sampling. Data was collected till the point of saturation with a semi-structured interview guide through six in-depth interviews among accident victims and six key informant interviews among stakeholders. Content analysis of the data was performed, and a conceptual framework was developed. Written informed consent from each participant was sought. Ethical clearance was obtained from the Institute Ethics Committee. Results: Four themes were identified: reasons for road traffic accidents, problems faced by the victims, problems faced by the caretaker or family member, and preventive measures for road traffic injuries. Conclusion: Physical, psychological, and financial problems were encountered by the victims, caretakers, and family members after a major road traffic accident. Accident victims felt that support from family members was indispensable in returning to normal life

Pattern of cutaneous adverse drug reactions at a tertiary care hospital in southern India

Background: The objective of the study was to assess the pattern of cutaneous adverse drug reactions reported by active surveillance to the Pharmacovigilance center of a tertiary care hospital in southern india, and also to establish the drugs causing the same and observe the age wise and gender based incidence of such reactions.Methods: The cutaneous ADRs (CADRs) reported to the Pharmacovigilance center of the institution were analysed retrospectively during the period of March 2013 to December 2015. The various pattern of skin reactions and the most frequent drugs causing the same were established. An age wise and gender based incidence of CADRs and drugs causing them were also reported.Results: A total of 293 cases were taken for analysis. The male female ratio was 0.89-1.in our study. Among the age wise distribution of CADRs, 57(19.4%) were seen in paediatric, 194(66.2%) in adults and 33(11.2%) in geriatric age groups. The most frequent drugs to cause the CADRs were antimicrobials 183(62.4%) followed by NSAIDs 38(12.9%) and antacids 17(5.8%).Among the skin reactions urticaria/ angioedema was the most common 109(37.2%) followed by generalised pruritis 57(19.5%) and fixed drug eruption 37(12.6%). In all the age groups and both the sexes urticaria/angioedema and generalised pruritis were the leading skin reactions observed.Conclusions: As CADRs are the most common ADRs among others, it is prudent to monitor them closely, as any change in pattern with older or newer agents can alert the health care personnel in instituting the appropriate prescription patterns, which can overall impact the quality of health care positively

An outbreak investigation of typhoid fever in Pondicherry, South India, 2013

Background: Preliminary investigation at Pediatric ward of Indira Gandhi Medical College revealed admission of a cluster of typhoid cases who were residents of one particular street in a nearby locality. Objectives: This study was undertaken to estimate the magnitude of the outbreak, identify the source of infection, and, thereby, institute control measures. Materials and Methods: An investigation team including 10 MBBS students carried out a sanitary survey, house-to-house survey, data collection using epidemiological case sheets, and spot mapping. Typhoid diagnosis was confirmed as per the IDSP guidelines, i.e., either a blood culture growth positive for Salmonella typhi or a fourfold rise in antibody titer. An age- and gender-matched case–control study was conducted to find the association of occurrence of typhoid with various possible sources of infection. Water samples were collected from the affected households and public taps for investigation. Results: Rapid survey of all the 6 streets of Thilaspet covered 1106 people living in 283 households. All nine confirmed cases were residents of one particular street. The attack rate calculated was 3.4% in this street. A significant association of occurrence of typhoid was found only with consumption of raw drinking water (OR = 12.6, P = 0.01). Water samples only from the affected street tested positive for the presence of coliforms. The sanitary survey documented water pipeline breakage at the junction of this street. Further spread of disease was stopped by advocating drinking of boiled water and repair of pipeline. Conclusion: Strengthening of disease surveillance for early identification of localized outbreaks and instituting control measures can effectively control disease spread

A Community-based Epidemiological Study on non-fatal Road Traffic Accidents in Puducherry, South India

Introduction: Road traffic accidents are the sixth leading cause of death in India with a greater share of hospitalization, disabilities, deaths and socio-economic losses. Objective: To identify the pattern of non-fatal road traffic accidents, socio-demographic profile of accident victims and antecedent factors influencing these road traffic injuries. Method: A cross-sectional study was conducted for six months in Puducherry. From existing 27 wards of Lawspet, six wards were selected by simple random sampling technique and all the households in selected wards were included. The minimum required sample size was estimated to be 165 by considering prevalence of non-fatal road traffic accidents in Puducherry as 5.6%. Face-to-face interview with a semi-structured questionnaire was used for data collection. Data entry and analysis were performed using Epi-data manager 4.2.0. Results: Total 169 accident victims were included in the study from the households of selected wards. Mean age of the accident victims was found to be 36.2 (11.4) years. Two‑wheeler accidents accounted for 144 (85.2%) and 123 (72.7%) accident victims were drivers at the time of accident. Majority (95.1 %) of the victims did not wear helmet while driving two-wheelers and none of the four-wheel drivers/pillions wore seat belts. Majority of the accidents occurred on usual tar roads 116 (68.6%) and 42 (24.9%) on highways. 102 (60.4%) accidents occurred in bi-directional roads.Conclusion: Simple or minor injuries were high compared to serious injuries requiring hospitalization. Majority of the accidents occurred during Fridays, Saturdays and Sundays. The accidents exhibited a bimodal distribution with day and night time

