Rural Community In South India Research Articles

Factors influencing access to psychiatric care among persons with psychosis living in a rural community in south India.

A substantial proportion of persons with psychosis (PWP) remain untreated in the community across the world. Factors that preclude them from accessing psychiatric treatment are poorly studied. In this study, we explored the factors that prevented persons with schizophrenia and their caregivers from accessing psychiatric treatment using an interview schedule specifically developed for this purpose. We identified individuals with schizophrenia and related disorders who had never accessed psychiatric treatment. We interviewed 67 such individuals and their family members using a validated tool, the Schedule of Factors Influencing Access to Treatment (SOFIAc) and analysed the data using descriptive statistics. The M (SD) number of factors reported to preclude individuals with psychosis and families from seeking psychiatric treatment was 10 (3.32). No PWP/family reported any single factor as the sole reason for not accessing treatment. Distance to the nearest psychiatric centre (97%), PWP's/family members' knowledge and attitude towards symptoms of psychosis and treatment (92.5%), financial problems (91%), lack of insight and active resistance to efforts towards treatment (86.6%), lack of support from the family (83.6%) and family issues and dynamics (79.1%) were reported to be the commonest factors that precluded them from accessing psychiatric treatment. The reason for individuals with psychosis and their family members not accessing psychiatric treatment was invariably multifactorial, involving, on average, 10 factors. Programmes that target the reduction of the treatment gap should be cognizant of the multifactorial nature of the challenge of reaching psychiatric treatment for persons with psychoses.

Assessment of self-medication with analgesics among rural community of South India

World Health Organization defines self-medication (SM) as the self-administration of a medication in the absence of a current prescription and/or without consulting a healthcare professional. Analgesics are the most commonly abused drug as a self-medication for relieving pain of any kind among the people. Our aim was to assess the prevalence of self- medication with analgesics and find the social factors associated among the rural people in Southern India. A community based cross sectional study using cluster sampling technique, four villages (clusters) were randomly selected in a rural District and among 460 respondents belonging to age group 18 to 60 years were interviewed. The mean age in years was 48.4 ± 15.5. About 182(39.6%) were illiterates and many respondents belonged to Agricultural laborers 350(76.1). Self-medication with analgesics is practiced by 24.8% of the respondents. Reason for self-medication was to reduce the out-of-pocket expenditure (72.4%). About 65.8% respondents purchased analgesics over the counter from pharmacy. The prevalence of self‑medication with analgesics was relatively high which is a threat for the community and can lead to multi organ damage to among rural people. Universal policy on drug selling over the pharmacy counter should be strictly implemented.

Impact of incentivizing ASHAs on the outcome of persons with severe mental illness in a rural South Indian community amidst the COVID-19 pandemic.

Task shifting has been recommended as a strategy to reach out to persons with mental illness and bridge the treatment gap. There is a need to explore task-shifting using existing health staff like Accredited Social Health Activists (ASHAs). We examined the impact of incentivizing ASHAs on the outcome of persons with severe mental illness (SMI) amidst the pandemic. One hundred eighty-four adults with SMI from Jagaluru taluk were enrolled and followed up for a year. They were assessed for disability, work performance, internalized stigma, and illness severity at baseline, six months, and 12 months follow-up. ASHA workers were incentivized to ensure follow-up consultations, address concerns regarding illness/ medication side effects and monitor medication adherence. Out of the 184 recruited patients, 7 died (non-COVID-19 causes), 22 stopped treatment and did not report for follow-up consultations, 11 shifted to treatment from other centers, and in 1 case, there was a change in diagnosis. 143 (78%) patients with SMI completed the study amidst the COVID-19 pandemic. At one year follow-up, there was a significant reduction in disability, illness severity, self-stigma, and improved work performance. Incentivization of ASHAs helped ensure continuity of care to persons with SMI despite lockdowns and COVID-19 exigencies. It is feasible to involve ASHAs in the treatment of persons with SMI.

