Kerala Population Research Articles

Gender differences in self care in type 2 diabetes in rural Kerala

Background: Noncommunicable Diseases (NCDs) were estimated to have contributed to almost 60% of deaths in the world and 43% of the global burden of disease in 1999. NCDs are rapidly becoming a major public health threat in the developing world. The W.H.O fact file on NCDs states that healthy diet, regular physical activity, maintaining a normal body weight (self-care) are ways to prevent or delay the onset of type 2 diabetes or its complications. Thus, self-care in diabetes is the corner stone in achieving good glycemic control, thereby preventing the onset of diabetes complications which increases the morbidity and mortality of the disease. This study was undertaken to understand the effect of self-care on HbA1C (blood sugar control) among males and females with Type -2 diabetes in a rural population in Kerala. The study tries to draw out the differences in self-care among males and females taking into consideration the patriarchal nature of the society and to understand the gender differences in approaches to self-care. Sex- based differences should be considered when developing awareness and treatment programs for people with diabetes, more precisely in NCD preventive measures specifically for the Indian subcontinent.
 Materials and methods: A cross sectional study was conducted in a stratified random sample of diabetes patients belonging to the three religious groups found in the study area, in a diabetes treatment center in Kanjirapally taluk of Kottayam district. Based on pilot study, a sample of 300 is chosen with 138 males and 162 females. For part 1 of the questionnaire, demographic details were entered by the researcher and the medical records were accessed to record the relevant details like height, weight, A1C, B.M.I., F.B.S. and chronic conditions of the patients. The selfcare activity of the patients were assessed with the SDSCAS (Summary of diabetes self-care activity scale). It
 consists a core set of 12 questions to assess the dietary habits, exercise regimen, blood sugar testing, foot care and smoking status for the past 7 days. 
 Results: Since the representative sample is not made of equal number of males and females, comparison of blood sugar control (HbA1C) based on self-care activities for males and females were calculated. The independent sample t-test is highly significant at 0.01 level with respect to general diet, specific diet, dietary adherence and podiatric care. The t-test again shows significance at 0.05 level with respect to physical activities on comparison. 
 Conclusions: The self-care activities varied greatly between males and females. The self-care activities of the females were very poor when compared with the males. The poor self-care activities of the females could be attributed to behaviour conditioned by gender relations prevalent in the society. Women seem to assimilate or internalize the patriarchal subjectivity of the society. But this is a feature of most households not only in the study area but of the country as a whole. This gender difference in self-care can be annihilated by stringent awareness and health education campaigns. NCD prevention strategies should include gender sensitive health promotion measures to achieve the WHO Global Strategy for the Prevention and Control of Noncommunicable Diseases (NCD Action Plan).

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Health Conditions, Medication and Hospitalisation Preferences of Elderly in Kerala

This article intends to study the health conditions, medication and hospitalisation preferences, and the determinants of medication preferences of the elderly population in Kerala. It is based on the primary data collected from a sample of 801 households and three old-age homes (OAHs) in three districts of the state, namely Kozhikode, Ernakulum and Trivandrum. The evidence suggests that the elderly population are vulnerable to various chronic diseases and they tend to spend more on healthcare. In the absence of public provision of effective healthcare services in Kerala, the elderly spend out-of-pocket on health expenses and choose private hospitals for effective and better treatment. However, those who prefer government hospitals mostly belong to poor and marginalised groups, including the inmates of OAHs. With regard to the type of medicines, the elderly often prefer Ayurveda and Homeopathy to Allopathy medicines. Based on these findings, we suggest that the government intervention in terms of more health care facilities and health insurance schemes for the elderly is necessary to improve their quality of life.

