Thiruvananthapuram District Research Articles

Characterization of weathering profile and quality of groundwater over hard rock terrain

In this study, we present a detailed characterization of weathering profile and groundwater over a hard rock terrain showing the formation of kaolinite, groundwater quality assessment, and hydrogeochemistry. The crystal structure, chemical composition, and spectral characteristics of a weathering profile collected from Thiruvananthapuram district, the southern part of Kerala, India, were studied using XRD, ED-XRF, TG-DTA, UV-Vis-NIR, XPS, and FTIR spectroscopy. The physicochemical parameters of the groundwater were determined and evaluated for the groundwater suitability for drinking, irrigation, and industrial purposes based on the values of total hardness, TDS, corrosivity ratio, RSC, SAR, USSL classification, saturation index, and Schoeller and Stuyfzand classification derived using “HYCH” program. Interpretation of the results shows that the groundwater is suitable for drinking, irrigation, and industrial purposes. The characterization of the profile samples reveals that the aquifer is a weathered profile with the formation of kaolinite mineral at the bottom. The results show that the hydrogeochemical processes that exist in the present study area are controlled by precipitation, not by rock–water interaction or evaporation, which suggests that the groundwater chemistry is not influenced by the aquifer minerals.

A recurrent neural network forecasting technique for daily PM2.5 concentration level in Southern Kerala

The natural environment and public health are seriously impacted by air pollution. One of the most dominant contributors to air pollution around the world is particulate matter PM2.5. Predicting air pollution in advance has considerable importance for the regulation of people’s health and to implement pollution control strategies for air quality management. The study was conducted for Thiruvananthapuram district, the southernmost region of Kerala. The data for the period from 1st July 2017 to 31st December 2019 were collected from the Central Pollution Control Board (CPCB) website. To predict the daily PM2.5 concentration, Recurrent Neural Network (RNN) based Long Short-Term Memory (LSTM) was used here. LSTM was built on the inputs of four meteorological parameters, namely average temperature, wind speed, wind direction and relative humidity and air pollutant parameter PM2.5 values. Performance evaluation of the prediction model has conducted, and the results showed that the model attained considerable prediction accuracy.

English

BACKGROUND Dengue fever is a major public health problem in Kerala. Vector control measures practiced at household level is the most cost-effective way of controlling dengue. This study aims to assess environmental measures of vector control practised among households of suspected or confirmed dengue patients in Thiruvananthapuram district of Kerala. METHODS A cross sectional study was done among households of patients diagnosed with dengue fever and reported in Integrated Disease Surveillance Programme (IDSP) in Thiruvananthapuram district from June to December 2018. Investigators interviewed the household members and made direct observations to collect data on vector control practices using a structured questionnaire. RESULTS A total of 108 houses were surveyed. Potential breeding habitats were found in 58 (53.7 %) houses. Aedes larva was found in containers from four (3.7 %) houses. Dry day observance was not regular with only 5 (4.6 %) houses practicing it weekly. Waste management practiced was proper in 47 (43.5 %) houses. Community level pre monsoon preparedness for epidemics was done in the vicinity of 53 (49.1 %) houses and it was found to be a protective factor against presence of breeding habitats in and around houses (p = 0.013). Low education (p = 0.012) and low occupational status (p = 0.017) were found to be significant risk factors. CONCLUSIONS Even during an epidemic, with occurrence of infections in the family, only half of the households are practising adequate vector control methods. Community level interventions and targeted information education campaign will help improve practice of environmental methods of vector control in dengue. KEYWORDS Dengue, Vector Control, Aedes Control, Environmental Methods, Community Interventions

