Morbidity Profile Research Articles

Risk Factors for Unfavorable Glycemic Control Trajectory in Type-2 Diabetes Mellitus: A Community-based Longitudinal Study in Urbanslums of Central India.

Diabetes mellitus (DM) is a chronic disease, which requires optimal glycemic control to prevent its ensuing vascular complications. Pathway to optimal glycemic control in T2DM has a complex socio-behavioral construct, especially in vulnerable populations, like slum dwellers, who have reduced health-care access and lower prioritization of health needs. The study aimed to map trajectories of glycemic control amongst individuals with T2DM living in urban slums and identify key determinants associated with unfavourable glycaemic trajectory. This study was a community-based longitudinal study conducted in an urban slum of Bhopal in Central India. Adult patients diagnosed with T2DM and on treatment for more than one year were included. All 326 eligible participants underwent a baseline interview, which captured sociodemographic, personal behavior, medication adherence, morbidity profile, treatment modality, anthropometric and biochemical measurements (HbA1c). Another 6-month follow-up interview was conducted to record anthropometric measurements, HbA1c and treatment modality. Four mixed effect logistic regression models (through theory-driven variable selections) were created with glycemic status as dependent variable and usage of insulin was considered as random effect. A total of 231 (70.9%) individuals had unfavorable glycemic control trajectory (UGCT), and only 95 (29.1%) had a favorable trajectory. Individuals with UGCT were more likely to be women, with lower educational status, non-vegetarian food preference, consumed tobacco, had poor drug adherence, and were on insulin. The most parsimonious model identified female gender (2.44,1.33-4.37), tobacco use (3.80,1.92 to 7.54), and non-vegetarian food preference (2.29,1.27 to 4.13) to be associated with UGCT. Individuals with good medication adherence (0.35,0.13 to 0.95) and higher education status (0.37,0.16 to 0.86) were found to be protective in nature. Unfavorable glycemic control trajectory seems to be an inescapable consequence in vulnerable settings. The identified predictors through this longitudinal study may offer a cue for recognizing a rational response at societal level and adopting strategy formulation thereof.

MORBIDITY PROFILE AND RISK FACTORS AMONG UNDER-FIVES AND HEALTH CARE SEEKING BEHAVIOURS OFTHEIR PARENTS

The present study investigated the morbidity profile and its risk factors amongunder-fivesand the health care seeking behavioursof their parents in a selectedPanchayat,Ernakulam.Theobjectivesofthestudyweretoassessthemorbidityprofileand its risk factors among under-fives and health care seeking behaviours of parentsand to find the association between morbidity and selected demographic variables andselectedriskfactors.Across-sectionalcommunity-baseddescriptivesurveydesignwasemployed.Thesamplewereselectedusingconveniencesamplingtechnique.Thetoolsweremorbidityprofileassessmentchecklist,riskfactorassessmentchecklistandhealthcare seeking behaviour checklist tool. The findings showed that 81% children hadmorbidityand19%hadnomorbidity.Themost commonmorbidconditionswerecoldand running nose (76%),followed by cough (73%),fever (64%) and hand foot andmouth disease(8%).With regard to a risk factors leading to morbidity, 27% were notgiven exclusive breast feeding, 25% did not start complimentary feeding at the end ofsix months, 14% did not wash their hands before feeding the children, 28% had nofamily history of respiratory tract infection, 20% had no proper ventilation at home,34% had no proper waste disposal, 67% were exposed to passive smoking, 52% ofchildrenweregoingtoAnganwadiand4%hadcongenitaldisorders.Presentstudyalsoshowsthat52%ofmothersreliedonallopathicsectorandequalpercentage(12%)usedAyurvedaandprevious medicationand14%madeuseofhomeremedyduringdiseaseconditions of their children. The findings also showed that there was no associationbetweenmorbidityandselecteddemographicvariables.Thefindingsshowedtherewasassociation between morbidity and using boiled water for drinking (p = 0.038), familyhistoryofrespiratory infections(p=0.05),child goingto day-care/Anganwadi.

