Rural Vellore Research Articles

Trichomonas vaginalis: comparison of primers for implementation as an in-house PCR in rural Vellore, South India

BackgroundTrichomonas vaginalis (TV) accounts for the highest burden of curable, non-viral sexually transmitted infections worldwide. Prevalence in India ranges from 0.4 to 27.4% in women and 0.0-5.6% in men. In 2015, the prevalence of TV among pregnant women of rural Vellore was 3.11% using Sekisui OSOM® Trichomonas test and culture methods. Molecular methods are the most sensitive, rapid diagnostic tool for Sexually Transmitted Infection’s (STI) albeit cost hinders implementation of commercial platforms. To determine a sensitive, sustainable molecular method, we compared three targets (Adhesin AP65, cytoskeleton Beta-tubulin BTUB 9/2 and TVK 3/7) with the highest published diagnostic accuracy against microscopy, culture and Real Time PCR (RT- PCR).Materials & methodsSix-hundred adult, sexually active women attending the Obstetrics-Gynaecology rural out-patient clinic the Rural Unit for Health and Social Affairs (RUHSA) from July 2020 - February 2021 were enrolled. A vaginal lateral and posterior fornix specimen was inoculated, onsite, into Biomed InPouch® TV culture and smeared onto a slide for fluorescence microscopy using Acridine orange. A flocked nylon swab specimen for PCR was used to determine the sensitivities of the Adhesin AP65, cytoskeleton Beta-tubulin BTUB 9/2 and TVK 3/7 gene targets. Seegene Allplex™ STI Essential Assay, S.Korea was used to confirm TV positives.ResultsNine specimens (9/600, 1.5%) were positive for TV. There was a 100% correlation between Biomed InPouch TV® culture, PCR with TVK 3/7 and RT-PCR while a correlation of 66.6% with BTUB 9/2 and AP65 gene targets. Clinically, 77.7% (n = 7) presented with white-greenish discharge per vagina, 11% (n = 1) with infertility, 22.2% (n = 2) were asymptomatic. Eight of nine patients (88.9%) had co-infections with other bacterial STIs. Prevalence of TV coinfection with Neisseria gonorrhoea was 1.1%.ConclusionCurrent hospital-based prevalence of TV in rural Vellore was 1.5%. Repetitive DNA target TVK 3/7 was more sensitive than AP65 and BTUB 9/2 primers.

Rural South Indian spirometry values show wide variation compared to existing prediction equations.

India, a highly heterogeneous country, has no common reference standards for predicting spirometry values, with very few recent studies from south India. This study aimed to create reference equations for rural south Indian adults, based on a population-based survey in Vellore, south India and compare it with other equations from India. The data from 583 non-smoking, asymptomatic participants (30 years and older) from a spirometry-based survey for airflow obstruction (rural Vellore, 2018), were used to develop equations for FEV1, FEV1/FVC, and FVC. The dataset was divided for development (70%) and validation (30%), by gender. Differences between observed and predicted values were assessed using the new equations and comparisons made with other equations from India. Predictions with Vellore rural equations were closest to the previous south Indian equations from urban Bangalore. However, the Bangalore equations led to overestimation of FVC values in males, and of both FEV1 and FVC values in females. Using the rural Vellore equations also led to a higher percent of males being classified as having airflow obstruction, compared to the Bangalore equations which underestimated airflow obstruction in this rural population. Comparison with previously derived Indian equations from other parts of the country showed pronounced variations. Our study reiterates the need for representative rural and urban studies of adults from various parts of India, to obtain region specific reference equations, given the wide variations in spirometry values in "normal" individuals, due to social heterogeneities of the Indian population and resulting complexities in defining normal.

Knowledge, Attitude and Practices of Contraceptives Among Married Women of Rural Vellore.

Ensuring reproductive health is central to the process of developing and improving the health of women and children and is linked to the issues such as sexually transmitted diseases, poverty, education, gender equality, and human rights. This community-based cross-sectional study was conducted to assess the knowledge, attitude, and practices of contraceptives of married women aged 18-49years in rural Vellore, Tamil Nadu. This study was conducted in Kaniyambadi block in Vellore, Tamil Nadu. Two-stage cluster sampling was used. A total of 200 households were selected. From each household, one eligible woman was selected. Two hundred women participated in the study. Nine percent had good knowledge, 52.5% had a good attitude and 67.5% had good practices as defined by this study. Education, belonging to non-scheduled caste, age, type of family, and the number of living children were significantly associated with knowledge, attitude, and practices in both bivariate analysis and multivariate analysis. The main reasons for not using contraception were the desire to have a child and the fear of side effects of contraceptives. Despite poor knowledge levels and moderate levels of good attitude, modern contraceptive usage in this study population was high. Women thought traditional methods were more effective than modern contraceptives. Permanent sterilization in women was the widely practiced modern contraceptive method. Strategies and methods to improve knowledge, and adoption of modern contraceptive usage among women and men need to be designed, implemented and studied.