English

BACKGROUND Dengue Fever is a major contributor to morbidity and mortality among all communicable diseases in Kerala. Delay in seeking care is significantly associated with complications. Understanding health seeking behaviour of persons with risk of infection, helps in improving health care delivery. METHODS A cross sectional study was done among 100 dengue fever patients listed under Integrated Disease Surveillance Programme (IDSP) of Thiruvananthapuram district, Kerala state. Data regarding their health seeking behaviour during the course of the disease was collected using a structured questionnaire. RESULTS Inappropriate health seeking behaviour indicated by delay in seeking care and self medication was found in 22 % (95 % CI; 13.9 - 30.1) of subjects. Mean (SD) of delay in seeking health care was 3.01 (1.3) days. Treatment was initiated from government health facility by 63 % of patients. Primary level health care facility was sought by 61 % patients whereas 30 % opted for a secondary level facility. Proximity of the location of health facility to the patient’s dwelling was the factor influencing choice of treatment facility in 70 % of patients, followed by perceived quality of facility (15 %) and patient perceived competency of the physician (9 %). Male gender (p = 0.03) and educational status less than secondary level (p = 0.008) were significant risk factors for self-medication and delay in seeking health care. CONCLUSIONS Inappropriate health seeking behaviour in patients with suspected Dengue Fever is comparatively less in Kerala. Majority are seeking care from Government facilities and access to health care is influencing health seeking behaviour. Awareness generation in general and specific interventions targeting those with lower education status can further improve health seeking behaviour and reduce complications of dengue. KEYWORDS Health Seeking Behaviour, Dengue Fever, Self-Medication, Delay in Seeking Care, Healthcare Access, Kerala

Institutional quarantine centres as a strategy in control of COVID-19 outbreak: An evolving model from Kerala, India.

Background:Institutional quarantine centres were set up in all districts in Kerala as a novel strategy in the fight against novel COVID-19 virus. These were meant for returnees from affected areas, for whom home quarantine was not possible due to lack of facilities. This research aims to evaluate facilities and services of Institutional quarantine centres in Thiruvananthapuram district, Kerala state and to study profile of persons under quarantine in these centres.Methods:A cross-sectional study was conducted to evaluate institutional quarantine centres established in Thiruvananthapuram district of Kerala in April 2020. Evaluation was done using a checklist based on standard operating procedures for functioning of centres issued by Health department. Inspection of facilities and registers was done. Details of a subset of inmates were collected by telephonic interviews using a semi-structured questionnaire.Results:Two (0.41%) inmates in the centre turned positive on testing while in quarantine. Both of them were foreign returnees and were asymptomatic. There was not a single case of transmission of infection between inmates or to staff and volunteers. The adherence to infection control practices was satisfactory in all centres. One third of inmates were from listed highly affected countries and were mandatorily quarantined.Conclusion:Institutional quarantine centres were functioning effectively to provide quarantine facilities for high-risk individuals and thereby controlling the spread of COVID-19. Selection of facilities, staffing pattern and day to day functioning of these centres is a model which can be replicated at other COVID-19 affected areas.

Social, health system and clinical determinants of fever mortality during an outbreak of dengue fever in Kerala, India.

Background and Objectives:The morbidity and mortality spectrum of the south Indian state of Kerala is dominated by chronic non-communicable diseases, yet febrile illnesses because of neglected tropical diseases and emerging viral infections are often reported. As fever deaths are mostly avoidable, understanding the determinants of mortality is essential for implementing preventive measures.Methods:A case-control study was done during an ongoing dengue outbreak in Thiruvananthapuram district, Kerala during 2017–18. Cases included all fever deaths from the line list of Integrated Disease Surveillance Program (IDSP). Data were obtained from hospital case records and by interviewing patients or care givers. The theoretical model for determinants of mortality was constructed at three levels namely sociodemographic factors, access to health care and health seeking behavior, and clinical determinants.Results:This study confirmed association of mortality with age above 40 years (P = 0.010, OR = 3.48), being heavy built (P = 0.029, OR = 13.25), clinical symptoms of breathlessness (P < 0.001, OR = 24.89), restlessness (P < 0.001, OR = 97.26), clinical signs of drowsiness (P = 0.024, OR = 7.97), hypotension (P < 0.001, OR = 42.22), complications such as ARDS (P = 0.047, OR = 171.56), and myocarditis (P = 0.012, OR = 16.59). A low occupation status of semiskilled work or less (P = 0.012, OR = 0.30), choosing a nearby hospital for treatment (P = 0.018, OR = 0.48) and shortening the time gap between onset of symptom and final diagnosis (P = 0.044, OR = 0.72) was found to be protective.Conclusion:Along with biological and clinical factors, distal determinants like social factors, health seeking behavior, and health system factors are associated with fever mortality.

