COVID transmission and contact tracing using WHO risk assement tool among frontline healthcare workers : Insights from a South Indian tertiary care centre

BackgroundThe high exposure risk to COVID among frontline heathcare workers was a major challenge to healthcare systems across the globe that warranted close monitoring through risk assessment and contact tracing strategies. The objective of our study was to characterize exposure risk factors for transmission and subsequent COVID positivity among the frontlinehealthcare workers in our institution during the pandemic period. MethodsThe retrospective observational study conducted over a period of 6 months from June 2020 to November 2020 at a 1300-bedded South Indian tertiary care centre included frontline healthcare workers who were assessed for their identified encounter with COVID positive individual using a modified WHO COVID risk assessment tool. Additional risk attributes of exposure characterized among COVID positive healthcare workers comprised of shared space, cluster related transmissions and multiple instances of exposure to COVID. ResultsAmong a total of 4744 contacts with COVID positive individuals assessed for risk stratification during the study period, 942 (19.8%) were high risk and 3802 (80.2%) were low risk exposures respectively. 106 (2.2%) turned COVID positive during the surveillance period of 14 days. Frontline workers working in COVID areas had significant low COVID rates as compared to other areas (N=1, 0.9%). The average monthly COVID positivity rates being 1.66%, the attack rates among high risk and low risk contacts among the total HCWs screened were 5% (46/942) and 1.57% (60/3802) respectively. Shared space (70%) and IPC breaches (66%) were found to be highly prevalent in the COVID positive cohort, along with maskless encounters (43%) and multiple exposure (39%). The attack rate among the 6 identified COVID cluster groups (5.5%) were found to be higher than the attack rate (2.2%) noted among the total contacts screened and no significant association was observed between risk categories in the clusters. DiscussionOur study highlights higher risk of COVID positivity among high risk contacts as compared to low risk contacts. However, the high COVID positivity rate in low risk group among cluster transmissions and its lack of association with risk assessment highlight the suboptimal utility of the risk assessment strategy among cluster groups.

Prevalence and Correlates of Self-Reported ADHD Symptoms in Children Attending School in India.

Objective: To study the prevalence and correlates of self-reported ADHD symptoms among school-going adolescents from Kerala, India. Method: Seven thousand five hundred sixty students from Classes 8, 10, and 12, aged 12 to 19 years, across 73 schools selected by cluster random sampling, were invited to participate, but only 7,150 successfully completed the questionnaire incorporating standardized instruments. Results: Three hundred five (4.3%) self-reported symptoms for ADHD combined type, 131 (1.8%) for ADHD hyperactive-impulsive type, and 102 (1.4%) for ADHD inattentive type with a male predominance. Binary logistic regression analysis showed that those with symptoms of ADHD (combined type) compared with the non-ADHD group had poorer academic performance, significantly higher substance use, psychological distress, suicidality, and sexual abuse. Conclusion: The high prevalence of self-reported ADHD symptoms and its association with negative correlates previously reported in literature in those with a diagnosis of ADHD suggests that clinically significant self-reported ADHD symptoms could be as disabling as ADHD.

Anemia Among School Children in Ernakulam District, Kerala, India.

Anaemia has significant negative impact on the health of school children including poor scholastic performance and cognitive impairment. The present study was done with the objective to estimate the prevalence of anemia among school going children in Ernakulam district, Kerala and to determine a few factors associated with anemia. Hemoglobin of 880 students of 6th to 9th standard in 11 randomly selected schools of Ernakulam district was estimated using HemoCue 201 photometer. Prevalence of anaemia was expressed using frequencies and percentages. Univariate analysis for factors associated with anemia was done. Selected variables were entered into a logistic regression model. The prevalence of anemia was estimated to be 44% (95% CI 40.67-47.33). Among them 0.8% had severe anemia, 3.5% had moderate anemia and 39.7% had mild anemia. Among them 21.3% and 52.6% reported not in the habit of consuming green leafy vegetables and citrus fruits respectively, at least three times on a usual week. Anemia among children was associated with female gender (adjusted OR 1.53, 95% CI 1.16-2.04), higher age group (adjusted OR 2.24, 95% CI 1.69-2.91) and regular intake of tea/coffee along with major meals (adjusted OR 1.62, 95% CI 1.20-2.04). Anemia among school going children in Ernakulam remains a public health problem and was more among females, higher age groups (12-15 years) and those reported regular intake of tea/coffee along with major meals. The consumption of iron rich foods among the students was poor. Behavior change communication for dietary modification and universal supplementation of iron is warranted.

Prevalence & correlates of chronic perinatal pain - a study from India.