Morbidity and mortality profile of neonates: a five-year retrospective study in a tertiary care neonatal unit in Kolkata

Background: Neonatal mortality and morbidity pattern reflects a nation's efficiency and effectiveness of health care services. There is a paucity of reliable data in India on this, while India Newborn Action Plan (INAP) targets single digit neonatal mortality by 2030. Aim was to identify the morbidity and mortality profile of neonates admitted to a tertiary neonatal care unit. Methods: This retrospective descriptive study was conducted at a tertiary care neonatal unit in Kolkata. Data of neonates admitted in this unit were extracted from admission, discharge, and death registers, compiled, and analyzed from January 2015 to December 2019. Neonates brought dead to the unit were excluded. Results: A total of 10301 neonates were admitted during the study period of which 75.05% were inborn. Most of them were male (55.46%) and only 0.70% had differential sexual disorders. A total of 709 deaths were recorded during the study period equating to a rate of 6.9 deaths per 100 neonatal admissions. The major cause of admission was neonatal hyperbilirubinemia (19.30%) followed by congenital anomalies (11.15%), respiratory distress syndrome (10.58%), prematurity (9.72%), and birth weight <1800 grams. (9.51%), perinatal asphyxia (8.11%) and maternal sickness (8.09%). Among congenital anomalies, anomalies related to the gastrointestinal system were most frequent (30.81%). Congenital anomalies (29.9%) were the leading cause of neonatal mortality followed by perinatal asphyxia (17.07%). Conclusions: The commonest causes of neonatal morbidity and mortality were congenital anomalies. Thus, special focus has to be given to the management of congenital malformation in tertiary care units.

Risk factors and trends in neonatal mortality in NICU in a tertiary care hospital in India

Introduction: The most vulnerable period of human life is neonatal period, which accounts for most of the morbidities and mortalities. Most of them are preventable with adequate health-care facilities. Objectives: The aim of the study was to determine the trends of neonatal mortality and identify the risk factors, most of which are preventable and measure the progress of health-care services. Methods: A retrospective study was conducted in neonatal intensive care unit (NICU) of Al-Ameen Children Hospital (AMCH) Vijayapura, Karnataka, India. Data were extracted from paper medical records at AMCH of a period of 1 year and digitized. Data obtained included age, sex and birth weight, place of delivery, morbidity profile, mortality profile, diagnosis, and period of stay in NICU. Results: A total of 648 neonates were admitted in NICU during the study period of 1-year duration, between January and December 2021. A total of 382 (58.9%) infants were discharged on recovery, 65 (10.3%) were referred due to unavailability of advanced surgical intervention, 39 (6%) were discharged against medical advice, 162 (25%) died due to various reasons. Male neonatal deaths outnumbered female neonates (56.8%). Among the total neonatal deaths, 82 (50.6%) were preterm neonates, 73 (45.1%) were term neonates and 7 (4.3%) were post-term neonates. It was noticed that among neonatal deaths, 87 (54.3%) babies were out-born and 75 (46.2%) babies were inborn. In this study, it was noticed that the mortality percentage of the neonate falling in the category of 1.5–1.9 kg was high compared to other categories. In our study, respiratory distress syndrome was the main cause of mortality accounting for 19.1% (31 cases) of total cases and prematurity was the most common risk factor. Conclusion: Improving the standard of antenatal care and encouraging deliveries in institutions having good NICU facility and early identification of risk factors help to reduce the mortality and its complications.

‘Human Milk Bank (HMB): The Journey till Now and the Road Ahead’: A Retrospective Observational Study in a Tertiary Care Centre of Western India

Background In the era of the 21st Century, Human Milk Bank (HMB) is making its tortoise steps towards revolution. The goals and objectives of this study is to compare five years of data between the Pre Human Milk Bank phase (2018–2021) and Post Human Milk Bank phase (2021–2023) in order to evaluate the morbidity and mortality profile of neonates fed with PDHM (pasteurized donor human milk) or MOM (Mother’s Own Milk). Methods A retrospective observational study was done in HMB, Neonatal Intensive Care Unit, Department of Paediatrics, Gmers Medical College, Gandhinagar, Gujarat. Data obtained retrospectively comparing pre-HMB Phase (4th August, 2018–3rd August, 2021) and post-HMB Phase (4th August, 2021–3rd August, 2023). Results Around 1822 newborns benefited from the establishment of the HMB and 2.89 lakh ml of milk from 188 donor mothers were gathered during the study. Bacterial contamination of PDHM was reduced. There was a reduction in mortality and morbidity profiles like sepsis rate, NEC/Feed intolerance and ROP. Duration of NICU stay was improved in all preterm babies. Conclusions In this study, mortality and morbidity outcomes improved and sepsis decreased after the establishment of the HMB with reduced time to reach full feeds and shorter hospital stay. It helps significantly in NEC cases. We concluded that the creation of an HMB will be more advantageous and useful for all preterm babies in order to achieve better results.

