South Indian Community Research Articles

Determinants of the Epilepsy Treatment Gap in a Resource Limited Setting: A Study in a Rural Community in South India (P1.082)

Determinants of the Epilepsy Treatment Gap in a Resource Limited Setting: A Study in a Rural Community in South India (P1.082)

Reasons for Schizophrenia Patients Remaining out of Treatment: Results from a Prospective Study in a Rural South Indian Community.

Background:A few studies have examined the factors associated with schizophrenia patients remaining untreated in India.Materials and Methods:We identified 184 schizophrenia patients in a rural community, offered the treatment with antipsychotics and followed them up in their Primary Health Centers for 1-year. Twenty-nine (15.8%) patients remained untreated at both the baseline and 1-year follow-up despite our best attempts to keep them under the treatment umbrella. They were interviewed in detail regarding the reasons for remaining untreated. This group was compared with another group of patients (n = 69) who had stopped the treatment at baseline but were successfully brought under the treatment umbrella throughout the 1-year follow-up period.Results:The reasons for remaining untreated were (n; %): (a) Unsatisfactory improvement with previous treatment attempts (19; 65.5%), (b) poor bond between the patients and the families (6; 20.7%), (c) active symptoms not allowing any treatment efforts from the family members (6; 20.7%), (d) magico-religious beliefs about the illness and its treatment (4; 13.8%), (e) poor social support (3; 10.3%), (f) adverse effects of the medications (2; 6.9%), and (g) perception of recovery and cure (1; 3.4%). For many patients, a constellation of these reasons was responsible for them remaining untreated. In contrast, the common reasons for those who restarted medications to have stopped the treatment at some time were the lack of awareness, the need to continue medications (47; 68.1%), and the financial constraints (28; 40.6%).Conclusion:The predominant reason for schizophrenia patients not remaining on the treatment in this rural community was the families’ lack of faith in antipsychotic treatment. Provision of comprehensive treatment package including medical, psychosocial and rehabilitative services, and sensitizing the community about benefits of the treatment may help in ensuring that all patients with psychosis receive the best care.

Assessment of Drug Related Problems in Patients with Chronic Diseases through Health Status Survey in a South Indian Rural Community Setting

A prospective study has been carried out to assess the incidence, prevalence and cost implications of drugrelated problems in patients with chronic diseases dwelling in a south Indian rural community setting. Details of patients with chronic diseases were recorded in a suitably designed data collection form and assessed for the potential drug-related problems in the prescriptions with the patient’s consent. Hepler and Strand classification was used to categorize the identified drug related problems. Each drug-related problem was assessed for its significance level and graded either as minor, moderate or major based on expected clinical outcome. Cost implications due to drug-related problems were also evaluated. During the study period, the research pharmacist visited 550 houses and interviewed 2370 people. Among the interviewed individuals, 215 (8.36%) people were found with chronic diseases. A total of 90 drug-related problems were observed in the patients’ prescriptions who met the study criteria. Noncompliance (22), untreated indications (18) and drug interactions (14) were the most commonly found drug-related problems. Among all drug-related problem’s, 9 drug related problems were graded as major, 37 were moderate and 44 were minor in severity. It is estimated that, a sum of 84 64 950 rupees could have been saved through the pharmacist intervention.

A study to assess the prevalence of anemia and activities of daily living among elderly population residing in a South Indian rural community

Background: As we age the interface between health & illness blurs. Balance gradually shifts from health to disease. While health is usually inversely related to age, disease is directly related to ageing both in number & severity. Anaemia is defined as reduction in the red cell mass. The WHO criteria for anaemia are haemoglobin less than 13gm/dl for men and 12gm/dl for women. The same criteria can be applied for the elderly. The objective of the study was to assess the prevalence of anemia among the geriatric population group and their activities of daily living. Methods: The study was carried out at the community level, of the field practice area of Department of Community Medicine, MGMC&RI, Puducherry from Jan 2010 to Dec 2010. All the persons aged 60 years and above were listed. Samples were selected proportionately according to geriatric population of individual villages. Simple Random Sampling was used to select the study sample of 360 from the list. House to house visits was made to collect the data. WHO criteria were used to classify anemia. PADL and IADL from KATZscale were used for assessing ADL. Results: In our study Anemia was prevalent in 344 of the subjects (96%). Females were more anemic (98%) than males (92%). Out of the 360 elderly studied five males (1%) were fully dependent followed by 101 (28%) partially dependent and 254 (71%) were independent for their daily activities. Only males were fully dependent. More elderly females were partially dependent. Majority of the males (73%) independently managed their day to day activities. Conclusions: The increase of demographic ageing process in our country in general and in our study area in particular has a series of socio-economic problems as well as health problems. Problems of the elderly are mostly not due to ageing per se but also largely due to psychosocial environment, diminishing family system, support and changes in life situation.

