Social Isolation, Social Support, and Psychological Distress Among the Elderly During the COVID-19 Pandemic: A Cross-Sectional Study from Central India

Background: In the present COVID-19 pandemic, social distancing measures have been advised to protect elderly from infection which might have led to poor mental health state. Objective: A cross-sectional study was carried out to assess the magnitude of social isolation, social support, and psychological distress among the elderly during the COVID-19 pandemic in Central India. Methods: The estimated sample size was 1535. The sample was equally distributed among rural, semiurban, and urban strata of districts. Social isolation was measured using Lubben’s Social Network Scale?Revised, and psychological distress was assessed using Kessler K10 Psychological Distress Scale. Other parameters such as a history of COVID-19 illness and COVID-19 vaccination were assessed. Results: The prevalence of social isolation was higher at 23.6% during the COVID?19 pandemic compared to before the pandemic period (15.0%). The majority perceived a high level of social support during the pandemic (55.3%) and 39.9% received moderate support. Overall, 18.4% of the respondents had psychological distress. Out of them, 56.2% had mild distress, 20.1% had moderate distress, and 23.7% had severe distress. Significant predictors of psychological distress were female gender, lower socioeconomic status, history of COVID-19 disease among the participants, social isolation, and lack of social support. Conclusion: Social isolation and lack of social support were significant predictors of psychological distress among the elderly during the pandemic.

Scrub typhus in urban areas of Wardha district in central India

Background & objectives: Scrub typhus caused by Orientia tsutsugamushi presents as acute undifferentiated fever and can be confused with other infectious causes of fever. We studied scrub typhus as part of a study on hospital-based surveillance of zoonotic and vector-borne zoonotic diseases at a tertiary care hospital located in the Wardha district, Maharashtra, India. We report here descriptive epidemiology and climatic factors affecting scrub typhus. Methods: Patients of any age and sex with fever of ?5 days were enrolled for this study. Data on sociodemographic variables were collected by personal interviews. Blood samples were tested by IgM ELISA to diagnose scrub typhus. Confirmation of scrub typhus was done by indirect immunofluorescence assay for IgM (IgM IFA). The climatic determinants were determined using time-series Poisson regression analysis. Results: It was found that 15.9 per cent of the study participants were positive for scrub typhus by IgM ELISA and IgM IFA, both. Positivity was maximum (23.0%) in 41-60 yr of age and more females were affected than males (16.6 vs. 15.5%). Farmworkers were affected more (23.6%) than non-farm workers (12.9%). The disease positivity was found to be high in monsoon and post-monsoon seasons (22.9 and 19.4%) than in summer and winter. Interpretation & conclusions: There were three hot spots of scrub typhus in urban areas of Wardha district. Rainfall and relative humidity in the previous month were the significant determinants of the disease

Metabolic syndrome among elderly care-home residents in southern India: a cross-sectional study.

Background: The health of the elderly population and the emergence of noncommunicable diseases have become major public health issues in recent years. Metabolic syndrome is thought to be the main driving force for the global epidemic of cardiovascular diseases, as well as for type 2 diabetes. This cross-sectional study aimed to determine the prevalence of metabolic syndrome and its correlates among the residents of care homes for the elderly in Hyderabad city, India. Methods: A total 114 elderly persons (aged ≥60 years) were evaluated in a cross-sectional study. Metabolic syndrome was defined by the 2005 criteria of the International Diabetes Federation. Data were collected on selected sociodemographic, behavioural and nutritional variables and cardiometabolic risk factors. Blood pressure and anthropometric measurements were also recorded. Fasting blood samples were collected for measurement of blood glucose and serum lipid levels. Univariable logistic regression was applied to investigate the associations between metabolic syndrome and known risk factors; adjusted analysis was then done by multivariable logistic regression for significant variables. Results: The overall prevalence of metabolic syndrome was 42.1% (48/114) among the study population. A higher prevalence (50.9%; 27/53) was found among women. High blood pressure or taking antihypertensive medication was found to be the most common (95.8%; 46/48) cardiometabolic component. The risk of metabolic syndrome did not differ significantly by age group, sex, caste, religion, type of diet (vegetarian or non-vegetarian), educational status, behavioural factors such as tobacco use and alcohol intake, physical activity (assessed by modified Eastern Cooperative Oncology Group [ECOG] scale), or physical exercise. However, a body mass index ≥23 kg/m2 was associated with metabolic syndrome (unadjusted odds ratio [OR]: 8.97; 95% confidence interval [CI]: 3.78–21.28); adjusted OR: 9.31; 95% CI: 4.12–22.14) Conclusion: The overall prevalence of metabolic syndrome in this study population of elderly care-home residents in India was more than 40%. Further research on the burden of metabolic syndrome in the elderly population is warranted.

