Contact tracing for COVID-19 in a healthcare institution: Our experience and lessons learned

During the initial phases of the COVID-19 pandemic contact tracing was used to control spread of the disease. It played a key role in health care institute which continued to work even during lockdown. In this piece of work, we share the lessons learnt from the contact tracing activity done in the health care institution during April to July 2020. The training needs of persons involved in contact tracing, the follow of activities, use of technology, methods to fill the missing gaps were the key lessons learnt. Its documentation supports in setting up contact tracing activity for any emerging infectious disease outbreaks in future

Level of tobacco dependence among tobacco users in an urban slum of Puducherry: A pilot study

Context: Successful tobacco quit by the tobacco users can avoid millions of premature death. However, the physical dependence on tobacco use results in frequent relapse most commonly due to withdrawal symptoms. Aims: The aim of this study was to study the level of tobacco dependence among tobacco users in an urban slum of Puducherry. Materials and Methods: This facility-based descriptive pilot study was conducted among patients aged 15 years or above attending an urban health and training center in an urban slum of Puducherry. A total of 90 consecutive current tobacco users were included after obtaining verbal informed consent and interviewed using a pretested questionnaire. The information on tobacco dependence was collected using Fagerstrom Addiction Scale for smokers and smokeless tobacco users separately. Results: Of the 90 current tobacco users, 95% were daily tobacco users. Of the current tobacco users, 48.8%, 45.6%, and 5.6% were smokers, smokeless tobacco users, and dual users, respectively. Majority of the smokers (61%) and most of the smokeless tobacco users (41%) had medium dependence for tobacco use. However, physical dependence was much higher among smokeless tobacco users (41.3%) than smokers (20.4%). Conclusion: Proportionately high physical dependence on tobacco is a concern in the study population. Community-based interventions are required to curb the problem; however, study with representative sample should be carried out before that

Overweight and obesity among elderly in an urban slum of Puducherry: A facility-based descriptive study

Background: Overweight and obesity are important addendum to the pool of risk factors for noncommunicable disease (NCD) among the elderly. Objectives: The objectives of this study were to find (1) the proportion of overweight and obesity and (2) the distribution of overweight and obesity based on sociodemographic characteristics and four major risk factors for NCDs (smoking, alcohol consumption, unhealthy diet, and physical inactivity) among the elderly attending the out-patient department/NCD clinic of a Urban Health and Training Centre (UHTC). Materials and Methods: This facility-based descriptive study was conducted among 181 elderly attending one UHTC, in Puducherry during June and July 2015. A pretested interview schedule was used to obtain information on sociodemographic details and history of NCD risk factors after obtaining verbal informed consent. Anthropometric measurements were taken as per standard procedures prescribed by the World Health Organization. Body mass index (BMI) was calculated and classified using BMI classification for the Asian population. Results: Among the elderly, 18% were overweight and 51% were obese. The proportion of obesity was more among females than males. Obesity was found to be decreasing with increase in age. Overweight and obesity were found to be significantly inversely related to chronic disease status. Overweight and obesity were proportionately more among elderly who were consuming alcohol and doing less physical activity than prescribes. However, the proportion of overweight/obees elderly with no tobacco use and not having unhealthy diet was found to be more than their counterpart. Conclusion: Overweight and obesity are important public health problems in the study population. Hence, interventions should be implemented targeting elderly as well as the adult to decrease the obesity and overweight among the elderly

Failure to achieve goal blood pressure and its associated factors among hypertensive patients registered in a primary health centre in South India

Introduction: Uncontrolled blood pressure (BP) among hypertensive patients leads to life-threatening complications, hospitalization, and premature mortality. Knowledge on the burden of uncontrolled BP and its correlates will help in devising strategies to achieve goal BP. We aimed to determine the proportion who have not achieved goal BP and its associated factors among hypertensive patients in a Primary Health Centre (PHC). Materials and Methods: A facility-based cross-sectional analytical study was conducted among the hypertensive patients attending chronic disease clinic of PHC at Ramanathapuram, Puducherry. BP was measured and goal BP was defined based on Joint National Committee-8 criteria. The interview was conducted using semi-structured questionnaire capturing sociodemographic details, behavioral characteristics, physical activity with the International Physical Activity Questionnaire (IPAQ), medication adherence with Morisky Medication adherence scale-8 (MMAS-8), and stress with perceived stress scale. The data were entered and analyzed using EpiData software. The proportion “not achieved goal BP” was expressed as percentage and association were measured using prevalence ratios (PRs) with 95% confidence interval (CI). Results: Of total 259 hypertensives studied, 140 (54.1%) were aged above 60 years, and 161 (62.2%) were females. Overall, 63 (24.3%) participants had not achieved goal BP. On univariate analysis, individuals aged 45–59 years (PR-2.1 [95% CI: 1.4–3.4]), being male (PR-1.6 [95% CI: 1.1–2.4]) and employed (PR-2.0 [95% CI: 1.1–3.5]) were associated with not achieving goal BP. Conclusion: One-fourth of patients treated for hypertension in PHC failed to achieve goal BP. Considering the consequences of uncontrolled BP, cost-effective, context-specific interventions at the primary health-care level are needed