Biochemical and Radiological Parameters in Acute Pancreatitis among Patients from a Rural Community of South India: A Retrospective and Correlational Study

Background and Purpose: Acute pancreatitis is one of the major causes of acute abdominal pain that requires hospital admission worldwide. Our objective was to find the proportion of acute pancreatitis in acute abdomen cases among the rural population and to assess pancreatic enzymes (lipase and amylase) for the severity of acute pancreatitis. By doing so, we can establish the importance of a single enzymatic marker in acute pancreatitis. Methods: A retrospective and observational study was undertaken on men and women of all age groups admitted over 1 year with acute pancreatitis at a rural tertiary care hospital located at the tristate junction of South India. Pancreatic enzymes (lipase and amylase) were compared based on the grading and severity of pancreatitis according to the modified computed tomography severity index. Results: The proportion of acute pancreatitis was 40% among all acute abdomen cases. Most patients with acute pancreatitis were chronic alcoholic men (62.5%). The common finding in abdominal ultrasonography (USG) was the enlargement of the pancreas (97.5%). There was an overall rise in serum lipase levels in all acute pancreatitis patients, especially in alcoholic patients. The median lipase levels were higher in severe acute pancreatitis than in moderate acute pancreatitis, with P = 0.006. In comparison, there was no significant difference in amylase values between them. Conclusions: In this study, we could conclude that acute pancreatitis is one of the major emergency conditions in this region of rural India, especially among men who are chronic alcoholics. The enlargement of the pancreas was the most frequent finding in USG among these patients. We suggest that a single pancreatic marker (serum lipase) in acute pancreatitis can be cost-effective. Moreover, serum lipase can also be a marker for assessing the severity of acute pancreatitis.

Nutritional anemia in a rural community in Tamil Nadu

Background: The prevalence of anemia in India is moderately high, leading to a thrust toward iron fortification of commonly used dietary cereals. We undertook a study to determine the prevalence of anemia in a rural population in Tamil Nadu and to evaluate its association with social, cultural, and dietary practices. Methods: Four hundred and twenty-three adults living in 39 villages comprising the Kattankulathur block of Kancheepuram district in Tamil Nadu were recruited for this study. Data regarding social, cultural, and dietary practices were recorded and hemoglobin estimated using capillary blood samples. Anemia was classified according to the criteria specified by the World Health Organization. Results: Anemia was found in 91 of 244 (37.3%) female respondents and in 17 of 179 (9.5%) male respondents. In univariate analysis, anemia exhibited associations with marital status, level of education, occupation, and socioeconomic status. The prevalence of anemia was higher in diabetics, and in those who had no awareness of anemia. Anemia was less prevalent in those who frequently consumed milk, fish, beef, or dates. In multivariate analysis, when gender was eliminated, consumption of dates, socioeconomic class, frequent milk consumption, and alcohol consumption were independently associated with anemia. Conclusions: Socioeconomic class and dietary practices were the strongest determinants of anemia in a rural South Indian community and should inform interventions in the community.

Parental consanguinity among patients with schizophrenia in a rural community of South India: A clinical and genetic investigation.

Studies from certain regions of the world indicate that consanguineous marriages are a risk factor for the development of schizophrenia in offspring. However the evidence is inconsistent partly due to methodological limitation of which hospital based recruitment contributing to significant bias. The studies from the Indian subcontinent, is scarce, where rates of consanguinity is high. The schizophrenia patients living in a geographically defined rural south Indian community and randomly selected controls dwelling in the same community sharing sociocultural, economic and lifestyle factors were recruited. They were assessed for parental consanguinity using the clinical interviews as well as DNA-based estimates. The latter was conducted by calculating the coefficient of inbreeding 'f'. A participant was considered to have consanguineous parentage if his/her parents shared a common ancestor no more remote than a great-great-grandparent, corresponding to DNA-based estimates of 'f' ≥ 0.0156. The rates of parental consanguinity assessed by clinical interview were comparable in both groups (Cases: 10.71 %, Controls: 7.25 %; χ2 = 0.493, p = 0.4825). However, DNA-based rates of parental consanguinity showed that 'f' was significantly higher among cases than controls (Mann-Whitney U = 11315.5; p = 0.022). Seventy-five cases (62.5 %) and 108 control participants (48.6 %) had 'f' ≥ 0.0156 (χ2 = 6.008; p = 0.014). The results were consistent across different quality control measures. Schizophrenia is associated with higher parental consanguinity, suggesting a role for multiple recessive risk alleles in its etiology. Replication in future studies in diverse settings would add further strength to this.

Challenges faced by community-level workers in delivering mental health services for a rural community in South India.

Challenges faced by community-level workers in delivering mental health services for a rural community in South India.