Nutritional Knowledge and Attitudes of Physical Education Students in Thiruvananthapuram District, Kerala

Nutritional Knowledge and Attitudes of Physical Education Students in Thiruvananthapuram District, Kerala

A comparative study to evaluate wonder and Sherman traps for the surveillance of ectoparasitic chigger vector mites of the scrub typhus.

Scrub typhus is caused by Orientia tsutsugamushi and transmitted by larval trombiculid chigger mites. Rodents and shrews are hosts for chigger mites in the transmission to humans. Wonder and Sherman traps are widely used for trapping rodents and shrews for the collection of ectoparasitic chigger mites. A comparative trapping study was undertaken in different villages in Vellore district, Tamil Nadu and Thiruvananthapuram district, Kerala, India to evaluate the efficiency of traps for trapping rodents & shrews. Wonder and Sherman traps were set in outdoors and indoors to capture the rodents. Wonder Traps, large wired cage, and Sherman Traps are foldable. These traps were employed for the rodents/ shrew surveillance to gather chigger vector mites. Identification of rodents, chigger mites and Trap index were observed. Z Test comparing the capture rates showed wonder trap (P<0.001) to be significantly more efficient than the Sherman traps. The number of rodents /shrews collected in a Sherman trap was always one. But the number of rodents /shrews collected in a positive wonder tap was 2.83 in both states, 2.25 and 1.24 in Tamil Nadu and Kerala, respectively. Wonder traps (77%) were found more attractive in collecting more rodents in Tamil Nadu compared to Sherman traps (23%). But the Sherman trap (60.9%) was found efficient in collecting more shrews in Kerala compared to wonder traps (39.1%). Shrew's collection was more in Sherman collections from both Tamil Nadu and Kerala. In Tamil Nadu and Kerala sex-wise collection of Male & female rodent/shrew was uniformly found in both the wonder (85% &75%) and Sherman traps (86% & 83%) with a maximum proportion of females. Sherman traps can be used as single-capture live traps and on the other hand wonder traps can be used as multiple-capture live-traps. The geographical distribution pattern of various rodents trapped can be determined to identify the target areas for control of a particular species and also for the control of selected species. Mostly females were captured abundantly in both wonder and Sherman traps. In wonder traps, female rodents were trapped as family members in large numbers. Wonder traps are more attractive for trapping more rodents. This study addressed the careful choice of wonder traps for ectoparasitic chigger vector surveillance.

Regional assessment of groundwater quality for drinking purpose

Abstract The present study was carried out to access the ground water quality and it is suitable for drinking, agriculture, irrigation, cooking etc. The bore well water samples collected from Kallara, Pangode, Karette, Kazhakoottam, Vamanapuram of Thiruvananthapuram district in Kerala. The physical and chemical parameters were tested for collected samples. The physical parameters include odour, temperature, colour, TDS, electrical conductivity, turbidity was studied. In addition, the chemical parameters such as pH, total hardness, chloride, calcium, magnesium, iron, sodium was determined by using experimental methods. The amount of dissolved oxygen in water also be determined for quality analysis. The results demonstrated that, all the tested datas are existing within the permisible limit of WHO standard. Especially, the amount of chloride and hardness present in the collected water samples exploring better results. Hence, the present report suggested that the quality of the water samples under study was suitable for drinking purpose.