Institutionalizing district level infant death review: an experience from southern India.

Background: An Infant Death Review (IDR) programme was developed and implemented in two districts of Karnataka. Objective: We explored the processes that led to the development of the IDR programme with a view to improving the existing pilot programme and to ensuring its sustainability. Methods: A sequential mixed-methods design was followed in which quantitative data collection (secondary data) was followed by qualitative data collection (in-depth interviews). Quantitative data were entered using EpiInfo (version 3.5.1) software and qualitative data were analysed manually. Results: Apart from ascertaining the cause of infant deaths, the IDR Committee discusses social, economic, behavioural and health system issues that potentially contribute to the deaths. As a result of the IDR programme, key actors perceived an improvement in infant death reporting at district level, the development of a rapport with the local community, and elaboration of a feedback system for corrective actions. This has led to improved health care during pregnancy. Conclusions: We found that involvement of the different stakeholders in planning and implementing the IDR programme offered a platform for collective learning and action. Impediments to the success of the programme need to be addressed by corrective actions at all levels for its future sustainability.

Health-promoting school initiative in Ashram schools of Wardha district.

Background. We studied the effect of a health-promoting school-based intervention for disadvantaged children in the residential Ashram schools of rural Wardha, Maharashtra. Methods. At baseline, 1287 children in 10 Ashram schools were examined using a locally adapted Global Schoolbased Student Health Survey questionnaire. The haemoglobin level of all children was estimated using the haemoglobin colour scale. Body mass index and physical activity score for each child were calculated. The intervention was carried out through school health committees. After 1 year, 1226 children were examined using the same questionnaire. Results. There was significant improvement in personal hygiene and reduction in hygiene-related morbidity among the children. The median haemoglobin level of the children increased from 10.7 g/dl to 11.4 g/dl. There was also a significant increase in the proportion of children with body mass index that was normal for age (5th–85th percentile) from 32.2% to 38.5%. Conclusion. The need-based participatory health-promoting school initiative for disadvantaged children in Ashram schools led to an improvement in their personal hygiene and health.

Metabolic syndrome in adult population of rural Wardha, central India.

Background & Objectives: Prevalence of metabolic syndrome is high among Asians including Indians. Scarce information is available about the magnitude of metabolic syndrome in rural areas and hence present study in rural area of Wardha district, central India. Methods: In 300 randomly selected subjects, blood pressure and anthropometric measurements such as height, weight, waist circumference and hip circumference were noted. Blood sample was collected after overnight fasting and was subjected to biochemical quantification such as fasting blood sugar, total cholesterol, triglycerides, HDL-C, VLDL-C and LDL-C. Data were analyzed using ATP-III definition as well as by modifying the waist circumference cut-offs as per Asia-Pacific guidelines. Results: Overall metabolic syndrome as per ATP-III criteria was observed in 5.0 per cent adult rural population. When ATP-III criteria were modified using waist circumference cut-offs recommended by Asia-Pacific guidelines, metabolic syndrome was seen in 9.3 per cent. It was 10.7 per cent among females and 8.2 per cent among males. Receiver operating characteristic curve was plotted to find out the best cut-off of BMI to identify the individuals with metabolic syndrome. The best cut-off for BMI came out to be 23.32 kg/m2. Interpretation & conclusions: The magnitude of metabolic syndrome was low among rural adults of Wardha as compared to reported values in urban areas. BMI of 23.32 kg/m2 and higher was found to predict significant risk of metabolic syndrome in these study subjects. However, studies with larger sample need to be conducted to confirm these findings.

Portfolio based approach for teaching Community Medicine among medical undergraduates and assessment of their learning in a medical college in rural India.