The familial clustering of dyslipidaemia in patients with coronary artery disease with markedly elevated LDL cholesterol – A hospital based study in south Kerala population

The familial clustering of dyslipidaemia in patients with coronary artery disease with markedly elevated LDL cholesterol – A hospital based study in south Kerala population

Narrow gene pool can threaten the survival of Calamus nagbettai R. R. Fernald & Dey: a highly, endemic dioecious rattan species in the Western Ghats of India

Rattans, the spiny climbing palms of Arecaceae (Palmae) family exhibit high endemism to the biodiversity hot spots in India. Of the five rattan genera, Calamus is the only genus found in peninsular India with 15 of 21 species, endemic to the Western Ghats. The extensive utilization of rattans owing to their strength, durability and huge demand has resulted in depletion of their natural resources. Of the 15 endemic species, C. nagbettai is the most affected species on account of endemism, low population size and restricted distribution with fragmented populations. The present study revealed high amount of genetic diversity in the surviving scattered populations of the species using microsatellite markers. High gene flow (Nm = 1.498) observed across the populations resulted in low genetic differentiation (14%). A clear genetic admixture could be seen in Kerala as well as one of the Karnataka's populations while the remaining two populations were genetically distinct. UPGMA, PCoA and STRUCTURE analyses showed significantly different genetic composition in Kerala population compared to other populations. Kerala and Karnataka populations of C. nagbettai were also unique in their genetic structure and allelic composition. Therefore, effective management and conservation strategies have to be implemented to preserve the rarealleles with adaptive potential to protect this economically valuable Calamus species from endangerment. Over exploitation, low seed set and poor regeneration, as well as habitat fragmentation can further threaten the survival of this endemic, narrowly distributed dioecious rattan species in the Western Ghats region.

Spatial Clusters of Diabetes and Physical Inactivity: Do Neighborhood Characteristics in High and Low Clusters Differ?

This study aims to find spatial clusters of diabetes and physical inactivity among a sample population in Kerala, India, and evaluate built environment characteristics within the high and low spatial clusters. Spatial clusters with a higher and lower likelihood of diabetes and physical inactivity were identified using spatial scan statistic at various radii. Built environment characteristics were captured at panchayat level and 1600 m buffer around participant location using Geographical Information Systems. Comparison of sociodemographic and built environment factors was carried out for participants within high and low spatial clusters using t tests. Ten high and 8 low spatial clusters of diabetes and 17 high and 23 low spatial clusters of physical inactivity were identified in urban and rural areas of Kerala. Significant differences in built environment characteristics were consistent for low spatial clusters of diabetes and physical inactivity in the urban scenario. Built environment characteristics were found to be relevant in both urban and rural areas of Kerala. There is an urgent call to explore spatial clustering of non-communicable diseases in Kerala and undo the one-size-fits-all approach for prevention and control of non-communicable diseases.

Prevalence and Pattern of Distribution of Impacted Mandibular Third Molars on Digital Panoramic Radiograph among Central Kerala Population: A Cross Sectional Study

Prevalence and Pattern of Distribution of Impacted Mandibular Third Molars on Digital Panoramic Radiograph among Central Kerala Population: A Cross Sectional Study

Mesiodistal Crown Width Digital Ratio for Kerala Population: A Cross-sectional Survey

Introduction: The orthodontic examination may be incomplete without a careful analysis of the patterns of mesiodistal crownsize relationships. No published data are available regarding tooth size— arch length discrepancy (Bolton values) for Kerala population. Aim: To establish Bolton's values specific to Kerala population. Thus, this was done in order to determine Bolton's anterior and overall and posterior ratio between males and females specific to Kerala population and compare it with Bolton's values. Secondly to determine the values outside of 1 standard deviation (SD) and 2SD. Materials and methods: The sample for the present study consisted of 160 pretreatment study casts (Group A— 75 male patients and Group B— 85 female patients). Digital vernier caliper (Standard Digital Caliper Series: EC16) with a 0.01 mm resolution, ±0.02 mm accuracy and 0.01 mm repeatability, manufacturer specification) was used to measure the mesiodistal width of the teeth. Result: Mean anterior, overall and posterior ratios were found to be 77.32 ± 6.67; 91.78 ± 7.43; 1.07 ± 0.06 respectively. 93.8% of the sample had anterior ratio in 1SD and 3.8% in 2SD. 94.4% were in 1SD and 2.5% in 2SD for overall ratio. Conclusion: Although the means were nearly identical with those of Bolton's study, ranges and SDs were significantly larger. This study indicates that the Bolton's analysis can also be used on Indian or at least Kerala population but with increased standard deviation.

