Risk of falls and its association with activities of daily living and depression among elderly residing in a rural area in Bangalore, Karnataka

Background: According to 2011 censes, elderly account for 8.6% of Indian population and is projected to become 20% by 2050. Early identification and prevention of fall-related factors would play a vital role in reducing the health costs in elderly. The objective of the study was to assess the risk of falls among elderly residing in Mugalur subcentre, Bangalore Urban.Methods: A cross-sectional study was conducted at the ten villages of Mugalur subcenter, from March-May 2019 using a structured questionnaire that was administered through a face-validated interview. Systemic random sampling was done from the ten villages, proportionate allocation was done to reach a calculated sample size of 220. Timed up and go test (TUG) was done for all participants.Results: Mean age of the study population was 69.05±8.3years. Among the study subjects, 40 (18.2%) had moderate risk of fall and 9 (4.1%) were seen to have high risk of fall. 26 (11.8%) subjects had a fall in past one year. TUG test showed a median value of 18.5 seconds, and 179 (18.4%) elderly had TUG result ≥13 sec. According to Geriatric Depression scale (GDS-15), 18 (8.2%) subjects were found to be severely depressed. Significant association was seen between the GDS-15 scores and risk of falls according to Fisher’s exact test. The mean TUG score was shown to have a significant association with the risk of falls according to ANOVA.Conclusions: Moderate to high risk of fall is seen among 22.3% of the elderly. Significant association was seen between age, TUG score and depression with risk of falls.  

Occupational risk assessment and selected morbidities among cement brick unit workers in a rural area of Bangalore District, India

Introduction: The labor-intensive nature of cement brick manufacturing, its unorganized nature and internal migration, expose the employees to several occupational health hazards. The objective of the study was to assess the occupational risks in cement brick unit settings and to estimate the prevalence of respiratory and musculoskeletal morbidities among the cement brick unit workers in a rural area of Bangalore urban district. Methods: A cross-sectional study was conducted among cement brick unit workers over two months. A semi-structured questionnaire was used to capture sociodemographic details. Multiple observations on the field and the World Health Organization semi-quantitative risk assessment matrix were used to obtain risk scores of the occupational hazards. A structured questionnaire on respiratory symptoms and Minispir Portable Spirometer were used to assess the respiratory morbidities and lung functions. Musculoskeletal morbidities were assessed using the Modified Nordic questionnaire. Proportions were used to describe respiratory and musculoskeletal morbidities. Chi-square test, Fisher’s exact test and multivariate logistic regressions were done to identify significant variables. Results: Among 120 subjects, 110 (91.6%) were men and 85.8% were migrants. Injury due to falls of heavy objects, back injury, respiratory complaints and slips/falls were found to be high-risk health hazards. The prevalence of respiratory morbidity was 21.7% and that of musculoskeletal morbidity was 51.7%. Workers receiving a higher salary (≥ 1500 Indian rupees) had higher odds of having respiratory morbidity. Conclusion: The prevalence of respiratory and musculoskeletal morbidities was high. Introduction of mechanical equipment, decreasing work hours, periodic medical examinations and appropriate use of personal protective equipment will help in risk reduction as per this study

Postpartum and Newborn Care - A Qualitative study

Community-based postpartum care of mothers and newborns is vital to achieve mortality reduction. This qualitative study explored cultural beliefs and practices regarding postpartum care of mothers and newborns in rural Karnataka. Focus group discussions with newly delivered mothers and their caregivers in a rural maternity hospital, and in-depth interviews with community level health workers revealed cessation of the practice of withholding colostrum and the barbaric practice of branding, but found persisting harmful cultural beliefs and practices like withholding nutritious foods considered “hot” or “cold”, inadequate postpartum ambulation, separating husband and wife for up to a year or more after the birth, application of various substances to the umbilical stump and eyes of the newborn and giving pre-lacteal feeds. Antenatal and postpartum mothers, their caregivers, including elders in the family should be targeted by community level health workers for counseling and behavior change

Prevalence of Malnutrition and Relationship with Scholastic Performance among Primary and Secondary School Children in Two Select Private Schools in Bangalore Rural District (India)

Background: Malnutrition is a serious problem among children in developing countries. In India; a school meal program is in place to combat malnutrition, but only in government schools. This study is an attempt to assess the prevalence of malnutrition in primary and secondary school children in private schools and to also assess the relationship between malnutrition and academic performance. Materials and Methods: All 582 students from class 1-7 from two select schools in rural Bangalore, India were included in the study. Information on age of study subjects were collected from school records. Height and weight measurements were taken. BMI was calculated. Children were clinically examined for pallor. Data on height, weight and BMI was transformed into WHO 2007 Z scores and then was categorized as -2 SD, > 2 SD. Mathematics and English scores of the previous two class tests were taken, average scores were calculated. Statistical tests used were Chi square test, Odd′s ratio, Chi square for trend. Results : A total of 582 students participated in this study. Males were 54% (315) and females were 46% (267). One hundred and fifty-nine (27%) of the children had pallor, 81 (20%) had under nutrition, 38 (7%) had stunting, 197 (34%) had thinness and 5 (1%) were found to be obese. Positive relationship was found between weight for ageZscores and English as well as Maths; Height for age Z scores with English. Conclusion : Hence we conclude that the prevalence of malnutrition is high among children in private schools also; and the nutritional status of the children is strongly associated with their academic performance

