From neglect to equity vis-a-vis noncommunicable diseases and neglected tropical diseases Vijayakumar Krishnapillai, Aswathy Sreedevi, Devraj Ramakrishnan Indian Journal of Community Medicine 2019 44(5):1-2

Relationship between dental caries experience and social capital among children – A pilot study Yeturu Sravan Kumar, PS Rakesh, Pentapati Kalyana-Chakravarthy, S Vijay Kumar Indian Journal of Community Medicine 2019 44(5):3-6 Background: The effect of larger and distal environmental and societal factors on oral health is established and the concept of social capital (SC) is gaining importance. Aim: The aim of the study is to evaluate the association of dental caries (DC) experience of children with parental social SC. Methods: A cross-sectional survey was conducted among 200 pairs of 5–12-year-old children and their parents of Kaloor (65th division), Kerala. A 30-item self-administered neighborhood SC Index questionnaire. DC of children was assessed as per the WHO guidelines. Results: The final analysis included 186 pairs of children and parents, out of which 54.8% were boys. The mean caries experience of children was 3.3 ± 3.7. A significantly higher proportion of parents rated their children as “poor oral health” in caries experienced group than caries-free group (P = 0.006). No other significant differences were found with total SC and demographic variables except for “frequency of having meal together.” Regression analysis showed that trust, control, and political domains were significant with carious status. On adjusting the confounders that were significant in bivariate analysis, only control domain of the SC remained significant. Conclusion: The social control domain (family members or neighbors actions that seek to correct deviant behavior) of SC was associated with caries experience of the children. Distal factors such as SC can influence the caries status of children.

Transgenerational preventive practices of diabetes mellitus type II patients attending a tertiary care hospital in Cochin, India Paul T Francis Indian Journal of Community Medicine 2019 44(5):7-9 Introduction: The incidence and prevalence of diabetes mellitus type II (DM type II) has been increasing relentlessly over the past few decades despite amassing a great body of evidence regarding its causation and prevention. Objective: To determine the practices of DM type II patients to prevent the disease in their children. Methodology: This is a mixed-methods study at a tertiary care teaching hospital. DM type II patients attending the department of endocrinology and its urban health center were the study participants. Data were collected using an investigator-administered questionnaire and in-depth interviews. A total of 137 patients were included in the quantitative part, and 16 in-depth interviews were conducted. Quantitative data were analyzed by SPSS software, and qualitative data were analyzed manually. Results: Nearly 62% of the patients had a family history of DM type II, 62% of the patients were aware of the genetic risk of the disease, and 26% of the patients had tried some form of preventive measure. Most of them advised their children to be careful about diet and exercise, but did not implement any specific or sustained behavioral change. The main reason was that the patients were not aware of the importance of the hereditary nature of the disease. Other reasons were children were grown up, were living separately, or did not appreciate the seriousness of the risk. Conclusion: There is a need to educate the patients about the hereditary risk of developing DM type II to empower them to implement preventive practices in their households.

A comparative study assessing sleep duration and associated factors among adolescents studying in different types of schools in an urban area of Kerala, India Geethu Mathew, Aby Dany Varghese, Anoop Ivan Benjamin Indian Journal of Community Medicine 2019 44(5):10-13 Background: Sleep is essential for optimizing physical, cognitive, and emotional functioning of adolescents. Adolescents are one of the most sleep-deprived age groups in the society. Objectives: To assess sleep duration and associated factors among adolescent children studying in different types of schools in an urban area of Kerala. Methodology: This cross-sectional study was conducted in Pathanamthitta district, Kerala, from January to December 2017. All adolescent children studying in high school and higher secondary classes were included using stratified random sampling. Study tool included a questionnaire which collected sociodemographic information, sleep duration, and schedule. Results: In this study, 657 students were enrolled. The mean age of the participants was 15.09 ± 1.33 years. 201 students (30.6%) were from government school, 242 (36.8%) from aided, and 214 (32.6%) were from private school. The mean sleep duration among the students was 7.2 ± 1.26 h. Sleep duration was found to be inadequate in 60% of the children. The sleep duration was found to be longer during weekends compared to weekdays. Nearly 92% of students take a daytime nap of >1 h during weekends. Private school students had inadequate sleep duration, late bedtime, and early wake-up time compared to other students. Higher age, class, education of parents, family income, distance travelled to school, and female gender were the other factors associated with inadequate sleep among adolescents. Conclusion: Inadequate sleep duration and difference in sleep schedule during weekends were observed among adolescents, especially among private school students. Primary prevention approach aimed at spreading adequate awareness regarding the importance of sleep among students, parents, and teachers should be practiced.