Assessment of morphological and genetic variability through genic microsatellite markers for essential oil in Sandalwood (Santalum album L.).

Sandalwood (Santalum album L; family Santalaceae) is a highly significant aromatic oil yielding tree. It is valued for two important traits, heartwood and essential oil obtained from the heartwood. This study was proposed to assess the morphological and genetic variability of sandalwood accessions. For this, genotypes were randomly selected (n = 177) from the 14 populations from three states in southern India. The total heartwood oil content and quality was estimated by UV method and GC-MS. Total 14 oil-specific genic SSR markers were procured to evaluate the genetic diversity among the sandalwood accessions. Total core size, heartwood content, and oil of S. album ranged from 4.4 to 19.1cm; 0.0 to 17.3cm; and 0.0 to 5.96% with covariance 27.61, 85.25, and 73.12% followed by mean 9.74, 3.77, and 2.71, respectively. Genetic diversity estimates were highly polymorphic in terms of Na 7.28, Ne 5.89, He 8.0 PIC 0.891, with little Ho, and F-0.922. AMOVA revealed that minimal genetic variation among populations and highest variation was found among individuals with Nm (58.4). The UPGMA reveals the cluster favored the grouping pattern by the PCA analysis. Structure and PCA analysis clustered the entire populations into two major groups with F ST 0.046 in which population of Kerala and Karnataka were pure and Telangana accessions were found admixtures. No significant correlation (r 2 = 0.23, P = 0.00) was observed between heartwood oil and genetic structures. A high degree of transferability of genic markers would facilitate the assessment of novel genotypes for future tree improvement and conservation of Sandalwood populations.

An epidemiological study of dental caries and associated factors among children residing in orphanages in Kerala, India: Health in Orphanages Project (HOPe)

It is estimated that, as of 2010, there were 32 million orphaned children in India. There is little published information on the oral health of children in orphanages in India. To determine caries status and associated risk factors among children in orphanages in Kerala, India. This cross-sectional study assessed caries using World Health Organization (WHO) criteria, and caries experience was reported as decayed, missing and filled primary or secondary teeth (dmft or DMFT, respectively). A brief questionnaire captured information on child oral health behaviours. Mean [standard deviation (SD)] and median [interquartile range (IQR)] scores were used to describe caries rates. Multivariable logistic regression analysis was conducted to identify independent disease predictors. Study design complexities, such as clustering by orphanage and stratification by district, were accounted for in the multivariable regression analysis. This was carried out using the survey commands in STATA 13. A value of P<0.05 was considered as statistically significant. Overall, 1,137 children residing in 31 orphanages across the State of Kerala were recruited to the study. Female children made up 82% of the sample. In 6-year-old children the prevalence of caries was 77% and the mean dmft score was 3.60 (SD= 3.50); in 12-year-old children the prevalence of caries was 44% and the mean DMFT score was 1.35 (SD = 1.96). Among 12-year-old children, those who reported being shown how to clean their teeth were less likely to have caries (odds ratio=0.62; 95% confidence interval: 0.38-0.95). Caries rates among children in orphanages were much higher than among children in the general population in Kerala. There is an urgent need for evidence-based and sustainable primary prevention strategies to reduce the burden of caries in this highly vulnerable population.

Prevalence of chronic respiratory symptoms in an urban population of North Kerala

