Vol 9, Issue 4, Oct-Dec, 2019

Development of any nation hinges on its human capital. Human capital formation starts from early stages of childhood. Early childhood nutrition is one of the determinants of improved health and development. The purpose of this paper is to investigate the role of nutrition in impacting cognitive development, education attainment and skill development, which are the determinants of human capital. This is an attempt to analyse the intrinsic relationship between stunting and its intergenerational impact on human capital. Systemic review of literature method was put to use, to analyse the interactions between stunting and human capital. The search criteria limited the period to 30 years (1986-2017) and relevant to childhood nutrition. The search was drawn from PubMed, Web of Science and relevant independent surveys, journals and reports of repute. The study reveals that the human capital formation starts from the early stages of childhood and healthy childhood holds positive relationship to formation of human capital in the long run. Healthy childhood is largely attributed to improved nutrition which has an impact on underweight, wasting and stunting. While improvement in underweight and wasting can be achieved in short run, stunting is intergenerational and needs more long-term investments. Both nutrition specific as well as nutrition sensitive interventions play a critical role in development of robust human capital that leads to improved employability and enhanced earnings for an individual in the future. However, to have an impact on stunting, it calls for a shift in focus by augmenting investments towards nutrition sensitive domain as well, along with its present focus in nutrition specific domain. We use the evidences from South Asian and Sub Saharan countries, to make a case for India where 38 percent of children are stunted and where WASH, agriculture and women empowerment programmes do not focus on nutrition nor measure nutritional outcomes. Key words: Human Capital, Health, Human Capital Investment, Malnutrition, Stunting, Nutrition Sensitive Intervention, Nutrition Specific Intervention.

The prevalence of HIV in India has been steadily increasing over the last three decades and India is now thought to possess the third largest number of cases out of any country in the world. India is currently experiencing a significant feminization of its HIV epidemic; a large proportion of new HIV infections are observed in women and the majority of all HIV cases in India are contracted by heterosexual transmission. While married, monogamous women were initially considered at low risk for contracting HIV in India, they are now recognized as being a high-risk group, as the prevalence of HIV among women who have ever been married is higher than the national average. Because the vast majority of these women report that unprotected intercourse with their husband is their only risk factor for HIV infection, it can be concluded that they have likely been infected by their husband. This review investigates the principal factors involved in the infection of married, monogamous Indian women with HIV by their husbands, within the context of traditional Indian gender roles and cultural expectations of behaviour. Specifically, this article examines three high-risk sexual behaviour commonly perpetrated by Indian men: extramarital sexual relations, lack of condom use during sex and intimate partner violence. Given the magnitude of the problem of HIV in India and its implications for the spread of HIV throughout the world, the topic of women’s risk of HIV infection in India is clearly of immense public health significance. Key words: HIV, India, women.

Introduction: Medical students are a subgroup of the general population who are more vulnerable to poor sleep quality. Objectives: To assess the sleeping pattern and determinants among the medical undergraduate students of a Government teaching Hospital, Kolkata. Materials and Methods: An Institution-based cross-sectional study was conducted among 293 undergraduate medical students of a teaching Hospital of Kolkata from October 2017 to December 2017 using a pre-designed, pre-tested structured questionnaire, Pittsburgh Quality of Sleep Index (PSQI) score and Epworth Daytime Sleepiness Scale (EDSS). Results: About 24.91% of students had daytime sleepiness as per Epworth Daytime Sleepiness Scale (EDSS) and about 63.48% had poor sleep quality as per Pittsburgh Quality of Sleep Index (PQSI) score. There was significant correlation between Poor Sleep Quality (PSQI) score and age, year of study, hostel residence, socio-economic condition, body mass index, smoking, alcohol intake, caffeine consumption, exercise, stress and excessive use of mobile/laptop. EDS score was significantly associated with age, semester of study, residence and habit of exercise. Conclusion: To improve the sleep quality of medical students, we should provide a positive environment by establishing counselling facilities and promoting good sleep hygiene. Key words: Medical students, Sleep, PSQI, EDSS, Tertiary hospital.

Background: Poor Sleep Quality (PSQ) is one of the increasing public health problems and adolescents also constitute risk groups. The aims of this study were to explore the prevalence of PSQ and to examine the association between PSQ and depression among adolescents who studied in grades 10 through 12 in high schools. Methods: This cross-sectional study was conducted in Ratchaburi Province. A multi-stage sampling technique was used to enroll 777 adolescents from 8 schools from August-October 2016. The research instruments comprised demographic factors, the questionnaire of Pittsburgh Sleep Quality Index and the center for epidemiological studies depression scale. Multivariable logistic regression was used to calculate adjusted Odds Ratios (OR) and 95% Confidence Intervals (CI). Results: Prevalence of PSQ was 56.24%. The study samples were mostly 16-17 years old (67.82%) and females (70.39%). Multivariable logistic regression, after controlling for possible confounders showed that depression increased the risk of PSQ by a factor of 2.48 times (ORadj=2.48, 95% CI=1.70-3.63). Conclusion: The surveillance system of depression and PSQ should be conducted accompanied with knowledge sharing on depression and associated factors among parents, teachers and adolescents. School activities should include a program for adolescents’ stress management and conflict resolving skills. PSQ is recommended as one of the surveillance factors to prevent depression among adolescents. Key words: Youth, Teenage, Poor sleep quality, Depression, Senior high school students.