Mortality among patients with severe mental disorders from a rural community in South India

Background: Even though excess mortality in patients with severe mental disorders (SMD) has been established in many high-income countries, literature on this from the low- and middle-income countries including India is rather scant. Our study seeks to estimate the standardized mortality ratio (SMR) of patients with SMD from a rural community in Tamil Nadu for the years 2011–2015. Materials and Methods: We included patients with SMD from four taluks of Pudukkottai district, Tamil Nadu, during the years 2011–2015. We collected information on a total number of patients with SMD registered, their sociodemographic details, alive/dead status, and cause of death from the clinic registers and patient case records. We used the crude death rates for rural Tamil Nadu for the years 2011–2015 for the calculation of SMR, which is calculated by the formula observed deaths/expected deaths. Results: The SMR of patients with SMD was 3.33, 2.76, 2.11, 1.91, and 1.89 in the years 2011–2015. Of the 74 total deaths in these 5 years, 62 (83.7%) were due to natural causes, while 12.2% died by suicide. Statistically significant differences were observed in age, education, and marital status between patients with SMD who were alive and dead. Conclusion: We observed nearly two-times higher mortality among patients with SMD in rural Tamil Nadu. Further research is needed to examine the reasons for increased mortality among patients with SMD and interventions to reduce this excess mortality.

Current Prevalence of Malaria Knowledge and Practices among Residents of a Rural Community in South India

Introduction: Malaria is a major public health problem in India. The prevention of Malaria is mainly dependenton knowledge and beliefs of people.The National Framework for Malaria Elimination (NFME) 2016-2030in India insists to eliminate malaria in India and for this to achieve the current malaria awareness on causesand protection in the region where malaria was a major problem about 7 years back is very important. In thisbackground this study was undertaken to know the current Knowledge of Malaria in this area.Objectives: To know the knowledge and practices of Malaria which was problem in the area about 7 yearsback.Methodology: Its a Cross-sectional study conducted in a rural community.Since the proportions of knowledgeand practices regarding malaria transmission in this setting was unknown, a 50% proportion was assumedto ensure the maximum sample size.The total number of houses visited was 110 to achieve the sample sizeof 384. The information of malaria with respect to Socio-demographic, knowledge and practices has beencollected from the adult respondent (aged >18 years) of the households in the villages of field practice areaof the medical college. Data was collected by semistructred questionnaire method. Frequencies, proportionsand chi-square test are the test of significance.Results: Among the 384 subjects interviewed 73% (i.e. 280) knew about malaria and were assessed forKnowledge and practices regarding malaria. About 32.8% (i.e. 126) said that malaria is a communicabledisease, Majority 74.7% (i.e. 287) said that malaria is transmitted from mosquito bite. About 19% (i.e. 72)were not aware regarding mode of transmission of malaria. About 74.7% (i.e. 287) respondents informedthat mosquito nets were used in the night to protect from mosquito bites.Conclusions: The study revealed that knowledge and practices about malaria was satisfactory and therewas varied perception about causes, spread of disease, symptoms and protection from mosquitoes. Healthpersonnel and medical students were the major source of knowledge in this the population. Since the malariais not a problem from the past 5 years, but still the overall awareness regarding malaria was good in this area.

Comparison of cost-effectiveness of long-acting depot injection antipsychotics and oral antipsychotics in patients with schizophrenia in a rural community in South India.

Comparison of cost-effectiveness of long-acting depot injection antipsychotics and oral antipsychotics in patients with schizophrenia in a rural community in South India.

Epidemiological Correlates of Psychological Distress in a Rural Community of South India: A Cross-sectional Study.

Context:Integration of mental health into primary care is essential to establish access to mental health services. Screening the community for psychological distress is the first step.Aims:The aim of the study was to estimate the burden and the determinants of psychological distress in a rural community.Settings and Design:This was a community-based cross-sectional study among adult members of a rural community of Nitte Village in Udupi district in Karnataka, South India.Methodology:Three hundred and ten households were surveyed using the World Health Organization Self-Reported Questionnaire (SRQ). A cutoff value of 8 in SRQ was taken as screening positive.Statistical Analysis Used:Descriptive data were analyzed in proportions, whereas Chi-square test and regression analysis were used to explore associations.Results:Hypertension and diabetes were the two common comorbidities. The prevalence of psychological distress was 42.4 per thousand. “Being easily tired” and “feeling tired all the time” were the two most common responses out of the SRQ checklist. Distress was significantly associated with gender, educational status, and marital status.Conclusions:The prevalence of psychological distress was 42.4 per thousand, and somatic complaints were common presentations of distress in the study population.

