Vol 6, Issue 2, Apr-Jun, 2016

The proportion of elderly defined as those above 60 years of age in India is increasing; from 7.4% of the overall population in 2011 it is expected to be over 10% in 2021, a projected increase from 76 million to approximately 140 million.1 Old age is the period of life when the physical ability wanes and morbidities are on a rise, therefore considered a vulnerable population. But the elderly have not received enough attention till a policy “The National Policy on Older Persons (NPOP)” was announced by the government in 1999 and a programme, the National Programme for Health Care of the Elderly (NPHCE) was launched in 2010-11. The National Policy on Senior Citizens 2011 rightly recognizes the most vulnerable among the elderly that is the rural poor and the women.2 In India, three-fourths of elderly are in the rural areas, the percentage share being 7.6 in rural compared to 7.2 in urban as per the NSSO 2007-08.1 Poverty too is more acute a problem for rural elderly than the urban. Most of India’s poor are in rural areas3 and so also the elderly.

The year 2016 is an important milestone for International Journal of Medicine and Public Heath [IJMEDPH] (www.ijmedph.org) as it is entering 5th year. It is known as one of the peer-reviewed medicine and Public Health journal and I am pleased to present you this issue being published by EManuscript (A Publishing division of Phcog.Net). The new issue content for volume 5 is available “http://www.ijmedph.org” and archives are also available in the same link. IJMEDPH is now built with the responsive website the site can be easily browsed on mobile devices, tablets, and desktop screens.

The purpose of this systematic review is firstly to critically appraise and summarize the peerreviewed published evidence on the relationship between the caste system and risk factors for poor health status in India and secondly, to discuss the concept of the social gradient and policies that have been developed to address social inequalities of healthcare in India. Studies explored the relationship between caste membership and health-related risk factors such as mortality, health behaviors, and nutritional status. Review revealed odds of mortality; poor health behaviors and poor nutritional status were higher and in some cases were significantly higher in lower caste groups in comparison to reference groups. Odds ratios reported for mortality and poor health behaviors were significantly higher in older populations. Odds ratios reported for nutritional status and mortality were significantly higher in younger populations. Further research on the independent effects of wealth and education would broaden the scope of the social gradient health equation in India. Key words: Caste system, Health-related risk factors, Smoking, Tobacco, Mortality, Nutrition, India.

Abdominal obesity is one of the pivotal factors in defining the metabolic syndrome. Abdominal obesity is assessed by the various clinical surrogates among which waist circumference is considered to be simple, inexpensive & sensitive tool. But various controversies surround the exact cut offs and the ideal sites of waist circumference measurement, so in this review we discussed these issues. Key words: Metabolic syndrome, Waist circumference, Cardio metabolic risk, Abdominal obesity, Harmonized Definition.

Background: Chronic diseases are increasingly becoming a health burden in terms of bothmorbidity and mortality in low and middle-income countries (LMICs). The role of body mass index (BMI) especially overweight and obesity in the prevalence of multimorbidity, the occurrence of two or more chronic conditions, is understudied in LMICs where two thirds of the world’s obese individuals reside. We estimated the association between BMI and prevalence of chronic non communicable disease multimorbidity in six LMICs. Methods: Cross-sectional data of total of 40,166 participants from China (n=13,970), India (10,915), Mexico (2,4 26), Russia (3,892), South Africa (4,000) and Ghana (4,971), aged 18 years and above included in the WHO Study on Global Ageing and adult health (SAGE), 2007–2010 were analyzed. Multimorbidity was measured as the simultaneous presence of two or more of the nine chronic conditions including angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, depression, and vision impairment. Multivariable logistic regression models were fitted to test for associations between overweight/obesity and prevalence of non communicable multimorbidity after adjusting for age, sex, rural/urban residence, education, marital status, occupation, household wealth, tobacco smoking, alcohol drinking, fruits and vegetable intake and health insurance status. Data were analyzed country wise as well as pooled together to give overall LMIC estimates. Results: The mean BMI was 24.4 [±7.3SD] in the pooled countries, being as low as 20.8 [±8.0 SD] in India to 23.4 [±6.3 SD] in Ghana, 23.9 [±4.9 SD] in China, 28.4 [±5.4 SD] in Mexico, 28.6 [±6.3 SD] in Russia, to as high as 30.5 [±12.0 SD] in South Africa. The prevalence of overweight was 13% and obesity was 24% in the pooled sample. The prevalence of non communicable disease multimorbidity was 23% in the pooled sample of six countries– the highest being in Russia (50%), followed by Mexico (27%), India (24%), Ghana (23%), South Africa (32%) and China (22%). The prevalence of multimorbidity was 37% among obese population and 27% among overweight population in the pooled sample– highest prevalence was in Russia (59% among obese; 45% among overweight) and lowest in Ghana (28% among obese; 23% among overweight). Being obese (OR:5.78;95%CI:3.55– 9.40;p<0.0001) was associated with significantly higher likelihood of having multimorbidity as compared to normal weight category in the pooled sample. The likelihood of multimorbidity among obese were almost ten times higher in Russia (OR:9.90;95%CI:3.90– 25.17;p=<0.0001), seven times higher in China (OR:7.06;95%CI:2.47–20.21;p=0.003), six times higher in Ghana (OR:5.61;95%CI:1.21–26.02;p= 0.007) and five times higher in South Africa (OR:4.66;95%CI:2.16–10.08;p=0.005). Non-significant but positive association were also observed in case of India and Mexico. The likelihood of multimorbidity was more than two times higher among overweight population in India (OR:2.33;95%CI:1.35–4.02;p=0.003) and pooled countries (OR:1.47;95%CI:1.05–2.07;p=0.004) while non-significant but positive association were also observed in case of China, Russia.