Background: We evaluated the clinical profile of HIV positive patients freshly diagnosed with Disseminated Tuberculosis (DTB) and assessed their response to Anti-tuberculosis treatment (ATT). Aim: To describe various clinical, radiological and pathological parameters encountered in patients of Disseminated Tuberculosis having an HIV co-infection and assessing the response to standard ATT. Settings and Design: This study is a descriptive study. Materials and Methods: We conducted a study on 54 patients of disseminated TB with HIV coinfection who were already on Anti-retroviral therapy. Assessment was focused on mode of diagnosis and distribution of organ involvement. Four months of HRZE and two months of HRE were prescribed as the standard ATT. Effect of this treatment was observed on change in weight, CD4+ counts and HIV RNA viral loads. Statistical analysis used: Wilcoxon Sign Rank Test for assessing response to ATT. Results: This study included 54 patients. The lymphatic system was the most commonly involved organ system (64.81%) and other organs involved were the liver (55.56%), the lungs (46.3%), the pleurae (12.96%), the meninges (5.54%) and the bone marrow (3.71%). Median weight at baseline was 53 kg (IQR, 49-58) and after six months of standard ATT was 62 kg (IQR, 58-67) (p<0.001). Median CD4+ count at baseline was 107.5 cells /mm3 (IQR, 51.5-150.75) and after six months of standard ATT was 246 cells /mm3 (IQR, 184-335.75) (p<0.001). Median HIV RNA viral load at baseline was 2,83,575 copies/mL (IQR, 1,78,376.25 - 3,83,370) and after six months of standard ATT was 19,916.5 copies/mL (14,376.25 - 28,622.5) (p<0.001). Conclusion: DTB in HIV positive patients has a variety of clinical manifestations which should be incorporated in the clinical decision making and change in weight, CD4+ count and HIV RNA viral load is a reliable indicator of therapeutic response in such cases. Key words: Disseminated TB, HIV, Clinical Profile, ATT, Plasma HIV RNA viral load. Key Messages: Anti-Tubercular Therapy (ATT) is instrumental in improving clinical and serological parameters in patients of Disseminated TB having an HIV co-infection.

Introduction: Demographic transition with ageing of the population is a global phenomenon which demands international, national, regional and local action. The percentage of the elderly population in India increased from 5.4 percent in 1950 to be about 8.7 percent in 2015 and expected to be 12.4 percent in 2030 and 19.6 percent in 2050. Several forces are driving India’s changing age structure, including an upward trend in life expectancy and falling fertility. The aging populations is a sign of successful development in medical sciences and technology, living standards and education, but also raise unique social, economic and clinical challenges, including a growing demand for increasingly complex healthcare service. Materials and Methods: This cross-sectional study was conducted period of one year (August 2014 to July 2015) in Allahabad districts on elderly population only. Data was collected by house to house visits. Informed consent was obtained. Morbidity was assessed by taking history, doing a clinical examination, reviewing past medical records (musculoskeletal disorders, hearing problems, eye problems,hypertension and diabetes) and medicines taken by the study subject. Chi-square test was used to find out associated with morbidity in elderly population. Results: We were found mean age of study participant was 68.86 years. Majority of subjects (31.8%) were suffering from two chronic conditions, followed by 15.5% were having three chronic conditions, 4.8% having four chronic diseases and 1% were found to be suffering from five chronic diseases conditions. Conclusion: The preventive programme and strategies should be focused on more frequent and periodic screening of elderly with special focus to elderly female, Health education and health service provision near the dwelling place through mobile health team and by peripheral workers. Key words: Elderly, Multi-morbidity, Life expectancy, Chronic Disease, Screening.

Context: Chronic disease, a global burden, puts patients in increased and prolonged need of care. Adequate and reliable information on chronic diseases is necessary for the implementation of health policies. Aim: The aim is to study the epidemiological characteristics of chronic diseases that exist in Benin and the Ouémé department and to compare the prevalence of chronic diseases identified in urban areas with those of the rural areas in this department. Settings and design: This is a comparative cross-sectional study. Materials and Methods: The study was conducted using a chronic disease identification sheet, the Delphi method, interview and analysis of consultation records. Statistical analysis used: The data collected with the questionnaire were processed with the SPSS software (IBM, version 21.0). The information collected during the interviews was processed by content analysis in three parts: information condensation, coding, analysis and interpretation of the results. Results: The study participants were active, married and aged 31 to 60. High blood pressure, diabetes, sickle cell disease, SS and SC, peptic ulcer disease, hepatitis B and C, sinusitis, asthma and AIDS have been identified, both in urban and rural areas. Considering the eight identical diseases in both settings, the highest prevalence in urban areas is diabetes, while, hypertension in rural areas. The lowest prevalence is that of AIDS, whether in urban or rural areas. Conclusion: The data from this study constitute a database for the definition of policies and strategies for the management of people with chronic diseases. Key words: Health policy, Rural environment, Urban environment, Communicable disease, Non-communicable disease. Key messages: Chronic diseases in rural areas are identical to those in urban areas. The only difference is that in urban areas, rheumatic diseases exist. The lack of infrastructure and qualified personnel does not allow rheumatology consultations to be recorded in rural areas.