Prevalence of depression among students of a dental tertiary care center in Kerala Dhanya Raghunathan, Devraj Ramakrishnan, KV Iris Valsan, Suchitra Ambika Indian Journal of Community Medicine 2019 44(5):14-18 Introduction: According to the World Health Organization, more than 300 million people were estimated to suffer from depression in 2017. Many studies have observed that medical personnel have a higher level of depression, but studies among dentists are scarce. Early diagnosis will help in controlling the morbidity and mortality due to depression. Hence, this study was undertaken to estimate the prevalence of depression among students of Government Dental College (GDC), Thiruvananthapuram, the capital city of the state of Kerala, India. Materials and Methods: A cross-sectional study was conducted at GDC, Thiruvananthapuram, for a period of 3 months from September to December 2017, using the Patient Health Questionnaire-9 (PHQ-9) and a pro forma comprising 37 questions. Students having PHQ scores >9 were considered to have depression. The questionnaire was administered on 364 students comprising undergraduate students, paradental students, house surgeons, and postgraduates. Separate sessions were arranged for each group and four reminders were given. Results: The prevalence of depression was estimated as 26.9% (95% confidence interval: 22.4–31.8). Being married, having high and average level of course satisfaction, and having close friends were found to act as independent protective factors, whereas female gender and breakups in relationships were found to be independent risk factors. Conclusion: It is high time we provide supportive programs and implement preventive measures to help professional students, especially those who are at higher risk of mental ill-health. Further studies need to be conducted to explore the academic reasons for depression.

Impact of Swachh Bharat Abhiyan on residents of Cochin corporation Amrita Das Mavila, Paul T Francis Indian Journal of Community Medicine 2019 44(5):19-22 Context: Environmental sanitation is a major public health issue in India. Sustainable Development Goal 6 envisages the accessibility of safe water and sanitation throughout the world. Swachh Bharat Abhiyan (SBA), a national cleanliness campaign established by the Government of India in 2014, has six main objectives. It has crossed the half-way point of its intended implementation course. Aims: This study aims to assess the impact of SBA on the sanitation of Cochin Corporation and to identify factors associated with awareness and practice of SBA. Settings and Design: A cross-sectional study among residents of Cochin Corporation. Materials and Methods: Semi-structured questionnaire was used to measure awareness, practice, and impact of SBA. Three divisions were selected purposively. A score was assigned for knowledge and impact assessment questions and was classified into three categories. Statistical Analysis Used: Descriptive statistics using frequencies and percentages were done. Chi-square test was used to test differences between proportions. Results: Thirty percent had no awareness regarding SBA and 42% had minimal awareness regarding the program and its objectives. Only 24% responded that SBA had a good impact on the overall sanitation of the community. The impact of SBA was significantly associated with socioeconomic status. The study revealed the major sanitary concern of the community to be the disposal of solid waste. Conclusion: The SBA did not have a significant impact on Cochin population due to existing good sanitation. Solid waste disposal is still a concern of the community. As far as, Kerala is concerned, it appears that the primary focus of SBA should be on Municipal Solid Waste Management.

Assessment of health facilities for airborne infection control practices and adherence to national airborne infection control guidelines: A study from Kerala, Southern India Arun Raj, Devraj Ramakrishnan, Carmel Regeela Mainu Thekkeveettil Thomas, Amrita Das Mavila, Midhun Rajiv, Rakesh Purushothama Bhat Suseela Indian Journal of Community Medicine 2019 44(5):23-26 Introduction: Nosocomial transmission of airborne infections, such as H1N1, drug-resistant tuberculosis, and Nipah virus disease, has been reported recently and has been linked to the limited airborne infection control strategies. The objective of the current study was to assess the health facilities for airborne infection control (AIC) practices and adherence to the National AIC (NAIC) guidelines, 2010. Materials and Methods: A cross-sectional study was conducted in 25 public and 25 private hospitals selected from five randomly selected districts in the state of Kerala. A checklist with 62 components was developed based on the NAIC guidelines. Frequencies, percentages, and mean with standard deviation were used to summarize facility risk assessment and compliance to guidelines. Results: Most of the facilities had infection control committees 35 (70%). Annual infection control trainings were held for staff in 21 (42%) facilities. Twenty (40%) facilities were not familiar with NAIC guidelines. Counseling on cough etiquette at registration was practiced in 5 (10%) institutions. Cross ventilation was present in outpatient departments in 27 (54%) institutions. Sputum was disposed properly in 43 (86%) institutions. N95 masks were available in high-risk settings in 7 (14%) health facilities. Conclusion: There exist deficiencies in adherence to all components of NAIC guidelines including administrative, environmental, and use of personal protective equipment in both government and private hospitals in the state.

