Prediction of dengue outbreaks in Kerala state using disease surveillance and meteorological data

Background: Dengue is one of the most serious and fast emerging tropical diseases. Its incidence of is influenced by many meteorological factors such as rain fall in mm, temperature, humidity etc. Information about these factors can be used to forecast the incidence of dengue fever cases in the next coming months.Methods: The current study was an analytical study using retrospective secondary data from Kerala state. The annual integrated disease surveillance reports of dengue fever cases. Rain fall data and mean monthly temperatures for a period of twelve years from 2006 to 2017 were used. Best fitted model was developed and accuracy of the prediction was tested. All analyses were performed in R software using the mgcv package and nlme package.Results: A total of 144 months study period from January 2006 to December 2017 was used for analysis. Five different models developed for prediction of dengue cases among them, best fitted model including optimal combination of meteorological variables and recent and long term transition of dengue was selected. Out of 84 months predictions in the training period, 68 months prediction was correctly negative, 5 months prediction was correctly positive, 2 months prediction was incorrectly negative and 9 months prediction was incorrectly positive.Conclusions: A better predictive generalized additive model can be developed using the optimal combination of meteorological predictors and dengue fever counts. It will enable the health care administrators to forecast future out breaks and to take better precautionary measures.

Teaching racial understanding to medical students.

Aim: To facilitate and promote racial understanding among medical students as part of their training Methodology: A descriptive study comprising of opinions of students and foster parents about the home stay programme and its influence on racial understanding. Results and Discussion: 229 medical students and 47 foster parents participated to state their opinions regarding living with other races, the home stay programme and racial understanding. Results showed a positive change post home stay among the students and foster parents on these three domains. There was also a significant change in the mean scores of the students’ perception about the villagers and their own skills and ability post home stay. Majority of the foster parents experienced moderate improvement of their understanding of the different races and their cultures. Conclusions: The home stay programme has made a positive change in the perception of the participants on racial understanding. It is particularly of importance because the students are in training for an important profession; that of a medical doctor.

Prevalence Of Exclusive Breast Feeding And Its Correlates In An Urban Slum In Western India

Background: The World Health Organization recommends the practice of exclusive breastfeeding of infants for the first 6 months after birth. The objective of present study was to estimate the prevalence and the factors influencing exclusive breastfeeding. The perceptions of mothers about breastfeeding in an urban slum area of Western India were also enquired. Methods: This cross sectional study was conducted over six months amongst 200 mothers of children in the age group of 6 – 12 months attending the growth and development clinic in one of the urban health centres. Data was collected using a pre-tested, structured questionnaire on breastfeeding practices. Factors related to exclusive breastfeeding were analysed using bivariate and multivariate analysis. Results: Prevalence of exclusive breastfeeding reported by the participants was 61.5%. Having a male child, maternal age < 30 years, level of education of mother, parity, receiving infant feeding advice, initiation of breastfeeding within one hour of birth and administration of colostrum to the baby were associated with exclusive breastfeeding (p<0.001). Multivariate logistic regression analysis revealed that male sex (adjusted odd ratios: 20.03), primiparity (0.19), home delivery (0.32), receiving infant feeding advice (5.90), initiation of breastfeeding within one hour of birth (0.26) and giving colostrum to the baby (2.56) were independently associated with exclusive breastfeeding. Prelacteal feeds were given by almost 35% of mothers. Conclusion: Prevalence of exclusive breastfeeding was higher than the national figures. However, practices like discarding the colostrum, giving prelacteal feeds, early/late weaning and use of formula feeds are still widely prevalent and need to be addressed.

Teaching community diagnosis: experience of a new institution.

Community diagnosis is one method of making medical education more community oriented and making the students learn and appreciate intellectual discovery and critical thinking. Being a relatively young institution with constraints of manpower, finances and logistic support we proceeded to developed a short programme which would allow students to achieve the skills of community diagnosis. Instead of a structured programme, we empowered the students to plan their own from meeting the villagers’ right up to developing and successfully implementing a health promotion campaign specially focused to the need of the villagers. The lecturers were present only to guide and supervise the students. Self assessment by the students at the end of the programme showed improvement in all the five domains assessed i.e. change in knowledge, change in skills, leadership and team work, attitudes and perceptions and humanistic attributes. The paper outlines how a brief programme can achieve substantial gain in skills and attitudes.

