South Indian District Research Articles

Economic Empowerment of Tribal Women in the Nilgiris District of South India

The study is about the status of tribal women in their community and the way how they empowered themselves through Self Help Groups and other organisations. It gives a brief description about the tribal population in the district. The study reveals the traditional customs which were considered as the hurdles for women empowerment. It also sketches the tribal habitat in the Nilgiris district of South India. The study states that the upliftment of women in tribal community brought a tremendous change in their economy. It has been evident that after the formation of SHG (Self help groups), there was a notable change in the status of tribal women. It has also been suggested that the government has to take positive measures in educating the girls of the upcoming generation in the tribal community. The study has a conclusion that the tribal woman has to be given proper awareness about the schemes provided for the women development by the voluntary groups. There should be more development in the Self Help Group projects.

“Burnt-Out” Endomyocardial Fibrosis—An Overview

Tropical endomyocardial fibrosis (EMF) is a public health problem affecting the children, young adults and elderly individuals in an epidemic fashion in the coastal districts of south India. Due to lack of resources for research in these endemic areas, its etiology remains elusive and hypotheses ranging from infections and allergic causes to malnutrition and toxins have not been tested rigorously. The disease is characterized by endocardial fibrosis and the right ventricle is the cardiac chamber most frequently affected. Patients may present clinically with heart failure and an associated AV (atrioventricular) valve regurgitation is common. Several features of the advanced disease called as “burnt-out” stage of endomyocardial fibrosis (EMF) are not fully understood. Background of these case studies described the clinical presentation, echocardiographic features and management of this late stage of the disease.

The Karnataka Anemia Project 2--design and evaluation of a community-based parental intervention to improve childhood anemia cure rates: study protocol for a cluster randomized controlled trial.

BackgroundChildhood anemia is highly prevalent worldwide. Improving the hemoglobin level of preschool age children could yield substantial benefits in cognitive and psychosocial development and overall health. While evidence-based recommendations for reducing childhood anemia in high anemia prevalence countries are available, there is no experimental evidence of community centered education and counseling programs, as a route to improved acceptance of iron supplements, demonstrating beneficial effects on anemia outcomes. We report on the evaluation protocol of a complex educational intervention led by the community lay health worker (LHW) and delivered to mothers of 12–59-month-old anemic children living in and visiting village day care centers in a large district of southern India.Methods and designThe study is designed as a cluster randomized controlled trial. The intervention is based on the social cognitive theory and aims to promote among mothers, anemia awareness, dietary modifications to increase iron intake in the child, and recognition of the need for enhanced adherence to supplemental iron in the anemic child. From 270 eligible villages in the study area, a sample of 60 villages will be randomized to intervention [n = 30] or to treatment as usual [n = 30] of the study. LHWs in the intervention arm will be trained to administer the following intervention components to mothers of anemic children: 1] monthly distribution of Iron and folic acid (IFA) supplements to mothers of anemic children, and 2] five monthly counseling sessions of mothers of anemic children covering: a] anemia awareness education b] IFA adherence counseling and assessment, c] dietary modification to improve iron intake, and d] hygiene and sanitation. LHWs in the control arm will distribute IFA to mothers of anemic children as in the intervention arm but will not provide monthly education and counseling support. The primary outcome is the difference between the two experimental groups in anemia cure rates of children found to be anemic at baseline. Secondary outcomes, assessed as differences between all participants in both experimental groups, are: change in mothers’ knowledge regarding anemia; 24 hour dietary iron intake; net improvement in individual hemoglobin values; serum ferritin; and the difference in overall cluster level childhood anemia prevalence. All outcomes will be measured 6 months after the start of the intervention. Multilevel linear and logistic regression models will be used to analyze differences between intervention and control groups in outcome variables.DiscussionThis trial is designed to evaluate the effectiveness of an intervention intended to improve anemia cure rates in anemic children living in villages of Chamarajnagar, Karnataka a large district in south India. The extensive study of secondary endpoints will be used to identify possible weak points in the compliance to intervention delivery and uptake. This evaluation is one of the few large randomized trials evaluating the impact of an education and counseling intervention to reduce childhood anemia prevalence.Trial registrationThis trial was registered with ISRCTN.com (identifier: ISRCTN68413407) on 17 September 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-1135-x) contains supplementary material, which is available to authorized users.