A single centre experience on the formation of double barrelled uro-colostomy in pelvic exenteration surgery: a cohort study.

Double barrelled uro-colostomy (DBUC) is an alternative to traditional ileal conduit (IC) and separate colostomy in patients requiring simultaneous urinary and faecal diversion for reconstruction in pelvic exenteration surgery (PES). This cohort study evaluated short- and long-term morbidity and mortality associated with DBUC formation in 20 consecutive adult patients undergoing PES in an Australian Complex Pelvic Surgical Unit. Data were obtained from a prospective database. Mean age 59 years (range 27-76 years). PES was performed for malignant disease in 18 patients (curative intent in 17). Mean operative duration 11.8 h (range 7-17 h). Mean follow-up duration 29.1 months (range 2.6-90.1 months). Early DBUC-related complications occurred in four patients (20.0%): urinary tract infection (UTI)/urosepsis (n = 4) and early ureteric stenosis requiring intervention (n = 1). Late DBUC-related complications occurred in five patients (25.0%): recurrent UTI/urosepsis (n = 4), chronic kidney disease (n = 4), ureteric stenosis (n = 2) and parastomal hernia (n = 4). No mortality occurred secondary to a DBUC complication. DBUC is a safe reconstructive option with acceptable morbidity profile in patients requiring simultaneous urinary and faecal diversion.

A cross-sectional study on the etiological spectrum and morbidity profile among geriatric patients: A hospital-based study

Background: Elderly people are now the most rapidly growing population group worldwide, and the challenge ahead for the health-care system is to ensure the quality of life and provide adequate health care for a large group the of geriatric population. Aims and Objectives: The objective of the study was to determine the most common causes of emergency hospital admission of geriatric patients and to evaluate their morbidity profile. Materials and Methods: This present study was carried out on 208 geriatric patients (age >60 years) in a medical college and teaching hospital, in eastern India between May 2019 and October 2020 after taking institutional ethical clearance and informed consent of the participants. Results: Nearly 38.9% of the participants belonged to the age group of 60–70 years. 73.7% of the participants presented with respiratory diseases (chronic obstructive pulmonary disease and respiratory failure), 21.0% had pulmonary tuberculosis, and 5.3% had cancer lung. Nearly 88.46% had endocrinal morbidity, followed by cardiovascular morbidity (74.03%) and respiratory morbidity (62.50%). 81.25% of the participants had diabetes, and 60.58% suffered from musculoskeletal disorder. 36.53% had osteoarthritis and 22.59% had rheumatoid arthritis. Conclusion: The present study result showed the most common presentation in hospital admissions during the emergency in the elderly were cardiovascular, respiratory diseases, neurological causes, and gastrointestinal disorders. The majority of cases had three or more complications necessitating admission contributing to a higher disease burden in the elderly.

Temporal trend, regional distribution and profile of morbidity and mortality due to childhood burns in Santa Catarina: An ecological study

Temporal trend, regional distribution and profile of morbidity and mortality due to childhood burns in Santa Catarina: An ecological study

Human–river interaction and perceived morbidities: A cross-sectional study on River Killi, Kerala

Abstract INTRODUCTION: Almost all water resources around the world have been polluted by human activities. River pollution from industries and agricultural/domestic areas is ultimately affecting human life. It is important to understand such a problem from a public health angle as well as from the perspective of the river bank population. OBJECTIVE: The study examines the public health dimensions of human-river interaction in relation to the riverbank population and to assess their morbidity profile with respect to river Killi in Trivandrum district, Kerala. METHODOLOGY: The full stretch of the river was divided into grids for every 3 kms. and houses from alternate grids within 50 meters from the river edge were selected for the study. Data collection among 302 riverbank residents was done based on a pre-tested, semi-structured interview schedule in addition to in-depth interviews among 15 stakeholders. RESULTS: The study results showed that 161 (53.3%) households belonged to the Below Poverty Line (BPL) and 169 (56%) respondents were from low socioeconomic status. The human-river interaction was significantly associated with the place of residence (rural/urban) and their economic status. Common self-reported morbidities include itching on the skin (16.2%) and fungal infections (12.9%). The riverbank population also stated their vulnerability to flooding during the rainy season and the unavailability of fresh water during dry summer. The cleaning program by the government had a positive impact on river cleanliness. However, in many places along the stretch of the river, sewage drainage, waste dumping and aquatic weeds are still a problem. CONCLUSION: This study shows several factors that disturbed the positive human-river interaction. A collaborative approach including stakeholders and the riverbank population for better river management and persistent surveillance on river water quality and health evaluation of the riverbank population are needed.

