Rural Community In South India Research Articles

Prospective comparison of course of disability in antipsychotic‐treated and untreated schizophrenia patients

To compare the course of disability in schizophrenia patients receiving antipsychotics and those remaining untreated in a rural community. Of 215 schizophrenia patients identified in a rural south Indian community, 58% were not receiving antipsychotics. Trained raters assessed the disability in 190 of these at baseline and after 1 year. The course of disability in those who remained untreated was compared with that in those who received antipsychotics. Mean disability scores remained virtually unchanged in those who remained untreated, but showed a significant decline (indicating decrement in disability) in those who continued to receive antipsychotics and in those in whom antipsychotic treatment was initiated (P < 0.001; group x occasion effect). The proportion of patients classified as 'disabled' declined significantly in the treated group (P < 0.01), but remained the same in the untreated group. Disability in untreated schizophrenia patients remains unchanged over time. Treatment with antipsychotics in the community results in a considerable reduction in disability.

Diabetic retinopathy screening model for rural population: awareness and screening methodology

Worldwide, the prevalence of diabetic retinopathy is increasing at an alarming rate. WHO has predicted that in India the number of adults with diabetes will be the highest in the world: from 19 million in 1995 to 80 million in 2030. Although originally thought to be a disease of an urban population, the prevalence of diabetes mellitus is increasing in rural areas as well. The socioeconomic burden resulting from visual impairment or blindness caused by diabetic retinopathy, particularly in the working age group, is a serious concern. In order to combat diabetic retinopathy related blindness, Sankara Nethralaya, the premier eye institute of India, in collaboration with the Lions Clubs International Foundation (LCIF) and the RD Tata Trust, Mumbai, India launched a major diabetic retinopathy screening program in the rural community of South India. The objectives were to create awareness among the rural population of diabetic retinopathy with emphasis on early detection, to conduct diabetes and diabetic retinopathy screening camps, and to bring to the base hospital patients who have sight-threatening diabetic retinopathy, for ancillary investigations such as fluorescein angiography, ultrasound and to perform laser photocoagulation or vitreous surgery, or both. Other objectives included training general ophthalmologists and general physicians in order to develop an integrated diabetic retinopathy model. To address the question as to why certain individuals run the risk of developing sight threatening diabetic retinopathy, biochemical and genetic factors were also studied. The program was launched in June 2003 and 3 rural districts have been screened. To the time of writing, 128 screening camps had been organized, 103 awareness meetings conducted, 23 ophthalmologists trained and 43 general physicians attended the continuing medical education program on diabetic retinopathy. The key elements in the successful implementation of this program have been a team approach, involvement of community leaders and voluntary organizations, and support of the district and state administrators.

Differentiation of highly prevalent IS6110 single-copy strains of Mycobacterium tuberculosis from a rural community in South India with an ongoing DOTS programme

We have prospectively analysed the DNA fingerprinting of Mycobacterium tuberculosis strains in a rural community from high prevalence area in South India with an ongoing DOTS programme. Strains from 451 culture-positive cases, diagnosed during July 1999–December 2000, were fingerprinted initially by both IS6110 and DR probes followed by polymorphic GC-rich repeat sequences (PGRS) typing only on low-copy strains. The results were correlated with selected epidemiological and clinical data. Forty one percent of strains showed single copy of IS6110, which further got differentiated into 62 DR and 27 PGRS patterns. One predominant DR pattern (5B/2) was found in 20% of the low-copy strains and was also involved in clusters. In all, 183 patients out of 451 (40%) were clustered in total 44 clusters when analysed by IS6110 and DR probes. With additional PGRS typing, the number of patients clustered was further reduced to 106 (23%). More number of patients (131) were clustered in IS6110 single-copy group. The maximum number of clusters was found with two or three patients. Only a small percentage (16%) of the patients reported direct epidemiological links while remaining patients might have had indirect links or casual contacts. Thus, a combination of two to three genetic markers is able to differentiate the most endemic strains of M. tuberculosis in areas with a high incidence of tuberculosis. The epidemiological data do not suggest any major outbreaks or a hot-spot hypothesis of transmission in this region. Phylogenetic analysis using IS6110, DR and PGRS RFLP (restriction fragment length polymorphism, RFLP) fingerprints showed that isolates exhibited clonal evolutionary pattern. The predominance of certain genotypes and agreement between the phylogenetic trees indicated that these strains were closely related and might have evolved or propagated from the common ancestor.

