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Introduction: We conducted this study among older adults with the following objectives: (1) To find out the prevalence, awareness, treatment and control of hypertension, (2) To understand the factors associated with hypertension prevalence and control. Methods: A mixed-methods study employing a sequential explanatory design was conducted with a survey of 300 participants aged _x0001_60 years, and 15 in-depth interviews. Blood Pressure (BP) and waist circumference were measured using standard protocol. Survey data were analysed using univariate and multivariate procedures. In-depth interviews were analysed employing thematic analysis. Results: Hypertension prevalence was 72.3% (95% CI ¼ 67.1e77.2), 68.2% (CI ¼ 61.8e74.2) were aware, 65.4% (CI ¼ 59.0e71.6) were treated and 24% (CI ¼ 18.6e29.9) achieved adequate control. Inadequate physical activity [(adjusted odds ratio (AOR)] ¼ 2.34; CI ¼ 1.19e4.59), current alcohol use (AOR ¼ 2.28; CI ¼ 1.06e4.91) and self-reported diabetes (AOR ¼ 2.02; CI ¼ 1.15e3.52) were associated with hypertension prevalence. Those who reported diabetes (AOR ¼ 2.72, CI ¼ 1.34e5.55), with education level up to high school (AOR ¼ 2.58, CI ¼ 1.11e6.00) and who were in the age group 60e70 years (AOR ¼ 2.14, CI ¼ 1.09e4.20) were more likely to have controlled hypertension compared to their counterparts. From the in-depth interviews it was found that availability and accessibility of services, family support, financial wellbeing, habits and beliefs and conducive environment played a role in hypertension diagnosis and management. Discussion: Prevalence of hypertension was high in this population along with poor control. Efforts are required to improve hypertension control focussing on older adults with low education and those who are aged 70 years and above
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Kerala is rich in its culture for the traditional Ayurveda practices in children from the time of birth onwards. These traditional practices are mainly immune boosters and also enhance overall nourishment and development in children. Commonly used traditional Ayurveda practices are Uramarunnu Prayoga, Prakara Yoga, Abhyanga, Rasanadi churna lepana, Snana etc. for enhancing immunity and providing overall development to children. Uramarunnu is a baby care practice comprising of a group of drugs administered to the child in the form of paste in breast milk, after 28 days till 2 years of age. Prakara Yogas are immunomodulatory recipes and procedures to be adopted right from the day after delivery. Abhyanga provides nourishment, health, protection, emotional well-being and improves skin tone. All these can be used for enhancing immunity and preventing recurrent infections thereby helps in the maintenance of health and prevention of diseases. This mentions the importance of Kerala traditional Ayurvedic practices in the field of primary child health care. So, the present study aims to compile Kerala’s traditional Ayurvedic practices in children, by reviewing regional textbooks like Arogyakalpadruma, Vaidya Tarakam, Parambarya Balachikitsa etc., and also interviewing Ayurveda pediatrician through telephone.