Background: Chronic respiratory diseases are becoming a challenge to public health due to its high morbidity and mortality. Most of these diseases are preceded by variable periods of chronic respiratory symptoms. If chronic respiratory symptoms can be diagnosed and managed properly and timely, we can reduce the incidence and complication of chronic respiratory diseases.Methods: A community based cross sectional survey was conducted in 20 electoral wards of Calicut corporation of Northern Kerala among the adult resident population of 20-70 years to assess the prevalence of chronic respiratory symptoms such as chronic cough, phlegm, wheezing, breathlessness and nasal allergy and the factors associated with these chronic symptoms. The information was collected from 1384 eligible subjects selected by cluster sampling using British research council respiratory questionnaire.Results: About 9.2% (n=95) of study population had at-least one of the chronic respiratory symptoms. 1.8% (n=19) had all the chronic respiratory symptoms. Prevalence of various chronic respiratory symptoms was chronic cough (8.7%), Phlegm (14.3%), wheezing (8.5%), breathlessness (2.2%) and nasal allergy (14.5%). Advancing age, current smoking, family history and past history of various respiratory diseases are significantly associated with the development of chronic respiratory symptoms. Female gender, longer duration of stay in Calicut corporation and regular alcoholism were significantly associated with chronic phlegm in the study population. Wheezing, breathlessness and chronic nasal allergy was significantly higher among lower socio economic status.Conclusions: Prevalence of chronic respiratory symptoms is high among the urban population of Northern Kerala. Older age group, smoking, past and family history of respiratory diseases are the major risk factors associated with these respiratory symptoms.

Suspected spread of hepatitis A virus from a restaurant among adults in rural area of the Kerala state, India.

India is experiencing a substantial decrease in early childhood exposure to hepatitis A virus (HAV). Kerala has experienced several hepatitis A outbreaks in young adults/adults in the recent past. The current hepatitis outbreak occurred in Nellikuzhi, Kerala state, India in December 2016. Investigation was carried by preparing a line list of suspected hepatitis cases. The blood and stool samples collected from patients were tested for anti-HAV/anti-Hepatitis E virus (HEV) immunoglobulin (IgM) antibodies and RNA respectively. A total of 562 suspected hepatitis cases were reported during the outbreak. Along with the first case (35 years, male), 86.1% (484/562) of the cases gave history of consuming food/water/cold drinks from one restaurant. Anti-HAV IgM positivity was 74.5% (73/98) in tested samples and amongst the positives, 81% were adults/young adults and adolescents. None of the samples tested positive for anti-HEV IgM. There were three HAV associated deaths without any co-morbidity. Sequence analysis of HAV RNA positive stool samples showed the presence of genotype IIIA HAV. The suspected source of the infection was a private well situated in the premise of a restaurant. Considering increasing HAV naive population in Kerala, there is a need to introduce hepatitis A vaccine in high-risk age groups.

Assessment of Common Risk Factors Between Oral Diseases and Non-communicable Diseases in a Hospital-based Population in Kerala, IndiaA Cross-sectional Study

Assessment of Common Risk Factors Between Oral Diseases and Non-communicable Diseases in a Hospital-based Population in Kerala, IndiaA Cross-sectional Study

Prevalence of precancerous lesions in an adult population.

The present study aimed to identify the prevalence of precancerous lesions among an adult population in Kerala, India. A dental screening camp was organized in each district at two locations for two consecutive days to draw maximum participation of the community. All adult subject's attending the camp were initially screened for precancerous lesions using conventional light. An initial oral screening was done by two public health dentists and suspected cases were subjected to Identafi Oral cancer screening device and followed by histopathological evaluation. The prevalence of oral precancerous lesions in the adult population of Kerala was 4.4%. Most of the lesions were associated with the use of tobacco followed by alcohol and spicy foods. The oral cancer detection device is an aid in detection of oral precancerous lesions.

Prevalence and Determinants of Somatization and Anxiety among Adult Women in an Urban Population in Kerala.

