Indian Journal of Preventive Medicine

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The incidence of diabetes is increasing tremendously worldwide. According to IDF India has the second largest number of patients with diabetes. Discoveries of new drugs in treatment of diabetes have improved the longevity of patients with diabetes. But along with this the incidences of chronic complications of diabetes have also increased. Though the association of diabetes with that of neuropathy, nephropathy, and retinopathy has been well documented, majority of other complications have remained unfocussed. The present review focuses on some of the recently discovered complications of diabetes, such as diabetic myopathy and diabetes and lung function.

Key words:Diabetes;Myopathy;Lung function;Chronic complications.

Dengue is the most common arthropod-borne viral (Arboviral) illness in humans also known as breakbone fever an infectious tropical disease caused by the dengue virus transmitted by the bite of an Aedes mosquito. There are four distinct, serotypes of the virus that cause dengue (DEN-1, DEN-2, DEN-3 and DEN-4). Symptoms appear 3-14 days after the infective bite. About half of the world’s population is now at risk. Classic dengue fever is marked by rapid onset of high fever, headache, retro-orbital pain, diffuse body pain (both muscle and bone), weakness, vomiting, sore throat, altered taste sensation, and a centrifugal maculopapular rash. There is no vaccine available against dengue, and there are no specific medications to treat it. Bed rest and mild analgesic-antipyretic therapy are often helpful in relieving lethargy, malaise, and fever associated with the disease. Prevention is mainly by means avoiding mosquito bites or travel to an endemic area. Several vaccine candidates are currently being evaluated in clinical studies. Different attenuation mechanisms have been used to develop three of the leading candidates: 1) Chimerization with yellow fever 17D vaccine strain, 2) Combinations of defined mutations/deletions and chimeras, 3) Chimerization with dengue 2 PDK53 virus, attenuated by cell culture passage. Dengue prevention and management can now exploit opportunities presented by promising advances in vector control technology interventions, evidence-based clinical interventions and candidate vaccine developments.

Keywords: Dengue; Dengue fever; Breakbone fever; Dengue hemorrhagic fever; Dengue prophylaxis;

ackground: Tuberculosis (TB) remains one of the major public health concerns in India. Studies have shown that TB is more common among low socio-economic status and illiterates. The knowledge of these people regarding TB is essential in the control and prevention of the disease. So this study is undertaken to know the level of knowledge, attitudes about TB among rural adults in relation to their socio-demographic factors. Objective: To assess the level of knowledge, attitudes and awareness of health care facilities regarding Pulmonary Tuberculosis (TB) among rural adult population. Methods: A cross-sectional study was conducted among the rural adults in Handiganur PHC in Belgaum, Karnataka which was selected purposively. Using the universal sampling technique, a total of 678 adults were contacted during the study period and data collected.  Pre-designed and pre-tested questionnaire was used to collect the data and written informed consent was obtained from all the participants. The study was conducted for a period of 10 months, from Feb 2012 to Nov 2012. Ethical clearance from Institutional Ethics Committee was obtained. Data were entered and analyzed using SPSS software. Chi square test was used to find the statistical significance. Results: Out of 466 respondents, 285 (61.20%) males and 181 (38.80%) females had reported of having heard about TB. The most common symptom of TB replied was cough >2 weeks (53.00%) and the risk factor was close contact with TB patient (34.76%). Only 56.86% were aware that TB was a communicable disease. About 35.20% had thought that TB could be transmitted through eating utensils. Only 22.75% knew the correct duration for TB treatment and 47.64% thought TB is curable. Only 4.5% were aware that BCG vaccination is preventive measure and 6.43% were aware of DOTS. Conclusion: The overall knowledge of TB is insufficient in most aspects e.g. symptoms, risk factors, transmission and prevention, and there are misconceptions about TB as well.  

Keywords:  Pulmonary tuberculosis; Rural adults; Awareness; DOTS.

Objectives: 1) To find out prevalence of contraceptive use & unmet need for contraception & reasons thereof in rural area. 2) To assess the impact of interventional measures among unmet need groups. Methodology: Community based interventional study was carried out in Rural area - Parol Primary Health Centre, District Thane, Maharashtra state among women of reproductive age groups who were selected by stratified simple random sampling technique. Systematically planned interventional measures (counseling, health education & audio-visual shows) were directed for unmet need groups, husbands & their family members by ANMs during the study period & thereafter. Follow-up visits were made to unmet need groups to assess the impact of interventions. Results: Prevalence of unmet need for contraception was 44.1%; for spacing-23.7% & for limiting-17.1%. Most common unmet need reasons for contraception were related to its side-effect (36.3%) followed by contraceptive methods i.e not knowing different contraceptive methods, their usage & source (24.4%). Fertility related reasons (desire for more children/male child) & health concern reasons were mentioned by 23.8% & 21.3% women respectively. 18.8% women stated family planning staff doesn’t give information about all available contraceptive methods, method of their use & their source. Disapproval by family members was mentioned by 15.6% women & 3.1% said that source of obtaining contraceptive method is out of their reach. After interventions, unmet needs for contraception were significantly reduced to 14.3% from 44.1%. Statistical Analysis: SPSS 11.0 version, Chi-square & Z test. Conclusion: Intensified, well planned interventional measures reduce unmet need of contraception.

