Community utilisation of subcentres in primary health care--an analysis of determinants in Kerala.

The determinants of utilisation of subcentre services in a random sample of 247 subcentres from three out of 14 districts of Kerala were investigated. Physical verification of the facilities was done in a subset of 90 subcentres and household surveys of 750 households were performed in the service areas of those subcentres. About 30 per cent of the beneficiaries utilised services of the subcentres during the reference period. The relationship of selected predictor variables on utilisation of the services was found out. The district in which a subcentre was physically present was found to be the most important correlate of its utilisation.

Prevalence, correlates, awareness, treatment, and control of hypertension in a middle-aged urban population in Kerala.

BACKGROUND: Hypertension is an important cause of cardiovascular morbidity and mortality. METHODS AND RESULTS: We conducted a cross-sectional survey of 314 middle-aged subjects (163 men; age range 40-60 years, mean 49 years) in urban Thiruvananthapuram City. Kerala, to estimate the prevalence of hypertension, examine its correlates, and assess the degree of awareness, treatment, and control of high blood pressure. Blood pressure was measured by a nurse graduate using a mercury column sphygmomanometer and a standardized technique. We used multivariable analyses to examine the sociodemographic and clinical correlates of hypertension. The overall prevalence of hypertension in our sample was 54.5% (men 56.3%, women 52.3%). The factors associated with an increased prevalence of hypertension were higher body-mass index (odds ratio for a value in the top tertile of 2.33, 95% confidence interval: 1.2-4.4), and older age (odds ratio for the age group 55-60 years of 2.65, 95% confidence interval: 1.3-5.6). An occupation involving moderate or greater physical activity was inversely associated with the prevalence of hypertension (odds ratio 0.35, 95% confidence interval 0.13-0.94). Among hypertensives, 39% were aware of the condition, while 29% were treated with blood pressure-lowering medications. Adequate control of elevated blood pressure was achieved in only 30.6% of treated hypertensives. In our community-based sample, over half of all middle-aged individuals were hypertensive, but less than a third were under treatment. Adequate control of hypertension was achieved in less than a third of the treated individuals. CONCLUSIONS: These observations re-emphasize the need for hypertension awareness programs targeting the general public and the increased use of opportunistic blood pressure screening, and underscore the importance of measures to increase the knowledge of current guidelines for the detection and treatment of hypertension among healthcare providers.

Knowledge and attitude of college students in Kerala towards HIV/AIDS, sexually transmitted diseases and sexuality.

BACKGROUND: Knowledge about the spread of HIV and safe sexual practices has a critical impact on the prevention of the acquired immunodeficiency syndrome (AIDS). We assessed the knowledge of and attitude towards AIDS, sexually transmitted diseases (STDs) and sexuality among college students in Thiruvananthapuram district, Kerala. METHODS: We performed a community-based, cross-sectional survey of 625 randomly selected undergraduate college students (164 boys, 461 girls, age 18-22 years). We administered a pretested, structured questionnaire to assess the knowledge and attitude of the students towards AIDS, STDs and sexuality. We generated knowledge and attitude scores from the student responses, and used multivariable linear regression to study the association of these scores with select predictor variables (notably gender and place of residence). RESULTS: All the students in our sample had heard about AIDS. However, only 45% knew that AIDS is not curable at present. Only 34% were aware of the symptoms of STDs, and 47% knew that STDs are associated with an increased risk of AIDS. In multivariable analyses, male students (p < 0.001), and urban residents (p = 0.006) demonstrated a higher knowledge of AIDS and STDs. Students from urban areas (p = 0.014) and those practising the Christian religion (p = 0.042) demonstrated more favourable attitudes towards AIDS. CONCLUSIONS: Our study identified substantial lacunae in the knowledge of and attitude towards AIDS, STDs and sexuality among college students in Kerala. The gap in knowledge between boys and girls, and between rural and urban students suggests the need for targeting girls and rural areas in the national AIDS education and awareness campaigns.

Prevalence, awareness, treatment and control of hypertension in an elderly community-based sample in Kerala, India.

BACKGROUND: Hypertension is one of the most important causes of cardiovascular morbidity and mortality in the elderly. With the increase in the number of elderly in India, hypertension is likely to emerge as an important public health problem. METHODS: We performed a cross-sectional survey of a random sample of 357 community-dwelling elderly individuals (191 women, 166 men; mean age 70 years) in Kerala. We measured blood pressure on all study participants using a standardized technique to assess the prevalence of hypertension. We compared the variations in prevalence, awareness, treatment and control of hypertension according to age, sex and place of residence of the subjects, and examined the socio-demographic correlates of hypertension using sex-specific multiple logistic regression. RESULTS: The overall prevalence of hypertension in our sample was 51.8% (95% CI: 46.8%-56.8%), which did not vary with sex but increased with age. Fewer than half of the hypertensive subjects were aware of their condition or were on treatment, and only a quarter of the treated hypertensives achieved adequate control of blood pressure. Rural elderly subjects were especially less likely to be aware of, and on treatment for hypertension. Smoking status and rural residence (in men) and marital status (in women) were important correlates of hypertension. CONCLUSIONS: Our findings emphasize the public health importance of hypertension in the elderly in Kerala at present, and point to a likely increase in burden of this problem in India in the near future. A National Hypertension Programme, targeted to meet the imminent public health challenge posed by hypertension seems warranted.