Multimorbidity patterns among rural adults with Type-2 diabetes mellitus: A cross-sectional study in Kerala, India.

The study evaluated the prevalence and pattern of multi-morbidity among rural adults with type-2 diabetes mellitus and explored the factors associated with multi-morbidity among 400 adult diabetic patients from rural areas of Thiruvananthapuram district in the Kerala state of India. The presence of multi-morbidity was assessed using a semi-structured interview schedule based on the physician's confirmation. The reported chronic diseases were classified as concordant (conditions with a similar pathophysiologic risk profile as diabetes) and discordant (conditions whose treatments are not directly related to the pathogenesis for diabetes) co-morbidity. Multivariate analysis was done to find the factors associated with multi-morbidity. Prevalence of multi-morbidity among diabetic patients was 74% (95% Confidence Interval (CI): 69-77), around 66% reported at least one concordant co-morbidity, 30% reported at least one discordant co-morbidity and 21% reported both concordant and discordant co-morbidity with diabetes. Hypertension (59%) was the most frequent co-morbidity. Older adults (above 60 years of age) [Odds Ratio (OR):3.42, 95% CI:1.97-5.94] and women (OR:2.16, CI:1.13-3.51) were more likely to have multi-morbidity compared to their counterparts. Those using insulin and/or oral medication were more likely to have multi-morbidity compared to those using oral medication only (OR: 2.19, CI: 1.07-4.09). Multi-morbidity among diabetic patients needs to be addressed by a comprehensive and integrated approach rather than a diabetes specific approach.

An observational study on health-related demography of women and children belonging to scheduled caste population in selected areas of Thiruvananthapuram district of Kerala state, India

BACKGROUND: The scheduled caste (SC) population of India, especially women and children, lags behind others in the health scenario and the problem should be addressed with emergency concern. AIM: The aim of this article is to describe the health-related demography of women and children of SC population in selected areas of Thiruvananthapuram district of Kerala state, India during the year 2019. MATERIALS AND METHODS: The Reproductive and Child Health project team of Regional Ayurveda Research Institute for Lifestyle-Related Disorders, Thiruvananthapuram conducted health camps at four village panchayaths (village councils), namely, Maranalloor, Venganoor, Vilappil, Poovachal, and Neyyattinkara municipality of Thiruvananthapuram district, Kerala through 240 tours during the period January to December 2019 through a door-to-door household survey for collecting the information on socio-economic and health status. Medical aids were also provided to needy individuals. RESULTS: A total of 5145 individuals were surveyed, which includes 3662 women and 1483 children. In the survey, 62 disease conditions in women and 25 various disorders in children were diagnosed. The most common clinical manifestation found in women and children was Sandhigatavata (polyarthritis) and Agnimandya (digestive impairment), respectively. CONCLUSION: The women and children belonging to SC population in the areas of Thiruvananthapuram district where study was conducted have good health status. However, considering the prevalence of polyarthritis in women and digestive impairment in children, diet and lifestyle related-vigilance needs to be promoted. Ayurveda includes noteworthy guidelines regarding personalized as well as season-based diet and lifestyle. Therefore, increasing vigilance in rural population toward such Ayurveda guidelines along with use of relevant Ayurveda medicines can be a strategy to improve the health status of women and children. IEC number: 9–19/2012-ARIMCHC/Tvpm/Tech/220

Secondary prevention of stroke by a primary health care approach: An open-label cluster randomised trial