Multilevel Analysis of the Predictors of HIV Prevalence among Pregnant Women Enrolled in Annual HIV Sentinel Surveillance in Four States in Southern India.

BackgroundHeterogeneity of the HIV epidemic across districts of south India is reflected in HIV positivity among antenatal clinic (ANC) attendees. Along with individual factors, contextual factors also need consideration for effective HIV interventions. Thus, identifying district and individual level factors that influence ANC HIV positivity assumes importance to intervene effectively.MethodsData on HIV sentinel surveillance among the ANC population were obtained from the National AIDS Control Organization (NACO) between years 2004 and 2007. Data from serial cross-sectional studies among female sex workers (FSWs) conducted during this time period in 24 districts were used to generate district level variables corresponding to parameters concerning this high risk population. Other district level data were obtained from various official/governmental agencies. Multilevel logistic regression was used to identify individual and district level factors associated with ANC-HIV positivity.ResultsThe average ANC-HIV prevalence from 2004 to 2007 in the 24 integrated biological and behavioural assessments (IBBA) districts ranged from 0.25 to 3.25%. HIV positivity was significantly higher among ANC women with age≥25 years [adjusted odds ratio (AOR):1.49; 95% confidence interval (95%CI):1.27 to 1.76] compared to those with age<25 years; illiterate (AOR:1.62; 95%CI:1.03 to 2.54) compared to literate; employed in agriculture (AOR:1.34; 95%CI:1.11 to 1.62) or with occupations like driver/helper/industry/factory workers/hotel staff (AOR:1.59; 95%CI:1.26 to 2.01) compared to unemployed. District level HIV prevalence among FSWs (AOR:1.03; 95%CI:1.0 to 1.05) and percentage women marrying under 18 years were significantly associated with ANC-HIV positivity (AOR:1.02; 95%CI:1.00 to 1.04).ConclusionIlliteracy of the woman, higher HIV prevalence among FSWs and early marriage were associated with HIV positivity among pregnant women in southern India. In addition to targeted HIV preventive interventions among FSWs, studying and changing the behavior of FSW clients and addressing structural drivers of the epidemic might indirectly help reduce HIV infection among women in southern India.

Occupational Health Problems Among Beedi Workers of Udupi District in South India

Occupational diseases arise out of, or in the course of employment. Beedi rolling is the major occupation of the women residing in the villages throughout the country. Beedi industry is one of the country's oldest industries and employs over 6.4 million workers in India. The objective of the study is to identify the occupational health problems among beedi workers. A descriptive study was conducted among 200 samples of those who had rolling beedi as an occupation, between the age group of 20 to 70 years and those who had more than one year of experience, in the villages of Udupi District. The study subjects were interviewed to collect the details with a clinical proforma. A total of 200 beedi workers were selected by non-probability convenient sampling technique. Data were entered in SPSS 16 version and analysed by using descriptive analysis. Out of 200 beedi workers, majority of the samples had back pain (90%), shoulder pain (62.5%), knee joint pain (52%), sneezing during beedi rolling (67.5%), early morning cough (24.5%), 26.0% of the workers had sinusitis, pain in the fingers (20.5%), nail discoloration(21.5%), vision problems (59.5%), and watering of the eyes (63.5%). Majority of the beedi workers had one or more health problems like musculoskeletal, respiratory, eye and skin problems. Finally this study concluded that beedi workers need to be educated regarding early identification of the health problems and prevention.

“Ginger is a gamble”

Responding to agrarian crisis at home, cash crop cultivators hailing from the South Indian district of Wayanad increasingly engage in the seasonal production of ginger in other states of India. This is a purely profit-based and unsustainable crop boom that takes a toll on both labor and the environment. This ethnographic analysis of speculative ginger cultivation situates this emerging economic complex in the regional political ecology, farming practices, individual farmers' hopes and aspirations, and in relation to the qualities of ginger as a cultivar. It argues that ginger is a special kind of boom crop and that its cultivation on large tracts of leased land is the manifestation of a moment of agrarian uncertainty and the neoliberalization of agriculture in South India coproduced by the properties of ginger. As a neoliberal boom crop, ginger exemplifies a regime of flexibilization of agrarian accumulation that has proved a profitable move for some, but has brought financial ruin and debt traps for many others.