Distribution of ABO and RH Blood Grouping in Rural Community of South India: A Population Based Study

Distribution of ABO and RH Blood Grouping in Rural Community of South India: A Population Based Study

Population Study of Urban, Rural, and Semiurban Regions for the Detection of Endovascular Disease and Prevalence of Risk Factors and Holistic Intervention Study: Rationale, Study Design, and Baseline Characteristics of PURSE-HIS.

We designed and implemented the PURSE-HIS (Population Study of Urban, Rural and Semiurban Regions for the Detection of Endovascular Disease and Prevalence of Risk Factors and Holistic Intervention Study) to understand the prevalence and progression of subclinical and overt endovascular disease (EVD) and its risk factors in urban, semiurban, and rural communities in South India. The study is also designed to generate clinical evidence for effective, affordable, and sustainable community-specific intervention strategies to control risks factors for EVD. As of June 2012, 8,080 (urban: 2,221; semiurban: 2,821; rural: 3,038) participants >20 years of age were recruited using 2-stage cluster sampling. Baseline measurements included standard cardiovascular disease risk factors, sociodemographic factors, lifestyle habits, psychosocial factors, and nutritional assessment. Fasting blood samples were assayed for putative biochemical risk factors and urine samples for microalbuminuria. All nondiabetic participants underwent oral glucose tolerance test with blood and urine samples collected every 30 min for 2 h. Additional baseline measurements included flow-mediated brachial artery endothelial vasodilation, assessment of carotid intimal medial wall thickness using ultrasonography, screening for peripheral vascular disease using ankle and brachial blood pressures, hemodynamic screening using a high-fidelity applanation tonometry to measure central blood pressure parameters, and aortic pulse wave velocity. To assess prevalence of coronary artery disease, all participants underwent surface electrocardiography and documentation of ventricular wall motion abnormality and function using echocardiography imaging. To detect subclinical lesions, all eligible participants completed an exercise treadmill test. Prospectively, the study will assess progression of subclinical and overt EVD, including risk factor-outcome relation differences across communities. The study will also evaluate community-specific EVD prevention using traditional Indian system of medicine versus recognized allopathic (mainstream) systems of medicine.

A task shifting mental health program for an impoverished rural Indian community.

Psychiatric disorders constitute a major source of disability across the globe. In India, individuals with mental disorders are diagnosed and treated inadequately, particularly in under-served rural areas. We implemented and evaluated a psychiatric 'task shifting' program for a rural, marginalized, impoverished South Indian tribal community. The program was added to a pre-existing medical program and utilized community workers to improve health care delivery. Following community wide discussions, health workers were trained to provide community education and to identify and refer individuals with psychiatric problems to a community hospital. Subsequently, they also followed up the psychiatric patients to improve treatment adherence. The program was evaluated through medical records and community surveys. Treated patients experienced significant improvement in daily function (p=0.01). Mean treatment adherence scores remained stable at the beginning and end of treatment, overall. The proportion of self-referrals increased from 27% to 57% over three years. Surveys conducted before and after program initiation also suggested improved knowledge, attitudes and acceptance of mental illness by the community. The annual per capita cost of the program was 122.53 Indian Rupees per person per annum (USD 1.61). In conclusion, the community-driven psychiatric task shifting program was implemented successfully. It was accompanied by positive changes in knowledge, attitudes and practice. Initial community consultations and integration with a pre-existing medical program increased acceptance by the community and reduced costs. We recommend a similar model with integrated medical and psychiatric health care in other resource-deficient communities.

