Association of Obesity with Cognitive Impairment and Depression among Oldest Old Population having Frailty syndrome.

Objectives: The objectives were to estimate prevalence of obesity among frail individuals aged ≥80 years and examine the association of obesity with cognitive impairment and depression among frail individuals aged ≥80 years. Methods: Two-hundred community-dwelling participants aged ≥80 years, were enrolled; 166 frail participants were further analyzed. Obesity and adiposity were determined by Body Mass Index (BMI), Waist Circumference (WC) and Body Fat Percentage (BF%). Cognitive impairment and Depression were assessed using Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-15). Frailty was assessed by Fried criteria. Chi-Square, t-test, trend-analysis and Logistic Regression (LR) were done. Results: Obesity among Frail individuals aged ≥80 years was 40% using BMI and 73.2% using WC. Obesity was inversely associated with cognitive impairment and depression among frail individuals. Severity of cognitive impairment and depression was lower among obese frail than non-obese frail. Trend-analysis showed decreasing cognitive impairment and depression with increasing BF%. On LR, obesity among frail individuals had inverse association with cognitive impairment and depression. Conclusion: Obesity among frail individuals aged ≥80 years was associated with lower odds of cognitive impairment and depression in our population. Positive effects of weight gain in oldest old frail individuals and development of cognitive impairment and dementia should be explored in further researches.

Assessment of frailty syndrome with coexisting hypertension and depression among older individuals, aged >80 years of age.

Objectives: The objective was to determine odds of frailty syndrome with coexistence of hypertension and depression among oldest-old adults. Methods: We analysed secondary data from 167 community-dwelling hypertensive participants aged 80 years and older from a cross-sectional study of frailty conducted in India. Data included sociodemographic, medical history, physical performance, functional limitations, mobility-disability, cognition, depression, sleep, frailty syndrome and chronic diseases. Odds of frailty syndrome was compared among individuals having only hypertension, and individuals having hypertension and depression. Chi-square test, t-test and logistic regression were performed to determine odds of frailty. Results: Frailty was significantly higher (OR: 4.93;95% CI: 1.89-12.84) among individuals having hypertension and coexisting depression, compared to individuals having only hypertension. Men (OR: 5.07;95% CI: 1.02-25.17) and women (OR: 4.58;95% CI: 1.36-15.40) with hypertension and depression showed a higher risk of frailty, compared with hypertension alone. Logistic regression models were adjusted for age, sex, cognitive impairment, chronic obstructive pulmonary disease, cardiovascular diseases, anaemia, diabetes, obesity, physical performance, activities of daily living and 4-meter walking speed. Conclusion: Coexistence of hypertension and depression increased risk of frailty syndrome among men and women above 80 years of age by almost 5 folds. Treating depression in hypertensive older individuals may reduce the risk of frailty among them.

Frailty Syndrome among oldest old Individuals, aged ≥80 years: Prevalence & Correlates.

OBJECTIVES: Objectives were to study prevalence of frailty among Indian oldest old population, and to detect its correlates. METHODS: A cross sectional community based study was done including 200 healthy participants aged ≥80 years, randomly sampled from Hyderabad city in India. They completed an administered questionnaire and physical function tests including SPPB, grip strength. Cognitive function was assessed using MMSE and depression using GDS. Blood pressure, haemoglobin, and fasting blood sugar were measured for all participants. Frailty was defined using Fried phenotype criteria. Logistic regression was done to identify independently associated correlates. RESULTS: The prevalence of frailty syndrome was 83.4% in our study population. Frailty among men was 80.3% and among women was 84.7%, and it increased with increasing age. The independent correlates which increased the odds of frailty were poor physical performance (SPPB) (OR: 4.21; 95% CI: 1.12-15.83), depression (OR: 3.35; 95% CI: 1.29-8.73), chronic joint pains (OR: 4.90; 95% CI: 1.97-12.18) and COPD (OR: 3.01; 95% CI: 1.03- 8.78), while hypertension showed inverse association (OR: 0.33;95% CI: 0.11-0.94). CONCLUSION: The prevalence of frailty among the oldest old is very high. Geriatric medicine protocols must include routine screening for frailty, while also including early detection of poor physical performance, depression, COPD and osteoarthritis.