Objectives: To study the prevalence of chronic perinatal pain among mothers who had infants between the ages of 13-25 months in the State of Kerala, India and to report its correlates in the socio-demographic, obstetric and psychological domains. Methods: A total of 9305 mothers selected by cluster random sampling were assessed cross-sectionally for chronic perinatal pain using a questionnaire by Junior Public Health Nurses (JPHNs). In addition, information regarding socio-demographic profile, obstetric history, infant details and perinatal depression were collected. Results: Of the 8302 (89.3%) valid responses, 552 (6.6%) mothers reported chronic perinatal pain. Among those with pain, 142 (25.6%) reported pain during pregnancy, 314 (56.7%) during postpartum and 96 (17.7%) during both periods. The commonest sites of pain reported were back 280 (51%) and pelvic region 110 (19%). Mothers with chronic perinatal pain were more likely to be younger, less educated, employed and from an urban background. Chronic perinatal pain was associated with obstetric complications, delivery by instrumental/caesarean section, non-exclusive breast feeding and higher maternal depression scores. Conclusion: Chronic pain is common among mothers in India during the perinatal period and greater attention needs to be given for it to be recognised and treated early.

Alcohol harm to adolescents from others' drinking: A study from Kerala, India.

CONTEXT: There is scarce data on the prevalence of harm to adolescents from others' use of alcohol from India. AIMS: The aim is to study the prevalence of harm to school students from others' alcohol use in the district of Ernakulam, Kerala and examines its psychosocial correlates among victims. SETTINGS AND DESIGN: This was a cross-sectional survey of 7560 students of the age range of 12-19 years from 73 schools. MATERIALS AND METHODS: Harm consequent to others' drinking was assessed using a brief version of the World Health Organization-Thai Health Questionnaire on Harm to Others from Drinking. Standardized instruments were used to assess other measures. STATISTICAL ANALYSIS: The prevalence of various harms was determined. Mixed-effect logistic regression was used to explore the sociodemographic, academic, and psychological factors associated with various types of harms and odds ratios reported. RESULTS: Harm due to others' alcohol use was reported by 44.5%, frequent harm by 15.7%, psychological harm by 43.3%, physical harm by 9.7%, property harm by 2.9%, and financial harm by 15.4%. Boys reported greater harm than girls. Girls experienced relatively greater harm within the family and boys outside the family. Being older, having a part-time job and urban residence increased the odds of harm. Adolescents reporting harm had higher odds of substance use, psychological distress, suicidality, sexual abuse, and attention-deficit/hyperactivity disorder symptom-counts. CONCLUSION: The high prevalence of harm from others alcohol use to adolescents with multiple negative impacts underscore the urgent need for public health measures to reduce social costs of alcohol use.

Prevalence and Correlates of Psychological Distress in Adolescent Students from India.

OBJECTIVE: There are limited data on the prevalence and correlates of psychological distress among adolescents in India. This study assessed psychological distress among adolescents who attended school in Kerala, India. METHODS: A total of 7560 students from 73 schools, aged 12 to 19 years completed a self-administered questionnaire that included Kessler Psychological Distress Scale and other standardised instruments to assess various domains. RESULTS: Mild psychological distress was reported by 10.5%, moderate distress by 5.4%, and severe distress by 4.9% of students. Older age, not living with both parents, and urban residence were significantly associated with psychological distress (p < 0.05). Students who experienced psychological distress had a higher risk of reporting academic failure, alcohol and tobacco use, suicidality, and sexual abuse. Increasing severity of psychological distress was associated with higher odds of these correlates. CONCLUSIONS: Psychological distress is common among adolescents and its correlates with negative outcomes suggest the need for early recognition and treatment.

Do High School Students in India Gamble? A Study of Problem Gambling and Its Correlates.

Studies from the West suggest that significant numbers of high school students gamble, despite it being illegal in this age group. To date, there have been no studies on the prevalence of gambling among senior high school and higher secondary school students in India. This study reports point prevalence of gambling and its psychosocial correlates among high school students in the State of Kerala, India. 5043 high school students in the age group 15-19 years, from 73 schools, were selected by cluster random sampling from the district of Ernakulam, Kerala, South India. They completed questionnaires that assessed gambling, substance use, psychological distress, suicidality, and symptoms of Attention Deficit Hyperactivity Disorder (ADHD). Of a total of 4989 completed questionnaires, 1400 (27.9 %) high school students reported to have ever gambled and 353 (7.1 %) were problem gamblers. Of those who had ever gambled, 25.2 % were problem gamblers. Sports betting (betting on cricket and football) was the most popular form of gambling followed by the lottery. Problem gamblers when compared with non-problem gamblers and non-gamblers were significantly more likely to be male, have academic failures, have higher rates of lifetime alcohol and tobacco use, psychological distress, suicidality, history of sexual abuse and higher ADHD symptom scores. Gambling among adolescents in India deserves greater attention, as one in four students who ever gambled was a problem gambler and because of its association with a range of psychosocial variables.

Prevalence and correlates of alcohol use among adolescents attending school in Kerala, India.

