Urban Karnataka Research Articles

“I Don’t Mind Them Drinking, as Long as…”: A Cross-sectional Study to Identify Codependence among Primary Caregivers of Patients with Alcohol Dependence in Urban India

Background: Codependence is a form of relationship addiction, described as a “disease of lost selfhood.” Codependence among primary caregivers adversely impacts treatment outcomes in Alcohol Dependence Syndrome (ADS) patients. Personality traits of the caregiver may also influence codependency and its severity. However, in routine clinical practice, codependence among primary caregivers of alcoholic patients is not assessed and addressed. This study aimed to identify codependence among caregivers of ADS patients and determine its association with personality traits in various subgroups. Materials and Methods: A cross-sectional study was conducted in a private mental health establishment in urban Karnataka, India, among 125 adult primary caregivers of ADS patients who were spending at least 4 h daily with the patient for more than a year. Spann-Fischer codependence scale and Big Five personality inventory were used to assess codependence and personality domains, respectively. Codependence scores were correlated with Big Five personality scores and examined in various subgroups. Results: Among 125 study participants, 103 (82.4%) were female and 81 (64.8%) were spouse of ADS patients. Moderate and high codependency was found in 86 (68.8%) and 38 (30.4%) participants, respectively. Codependence was found to be significantly higher among females (64.5 ± 7.7) than males (57.6 ± 10.9), (t = −2.8, df = 25.6, P = 0.000), independent of the type of relationship with the patient. There was a significant positive correlation with neuroticism personality trait. Sociocultural and economic conditions of the caregiver also contributed to codependence. Conclusions: The study identified the presence of moderate-to-severe codependence, especially among female caregivers of ADS patients. This emphasizes the need for a protocol to assess codependency and personality traits among caregivers of ADS patients to improve treatment outcomes in urban Indian settings.

Psychological Well-being of Late Adolescents in Urban Karnataka and Tamil Nadu during the COVID-19 Pandemic: A Cross-sectional Study

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic and prolonged lockdowns has impacted the mental health of adolescents. Late adolescence is an age peculiarly vulnerable to mental health issues, and very few studies have exclusively focused on this age group during the pandemic. Aim: To evaluate the presence and severity of anxiety and depression symptoms among late adolescents (15-18 years), taking into account their socio-demographic variables and additional stressors like board exams during the pandemic in India. Materials and Methods: A cross-sectional questionnairebased study was conducted in High schools in Urban Karnataka and Urban Tamil Nadu from October 2020 to December 2021 with snowball sampling. An online form was given to 104 students, which included socio-demographic data, the Patient Health Questionnaire (PHQ-9, adopted for adolescents), and the Generalised Anxiety Disorder Assessment (GAD-7) questionnaires. The participants were divided into two groups for subgroup analysis. Group-1 constituted standard X and XII and Group-2 constituted standard XI. Unpaired t-tests, Spearman’s correlations, and univariate analysis of variance were used for data analysis. Results: A total of 104 late adolescents from an urban setting participated in the study. A total of 24% had significant clinical depression, and 20.2% had significant anxiety levels. Board exams did not influence the presence of depression or anxiety. Among the socio-demographic variables, presence or absence of pets caused significant differences in PHQ 9(A) levels between the two groups (p=0.01). The PHQ-9(A) scores for Group-1 (p=0.031) and Group-2 (p=0.001) showed a significant correlation with increased social media usage. GAD-7 scores also showed a significant correlation with increased social media usage in both groups (Group-1, p<0.001 and Group-2, p=0.018) and the presence of siblings in Group-2 (p=0.010). No other variable showed a significant correlation with PHQ-9(A) and GAD 7 scores in the groups. Suicide risk and ideation were seen in 17.7% of the cohort. Conclusion: The study revealed the negative impact of the COVID-19 pandemic on the mental health of late adolescents. The increased usage of social media impacted depression and anxiety levels.