A retrospective study on the microbial spectrum and antibiogram of uropathogens in children in a secondary care hospital in Rural Vellore, South India.

Background:Urinary tract infection (UTI) is common among children. Empiric antibiotics have to be started as early as possible or it may lead to an irreversible renal parenchymal damage and renal scarring in children. The objectives were to determine the prevalence and microbial profile of paediatric UTI and to determine the antimicrobial susceptibility pattern.Methodology:This is a retrospective study which looked at urine cultures of children below 15 years that were sent during the study period.Results:Among the total urine cultures sent only 21.2% showed significant growth of organisms. The most common organism isolated was E. coli (75.5%). E. coli was least sensitive to cefpodoxime and co-trimoxazole, whereas highly sensitive to nitrofurantoin. Of the total children who had significant growth, 46% had ESBL.Discussion:The prevalence of culture-proven UTI among children was found to be 21.2%. The most common organism isolated among the study population was E. coli (75.5%) followed by Enterococcus species (19.0%) and Klebsiella species (14.5%). It was also found that E. coli was least sensitive to cefpodoxime (31.6%) and co-trimoxazole (26.3%), moderately to amoxicillin-clavulanate (52.4%), whereas highly sensitive to nitrofurantoin (82.9%). This was similar with the studies done at other secondary care hospitals, in Oman and Oddanchathram, South India.Conclusions:With the increasing resistance, cephalosporins should not be used in treating paediatric UTI, whereas nitrofurantoin can be started as an empiric antibiotic, which can later be changed according to the susceptibility pattern.

A Study on New IAP 2015 Growth References in Rural South Indian Children.

To ascertain the utility of the new pan Indian 2015 IAP references in rural South Indian children and the ability of new IAP charts to recognise children with abnormal cardiometabolic risk factors in 10 to 16 y age group. Among school health camps conducted at two centres of Tamil Nadu- rural Vellore and rural Erode- height, weight, waist circumference, blood pressure, triceps skin-fold thickness and body fat percentage were measured by trained pediatricians and Z-scores calculated. The anthropometric measures were studied as per IAP 2015 references and compared to other national and international references. Their utility in identification of malnutrition and cardiometabolic risk ascertained. A total of 420 children (210 from Erode and 210 from Vellore) in the age group of 10 to 16 y were included in the study. New IAP references recognized more short stature (4.2 vs. 3%), wasting (11 vs. 1.5%) and overweight (14.2 vs. 13.2%) children compared to old IAP charts. The Z-scores of anthropometric measures as per New IAP 2015 references had significant correlation with old IAP and other international data (p < 0.05). It was noted that new IAP charts could detect 83.3%, old IAP chart50% and WHO 83.3% of subjects with malnutrition. New IAP charts could detect 70.3% cardiometabolic risk associated with over nutrition compared to old IAP (57.4%) and WHO (51.8%). There is a significant prevalence of both under nutrition and overweight in rural setting. IAP 2015 reference is useful to diagnose children with under nutrition and overweight including abnormal cardiometabolic risk.

Vaccination coverage and factors associated with routine childhood vaccination uptake in rural Vellore, southern India, 2017

BackgroundVellore district in southern India was selected for intensified immunization efforts through India’s Mission Indradhanush campaign based on 74% coverage in the National Family Health Survey in 2015. As rural households rely almost entirely on the Universal Immunization Program (UIP), we assessed routine immunization coverage and factors associated with vaccination status of children in rural Vellore. MethodsWe conducted a cross-sectional household survey among parents or primary caretakers of children aged 12–23 months during August–September 2017 using two-stage, EPI cluster sampling. We verified vaccination histories from vaccination cards and collected data on sociodemographic and non-socio-demographic characteristics by using mobile data capture. Associations with vaccination status were examined with univariate and multivariate logistic regression models. ResultsA total of 643 children were included. Coverage of BCG, third dose pentavalent/DPT, measles/MR vaccines and full vaccination (BCG, three doses of polio and pentavalent/DPT and measles/MR vaccines) among children with vaccination cards (n = 606) was 94%, 96%, 93% and 84%, respectively. Of children with vaccination cards, 70.8% had received all recommended doses according to the UIP schedule. No socio-demographic differences were identified, but parents’ familiarity with the schedule (Adjusted Prevalence Odds Ratio (aPOR): 2.06, 95%CI = 1.26–3.38) and receiving information on recommended vaccinations during antenatal visits (aPOR: 2.16, 95% CI = 1.13–4.12) were significantly associated with full vaccination status of the children. ConclusionsWe found higher UIP antigen coverage and proportion of fully vaccinated children than previously reported from rural Vellore. However, adherence to the recommended schedule was still not optimal. Our study highlights the potential of improving parental awareness of vaccination schedule and targeting health education interventions at pregnant women during antenatal visits to sustain and improve routine immunization coverage.