Hypertension and its Correlates in the Oldest Old Population Aged 80 Years and Above in Urban South India.

BACKGROUND: Hypertension is a major problem among the geriatric population, presenting the risk of multiple associated co-morbidities and organ system damage. Data related to the epidemiology of controlled and uncontrolled hypertension among the oldest old population is sparse, more so from developing countries. The objectives of the present paper were to identify the prevalence and correlates of hypertension according to gender among the urban community-dwelling healthy oldest old population. METHODS: 200 healthy people aged 80 years and above were recruited by random selection from Hyderabad city of South India in 2017. A trained investigator collected data on background history, history of hypertension and other co-morbidities, medications and sleep. Participants were tested for muscle strength, gait speed, and SPPB and cognitive impairment. RESULTS: The prevalence of hypertension was 83.5%; 81.6% among men and 84.7% among women. 64.5% was self-reported. Hypertension was controlled with treatment among only 46.2%. In 74.6%, it was controlled even without treatment. The independent correlates were BMI per SD increase (OR: 1.92, 95% CI: 1.17-3.16), diabetes (OR: 6.02, 95% CI: 1.24-29.11) and asthma (OR: 3.59, 95% CI: 1.05-12.29). Among men, BMI per SD increase was significantly associated while hemoglobin per SD increase, height per SD decrease, and arthritis were positively associated among women. Increasing heart rate among total subjects (OR: 0.44, 95% CI: 0.27-0.71), and among women (OR: 0.47, 95% CI: 0.24-0.92) showed a negative association. CONCLUSION: The prevalence of hypertension was high. The correlates were different for men and women. Subjects were unaware of their control status which posed an increased risk for organ damage, and development of co-morbidities. Policies aimed at improving quality of life of the oldest old should place due stress on appropriate hypertension management in developing countries.

Fever awareness, management practices and their correlates among parents of under five children in urban India.

BACKGROUND: Awareness regarding fever is reportedly low among Indian urban parents, leading to its over- management among under five children. We attempted to study the awareness and fever management practices of South Indian urban parents. The objectives were to find the awareness of parents regarding childhood fever management, and correlates of practices. METHODS: One hundred parents of under-five children with history of fever in past three months were randomly selected and interviewed using a predesigned tool. Children's weight and height was measured. Awareness scores for causes of fever and fever management were constructed. Logistic regression was done to identify correlates of incorrect practices. RESULTS: 95% parents were aware about correct temperature above which fever became harmful. Awareness score for causes of fever was poor (<1) among 41% parents. Mothers' complications awareness scores were better than fathers (p<0.05). 81% parents used antibiotics; only 18% consulted a doctor before doing so. 17% parents using antibiotics did not complete the prescribed course. The independent correlates of poor fever management practices were working parents (OR: 6.28; 95%CI: 1.7-23.16), lesser number of children (OR: 3.08; 95%CI: 1.01-9.37), poor compliance for antipyretics (OR: 9.20; 95%CI: 1.64-51.52) and giving antipyretics without consulting doctors (OR: 5.43; 95%CI: 1.69-17.47). Poor knowledge of available pediatric antipyretic preparations was negatively correlated (OR: 0.13; 95%CI: 0.02-0.64). CONCLUSION: Fever awareness was fair among urban parents. Mothers had better awareness than fathers. Increased awareness for correct fever management of under-five children is desirable among urban parents to reduce misuse of antibiotics and antipyretics.

Increasing Full Child Immunization Rates by Government Using an Innovative Computerized Immunization Due List in Rural India.