Budget impact and cost-utility analysis of prophylactic emicizumab versus on-demand bypassing agents for adolescent severe haemophilia A patients with inhibitors in India

Introduction: Severe Haemophilia A patients with inhibitors are currently being treated with bypassing agents like activated prothrombin complex concentrates (aPCC) and recombinant factor VIIa. Emicizumab is a recombinant humanized monoclonal antibody, introduced to reduce the bleeding events, improve treatment adherence, and quality of life. However, cost-effectiveness and long-term sustainability of the intervention is not studied in a low middle income setting like India. Aim: The primary objective of this study was to evaluate the cost-utility of Emicizumab compared to traditional bypassing agents in the treatment of severe haemophilia A patients with inhibitors in India. Secondary objective was to analyze the budgetary impact of introducing Emicizumab for this patient population from the perspective of public health system in India. Methods: Markov model was created to compare the prophylactic emicizumab therapy against bypassing agents for a hypothetical cohort of 10-year-old adolescents in India. The time horizon was 10 years and model built based on health system perspective. Cost utility was expressed as costs per quality-adjusted life-years (QALYs) gained. All costs were expressed as 2021 US dollars. Probabilistic sensitivity analysis was performed to check the robustness of the estimates. Results: Prophylactic emicizumab was a cost saving intervention with negative Incremental Cost Utility Ratio (ICUR) against recombinant factor VIIa of −853,573 USD (INR -63,109,773), and negative ICUR of −211,675 USD (INR -15,650,403) against APCC. The estimated total budget for treating all the severe Haemophilia A patients with inhibitors in India was USD 59,042,000 (INR 4,365,329,312) for 10 years’ time horizon (per patient cost of USD 295,210 [INR 21,826,646.56]). Conclusion: Prophylactic emicizumab therapy is a cost saving intervention when compared to both the bypassing agents as it is less costly and more effective for severe Haemophilia A patients with inhibitors in India

Association between Indoor Air Pollution and Cognitive Impairment among Adults in Rural Puducherry, South India

Background: Recent evidences showed that outdoor air pollution had significant influence on cognitive functioning of adults. However, little is known regarding the association of indoor air pollution with cognitive dysfunction. Hence, the current study was done to assess the association between indoor air pollution and cognitive impairment among adults in rural Puducherry. Methodology: A community-based cross-sectional study was done among 295 adults residing in rural field practice area of tertiary care institute in Puducherry during February and March 2018. Information regarding sociodemographic profile and household was collected using pretested semi-structured questionnaire. Mini-Mental State Examination was done to assess cognitive function. We calculated adjusted prevalence ratios (aPR) to identify the factors associated with cognitive impairment. Results: Among 295 participants, 173 (58.6) were in 30–59 years; 154 (52.2%) were female; and 59 (20.0%) were exposed to indoor air pollution. Prevalence of cognitive impairment in the general population was 11.9% (95% confidence interval [CI]: 8.7–16.1). Prevalence of cognitive impairment among those who were exposed to indoor air pollution was 27.1% (95% CI: 17.4–39.6). Individuals exposed to indoor air pollution (aPR = 2.18, P = 0.003) were found to have two times more chance of having cognitive impairment. Conclusion: About one-fourth of the participants were exposed to indoor air pollution, out of which more than one-fourth was found to have cognitive impairment which is twice that of the general population. Hence, prevention of exposure to indoor air pollution needs to be done through increased availability to cleaner fuels for household usage

A longitudinal study on high risk pregnancy and its outcome among antenatal women attending rural primary health centre in Puducherry, South India