Statistical Assessment of Physico-chemical Parameters of Water from Bore Holes and Shallow Wells in Agateeswaram and Kalkulam Taluks of Kanyakumari District, India

A systematic study has been carried out to explore physico-chemical parameters of drinking water from bore holes and shallow wells in five different stations (sites) of Agasteeswaram and Kalkulam Taluks in Kanyakumari District of South India. Water samples from bore holes and shallow wells in five stations were collected and analyzed for temperature, pH, turbidity, alkalinity, hardness, salinity, fluoride, chloride, total dissolved solids, dissolved oxygen, BOD, electrical conductivity, total nitrogen, nitrate, sulphate, ammonia, phosphate, total phosphorus, sodium, potassium and oxidation & reduction potential. Comparative studies of parameters in different stations and in different Taluks were also carried out. The physico-chemical parameters were analyzed and the results were compared with water quality standards described by WHO. Statistical techniques, calculation of basic statistics, Correlation matrix, Hierarchical Cluster analysis were simultaneously applied to the physico-chemical parameters of water samples taken from in different stations and in different Taluks. The above study will be useful to know the water quality and their fitness for drinking purposes at various stations undertaken. Overall water quality was found satisfactory for drinking purpose without prior treatment.

Projected and Observed Aridity and Climate Change in the East Coast of South India under RCP 4.5.

In the purview of global warming, the present study attempts to project changes in climate and quantify the changes in aridity of two coastal districts in south India under the RCP 4.5 trajectory. Projected climate change output generated by RegCM 4.4 model, pertaining to 14 grid points located within the study area, was analyzed and processed for this purpose. The meteorological parameters temperature and precipitations were used to create De Martonne Aridity Index, to assess the spatial distribution of aridity. The original index values ranged from 13.7 to 16.4 mm/°C, characterizing this area as a semidry climate. The outcome from the changed scenario analysis under RCP 4.5 showed that, during the end of the 21st century, the aridity may be increased more as the index values tend to reduce. The increasing trend in the drying phenomenon may be attributed to the rising of mean annual temperatures.

Modified SCS-CN and Green-Ampt Methods in Surface Runoff Modelling for the Kundahpallam Watershed, Nilgiris, Western Ghats, India

Kundapallam watershed is located in Nilgiris District of south India. This ungauged watershed has an areal extension of 14.37 km2. There are increasing numbers of rainfall induced landslide occurrences in this area. The causes of rainfall induced landslides require a thorough understanding of runoff characteristics of the watershed. In this respect, the runoff of the study area is estimated with two approaches such as modified Soil Conservation Curve Number (SCS-CN) and Green-Ampt loss method. By these approaches, the related thematic factors on runoff characteristics are prepared with satellite images by using ARCGIS and IDRISI image processing software. The catchment delineation is generated for the Kundapallam watershed to get watershed parameters by using HEC-GeoHMS extension in ARCGIS. Curve number is assigned based on Soil Wetness Index (SWI). Sixteen soil samples were collected from different localities for the determination of hydraulic conductivity, moisture content, wetting front capillary pressure, bulk density, porosity etc. The infiltration rate of sample locations is determined by using double ring infiltrometer. Then all the parameters are assigned to models applied in this study to determine runoff characteristics of the study area. The accuracy and goodness of fit of the model are tested by determining the correlation coefficient (SCS-CN = 0.979 and Green-Ampt = 0.985) and coefficient determination (SCS-CN = 0.958 and Green-Ampt = 0.97) and it indicates statically positive correlations and perfect fit between the results of the study. The results showed that the modified SCS-CN provides low runoff estimation compared than Green-Ampt loss method.

