Analysing the outbreaks of leptospirosis after floods in Kerala, India

A growing number of studies have linked the incidence of leptospirosis with the occurrence of flood events. Nevertheless, the interaction between flood and leptospirosis has not been extensively studied to understand the influence of flood attributes in inducing new cases. This study reviews leptospirosis cases in relation to multiple flood occurrences in Kerala, India. Leptospirosis data were obtained for three years: 2017 (non-flood year) and two years with flooding-2018 (heavy flooding) and 2019 (moderate flooding). We considered the severity of flood events using the discharge, duration and extent of each flooding event and compared them with the leptospirosis cases. The distribution of cases regarding flood discharge and duration was assessed through descriptive and spatiotemporal analyses, respectively. Furthermore, cluster analyses and spatial regression were completed to ascertain the relationship between flood extent and the postflood cases. This study found that postflood cases of leptospirosis can be associated with flood events in space and time. The total cases in both 2018 and 2019 increased in the post-flood phase, with the increase in 2018 being more evident. Unlike the 2019 flood, the flood of 2018 is a significant spatial indicator for postflood cases. Our study shows that flooding leads to an increase in leptospirosis cases, and there is stronger evidence for increased leptospirosis cases after a heavy flood event than after a moderate flooding event. Flood duration may be the most important factor in determining the increase in leptospirosis infections.

Quarantine practices and COVID-19 transmission in a low-resource setting: Experience of Kerala, India

INTRODUCTION

Disease transmission patterns of COVID-19 have shown that masking, social distancing, contact tracing and quarantine measures are important strategies for reducing transmission. The effective implementation of quarantine is determined by the commitment of the people and monitoring by the State. The aim of the study was to find out the effectiveness of home quarantine practises and its role in determining SARS CoV2 transmission.

METHODS

Record-based retrospective cohort study was conducted among expatriates of Kerala who were on quarantine at their homes and later tested positive for SARS -CoV-2. Quarantine practises were categorised as strict room quarantine, incomplete room quarantine, home quarantine and no quarantine. Risk of transmission was assessed using risk ratios. Multiple logistic regression analysis was performed to find out the determinants of SARS CoV2 transmission.

RESULTS

The median (IQR) age and duration of quarantine of 95 study participants were found to be 35 (29, 44) years and 7 (3,13) days, respectively. Majority of the participants practised strict room quarantine (57%), whereas 11.6%, 16.8% and 14.7% practiced incomplete room, home and no quarantine, respectively. Home quarantine without room quarantine had 24 times odds for transmitting disease [OR (95%CI)): 24.14 (4.87--119.75), P < 0.001] and not being in quarantine for any duration before being diagnosed was found to be 14 times riskier when compared with strict room quarantine [OR (95%CI)): 14.44 (2.42-86.17), P = 0.003].

DISCUSSION

Low-resource settings successful in the initial phases of COVID-19 pandemic should make periodic revisions in the quarantine guidelines while continually promoting physical distancing strategies.

Spatial analysis of hypothyroidism and ground water pH in an Urban Area of Kerala using the geographic information system

Hypothyroidism is a disease assuming increasing relevance. The causative role of acidic nature of drinking water has not yet been investigated in Kerala. We attempted to determine the spatial association between the occurrence of self-reported hypothyroidism and pH of ground water using the geographic information system. The cross-sectional study was conducted among 1649 individuals residing in the subcenter area in urban Trivandrum. Self-reported hypothyroidism was obtained by the interview. Differential Global Positioning System was used to record the location of each house and its drinking water source. PH of 50 open-well water samples was estimated. The prevalence of self-reported hypothyroidism was 4.24%. Maps depicting pH distribution and occurrence of hypothyroidism were prepared. Most of the areas had acidic ground water. Geo-statistical analysis revealed the occurrence of statistically significant clustering of hypothyroid individuals in areas having acidic ground water. The study brings out possible linkage between hypothyroidism and acidic water intake necessitating detailed epidemiological investigations for drawing more robust associations.

Quality of life and sociodemographic factors associated with poor quality of life in elderly women in Thiruvananthapuram, Kerala

BACKGROUND

India is going through a phase of demographic transition leading to population aging and feminization of aging resulting in increased proportion of elderly women than men. Problems faced by the elderly women are more critical than men due to family and social conditions prevailing in India.

OBJECTIVE

The study made an attempt to assess the quality of life (QOL) using the World Health Organization QOL (WHOQOL-BREF) scale and sociodemographic factors affecting QOL of elderly women residing in a community setting in South Kerala.

