Mapping of pathways of care, assessment of delays and gap analysis in provision of care following road traffic injury among patients in selected tertiary hospitals in urban Karnataka, South India

Background: Evidence-based public health advocates decision making based on best available scientific evidence, hence it is important to gather evidence of current scenario of trauma care. Aim & Objective: To determine pathways of care and delays among Road Traffic Injury patients and assess gaps in resources. Settings and Design: This cross-sectional study was conducted in selected tertiary care hospitals in Mangaluru taluk, Karnataka. Methods and Material: Participants were administered validated proformas on prehospital and hospital care. WHO trauma care checklist was used for capacity assessment and gap analysis. Statistical analysis used: Time intervals are expressed as measures of central tendency and dispersion. Descriptive analysis is given as percentages and proportions. Results: Median pre-hospital time was 30 minutes. Overall, 67.5% of the patients reached within golden hour. Majority (64.1%) were directly transported to current hospital. All patients received first aid, but only 0.8% received it at the RTI site. First aid was mostly administered by doctors (68.7%) or nursing staff (31.1%) and none by bystander. Insurance coverage was 32.8% and 87.9% incurred out of pocket expenditures. Scores were low in GP level hospital. Conclusions: Although transport was within the golden hour, pre-hospital care was poor. Out of pocket expenditures were high

A qualitative analysis of perspectives of district level frontline managers in Karnataka during first wave of COVID 19

With the emergence of pandemic, health sector has been facing innumerable challenges right from prevention to management of COVID-19. This study attempts to understand these factors from a local perspective that will help in better planning and management of situation for the future. Karnataka was one of the 8 states selected as part of a multisectoral qualitative study. Perspectives of frontline managers regarding the management of COVID 19 pandemic situation were taken by in depth interviews. Deductive thematic analysis from the audio recordings and transcripts showed public apprehensions, gaps in decentralized approach and specific guidelines, monitoring difficulties and workforce related issues as factors of concern

Household Survey on Determinants of Indoor Air Pollution (IAP) and Its Health Hazard Awareness among Women: A Cross-Sectional Study

Introduction: In India, majority of the households still use biomass fuel. It is a major cause of death and disability in India.Aims and objectives: To assess determinants of Indoor air pollution and its health hazard awareness among women in semi-urban Mangalore.Methodology: 200 randomly selected households were recruited in two villages of Mangalore. A standard, structured questionnaire was administered after taking informed consent. Descriptive analysis of household area, cooking fuel usage, smoking status was done.Results: Of the participants, mean age was 45.22 with standard deviation of 11.36 years and mean time spent in kitchen in a day was 3.4 hours with standard deviation of 0.80. 64.2% of the houses lack cross ventilation and 72.5% of houses had tiled roofs. 17.9% were using chullah as cooking media and firewood, sawdust as cooking fuel. Regarding hazards of indoor air pollution, over half (50.9%) of women were unaware of it and among those who were aware, only 37.6% knew that indoor air pollution causes respiratory symptoms. Around 57.3% participants replied that their respiratory complaints increased on exposure to smoke. Of those who complain of respiratory symptoms, 49.0% are women. Almost three-fourth (72.5%) houses were tobacco smoke-free.Conclusion: participants’ residence, pattern and fuel use were the probable determinants of exposure to indoor air pollution. Knowledge regarding ill effects of indoor air pollution (IAP) varied among women. The present study is limited to small sample size. Further studies with a large sample size are required to conclude the above findings

Lifestyle, dietary and treatment adherence pattern of uncontrolled diabetics in coastal Karnataka, India

Background: Diabetes Mellitus shows a rising trend in India, driven by a combination of factors like sedentary lifestyle, unhealthy diet and tobacco use. The cornerstone for interventions to reduce this is lifestyle modification. Aim & Objective: This study aims to determine lifestyle behaviours among uncontrolled diabetics in rural South India. Settings and Design: This is a pilot study conducted as part of a community trial which enrolled uncontrolled diabetics (Glycosylated haemoglobin, HbA1C of 7% or more) selected from baseline survey of 2 RBS readings. Methods and Material: The sociodemographic details, lifestyle habits and treatment adherence of eligible participants were recorded with a validated questionnaire. Statistical analysis used: Data was compared among 2 groups of poor glycaemic control using Chi square test. Results: There was no significant association of age or gender with HbA1C levels. Majority were non-smokers, non-alcoholics and did not exercise. Higher proportions of those with hospital admissions, longer duration of disease and less frequent check-ups had poor control; but these were not statistically significant. Dietary control was inadequate. However, there were no significant association of dietary habits with poor control. Conclusions: Although overall adherence to medication and follow up was satisfactory, lifestyle modification is not being sufficiently followed

Practice patterns in the management of preterm labor in India: a multi-centric, retrospective study

Background: Preterm labor (PTL) is considered as one of the leading cause of perinatal morbidity and mortality. Preterm labor refers to the onset of uterine contractions of sufficient strength and frequency to effect progressive dilatation and effacement of cervix between 22 and 37 weeks of gestation.Methods: In this study, 285 patients of PTL admitted/treated (during the period of 1st January 2014 to 31st December 2016) across 5 centres in India were enrolled. Adult women with PTL, receiving oral or intravenous regime of tocolytic drugs were screened based on eligibility criteria.Results: We evaluated the practice patterns in the management of PTL in India. The pharmacological management (n=193) was preferred over nonpharmacological management (n=92) in the present study. Amongst the pharmacological agents, isoxsuprine (60.10%) was more frequently used followed by nifedipine (23.83%). Prolongation of delivery for at least 48 hours was observed in 57.76% patients receiving isoxsuprine compared to 34.78% patients receiving nifedipine. The mean latency period (36.77±28.09 vs. 1.44±1.33 days), birthweight (2.25±1.34 vs. 1.07±0.34 kg) and Apgar score at 5 mins (7.56±2.36 vs. 4.87±2.10) was higher for isoxsuprine compared to nifedipine group patients, with mean gestational age of 32 weeks).Conclusions: Pharmacological treatment was preferred for the management of PTL in India. Among pharmacological agents, isoxsuprine was preferred over other tocolytics. Significant improvement in mean latency period, prolongation of delivery beyond 48 hours and perinatal outcomes were noted amongst patients on isoxsuprine versus other pharmacological agents