Incidence of metabolic syndrome in rural pre-menopausal women and associated risk factors

The prevalence of metabolic syndrome (MetS) is increasing in the Asia Pacific region, as well as globally. This study was aimed at determining the incidence of MetS and associated risk factors among pre-menopausal women in rural Vellore, Tamil Nadu, South India. A community-based non-concurrent cohort design was used to study the incidence and risk factors associated with MetS in women from a rural block in Vellore district. Pre-menopausal women aged 38–45 years free of MetS in 2011–2012 were followed up 5 years later, for MetS. Body mass index (BMI), waist circumference, blood pressure, fasting glucose, and lipids were measured in addition to diet and physical activity. Cumulative incidence was calculated, and adjusted odds ratios (OR) obtained using logistic regression to measure association with risk factors. The cumulative 5-year incidence of metabolic syndrome among women aged 38–45 years was 32.5% (95% confidence interval (CI), 25.9–39. 1%). Women engaged in moderate physical activity alone were more likely to have MetS than those with vigorous activity (adjusted odds ratio (OR), 2.68; 95% confidence interval, 1.08–6.69). Those with BMI ≥ 23 kg/m2 were more likely to have MetS compared to those with a lower BMI (adjusted OR, 10.38; 95% CI, 3.50–30.80). Around one-third of pre-menopausal women aged 38–45 years developed metabolic syndrome within 5 years, in rural Vellore, South India. This high incidence emphasizes the need for raising awareness about risk factors for metabolic syndrome and encouraging lifestyle changes that may eventually help in reducing overall cardiovascular risk.

Levels of physical inactivity in rural and urban Tamil Nadu, India: A cross-sectional study

Background and Objectives: Physical inactivity is an important cardiovascular risk factor. This study assessed the prevalence and factors associated with insufficient physical activity (PA) in urban and rural Vellore, Tamil Nadu, India, among adults aged 30–64 years. Methodology: A cross-sectional World Health Organization STEPS survey was carried out in 48 wards of Vellore Municipality and nine rural villages of Tamil Nadu in 2010–2012. Adults (n = 6164, men 43.9%) aged 30–64 years were interviewed using the Global PA Questionnaire (2390 urban and 3774 rural). Insufficient PA was defined as not meeting the recommendation of 150 min of moderate aerobic PA, or 75 min of vigorous aerobic PA, or an equivalent combination, achieving at least 600 metabolic equivalent-minutes per day. Results: The prevalence of insufficient PA was 63.3% (95% confidence interval [CI]: 61.3%–65.3%) in the urban area and 40.6% (95% CI: 39.0%–42.2%) in the rural area. Women had a higher prevalence of insufficient PA compared to men, in both urban (70.8% vs. 53.8%) and rural (44.5% vs. 35.6%) areas. Those with higher education (odds ratio [OR]: 1.36, 95% CI: 1.20–1.53) and who were unemployed (OR: 2.97, 95% CI: 2.59–3.39) reported insufficient PA which was significantly higher than their counterparts. While urban participants had higher leisure time PA, rural participants had higher work- and travel-related PA. Conclusions: The high prevalence of insufficient PA found in this study shows that targeted interventions are needed to reduce insufficient PA, especially for women and urban populations.

Prevalence of statin use among high-risk patients in urban and rural Vellore, Tamil Nadu: A population-based cross-sectional study.

OBJECTIVES:This study assessed statin use among diabetics and those with coronary heart disease (CHD) in Vellore, Tamil Nadu.METHODS:A cross-sectional survey was conducted in rural and urban Vellore, among 6196 participants (30–64 years), in 2010–2012. Statin use among those with known CHD and diabetes (on diabetic medication) was recorded. A randomly selected sample of rural diabetics was resurveyed in 2016 to reassess statin use.RESULTS:Among 61 with CHD, 23 (37.7%) were on statins. Statin use among 422 diabetics aged ≥40 years with low-density lipoprotein ≥70 mg/dl was 13.4% in urban and 7.6% among rural. Statin usage among rural diabetics aged ≥40 years increased from 7.7% in 2010–2012 to 16.6% in 2016.CONCLUSIONS:Statin use for CHD was below 50% although higher than the use among diabetics, indicating the need to address this low rate of usage among these high-risk groups.