Mapping of pathways of care, assessment of delays and gap analysis in provision of care following road traffic injury among patients in selected tertiary hospitals in urban Karnataka, South India

Background: Evidence-based public health advocates decision making based on best available scientific evidence, hence it is important to gather evidence of current scenario of trauma care. Aim & Objective: To determine pathways of care and delays among Road Traffic Injury patients and assess gaps in resources. Settings and Design: This cross-sectional study was conducted in selected tertiary care hospitals in Mangaluru taluk, Karnataka. Methods and Material: Participants were administered validated proformas on prehospital and hospital care. WHO trauma care checklist was used for capacity assessment and gap analysis. Statistical analysis used: Time intervals are expressed as measures of central tendency and dispersion. Descriptive analysis is given as percentages and proportions. Results: Median pre-hospital time was 30 minutes. Overall, 67.5% of the patients reached within golden hour. Majority (64.1%) were directly transported to current hospital. All patients received first aid, but only 0.8% received it at the RTI site. First aid was mostly administered by doctors (68.7%) or nursing staff (31.1%) and none by bystander. Insurance coverage was 32.8% and 87.9% incurred out of pocket expenditures. Scores were low in GP level hospital. Conclusions: Although transport was within the golden hour, pre-hospital care was poor. Out of pocket expenditures were high.

Unmet needs of family planning and its associated factors among married women in reproductive age group, Mysuru

Background: According to national family health survey-5 (NFHS-5), in urban Karnataka, the total unmet need was 7.3. An important concept to describe effectiveness of family planning program is unmet need for family planning. Most married women want to limit childbirth and space deliveries but are unable to use contraceptives for varying reasons leading to unmet need. To assess unmet need of family planning and its associated factors among married women in reproductive age group in Mysuru.Methods: A community based cross-sectional study was done from November 2020-January 2021 among married women in reproductive age group (18-49 years) in urban Mysuru. Sample size calculated was 162. The samples were selected by systematic random sampling and interviewed using a pre-tested semi- structured questionnaire. Data was analysed using SPSS version 23 (licensed to JSS AHER).Results: The overall unmet need was 29.01%, among this 17.3% was for spacing and 11.71% for limiting. Out of 162 females studied, around 131 had knowledge about at least one contraceptive method. Unmet need was higher in unemployed women belonging to the lower socio-economic group. Important reasons cited for not using contraceptives were family opposition, fear of side effects, negligent attitude of the women and lack of knowledge about family planning.Conclusions: Unmet need of family planning in the study area was comparatively high, therefore, routine family planning counselling, health education, and health awareness programs need to be strengthened.

Junk Food Addiction Across Generations in Urban Karnataka, India

Background: Junk food consumption is progressing from being just an unhealthy life style habit to a full-fledged addiction.Objectives: To assess the health problems related to junk food habits; To assess the burden of addiction to junk food using a novel junk food addiction scale and to describe the alternate diets followed.Methodology: A cross-sectional study was conducted among people across three generations: Generation X, Millenials and Generation Z residing in urban Karnataka, India. Using convenient sampling, a sample size of 500 subjects were selected. Addiction to junk food was assessed by a novel Junk Food Addiction Scale developed for the study.Result: All 500 study subjects had consumed either junk/street/fast/instant food any time in the past 1 year. A total of 211 (42.2%) subjects reported acute health problem and 182 (36.4%) chronic health problems following junk food consumption. The burden of junk food addiction was found to be 80 (16%) [CI (95%): 13.32-18.68] of which majority 70 (14%) had mild addiction. The prevalence of different fad diets followed for 3 months or more was 137 (27.4%).Conclusion: Junk food addiction was observed in more than one tenth of the subjects. Majority had mild addiction and observed equally between Millennials and Generation Z. Obesity, habits and gadgets had independent effects on junk food addiction. More than one forth subjects followed fad diets. How to cite this article:Masthi NRR, Jahan A. Junk Food Addiction Across Generations in Urban Karnataka, India. J Commun Dis 2020; 52(1): 65-71. DOI: https://doi.org/10.24321/0019.5138.202008