Increasing child vaccination coverage to 85% or more in rural India from the current level of 50% holds great promise for reducing infant and child mortality and improving health of children. We have tested a novel strategy called Rural Effective Affordable Comprehensive Health Care (REACH) in a rural population of more than 300 000 in Rajasthan and succeeded in achieving full immunization coverage of 88.7% among children aged 12 to 23 months in a short span of less than 2 years. The REACH strategy was first developed and successfully implemented in a demonstration project by SHARE INDIA in Medchal region of Andhra Pradesh, and was then replicated in Rajgarh block of Rajasthan in cooperation with Bhoruka Charitable Trust (private partners of Integrated Child Development Services and National Rural Health Mission health workers in Rajgarh). The success of the REACH strategy in both Andhra Pradesh and Rajasthan suggests that it could be successfully adopted as a model to enhance vaccination coverage dramatically in other areas of rural India.

Geriatric Depression and its Correlates among South Indian Urbans.

BACKGROUND: Geriatric depression is a growing global problem, expected to be the leading cause of mortality in the next decade. We attempted to explore the previously unidentified burden of depression and its correlates amongst South Indian elderly residing in an urban area. METHODS: A cross sectional study including 100 community dwelling urban elders aged 60 years and older was conducted. A predesigned questionnaire was used to collect data on sociodemographic variables, chronic health conditions, changes in vision and cognition, addictions, and medication usage. Depression was assessed using Geriatric Depression Scale. Other measurements included anthropometry and blood pressure. Logistic regression was done to identify the independently associated correlates of depression. RESULTS: The prevalence of geriatric depression was 23%. 15.4% men and 31.2% women had depression. On logistic regression, the independent correlates of depression were living single (OR:4.26; 95% CI:1.06-17.09), poor self-rated health (OR:12.09; 95% CI:1.41-103.14), bedridden (OR:5.29; 95% CI:1.21-23.04) and osteoarthritis (OR: 4.91; 95% CI:1.39-17.28). CONCLUSION: The burden of depression in our urban geriatric population was moderate. Several correlates were positively associated. While addressing geriatric morbidity, screening for elderly depression, as well as exploration and management of related factors would be of significance.

Correlates of Cognitive Impairment among Indian Urban Elders.

BACKGROUND: Cognitive impairment among elderly is increasing owing to increases in life expectancy globally. The problem is multifactorial. The objective of the present paper was to study the correlates of cognitive impairment in an urban elderly population in India. METHODS: A cross sectional study was conducted among 100 randomly selected urban elderly population. Data was collected upon household visits using a predesigned pretested questionnaire administered by a trained investigator. Measurements included cognitive function assessment using Mini Mental State Examination, depression assessment using Geriatric Depression Scale, blood pressure measurement and anthropometry. Cognitive impairment was defined at MMSE score <24. Logistic regression was done to identify independently associated factors with cognitive impairment. RESULTS: Prevalence of cognitive impairment among elderly was 10%. Women had a higher prevalence than men. Higher age, no schooling, living single, lower weight, lower waist and hip ratios, difficulty in activities of daily living, poor self-reported health, bedridden and depression significantly associated with cognitive impairment. The independently associated factors upon logistic regression were increasing age, no schooling and bedridden status for past six months. CONCLUSION: Although the current prevalence of cognitive impairment among Indian urban elderly is low, several associated factors exist in this population that may increase the burden in future. Geriatric health policy should address the modifiable risk factors to manage the problem of cognitive impairment and its consequent outcomes.

Morbidity profile of orphan children in Southern India.

BACKGROUND: Orphan children globally and in India are increasing. Magnitude of their health problems is unknown. The present study was carried out to assess the morbidity pattern of orphan children aged 10-16 years, assess their knowledge about signs and symptoms of common childhood morbidities and treatment-seeking practices. METHODS: One hundred institutionalized orphan children aged 10-16 years were studied for 6 months. Data was collected by trained investigators regarding sociodemographic background, awareness about common morbidities and treatment seeking practices. Thorough clinical examination and anthropometric measurements were done. Distribution of morbidities was shown. RESULTS: 80% of the boys and 68% of the girls had low BMI. 78% suffered from multiple morbidities of which 76% had infections of skin and appendages while 74% had ear problems. 26% had diarrhea and 21% had B-complex deficiency. The mean duration of all diseases was 7±1.1 days. Awareness about diseases and their complications was low; and self-care was highly prevalent for most health problems. CONCLUSIONS: Orphan children in South India suffer from many morbidities about which their awareness and treatment seeking is low.