METHODS

A community-based, cross-sectional study to assess the QOL of elderly women using WHOQOL-BREF questionnaire. Data were collected from 160 elderly women.

RESULTS

2.5% (95% confidence interval [CI]: 0.07-4.84) of the study participants were having "very good" QOL. 38.8% (95% CI: 31.2-46.4) had "good," 43.1% (95% CI: 35.4-50.8) had "poor," and 15.6% (95% CI: 9.98-21.22) had "very poor" QOL, respectively. QOL was least in the psychological domain followed by physical and health-related, social, and environmental domains. Logistic regression revealed age above 70 years (adjusted odds ratio [OR] - 11.3), nonpossession of property (adjusted OR - 8.99), neglecting attitude by family (adjusted OR - 6.9), and absence of visit by friends and relatives (adjusted OR - 9.9) as risk factors, whereas residing in the urban area as a protective factor (adjusted OR - 0.1) for poor QOL.

CONCLUSION

It is possible to improve the QOL of elderly women by providing financial security, ensuring care, and by enhancing social relationships of elderly women.

Contamination of Household Open Wells in an Urban Area of Trivandrum, Kerala State, India: A Spatial Analysis of Health Risk Using Geographic Information System

OBJECTIVE

To assess the sanitary condition and water quality of household wells and to depict it spatially using Geographic Information System (GIS) in an urban area of Trivandrum, Kerala state, India.

STUDY DESIGN

A community-based cross-sectional census-type study.

METHODS

Study was conducted in an urban area of Trivandrum. All households (n = 449) residing in a 1.05 km² area were enrolled in the study. Structured questionnaire and Differential Global Positioning System (DGPS) device were used for data collection. Water samples taken were analyzed in an accredited laboratory.

RESULTS

Most of the wells were in an intermediate-high contamination risk state, with more than 77% of wells having a septic tank within 7.5 m radius. Coliform contamination was prevalent in 73% of wells, and the groundwater was predominantly acidic with a mean of 5.4, rendering it unfit for drinking. The well chlorination and cleaning practices were inadequate, which were significantly associated with coliform contamination apart from a closely located septic tank. However, water purification practices like boiling were practiced widely in the area.

CONCLUSION

Despite the presence of wells with high risk of contamination and inadequate chlorination practices, the apparent rarity of Water-borne diseases in the area may be attributed to the widespread boiling and water purification practices at the consumption level by the households. GIS technology proves useful in picking environmental determinants like polluting sources near the well and to plan control activities.

Prevalence and Social Determinants of Type 2 Diabetes in a Coastal Area of Kerala, India

Introduction

Varying prevalence rates of type 2 diabetes have been observed in different parts of the southern state of Kerala, India which is in an advanced stage of epidemiologic transition. Social patterning is evident in diabetes and therefore it was decided to undertake a study on estimating the prevalence of diabetes and associated social determinants.

Methodology

The adopted local self administration unit of the Medical College which is also the field practice area with a population of 25,096 was taken for the study. All the households in the area were visited and the details regarding self reported diabetes was collected after obtaining informed consent and analysis done by multivariate logistic regression.

Result

The prevalence of self reported diabetes in this coastal area was found to be low at 7.4%. Type 2 diabetes was also found to occur significantly earlier among the respondents belonging to the below poverty line. Age above 40 years (OR 2 95% CI 1.5-2.7, p=.000), marital status (OR 1.9 95% CI 1.1-2.1, p=.006) presence of comorbidities (OR 635 95% CI 389-969, p=.000), more than 8 years of schooling (OR 0.64 95% CI 0.46-0.86, p=.004), living conditions as represented by presence of household source of drinking water(OR 1.4 95% CI 1.01-1.5) were found to be independent predictors. Though there was increasing trend of diabetes among the forward caste line families after backward logistic regression this disappeared leaving behind the proxy of socioeconomic status, household source of drinking water.

Conclusion

Though, the state of Kerala is in an advanced stage of epidemiologic transition, coastal areas are still in the earlier phases of transition with low prevalence of type 2 diabetes mellitus. Higher education and better living conditions are important social determinants of diabetes though further studies are necessary to delineate the impact of economic status and education.

Multiple Nutritional Deficiencies in Cerebral Palsy Compounding Physical and Functional Impairments

Introduction:

Cerebral palsy (CP) refers to a spectrum of disorders causing physical and intellectual morbidity. Macro and micro nutrient deficiencies often contribute to the subnormal physical and mental capabilities of them.

Objectives:

To assess the growth, nutritional status, physical and functional ability and quality of life in cerebral palsy children and to determine any relation with their gross motor and functional capabilities.