Background and aimIncreasing stroke burden in developing countries necessitates measures to strengthen health systems. We aimed to evaluate whether a Community Health Worker (CHW) based educational intervention will improve risk factor control among stroke survivors and enhance behavior change communication. MethodAn open-label, cluster-randomized trial was conducted in rural area of Thiruvananthapuram district, Kerala from December 2017 to December 2018. A CHW-based educational intervention in addition to standard of care was provided in intervention arm and compared to standard clinical care in the control arm with follow-up at three and six months. The primary outcome measures were risk factor control and quality of behavior change communication provided by CHWs. ResultsOf the 234 Stroke/TIA survivors enrolled, the mean age (SD) was 59.43 (11.07) years. At 6-month follow up, all patients with smokeless tobacco consumption had quit in the intervention arm (5 at baseline and 0 at six months) and no relapse in smoking was found (as compared to control arm wherein 9 at baseline and one at 6 months). The control of hypertension and diabetes was not significant at 3 months and 6 months in both intervention and control groups. Home visits as well as health education on risk factors by CHWs in the intervention arm were significantly higher. ConclusionCommunity health worker-based intervention is feasible in resource constrained settings for secondary stroke prevention. Training of CHW on risk factor control and lifestyle modifications for stroke survivors enhances quality of health education provided by health services.

Quantification of Municipal Solid Wastes Generated in Attingal Municipality and Design of Sanitary Landfill

Management of Municipal Solid Wastes is a serious environmental and health problem which is faced in major cities all over the world. Waste management studies of municipalities will help identify the lacunae and loopholes in solid waste management and thus help to minimize generation of solid wastes and pollution. In this regard, a waste management study was carried out for Attingal Municipality, Thiruvananthapuram District, through field visits and data collection from the Municipality. The study was concentrated to investigate the present status of the solid waste management, to quantity the wastes generated in the Municipality and to suggest remedial measures for improvement. Design of sanitary landfill was done based on the quantity of wastes generated and population growth of the Municipality. A sanitary landfill of length 52m and breadth 26m was designed for a period of 10 years. The design also included liner system, final cover system, leachate collection and treatment facility and environmental monitoring system.

Prevalence and factors associated with psychological violence against married women in Thiruvananthapuram district, Kerala

Background: The distribution and determinants of violence against women may vary in time across the region and within the region. It results in women’s physical and psychological sufferings and the final impact will reflect in the health system. Kerala is one of the leading states in India for female literacy and health indices. Still different forms of domestic violence including physical, psychological, economical and sexual violence are prevailing as a public health problem. Among the various domains this study measured the prevalence of psychological violence and identified associated factors, among married women aged 18-55 years in Thiruvananthapuram district.Methods: A community based cross-sectional study was conducted between January and May 2017. Sample size calculated was 270. Multistage cluster sampling was done. Tool used was semi structured questionnaire; conducted house visits and direct interview. Psychological violence was measured using modified scale validated in local language.Results: The life time prevalence of psychological violence was 25.2% (95% CI 20.2-30.6). The predictors of psychological violence found were care obtained during pregnancy (AOR 0.107), household structure (AOR 7.8), in laws’ satisfaction with marriage (AOR 0.046), less communication with own family (AOR 8.6) and partner’s parents quarrel (AOR 31.3).Conclusions: Psychological violence is still prevalent in the community. The associated factors include those relating to habit of the partner, house hold conditions, marital elements and family environment. The study identified nurturing friendly atmosphere in the family and improving familial bond as the core strategy to prevent psychological violence. Similar studies are recommended in each setting separately since risk factors varies with change in settings.

Hydrogeochemical characterization and analysis for irrigation applicability of groundwater in the shallow coastal aquifers: a multivariate statistical approach