Background: Amoebic liver abscess (ALA), which is caused by Entamoeba histolytica a protozoa is common and serious extra-intestinal manifestation of amoebiasis. ALA is prevalent in areas of poor sanitation and hygiene. It has varied clinical presentations and complications. This study highlights the recent clinical trends of ALA. Material and Methods: This study was a hospital based prospective observational study. All patients admitted from March to December 2011 with the diagnosis of ALA were included. Demographic and clinical history was recorded and the systematic examination was done to understand disease pattern. Clinical diagnosis was supported and confirmed by ultrasound abdomen and positive amoebic serology. The outcome of the patient was recorded at discharge. Data was analysed using SPSS 17. Results: Out of total 100 ALA Patients, 72% were from urban slums, 88% were uneducated and belonged to low socioeconomic status. 76% were alcoholic, 52% patients were in age group of 21–40 yrs with male preponderance (89%). Commonest presenting symptom was pain in right hypochondrium (94%)while jaundice was noticed in only 4%. Mean duration of symptoms before hospitalization was 10 days. Personal & family history was not contributory. Hepatomeagly was present in 52%. Mean TLC – 13694, Bilirubin – 1.27 mg%. Serum Alkaline Phosphatase – 698 IU. X ray showed raised right diaphragm in 50% cases. On USG Examination 7% located in left lobe of liver and 84% were more than 5 cm in size. Multiple abscesses in 21%. Amoebic Serology was positive in all patients. Mean duration of hospitalization was 7 days. Management was done with metronidazole, antibiotics and/or percutaneous aspiration. Rupture occurred in 10%. One patient died of DIC. Conclusion: ALA is a medically treatable common infection prevalent in developing countries due to lack of sanitation and hygiene .Health education and adequate sanitation are imperative in preventing amoebic infections. Key words: Amoebiasis, Amoebic liver abscess, Entamoeba histolytica, Hepatic abscess, liver abscess, Percutaneous aspiration.

Introduction: We conducted this study to assess the utility of e-learning as a teaching and learning method in Community Medicine using quantitative and qualitative methods. Methods: We carried out a cross sectional study to fulfill the study objectives for a period of three months. The study participants were undergraduate students of a Private Medical College, who were exposed to e-learning conducted by the Department of Community Medicine. Thus, we invited a total of 437 students to take part in this study. A self-administered, pre-tested, pre-designed and validated questionnaire was used for quantitative assessment. Qualitative assessment was conducted by a Force Field Analysis (FFA) on a subset of the study population. Results: A total of 323 medical students participated in the study, of which 82.35% believed that they were confident overall in using a computer, 78.33% considered themselves as having good computer skills. Majority utilized e-learning (76.16%) while 81.74% reported that they are confident in use of e-learning. Demonstration videos if uploaded would be useful according to 76.78% of the study participants. Most of the study participants agreed that e-learning is useful (62.29%). Through FFA, we were able to identify certain key driving forces associated with e-learning use. Moreover, factors like lack of user friendliness and a slow network were identified as restraining forces. Conclusion: Majority were of the opinion that e-learning is an effective learning tool. However, successful execution of an e-learning programme can be ensured if the barriers are overcome and orientation programmes are conducted. Key words: E-learning, Utility, Attitudes, Force Field Analysis.