Burden and Correlates of Falls among Rural Elders of South India: Mobility and Independent Living in Elders Study.

AIM: Falls are an important contributor to loss of function, morbidity, and mortality in elders. Little is known about falls in Indian populations. The objective of this cross-sectional report was to identify the prevalence and correlates of falls in a cohort of 562 rural southern Indian men and women. METHODS: Risk factors included demographics, anthropometrics, self-reported health, medical history, physical function, vision, depression, and lifestyle. Odds ratios were calculated using logistic regression. RESULTS: 71 (13%) subjects reported at least 1 fall in the past year. Prevalence was higher among women (17%) than men (8%), P = 0.003. Sex and age showed significant interaction (P = 0.04) whereby falls prevalence increased with age among women but decreased among men. Correlates of falls among men included a history of osteoarthritis (OA) (odds ratio (OR): 6.91; 95% CI: 1.4-33.1), depression (OR:9.6; 3.1-30.1), and greater height (OR per 1 standard deviation increase: 2.33; 1.1-5.1). Among women, poor physical performance (OR: 3.33; 1.13-9.86) and history of cardiovascular disease (CVD) (OR: 2.42; 1.01-5.80) were independently associated with falls. IMPLICATIONS: Prevalence of falls in elderly South Indians was lower than published reports from western countries and likely reflects low exposure to fall risks. Patterns with age differed in men and women and may reflect sex differences in the accuracy of age recall. Presence of comorbidities specifically OA, CVD, and depression was independent correlate of falling.

Dengue serotype-specific seroprevalence among 5- to 10-year-old children in India: a community-based cross-sectional study.

BACKGROUND: Dengue surveillance data in India are limited and probably substantially underestimate the burden of disease. A community-based study was undertaken to assess the prevalence of dengue-specific immunoglobulin G (IgG) antibodies in children across India and to examine historical dengue exposure rates. Potential associations between socio-economic factors and dengue seroprevalence were also assessed (registered at ctri.nic.in: CTRI/2011/12/002243). METHODS: A convenience sample of 2609 healthy children aged 5-10 years was enrolled; these children were registered at or were living in the vicinity of eight centres located at six geographically distinct sites across India. Blood samples were drawn to test for the presence of dengue IgG antibodies using ELISA. Serotype-specific neutralizing antibody titres were measured in dengue IgG-positive children using dengue plaque reduction neutralization tests. Socio-demographic and household information was collected using a questionnaire. RESULTS: Overall, 2558/2609 children had viable samples with laboratory results for dengue IgG. Dengue IgG seroprevalence across all sites was 59.6% (95% confidence interval 57.7-61.5%): the lowest (23.2%) was in Kalyani, West Bengal, and the highest (80.1%) was in Mumbai. Seroprevalence increased with age. Multivariate analysis suggested associations with household water storage/supply and type of housing. Half of the subjects with positive IgG results presented a multitypic profile, indicating previous exposure to more than one serotype. CONCLUSIONS: The overall dengue seroprevalence suggests that dengue endemicity in India is comparable to that in highly endemic countries of Southeast Asia. Additional prospective studies are required to fully quantify the disease burden, in order to support evidence-based policies for dengue prevention and control in India.

Burden of acute infections (except respiratory and diarrheal) and its risk factors among under-five children in India: A systematic review and meta-analysis.