Clinical Profile and Outcomes of Severe Acute Maternal Morbidities in a Tertiary Care Centre, Bangalore, India: A Descriptive Study

Clinical Profile and Outcomes of Severe Acute Maternal Morbidities in a Tertiary Care Centre, Bangalore, India: A Descriptive Study

Complications following resection of primary and recurrent pediatric posterior fossa ependymoma.

Extent of resection (EOR) is the most important modifiable prognostic variable for pediatric patients with posterior fossa ependymoma. An understanding of primary and recurrent ependymoma complications is essential to inform clinical decision-making for providers, patients, and families. In this study, the authors characterize postsurgical complications following resection of primary and recurrent pediatric posterior fossa ependymoma in a molecularly defined cohort. The authors conducted a 20-year retrospective single-center review of pediatric patients undergoing resection of posterior fossa ependymoma at the Hospital for Sick Children in Toronto, Canada. Complications were dichotomized into major and minor groups; EOR was compared across complication categories. The association between complication occurrence with length of stay (LOS) and mortality was also assessed using multivariable regressions. There were 60 patients with primary resection included, 41 (68%) of whom were alive at the time of data collection. Gross-total resection was achieved in 33 (58%) of 57 patients at primary resection. There were no 30-day mortality events following primary and recurrent ependymoma resection. Following primary resection, 6 patients (10%) had posterior fossa syndrome (PFS) and 36 (60%) developed cranial neuropathies, 56% of which recovered within 1 year. One patient (1.7%) required a tracheostomy and 9 patients (15%) required gastrostomy tubes. There were 14 ventriculoperitoneal shunts (23%) inserted for postoperative hydrocephalus. Among recurrent cases, there were 48 recurrent resections performed in 24 patients. Complications included new cranial neuropathy in 10 patients (21%), of which 5 neuropathies resolved within 1 year. There were no cases of PFS following resection of recurrent ependymoma. Gastrostomy tube insertion was required in 3 patients (6.3%), and 1 patient (2.0%) required a tracheostomy. Given the differences in the location of tumor recurrence, a direct comparison between primary and recurrent resection complications was not feasible. Following multivariate analysis adjusting for sex, age, molecular status, and EOR, occurrence of major complications was found to be associated with prolonged LOS but not mortality. These results detail the spectrum of postsurgical morbidity following primary and recurrent posterior fossa ependymoma resection. The crude complication rate following resection of infratentorial recurrent ependymoma was lower than that of primary ependymoma, although a statistical comparison revealed no significant differences between the groups. These results should serve to inform providers of the morbidity profile following surgical management of posterior fossa ependymoma and inform perioperative counseling of patients and their families.

Assessing the link between nutritional status, functional capacity, and morbidity profile in the community-dwelling elderly of Maharashtra, India