Article summary: Article Focus & Key words:
•    Rural area
•    Unmet needs reasons for contraception
•    Impact of Intervention on reducing unmet need reasons & increasing contraceptive use.
Strengths of the study: Rural based interventional study wherein all remote areas are also covered.

Keywords: Women of reproductive age group; Unmet need for contraception; Intervention; Rural area.

Background: Overweight and Obesity though not an immediate lethal disease by itself is a significant risk factor associated with a range of serious non-communicable diseases. Worldwide, overweight and obesity cause more deaths than underweight. Transition of lifestyle due to rapid urbanization is a contributing factor for increased prevalence of lifestyle diseases. Objective: To determine the prevalence of overweight and obesity in urban population and to study the relationship of obesity with age. Methodology: A population based cross sectional study was conducted among 1000 subjects (43.8% males and 56.2% females) aged 20 and above residing in urban areas of Belgaum, South India. Data was collected using pretested questionnaire and physical measurements including weight, height, Waist Circumference (WC) and Hip Circumference (HC) were obtained. Body Mass Index (BMI) and Waist to Hip ratio (WHR) was calculated. Data was analyzed with SPSS 16.0 version using chi-square test for statistical significance.  Results: The overall prevalence of overweight and obesity was 23.4% and 7.9% respectively. Females had higher prevalence of both overweight and obesity (25.0%, 10.0%) when compared with that of males (21.2%, 5.2%) respectively (p=0.0039). Majority of the overweight and obese participants were in the age group of 40 – 49 years. Central obesity assessed using WHR observed that 42.6% of the females and 34.8% of the males were at high risk (p=0.012) and increased waist circumference among females was 46.5% and in males was 36.1% (p=0.001). Conclusion: High prevalence of overweight and obesity in the urban population establishes the urgent need to consider it one of the top priorities in formulation of national health policies and reducing the health care costs arising due to hazards of obesity.

Keywords: Overweight; Obesity; Body mass index; Waist  circumference; Waist to hip ratio.

Objectives: To study relationship between son preference & use of contraception & fertility pattern among married women of reproductive age group in an urban slum community of Maharashtra. Methodology: A community based, cross-sectional study was carried out among 900 married women of reproductive age group selected by systematic random sampling in an urban slum of community of Mumbai, Maharashtra. Results: In the present study, majority women were muslims, they were educated, belonging to high socio-economic status, married after legal age of marriage & having less than or equal to two living children.   88.9% women had knowledge of contraceptives of which 40% were using contraceptives. Among contraceptive users, maximum (64.8%) were using temporary contraceptive methods while 35.2% women had undergone sterilization. There was statistically significant association between use of contraception & number of living sons. There was statistically significant difference in proportion for practice rate of contraception & desired family size & son preference as maximum women of their desired family size & desired sex composition of children were using contraceptives either temporary or permanent. Statistical Analysis: SPSS 11.0 version, Chi-square & SEP. Conclusion: The findings confirm that family sex composition affects fertility behavior and also reveals that preference for sons persists in urban community of Mumbai.

Keywords: Son preference; Fertility pattern; Contraceptive use.

Background: Tuberculosis remains a major cause of morbidity & mortality in many countries & a significant public health problem worldwide.TB kills more adults in India than any other infectious diseases. Controlling it in India is a tremendous challenge & the burden is still staggering. Aims & Objectives: To study the status of RNTCP at Handignur PHC- Belgaum District. Materials and Methods: Present study is a retrospective study. The data was collected from the records maintained at PHC Handignur from 2004 to 2009 (6 years) and analysed.The results were compared with performance of RNTCP at National level figures. Results: PHC Handignur covers a population of  25,606 & prevalance of TB in this PHC during last 6 yrs has ranged from 2.6% to 7.7% average being 5.5% .Out of total 166 TB patients 103 were males & 63 females( sex ratio of 1.6:1). Amongst the total OPD patients 3.3% has been symptomatic cases who were subjected to sputum examination, amongst them the prevalance of sputum positive cases has been 2.6%. 2/3rd  of the cases i.e. 65.7% belonged to category-I,17.4% category- 2 & 16.9% category- 3. Overall compliance for treatment has been 90.3%.The case fatality amongst these patients was 8.4%.Although the mortality was more in males (11.6%) than in females ( 4.7%) it was not statistically significant with Z score 1.51 & p>0.05. (95% CI for difference in mortality rate is -3.9% to 15.9%). HIV screening was started from 2008, out of 57 cases 5 were HIV-TB coinfected 7 deaths were reported in these 2 years. Out of which 3 were HIV infected . This difference in mortality between HIV & non HIV TB cases was statistically significant with Fischer exact P=0.011. Conclusion: The prevalance of TB was more in males than females . In spite of compliance being as high as 90% the mortality has been high. Reasons for mortality need to be studied by doing prospective studies.

Keywords: RNTCP; HIV-TB Co-infection; TB mortality.