HIV-1 seroprevalence and awareness of mother-to-child transmission issues among women seeking antenatal care in Tamil Nadu, India.

BACKGROUND: Despite increasing availability of HIV-1 testing, education, and methods to prevent transmission, Indian women and their children remain at risk of acquiring HIV. We assessed the seroprevalence and awareness about HIV among pregnant women presenting to a private tertiary care hospital in South India. METHODS: Seroprevalence was determined via enzyme-linked immunosorbent assay (ELISA) testing, and questionnaires were analyzed using chi-square statistics and odds ratios to look for factors associated with HIV positivity. RESULTS: A total of 7956 women who presented for antenatal care were interviewed. Fifty-one women of the 7235 women who underwent HIV testing (0.7%) were found to be HIV positive. Awareness of mother-to-child transmission (MTCT) of HIV (64%), HIV transmission through breast milk (42%), and prevention of MTCT (13%) was low. CONCLUSIONS: There is a need to educate South Indian women about HIV to give them information and the means to protect themselves and their unborn children from acquiring HIV.

The effect of community based daycare on mental health and quality of life of elderly in rural south India: a community intervention study.

BACKGROUND: Sustainable cost-effective interventions to improve psychiatric morbidity and quality of life among the elderly have not been systematically evaluated in developing countries. METHOD: The most vulnerable elderly living in Pennathur, Vellore district, India, in terms of socioeconomic status and social supports, were invited to participate in a day-care program. Baseline assessments were done using the Mini Mental Status Examination, the Revised Clinical Interview Schedule and the World Health Organisation Quality of Life- Bref. Follow-up assessment was done at 3 months on subjects who took part and those who refused. RESULTS AND CONCLUSIONS: Forty-one (16.4%) were invited to take part. Twenty subjects took part in the program while 21 refused. There was a significant reduction in psychiatric morbidity and improvement in quality of life scores at 3 months for subjects who attended the program. The improvement in quality of life persisted after adjusting for gender, socioeconomic status and baseline scores. Costing of the program suggests sustainability.

Mortality rate and years of life lost from unintentional injury and suicide in South India.

We calculated mortality rates and years of life lost because of unintentional injuries and suicides using community based information obtained prospectively over a 7-year period, from 1998 to 2004, among a rural and peri-urban population of 108,000 in South India. Per 100,000 population the total mortality rate for unintentional injuries and suicides combined was 137.1, with 54.9 for unintentional injuries and 82.2 for suicides respectively. Hanging and self-poisoning with pesticides were the preferred means of suicide. Unintentional injuries and suicides resulted in 26.9% of total life years lost over the study period while 18.9% of all deaths in the population were attributable to unintentional injuries and suicides in the same period. The high burden is particularly notable in the 15-29 age group, where up to 70% of years of life lost are due to injury. The burden of injuries reported in this study is significantly higher than the figures reflected in available reports for India and is likely due to the under reporting in routine mortality statistics, particularly of suicides.

A community health programme in rural Tamil Nadu, India: the need for gender justice for women.

This article highlights the efforts of the Community Health and Development (CHAD) Programme of Christian Medical College to address the issues of gender discrimination and improve the status of women in the Kaniyambadi Block, Vellore, Tamil Nadu, India. The many schemes that are specifically for women and general projects for the community from which women can also benefit represent a multi-pronged approach whose aim is the improvement of women's health, education and employment in the context of community development. However, despite five decades of work with a clear bias in favour of women, the improvement in health and the empowerment of women has lagged behind that achieved by men. We believe this is because the community, with its strong male bias, utilises the health facilities and education and employment programmes more for the benefit of men and boys than women and girls. The article argues for a change of approach, in which gender and women's issues are openly discussed and debated with the community. It would appear that nothing short of social change will bring about an improvement in the health of women and a semblance of gender equality in the region.

Reproductive tract infections among young married women in Tamil Nadu, India.