BackgroundAgeing challenges elderly individuals, increasing the risk of malnutrition due to physical, psychological, functional, and social changes. Poor nutritional status is directly related to functional capacity and can increase the risk of morbidity and mortality. Early identification of the risk of malnutrition among the elderly can promote independence and well-being with a good quality of life. ObjectivesTo assess the interrelationship between the nutritional status and indicators of functional capacity and morbidity profile among the elderly population from the Pune District of Maharashtra, India. MethodsThe study followed a cross-sectional survey design. The convenience sampling technique was used to recruit participants. Three standardised instruments - the Mini-Nutritional Assessment – Short Form (MNA-SF), the Katz Index of Independence in Activities of Daily Living (Katz ADL) and the Cumulative Illness Rating Scale-Geriatric (CIRS-G) – were used to assess the nutritional status, functional capacity and morbidity profile respectively. The data were analysed using Chi-square tests of association, and independent t-test and one-way ANOVA for difference in means. ResultsParticipants were 100 older adults (age range: 60–90 years). 24 % of the sample were malnourished and 33 % were at risk for malnutrition. Dependent participants had a significantly lower MNA-SF score (5.6 ± 3.5) than independent participants (10.4 ± 3.0) (p < 0.001). There was a significant association between poor nutritional status and morbidity profile specific to disability in organ systems like eyes, ears, throat, haematopoietic, musculoskeletal, and upper GI systems, as well as psychiatric illness (p ≤ 0.05). The CIRS-G score was significantly higher for malnourished participants (12.6 ± 6.2) than those at risk of malnutrition (8.9 ± 4.8) and well nourished (6.0 ± 4.0) (p < 0.001). ConclusionNutritional status was associated with functional capacity and indicators of morbidity profile in the elderly. Incorporating routine nutritional risk screening as a component of healthcare can facilitate early identification of at-risk individuals, enabling timely intervention and improving health outcomes. Future research should prioritise investigating routine screening programs to assess the risk of malnutrition and the effectiveness of nutrition interventions such as dietary modifications and supplementation to prevent malnutrition in older adults.

CHALLENGES OF VERY LATE LIFE: PHYSICAL AND MENTAL HEALTH, CAREGIVING, AND AGING PERCEPTIONS

Abstract The very old are the fastest growing population in developed countries, yet research on this age group remains limited. There are, however, specific challenges of very old age that differ from those in earlier late life phases. Very old individuals and their families may thus have unique needs and may require adapted services. In this symposium, we address selected challenges associated with reaching very old age, including physical and mental health issues, as well as implications of both receiving and providing care. Ribeiro and colleagues report on centenarians’ health and morbidity profiles using the Portuguese census, by comparing individuals aged 100 years old in 2011 and 2021. Jopp and colleagues present findings from the first national Swiss centenarian study on centenarians’ health, cognition, and well-being. Gomes da Rocha and colleagues investigate depressive symptoms in Swiss centenarians during the COVID-19 pandemic, showing notably elevated scores. Kim and colleagues focus on aging perceptions and their correlates among dyads of very old parents and their old children from South Korea, highlighting the impact of the care experience for both dyad members. Gallagher and colleagues examine how old children of very old parents with dementia manage behavioral and psychological symptoms through specific strategies, offering insights on how to better support family care givers of very old dementia patients. In sum, this symposium offers novel insights on specific challenges encountered in very old age, by the individual and their families, and proposes potential pathways towards better understanding and handling of such challenges.

Sentinel Lymph Node Staging in Early-Stage Cervical Cancer: A Comprehensive Review.

Cervical cancer (CC) continues to be a significant global public health concern, even with preventive measures in place. In women with early-stage CC, the status of lymph nodes is of paramount importance, not only for the final prognosis but also for determining the best therapeutic strategy. According to main international guidelines, pelvic full lymphadenectomy (PLND) is recommended for lymph node staging. However, in these early stages of CC, sentinel lymph node biopsy (SLNB) has emerged as a precise technique for evaluating lymph node involvement, improving its morbidity profile. We performed a literature review through PubMed articles about progress on the application of SLNB in women with early-stage CC focusing on the comparison with PET/CT and PLND in terms of oncological outcomes and diagnostic accuracy. While the superiority of SLNB is clear compared to radiologic modalities, it demonstrates no clear oncologic inferiority over PLND, given the higher detection rate of positive lymph nodes and predominance of no lymph node recurrences. However, due to a lack of prospective evidence, particularly concerning long-term oncological safety, SLNB is not the current gold standard. With careful patient selection and adherence to straightforward protocols, a low false-negative rate can be ensured. The aim of the ongoing prospective trials is to address these issues.