Body mass index and nutritional status of adults in two rural villages in Northern Malaysia

There has been a change in the lifestyles of populations, including reduced physical activity and consumption of foods high in calories. Overweight and obesity are now replacing the more traditional public health concerns such as under-nutrition and infectious diseases as some of the most significant contributors to ill health. Determination of the body mass index (BMI) profile and nutritional status of adults of two rural coastal villages in Northern Malaysia was part of a community diagnosis in a community survey. Height and weight were measured and BMI calculated. Blood pressure was measured using a manual sphygmomanometer according to WHO guidelines. A standardized questionnaire was used to interview the villagers concerning their health. Out of the total population, 504 were above 20 years of age. Data was available for 441 persons for analysis. There were 210 (47.6%) males and 231 (52.4%) females. The prevalence of underweight was 9.8% (n=43), overweight 25.9% (n=114) and obesity 17% (n=75). The problem of over-nutrition was significantly higher among females, especially housewives. (p< 0.05). Those in ages 41-70 years were the majority with problems of over-nutrition (p=<0.05). More than half (52.9%; n=39) of those who were obese had hypertension (p=<0.05). Results show that a higher number of women especially housewives were obese and more than half of those obese subjects had hypertension. A more thorough nutritional profile using waist, hip and body fat measurement as well as an assessment of the dietary intake and activity regime of these villagers is needed. Interventions need to be carried out before more serious complications of obesity become rooted in this community.

Byssinosis among male textile workers in Pondicherry: a case-control study.

BACKGROUND: In India, 20 million workers are involved in the manufacturing of textiles. However, there are few epidemiological studies from India that have assessed the magnitude or the risk factors associated with byssinosis. In Pondicherry, textile mills have been in existence for over a century. This case-control study aimed to find the factors associated with the development of byssinosis in textile workers. METHODS: The sample consisted of 761 men above the age of 30 years who had worked for at least 10 years in a textile factory. All the respondents were interviewed by a pretested questionnaire to gather information regarding the symptoms of byssinosis, certain personal characteristics and occupational history. Byssinosis was identified using the classification proposed by the World Health Organization. Two age-matched controls were selected for each case. RESULTS: Univariate analysis of the factors for symptomatic byssinosis showed that dusty worksites, heavy smoking and duration of service > or = 30 years were significant. Logistic regression analysis showed that working in the spinning (odds ratio 6.1) and weaving sections (odds ratio 1.9), heavy smoking (odds ratio 3.9) and > or = 30 years of service (odds ratio 2.0) were independent significant risk factors. CONCLUSION: Efforts to reduce dust levels in the working environment and to discourage smoking among textile workers need to be strengthened to minimize the risk of developing byssinosis.

Scorpion envenomation as a risk factor for development of dilated cardiomyopathy.

OBJECTIVES: Though scorpion envenomation is known to lead to acute myocarditis and a reversible decrease in left ventricular function, it has not been implicated as an etiological factor in idiopathic dilated cardiomyopathy. We studied the association of idiopathic dilated cardiomyopathy with a history of scorpion sting as well as with socio-economic status, history of smoking and alcoholism, rural habitation, and history of snake bites. METHODS: Consecutive cases of idiopathic dilated cardiomyopathy were recruited for this study: The association with putative risk factors was studied using a case-control study design with two sets of controls. One set of controls were age and sex matched inpatients selected at random, the other set of controls were spouse, or if not available, a close relative, ordinarily resident with the patient. RESULTS: On analysis, none of the factors except scorpion envenomation had a significant association. A past history of scorpion envenomation had an adjusted odds ratio of 8.01 (3.55-18.06) when compared to one set of controls and an odds ratio of 8.33 (6.55-10.59) when compared to the second group of controls. CONCLUSIONS: Our study indicates that a history of scorpion envenomation acts as a risk factor for the subsequent development of idiopathic dilated cardiomyopathy. Despite an apparently complete recovery from a scorpion sting, many patients probably retain sub-clinical deficits that predispose to the development of cardiomyopathy later in life, when other factors get added on. The known association of cardiomyopathy with catecholamine excess in experimental situations in animal studies, and in other disease states in humans, supports this hypothesis.

Infant mortality in Pondicherry--an analysis of a cohort of 8185 births.

Infant mortality rate is one of the 12 global indicators for monitoring Health for All. Reliable data on infant mortality are not available for the majority of developing countries including India. To plan strategies for bringing down the rate and, later, to evaluate them, 'Cause Specific Rates' would be necessary. Pondicherry has achieved low rates of infant mortality. A study was conducted in the Anganwadis of Pondicherry to determine the causes of infant deaths. The 8185 children born between 1-4-1987 and 31-3-1988 in Pondicherry formed the study group. The Anganwadi workers collected information on the cause of death for the 222 children dying within the first year. The infant mortality rate was 27.1 per 1000 live births. Acute respiratory infections and diarrheal diseases accounted for 45% of the deaths.