Background:Common mental disorders (CMDs) such as somatization and anxiety are prevalent in general practice. These are twice more common in women.Objectives:The objective of this study is to estimate the prevalence and determinants of somatization and anxiety among adult women in an urban population of Kochi.Materials and Methods:A cross-sectional study was conducted among 1210 adult women of Kochi in 2016–2017. The Patient Health Questionnaire-15; the Generalized Anxiety Disorder-7 questionnaire; the Hurt, Insult, Threaten, and Scream tool; and a semi-structured questionnaire were used to estimate the prevalence of somatization and anxiety. Descriptive statistics and univariate and multivariate analysis were done for factors associated with CMDs.Results:Most of the respondents were married (77.7%), with a mean age of 45.24 ± 15.59. In the current study, 40.8% (95% confidence interval [CI] =38.09–43.62) had somatization and 23.9% (95% CI = 21.57–26.37) had anxiety disorders. In the final logistic regression model, hypertension, perception of illness, positive family history of mental illness, and arthritis were the four determinants common to somatization and anxiety. Menstrual problems (odds ratio [OR] =3.19; 95% CI = 1.12–5.9), cardiac illness (OR = 2.31; 95% CI = 1.08–4.9), and history of major surgeries (OR = 1.62; 95% CI = 1.14–2.41) were independent determinants of somatization. The status of being single (OR = 1.71; 95% CI = 1.25–2.32), adverse life circumstances (OR = 5.85; 95% CI = 3.98–8.6), diabetes (OR = 2.04; 95% CI = 1.25–3.34), sleep problems (OR = 1.64; 95% CI = 1.77–2.91), and history of drug use (OR = 4.89; 95% CI = 1.92–12.46) were independent determinants of anxiety.Conclusion:Mental health services for urban women deserve immediate attention as the prevalence of somatization and anxiety is high. Hence, it is important to screen for somatization and anxiety among women with noncommunicable diseases.

Multivariate analysis of nonmetric traits in permanent anterior teeth: A forensic overview

Introduction: Dental morphology is a highly heritable characteristic, also stable with time and has a fairly high state of preservation. Nonmetric dental traits have a crucial role in ethnic classifications of a population which helps in forensic racial identification purposes. Aims and Objectives: The objective of the study is to determine the frequency and variability of possible nonmetric tooth traits using extracted permanent anterior teeth from Kerala population for discerning racial ethnicity. Materials and Methods: This qualitative, cross-sectional study was carried out using 1761 extracted intact permanent anterior teeth collected from different dental clinics situated all over Kerala. Results: The most common trait noted was shoveling in both incisors and canines with maximum expression in 11 (69.12%) followed by 21 (62.94%). Double shoveling and lingual tubercle prevalence in canines (12.64% and 10.18%) were more than incisors (6.09% and 7.55%). In canines, the expression percentage of palatal fossae, lingual fossae, and distal accessory ridge was 31.13, 18.49, and 10.56, respectively. Conclusion: The results showed a higher degree of shoveling trait in this population. This research suggested new elements of invaluable ethnographic tooth traits value to understand racial ethnicity of Kerala population.

Prevalence and gender distribution of malocclusion among 13-15-year-old adolescents of Kerala, South India.

To determine the prevalence and gender distribution of malocclusion in 13-15-year-old adolescents of Dravidian ethnicity, residing in urban and rural areas of Kerala, South India. A total of 1554 children (779 males, 775 females), from both urban and rural areas were examined in school settings. Survey proforma for personal details and occlusal registration according to Bjork et al. (1964) were used. Chi-square test was used for analysis. Overall prevalence of malocclusion was 89.9% which included Angle's Class I, Class II (17.6%) and Class III (8%) malocclusions. Other anomalies detected were increased overjet (11.8%), anterior crossbite (27.5%), anterior open bite (1.6%), posterior crossbite (5.1%), scissor bite (4.4%), midline deviation (6.8%), bimaxillary protrusion (BMP-21.3%), crowding (66.6%), spacing (15.3%), rotations (45.4%), ectopic eruptions (11.1%), peg laterals (2.4%) and missing teeth (6.6%). Males showed a higher predilection for increased overjet, deep bite, spacing and missing teeth. Class III, BMP, midline deviations and rotations were found to be more prevalent among the rural group, whereas Class II, increased overjet, deep bite and ectopic eruptions were more prevalent among the urban. Information regarding the detailed pattern of malocclusion prevalence and the high prevalence of BMP among South Indian population of Kerala may provide a baseline data for planning orthodontic services.

Prevalence and Pattern of Antibiotic Self-Medication Practice in an Urban Population of Kerala, India: A Cross-sectional Study.