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Introduction: The Coronavirus disease 2019 (COVID-19) pandemic rapidly spread across continents causing widespread mortality. Older adults, especially those with underlying diseases, are more susceptible for COVID-19 infection. Due to this concern, reverse quarantine was adopted as a protective strategy. This can lead to several psychological and physical detrimental effects. Aims: 1). To assess the mental health status (depression and anxiety) among elderly people in the community during the COVID-19 pandemic.2) To assess the impact of COVID-19 pandemic restrictions and mental health issues on quality of life. Materials and Methods: This is a descriptive cross-sectional study among older adults (>60 yrs) residing in urban community in Central Kerala, India. Results: Of the 200 patients, more than half had moderate to high levels of anxiety and a poor social support. Depression was seen in only 1/4th of patients and that was significant in older women. Mean knowledge about COVID was below 80%. Social support was inversely associated with anxiety and depression. Anxiety and depression significantly affected QOL scores. Conclusion: This study emphasizes on the need for better mental health programmes tailored for our geriatric population. Joint multidisciplinary action plans with focus on enhancing social support can improve the quality of life of this vulnerable group
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Background: Pre-marketing clinical trials can filter only about 50% of the drug reaction. Hence, to prevent the morbidity and mortality due to severe cutaneous reactions early detection, evaluation and monitoring of adverse drug reaction (ADR) especially cutaneous ADR (CADR) are mandatory. Hence, it is imperative that we update our knowledge of the precise nature of ADR which will prevent the reactions as well as to find the offending drug. Aim and Objectives: The aim of the study was to evaluate the pattern of CADR, the suspected drugs and to perform the causality assessment using WHO casualty assessment scale. Materials and Methods: A retrospective descriptive study was done using the data reported to ADR monitoring center in the Department of Pharmacology by the health-care professionals. Suspected CADR was diagnosed by the consultants concerned. The CADRs collected were categorized according to their morphology into maculopapupar rash (MPR), fixed drug eruptions (FDE), urticaria, Stevens-Johnson syndrome, and toxic epidermal necrolysis. The causality assessment was done using WHO Causality assessment scale. Results: The mean age was 47.20 + 22.31. The most common CADR reported was Urticaria 65.5% followed MPR 23%, FDE 8.8%, and Steven Johnsons Syndrome 2.2%. Anti-microbial drugs were the most frequent cause of the adverse reactions with Amoxicillin clavulinic acid combination being the most frequent suspected drug producing CADR (13.3%). The WHO causality assessment for majority of CADR was Possible (73.5%). Conclusion: Clinical Patterns of CADRs in this set up have some minor variations when compared to studies done across India. Amoxicillin clavulinic acid is the most common suspected drug in this study which was not frequently reported in other ADR monitoring centers.
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Background: Orthostatic hypotension (OH) increases the risk of falls and associated morbidity and mortality in elderly. Hence, determining the prevalence of OH and its associated factors is important, especially in understudied LMIC settings. Methods: A community-based cross-sectional study was conducted among randomly selected 240 community-dwelling elderly from Thiruvananthapuram, Kerala. The OH symptoms were assessed by standard clinical measurements and frailty was assessed by modified Fried frailty phenotype. Logistic regression analysis was conducted to assess the factors associated with OH. Results: The prevalence of OH and frailty among participants was 9.6 and 29.2 percent respectively. In the first minute, OH was associated with increased odds of falls (OR ¼ 1.97 [95%CI ¼ 1.05, 3.72]). Increase in number of co-morbidities (ORadj ¼ 1.82 [95%CI ¼ 1.36, 2.48]), number of medicines used (ORadj ¼ 1.73 [95%CI ¼ 1.28, 2.34]), and orthostatic intolerance (ORadj ¼ 3.67 [95%CI ¼ 1.13, 11.94]) increased the odds of having OH. Elderly with diabetes (ORadj ¼ 4.81 [95%CI ¼ 1.57, 14.77]), hypertension (ORadj ¼ 4.97 [95% CI ¼ 1.01, 24.46]) and cognitive impairment (ORadj ¼ 5.01 [95%CI ¼ 1.40, 18.51]) were at a higher odds of having OH. Conclusions: OH and frailty are prevalent in community dwelling elderly in Thiruvananthapuram district. Frailty may be a risk factor for OH in the first minute. The number of co-morbidities may be an independent risk factor for OH. Hence, elderly people with comorbidities and cognitive impairment may be actively assessed for OH to prevent falls and associated injuries.