Predictive Accuracy of a Cardiovascular Disease Risk Prediction Model in Rural South India – A Community Based Retrospective Cohort Study

Background: Identification of individuals at risk of developing cardiovascular diseases by risk stratification is the first step in primary prevention. Aims & Objectives: To assess the five year risk of developing a cardiovascular event from retrospective data and to assess the predictive accuracy of the non laboratory based National Health and Nutrition Examination Survey (NHANES) risk prediction model among individuals in a rural South Indian population. Materials & Methods: A community based retrospective cohort study was conducted in three villages where risk stratification was done for all eligible adults aged between 35-74 years at the time of initial assessment using the NHANES risk prediction charts. Household visits were made after a period of five years by trained doctors to determine cardiovascular outcomes. Results: 521 people fulfilled the eligibility criteria of whom 486 (93.3%) could be traced after five years. 56.8% were in low risk, 36.6% were in moderate risk and 6.6% were in high risk categories. 29 persons (5.97%) had had cardiovascular events over the last five years of which 24 events (82.7%) were nonfatal and five (17.25%) were fatal. The mean age of the people who developed cardiovascular events was 57.24 ± 9.09 years. The odds ratios for the three levels of risk showed a linear trend with the odds ratios for the moderate risk and high risk category being 1.35 and 1.94 respectively with the low risk category as baseline. Conclusion: The non laboratory based NHANES charts did not accurately predict the occurrence of cardiovascular events in any of the risk categories

Effectiveness of color coded diabetic control monitoring charts among elderly diabetics attending outreach primary care geriatric clinics in rural Karnataka: An open label randomized control trial

Introduction: Type 2 diabetes mellitus problem is progressively rising every day. The adherence to the treatment approaches and health-seeking make major difference in case of diabetics particularly elderly. Visual tools improve the involvement of patients in their care, especially among populations with low health literacy. Objective: To evaluate the effectiveness of color-coded diabetic control monitoring charts on glycemic control among elderly diabetics. Methodology: 144 elderly diabetic patients attending rural primary care geriatric clinics were randomized into two groups. Those randomized to the intervention group received the color-coded diabetic monitoring chart and a health education package in addition to the usual consultation services. Baseline and 1-year follow-up glycated hemoglobin (HbA1C) values were used to assess the effectiveness of the intervention. Results: The results of multivariate linear regression analysis showed that there was an average reduction of 0.265% in HbA1C value in the intervention group when compared to the nonintervention group when adjusted for baseline HbA1C and number of visits during the intervention period (β coefficient = 0.265,P < 0.05). Conclusion: Color-coded diabetes charts are effective in achieving glycemic control among elderly diabetics, and steps should be made to inculcate visually appealing management approaches in case of elderly diabetic patients

No child's play: Under-five child feces management in a rural area of Bengaluru Urban District, India

Background: Inappropriate feces disposal leads to environmental contamination, and increases the risk of exposure to children. We aimed to estimate the proportion of rural households with knowledge and practice of safe management of feces (SMoF) among under-five children and to identify associated factors. Materials and Methods: A cross-sectional study was conducted in eight villages in Bengaluru Urban district over 2 months, using a face-validated semi-structured interview schedule. SMoF was defined based on five criteria – defecation site, transport tool, feces disposal, cleaning of transport tool, and hand washing. Results: Out of 320 under-five children surveyed, 15.7% were pre-ambulatory and 84.3% were ambulatory. The majority of the caregivers (92.5%) felt that children should defecate in the latrine and only 23.7% were aware that child feces were more infectious than adult feces. SMoF was only practiced by caregivers of ambulatory children (52.6%). Households with older caregivers (P = 0.01) and those living in a pucca house (P = 0.02) with a latrine inside (P = 0.04) were found to practice SMoF. Children of households that practiced unsafe disposal of child feces experienced more diarrheal episodes (P = 0.04). Caregivers >20 years were found to have better odds of SMoF [20–25 years (adjusted odds ratio, aOR: 9.02), 26–30 years (aOR: 12.17), >30 years (aOR: 8.93)] compared to those <20 years. Conclusion: The proportion of households with knowledge and practice of SMoF was low. Awareness of SMoF is essential to reduce the incidence of diarrheal diseases and improve sanitation. Our findings also call for awareness building at schools and colleges