Differentiation of highly prevalent IS6110 single-copy strains of Mycobacterium tuberculosis from a rural community in South India with an ongoing DOTS programme

We have prospectively analysed the DNA fingerprinting of Mycobacterium tuberculosis strains in a rural community from high prevalence area in South India with an ongoing DOTS programme. Strains from 451 culture-positive cases, diagnosed during July 1999–December 2000, were fingerprinted initially by both IS6110 and DR probes followed by polymorphic GC-rich repeat sequences (PGRS) typing only on low-copy strains. The results were correlated with selected epidemiological and clinical data. Forty one percent of strains showed single copy of IS6110, which further got differentiated into 62 DR and 27 PGRS patterns. One predominant DR pattern (5B/2) was found in 20% of the low-copy strains and was also involved in clusters. In all, 183 patients out of 451 (40%) were clustered in total 44 clusters when analysed by IS6110 and DR probes. With additional PGRS typing, the number of patients clustered was further reduced to 106 (23%). More number of patients (131) were clustered in IS6110 single-copy group. The maximum number of clusters was found with two or three patients. Only a small percentage (16%) of the patients reported direct epidemiological links while remaining patients might have had indirect links or casual contacts. Thus, a combination of two to three genetic markers is able to differentiate the most endemic strains of M. tuberculosis in areas with a high incidence of tuberculosis. The epidemiological data do not suggest any major outbreaks or a hot-spot hypothesis of transmission in this region. Phylogenetic analysis using IS6110, DR and PGRS RFLP (restriction fragment length polymorphism, RFLP) fingerprints showed that isolates exhibited clonal evolutionary pattern. The predominance of certain genotypes and agreement between the phylogenetic trees indicated that these strains were closely related and might have evolved or propagated from the common ancestor.

Predictive testing for familial adenomatous polyposis in a rural South Indian community.

During the course of genome studies in a rural community in the South Indian state of Karnataka, DNA-based investigations and counselling for familial adenomatous polyposis (FAP) were requested via the community physician. The proposita died in 1940 and FAP had been clinically diagnosed in 2 of her 5 children, both deceased. DNA samples from 2 affected individuals in the third generation were screened for mutations in the APC gene, and a frame-shift mutation was identified in exon 15 with a common deletion at codon 1061. Predictive testing for the mutation was then organized on a voluntary basis. There were 11 positive tests, including confirmatory positives on 2 persons diagnosed by colonoscopy, and to date surgery has been successfully undertaken on 3 previously undiagnosed adults. The ongoing success of the study indicates that, with appropriate access to the facilities offered by collaborating centres, predictive testing is feasible for diseases such as FAP and could be of significant benefit to communities in economically less developed countries.

The reality of unsafe abortion in a rural community in South India

Though the law in India has permitted medical termination of pregnancy on broad legal grounds for over two decades, unsafe abortions carried out by unqualified providers show no signs of decreasing. A community-based study was undertaken in rural South India to determine the prevalence of induced abortion, women's reasons for seeking abortion, who was providing abortions and whether the procedures were safe or unsafe. A cross-sectional study design was used that included focus group discussions with 88 women and a quantitative survey with 195 married women who had a birth interval of two or more years since their last pregnancy. There was a high prevalence of induced abortion (28 per cent) among the studypopulation, mainly among women who were not using contraception. Most abortions were carried outin the first trimester of pregnancy and unqualified practitioners performed 65 per cent of terminations. The preference forillegal, untrained providers in a country where abortion is legally available exposes the ambiguity in the status of abortion and how inadequacies in legal service provision have served to promote and sustain unsafe providers and practices. An integrated approach to family planning and reproductive health which includes abortion is imperative if the reproductive health status ofIndian women is to be improved. The poor utilisation of existing government facilities suggests the need for improving the quality of services, expansion of abortion facilities and the introduction of safer methods of abortion. To do this, a re-examination and re-framing of aspects of the 1971 abortion law is needed.

Beliefs About Mental Illness: A Study of a Rural South-Indian Community

(1998). Beliefs About Mental Illness: A Study of a Rural South-Indian Community. International Journal of Mental Health: Vol. 27, No. 3, pp. 70-85.

Survey on Public Awareness On AIDS- Role Of Government And Non Government Agencies In A Rural South Indian Community

Survey on Public Awareness On AIDS- Role Of Government And Non Government Agencies In A Rural South Indian Community

Hypertension and determinants of blood pressure with special reference to socioeconomic status in a rural south Indian community.