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Background: The role of local self-government (LSG) bodies in planning community-level interventions for noncommunicable diseases (NCD) control is critical. An understanding of how much priority is given to NCD in decentralized health planning is needed. Objective: The objective of this study is to analyze the pattern of budgetary allocation for health sector projects at different levels of LSGs in Thiruvananthapuram, Kerala, with specific reference to NCD control. Materials and Methods: Secondary data analysis was done on economic review reports and reports on health sector projects obtained from LSG department with permission. The pattern of budgetary allocation of health projects in both urban and rural local bodies of Thiruvananthapuram district for 2019–2020 was studied. Results: The proportion of NCD projects in terms of number and budget allocation, respectively, among health sector projects for gram panchayaths(GP) was 47 projects (5.25%) and 63.19 lakhs (1.8%). Figures for block panchayaths(BP) were 13 (9%) and 98.10 lakhs(10.94%), for district panchayath (DP), 1 (0.9%) and 48 lakhs(3%), for municipalities 1 (1.6%) and 4.66 lakhs (1.2%), and for corporation were 1 (1.4%) and 3 lakhs (0.16%). Only 29 (40%) GP and 5 (45%) BP had at least one NCD project. At the GP level, 21% of projects were community?based interventions and 15% of projects were for cancer screening, mental health, and hospital?based NCD clinics each. Among local bodies with lower allocation for NCD projects, the amount allocated for construction and maintenance work in health institutions was higher. Conclusion: Decision-making in decentralized health planning needs an evidence-based realignment of priorities toward NCD.
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Multimedia, being more attention?getting and attention?holding, is a powerful tool for mass awareness creation and is used for intervention among students in many studies. Our aim was to see the effectiveness of an educational short film in tobacco awareness generation and to compare it with the traditional lecture?based awareness. Selected schools were divided into two groups as per convenience. Short film was used as intervention in Group 1 and PowerPoint?based lecture in Group 2. The increase in awareness was assessed by a pre and posttest. On analysis, though both methods increased awareness as given by higher posttest score, it is found that the awareness levels showed a statistically significant difference between educational short film on hazards of tobacco and power point?based lecture using Mann–Whitney test. Our study proves that an educational short film carefully scripted and picturized can be used effectively in imparting awareness in school?based tobacco control programs.
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Background: Covid-19 pandemic forced people to get confined to social isolation and maintain social distancing which affected their mental health. The study aims at understanding the impact on the mental health status of people in Kerala, based on their demographic profile and the psychological issues faced during the Covid-19 lockdown. Methodology: The study included 700 respondents from various districts of Kerala telephonic and mailed questionnaires for the period of December 2020 - May 2021. Ordered logit model is used for the econometric analysis using R software. Results: The overall mental health status of an individual is affected by various reasons which are taken as various categories for the analysis. As a result of log odds estimated, Covid-19 patients are more disposed to mental health issues. Male respondents had a positive impact on mental health issues and unmarried people of all gender are disturbed with lockdown distress. Almost all occupational categories taken into account are more or less shaken with the pandemic except those with proper job security including Government and PSU workforces. Psychological, physical well-being is affected by the pandemic lockdown overall mental health system of people of Kerala. Conclusion: Covid-19 pandemic have affected the overall mental health of the people regardless of age and profession which can be more or less solved by the individuals themselves through yoga, meditation, exercise, reading books, gardening, cooking, virtual contacts with friends and family, getting enough sleep, etc. which helps tocan keep the mind relaxed and stable.
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Background: This study investigated the epidemiological pattern of traumatic brain injury (TBI) in our hospital, so as to juxtapose with available statistics and formulate recommendations for patient betterment.Methods: The Government Medical College, Thiruvananthapuram was the setting of this cross-sectional longitudinal study and included all patients admitted with clinical/radiological evidence of TBI over a period of three months (October 2019 to December 2019). Details regarding mechanism of injury and the socioeconomic background of the subjects were collected during the stay in hospital, by means of a semi structured questionnaire. SPSS software was used to analyze the data collected.Results: Out of 658 patients included in the study, majority of the subjects belonged to the age group 30-60 years. About 80% of subjects were males. 63% were manual laborers. Majority of the patients had about 10-15 days’ stay in the hospital. Road traffic accidents were the most common mechanism of injury and involved two wheelers mainly. Lack of helmet and restraining seat belt was noted in a sizeable percent of the subjects. Loss of consciousness was the most common complaint and GCS in the majority of subjects ranged from 9-13. Subdural hematomas and hemorrhagic contusions were the most common CT findings. 39.7% of the patients had associated spinal injury. About 48% of the subjects were operated. There was 7% mortality.Conclusions: Road traffic accidents accounted for the majority of traumatic brain injury incidents and a sizeable portion of patients required expert neurosurgical care.