PERFIL DA MORBIMORTALIDADE POR DOENÇA PULMONAR OBSTRUTIVA CRÔNICA NO BRASIL ENTRE 2011 E 2021

The aim of the present study was to investigate the profile of hospital morbidity and mortality due to COPD in Brazil between 2011 and 2021, in order to understand the evolution of related health indicators and identify the need for improvement in public policies for prevention and treatment strategies. for the disease. From the processed information, a significant decrease in the prevalence of hospitalizations for COPD was evidenced. The age groups that represented the highest numbers of hospitalizations were “50 years or older” and “under 5 years”. Proportional mortality declined, while COPD-specific mortality did not change statistically significantly over the entire decade. Mortality showed an increasing pattern according to age group, with more than 40% of deaths occurring in individuals aged 80 years or older. The highest numbers of hospitalizations and deaths occurred in the Southeast, South and Northeast regions, with a predominance of males. COPD is a problem that requires greater attention from health services, because despite the decrease in hospitalizations due to exacerbations, severe forms of the disease are still frequent, which highlights weaknesses in the primary and secondary prevention of the disease. Thus, new studies that extensively investigate the factors that determine the epidemiological behavior of the disease are fundamental, because only in this way can strategies and interventions be developed to improve trends in hospitalization and mortality due to COPD in Brazil.

Exploring the Intersectionality of Place and Gender Among Older Adults in Ghana: An Examination of Women's Disability Disadvantage.

Ghana's older adult population is growing rapidly and is projected to double by 2050. It is well-documented that social, health, and housing factors influence segmented aging trajectories that lead to disparate rates of disability. However, little is known about how the intersection of place (i.e., urban and rural) and gender (i.e., woman and man) inform rates of disability among older Ghanaians. We seek to examine this gap in the literature through an intersectional approach. Using logistic regression with Wave 1 (2007/2008) data from the World Health Organization's Study on global AGEing and adult health (SAGE) Ghana, we investigate the prevalence of reporting activities of daily living (ADL) disability among respondents ages 50+ (n = 4,106). To document gender differences by place, we compute separate adjusted odds ratio models among urban and rural respondents. We also control for health, social, and housing factors that might explain gender differences. Compared to urban men, urban women's ADL disability disadvantage was explained by marital status, particularly widowhood. In contrast, rural women consistently reported an ADL disability disadvantage when compared to rural men. Additionally, we found that the morbidity profiles of those who reported ADL disability differed by place and that certain ADL difficulties (i.e., bed transferring and toileting) were especially common among women respondents. Women, regardless of urban or rural residence, were especially vulnerable to ADL disability. Marital status, particularly widows, explained the difference in disability risk between urban men and urban women. This finding suggests that urban women's risk of ADL disability is attenuated during the partnership. Also, we speculate that varied morbidity associations with ADL disability are due to different stressors in urban versus rural environments. These findings also generate further interest in about rural women's disability disadvantage.

A Retrospective Cohort Study on One-Year Mortality Following Emergency Laparotomy: A Tertiary Centre Experience From Western Australia.

Background Emergency laparotomy is a common general surgical procedure associated with a high mortality and morbidity profile. While short-term outcomes following emergency laparotomy have been increasingly described, there remains a paucity of literature on long-term outcomes in Australia. We report our one-year mortality following emergency laparotomy at Royal Perth Hospital, Australia. Methodology A retrospective observational series of emergency laparotomies performed during 2019 and 2020 at Royal Perth Hospital was collected. The primary endpoint is the one-year mortality, and the secondary endpoints are patient demography, COVID-19 status, ASA classification, surgical category, operative indication, primary surgical pathology, procedure and surgical duration, ICU stay, post-operative destination, length of stay, 30-day mortality, and 90-day mortality. Subgroup analysis was performed for years 2019 and 2020. Results A total of 272 emergency laparotomies were performed during the two-year study period. The average age was 61 years (range 18- 98, SD ± 18.32). The majority of patients were in the ASA classification III (n= 134, 49.26%). The average length of patients' stay was 14.17 days (median 10, IQR 11). Moreover, 31.98% of patients were admitted directly to the ICU following emergency laparotomy. One year mortality was 16.6%. However, a significant difference in the long-term mortality rates was observed between the two calendar years, 24.6% in 2019 and 8.66% in 2020. The one-month mortality rate was 7.33%, and the three-month mortality rate was 10.85%. Conclusion The one-year mortality rate observed is high and considerable and similar to experiences published elsewhere. The significant reduction in mortality during the study period warrants further investigation and may reflect improved planning and attitudes around these high-risk surgeries.

Morbidity Profile and Healthcare Service Utilization Pattern Among Geriatric Population in the Rural Himalayan Region of Uttarakhand, India: A Cross-Sectional Study.