Book Review: Miriam Benteler, Shared Values: Hierarchy and Affinity in a Latin Catholic Community of South India

Book Review: Miriam Benteler, <i>Shared Values: Hierarchy and Affinity in a Latin Catholic Community of South India</i>

Environmental predictors of diarrhoeal infection for rural and urban communities in south India in children and adults.

Diarrhoeal diseases are major causes of morbidity and mortality in developing countries. This longitudinal study aimed to identify controllable environmental drivers of intestinal infections amidst a highly contaminated drinking water supply in urban slums and villages of Vellore, Tamil Nadu in southern India. Three hundred households with children (<5 years) residing in two semi-urban slums and three villages were visited weekly for 12-18 months to monitor gastrointestinal morbidity. Households were surveyed at baseline to obtain information on environmental and behavioural factors relevant to diarrhoea. There were 258 diarrhoeal episodes during the follow-up period, resulting in an overall incidence rate of 0·12 episodes/person-year. Incidence and longitudinal prevalence rates of diarrhoea were twofold higher in the slums compared to rural communities (P < 0·0002). Regardless of study site, diarrhoeal incidence was highest in infants (<1 year) at 1·07 episodes/person-year, and decreased gradually with increasing age. Increasing diarrhoeal rates were associated with presence of children (<5 years), domesticated animals and low socioeconomic status. In rural communities, open-field defecation was associated with diarrhoea in young children. This study demonstrates the contribution of site-specific environmental and behavioural factors in influencing endemic rates of urban and rural diarrhoea in a region with highly contaminated drinking water.

Between Daughter Deficit and Development Deficit: The Situation of Unmarried Men in a South Indian Community

A likely effect of the continuing sex ratio imbalance in countries such as India is bride shortage. But can daughter deficit alone account for men’s difficulty in finding brides in such contexts? Drawing from research in the Kongu Velalla (KV) community in Tamil Nadu in south India which has had a long history of daughter elimination resulting in female deficit, the paper addresses this question. It demonstrates how the effects of daughter deficit unfold in the midst of changing economic processes and development gains made by women while sharpening the development deficit among men. These effects are immediately evident in women’s bargaining position in the marriage market. Whether daughter deficit will increase violence against women and society in general or enhance the value of women will depend on its interaction with development deficit, gender inequality and the important gains women are making to challenge traditional gender norms.

Community perceptions of health and chronic disease in South Indian rural transitional communities: a qualitative study

BackgroundChronic diseases are now the leading cause of death and disability worldwide; this epidemic has been linked to rapid economic growth and urbanisation in developing countries. Understanding how characteristics of the physical, social, and economic environment affect behaviour in the light of these changes is key to identifying successful interventions to mitigate chronic disease risk.DesignWe undertook a qualitative study consisting of nine focus group discussions (FGDs) (n=57) in five villages in rural Andhra Pradesh, South India, to understand people's perceptions of community development and urbanisation in relation to chronic disease in rural transitional communities. Specifically, we sought to understand perceptions of change linked to diet, physical activity, and pollution (because these exposures are most relevant to chronic diseases), with the aim of defining future interventions. The transcripts were analysed thematically.ResultsParticipants believed their communities were currently less healthy, more polluted, less physically active, and had poorer access to nutritious food and shorter life expectancies than previously. There were contradictory perceptions of the effects of urbanisation on health within and between individuals; several of the participants felt their quality of life had been reduced.ConclusionsIn the present study, residents viewed change and development within their villages as an inevitable and largely positive process but with some negative health consequences. Understanding how these changes are affecting populations in transitional rural areas and how people relate to their environment may be useful to guide community planning for health. Measures to educate and empower people to make healthy choices within their community may help reduce the spread of chronic disease risk factors in future years.