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Background: Endocrine therapy for breast cancer is directed at reducing oestrogen synthesis or alternatively blocking oestrogen receptors (ER) in tumour-sensitive tumors. Despite side effects, the use of systemic adjuvant therapy after local management of breast cancer substantially improves survival and reduces the risk of relapse. The study objective was to assess the recurrence of breast cancer and the complications seen in breast cancer patients on tamoxifen therapy at a hospital-based cancer registry, Thrissur, Kerala.Methods: After obtaining institutional ethical clearance, included 75 patients of histologically diagnosed breast carcinoma currently on tamoxifen, diagnosed in the year of 2016. Data was obtained from the patient files and by personal intimation.Results: Of the 75 patients on tamoxifen, four (5.33%) patients had history of recurrence. 22.6% of patients on tamoxifen were noted to have increased endometrial thickness. Other side effects noted were weight gain, TIA, bone pain and vaginal discharge.Conclusions: It was found that the recurrence rate at three years for the study population was 5.33%. More studies from developing countries, with larger sample size and clinical trials will give us more accurate information regarding the efficacy of the drug.
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Background: Cervical spine injuries, according to severity can leave victims with long standing neck pain or varying degrees of weaknesses. The purpose of this study is to determine the epidemiological pattern of cervical spine injury in our hospital so that comparison may be made with other institutions and guidance regarding management may be formulated for the betterment of patients.Methods: This cross-sectional longitudinal study was conducted in Government Medical College, Thiruvananthapuram and included all patients admitted with clinical or radiological evidence of cervical spine injury, over a period of three months. Semi-structured questionnaire was used to collect socio demographic data and details regarding mechanism of injury. Data was analyzed using SPSS.Results: Out of 452 patients enrolled, 69.7% were males and 30.3% were females. Patients were the most commonly between 30-60 years of age (52.4%). Majority (56.1%) had hospital stays lasting less than 10 days. Most common mechanism of injury was road traffic accidents (46.6%). Neck pain was the most common symptom and cervical spine straightening was the most common radiological abnormality. The severity of injuries was more severe in patients who were not restrained by seat belt or using a helmet.Conclusion: Road traffic accidents are the most common cause for cervical spine injuries and majority of patients required only symptomatic care.
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Background: There is a rising trend in the incidence of stroke among Keralites, but proper data regarding the same are scarce.To date, no study has been published delineating the epidemiological profile of stroke in Central Kerala harboring a populationof more than 5 million.Objectives: The objectives of the study were to characterize the clinical profile, risk factors, type, and etiology of stroke inCentral Kerala.Methodology: A prospective cohort study was conducted in the Department of General Medicine in Amala Institute of MedicalSciences, Thrissur, Kerala, from January 2014 to January 2015 that evaluated 464 patients admitted with a diagnosis of stroke.Based on clinical examination and brain computed tomography/magnetic resonance image findings, patients were classifiedinto ischemic and hemorrhagic stroke subtypes and enrolled.Results: Of the total 464 patients, 44.6% were female and 55.4% were male. A maximum amount of cases were observed inthe age group between 61 and 70 years. Among them, 63.6% of patients were hypertensive, 45.5% were diabetic, 12.7% hada cardiac disease, and 0.6% of patients had peripheral vascular disease. The incidence of hemorrhagic stroke was 27.8% andischemic stroke was 72.2%. Most of the ischemic strokes were due to large artery atherosclerosis.Conclusion: Our study has shown that systemic hypertension followed by diabetes mellitus was the prime risk factor contributingto stroke among Central Keralites. Tobacco use is widely prevalent among males in Central Kerala which could account forthe increasing incidence of stroke among males. There is an urgent need to improve the lifestyle of people, especially in theage group between 61 and 70 years who were the most susceptible to stroke by implementing proper monitoring and controlof modifiable risk factors.