Children commute to schools in Bangalore urban and rural districts: travel pattern, behaviour and perceptions

Background: Children form vulnerable road users during their regular school commute. School children safety is not taken into consideration before construction of road network. The total number of persons injured in India during 2015 near schools or colleges or educational institutions due to road traffic accidents are 13,270 in urban areas according to National Crime Records Bureau which is quite alarming. Current study is the first attempt in both rural and urban Karnataka towards understanding travel pattern, behaviour and perceptions among school children during commute to schools. The objectives of the present study were to assess travel pattern, behaviour and perception of school children in Bangalore urban and rural districts and to assess factors associated with travel pattern.Methods: A cross sectional study was conducted using a representative sample of schools selected by simple random sampling. Data was collected using a pre-tested, semi-structured questionnaire which was analysed using SPSS version 20.Results: Nearly 86% of school children travelled less than 5 kms to reach their schools. Nearly 39% of school children travelled alone to school. Most common mode of travel to school was by walk. Nearly 27.4% did not cross the main roads safely. Adherence to road safety behaviour was insufficient. Vehicular traffic was perceived as a major apprehension by children during school commute.Conclusions: Commute of children to schools in both urban and rural part of Bangalore was unsafe with least adherence to safety measures, which might increase their vulnerability to road traffic injuries.

Clinical profile of pityriasis rosea: a descriptive study from urban Karnataka

<p class="abstract"><strong>Background:</strong> Pityriasis rosea (PR) is common, self-limited papulo-squamous dermatosis of unknown origin, which mainly appears in adolescents and young adults (10-35 years). It has a sudden onset, and in its typical presentation, the eruption is proceeded by a solitary patch termed “herald patch”, mainly located on the trunk. The objective of the study was to assess the clinical profile of pityriasis rosea.</p><p class="abstract"><strong>Methods:</strong> The data was collected from patients attending the Department of Dermatology, Basaveshwar Teaching and General Hospital attached to Mahadevappa Rampure Medical College, Gulbarga. It is a descriptive observational study. A total 79 patients suffering from pityriasis rosea who attended the outpatient department were included in the present study during the period from 2006 to 2007.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 79 patients studied, majority were from 11-20 years age group 33 (41.8%) followed by 27.8% from 21-30 years age group. The mean age of study population was found to be 21.3±6.4 years. 11% gave history of acne vulgaris, 8% each had history of atopy and drugs. Commonly observed prodromal symptoms were URTI (25.3%) and fever (17.7%). Herald patch was seen on trunk in majority of patients i.e. 36 (61%) followed by 18.6% cases on upper extremity and on neck (8.5%).</p><p class="abstract"><strong>Conclusions:</strong> Our study concludes that pityriasis is common in 11-20 years age group with male predominance having URTI as common prodromal symptom and typical rash.</p>

Assessment and management of ambient air quality of Bengaluru urban Karnataka, India

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Comparative study of oral methotrexate and narrow band ultraviolet-B in chronic plaque psoriasis: a study from urban Karnataka