Age- and height-specific reference limits of blood pressure of Indian children.

BACKGROUND: Blood pressure in childhood is the most powerful predictor of hypertension in adults. Norms for blood pressure in children are based on the age- and height-specific distribution of blood pressure in a reference sample of healthy children. METHODS: We performed a cross-sectional survey of school-children in the age group 5 to 14 years in south Delhi and studied the distribution of systolic and diastolic blood pressure in 8293 children (4623 boys and 3670 girls). Blood pressure was measured in all children with a mercury column sphygmomanometer using a standardized technique. The first and the fourth Korotkoff sounds were taken as indicative of the systolic and the diastolic blood pressure, respectively. Height percentiles were computed for the study sample for every one-year sex-pooled group. Multiple linear regression was then performed for every one-year group in order to estimate the 90th and 95th percentiles of systolic and diastolic blood pressure according to percentiles of height. RESULTS: Age and height, but not gender, emerged as the principal determinants of systolic and diastolic blood pressure in multivariable linear regression analyses. Age- and height-specific 90th and 95th percentile values of systolic and diastolic blood pressure were estimated, which enabled us to categorize children into 'normal', 'high normal' and 'high' blood pressure groups. CONCLUSIONS: We present age- and height-specific reference values for blood pressure of Indian children based on a large study sample. The use of these standards should aid the identification of children with high blood pressure.

Prevalence of dental fluorosis and associated risk factors in Alappuzha district, Kerala.

BACKGROUND: Fluorosis is considered endemic in 15 states of India. Dental fluorosis is the most convenient biomarker of exposure to fluoride. In Kerala, although the condition is reported to be endemic in the districts of Alappuzha and Palakkad, there are no systematic epidemiological studies evaluating dental fluorosis. We studied the prevalence of dental fluorosis among school children in Ambalappuzha taluk, Alappuzha district, Kerala and evaluated the contribution of potential risk factors. METHODS: We conducted a community-based, cross-sectional survey of 1142 school children (630 girls, 512 boys) in the age group of 10-17 years, using a multistage random cluster sampling technique. A pre-tested structured questionnaire was used to assess exposure to various sources of fluoride. A dental specialist examined all the children to determine the presence or absence of dental fluorosis and graded the degree of dental fluorosis using Dean's Index. The water fluoride content in the study area was obtained from the district water authority department. Bivariate associations were examined using the Chi-square and Chi-square trend tests, while multiple logistic regression was used to evaluate the association of select risk factors with the presence or absence of dental fluorosis. RESULTS: The overall prevalence of dental fluorosis in our study sample was 35.6% and the community fluorosis index was 0.69. The prevalence of dental fluorosis was higher in the urban compared to the rural areas (55.3% v. 16.8%; p < 0.001), and in girls compared to boys (39.2% v. 31.3%; p < 0.01). The prevalence of dental fluorosis was higher among children who consumed pipe water as compared to children who consumed well water (44.8% v. 12.7%; p < 0.001). We noted a step-wise increase in the prevalence of dental fluorosis with a corresponding increase in water fluoride content in different panchayats (p = 0.024). The principal factor associated with the presence of dental fluorosis was a high fluoride content of drinking water (OR 1.85, 95% Cl: 1.17-2.92). We did not observe any significant association between dental fluorosis and the intake of brick-tea, consumption of fish or the use of toothpaste. CONCLUSION: Dental fluorosis is a public health problem in the Ambalappuzha taluk. Active steps must be taken to partially defluoridate the water before distribution to reduce the morbidity associated with dental fluorosis in this area. Similar surveys are required in other parts of India to identify areas with high water fluoride content and determine the extent and manner in which defluoridation can be carried out.

Lymphocytotoxic antibodies in patients with systemic lupus erythematosus & their household contacts.

Twenty patients with systemic lupus erythematosus (SLE) and their 51 household contacts were screened for the presence of lymphocytotoxic antibodies. A high prevalence of lymphocytotoxic antibodies (LCTAB) was observed in the patients (80% against T cells and 100% against B cells). The antibodies carried specificity for HLA-B5/35 and HLA-DR2/DR3. A high prevalence of LCTAB was also observed in contacts (55% LCTAB-T cells, 88% LCTAB-B cells) with no difference being seen between consanguineous and non-consanguineous male or female relatives.