BACKGROUND: Almost 15% of all pregnant women can develop potentially life-threatening complications. As a result, identification of high-risk pregnancy at earliest stage will be useful in directing appropriate intervention. Hence, the current study was done to determine the prevalence and outcome of high-risk pregnancy among antenatal women in rural Puducherry. MATERIALS AND METHODS: A record-based longitudinal study was done during March 2018 among 569 antenatal women who have attended rural health center of tertiary care institute. High-risk pregnancy was classified based on the guidelines from Pradhan Mantri Surakshit Matritva Abhiyan and outcome assessment based on the obstetric and neonatal outcomes. RESULTS: Among 569 antenatal case record reviewed, 315 (55.3%) were in the age group of 20–25 years and majority (463, 81.4%) belonged to below poverty line families; 410 (74.3%) registered their current pregnancy within the first trimester. The prevalence of high-risk pregnancy among study participants was 18.3% (95% confidence interval: 15.3%–21.7%). Majority (81.9%) had term delivery. Regarding obstetric and neonatal outcomes, majority had spontaneous vaginal delivery (73.9%); about 10.4% gave birth to low-birth weight baby, and only 1.7% had stillbirth. Parity, socioeconomic status, and unfavorable outcomes such as low-birth weight, preterm, and postterm delivery were associated with high-risk pregnancy. CONCLUSION: The current study found that almost one-fifth of the pregnant women in rural area have high-risk pregnancy. Unfavorable obstetric and neonatal outcomes were common among high-risk cases. Hence, early detection of high-risk pregnancy needs to be done at primary health-care level to improve the maternal, obstetric, and neonatal outcomes

How much do persons with diabetes in a rural area of South India know about diabetes management? A step toward person-centered care

Introduction: The burden of diabetes mellitus is increasing worldwide, more so in developing countries. Optimal diabetes care depends on adherence to management protocol, which can be brought about by shared decision-making. Patient's knowledge on life-threatening complications and preventive strategies for the same is a prerequisite for shared decision-making. Hence, this study was carried out among diabetes patients to assess the level of knowledge on different aspects of diabetes management. Methodology: A facility-based cross-sectional study was conducted among patients registered and seeking care from a Rural Primary Health Centre in Puducherry, South India. All the individuals with diabetes were included in the study. Trained MBBS interns interviewed the patients after obtaining informed consent. A semi-structured interview schedule was used to capture information on sociodemographic profile, disease characteristics, knowledge on different aspects of diabetes management, and prevention of diabetic complications. Data were entered and analyzed using EpiData software. Knowledge on each item was expressed as percentages. Results: Of the total 172 participants, 58% were females, 63% were aged between 31 and 60 years. About half of the participants had diabetes for more than 5 years. Of the total, about 83% knew that there is a need for lifelong treatment. About 51%, 44%, 21%, and 9% were aware that diabetes can cause complications to eye, renal, foot, and heart, respectively. Of the total, about 74%, 78%, 17%, 15%, 35%, and 56% knew the correct frequency for monitoring of blood sugars, blood pressure, renal function, lipid profile, fundus, and foot, respectively. Conclusion: This study shows that knowledge on few components of diabetes management is still limited, and there is a need to impart knowledge through health education to patients. Adequate knowledge on diabetes management principles is important for implementing patient-centered care in primary care setting

Morbidity profile of adult outpatients attending traditional medicine health facilities in a district of South India

abstract: Background: Siddha system is a complementary system of medicine popular in South India. Information on common morbidities for which people seek care in Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) systems and especially in Siddha hospitals is very limited. This knowledge will help in prioritizing diseases and developing standard treatment guidelines. Objective(s): The present study was designed with the aim to describe the morbidity profile of the adult patients attending Siddha Out Patient Department (OPD) at Government Hospitals in Erode district of Tamil Nadu. Materials and methods: A facility-based cross-sectional descriptive study was conducted among adult (15–59 years) patients, who attended Siddha Hospital OPDs during February, 2014. Two block level health facilities were randomly selected from ten block hospitals offering Siddha services in Erode district of Tamil Nadu. Information on socio-demographic characteristics like age, gender and education was captured using a pre-tested proforma. Diagnosis was done by treating Siddha practitioners as per reporting format. Data were single entered and analyzed using EpiData software. Results: Of the total 1786 patients who attended the Siddha OPD, 1720 (96%) completed the interviews. Mean (Standard Deviation) age of participants was 41 (11) years and 913 (53%) were females; 20% had no formal education. Of 1720 participants, arthritis (21%), neuritis (10%), fungal diseases (7%) were the top three morbidities, with arthritis and neuritis being most common morbidities in both males and females. Conclusion: Arthritis, neuritis and fungal diseases were the most common morbidities, for which patients sought care in Siddha hospitals. These morbidities can be considered for preparing standard treatment guidelines under the national programme. Keywords: Complementary therapy, Indigenous health services, Morbidity profile, Siddha, AYUS