Epidemiological correlates of Common Mental Disorders in a rural community of South India: A cross sectional study

Background: Common Mental Disorders (CMDs) encompass a range of anxiety/depressive disorders. They cause considerable morbidity at individual level and pose a significant burden to the community in terms of the suffering and cost. Objectives: This study was done to determine the prevalence, determinants, patterns and severity of CMDs in a rural community of Udupi district. Methods: A cross sectional two- stage study was done in rural field practice area of Department of Community Medicine with the help of the Rural Psychiatry team from Department of Psychiatry. Screening for psychological distress in the first stage was done using SRQ-20. In second stage screen positive patients were assessed in Nitte CHC by trained psychiatrists using M.I.N.I schedule. Assessment of severity was done using Hamilton A scale (HAM A), Hamilton D scale (HAM D), Yale Brown Obsessive Compulsive Scale (YBOCS) and the Scale for Assessment of Somatic Symptoms (SASS). Results: Prevalence of CMDs was 26.5 per thousand population. Dysthymia was the most common diagnosis. Gender, marital status and educational status were the significant determinants of CMDs. Those who were married but staying separate/ divorced, illiterates and those educated up to primary school were the only groups with higher adjusted odds on multivariate analysis. The common presenting symptoms were sad mood/ crying episodes and somatic complaints. Conclusion: Prevalence of CMDs was low at 26.5 per thousand. Sad mood/ crying episodes as well as somatic complaints are the common presentations which have to be borne in mind when treating patients at the primary care level.

Prevalence, clinical characteristics, and seizure outcomes of epilepsy due to calcific clinical stage of neurocysticercosis: Study in a rural community in south India

ObjectiveThe objective of this research was to study the prevalence, clinical characteristics, and seizure remission rates of epilepsy due to calcific stage of neurocysticercosis (cNCC) in a rural community in south India. Material and methodsComprehensive Rural Epilepsy Study South India (CRESSI) is a prospective longitudinal study of epilepsy care in a rural community in south India. As part of this study, prevalence of epilepsy was studied in a population of 74,086 in 22 villages. The prevalence study identified 451 people with epilepsy including 62 (13.7%) with epilepsy due to cNCC. Diagnosis of cNCC was based on computed tomography (CT) findings. The clinical characteristics and seizure outcomes were studied in this cohort of 62 patients. The data collected included demographics, seizure type, antiepileptic drugs (AEDs), seizure remission rates, and predictors of long-term seizure remissions. ResultsThe crude prevalence of epilepsy due to cNCC in this rural community was 0.84 per 1000 (95% confidence interval [CI]: 0.65–1.07). This lesion accounted for 41% of the established etiology among 451 prevalence cases of epilepsy. Mean age at presentation was 28.87 ± 14.45 (range: 8–65 years) with equal gender distribution. The common location of the lesion was in the perirolandic region. Focal onset motor seizures were the common seizure type. Seizure remission (≥2 years) rate was 80.3%. The independent predictor of drug resistance was failure to respond to monotherapy (odds ratio: 63.9; 95% CI: 8.4–485.4; p < 0.0001). Focal impaired awareness behavioral arrest/automatisms with lesion located in the temporal lobe in all the three patients were drug-resistant. ConclusionsIn this rural community in south India, epilepsy due to cNCC was the commonest acquired epilepsy in people aged ≥20 years. Long-term seizure remission rates were high, and failure to respond to monotherapy was the predictor of drug resistance. Drug-resistant epilepsy was extremely rare with this lesion.

Prevalence and factors related to the unmet need for family planning among married women in the rural community of South India

Background: Family planning program was implemented in India since 1952 so that the couples can exercise control over their own fertility. As per NFHS-4, unmet need for family planning in our country was 13%. However, in rural areas, this prevalence might be high. Objectives: The objective of this study was to assess the prevalence of unmet need for family planning method and its associated factors among the rural married women. Materials and Methods: This cross-sectional study was conducted in the rural community of South India for 1 year. By the cluster sampling method, 1024 married women in the reproductive age group were selected. After written informed consent, each subject was interviewed using a pre-tested questionnaire and the data were collected. Results: The mean age of the study subjects was 31.07 ± 4.6 years. Unmet need for the permanent method of family planning was 34%, and for spacing, it was 69.7%. Factors such as age, parity, and education of participant and husband influenced the unmet need for the permanent method; for the temporary method, socioeconomic status was significantly associated. Conclusion: Unmet need for family planning was high among the rural women in this community and many factors were related to this. Health education and motivation by community health workers are needed to bring a positive change in this regard.