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Background: Breastfeeding is accepted as the natural form of infant feeding. The world health organization recommends exclusive breastfeeding of infants for first six months of age. The primary objective of the present study is to estimate the prevalence of exclusive breastfeeding and the secondary objectives were to identify factors influencing exclusive breastfeeding.Methods: A cross-sectional study was conducted among all mother infant pairs of 6-12 months age enlisted in the updated MCH register of KMCH center, Ettumanoor. Data was collected using a semi structured interview schedule. Factors related to exclusive breastfeeding were analysed by bivariate and multivariate analysis using SPSS version19.0.Results: Prevalence of exclusive breastfeeding was 21.9% with a median duration of four months. Multivariate logistic regression analysis revealed that maternal education, working mother, advice on exclusive breast feeding during antenatal visits and length of breast-feeding session were independently associated with exclusive breastfeeding. Inadequacy of breast milk was the major reason for non-exclusive breastfeeding.Conclusions: Prevalence of exclusive breastfeeding is low in this particular area. Hence promotion of exclusive breastfeeding and focus on factors affecting them is highly warranted in this area.
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Background: In the year 2018, Kerala experienced natural disastrous due to heavy rainfall and floods due to breakdown of dams. More than five lakhs people were affected and disruption in transportation, communication and damaged health care facilities. Objective of this study was to access the morbidity pattern of flood victims in the post flood recovery phase.Methods: The study was carried out by the investigators along with medical team conducted free camps in seven different locations in the districts of Wayand and Kozhikode in the month of October 2018. Data were obtained in the format designed by the National Centers for Disease Control and Prevention, India.Results: A total of 3123 patients were attended the flood relief camp. The most of the camp people were come up with complaints of myalgia 24.8%, acute respiratory infections 14.6%, skin infections 8.3% and 7.7% had fever.Conclusions: To create awareness to the community about the natural disaster and appropriate action to prevent it through information, education and communication by regular period of intervals. And to provide basic amendments to improve the health care infra structure
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Background: Snakebites are well-known medical emergencies in many parts of the world, especially in rural areas.The incidence of snakebite mortality is particularly high in South-East Asia. Rational use of snake anti-venom can substantially reduce mortality and morbidity due to snakebites. Snake bite is an important health problem in India also especially in North Kerala which has an agricultural background. There is a lack of study regarding this topic in this area. North Kerala differs from other areas in the country as hump nosed pit viper bites are more common here due to its proximity to western Ghats where it .Anti snake venom is ineffective to bites by hump nosed pit viper. Authors objectives was to assess the clinical and epidemiological profile and outcome of poisonous snake bites.Methods: Retrospective observational study done among patients with snake bite with envenomation admitted in Academy of Medical education, Pariyaram, Kannur, Kerala from January 2018 to September 2018.Results: There were 90 cases of venomous snake bite during the study period. Of these males were predominant (70%). Majority were in the age group between 20 and 40. Majority of bites occurred in the months of June and July. Bite in the extremities were more common. Nine patients were brought 1 day after the bite. Snake identified most common was Russell’s viper followed by pit viper. Majority of the systemic envenomation was hemotoxic 80 patients (85%).Conclusions: The study stress the fact that snake bite is an important problem in North Kerala. The study also shows that delay in treatment is a major risk factor for morbidity. Hump nosed pit viper bites are more common in this area.
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Background: Globally, the caesarean delivery rate is rising continuously, making caesarean one of the most common surgical procedures. The purpose was to analyse the determinants and maternofoetal outcomes in elective versus emergency caesarean sections in a tertiary care centre.Methods: All women, who gave birth by Caesarean deliveries done over a period of 1 year (January 2018-December 2018), were studied in Travancore Medical College in Kerala, India. Indications of caesarean, whether emergency or elective, medical morbidities, Gestational age at decision, birthweights and extended hospital stay and new-borns needed to resuscitate were looked into. The data was collected and analysed from the hospital registry.Results: Out of the 378 selected patients, 95 patients in group of elective and 283 emergency caesarean section were studied. The indications of emergency caesarean sections were failed induction, non-progression of labour, CPD, Previous caesarean in labour, foetal distress. The most frequent indicator for elective lower segment caesarean section (LSCS) was patient with previous LSCS not willing for vaginal birth, followed by breech presentation and high risk pregnancy ( BOH and ART). Younger mothers, gestational age remote from term, low-birth weight, and extended hospital stay were statistically significant in mothers undergoing emergency caesarean delivery. Fever, urinary tract infections, need for maternal and neonatal ventilation, blood transfusion, scar dehiscence were more common in the emergency caesarean group.Conclusions: The antenatal morbidity, low birth weights, decision taken preterm for salvaging the baby, postoperative complications and extended stay were more in the emergency caesarean when compared to elective caesarean.
