A multicentric cross-sectional study to characterize the scale and impact of polypharmacy in rural Indian communities, conducted as part of health workers training.

CONTEXT: Polypharmacy and inappropriate medication usage is one of the world's most important public health issues. Yet in rural India, where medications are readily available, little is known about polypharmacy. AIM: This study explores factors related to polypharmacy in rural India to inform the response. SETTINGS AND DESIGN: A household survey was conducted by community health trainees, across 515 Indian villages collecting medication prescription and usage information for single illness in the past month. METHODS AND MATERIAL: Polypharmacy was defined as the concurrent usage of four or more medications for single illness. Data from 515 rural India villages were collected on medication usage for their last illness. Respondents who consulted one healthcare provider for this illness were included for analysis. STATISTICAL ANALYSIS USED: Bivariate logistic regression and multivariate generalized estimating equation analysis were used to explore associations with polypharmacy. RESULTS: Prevalence of polypharmacy was 13% (n = 273) in the sample and ranges between 1% and 35% among Indian states. Polypharmacy was common among prescriptions for nonspecific symptoms (15%, N = 404). People aged over 61 years compared with people aged between 20 and 60 years (OR 1.11, 95% CI 1.03-1.19) and people with income of over 3,000 INR/month (OR 1.04, 95% CI 1.00-1.07) were more likely to be prescribed four or more medications. CONCLUSIONS: The study demonstrates high rates of polypharmacy, identifies vulnerable populations, and provides information to improve the response to polypharmacy in rural India.

Profile of elderly attending a general practice clinic in a poor urban area: A cross-sectional study from South India.

INTRODUCTION: In India, the number of elderly is steadily increasing and is likely to reach 301 million by 2051. The increasing number and proportion of elderly will have a direct impact on the demand for health and pension services. As per the Demography of Indian Aging (Rajan et al.), information on morbidity profile of this population is essential to plan health-care facilities. METHODS: A descriptive cross-sectional study was designed to study the morbidity profile of 100 elderly persons reporting to the outpatient clinic of a family practice unit of a tertiary care center in South India between June 2008 and May 2010. This was done with a view to plan better services for the elderly in that area. RESULTS: In this study, 88% of the participants were on a follow-up while new ailment(s) were diagnosed in 11 participants. A majority of participants were illiterate (62%), unemployed (83%), and financially dependent (54%). Forty-four participants screened had depression that required intervention such as counseling and follow-up; in ten participants, the screening score was sufficient to warrant therapy. In nearly half of the participants, the musculoskeletal system was involved, and a significant number had the involvement of cardiorespiratory system and urinary incontinence. CONCLUSION: A large number of elderly are affected by a constellation of conditions including mental as well social issues. A family practice unit may be a good setup to provide the first-contact care for the diagnosis and management of common problems in the elderly and help to improve their quality of life.

Reported healthcare utilisation for childhood respiratory illnesses in Vellore, South India.

A 30-cluster survey using a modified WHO method was performed to assess the healthcare utilisation patterns for respiratory illnesses in Indian children < 5 years of age. Families of 600 children were interviewed to assess respiratory illness and healthcare utilisation during the previous month as well as hypothetical healthcare-seeking behaviour in the future. Based on parental report, 381 children (63.5%) had experienced a respiratory illness 1 month prior to the interview; 10 children were reported to have had severe pneumonia, 49 non-severe pneumonia and 322 upper respiratory illnesses (URI), extrapolating to 0.20 (95% CI 0.1-0.4), 0.98 (0.7-1.3) and 6.44 (6.0-6.9) cases per child-year, respectively. Five severe pneumonia cases (50%) were reported to have directly accessed care at a secondary or tertiary care centre, whilst 18 children (36.7%) with non-severe pneumonia and 56 children (17.4%) with URI were reported to have been seen at secondary or tertiary centres. The remaining respiratory illnesses were reported to have been seen by primary care physicians, pharmacists, traditional healers and friends or were not seen by a healthcare professional. This community-based Indian study suggests that, in this community, tertiary care surveillance alone may not accurately sample community disease, even for severe illnesses.

The challenge of patients with severe psychiatric illness who do not access care - a way forward.

Psychiatric illnesses are a significant cause of morbidity all over the world. In India many people with mental disorders are unable to access psychiatric care for a variety of reasons. This article describes the successful management of a person with schizophrenia in the community through a primary care team in liaison with psychiatrist services.