Diabetes self-care activities: A community-based survey in urban southern India.

Background. Diabetes is a lifestyle disease and can be successfully managed by good self-care activities such as diet, exercise, monitoring and drug adherence. Adequate baseline information about the prevalence of good self-care activities is not available from India. We aimed to estimate the existing self-care behaviours and factors influencing these behaviours among adult patients with type 2 diabetes in urban southern India. Methods. A cross-sectional survey was conducted using a cluster design in an urban community in southern India. The Summary Diabetes Self-Care Activities questionnaire was used to collect information on diet, exercise, monitoring of blood sugars and adherence to drugs. Risk factors such as marital status, socioeconomic status, depression, benefit-finding and duration of illness, which are likely to influence self-care behaviour, were assessed. Results. Good dietary behaviour was present in 29% (95% CI 20.8%–37.2%), good exercise behaviour in 19.5% (95% CI 17.4%–21.6%), regular blood sugar monitoring in 70% (95% CI 62.2%–77.8%) and drug adherence in 79.8% (95% CI 75.1%–84.5%). Being male (OR 3.38; 95% CI 1.541–7.407) and married (OR 5.60; 95% CI 1.242–25.212) significantly favoured good exercise behaviour. Being married (OR 2.322; 95% CI 1.104– 4.883) and belonging to the higher socioeconomic status (OR 2.713; 95% CI 1.419–5.190) were significantly associated with monitoring of blood sugars. Conclusions. Self-care activities with respect to diet and exercise are poor in the population studied. The self-care activities relating to blood sugar monitoring and drug adherence are good. Improving self-care behaviour among patients with diabetes in India should start with adequate targeted health education.

Hazardous alcohol use in rural southern India: Nature, prevalence and risk factors.

Background. There is a dearth of data on the hazardous use of alcohol in rural India. Methods. We examined the nature, prevalence and factors associated with hazardous use of alcohol among men in a rural community in southern India. We used stratified sampling to select subjects from the Kaniyambadi block and employed ‘AUDIT’, a standard instrument, to assess the use of alcohol. Results. The prevalence of life-time use, use in the past year and hazardous use of alcohol was 46.7%, 34.8% and 14.2%, respectively. Using Indian made foreign liquor (OR 20.51; 95% CI 8.81–47.75) and living in a village which brewed illicit alcohol (OR 2.82; 95% CI 1.39–5.72) were risk factors for hazardous use while education (OR 0.39; 95% CI 0.21–0.72) was protective. These factors remained significantly associated with hazardous use after adjusting for age and education using logistic regression. Conclusion. The relationship between the availability of illicit and commercial alcohol and its hazardous use suggests the need for an alcohol policy which takes into account health and economic issues and also implements the law to prevent the negative impact of problem drinking.

Incidence of Haemophilus influenzae type b meningitis in India.

BACKGROUND & OBJECTIVE: Vaccine policy depends on locally relevant disease burden estimates. The incidence of Haemophilus influenzae type b (Hib) disease is not well characterized in the South Asian region, home to 30 per cent of the world's children. There are limited data from prospective population incidence studies of Hib in Asia, and no data available from India. We therefore carried out this study to assess the burden of Hib meningitis in India. METHODS: A prospective surveillance study was carried out during 1997 and 1999 in hospitals for cases of Hib meningitis from 5 administrative areas of an Indian district (Vellore, Tamil Nadu) with 56,153 children under 5 yr of age, over a 24 month period RESULTS: Ninety seven cases of possible meningitis (> 10 WBC/microl in CSF) were reported, an annual incidence of 86 per 100,000 (95%CI 69 to 109) in 0-4 yr old children, and 357 per 100,000 in 0-11 month infants. Eighteen had proven bacterial meningitis, an annual incidence of 15.9 per 100,000. Eight CSF had Hib by culture or antigen testing, an annual incidence of 7.1 per 100,000 (95%CI 3.1 to 14.0) in children 0-59 months. In infants 0-11 months of age, the incidence of Hib meningitis was 32 per 100,000 (95%CI 16 to 67) and in the 0-23 month group it was 19 (95%CI 8 to 37). INTERPRETATION & CONCLUSION: Our data are the first minimal estimate of the incidence of Hib meningitis for Indian children. The observed incidence data are similar to European reports before Hib vaccine use, suggest substantial disease before 24 months of age, and provide data useful for policy regarding Hib immunization.

Geographical information system (GIS) in investigation of an outbreak.

An outbreak of fever in a village in southern India was reported on 1st September, 2001. The first reported case presented with epistaxis and a platelet count of 27000h(1)/mm3. Clinical, laboratory and entomological evidence supported a diagnosis of dengue fever. One third of the village was affected and 3.7 % of the population presented with haemorrhagic symptoms; none were fatal. Five acute cases tested for dengue specific IgM showed that two were positive. The larvae of Aedes aegypti were discovered from domestic water collections in the village. Spatial analysis done with the help of Geographical Information Systems software (GIS) demonstrated a centrifugal spread of cases from the most affected street until it involved the entire village. Spatial analysis revealed that cases occurred in clusters and that these could not have occurred by chance. This was our first experience in producing a geo-referenced map of a village area and in spatial analysis. GIS is a novel and simple tool for outbreak investigations and the spatial analyst adds additional information to the data collected. Control of adult mosquitoes and larvae prevented the outbreak from spreading to an adjacent village.