Alcohol Use Disorders in patients with schizophrenia: Comparative study with general population controls

ObjectiveTo compare the prevalence of Alcohol Use Disorders (AUD) among schizophrenia patients with that of the general population in a south Indian rural community. MethodsAlcohol use pattern of 254 schizophrenia patients in the past year was compared with randomly selected healthy comparison subjects (n=350) from the same community in an administrative block of rural India using the Alcohol Use Disorders Identification Test (AUDIT). ResultsA significantly smaller proportion of patients used alcohol in the past year (10.2%; 95% CI: 6.5%–14.0%) than controls (18.3%; 95% CI: 15.8%–24.1%; OR=2.2; 95% CI=1.4–3.5). This was true for AUD (hazardous use and harmful use; total AUDIT score >8) also: 5.5% patients (95% CI: 2.7%–8.3%) and 10.3% controls (95% CI: 7.1%–13.4%) had hazardous use (OR=2.0; 95% CI=1.0–3.7). Hazardous use was associated with domicile in villages and lesser years of education. On logistic regression, after controlling for these confounds, the odds of having AUD were 2.7 times more for controls than for patients (95% CI=1.4–5.2). ConclusionsPrevalence of AUD is significantly lower in patients than in the general population in this community. Cross-cultural studies are needed to elucidate factors that underlie contrasting results across different countries.

B D Lalla's The Black Coolie: A Struggle for a Voice

B D Lalla's The Black Coolie (1946) is a romanticised reverie of the Indian diaspora to the Natal sugar belt. The Black Coolie is graphically suggestive of a racial other, and represents a significant and rare chronicle of the ideological development and expression of the South African Indian migrant community and their realignment in the politics of identity. Lalla's poetry is viewed in an intertextual relationship with the migrant folksongs of diaspora, and his work serves as witness to the racial politics of the time. Collectively, the focalised voices represent subjective narratives and utterances of an underclass driven by the contradictory pulses of despair and hope. The Black Coolie (1946) signified a realignment of Indian political identity, and prefigured the notion of Black Consciousness as being inclusive of Indians, Africans and Coloureds.

A study of knowledge and attitude of key persons of the rural South Indian community towards trance and possession disorder

A study of knowledge and attitude of key persons of the rural South Indian community towards trance and possession disorder

Knowledge and Beliefs about Ear and Hearing Health among Mothers of Young Children in a Rural Community in South India

Purpose: To study the knowledge and beliefs about ear and hearing healthcare among mothers from a rural community. Method: In 1 week, 6 focus group discussions were conducted across 6 villages of a district in Tamil Nadu in southern India. The participants were 60 mothers who had children below 5 years of age. Results: Mothers in this rural community had information about some aspects of ear and hearing healthcare. They were aware that use of hairpins and safety-pins to clean ears was harmful; they were knowledgeable about ways to identify hearing ability (child responds to name call, verbal instructions, and startles at loud sounds); and, conditions like consanguinity and malnutrition of expectant mothers were recognised as risk factors for hearing loss. However, misconceptions also existed. The practice of pouring herbal juices to remove insects in the ear continued; there was the perception that all children with a hearing problem were “deaf”, and a lack of awareness about the possibility of partial/unilateral hearing loss. Regarding the age of identification, mothers believed that a child’s ability to speak and the ability to hear was pertinent to assess hearing. None of the mothers related normal speech development to normal hearing. Conclusion: For the success of a community-based hearing screening programme, it is important to utilise the existing knowledge of the mothers, and simultaneously attempt to fill in gaps in knowledge and clarify misconceptions. These measures will facilitate greater compliance from the community in achieving the goals of early identification and early intervention for problems of hearing loss.

Recipes for Immortality: Medicine, Religion, and Community in South India, written by Richard S. Weiss

Recipes for Immortality: Medicine, Religion, and Community in South India, written by Richard S. Weiss

Diabetes awareness among caregivers in a semi-rural community in South India

The prevalence of diabetes in India has reached pandemic proportions. Compounding the issue is poor awareness about diabetes, risk factors, and prevention. Many diabetic patients in India are assisted by a younger caregiver during their disease therapy continuum. Though many studies have focused on awareness among patients, the value of the caregiver and the importance of awareness among caregivers are often neglected. Our aim is to target non-diabetic caregivers in an attempt to identify early awareness strategies. This questionnaire based study focuses specifically on 1) the role of the Indian caregiver for the diabetes patient, 2) their level of awareness of diabetes, and 3) sources of information for diabetes. A total of 158 caregivers were included. Informed consent was obtained. Most of the respondents in the survey were female (65 %), and the majority were the spouse of the patient (46 %). The patient was older than the caregiver by 20.4 ± 12.9 years in 71 % of the cases. The results of this study indicate that caregivers need to be more informed about diabetes in terms of preventive measures, symptoms and complications knowledge, general diabetes knowledge, risk factor identification. Caregivers’ major source of information was the doctor (49 %). Efforts to improve diabetes awareness should be focused communications from the patient’s primary physician.