Rising trend of cardiovascular risk factors between 1991–1994 and 2010–2012: A repeat cross sectional survey in urban and rural Vellore

BackgroundRepeat cross sectional surveys document the trend of prevalence rates for non-communicable diseases and their risk factors. In this study, we compare the prevalence rates for risk factors for cardiovascular disease in urban and rural Vellore between 1991–1994 and 2010–2012. MethodsCross sectional survey was carried out in 1991–1994 in a rural block in Vellore district and in Vellore town, to study the prevalence of cardiovascular risk factors among adults aged 30–60 years. A repeat survey was done in 2010–2012 using the WHO STEPS method. In both surveys, socio-demographic and behavioral history, physical measurements, biochemical measurements, and medical history were obtained. Age adjusted rates were used to compare the rates in the two surveys. ResultsIn the rural areas, there was a three times increase in diabetes and body mass index (BMI) ≥25kg/m2 (overweight/obese) with a doubling of the prevalence of hypertension. In urban areas there was a tripling of diabetes, doubling of proportion with BMI≥25kg/m2 and 50% increase in prevalence of hypertension. While the proportion of male current smokers reduced by 50% in both rural and urban Vellore, lifetime abstainers to alcohol decreased in the rural area from 46.8% to 37.5% (p<0.001). ConclusionsThere has been an alarming rise in diabetes, hypertension, and overweight/obese with an even greater increase in rural areas. Alcohol use is increasing while smoking is on the decline. Primary prevention programs are required urgently to stem the rising incidence of non-communicable diseases in India.

Prevalence of coronary heart disease in rural and urban Vellore: A repeat cross-sectional survey

BackgroundWith the increase of cardiovascular risk factors in India, the prevalence of coronary heart disease (CHD) is also expected to rise. A cross-sectional study in 2010–2012 assessed the prevalence and risk factors for CHD in urban and rural Vellore, Tamil Nadu. The secondary objectives were to compare the current prevalence with the prevalence of CHD in the same areas in 1991–1994. MethodsA cross-sectional survey was carried out among adults aged 30–64 years to determine the prevalence of CHD (previously diagnosed disease, symptoms detected using Rose angina questionnaire, or ischemic changes on electrocardiography). The study used the WHO STEPS method in addition to the Rose angina questionnaire and resting electrocardiography and was conducted in nine clusters of a rural block in Vellore district and 48 wards of Vellore town. The results were compared with a similar study in the same area in 1991–1994. ResultsThe prevalence of CHD was 3.4% (95% CI: 1.6–5.2%) among rural men, 7.4% (95% CI: 4.7–10.1%) among rural women, 7.3% (95% CI: 5.7–8.9%) among urban men, and 13.4% (95% CI: 11.2–15.6%) among urban women in 2010–2012. The age-adjusted prevalence in rural women tripled and in urban women doubled, with only a slight increase among males, between 1991–1994 and 2010–2012. ConclusionsThe large increase in prevalence of CHD, among both pre- and post-menopausal females, suggests the need for further confirmatory studies and interventions for prevention in both rural and urban areas.

Perceptions of Farmers' and Farmworkers' Wives on the Use and Hazards of Agrochemicals in Rural Vellore

Poor handling, storage, and application of agrochemicals have resulted in a steep rise in mortality and morbidity associated with their use. This study aimed at assessing the awareness of wives of farmers and farmworkers in rural Vellore on the use and health effects of agrochemicals to identify gaps in their knowledge. A cross-sectional survey among 512 wives was conducted. Nearly 75 percent of the wives (384/512) did not know that agrochemicals could pass through skin. Also, wives who owned between 1 and 5 acres of land had a higher odds of knowing that agrochemicals were harmful (OR: 1.71(1.03-2-85), p < 0.05) and need to be disposed safely (OR: 4.76 (1.47-15.36), p < 0.05), than those owning less than an acre or no land. There is a need to educate women associated with agriculture in India on the harms and proper use of agrochemicals in order to better protect and inform their households and communities.

Prevalence of anaemia and iron deficiency in three trimesters in Rural Vellore district, South India.

A multistage sampling technique was used to select 845 pregnant women from two blocks in Vellore district. Haematological measurement of haemoglobin (Hb) was done on all women and serum ferritin (SF) on a subsample of 445. The prevalence of anaemia (Hb <11 g/dl) was 56.6%, 70.2% and 69.5%, respectively among the first, second and third trimester women. The mean Hb of 10.7 g/dl was significantly higher among the first trimester than among the second and third trimester women, which was less than the recommended value of 11 g/dl. Iron deficiency (SF <12 microg/L) was significantly (P< 0.05) more among the third trimester women than among the first. The high prevalence of anaemia in each trimester in pregnancy indicates the need for iron supplementation as early as possible starting from the fourth month of pregnancy.