Objective: The study was undertaken to explore what and how first year medical undergraduates could learn about Community Medicine using a portfolio-based learning approach during the period of Social Service Camp in the village Pulai. Methods: Study participants were 65 first year medical undergraduates participating in Social Service Camp in the village Pulai, during 10 - 24 October 2008. The first step was to set Specific, Measurable, Actionable, Realistic and Time bound (SMART) learning goals focused on Community Medicine. These learning goals were to be achieved during the fifteen days and within the existing curriculum, using existing resources and opportunities. The portfolio based records of students who accomplished their learning objectives were subjected to qualitative content analysis. Results: Of 65 students, 41 (63.1%) completed and reflected on their portfolios. Methods adopted for learning were; interaction with community based groups (48.8%), interaction with allotted family members (43.9%), lectures series, role plays and demonstrations (36.6%), interactions with village level healthcare providers (31.7%) and journal exercises (26.8%). The portfolio based exercises were useful to 30 (46.2%) students to understand the social, economic and health problems of the villagers and their life style. Twenty four (36.9%) students said that it improved their communication skills. This exercise helped 11 (16.9%) students to explore weaknesses such as poor communication skills, poor knowledge of local language, inability to adjust in new environment. Conclusion: The Social Service Camp in the village Pulai offered opportunities for portfolio based leaning to medical undergraduates. The students learned about the major topics of primary health care through self-directed learning. Key words: Social Service Camp, community based teaching.

Effect of improvement of pre-school education through anganwadi center on intelligence and development quotient of children.

Objective. To find usefulness of a package of interventions to improve preschool education through Anganwadi centers on psychosocial development of children. Methods. A case-control study was undertaken to evaluate an intervention. Eight Anganwadi centers were selected using simple random sampling out of sixteen Anganwadi centers in Talegaon PHC area where intervention was done. Ten children in age group of 4-6 years were selected randomly from each of the eight Anganwadi center in intervention arm. For each child from intervention arm, one agematched child was selected from the matched Anganwadi center. For each subject, Intelligence Quotient and Development Quotient were assessed. Results. Mean Development Quotient (DQ) and Intelligence Quotient (IQ) values were higher among children in intervention Anganwadi centers (16.2 points for DQ and 10.2 points for IQ). This difference was found statistically significant (p = <0.01). Mean DQ among boys was found 10.1 points higher than that among the girls in control arm, this was statistically significant. According to multivariate linear regression model, the determinants of DQ were: intervention; age of the child; education of mother; sex of child; and PEM grade and the determinants for IQ were: intervention; age of the child; and income. Conclusions. This study shows that intervention to improve the Early Childhood Education and Development component through Anganwadi centers results in improvement in Developmental and Intelligence Quotient of children.

Health expenditure and care seeking on acute child morbidities in peri-urban wardha: A prospective study.

Objective. To find out health expenditure in public and private sector consultations for common childhood (under 5) morbidities and to compare the clinical practices and the duration of illness for morbidities treated by public and private doctors. Methods. The present prospective study over 12 months period was undertaken in the field practice area of a urban health centre in rural India. We could interview mothers of 202 enlisted children at monthly interval for one year. At each visits, mothers were asked to recall any morbidity for the child in the past four weeks, date of onset of symptoms and relief, source of treatment and recorded both direct and indirect expenditure. The data was entered and analyzed by using Epi_info 6.04 software package. Results. Overall, there were 625 episodes of respiratory infection, out of which 377 (60.3%) were treated by private doctors, 158 (25.3%) were treated by government doctors and remaining 90 (14.4%) were treated at home. Significantly more episodes treated in government health facilities i.e., 12 (5.7%) were recommended or done laboratory test where only 13 (2.3%) consultations with private doctors were advised or done laboratory tests (p=0.015). Notably, 145 (25.5%) and 17 (8.1%) episodes treated by private doctors and government doctors respectively received injections (p=0.001). Average total expenditure on treatment of child morbidity was 189 INR (10% of total household income). Families with less monthly income (<1500) had significantly more expenditure (16.1%) on treatment of morbidities than those families who had higher (>1500) monthly income. Conclusions. About 10% of total household income was spent on the treatment of acute child morbidities. Private providers are preferred for the treatment of acute illnesses where both direct and indirect cost of treatment was high. Household with lower monthly income had to spend more on treatment of their sick children. Hence, while devising PPP and health care financing strategies for urban poor should emphasize to reduce health expenditure.