CONTEXT: Women often suffer silently with reproductive tract infections (RTIs). Studies of the prevalence of these infections in South Asia have been hindered by low participation rates, and little is known about rates among the youngest married women. METHODS: A community-based cross-sectional study of RTIs was conducted in 1996-1997 among married women 16-22 years of age in Tamil Nadu, India. The women were questioned about symptoms, received pelvic and speculum examinations and provided samples for laboratory tests. Qualitative and quantitative data on treatment-seeking behavior were collected. RESULTS: Fifty-three percent of women reported gynecologic symptoms, 38% had laboratory findings of RTIs and 14% had clinically diagnosed pelvic inflammatory disease or cervicitis. According to laboratory diagnoses, 15% had sexually transmitted infections and 28% had endogenous infections. Multivariate analysis found that women who worked as agricultural laborers had an elevated likelihood of having a sexually transmitted infection (odds ratio, 2.4), as did those married five or more years (2.1). Two-thirds of symptomatic women had not sought any treatment; the reasons cited were absence of a female provider in the nearby health care center, lack of privacy, distance from home, cost and a perception that their symptoms were normal. CONCLUSIONS: Young married women in this rural Indian community have a high prevalence of RTIs but seldom seek treatment. Education and outreach are needed to reduce the stigma, embarrassment and lack of knowledge related to RTIs. The low social status of women, especially young women, appears to be a significant influence on their low rates of treatment for these conditions.

Suicides in young people in rural southern India.

Different rates of suicide have been reported in India. In Vellore, southern India, we have noted that the rates of suicides are several fold higher than those reported anywhere in the world, especially in young women. The department of community health at the Christian Medical College, Vellore, has obtained data prospectively on births, deaths, and morbidity in a population of 108?000. We used the verbal autopsy method to assign cause of death. The mortality rates were analysed for 10 years, from 1992 to 2001, for the age-group 10-19 years. Suicides accounted for about a quarter of all deaths in young men and between 50% and 75% of all deaths in young women. The average suicide rate for young women was 148 per 100?000, and for young men 58 per 100?000. We believe that our findings are reliable. The system of surveillance is well established and the verbal autopsy method has been validated. These very high rates of suicide need urgent intervention.

Post-partum depression in a cohort of women from a rural area of Tamil Nadu, India. Incidence and risk factors.

BACKGROUND: Community-based epidemiological data on post-partum depression from developing countries are scarce. AIMS: To determine the incidence of and risk factors for developing post-partum depression in a cohort of women living in rural south India. METHOD: We assessed 359 women in the last trimester of pregnancy and 6-12 weeks after delivery for depression and for putative risk factors. RESULTS: The incidence of post-partum depression was 11% (95% CI 7.1-14.9). Low income, birth of a daughter when a son was desired, relationship difficulties with mother-in-law and parents, adverse life events during pregnancy and lack of physical help were risk factors for the onset of post-partum depression. CONCLUSIONS: Depression occurred as frequently during late pregnancy and after delivery as in developed countries, but there were cultural differences in risk factors. These findings have implications for policies regarding maternal and childcare programmes.

Medico-social dimensions of menopause: a cross-sectional study from rural south India.

BACKGROUND: The quality of life of the increasing ageing population is becoming an important issue in India. There are very little data on the effect of menopause on women, especially from rural India. METHOD: A population-based cross-sectional study was conducted on perceptions regarding menopause, prevalence of menopausal symptoms and association of family environmental factors with menopausal symptoms among 100 postmenopausal and 100 premenopausal rural women in south India. RESULTS: Fifty-seven per cent of postmenopausal women perceived menopause as convenient. Sixty-nine per cent of them complained of diminishing abilities after menopause. Twenty-three per cent felt that sexual life ends with the onset of menopause. Sixteen per cent reported that their husbands had become disinterested in them after menopause and I1% were apprehensive about the loss of femininity. A higher proportion of postmenopausal women reported hot flushes, night sweats, urge incontinence and other somatic symptoms as compared to premenopausal women. Fifty-four per cent of postmenopausal and 32% of premenopausal women were currently not sexually active. Fifty-nine per cent of postmenopausal and 38% of premenopausal women expressed loss of sexual desire and this difference was statistically significant. There was no significant association between menopause and depression. A poor perceived relationship within the family was shown to have a significant association with depression. There was a significant association between multiple somatic symptoms and menopause. CONCLUSION: A significantly higher proportion of postmenopausal women suffer from vasomotor symptoms, urge incontinence, loss of sexual desire and multiple somatic symptoms. They do not link these symptoms with menopause. Poor family environmental factors have a stronger association with depression than menopause. In view of these findings, it is important to determine the feasibility and impact of hormone replacement therapy in preventive health care in rural India.