Oral health status and treatment needs of 12-year-old school children among urban and rural areas of Raichur Taluk, Karnataka, India Sudarshan Kumar Chinna, Arun Kumar Acharya, Rashmi Chinna Indian Journal of Community Medicine 2019 44(5):27-29 Introduction: Oral health is an integral part of general health. Oral health status has a direct impact on general health, and conversely, general health influences oral health. Objectives: The objectives of the study were to assess oral health status and treatment needs of 12-year-old school children among urban and rural areas of Raichur Taluk, Karnataka, India. Materials and Methods: A cross-sectional study was conducted on 1240 school children in the age group of 12 years from urban (620) and rural (620) areas of Raichur Taluk, Karnataka, India. Oral health status was assessed using the World Oral Health assessment form 1997. Results: The prevalence of caries in urban and rural areas of school children was 63.5% and 64.5%, respectively. The mean decayed teeth, missing teeth, filled teeth, and decay, missing, filled teeth of school children in Raichur Taluk were 1.15 ± 1.20, 0.0, 0.03 ± 0.23, and 1.19 ± 1.21, respectively. Conclusion: This study highlights the need for preventive and curative oral health services and should be made integral to other health programs. Oral health promotion strategies need to be implemented to improve the oral health of primary school children. Health education should be given regarding the prevention of dental caries by maintaining good oral hygiene.

Prevalence and factors of urinary incontinence among postmenopausal women attending the obstetrics and gynecology outpatient service in a tertiary health care center in Kochi, Kerala Aathira Kizhakkeveetil Ajith, Amritha Rekha, Sucharitha Duttagupta, Vinita Murali, Devraj Ramakrishnan, Vijayakumar Krishnapillai Indian Journal of Community Medicine 2019 44(5):30-33 Introduction: Urinary incontinence has an immense impact on the social and mental health, and the quality of life of a person. Women neither come forward seeking medical consultation nor do they discuss about their incontinence openly, and the condition remains underestimated in the society. Hence, this study was undertaken to assess the type of urinary incontinence in postmenopausal women visiting obstetrics and gynecology (OBG) outpatient in a tertiary health care sector and to determine the risk factors of urinary incontinence. Materials and Methods: All postmenopausal women of age 45–90 years visiting the OBG Department of Amrita Institute of Medical Sciences in the months of May and June 2018 were assessed for urinary incontinence. QUID questionnaire - a six item urinary incontinence diagnostic questionnaire to diagnose and differentiate stress, urge and mixed incontinence - was used. Results: The prevalence of urinary incontinence was 26.47%, stress urinary incontinence contributing 13.9%, mixed urinary incontinence 7.2%, and urge urinary incontinence 5.4%. Chronic cough, recurrent urinary tract infections (UTI), and prolonged duration of labor were independent risk factors associated with urinary incontinence in postmenopausal women. Conclusion: Stress incontinence was found to be the major type of urinary incontinence in the postmenopausal women. Those having history of chronic cough, prolonged duration of labor, and recurrent UTI should be screened regularly for urinary incontinence.

HIV related stigma and discrimination among people living with HIV/AIDS in Ernakulam District: A qualitative study Leyanna Susan George Indian Journal of Community Medicine 2019 44(5):34-37 Introduction: Human immunodeficiency virus (HIV)-related stigma refers to the negative beliefs, feelings, and attitudes, while discrimination is the unfair and unjust treatment of people living with HIV/acquired immunodeficiency syndrome (PLHA). Their manifestations are context-specific and have varied impacts. Objectives: (1) To determine the different contexts in which PLHA face stigma and discrimination. (2) To study the impact of stigma and discrimination on the health of the PLHA. Methodology: A qualitative study was conducted among PLHA at the office of the network for positives. Fourteen key informant interviews were conducted on PLHA and the peer counselors to determine the contexts in which they faced stigma and discrimination. To understand its impact on health, two Focus Group Discussions were carried out separately for male and female PLHA. The data were collected using a semi-structured interview guide and were audio recorded. They were then transcribed, manually coded, thematically analyzed, and triangulated. Results: The themes that arose showed that stigma and discrimination were context-specific and were experienced in different levels such as an individual, family, community, health-care system, and media. They experienced violence in addition to the loss of shelter and economic support. Stigma and discrimination was found to have a negative impact on the health of the PLHA. It was a major hindrance to health-care utilization resulting in worsening of health conditions and indirectly contributed to the spread of diseases. Conclusion: PLHA experience different forms of stigma and discrimination which have an adverse impact on their health. Behavior change communication initiatives for the community are required.