Background:Self-medication involves the use of medicinal products by a consumer to treat self-recognized disorders or symptoms or intermittent or continued use of a medication prescribed by a physician for chronic or recurring diseases or symptoms. Practicing self-medication for antibiotics is a major factor fueling the emergence of drug resistance. This study would help health-care providers in creating public awareness on the dangers of antibiotic abuse.Objectives:The aim of the study was to assess the prevalence and pattern of antibiotic self-medication in an urban population of Kerala.Materials and Methods:A community-based cross-sectional study was carried out in Thrippunithura municipality, Kerala. Data were collected from 755 adults by face-to-face interview using a questionnaire after obtaining consent. Data were entered in Excel and were analyzed using SPSS.Results:The percentage of respondents who practiced antibiotic self-medication was 3.31%. Males (4.1%), graduates (3.8%), and skilled workers (8.5%) were found to practice antibiotic self-medication. Majority took self-medication for sore throat (25%). Azithromycin (39%) was the major antibiotic used. Among the respondents, 36% used doctor's previous prescription to get antibiotics. The reason for antibiotic self-medication reported by majority was convenience (41%).Conclusion:Health education must be given to graduates and professionals, highlighting the problems due to antibiotic self-medication. With danger of antibiotic resistance developing, this is a major threat that has to be addressed urgently.

Comparison of Health-care Utilization Pattern and its Correlates among the Tribal and NonTribal Population of Kerala.

Background:The isolation from mainstream development activities, together with poverty and inaccessibility to health facilities made the tribal communities specifically vulnerable to various health problems.Objectives:This study aimed to compare the utilization of antenatal care, immunization, and supplementary nutrition services by tribal and nontribal mothers and its correlates in the selected districts.Materials and Methods:The study was a comparative cross-sectional study. The study population comprised tribal and nontribal mothers utilizing antenatal care, immunization, and supplementary nutrition services. A multi-stage cluster sampling strategy was employed for the study. The Chi-square test was used to assess the association between antenatal care services utilization, utilization of immunization services, supplementary nutrition services utilization and sociodemographic variables, and other service characteristics.Results:Effective utilization of antenatal care services was not seen in 5.6% of tribal mothers. The incidence of low-birth weight (≤2500) was significantly more among tribal mothers (31%) when compared to nontribal mothers (15%). The proportion of tribal children receiving complete immunization without delay was 74%, and among nontribal children, it was 78%. Effective immunization coverage was significantly lower among children of tribal mothers with education below high school level. Receipt of take-home ration was reported by nearly 90% of tribal and nontribal mothers. 90% of tribal mothers felt that quality of take-home ration that they received was of good quality.Conclusions:The comparison of health-care utilization restricted to the domains of antenatal care, immunization services, and supplementary nutrition suggests that the tribal mothers and children had a relatively comparable utilization pattern in most of the indicators measured.

Olfactory fossa depth: CT analysis of 1200 patients

Background:Olfactory fossa (OF) is a depression in anterior cranial cavity whose floor is formed by cribriform plate of ethmoid. Lateral lamella, which forms its lateral boundary, is a thin plate of bone and is at risk of injury during functional endoscopic sinus surgery, especially when fossa is deep/asymmetric.Aims:To measure the variations in the depth of OF and categorize Kerala population as per Keros classification using computed tomography (CT).Settings and Design:This study was conducted in our institution from January 2016 to August 2017. Patients >16 years of age undergoing CT scan of paranasal sinuses (PNS) were included.Materials and Methods:Coronal PNS CT scan studies of 1200 patients were reviewed. The depth of OF was measured from vertical height of lateral lamella.Statistical Methods:Results were analyzed according to gender and laterality using independent sample t-test and Chi-square test.Results:The mean depth of OF was 5.26 ± 1.69 mm. Statistically significant difference was seen in the mean depth of OF between males and females but not between right and left sides. Keros type I was found on 420 sides (17.5%), type II in 1790 (74.6%), and type III on 190 sides (7.9%). Type III Keros was more on the right (9%) than left (6.8%) side, more in males (9.5%) than females (5.9%), and more among males on the right side (11.4%). Asymmetry in OF depth between two sides was seen in 75% of subjects.Conclusion:Prevalence of the dangerous type III OF, even though low, is significant especially among males and on the right side. Therefore, preoperative assessment of OF depth must be done to reduce iatrogenic complications.