Prevalence of fecal incontinence among women in a rural community in Southern India

Background: The prevalence of fecal incontinence (FI) in the community is usually grossly underreported. There are very few studies done in the Asian population to assess FI. Objective: Our study aimed to assess the prevalence and the factors associated with FI in adult females aged 30–60 years in a rural community in south India. Materials and Methods: We conducted a community-based cross-sectional study among 200 people in three villages (Allivaram, Thoppanthangal, and Veppampet) in Kaniyambadi block, Vellore district, Tamil Nadu. Participants were recruited into the study after informed consent. Information about demographic details, comorbidities, and risk factors for FI was collected using a structured pilot-tested questionnaire. Revised FI Scale (RFIS) was used for evaluation and grading of FI. Results: Our study reports the community prevalence of 1.5% (3/200) with 95% confidence interval (0.05, 2.95) for FI using the RFIS scale. The women who were identified to have FI were referred to the secondary hospital for further evaluation and management. All the women who reported FI had a history suggestive of local anal conditions/surgery. Only “passing blood in stool” was statistically significant with FI in logistic regression. Multiple vaginal deliveries or associated obstetrical injuries did not show any association with FI. Conclusions: Large-scale multicenter studies are required to assess the prevalence and social burden caused by this disabling condition.

Comparison of 24 h recall and 3-day dietary cycle with 7-day dietary cycle as a tool for dietary assessment at community level in a rural South Indian community: A cross-sectional study

Background: Dietary assessment is important to give nutritional counseling, to monitor ongoing nutritional transition, and to initiate public health policies. However, dietary intake measurement is a challenge, as type of food, portion size, and food habits vary immensely. Objective: The objective of the study was to compare 24 h recall and 3-day dietary cycle with 7-day dietary cycle as dietary assessment tool at community level in the rural part of Southern part of India. Materials and Methods: It is a community-based cross-sectional study conducted in a rural community of H D Kote Taluk of Mysuru district. Fifty-five houses were selected randomly by lottery method. Medical social workers were trained and data were collected regarding dietary consumption from the households and analyzed using SPSS version 24. Results: Descriptive statistics such as mean and standard deviation were used and inferential statistics such as one-way analysis of variance showed a significant difference in the recorded calorie intake by three methods of dietary assessment; f (2,) = 10.109, P < 0.00. Bonferroni post hoc revealed significant higher recordings by 24 h recall method (2422.56 ± 1581) compared to 3-day dietary cycle (1462.14 ± 761) and 7-day dietary cycle (1782.97 ± 682.6). No significant statistical difference was noted between 3-day dietary cycle and 7-day dietary cycle. Conclusion: Three-day dietary cycle method could replace 7-day dietary cycle method for community-based dietary assessment, as it provides results comparable to the gold standard 7-day dietary assessment method and it is less time consuming, cost effective and ensures better compliance.

Prevalence of vitamin B12 deficiency among individuals with type 2 diabetes mellitus in a South Indian rural community

Background: To estimate the prevalence of vitamin B12 deficiency in a rural south Indian community and to evaluate the association between metformin use and prevalent vitamin B12 deficiency in people with T2DM stratified by oral vitamin B12 supplementation.Methods: Using a cross sectional study design, a random sample of people with T2DM (N=438) was recruited from a rural community. Vitamin B12 deficiency was defined as serum B12 ≤200pg/ml. Data on metformin dose, duration of use, oral vitamin B12 supplementation, and diet were collected. Laboratory measurements included complete blood count, tests for hepatic, renal, and thyroid function, as well as serum vitamin B12 levels and HbA1c.Results: The prevalence of vitamin B12 deficiency in people with T2DM was 11.2% (95% Confidence Interval (CI) 8.2%-14.1%). The odds of vitamin B12 deficiency in patients receiving a metformin dose of 2 grams/day were 4 times higher compared to those receiving ≤1 gram/day, after adjusting for oral B12 supplementation (odds ratio 4.2;95% CI 1.5-11.8). The odds of vitamin B12 deficiency in those taking metformin and receiving oral vitamin B12 supplementation were lower compared to those on metformin and not receiving vitamin B12 supplementation (adjusted odds ratio 0.20; 95% CI 0.06-0.70).Conclusions: Vitamin B12 deficiency affects 1 in 10 people with T2DM, is associated with higher dose metformin use, and oral vitamin B12 supplementation mitigates B12 deficiency in this group.

Treatment Discontinuation in Schizophrenia: A Qualitative Exploration from a Rural South Indian Community.