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Background: The proportion of elderly population is increasing considerably world over. The health and socio-economic issues of this section is to be considered separately and in depth insights about them is needed for formulating elderly friendly health policy. This study intends toidentify the important health concerns of elderly population above the age group of 70 years in a rural area in North Kerala, India.Methods: It is a community based cross-sectional descriptive study involving all individuals above the age group of 70 years in a randomly selected panchayath ward from rural North Kerala. The data regarding demography, socioeconomic aspects, medical history, access to health care and treatment of chronic illnesses were collected through interview of study participants by a trained health care volunteer using a pre-validated questionnaire.Results: A total of 93 individuals above the age group of 70 years were included in the study out of which 63% were females and 37% males. In the study population 55.9% of the elderly were widowed and 87.1 % were staying along with their children. Almost 75% of the elderly received social welfare pension from government agencies and 14.3% received service pensions. 67.74% of the study population were hypertensive and 35.56% were diabetic. Other health issues included arthritis, coronary artery disease, chronic kidney disease, genito urinary symptoms and cerebrovascular accident.Conclusion: The study provide valuable insights into the health and social issues of elderly in Kerala and points to the importance of formulating an elderly friendly health policy in the state.
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Background: Medical education for undergraduates is a challenging area and medical professionals are life-long learners. Self-directed learning (SDL) is adult learning process. SDL describes a process where individuals take initiative, with or without the help of others, in diagnosing their learning needs, formulating learning goals, identifying human and material resources for learning, choosing and implementing appropriate learning strategies, and evaluating learning outcomes. This study assessed knowledge and practices regarding SDL among medical undergraduates and looked for association between gender and year of study with knowledge and practices of different components of SDL. Methods: A cross-sectional study was conducted among 192 students doing final year and internship at Dr. Somervell Memorial CSI Medical College, Kerala from April to July 2018 after obtaining clearance from Institutional ethics committee. Data was collected using a predesigned and pretested structured self-administered questionnaire on socio demographic profile, knowledge, practices, barriers and opportunities regarding SDL. Data was entered in excel sheet and analyzed using SPSS trial version 21.0. Results: Majority of the students had good knowledge regarding the components of SDL and practiced components like identifying their learning needs, objectives, commitment and implementation of the learning process. Only 57.3% students evaluated learning process and 31.8% alone had an educator as facilitator. Important barriers identified were self-motivation (88%) followed by time (81.8%). Conclusions: Interns had better knowledge and practice of SDL components compared to final year students. Though females had a better knowledge and practice of SDL components compared to males it was not statistically significant.
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The South Asian populations have a mosaic of ancestries likely due to the interactions of long-term populations of the landmassand those of East and West Eurasia. Apart from prehistoric dispersals, there are some known population movements to India. Inthis study, we focussed on the migration of Jewish and Parsi populations on temporal and spatial scales. The existence of Jewishand Parsi communities in India are recorded since ancient times. However, due to the lack of high-resolution genetic data, theirorigin and affiliation with other Indian and non-Indian populations remains shrouded in legends. Earlier genetic studies onpopulations of Indian Jews have found evidence for a minor shared ancestry of Indian Jews with Middle Eastern (Jews)populations, whereas for Parsis, the Iranian link was proposed. Recently, in our high-resolution study, we were able to quantifythe admixture dynamics of these groups, which has suggested a male-biased admixture. Here, we added the newly availableancient samples and revisited the interplay of genes and cultures. Thus, in this study we reconstructed a broad genetic profile ofIndian Jews and Parsis to paint a fine-grained picture of these ethnic groups.