The objective of the study was to establish the prevalence of hypertension and to assess determinants of blood pressure with special reference to socioeconomic status in a rural south Indian community. This was a door to door, cross sectional survey. A rural south Indian community, KV Kuppam panchayat, North Arcot District, Tamil Nadu. The area has a total population of 3500 people. Those aged over 20 years who were available at the time of measurement were asked to participate (mean age 39.5 years). This convenience sample totalled 1027 (456 men, 571 women). Out of 697 families, 487 were visited; 15 people refused to participate. The following potential determinants of blood pressure were assessed: age, body weight, pulse rate, salt intake, meat intake, and socioeconomic class. The prevalence of hypertension was 12.5%. Using multiple linear regression analysis, the most important positive determinants of high blood pressure seemed to be age, body weight, and pulse rate. Salt and meat intake were not significantly associated with hypertension. The prevalence of hypertension in the highest socioeconomic group (22.5%) was more than twice that in the lowest socioeconomic group (8.8%). When adjusted for body weight, the mean (SEM) difference in systolic blood pressure between the highest and lowest socioeconomic classes was 5.83 mmHg (1.63). Hypertension is not yet as important a health problem in rural southern India as it is in westernised societies. Those particularly at risk of hypertension, however, are the elderly and overweight people of high socioeconomic class.

Hookworm infection in a rural community in South India and its association with haemoglobin levels

Faecal samples were obtained from 1113 persons living in a rural area in South India, and the hookworm ova load ( Necator americanus) was determined using Kato's thick smear method. Evidence of hookworm infection was present in 92%, 77% having a count of under 1000 epg, 11% a count of 1000 to 1999 epg, and 4% having counts between 2000 and 12 000 epg. Females had significantly higher ova counts than males on the average, but age did not appear to have any effect. Haemoglobin was also estimated: 80% of adult males, 87% of adult females and 90% of children were anaemic. There was a significant negative association between ova load and haemoglobin level, and the decrease in haemoglobin for a doubling of the ova load was estimated by regression analysis to be 0 · 18, 0 · 29 and 0 · 16 g/dl in adult males, adult females and children, respectively. There was nearly perfect agreement in the ranking of 10 clusters by mean ova count and mean haemoglobin level or percentage with anaemia.

Does health intervention ameliorate the effects of poverty-related diseases?--III. Propagating the use of oral rehydration in diarrhoea.

This paper reports on the effectiveness of an oral rehydration program in a disadvantaged rural community in South India. The program was launched in 1983 to educate parents about the causes of diarrhea how it can be prevented and managed at home and to promote a simple homemade oral rehydration solution (ORS) to replace traditional remedies. A structured questionnaire was administered to 210 mothers. 85% of the mothers said that they would opt for ORS as the treatment of choice in cases of diarrhea; 75% could demonstrate how to prepare ORS correctly. However very few knew the total quantity of ORS that needs to be administered. Although 70% could give a valid reason for the administration of ORS only 9% knew it was to replace salt and water loss. A great change has occurred in the traditional practice of starving the child who has diarrhea. However the belief regarding causation seemed to be only marginally altered. Most of the mothers had received their new knowledge and skill from the family care volunteer and not the doctor in the service unit. Since the inception of the program there has been a drop in the number of cases of diarrhea being reported an in the number of deaths.

Exclusive breast feeding versus supplementation: a prospective study in a rural south Indian community

In a non-interventional, prospective study in three south Indian villages, exclusively breast-fed infants were compared with those given supplements in addition to breast milk. The supplements provided less than 30% of caloric requirement in most cases. Both groups grew similarly and the growth curves showed a sharp fall after the third month. Whether this fall is physiological, or a result of poor socio-economic conditions is not clear.

Knowledge and attitude of mental diseases in a rural community of South India

Abstract An exploratory study was conducted to understand the people's perception of causes of mental diseases in the villages of a Rural Health Centre area in South India. The attitude towards mental disease and the type and place of treatment preferred were studied. Based on the respondents' opinion of the causes of mental disorders, a classification was hypothesised on the premise of evolution of ‘searching attitude’ of the mind for the cause of diseases. The findings are discussed.

Parental knowledge and attitude to smallpox vaccination in a rural community of south India.

A study was undertaken in a rural community to examine the knowledge and attitude of parents towards the ongoing smallpox vaccination programme and also to identify the factors responsible for the meagre coverage of smallpox vaccination. The study revealed that the educational status of the parents had no bearing on health knowledge like causation, spread and prevention of smallpox. The factors identified for meagre coverage of smallpox vaccination relate to situational, administrative as well as psychological influences

Child health in a rural community of South India

Child health in a rural community of South India