ABSTRACT Coastal groundwater is ubiquitously under threat due to a variety of natural and anthropogenic activities. Groundwater occurring along a stretch of the coastal tract (L = 15 km) of Thiruvananthapuram district, Kerala, India, was analyzed for hydrogeochemical characterization, identification of factors influencing water chemistry, suitability for drinking and irrigation purposes. A total of 48 water samples were collected over three sampling seasons (pre-monsoon – PRM, monsoon – MON and post-monsoon – POM) in 2012. The study area is sandwiched between two estuaries: the Akkulam–Veli estuary to the north and the Poonthura (Karamana River) estuary to the south, while a shore parallel man-made canal forms the eastern boundary on the landward side. The results of hydrogeochemical analysis showed that the parameters, such as electrical conductivity (EC), total dissolved solids (TDS) and total hardness (TH) are relatively higher in four locations towards the south due to proximity to the estuary/canal. Phosphate content exceeds the permissible limit for all samples in all sampling seasons. Water quality during POM is relatively good compared to other seasons. Hydrochemical facies of water samples suggests that groundwater samples belong to Ca-Cl type. Multivariate (R-mode) factor analysis identified a multitude of factors influencing groundwater chemistry. To assess the suitability of groundwater for irrigation use, different indices, viz., EC, percent sodium (%Na), sodium adsorption ratio (SAR), Kelley’s ratio (KR), residual sodium carbonate (RSC), permeability index (PI), and magnesium hazard (MH) were computed. The study reveals that the quality of groundwater is of concern, warranting attention. It is fit for drinking purpose only after amelioratory measures, whereas, it is permissible for irrigational purposes.

Association between rainfall and the prevalence of clinical cases of dengue in Thiruvananthapuram district, India

Dengue fever is a fast spreading mosquito borne viral disease transmitted by Aedes mosquitoes. The abundance and the transmission potential of Aedes mosquitoes are influenced by climatic factors. An investigation was carried out in Thiruvananthapuram district, Kerala to study the correlation between rainfall and prevalence of dengue infection during 2015–2019. Dengue data (2015–2019) were collected from Directorate of Health Services, Thiruvananthapuram and the rainfall data were derived from Indian Meteorological Department, Thiruvananthapuram. The correlation between the rainfall and the prevalence of dengue was assessed by regression analysis. Dengue cases usually follow a seasonal pattern, with most of the cases reported during the monsoon season. Rainfall were positively associated with the number of dengue cases and highly significant correlation was found between dengue cases and rainfall. The regression equation for prevalence of dengue (y) versus rainfall (x) is y = 1.28 x + 31.03 (r = 0.875, p

Geospatial analysis of the source of monazite deposits and the dynamics of natural radionuclides in the selected coastal environs of Kerala, south west coast of India

Present study is an attempt to identify the source of monazite deposits and understand the dynamics of natural radionuclides in the coastal environs of Alappuzha and Thiruvananthapuram districts, south west coast of India. The source of monaztite bearing black sands was identified by combining the activity concentration of the natural radionuclides, lithology and drainage systems of Alappuzha and Thiruvananthapuram districts. The activity concentrations of naturally occurring radionuclides (40K, 226Ra, and 232Th) in sand samples collected from the study area were determined using high efficiency NaI(Tl) detector. The radiological parameters viz. radium equivalent activity (Raeq), absorbed dose rate (D), annual effective dose (indoor and outdoor), annual gonadal dose equivalent, and excess lifetime cancer risk were also determined from the activity concentration and compared with the values reported for the other regions of the world. The results of these systematic investigations are presented and discussed in detail in the manuscript.

To Examine the Potential and Scope of Ecotourism in Kerala with a Special Focus on Tourists to Ecotourism Destinations in Trivandrum