Comparison of the knowledge, attitude and practices of essential medicines among medical practitioners of a medical college versus private medical general practitioners of an urban place of south India

Background: India is the third largest producer and exporter of medicines to most of the countries. The World Medicine Situation Report 2011 states that 65% persons in India do not have access to essential medicines. While, huge unethical prescribing ofdrugs for monetary gains has been a second major cause of rural indebtedness. Aims and Objectives: The primary objective of the study was to compare the Knowledge, Attitude and Practices of Essential Medicines among Medical Practitioners of a Medical College and Private Medical General Practitioners of an urban place, e.g. Perambalur District of South India. Materials and Methods: After ethical approval, the study was started, in Dhanalakshmi Srinivasan Medical College and Hospital (DSMCH), Siruvachur-621113, Perambalur, Tamil Nadu. It was a questionnaire based study. The faculties of the DSMCH and Medical Private Practitioner of Perambalur district included as participants in the study. We distributed knowledge, attitude and practice (KAP) based 15multiple choice questions on National Essential Medicine List, 2011 (NEML) to each healthcare professionals (HCPs) to attempt within 15 minutes. Results: Overall, Knowledge, attitude and practices regarding NEML 2011 were 57.06%, 38.36%; 51.16%, 51.82%; 21.73%, 28.7% to HCP from DSMCH and HCP from Perambalur district, respectively. Whereas, 42.2 % HCPs from DSMCH and 44.7 % HCPs from Perambalur district were prescribed branded and generic drugs both. Conclusion: The result’s data shows that regular awareness programmes should be conducted to update knowledge, change attitude and practices regarding essential medicines to serve the society as best as possible.

A study on anti-tubercular drug-induced adverse reactions in South Indian district tuberculosis center

Background: An adverse drug reaction (ADR) is any response to a drug which is noxious and unintended occurs at doses normally used in man for prophylaxis, diagnosis or therapy of disease or the modification of physiological function, anti-tubercular drugs can cause ADR and involving almost all systems in the body including the gastrointestinal (GI) tract, liver, skin, nervous system, and eyes. Methods: A prospective observational study was conducted on tuberculosis (TB) patient. The suspected drug identified for ADRs and the type, nature, severity of reaction were recorded. A total of 239 patients were enrolled in the study. The patient was monitored the suspected ADRs were recorded and assessed for causality and severity. Results: Out of 239 patients, 60 (25.11%) developed one and more than one ADR. A maximum number of tubercular patients were in age group of 21-40 years (44.4%). The majority of patients were males (69%). Incidence of ADRs based on affected organ was GI system disorders (30.33%), skin and appendages disorders (23.62%), central and peripheral nervous system disorders (15.28%), musculo-skeletal system disorders and liver and biliary disorder (9.72% each), hearing disorder (5.55%), and visual disorder accounts of (2.78%). Conclusion: TB still becomes worldwide health problem not only on developing country but also in the developed country even the number of TB patients most large in the developing country. The importance of developing strategies to ameliorate ADRs both to improve the quality of patient care and to control TB safely.

A descriptive study of tuberculosis case finding in private health care facilities in a South Indian district.

A South Indian district providing anti-tuberculosis services through the Revised National TB Control Programme (RNTCP) and private health care facilities. To ascertain the profile of tuberculosis (TB) patients diagnosed and/or treated in private health care facilities. Data on TB cases diagnosed and/or treated in all clinical departments of the medical college, 83 nursing homes and RNTCP health care facilities were collected prospectively. About 83% of new TB cases recorded in the private medical college, 47% in nursing homes and 24.5% in RNTCP TB registers were extra-pulmonary. The proportion of retreatment cases was respectively 5.5%, 9.6% and 19.8%. The proportion of males and those in the economically productive age group were similar in the three data sources. About 94% of cases diagnosed in the medical college and 55% in nursing homes were registered for treatment under the RNTCP. About 11% of the smear-positive patients diagnosed in RNTCP were initial defaulters. The proportion of extra-pulmonary cases was higher in the medical college and nursing homes and that of retreatment cases was lower than in the RNTCP.

Sexual behaviors and partner-specific correlates of heterosexual anal intercourse among truck drivers and their wives in South India.