CONTEXT: Acute infections of eyes, ears, skin, and others are a common cause of morbidity in under-five children. The overall burden of other infections and their risk factors is not known. EVIDENCE ACQUISITION: Available literature was searched comprehensively using PubMed for acute infections (except acute respiratory and diarrheal diseases) using the relevant medical subject heading terms. Extracted articles were independently reviewed against inclusion/exclusion criteria and rated for quality. 10 articles were abstracted and reviewed to identify the reported prevalence and risk factors for acute infections among children. RESULTS: The pooled prevalence of infections (not including acute respiratory and diarrhea) between 2002 and 2013 was 18.42 (95% confidence interval: 9.30-30.62), with reported range of 3.7-50.8%. The significantly positively associated factors reported in single studies were young age of the child, malnutrition, poor breastfeeding, low socio-economic status, animal rearing near household and mothers' illiteracy for independent morbidities. CONCLUSION: The evidence on risk factors including breastfeeding, vaccination, age, and sex that predispose under-five Indian children to different infections is inconclusive. There is a need to conduct more studies on acute infections other than acute respiratory and diarrhea, to establish their determinants in Indian children.

Prevalence and risk factors of diarrhea morbidity among under-five children in India: A systematic review and meta-analysis.

BACKGROUND: Acute diarrhea accounts for a huge burden of infectious diseases in under-five children. OBJECTIVE: This systematic review was carried out to study the prevalence and associated risk factors of diarrhea among Indian children aged <5 years. METHODS: Papers were identified by a comprehensive electronic search of relevant medical subject heading (MeSH) terms in PubMed. Identified articles were independently reviewed against inclusion/exclusion criteria and rated for quality. 15 articles were abstracted and reviewed to identify the reported prevalence and risk factors for childhood diarrhea. Meta-analysis was done for calculating the pooled prevalence of diarrhea and point estimates of risk factors using random effects model with use of appropriate population weights, and depicted using forest plot. RESULTS: The overall prevalence of diarrhea between 2002 and 2013 was 21.70% (95% confidence interval [CI]: 11.24-34.46). The significantly associated risk factors were malnutrition (odds ratio [OR]: 1.73, 95% CI: 1.53-1.96) and anemia (OR: 1.71, 95% CI: 1.29-2.28) in child, and low socioeconomic status (OR: 7.14, 95% CI: 2.19-23.32). Age of the child <24 months, not breastfeeding, mothers' low literacy status and untreated drinking water did not show a significant association. Sex of the child, religion, higher education of mothers, and seasonality were found to be inconsistently associated in single studies. CONCLUSION: It was concluded that there is sufficient evidence on the association of childhood diarrhea with socio-demographic factors, but evidence on other contributory factors including breastfeeding and vaccination is inconclusive. There is need to conduct more analytical studies on lesser known risk factors of diarrhea to establish their risk factors in Indian children.

Morbidity profile of long distance truck drivers in Hyderabad city, India.

CONTEXT: Truck drivers in India suffer from multiple health problems related to their long travelling and inadequate rest hours. AIMS: The objective was to study the health problems and risk factors in a sample of truck drivers in Hyderabad city. MATERIALS AND METHODS: A cross-sectional study was conducted during June 2011 among 59 truck drivers from a transport company, who were interviewed using a pretested proforma and examined by trained investigators. Lab results and medical consultations were provided the following day. Results were analyzed using Microsoft Access software. RESULTS: The mean age of truck drivers was 28.46 ± 9.3 years. 54% suffered from low backache, 16.95% from visual problems, 45.76% had hypertension, 8.47% had anemia and 30.51% had high-risk body mass index. The prevalence of risk factors for metabolic disorders was lower compared to the general population. CONCLUSION: Proper road and job policies for truck drivers should be framed, aiming at subjecting them for periodic health evaluations to detect the diseases early.

Client Satisfaction with Quality of Health Care in a Rural area in Southern India.