<p class="abstract"><strong>Background:</strong> Treatment of psoriasis continues to be a challenge. It is often frustrating experience for dermatologists. Methotrexate or PUVA or NBUVB when used properly, can produce good to excellent clinical benefit with minimal side effects. The objective of the study was to compare the efficacy and safety of oral methotrexate and NBUVB in the treatment of chronic plaque psoriasis.</p><p class="abstract"><strong>Methods:</strong> 100 patients of chronic plaque psoriasis attending the skin department of Navodaya Medical College and Hospital, Raichur from November 2012 to April 2014 were included in the study. Group A exhibited to Oral methotrexate and group B to NBUVB. Outcome was measured in terms of PASI 75 (it means 75% reduction in original PASI). Data was analysed using SPSS 19.0 version.<strong></strong></p><p class="abstract"><strong>Results:</strong> In Group A mean age was 33.68 years and in Group B mean age 33.7 years. The difference in mean PASI at baseline, at 4 and 8 weeks using oral methotrexate as well as NBUVB was found to be highly significant (<0.001). PASI score was less in-group using methotrexate at 4 and 8 weeks interval (<0.05). Mean time taken for PASI 75 in the baseline PASI score in Group A was 9.62±1.3 weeks whereas in Group B it was 11.3±0.7 weeks. Side effects were higher in group B (60%) compared to group A (36%).</p><p class="abstract"><strong>Conclusions:</strong> Improvement in the PASI score was best with methotrexate than NBUVB. The side effects observed in a methotrexate were minimal compared to NBUVB.</p>

Village in the City: Residential Segregation in Urbanizing India

One of the normative promises of Indian urbanization is the potential breaking down of the rigidities that characterize traditional caste hierarchies in an agrarian regime. In particular, urbanization holds the promise of breaking down spatial barriers between traditional caste groups. Using a unique census-scale dataset from urban Karnataka containing detailed caste and religion data, we present a contemporary snapshot of the relationship between urbanization and patterns of residential segregation. Our analysis shows that urban wards (the extant elementary spatial unit used in the literature) are heterogeneous and segregation within the wards at census-block scales account for a significant part of the overall patterns of city scale segregation. In particular, we show how intra-ward segregation is a central driver of ghettoization of the most spatially marginalized groups in urban India – Muslims and Dalits. We provide the first census-scale evidence in independent India that corroborates anecdotal accounts of urban ghettoization. The cross-section snapshot presented in this paper suggests that degree of residential segregation is uncorrelated with levels of urbanization. We report high levels of segregation across a diverse set of urban centers that include semi-urban settlements to arguably India’s most globalized metropolis of over ten million residents, Bengaluru.

Designing a comprehensive Non-Communicable Diseases (NCD) programme for hypertension and diabetes at primary health care level: evidence and experience from urban Karnataka, South India

BackgroundIndia accounts for more than two-third of mortality due to non-communicable diseases (NCDs) in south-east Asia. The burden is high in Karnataka, one of the largest states in southern India. There is a need for integration of disease prevention, health promotion, treatment and care within the national program at primary level. A public-private partnership initiative explored evidence gaps to inform a health system based, integrated NCD programme across care continuum with a focus on hypertension and diabetes.MethodsThe study was conducted during 2017–18 in urban parts of Mysore city, covering a population of 58,000. Mixed methods were used in the study; a population-based screening to estimate denominators for those with disease and at risk; cross-sectional surveys to understand distribution of risk factors, treatment adherence and out of pocket expenses; facility audits to assess readiness of public and private facilities; in-depth interviews and focus group discussions to understand practices, myths and perceptions in the community. Chi-square tests were used to test differences between the groups. Framework analysis approach was used for qualitative analysis.ResultsTwelve and 19% of the adult population had raised blood sugar and blood pressure, respectively, which increased with age, to 32 and 44% for over 50 years. 11% reported tobacco consumption; 5.5%, high alcohol consumption; 40%, inadequate physical activity and 81%, inappropriate diet consumption. These correlated strongly with elderly age and poor education. The public facilities lacked diagnostics and specialist services; care in the private sector was expensive. Qualitative data revealed fears and cultural myths that affected treatment adherence. The results informed intervention design across the NCD care continuum.ConclusionsThe study provides tools and methodology to gather evidence in designing comprehensive NCD programmes in low and middle income settings. The study also provides important insights into public-private partnership driving effective NCD care at primary care level.