Background:Medication discontinuation remains a big hurdle for retaining persons with schizophrenia under the treatment AMBIT. It is imperative to understand reasons for the same to effectively tackle it.Methods:The study was carried out in Turuvekere, a rural South Indian taluk (an administrative block). Qualitative interviews were conducted with consenting consecutive nineteen patients (along with their family members) who had discontinued medications. All interviews were transcribed. Enlisted reasons were then color coded to synthesize different factors. From the 16th patient onward, no new reason emerged. Three more interviews were done to ensure that there was no additional reason.Results:The following factors (average 4.26 factors per patient) led to medication discontinuation: (1) lack of support/supervision from family/well-wishers (n = 14/19 [73.68%]); (2) lack of insight and cooperation from the patient (n = 11; [57.89%]); (3) lack of awareness about the illness (8 [42.10%]); (4) adverse effects of medications (n = 8; [42.10%]); (5) financial factors (n = 8; [42.10%]); (6) distance/transport (n = 8; [42.10%]); (7) lack of knowledge about treatment process (n = 7; [36.84%]); (8) perceived lack of beneficial effects of treatment (n = 5; [26.32%]); (9) treatment center-related issues (n = 4; [21.05%]); and others.Conclusions:Medication discontinuation is driven by a diverse set of interrelated factors among community-living persons with schizophrenia. Professionals need to be aware of this complexity to effectively manage the problem.

An epidemiological study of prevalence of hypertension and its risk factors in a rural community of South India

Background: Chronic non-communicable diseases are important among adult population all over the world. Hypertension (HTN) is the most common cardiovascular disorder accounting for 20-50% of all cardiovascular deaths. The prevalence of HTN is increasing in both rural and urban communities. Objective: The objective of this study was to determine the prevalence of HTN and its associated risk factors in a rural population. Materials and Methods: A community-based cross-sectional study was conducted at rural areas of South India. The sociodemographic variables and risk factors were obtained by interviewing the participants in a predesigned semi-structured questionnaire. The sample size was calculated by the prevalence of HTN in previous studies and 650 participants were included. The blood pressure was assessed and classified according to the Joint National Committee VII classification. Statistical analysis was done using descriptive statistics and Chi-square test of significance. Results: Out of the 650 adults surveyed, 92 individuals (14.1%) were found to be suffering from HTN. Among males, 58 (16.2%) had HTN and 92 (25.7%) were prehypertensives, and among females, 34 (11.6%) had HTN and 71 (24.2%) were prehypertensives. The prevalence rate of HTN shows an upward trend as age advances. The prevalence rate was high among males, higher socioeconomic class, and among the highly educated groups. The risk factors such as tobacco usage, alcohol consumption, additional salt intake, family history of HTN, obesity, high waist-hip ratio, and diabetes mellitus were found to have statistically significant association with HTN. Conclusions: There is an increase in the prevalence of HTN in the rural communities of South India. Population-based prevention strategies and evidence-based clinical strategies should focus on early detection and appropriate treatment.

Standardized Mortality Ratio in Patients with Schizophrenia - Findings from Thirthahalli: A Rural South Indian Community.

Background:Schizophrenia is associated with excess mortality experience than the general population. Though this is one of the important outcome measures, it has not been adequately explored especially in rural community dwelling patients in India. We describe the standardized mortality ratio (SMR) of a cohort of schizophrenia patients of Thirthahalli, one such rural taluk of South India.Materials and Methods:SMRs for the years 2009-2011 were calculated. A number of patients in the cohort were 301, 317, and 325 for those consecutive years, respectively. Observed deaths among the patients were noted for these years separately. Crude death rates (CDRs) of the general population of Shimoga district were obtained from the Statistics Department of the Government of Karnataka. CDR (per 1000) was multiplied by the number of patients in each year to get the expected deaths. Then, observed deaths were divided by the expected deaths to get the SMR.Results:There were totally 12 deaths among the patients in these 3 years. SMRs for the years 2009, 2010, and 2011 were respectively 1.4, 1.8, and 2.2. Six had died out of natural (medical) causes. Four had committed suicide, and one died from an accident. Cause from one death remained unknown. There was no statistically significant difference between the alive and deceased patients in any of the demographic or clinical variables.Conclusions:Mortality among schizophrenia patients in this rural cohort is considerably lower than patients from developed countries. Nevertheless, nearly two-fold excess mortality in schizophrenia calls for attention to their medical and psychosocial needs.