BACKGROUND: Client satisfaction is an important method to assess the pattern of utilization of health care services amongst all sectors indirectly reflecting on the quality of services. Most of the clients prefer private over government services due to multiple reasons. AIM: To assess the level of satisfaction of patients attending rural government and private health facilities in rural Andhra Pradesh. METHODS: Ten villages were randomly selected from the field practice area of a teaching medical institution, and all patients who visited any facility during the past three months were interviewed using a semi-structured questionnaire focusing on access to care, competence of the providers, quality and cost of the services and overall satisfaction with the services. Data was analysed using Microsoft Access software. RESULTS: One hundred and eight clients who visited different facilities for common ailments, chronic diseases, maternal and child health services were interviewed. The average time to reach the facility was 52.23 ± 44.52 minutes. The average waiting time was 34.25 ± 42.47 minutes. More than 80% were satisfied with the clinic hours, cleanliness and comfort of the facility, and privacy maintained during examinations. 40% were satisfied with the cost of services. CONCLUSION: The client satisfaction with different health care providers in rural areas of Andhra Pradesh is high. Clients expect the quality of services to be better; nevertheless they continue to use the available services without complaining much.

Quality of health assistants in primary health centres in rural maharashtra, India.

INTRODUCTION: Health assistants are important functionaries of the primary health care system in India. Their role is supervision of field-based services among other things. A quality assurance mechanism for these health assistants is lacking. The present study was undertaken with the objectives of developing a tool to assess the quality of health assistants in primary health centres (PHCs) and to assess their quality using this tool. METHODOLOGY: Health assistants from three PHCs in the Wardha district of India were observed for a year using a tool developed from primary health care management Aavancement program modules. Data was collected by direct observation, interview, and review of records for quality of activities. RESULTS: Staff strength of health assistants was 87.5%. None of the health assistants were clear about their job descriptions. A supervisory schedule for providing supportive supervision to auxiliary nurse midwives (ANMs) was absent; most field activities pertaining to maternal and child health received poor focus. Monthly meetings lacked a clear agenda, and comments on quality improvement of services provided by the ANMs were missing. CONCLUSION: Continuous training with sensitization on quality issues is required to improve the unsatisfactory quality.

Supplementary Role of Health Metrics for Reducing Total Fertility Rate in a North-Indian State.

Reducing Total Fertility Rate (TFR) amongst rural Indian couples from the current level is a significant challenge to the population control policies relying solely on the Government efforts. REACH strategy, based on health metrics, succeeded in lowering the TFR below replacement levels in a rural population of more than 300,000 in Rajasthan. The REACH strategy was first developed and demonstrated success in decreasing TFR in a pilot project by SHARE India in Medchal region of Andhra Pradesh utilizing designated workers, and was replicated in Rajgarh District of Rajasthan in cooperation with Bhoruka Charitable Trust (supervisor of ICDS and NRHM health workers in Rajgarh) using Government health workers. The success of the REACH strategy in both Rajasthan and previously in Andhra Pradesh holds promise as a tool to reduce TFR in other areas of rural India.

Quality assessment of private practitioners in rural wardha, maharashtra.

OBJECTIVE: To assess the quality of care provided by private practitioners in rural areas of Wardha district. METHODOLOGY: The study was carried out in three primary health centres of Wardha district. 20% of the 44 registered private practitioners were selected randomly for the study. The data was collected using checklist through direct observation for the infrastructure. Assessment of quality of services delivered, 10 consecutive patients were observed and also the medical practitioner was interviewed. Supplies and logistics were assessed through observation. RESULTS: All the facilities were sheltered from weather conditions and 90% had adequate waiting space. But, drinking water and adequate IEC material was available in only 20% facilities. Complete history taking and relevant physical examination was done in only 20% cases. Only 20% practitioners recorded blood pressure and 30% recorded temperature in cases with fever. Provisional diagnosis was not written in any of the case and only 20% explained prescription to the patients. CONCLUSION: There is considerable scope to improve the quality of services of private practitioners. To achieve this quality assurance programs may be initiated along with the training of private medical practitioners.