Around the world, ecotourism has been hailed as a panacea: a way to fund conservation and research, protect fragile and pristine ecosystems, benefit rural communities, promote development in poor countries, enhance ecological and cultural sensitivity, instill environmental awareness and social conscience in the travel industry, and satisfy and educate the discriminating tourist. At the threshold of the new millennium, tourism has emerged as the biggest industry of the future. Tourism today is an economic activity of immense global importance. Perhaps there is hardly any other field of activity where so many people are involved directly or indirectly. Tourism has found a niche for itself as a very effective instrument for generating employment, earning foreign exchange, and thereby facilitating overall development. Kerala is popularly known as' God's Own Country'. Tourism is the fastest growing industry in Kerala and the State Government has been earnestly supporting the tourism sector and much of its growth is concentrated in natural areas. Changes in the market forces as well as move towards environmentally sensitive and sustainable forms of tourism offers the maximum potential for the promotion of ecotourism in Kerala. Kerala has excellent natural resources, several wildlife sanctuaries, and National parks. Major ecotourism resources of Kerala are 14 Wildlife Sanctuaries, 6 National parks, several scenic mountains, freshwater lakes, mangroves, etc. In Kerala 56 places have been identified for development as ecotourism destinations emphasizing conservation, ecological sustainability, environmental education, and local community benefits. Thiruvananthapuram district of Kerala is one such destination. In this background, an attempt is made to study the potential and scope of ecotourism in Kerala with a special focus on Tourists to Ecotourism destinations in Trivandrum.

Control of hypertension among teachers in schools in Kerala (CHATS-K), India

ObjectiveWe investigated the prevalence, awareness, treatment, control of hypertension and the factors associated with hypertension prevalence and control among school teachers in Kerala, India. MethodsWe surveyed 2216 school teachers in Thiruvananthapuram district of Kerala as part of the control of hypertension among teachers in schools in Kerala (CHATS-K), India. We used World Health Organization STEPS tools for non-communicable diseases risk factor surveillance. Blood pressure, weight and height were measured using standard protocols. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg, or self-reported current antihypertensive medication. Controlled hypertension was defined as SBP<140 and DBP<90 mmHg. Separate multivariate analysis was done for finding the associated factors with prevalence and control of hypertension. ResultsAge adjusted hypertension prevalence was 14.6%. Men, those with self-reported diabetes, having family history of hypertension and overweight were more likely to have higher prevalence of hypertension compared to their counterparts. Among hypertensives 62% were aware, 49% on treatment and 34% achieved adequate control. Hypertension control was significantly higher among women, diabetics and overweight individuals compared to their counterparts. ConclusionsA higher level of hypertension control among school teachers in this study indicates an attainable level of hypertension control in the general population of the state. Teachers, with their highly regarded place in the social construct of the country and the state, could thus be used as role models for hypertension control for the general population in the state.

Late-Night Salivary Cortisol in Healthy, Community-Dwelling Asian Indians Assessed by Second-Generation ECLIA.

Late-night salivary cortisol (LNSC) is used as a screening test for Cushing syndrome (CS), but there is no community-derived normative data for the normal upper limit in the South Asian population. This study aimed to determine the upper limit of normal (97.5th percentile) for LNSC in an Asian Indian population using a commercially available second-generation electrochemiluminiscence immunoassay (ECLIA). LNSC in apparently healthy community-dwelling individuals was assessed by multistage cluster sampling. Healthy individuals age 18 to 60 years from 8 urban and 8 rural clusters of Thiruvananthapuram district were studied. Thirty people from an approximate population of 1000 individuals from each cluster participated in the study. A saliva sample was collected between 11 PM and 12 midnight and analyzed using Roche COBAS-e-411 and ultrasensitive Cortisol II kits the next day. Cortisol values from 474 salivary samples were available for final analysis after exclusion of improperly collected samples. The 97.5th percentile of the LNSC concentrations was 0.25 μg/dL (6.89 nmol/L) (90% CI, 0.23-0.27 μg/dL; ie, 6.34-7.45 nmol/L). In postmenopausal women, median LNSC was significantly higher but the 90% CI for the upper limit of their LNSC (0.28μg/dL or 7.72 nmol/L) overlapped with that of premenopausal women. This study establishes the normal value of LNSC estimated by second-generation ECLIA in healthy community-dwelling Asian Indian individuals for the first time. Salivary cortisol at 11 pm to 12 am is less than 0.25μg/dL (6.89 nmol/L) in the general Asian Indian population. Menopause causes a significant increase in LNSC and may lead to overdiagnosis of CS if not interpreted carefully.