Background: The risk factors of neonatal mortality are complex, this health indicator is relatively improved slowly and its decreasing trend is not as great as other health indicators such as infant and under 5 years children mortality rates. This study aimed at identifying the risk factors of neonatal mortality in Gitwe District Hospital, based on observational casecontrol study design. Methods: A total of 3782 neonates, who took post-neonatal care at Gitwe Hospital (Rwanda), were enrolled from January 2013 to July 2014; and we found 62 died neonates. By using systematic random sampling, 186 controls were selected among survivors. Maternal and neonatal data were collected and the outcome of interest was neonatal mortality. Multiple logistic regression models were used to examine the association between studied factors and neonatal mortality. Results: The factors that highly associated with neonatal mortality(5 < aOR < 25, P ≤ 0.001) were grandmultigravida, HIV+, incomplete antenatal care visits, eclampsia, delivering at home, prolonged labor duration, and lower 1st minute Apgar score. Other factors were less associated with neonatal mortality (1 < a OR < 5, P ≤ 0.05), those are lack of health insurance, early childbearing (<20 years), preterm birth, and asphyxia. Lower birth weight and lower birth spacing (aOR < 1, P ≤ 0.01) showed the negative association with neonatal mortality. Conclusion: This study has identified some maternal and neonatal factors which should be used to educate health care services providers, administrators and as the whole the community so as to reduce neonatal death rates. Key words: Case control study, District Hospital, Neonatal mortality, Risk factors, Rwanda

Introduction: Use of mobile phones in planning of health care interventions is on the rise. Before planning of such interventions, it is essential to know about readiness among the target population. Objective(s): To identify the access to personal mobile phone, knowledge on usage in terms of making/receiving call/SMS and the willingness to use mobile phone as a medium for health communication among adults in an urban area of Puducherry, South India. Methodology: A community based cross-sectional study was conducted in two randomly selected areas out of the four in the urban field practice area of a medical college in Puducherry during July, 2014. Systematic random sampling was done to select 126 houses. All individuals above 18 years in those households were included. A pre-tested interview schedule was used to collect information. Association between socio-demographic factors and willingness to receive health tip through mobile phone was found using binary logistic regression. Results: Among 299 participants interviewed, 227 (75.9%) had personal mobile phones; 229 (76.6%), 128 (42.8%) and 131 (43.8%), were able to receive and make a call, read SMS, and text SMS respectively. Nearly 50% were willing to receive health information through mobile phones. Of these, 67.5% were willing to receive through call/SMS and 35.5% only through calls. On multivariate binary logistic analysis, individuals having personal mobile and younger age were found to be willing to receive health information through mobile phones. Conclusion: Three in every five individuals having personal mobile were willing to receive health information through mobile with most of them preferring call/SMS over only call. Key words: Health information, mHealth, Mobile phone, Readiness.

Background: Antithrombotic therapy is recommended in atrial fibrillation (AF) patients due to high risk of stroke. However, antithrombotic therapy is often underutilized due to adverse effects and limited data available in Indian population. Aims: Primary objective was to study usage pattern of antiplatelet and anticoagulant drugs in AF patients. Secondary objective was to assess the risk of stroke and compare usage pattern of antithrombotic drugs in non-valvular atrial fibrillation (NVAF) patients with application of CHADS2 and CHA2DS2-VASc score. Materials and Methods: A prospective and observational study was conducted in outpatient department for period of one year in patients > 35 years of either gender diagnosed with AF due to any established cause. CHADS2 and CHA2DS2-VASc score were used to assess risk of stroke among NVAF patients. Results: 111 patients diagnosed with AF (mean age 54 years; 54.96% female) were analyzed and out of these, 78 patients were valvular AF patients and 33 were NVAF patients. Anticoagulants were predominantly prescribed in 60 valvular AF patients. Out of 33 NVAF patients, 19 (57.57%) patients had CHADS2 score 1 while as per CHA2DS2-VASc score 28 (84.84%) patients had score ≥ 2. Out of 33 NVAF patients, 15 (45.45%) patients were prescribed warfarin, aspirin in 12 (36.36%) patients and no antithrombotic therapy in 6 (18.18%) patients. Conclusion: Oral anticoagulant drugs are most commonly prescribed antithrombotic drugs in valvular AF and NVAF patients for stroke prevention. CHADS2 and CHA2DS2-VASc score are easy, simple schemes to assess stroke risk in NVAF patients and helps physicians and patients to choose most suitable antithrombotic therapy. Key words: Atrial fibrillation, Anticoagulant, Antiplatelet, CHADS2, CHA2DS2-VASc score.