The increasing elderly population, along with their health problems, is a matter of concern, especially in the difficult terrains of the hilly Himalayan region of northern India. Hence, the present study was conducted to assess the healthcare-seeking behavior of the elderly and adherence to medication. The present community-based cross-sectional study was conducted on 250 elderly participants by a consecutive sampling method. Data were collected during the months of July 2021 to October 2021 after obtaining institutional ethical clearance. Bivariate logistic regression was done to assess factors associated with healthcare services utilization patterns and adherence to medications in chronic diseases. Significant factors were then analyzed with a multivariate logistic regression model. Variables with p-value <0.05 on multivariate analysis were considered statistically significant. The mean age of the study participants was 67.2 (±8.09) years, and 52% were males. Chronic illness was diagnosed in 45.6% participants. Only 121 (48.4%) participants were aware of health insurance schemes among whom95 (38%) were registered. Appropriate healthcare-seeking behavior for acute illness episodes was seen in 68.9% of participants. A government healthcare facility was the most preferred facility.Low adherence to chronic disease medication was seen in 41.2%. Participants registered under any health insurance scheme had higher adherence to medications (OR=0.36; 95% CI, 0.15-0.86; p-value=0.02). The majority of the participants preferred government healthcare facilities. Registration under any health insurance scheme was found to significantly influence adherence to medications. Further qualitative studies can be of paramount importance in understanding the perspectives of the geriatric population in the study area.

A study of morbidity profile and health seeking behaviour of inmates of selected old age homes of Bangalore city

Background: Assessment of the morbidity profile will help in the application of interventions, to improve the health status and the quality of life of the elderly Methods: A descriptive cross-sectional study was conducted among the inmates of selected old age homes of Bangalore city between November to December 2019 using complete enumeration with a pre-tested semi-structured questionnaire to assess morbidity profile and health seeking behaviour. Results: Majority of the study population (54.5%) was in the age group of 60-69 years followed by 80 years and above (25.5%) and 66.7% of were female. Most common morbidity identified among the elderly were Musculoskeletal disorders 100 (30.3%) followed by Diabetes 70 (21.2%), Hypertension 58 (17.6%), respiratory diseases 38 (11.5%), and Eye problems 34 (10.3%),) respectively. Majority of them 208 (63.0%) relied on Government health facilities citing free services as the common reason; whereas 122 (37.0%) approached the private sector for health assistance owing to the ease of access. Conclusions: Findings of the present study further reiterates the growing burden of chronic morbidities in the geriatric age group. It calls for programmes for creation of awareness among the elderly regarding regular medical checkups to ensure prevention and early detection of the chronic diseases.

Seasonal malaria chemoprevention in a context of high presumed sulfadoxine-pyrimethamine resistance: malaria morbidity and molecular drug resistance profiles in South Sudan

BackgroundSeasonal malaria chemoprevention (SMC) using sulfadoxine-pyrimethamine plus amodiaquine (SP-AQ), is a community-based malaria preventive strategy commonly used in the Sahel region of sub-Saharan Africa. However, to date it has not been implemented in East Africa due to high SP resistance levels. This paper is a report on the implementation of SMC outside of the Sahel in an environment with a high level of presumed SP-resistance: five cycles of SMC using SPAQ were administered to children 3–59 months during a period of high malaria transmission (July–December 2019) in 21 villages in South Sudan.MethodsA population-based SMC coverage survey was combined with a longitudinal time series analysis of health facility and community health data measured after each SMC cycle. SMC campaign effectiveness was assessed by Poisson model. SPAQ molecular resistance markers were additionally analysed from dried blood spots from malaria confirmed patients.ResultsIncidence of uncomplicated malaria was reduced from 6.6 per 100 to an average of 3.2 per 100 after SMC administration (mean reduction: 53%) and incidence of severe malaria showed a reduction from 21 per 10,000 before SMC campaign to a mean of 3.3 per 10,000 after each cycle (mean reduction: 84%) in the target group when compared to before the SMC campaign. The most prevalent molecular haplotype associated with SP resistance was the IRNGE haplotype (quintuple mutant, with 51I/59R/108N mutation in pfdhfr + 437G/540E in pfdhps). In contrast, there was a low frequency of AQ resistance markers and haplotypes resistant to both drugs combined (< 2%).ConclusionsThe SMC campaign was effective and could be used as an additional preventive tool in seasonal malaria settings outside of the Sahel, especially in areas where access to health care is unstable. Malaria case load reduction was observed despite the high level of resistance to SP.