Aim: To assess the knowledge and awareness related to antibiotic usage and resistance amongst general population. Materials and Methods: A total of one thousand citizens (of age group 25 – 65 years) from Delhi-NCR participated in this study. A questionnaire survey comprising of ten questions relating to knowledge and awareness of antibiotic usage were completed by the participants. Results: It was observed that 74% of people rarely used antibiotics. Also, 55% believed that misuse/overuse of anti–microbial drugs is harmful and can have adverse effects on our body. A large fraction comprising of about 60% are affected by infections on a yearly basis. Conclusion: A majority of the population of our community believed in using antibiotics without having the necessary knowledge and awareness regarding its proper use. Key words: Knowledge, Awareness, Attitude, Antibiotics, Resistance.

Background: Diabetes Mellitus (DM) is a serious chronic disease. The prevalence of diabetes in Bahrain in 2007 was 14.3%. One of the most important complications of diabetes is foot problems. In Bahrain the estimated prevalence of diabetic peripheral neuropathy was 36.6%, peripheral vascular disease 11.8% and foot ulceration 4.75%. Although there is a large amount of literature on the diabetic foot and the importance of foot care, there is a lack of population based study of foot care knowledge and practice. The aim of this study is to assess the knowledge and describe the practice of foot care in diabetic patients in diabetic clinic. Design: A cross –sectional survey in diabetic clinics in local health centers in Bahrain. Setting: Diabetic clinic, Primary health centers, The Kingdom of Bahrain. Methods: The target population was all diabetic patients attending diabetic clinics in primary health care in Bahrain during the period of 15th, July, 2008 till 15th October, 2008. The questionnaires were filled by direct interview of 400 patients, 100 patients from each health region. The questionnaire contained demographic data, questions about knowledge and practice of diabetic foot care. Results: The mean knowledge score was 8 (SD 2) out of 11. Only 33% of the patients knew that there is no relationship between diabetes and flat feet. 44% of the patients were unaware that they should inspect their feet daily. 38.7% did not think that they should inspect their footwear every time they were worn. Higher knowledge score was found in Bahraini patients (P=.000), Patients with high educational level (P=.004) and in patients with less than 20 years duration of diabetes (P=.001). On the other hand, there were no associations between the knowledge score and gender, glycemic control or having previous foot problem. Feet inspection was practiced by 66.5% of the patients. 86.8% were washing their feet daily and 78.5% were washing their feet in warm water. Practices that put patients at risk included trimming toenails straight across, not having their feet measured when they last bought footwear and walking barefoot regularly. Conclusion: This study revealed a good knowledge score in this study (mean 8, SD 2), but are still deficiencies in knowledge about the frequency of foot inspection (44%) and awareness regarding inspection of the inside of footwear for object and torn lining (38.7%). Feet inspection was practiced by 66.5% of the patients, 86.8% were washing their feet daily and 78.5% were washing their feet in warm water. Findings from this study can be used in implementing health education programs on foot care for diabetic patients to improve their knowledge and practice. Key words: Knowledge, Practice, Foot care, Diabetes, Health centers, Bahrain.

In order to find out the most sensitive anthropometric measurement that will diagnose Protein Energy Malnutrition (PEM) in Nigerian pre-school children, three hundred children between the ages of 12 and 60 months (100 each of Normal, PEM and other malnutrition) were measured for height, weight, upper-arm circumference, triceps skinfold and subscapular skinfold thickness. The results showed that Triceps skinfold is the most sensitive anthropometric indicator for diagnosis of PEM in the study population. This supports the hypothesis that energy deficiency may be a more predominant factor in the causation of PEM in Nigeria. Key words: Protein-Energy-Malnutrition, Under-five, Anthropometric measurement, Developing countries, Resource restricted.

The Heart Rate Variability (HRV) is an important parameter to assess psychophysiological changes associated with Autonomic Nervous System (ANS). The present study aimed to assess the effect of single bout yoga postures practice on parasympathetic nervous system activity of ANS. Three male subjects having more than 5 years of experience in yoga postures were selected in the current study. These participants were assessed for HRV immediately before and after practice of specific yoga postures practiced for 15 min, 21 min and 27 min on three different days. The yoga practices were selected from hatha yogic texts that may influence brain blood flow resulting autonomic activities. Key words: Yoga Postures (asana), Autonomic nervous system, Heart rate variability, Low frequency, Single bout. Key message: The regular practice of yogic postures improves autonomic modulation and enhances deep relaxation.