INTRODUCTION AND AIMS: Concern around potentially increasing alcohol use among young people has been growing in public discourse in India. However, there are few published studies on this issue. We studied the prevalence, patterns and correlates of alcohol use among adolescents in Ernakulam, Kerala State, India. DESIGN AND METHODS: A total of 7560 students in the age group 12-19 years from 73 schools completed a self-administered questionnaire incorporating standardised instruments to assess alcohol use. RESULTS: The overall prevalence of lifetime alcohol among adolescents use was 15% (23.2% among boys and 6.5% among girls) with prevalence increasing with age, and 25.3% of drinkers reported hazardous alcohol use. The mean age at onset of alcohol use was 13.6 years. Initiation of alcohol use typically preceded use of tobacco and illicit drugs. Most students reported initiation into alcohol use by family members in the context of family celebrations. The prevalence of alcohol use was higher among students from urban areas and those with a part-time job. Lower use was seen among Muslims. Lifetime alcohol use was associated with significantly higher tobacco and illicit drug use, suicidal thoughts, attention deficit hyperactivity disorder symptom-scores, history of non-contact sexual abuse and with poor academic performance. DISCUSSION AND CONCLUSIONS: Alcohol use among adolescents in India deserves greater attention than it has previously received, marked as it is by an early onset and associated with a range of negative mental health problems. [ Jaisoorya T S, Beena K V, Beena M, Ellangovan K, Jose D C, Thennarasu K, Benegal V. Prevalence and correlates of alcohol use among adolescents attending school in Kerala, India. Drug Alcohol Rev 2016;35:523-529].

Prevalence & correlates of tobacco use among adolescents in Kerala, India.

BACKGROUND & OBJECTIVES: Most tobacco users who initiate its use during adolescence are likely to continue the use into adulthood and contribute to the 90 per cent of premature deaths among tobacco users. In this context the prevalence, patterns and correlates of tobacco use were studied among adolescent school students in Kerala, India. METHODS: Total 7560 students from classes 8, 10 and 12, within the age group of 12-19 yr, across 73 schools in Ernakulam district, Kerala, India, selected by cluster random sampling, completed a self-administered questionnaire incorporating standardized instruments. RESULTS: Of the 7350 valid questionnaires, the overall lifetime prevalence of tobacco use was 6.9 per cent (12.5% males and 1.2% females). The prevalence of tobacco use increased from 3.1 per cent at 12-13 yr to 15.1 per cent at 18-19 yr. The mean age of onset of tobacco use was 14.0±2.2 yr. The prevalence was higher among students from urban backgrounds, lower socio-economic status and those with part-time jobs. Tobacco users had significantly higher rates of use of alcohol (67.8 vs. 11%) and illicit drugs (33 vs. 6.1%). They had poorer academic performance (24.7 vs. 9.1%), more severe psychological distress (10.8 vs. 4.5%), suicidal attempts (10.2 vs. 3.5%), higher scores of ratings of attention deficit hyperactivity disorder (8.3 vs. 2.5%) and history of sexual abuse (12.5 vs. 3.8%). INTERPRETATION & CONCLUSIONS: The prevalence of tobacco use in adolescents reported in this study was relatively lower than those reported from other Indian States. However, it correlates with multiple negative outcomes suggesting a need to promote specific interventions to prevent adolescent tobacco use.

An epidemological study of obsessive compulsive disorder in adolescents from India.

OBJECTIVES: There is scarce data on the prevalence of OCD among adolescents in India. This study reports point prevalence of OCD among school students (age 12-18years) in the Kerala state of India and examines its association with ADHD, psychological distress, tobacco/alcohol abuse, suicide risk and history of sexual abuse. METHOD: 7560 students of 73 schools were self-administered the OCD subsection of Clinical Interview Schedule-Revised, the Composite International Diagnostic Interview (CIDI) for obsessive compulsive symptoms and other relevant instruments to identify OCD and related clinical measures. A diagnosis of ICD-10 OCD was derived through the CIS-R algorithm which required duration of at least 2weeks and at least a thought/behavior to be resisted along with a cut-off score for severity and impairment. RESULTS: In the sample, 50.3% were males with a mean age of 15.2years (range of 12-18years). The response rate was 97.3% (7380 valid responses). 0.8% (n=61) fulfilled criteria for OCD with a male predominance (1.1 vs. 0.5%, p=0.005). Prevalence was higher among Muslims and increased with age. Taboo thoughts (62.3%) and mental rituals (45.9%) were the commonest symptoms. Those with OCD had significantly higher suicidal thoughts (59 vs. 16.3%, p<0.01) suicide attempts (24.6 vs. 3.8%, p<0.01), ADHD (28 vs. 4%, p<0.001), sexual abuse (24.6 vs. 4.2%, p<0.01), and tobacco use (23 vs. 6.8%, p=0.01). They also reported greater psychological distress and poorer academic performance. CONCLUSIONS: OCD is common among adolescents in India. Its associations with ADHD, sexual abuse, psychological distress, poorer academic performance and suicidal behavior are additional reasons for it to be recognized and treated early.