It is important to know about patterns of sexual behaviors among married couples in order to develop effective HIV prevention strategies for them. Herein we describe the sexual behaviors, estimate prevalence of anal intercourse (AI) among truck drivers ("truckers") and their wives, and determine partner-specific demographic and behavioral correlates of AI. We carried out a cluster-sampled cross-sectional survey among 18-49year-old wives and their trucker husbands in a south Indian district. Data were collected by same-gender research team members with color-coded computer-assisted interviews. We used random intercept logistic regression to identify the independent correlates of AI. Thirteen percent of 475 wives and 467 truckers reported ever having AI with their spouse. Of those who responded, 55% of 40 wives and 47% of 36 truckers never used condoms during AI. Of those who responded, 22 of 32 wives and 24 of 32 husbands felt that condoms were unnecessary during AI. Reporting ever having AI was associated with younger age and higher education of both husband and wife. AI reported by wives was associated with having sexual partner(s) other than husband (adjusted OR 8.8 [95% CI 3.2-24.0]), correctly answering all HIV knowledge items (adjusted OR 4.9 [95% CI 1.9-12.5]), husband's sexual debut occurring before marriage (adjusted OR 1.9 [95% CI 1.0-3.5]), and husband's high HIV risk perception (adjusted OR 2.5 [95% CI 1.2-5.4]). AI reported by truckers was associated with having sex with a male or transgender (adjusted OR 4.0 [95% CI 1.2-13.3]). Reported prevalence of AI was high considering that in India anal sex is non-normative, heavily stigmatized and, criminal. Indian heterosexual mobile populations need to be informed about the greater risk of HIV infection consequent to unprotected AI.

Isoniazid preventive treatment in children in two districts of South India: does practice follow policy?

Two districts of Tamil Nadu, India To determine the proportion of household contacts aged <6 years of patients with tuberculosis (TB) with positive sputum microscopy results who initiated and completed isoniazid preventive treatment (IPT), and to determine reasons for non-initiation and non-completion of IPT. Household visits were conducted on a random sample of adult patients registered during January-June 2012 to identify household contacts aged <6 years. Among 271 children living with 691 index patients, 218 (80%) were evaluated and 9 (4%) were diagnosed with TB. Of 209 remaining contacts, 70 (33%) started IPT and 16 (22.9%) completed a full course of IPT. Of 139 contacts who did not start IPT, five developed TB disease. Reasons for non-initiation of IPT included no home visit by the field staff (19%) and no education about IPT (61%). Reasons for non-completion included isoniazid not provided (52%) and long duration of treatment (28%). This study shows that Revised National TB Programme guidance was not being followed and IPT implementation was poor. Poor IPT uptake represents a missed opportunity to prevent future TB cases. Provision of IPT may be improved through training, improved logistics and enhanced supervision and monitoring.

Evaluation of capacity-building program of district health managers in India: a contextualized theoretical framework.

Performance of local health services managers at district level is crucial to ensure that health services are of good quality and cater to the health needs of the population in the area. In many low- and middle-income countries, health services managers are poorly equipped with public health management capacities needed for planning and managing their local health system. In the south Indian Tumkur district, a consortium of five non-governmental organizations partnered with the state government to organize a capacity-building program for health managers. The program consisted of a mix of periodic contact classes, mentoring and assignments and was spread over 30 months. In this paper, we develop a theoretical framework in the form of a refined program theory to understand how such a capacity-building program could bring about organizational change. A well-formulated program theory enables an understanding of how interventions could bring about improvements and an evaluation of the intervention. In the refined program theory of the intervention, we identified various factors at individual, institutional, and environmental levels that could interact with the hypothesized mechanisms of organizational change, such as staff’s perceived self-efficacy and commitment to their organizations. Based on this program theory, we formulated context–mechanism–outcome configurations that can be used to evaluate the intervention and, more specifically, to understand what worked, for whom and under what conditions. We discuss the application of program theory development in conducting a realist evaluation. Realist evaluation embraces principles of systems thinking by providing a method for understanding how elements of the system interact with one another in producing a given outcome.

