Nutritional assessment and counselling of tuberculosis patients at primary care in India: do we measure up?

SETTING: Dakshina Kannada District, coastal South India, under the Revised National Tuberculosis Control Programme (RNTCP). OBJECTIVE: To identify the potential and practices at primary health centres (PHCs) for the assessment of nutritional status of patients with tuberculosis (TB), the basic tools used to measure height and weight and the type of nutritional counselling provided. DESIGN: A cross-sectional study was conducted with physical verification of availability of height and weight measuring equipment. Information was collected on the method used by medical officers for assessing nutritional status in PHCs, action taken in case the patient is undernourished and any formal training in nutritional assessment and counselling. RESULTS: Of 37 PHCs assessed, weighing machines were available in all and stadiometers in 38%. Medical officers were not calculating body mass index for nutritional assessment even when height and weight were being uniformly measured. Nutritional classification was mostly based on the appearance and physique of the patient. Counselling included advice to take milk, eggs and protein powders with efforts to arrange funds from village health, sanitation and nutrition committees. CONCLUSION: There is a need to equip the PHCs and their medical officers with necessary tools and training for nutritional assessment and counselling of patients with tuberculosis.

Physical accessibility audit of primary health centers for people with disabilities: An on-site assessment from Dakshina Kannada district in Southern India.

BACKGROUND: Access to health care is important for persons with disability (PwD). The Government of India has launched the "Accessible India Campaign" (AIC) as a nationwide campaign for achieving universal accessibility for PwDs. OBJECTIVE: To conduct an on-site assessment for physical accessibility of all primary health care centers (PHCs) of Dakshina Kannada (DK) district in Karnataka using the AIC checklist. MATERIALS AND METHODS: A cross-sectional facility-based assessment of all 67 PHCs under the administrative control of the District Health and Family Welfare Office of the district was done using Physical Accessibility Audit Checklist prepared by the AIC. Ethics approval was obtained from the Institutional Ethics Committee and written permission was obtained from the District Health and Family Welfare Officer. Data were analyzed for frequencies and percentages. RESULTS: The Accessible India Physical Accessibility Audit Checklist consists of more than116 numbers of items. Out of 67 PHCs, 57 (85%) PHCs had an accessible pathway and 60 (90%) PHCs had a ramp for wheelchair. Only 25 (36%) PHCs had accessible doors. No PHCs had height-adjustable examination table, disable friendly toilets and only two PHCs had accessible weighing scales. CONCLUSION: This unique on-site assessment finds that our PHCs are not well equipped for catering to PwD. To realize AIC in terms of health care access for the PwD, there is much that remains desirable at primary health care level, a point of first contact in the public health system.

Is There an Association between the Duration of Stay in the Medical Colleges and the Smoking Behavior among Medical Students? A Cross-sectional Study.

BACKGROUND: Health-care providers must be at the forefront of tobacco cessation to ensure a downward shift in tobacco use. Medical schools constitute an important site for education and cessation efforts. Health-care professionals play a substantial role in influencing patients' lifestyle choices including tobacco cessation. OBJECTIVES: To examine the association between the duration of stay in the medical colleges and the smoking behavior among the medical students in Karnataka, India. MATERIALS AND METHODS: One government and four private medical colleges were selected using stratified random sampling technique for this cross-sectional study. Sample size was 3288 medical students. A pretested self-administered questionnaire was used to collect data. SPSS version 12.0 was used for data analysis. The statistical methods used were frequencies, proportions, and Chi-square test. RESULTS: Mean age of the study participants was 20.68 ± 2.05 years for males and 20.20 ± 1.91 years for females. Number of smokers among medical students after joining medical college increased 2.7 times. The duration of stay in the medical colleges was positively associated with the smoking behavior (P < 0.0001) among medical students, and the increase in the number of smokers reached up to 259.6% during internship. CONCLUSION: Smoking among medical students increases along with their stay in medical college.

Family centered approach in primary health care: experience from an urban area of Mangalore, India.

INTRODUCTION: "Health for All" still eludes public health experts despite many approaches to prevent disease and promote health among urban poor. Several key illness factors lie beyond the conventional healthcare boundaries. OBJECTIVE: To examine the effectiveness of family centered approach (FCA) in addressing health and related issues in an urban area of Mangalore, India. METHOD: A longitudinal study was conducted in Bengre, an outreach centre of Mangalore from June 2011 to November 2013. Family folders were created with pertinent details. Demand generation and health education activities were conducted through two female community health link workers. An FCA package was implemented by medical and nursing interns, under supervision, to address the priority issues. Effect was assessed by comparing their practices and service utilization before and after the study. RESULTS: About 809 families participated in this study. Social, cultural, and religious factors were responsible for viciousness of malaria and maternal and child health issues. FCA improved their perceptions and practices towards health and related issues. Significant (P < 0.05) and sustained hike in service utilization was evident. CONCLUSION: FCA exposes key illness factors beyond the conventional care, eases need based healthcare implementation, and provides feasible and enduring solutions. Community involvement makes it more practicable.

Physicians' tobacco intervention counseling in a tertiary care hospital of South India.

The tobacco epidemic is one of the biggest public health threats in the present world with a substantial contribution to mortality and morbidity. Patients' visits to their doctors for illnesses and health check-ups offer a great opportunity to screen them for tobacco use and also counsel them to quit tobacco use. This cross sectional study was carried out in out-patient departments of General Medicine and Pulmonary Medicine of a tertiary care medical college teaching hospital in Dakshina Kannada district of Karnataka state of India between April 2012 and July 2012 among the patients aged 18 years or above who were diagnosed as suffering from tobacco related diseases. Exit interview was conducted on the patients after obtaining a written informed consent using a pre designed semi-structured questionnaire. Data was entered, analyzed using SPSS v17 and Descriptive statistics, Fisher Exact test, Bivariate and multivariable logistic regression analyses were used. The present study reveals that 305 (87.1 %), 281 (80.3 %) and 257 (73.1 %) of the 350 participants were asked, assessed and advised respectively by the treating physicians to quit tobacco use where as only 18 (15.1 %) were assisted in their efforts to quit tobacco. Physician's counseling inventions were significantly associated with patient's age, sex, education, marital status and socio economic status of the patients as well as the treating physician's experience of more than 3 years. There is a need to incorporate tobacco history taking as a vital sign during medical history taking and this should be made as a routine in medical schools.