Effect of mobile reminders on screening yield during opportunistic screening for type 2 diabetes mellitus in a primary health care setting: A randomized trial

AbstractObjective. We wanted to study whether mobile reminders increased follow-up for definitive tests resulting in higher screening yield during opportunistic screening for diabetes. Methods. This was a facility-based parallel randomized controlled trial during routine outpatient department hours in a primary health care setting in Puducherry, India (2014). We offered random blood glucose testing to non-pregnant non-diabetes adults with age >30years (667 total, 390 consented); eligible outpatients (random blood glucose ≥6.1mmol/l, n=268) were requested to follow-up for definitive tests (fasting and postprandial blood glucose). Eligible outpatients either received (intervention arm, n=133) or did not receive mobile reminder (control arm, n=135) to follow-up for definitive tests. We measured capillary blood glucose using a glucometer to make epidemiological diagnosis of diabetes. The trial was registered with Clinical Trial Registry of India (CTRI/2014/10/005138). Results. 85.7% of outpatients in intervention arm returned for definitive test when compared to 53.3% in control arm [Relative Risk=1.61, (0.95 Confidence Interval — 1.35, 1.91)]. Screening yield in intervention and control arm was 18.6% and 10.2% respectively. Etiologic fraction was 45.2% and number needed to screen was 11.9. Conclusion. In countries like India, which is emerging as the diabetes capital of the world, considering the wide prevalent use of mobile phones, and real life resource limited settings in which this study was carried out, mobile reminders during opportunistic screening in primary health care setting improve screening yield of diabetes

Assessment of mental health status among adolescents in Puducherry, India – A mixed method study

Context: Adolescence is a crucial period during which biological and psychosocial changes occur in an individual. The prevalence of mental disorders among Indian adolescents was 7.3%. Early recognition and intervention will help to have favorable outcomes. Aims: To determine and compare the prevalence and risk factors associated with mental health illness among urban and rural adolescents in Puducherry. Methods and Material: An explanatory mixed-method design wherein the quantitative phase (an analytical cross-sectional study) was followed by qualitative phase (focus group discussion). Adolescents aged 13–17 years attending Government schools in urban and rural Puducherry were selected by stratified random sampling. Mental health status was screened using a validated Youth Report Measures for Children and Adolescents – SDQ and students with higher score were considered to be at risk of mental health illness. Results: Among 329 adolescent, 25.5% are found to be at risk of mental health illness. The mean total score and sub-domain scores of hyperactivity and emotional symptoms were found to be significantly higher in urban when compared to rural. Among those at risk of mental health illness, significant difference between urban and rural area was seen with respect to variables like family monthly income and parent's occupation. Behaviour change and deterioration in academic performance were the most common presentation as perceived by the teachers. Conclusions: One fourth of the adolescents were found to be at risk of mental health illness, so periodic screening could be done at schools, for early identification and proper treatment of mental disorders

Prevalence and knowledge, attitude, practices about diabetes mellitus among elderly people in urban slums of Puducherry India

Background: Diabetes mellitus (DM) is a chronic metabolic disease which is prevalent globally. The World Health Organisation (WHO) has warned of an alarming increase in the population with type II diabetes mellitus both in developed and developing countries over the next two decades. This study is aimed at estimating the prevalence of diabetes mellitus among the elderly persons residing in urban slums of Pondicherry.Methods: A cross-sectional community based study was conducted with an objective to estimate the prevalence of diabetes and to assess the knowledge, attitude and practices regarding diabetes, treatment and control of diabetes, among elderly persons (60 years and above) residing in an urban slum. A house to house community based study was carried out among a randomly selected sample of 202 persons aged 60 years and above, from urban slum of Pondicherry. Results: Total 202 participants were interviewed, 103 (53%) were males and 99(49%) were females. The prevalence of impaired fasting blood glucose is 6.9 (7%), while prevalence of diabetes is found to be 20.3%. A total of 181(90%) of participants have heard about Diabetes Mellitus while 10% have not ever heard about Diabetes Mellitus, while 155 (77%) participants agreed that regular exercise keeps diabetes under control while almost equal number 149(73.4%) agreed that people with DM should control their weight and 144(71%) dietary modification is useful for keeping DM in control. A total of 177(88%) did not know whether complications can be prevented by timely investigations while just 12% knew that it is possible to prevent complications of diabetes mellitus with timely investigation. 77% knew that regular exercise keeps diabetes under control but during the last one month 106(50%) either rarely or never participated in any moderate physical exercise.Conclusions: Strengthening primary health care services in urban slums, with special emphasis on vulnerable population like elderly persons, is needed. Non-communicable diseases are a major cause of morbidity and mortality in this age group, and deserve special attention of policy makers and programme managers