Seasonal prevalence of different species of Culicoides in Bangalore rural and urban districts of South India

Seasonal prevalence of different species of Culicoides in Bangalore rural and urban districts of South India

Farmers’ Suicides as Public Death: Politics, Agency and Statistics in a Suicide-Prone District (South India)

AbstractThis paper argues that Indian farmers’ suicides may fruitfully be described as public deaths. Based on ethnographic fieldwork in the South Indian district of Wayanad (Kerala), it shows that farmers’ suicides become ‘public deaths’ only via the enumerative and statistical practices of the Indian state and their scandalization in the media. The political nature of suicide as public death thus depends entirely on suicide rates and their production by the state itself. But the power of representations complicates the ethnographic critique of statistical knowledge about suicide. In a context like Wayanad, which had been declared a suicide-prone district by the Indian state, public representations of suicides have taken on a life of their own; statistical categories and the media interpretations of these statistics have had a curious feedback—mediated by development encounters—onto the situated meanings of individual suicides. Local interpretations of individual suicides mostly commented on personal failures of the suicide and on the perils of speculative smallholder agriculture. Ethnography of farmers’ suicide based on case studies alone, however, would soon encounter limitations equally grave as the limitations of statistical analysis. Not only is the meaning of suicide (intentions, causes, motives) at the actor level off limits for ethnography, but in addition to that the (public) meaning of suicide is co-determined by state practice including statistical accounting.

Increased HIV prevention program coverage and decline in HIV prevalence among female sex workers in south India.

As one way of assessing the impact of Avahan, the India AIDS Initiative of the Bill & Melinda Gates Foundation, we examined the association between HIV prevention program indicators and changes in HIV prevalence among female sex workers (FSWs) between 2005 and 2009. We conducted a secondary data analysis from 2 large cross-sectional surveys (2005-2006 and 2008-2009) across 24 districts in south India (n = 11,000 per round). A random-effect multilevel logistic regression analysis was performed using HIV as the outcome, with individual independent variables (from both surveys) at level 1 and district-level FSW-specific program indicators and contextual variables at level 2. Program indicators included their 2006 value, the difference in their values between 2008 and 2006, and the interaction between this difference and study round. HIV prevalence among FSWs decreased from 17.0% to 14.2% (P < 0.001). This decline varied significantly (P = 0.006) across levels of difference in program coverage (% of FSWs contacted by the program in a given year). Odds ratios comparing HIV prevalence between rounds changed with the level of increase in coverage and were statistically significant with coverage increase ≥ quartile (Q) 1: odds ratio, 0.85 at Q1; 0.78 at Q2; 0.66 at Q3; and 0.51 at Q4. These findings suggest that increased program coverage was associated with declining HIV prevalence among FSWs covered by the Avahan program. The triangulation of our results with those from other approaches used in evaluating Avahan suggests a major impact of this intervention on the HIV epidemic in southern India.

Awareness regarding eye donation among stakeholders in Srikakulam district in South India

BackgroundThere is a huge need for the availability of transplantable donor corneas worldwide to reduce the burden of corneal blindness due to corneal opacity. Voluntary eye donation depends on the awareness levels of various stakeholders in the community. This study aimed to assess the awareness level regarding eye donation among various stakeholders in Srikakulam district in the state of Andhra Pradesh, India.Methods355 subjects were selected from the district using multi stage random sampling. A pre tested semi structured questionnaire was used to collect information regarding each individual’s awareness, knowledge, and perception regarding eye donation. Each response was scored individually and a total score was calculated. Univariate and multivariate regression analysis was used to determine the factors associated with willingness towards eye donation and increased awareness levels.ResultsOf the 355 subjects interviewed, 192 (54%) were male and 163 (46%) were female. The mean age of the stakeholders was 35.9 years (SD ±16.1) and all the study subjects were literate. Ninety-three percent of subjects were aware of the concept of eye donation. Knowledge levels were similar among the teaching community and persons engaged in social service, but lower among students (p < 0.05). Among the stakeholders, there was considerable ambiguity regarding whether persons currently wearing spectacles or suffering from a chronic illnesses could donate their eyes. Older age group (p < 0.001), female gender (p < 0.001) and education (p < 0.001) were associated with increased knowledge levels. 82% of the subjects were willing to donate their eyes and this was unaffected by gender or geographical location (rural vs urban).ConclusionsAwareness levels and willingness to donate eyes are high among the stakeholders in Srikakulam district in India. The services of stakeholders could be utilized, in conjunction with other community based eye donation counselors, to promote awareness regarding eye donation among the general population.

A study to assess the prevalence of possession disorder in a district of South India

A study to assess the prevalence of possession disorder in a district of South India