Association of obesity with physical activity, television viewing, video /computer gaming among school children in Mangalore

Introduction: There is an increasing prevalence of obesity worldwide in children which can be attributed to changes in lifestyle such as sedentary habits, television (TV) viewing, playing computer games, and consumption of snacks while watching television. The present study was done to find the association between obesity and TV viewing, computer game playing, sedentary lifestyle in children and also with a secondary objective to assess the association between blood pressure and TV/computer game viewing, sedentary lifestyle in children. Materials and methods: A cross sectional study was conducted at 4 high schools and Pre University Colleges (PUC’S) in and around Mangalore during the study period of 4 days from 6 -12 august 2014. 509 students were enrolled. Information was gathered by asking the subjects to fill up a structured questionnaire. Nutritional status was assessed based on Body mass index (BMI) and waist-hip ratio, waist-height ratio for all subjects. Blood pressure was measured for all the subjects. Results: It was found that among males 2.7% of students were obese and in females it was 2.3%. There was a significant association between blood pressure and consumption of snacks while watching TV and also between blood pressure and their habit of consumption / buying of snacks/ fast-food advertised in TV. A significant association was found between central obesity (Waist-hip ratio and Waist-height ratio) and the number of hours of physical activity per week in schools. Conclusion: There is a need to develop preventive intervention like reducing snack consumption while watching TV and increasing the time dedicated to physical activity

Self‐Medication Patterns Among Medical Students in South India

BackgroundSelf-medication results in wastage of resources, increases resistance of pathogens and generally causes serious health hazards such as adverse drug reactions, prolonged suffering and drug dependence. This study was undertaken to determine the reasons for self-medication and the pattern of self-medication among medical students. Method This cross-sectional descriptive study was conducted at the K.S. Hegde Medical Academy, Mangalore. The participants were medical students from first to final year. Medical students were selected through convenience sampling. The data was collected using a pre-tested semi-structured questionnaire. The data was analysed using SPSS version 16 and the results expressed as proportions.Results A total of 200 students, 121 (60.5%) female and 79 (39.5%) male, were included in the study. Of the medical students surveyed, self-medication was reported among 92%. The respondents who used self-medication found it to be time-saving in providing relief from minor ailments. The most common ailments for which self-medication were used were: the common cold (69%), fever (63%) and headache (60%). The students consulted their textbooks (39%) and seniors or classmates (38%) for the medications. Antipyretics (71%), analgesics (65%), antihistamines (37%) and antibiotics (34%) were the most common self-medicated drugs. Of the respondents, 33% were unaware of the adverse effects of the medication and 5% had experienced adverse reactions. The majority (64%) of students advised medications to others, more often to family and friends. Conclusion The prevalence of self-medication among medical students is high, facilitated by the easy availability of drugs and information from textbooks or seniors. A significant number of students are unaware of the adverse effects of the medication that they themselves take and suggest to others. Therefore, potential problems of self-medication should be emphasised to the students

CD4 Count as a Determinant in Clinicalepidemiological Profile of HIV Positive Patients: A Cross-sectional Study

Introduction: With anti-retroviral drugs mortality from HIV has reduced over the past decade. There is a decline in deaths due to HIV/AIDS evident since mid- 2000’s. Progression of disease to different stages largely depends on the immune status of the individual. A depleting CD4 count correlates with progression of HIV. Hence, this study was carried out with the objective to find the various factors affecting the CD4 count.Materials and Methods: Information was gathered from a total of 1000 patient’s on ART medication attending the ART centre at the district government hospital was collected for a period of one year. Descriptive statistics, one sample t test and ANOVA were used for analysis.Results: 71.4% of the attendees the CD4 count was below 500 cells/mm3. The mean CD4 was significantly higher in: Females [Mean = 450.72 +/-213.63 (p = 0.001)]. It was also significantly different with respect to adherence, duration of disease, habits and opportunistic infections.Conclusion: CD4 count was influenced by gender, age, duration of disease and treatment and by personal habits like smoking and alcohol. It alone can be taken as a predictor of disease progression

Assessment of difference in physical activities in urban and rural adolescents of Mangalore

Background: The increasing prevalence of adolescents who are overweight is one of the most pressing public health problems in India. Aims & Objectives: To find the difference in Physical Activities(PA) among urban adolescents to that of rural in Mangalore. Materials and Methods: Cross sectional study among high school students using a standard questionnaire (PAQ-A) to elicit total hours of PA during the past seven days. Results: Average age of the adolescents was 13.9. We could find 56% boys and 44% girls studying in urban schools and 53.3% boys and 46.6 % girls in rural. Seventy seven percent of the total students do running/jogging as their major PA and 66.6% students do cycling. Only 32.8% students had PA while coming to school every day and it was most common among boys in rural schools (55%). Total PA Score for rural areas was 453.5 with a mean of 3.06(out of 5). For Urban areas, total score was 376.3 with a mean of 2.5 and the difference in proportion was statistically significant. Conclusion: We found that the adolescents studying in the schools of rural areas had better physical activities compared to their urban school counterparts