Awareness and health care seeking for newborn danger signs amongmothers in Peri-Urban Wardha.

Objective. To find out awareness of mothers about newborn danger signs and their health care seeking behavior for sick newborns in the peri urban field practice area of Urban Health Centre in Wardha. Methods. Triangulated study of quantitative (survey) and qualitative (mapping, pair-wise ranking exercise) methods were undertaken. 72 identified mothers of children (0-11 months) in social mapping exercise were interviewed by trained social workers using pre-designed and pre-tested questionnaire and by paying house to house visits. The structured questionnaire covered information on newborn danger signs, health care seeking and socio-demographic information. The data was analyzed by using Epi_info software package. A pair-wise ranking exercise for assessment of preferred health care facility for sick newborn was undertaken with the group of purposively selected mothers. Results. Out of 72 mothers, 29 (40.3%), 16 (22.2%) and 10 (13.9%) identified difficulty in breathing, poor sucking and lethargy/unconsciousness as newborn danger signs respectively. Only 7(9.7%) and 2 (2.8%) identified convulsion and hypothermia as newborn danger signs respectively. About 27 (37.5%) babies were sick during newborn period. About 11(15.3%) and 8 (11.1%) were reported to have poor sucking and difficulty in breathing respectively. All sick newborns with danger signs were taken to the doctor and only two mothers consulted faith healer for treatment. Conclusion. Considering the poor awareness of mothers regarding newborn danger signs, there is need for raising awareness building which required for early recognition and prompt treatment. Apart from strengthening government health facilities, the capacity of intermediate non government health care providers should be developed for newborn care.

A community based approach to improve health care seeking for newborn danger signs in rural wardha, India.

OBJECTIVE: To find out the effect of community mobilization and health education effort on health care seeking behavior of families with sick newborns, and to explore the rationale behind the changed health care seeking behaviors of mothers in a rural Indian community. METHODS: In the present community based participatory intervention, a triangulated research design of quantitative (survey) and qualitative (Focus group discussions, FGDs) method was undertaken for needs assessment in year 2004. In community mobilization, women's self help groups; Kishori Panchayat (KP, forum of adolescent girls), Kisan Vikas Manch (Farmers' club) and Village Coordination Committees (VCC) were formed in the study area. The trained social worker facilitated VCCs to develop village health plans to act upon their priority maternal and child health issues. The pregnant women and group members were given health education. The Lot Quality Assurance Sampling (LQAS) technique was used to monitor awareness regarding newborn danger signs among pregnant women. In year 2007, a triangulation of quantitative survey and a qualitative study (free list and pile sort exercise) was undertaken to find out changes in health care seeking behaviors of mothers. RESULTS: There was significant improvement in mothers' knowledge regarding newborn danger signs. About half of the mothers got information from CLICS doot (female community health worker). The monitoring over three years period showed encouraging trend in level of awareness among pregnant women. After three years, the proportion of mothers giving no treatment/home remedy for newborn danger signs declined significantly. However, there was significant improvement in mothers' health care seeking from private health care providers for sick newborns. CONCLUSION: The present approach improved mothers' knowledge regarding newborn danger signs and improved their health care seeking behavior for newborn danger signs at community level. Due to lack of faith in government health services, women preferred to seek care from private providers.

Antioxidant vitamin levels in sickle cell disorders.

BACKGROUND: Sickle cell disorder is a haemoglobinopathy prevalent in the Vidharbha region of Maharashtra, central India. With recent evidence of oxidative stress in sickle haemoglobinopathy, a possible deficiency of antioxidant vitamins was suspected. METHODS: We measured plasma vitamin E, vitamin C and beta-carotene levels in persons with heterozygous (n=80) and homozygous sickle cell state (n=20), and suitable healthy controls for these groups (n=100 and 66, respectively) in a community-based study in the villages near our institution. RESULTS: Subjects with heterozygous sickle cell trait had lower vitamin E levels than their respective controls (p < 0.05). Subjects with homozygous sickle cell disease had lower levels of all three vitamins (p < 0.05). Vitamins E and C levels showed a significant positive correlation in both forms of sickle cell disorder. CONCLUSION: Our findings suggest that there is depletion of the antioxidant vitamins, particularly in severe forms of sickle cell disorder. A trial of administration of therapeutic doses of vitamin E in this condition is warranted.