Method:

The study was conducted at a Tertiary Care Centre, with the participants in the age group 1-16 years. A pretested evaluation tool was prepared which included Anthropometric measurements, tests for hemoglobin and Vitamin D estimation, evidence of micronutrient deficiencies, Dietary patterns, Epidemiological factors, Functional assessment using GMFM (Gross Motor Function Measure ) and FIM (Functional Independent Measurement) scales and Quality of life (QOL) assessment. The data was statistically analyzed.

Results:

Out of the 41 children, 30 had quadriplegia, 3 had hemiplegia and 8 had spastic diplegia. 34 (82.9%) were severely underweight, 35 (85.4%) had severe stunting and 38 (92.7%) had severe wasting. Micronutrient deficiencies were noted like vitamin B complex deficiency in 37 (90.2%), vitamin A deficiency in 31 (75.6%), low vitamin D levels in 27 (65.9%) and insufficient levels in 9 (22%), severe anemia in 5 (12.2%) and moderate anemia in 26 (63.4%). The gross motor and functional scores were suboptimum in the majority of patients and the care givers had significant impairment in the quality of life.

Conclusion:

Majority of children with cerebral palsy had multiple nutritional deficiencies, gross motor and functional disabilities. QOL of the children and their care givers were suboptimum. A comprehensive package that address dietary intake, correction of micronutrient deficiencies especially anemia and vitamin D deficiency, physical and emotional support is recommended for the wellbeing of the affected children.

Gender Difference in Blood pressure, Blood Sugar, and Cholesterol in Young Adults with Comparable Routine Physical Exertion

Context:

Gender differences in the risk of developing non-communicable diseases (NCD) are a matter of debate. The susceptibility of a woman to NCD should be evaluated taking into consideration the social factors that limit the physical activity among women. It will be interesting to note what will happen if women are allowed to take part in physical exercise to the extent of men.

Aims:

To find out the gender difference in the pattern of the clinical and biochemical indices related to NCD in young adults with comparable daily physical activity.

Settings and Design:

This is an institution-based cross-sectional study and the setting was Lekshmibhai National College for Physical Education (LNCPE), Thiruvananthapuram, Kerala, India.

Materials and Methods:

The study participants were students who were regularly involved in more than three hours of physical exercise daily at least for the previous one year. The information on socio-demography, anthropometry, and blood pressure was recorded. Blood samples were taken for laboratory examination.

Results:

Out of 150 students registered, 126 (84%) in the age group of 17 to 25 years who fulfilled the eligibility criteria were studied. Fifty-five (43.7%) of them were women. Systolic blood pressure, fasting blood sugar, and low-density lipoprotein were found significantly lower in women. No significant difference was noted in the case of diastolic blood pressure and total cholesterol.

Conclusion:

Gender differences exist for NCD risk factors among young adults with comparable physical activity and physical exertion seems to be more protective for females.

White lesions in the oral cavity: a clinicopathological study from a tertiary care dermatology centre in kerala, India

CONTEXT

White lesions in the oral cavity may be benign, pre-malignant or malignant. There are no signs and symptoms which can reliably predict whether a leukoplakia will undergo malignant change or not. Many systemic conditions appear initially in the oral cavity and prompt diagnosis and management can help in minimizing disease progression and organ destruction.

AIM

The aim of the paper was to study the clinical and histopathological patterns of white lesions in the oral cavity presented at the study setting and to study the factors associated with the histopathological patterns of the lesions.

SETTINGS AND DESIGN

A hospital based cross-sectional study of patients with white lesions in the oral cavity attending the Department of Dermatology and Venereology, Medical College, Thiruvananthapuram was done.

MATERIALS AND METHODS

After taking a detailed history, microscopic examination of Potassium hydroxide smear and an oral biopsy with histopathologial examination was done.

RESULTS

Out of the 50 patients in the study, clinically the diagnoses made were Lichen planus (32 patients; 64%), Frictional Keratosis (4;8%), Dysplasia (2;4%), Oral Hairy Leukoplakia (1;2%), Pemphigus Vulgaris (2;4%), Cutaneous Lupus Erythematosus (1;2%), Oral Submucous fibrosis (3;6%) and Oral Candidiasis alone (5;10%). Out of the 45 patients who had undergone biopsy, 25 (55.6%) had Lichen planus, 9 (20%) had Frictional Keratosis and mild Dysplasia was found in 4 (8.9%) patients.

CONCLUSION

The measure of agreement between the clinical and pathological diagnosis was only 32%. Older age, difficulty in opening the mouth, consumption of non-smoked tobacco, site of the lesion (gingival, floor of mouth or lingual vestibule) and presence of tenderness on the lesion were significantly associated with Dysplasia.