Making Saints, Making Communities: Nāyaki Svāmikaḷ and the Saurashtras of Madurai

Naṭaṉa Gopāla Nāyaki Svāmikaḷ (1843–1914), born Ramabadran, was a Vaiṣṇava poet, mystic and performer who belonged to the Saurashtra community of Madurai. Revered within his community as the ‘Saurashtra Āḻvār’ (poet-saint), he is arguably their most important literary and musical figure. Initially known only to his intimate circle of family, as Nāyaki Svāmikaḷ's fame spread, his simple devotional compositions (kīrttaṉai) written in Tamil and Saurashtra are purported to have attracted disciples from all classes and castes in Madurai. Today, Nāyaki Svāmikaḷ's fame is largely confined to the Saurashtra community of Madurai, although the annual celebration in December of his samādhi (death, final liberation) brings together both the Tamil and Saurashtra communities of Madurai. The samādhi (sacred sepulchre) just outside Madurai is the primary locus for his worship, where he is remembered through the daily performance of his kīrttaṉais. In this paper, I trace the making of a twentieth-century Hindu saint within a small, but visible, migrant minority community in South India along the intersecting vectors of his hagiography and the circulation and performance of his Tamil and Saurashtri kīrttaṉais. I argue that Nāyaki Svāmikaḷ's hagiography and music bring together the Saurashtra community of Madurai, while simultaneously seeking to broaden his appeal outside the spatial confines of Madurai.

Determination of Chorionicity in Twins: Feasibility at a Tertiary Care Centre and Audit of Current Practice in the Community

AbstractTo assess the feasibility and to audit the practice of determining chorionicity in twin pregnancies in South India. Sonographic findings from first trimester scans of twin pregnancies were retrospectively analysed to evaluate the feasibility of determining chorionicity in the first visit to the unit. In addition, an audit was carried out on all twin pregnancies referred to the authors in the second trimester to ascertain whether chorionicity had been established prior to referral. It was feasible to determine chorionicity at the first visit in 100 % of the 611 twin pregnancies that were seen at 11–14 weeks in the unit. However, the audit revealed that only 40 % of the referred population had a diagnosis of chorionicity prior to referral. Whilst it is feasible to determine chorionicity in all twin pregnancies in the first trimester, the practice is not widespread in the referring community in South India and this needs to be addressed.

Prevalence of chronic kidney disease among adults in a rural community in South India: Results from the kidney disease screening (KIDS) project.

Prevalence of chronic kidney disease (CKD) appears to be increasing in India. A few studies have studied the prevalence of CKD in urban populations, but there is a paucity of such studies in the rural populations. This project was undertaken to study the prevalence of CKD among adults in a rural population near Shimoga, Karnataka and to study the risk factor profile. Door-to-door screening of 2091 people aged 18 and above was carried out. Demographic and anthropometric data were obtained, urine was analyzed for protein by dipstick and serum creatinine was measured in all participants. Glomerular filtration rate was estimated (eGFR) using the 4-variable modification of diet in renal disease (MDRD) equation and Cockcroft-Gault equation corrected to the body surface area (CG-BSA). The total number of subjects studied was 2091. Mean age was 39.88 ± 15.87 years. 45.57% were males. The prevalence of proteinuria was 2.8%. CKD was seen in 131 (6.3%) subjects when GFR was estimated by MDRD equation. The prevalence of CKD was 16.54% by the CG-BSA method. There was a statistically significant relationship of CKD with gender, advancing age, abdominal obesity, smoking, presence of diabetes and hypertension. The prevalence of CKD is higher compared to the previous studies from rural India and is comparable to that in the studies from the urban Indian populations. The wide difference between the CKD prevalence between MDRD and CG-BSA equations suggests the need for a better measure of kidney function applicable to Indian population.