Comparative assessment of side effects of etomidate and propofol: A double blinded study from urban Karnataka

Comparative assessment of side effects of etomidate and propofol: A double blinded study from urban Karnataka

Clinical evaluation of fibrinogen level in type II diabetes mellitus: A descriptive study from urban Karnataka

Clinical evaluation of fibrinogen level in type II diabetes mellitus: A descriptive study from urban Karnataka

Scaling up screening, diagnosis, and treatment of gestationaldiabetes mellitus in Karnataka: Policy Brief

Diabetes in Pregnancy Study Group of India was successful in determining the incidence of diabetes during pregnancy of women in India. The Asian Research and Training Institute for Skill Transfer demonstrated the incidence of diabetes in pregnancy in Urban Karnataka as 15.6. Maternal antecedents of adiposity and studying the transgenerational role of hyperglycaemia and insulin MAASTHI a cohort studyin Karnataka demonstrated the link between transgenerational factors and the risk associated with being diagnosed with GDM. The study was also instrumental in understanding the need of developing screening diagnosis and treatment guidelines for GDM in Karnataka. This study has developed and implemented procedures of screening in public hospitals and primary maternal clinics in Karnataka. Even though the national guidelines have been suggested by the government of India on February 2018they still have not been implemented in Karnataka. There is an urgent need to standardise methods of screening the cut off points the trimester and the weeks by which they should be screened and so on to avoid adverse maternal and fetal outcomes associated with GDM.We used qualitative research methods in this study to interview the various stakeholders. The recommendations of this study include the addition of GDM to Essential Diagnostic List and other existing programs such as NPCDCS dealing with maternal healthcare and diabetes separately among others.

Breeding Management Practices of Pet Dogs in Urban Karnataka

Breeding Management Practices of Pet Dogs in Urban Karnataka

Violence against Educated Women by Intimate Partners in Urban Karnataka, India.

Background:Initially viewed as a human rights issue, partner violence is increasingly seen as an important public health problem of international concern.Objectives:To assess the extent of physical, sexual, psychological, and controlling behavior of intimate partners against women in an educated society and find the association with age, age of marriage, married years, educational status of the women and that of partner.Materials and Methods:A prevalence of 15% was taken and final sample was 200, after considering loss of follow-up.Statistical Methods:Proportion, Z-test, Chi-square test.Results:The prevalence of violence against intimate partner in educated society was found to be 40.5% in a South Indian city. Physical assault was high in 30–50 years and increased with duration of marriage from 5.5% at 5 years to 33.3% in 10–20 years of married life. Sexual and psychological assault also increased in <5 years of married life to 35% and 47.6% in 10–20 years duration of marriage, which was statistically significant. Sexual and psychological assault showed a bimodal presentation. Less educated women and their partners were found to report more violence, which was statistically significant.Conclusion:Violence against women is not uncommon in the educated society.

How patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from India

ABSTRACT Background: Depending on a country’s diagnostic infrastructure, patients and providers play different roles in ensuring that correct and timely diagnosis is made. However, little is known about the work done by patients in accessing diagnostic services and completing the ‘test and treat’ loop. Objective: To address this knowledge gap, we traced the diagnostic journeys of patients with tuberculosis, diabetes, hypertension and typhoid, and examined the work they had to do to arrive at a diagnosis. Methods: This paper draws on a qualitative study, which included 78 semi-structured interviews and 13 focus group discussions with patients, public and private healthcare providers, community health workers, test manufacturers, laboratory technicians, program managers and policymakers. Data were collected between January and June 2013 in rural and urban Karnataka, South India, as part of a larger project on barriers to point-of-care testing. We reconstructed patient diagnostic processes retrospectively and analyzed emerging themes and patterns. Results: The journey to access diagnostic services requires a high level of involvement and immense work from patients and/or their caretakers. This process entails overcoming cost and distance, negotiating social relations, continuously making sense of their illness and diagnosis, producing and transporting samples, dealing with the social consequences of diagnosis, and returning results to the treating provider. The quality and content of interactions with providers were crucial for completion of test and treat loops. If the tasks became overwhelming, patients opted out, delayed being tested, switched providers and/or reverted to self-testing or self-treatment practices. Conclusion: Our study demonstrated how difficult it can be for patients to complete diagnostic journeys and how the health system works as far as diagnostics are concerned. If new point-of-care tests are to be implemented successfully, policymakers, program officers and test developers need to find ways to ease patient navigation through diagnostic services.