Economic impact of chikungunya epidemic: out-of-pocket health expenditures during the 2007 outbreak in Kerala, India

The southern state of Kerala, India was seriously affected by a chikungunya epidemic in 2007. As this outbreak was the first of its kind, the morbidity incurred by the epidemic was a challenge to the state's public health system. A cross sectional survey was conducted in five districts of Kerala that were seriously affected by the epidemic, using a two-stage cluster sampling technique to select households, and the patients were identified using a syndromic case definition. We calculated the direct health expenditure of families and checked whether it exceed the margins of catastrophic health expenditure (CHE). The median (IQR) total out-of-pocket (OOP) health expenditure in the study population was USD7.4 (16.7). The OOP health expenditure did not show any significant association with increasing per-capita monthly income.The major share (47.4%) of the costs was utilized for buying medicines, but costs for transportation (17.2%), consultations (16.6%), and diagnoses (9.9%) also contributed significantly to the total OOP health expenditure. The OOP health expenditure was high in private sector facilities, especially in tertiary care hospitals. For more than 15% of the respondents, the OOP was more than double their average monthly family income. The chikungunya outbreak of 2007 had significantly contributed to the OOP expenditure of the affected community in Kerala.The OOP health expenditure incurred was high, irrespective of the level of income. Governments should attempt to ensure comprehensive financial protection by covering the costs of care, along with loss of productivity.

Determinants of childhood tuberculosis--a case control study among children registered under revised National Tuberculosis Control Programme in a district of South India

AIM

To study the determinants of Tuberculosis (TB) in children between the age group of 0-14 years receiving treatment under Revised National TB Control Programme (RNTCP).

METHODS

A case (registered under RNTCP) control study was undertaken with 41 cases and 82 controls.

RESULTS

Factors found to have significance according to binary logistic regression were low-birth weight (LBW) [Odd's ratio = 3.56],Malnutrition [Odd's ratio = 3.96], Passive smoking [Odd's ratio=6.28] and exposure to fire-wood smoke [Odd's ratio = 6.91].

CONCLUSION

LBW, malnutrition, passive smoking and fire-wood smoke are the risk factors to be addressed to prevent pediatric TB.

Childhood cancer in developing society: A roadmap of health care

Background:

We assessed referral patterns of children with hematological malignancies (HM) in North India.

Materials and Methods:

The parents/guardians were interviewed at presentation, in the period between October 2001 and November 2002. Patient delay (symptom-contact), health system delay (contact-diagnosis), total delay (symptom-diagnosis), and number of contacts were compared between high- and standard-risk disease group.

Results:

Of the 79 children (55 boys; 69.6%) with HM, 47 (59.5%) had Acute Lymphoblastic Leukemia (ALL). Forty-four children had high-risk disease. The patient, system and total delay were a median of 2 days (with Interquartile range IQR of 1–6), 37 days (IQR 13–55), and 38 days (IQR 15–60) respectively. Majority of patients (64/79; 81%) went to private sector (non governmental health care providers) for health care. Number of contacts, which was the most significant, correlate with system delay.

Conclusions:

Sensitizing the private sector practitioners about cancer in symptomatic children (pallor, bleeding, fever) may be effective.

Environmental factors of households in five districts of Kerala affected by the epidemic of chikungunya fever in 2007

BACKGROUND

Two epidemics of chikungunya fever were reported from Kerala in 2006 and 2007. We aimed to investigate the environmental factors of households affected by chikungunya fever and to estimate the proportion of population that suffered from the disease during the epidemic in 2007.

METHODS

A cross-sectional survey was conducted in the 5 heavily affected districts of Kerala during October-November 2007. The 2-stage sampling technique was used to collect data from 10 clusters, each having 18 houses from every district, by interviewing the subjects using a structured questionnaire. The sample size was 900.

RESULTS

The proportion of the population affected by chikungunya fever was 57.1% (95% CI: 52.8%-61.4%). There was a significant association between location of houses and disease status. Houses located near a public conveyance facility (within 250 m) were relatively protected from the disease (OR 0.19 [0.06-0.60]). About 69% of the households perceived mosquito infestation as a problem and 46.6% used fumes to avoid mosquitoes. More than 42% of households were not using any anti-mosquito measures at the time of the survey. Stored drinking water was the most common potential breeding source in the houses (23.5%). Households which did not store water inside were protected from the disease (OR 0.22 [0.08-0.65]).

CONCLUSION

The study indicated the persistence of favourable domestic and environmental factors after the epidemic, reflecting the necessity to strengthen anti-mosquito campaigns.