Patients’ satisfaction survey on healthcare services among non-communicable disease patients at a tertiary care hospital in Puducherry

Background: Patient satisfaction is a scale to assess the services offered by the healthcare system. Patient’s feedback is necessary to identify problems that need to be resolved in improving health services. Aim & Objective: Keeping this in view, the present study is an initiative to estimate the patient’s satisfaction in service provision among NCD patients at a tertiary care hospital of Puducherry. Settings and Design: A Facility-based descriptive cross-sectional study was conducted among NCD patients attending General medicine OPD of a tertiary care hospital of Puducherry between April-June 2019. Methods and Material: Assuming 50% satisfaction level among study participants and 5% non-response rate, the sample size was estimated as 404. The NCD register maintained at the General medicine OPD was considered as the sampling frame & systematic random sampling was applied, so that every 5th patient satisfying the inclusion criteria will be included. A standardized patient satisfaction questionnaire with 31-items (4 domains) which is validated for Indian setting (Cronbach’s alpha 0.96) was used. Statistical analysis used: Data capture was done using Epicollect-5 android application and analysed using SPSS version 16.0. Results: Among the 404 NCD patients, the mean age was 56 ± 11.8 (SD) years and 60.6% were females. One in four patients felt poor in reception, doctor-patient relationship and dispensary services. The overall satisfaction of study subjects categorized as good, satisfactory, poor was 6%, 86% and 8% respectively. Conclusions: Majority of the study participants were satisfied with the service provision of the health facility. Still, there is a scope for improvement in dispensary, doctor-patient relationship and registration services

Association of socio-demographic determinants with quality of life among road traffic accident victims

Background: Road traffic accidents are the sixth leading cause of death in India with a greater share of hospitalization, disabilities, deaths, and socio-economic losses. Objectives: To assess the socio-demographic determinants associated with quality-of-life among road traffic accident victims. Methodology: A community-based, longitudinal study was conducted for 2 years in South India. Simple random sampling was employed to include 169 accident victims. Baseline data were collected with a semi-structured questionnaire on socio-demographic details and using SF-32. Follow-up was at the 6th and 12th month from the day of accident. Data entry and analysis were performed using Epi-data manager 4.2.0. Written informed consent from each participant was sought. Ethical clearance was obtained. Results: The mean ± standard deviation age of the subjects was found to be 36.2 ± 11.4 years. The results of the study showed that there was a statistically significant incremental change in quality of life among the accident survivors at baseline, 6 and 12 months (P < 0.05). Socio-economic determinants such as education, occupation, marital status, and religion were found to be associated with different domains of quality of life. (P < 0.05). Conclusion: The improvement in the quality of life of the victims over 1-year period was found to be significant

Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India

Background: The average expenditure incurred by patients in low- and middle-income countries towards diagnosis and treatment of TB ranges from $55 to$8198. This out-of-pocket expenditure leads to impoverishment of households. One of the three main targets of the End TB Strategy (2016–2035) is that no TB-affected household suffers catastrophic costs due to TB. Study setting was free care under national tuberculosis program (NTP), Puducherry district, India. Objectives: The objectives of the study were among the newly diagnosed and previously treated tuberculosis (TB) patients, to (a) estimate patient costs during diagnosis and intensive phase of treatment, (b) determine the proportion of households experiencing catastrophic costs, and (c) explore coping strategies. Methods: An explanatory mixed methods design comprising both quantitative cost description and qualitative descriptive component was used. Catastrophic cost was defined as total TB care costs exceeding 20% of annual household income. Results: Of 102 TB patients included, two-thirds (69%) were male, 6% were HIV positive, and 45% reported at least one episode of hospitalization for TB care. The median (IQR) total cost of TB care was US$195 (52.1, 492.9) with a direct cost of US$65.3 (22.3, 156.5) and indirect cost of US$50.2 (0.9, 295.1). Overall, 32.4% of households experienced catastrophic costs due to TB care, significantly higher in patients with HIV coinfection (p = 0.009) and hospitalization (p = 0.009). Pledging jewels and borrowing money were major coping strategies. Cash assistance was the expected remedy from the patient perspective. Conclusion: Despite free TB care under NTP, more than a third incurred catastrophic costs towards TB care