Point-of-care testing in India: missed opportunities to realize the true potential of point-of-care testing programs.

BackgroundThe core objective of any point-of-care (POC) testing program is to ensure that testing will result in an actionable management decision (e.g. referral, confirmatory test, treatment), within the same clinical encounter (e.g. POC continuum). This can but does not have to involve rapid tests. Most studies on POC testing focus on one specific test and disease in a particular healthcare setting. This paper describes the actors, technologies and practices involved in diagnosing major diseases in five Indian settings – the home, community, clinics, peripheral laboratories and hospitals. The aim was to understand how tests are used and fit into the health system and with what implications for the POC continuum.MethodsThe paper reports on a qualitative study including 78 semi-structured interviews and 13 focus group discussions with doctors, nurses, patients, lab technicians, program officers and informal providers, conducted between January and June 2013 in rural and urban Karnataka, South India. Actors, diseases, tests and diagnostic processes were mapped for each of the five settings and analyzed with regard to whether and how POC continuums are being ensured.ResultsSuccessful POC testing hardly occurs in any of the five settings. In hospitals and public clinics, most of the rapid tests are used in laboratories where either the single patient encounter advantage is not realized or the rapidity is compromised. Lab-based testing in a context of manpower and equipment shortages leads to delays. In smaller peripheral laboratories and private clinics with shorter turn-around-times, rapid tests are unavailable or too costly. Here providers find alternative measures to ensure the POC continuum. In the home setting, patients who can afford a test are not/do not feel empowered to use those devices.ConclusionThese results show that there is much diagnostic delay that deters the POC continuum. Existing rapid tests are currently not translated into treatment decisions rapidly or are not available where they could ensure shorter turn-around times, thus undermining their full potential. To ensure the success of POC testing programs, test developers, decision-makers and funders need to account for such ground realities and overcome barriers to POC testing programs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1223-3) contains supplementary material, which is available to authorized users.

In-Tensions to Infrastructure

Digital property databases are being developed across Indian cities. There are intentions to develop these into state-wide information infrastructure. Recently, the Delhi State Spatial Data Infrastructure was launched, which evolved from a property database. Because these efforts are recent, little research exists on the problems involved and the consequences of the development. Through a lens of information infrastructure (II) theory, my aim is to explore how the effort is currently shaping up in the case of urban Karnataka. I find that in the II development, tensions dominate that are related to the concern of aligning end goals. These tensions are manifest in competition over short-term funding, individuals’ interests with respect to computerization and problems of populating the databases through changing survey techniques. Survey techniques for property boundaries imply a stable and categorizable space aiming to provide a comprehensive snapshot of the city. This clashes with the flexibility in urban land and property regimes. While geospatial technologies are employed to eliminate flexibility, land and property regimes pose the major problem to implementation at the moment of digital recording. This implies that successful II development in the long run may change current property and land ownership regimes with the potential of closing spaces of the city to some groups of people. It becomes a question also of whose interests, or what communities, are to be served by the II development.

Informalisation and the social relations of production: Insights from urban Karnataka, 1990–2005

This article draws upon evidence from urban centres in the Indian state of Karnataka in order to explore the impact of informalisation on labour. It is argued that informalisation is best understood by outlining specific changes to the social relations of production. This issue is approached by comparing and contrasting Marxist claims about class formation with findings from an analysis of Economic Census data. The Economic Census has recorded a rise in waged labour in informal enterprises in urban Karnataka and a rise in sole trading in own-account establishments. It concludes by pointing towards the need for further research into the growing employment of ‘informal workers’ in the formal economy.