[Show abstract][Hide abstract] ABSTRACT: Primary headache disorders are among the commonest disorders, affecting people in all countries. India appears to be no exception, although reliable epidemiological data on headache in this highly populous country are not available. Such information is needed for health-policy purposes. Our aim was to estimate the prevalence of each of the headache disorders of public-health importance, and examine their sociodemographic associations, in urban and rural populations of Karnataka, south India.
In a door-to-door survey, 2,329 biologically unrelated adults (aged 18-65 years) were randomly sampled from urban (n = 1,226) and rural (n = 1,103) areas in and around Bangalore and interviewed by trained researchers using a pilot-tested, validated, structured questionnaire. ICHD-II diagnostic criteria were applied.
The observed 1-year prevalence of any headache was 63.9 %, with a female preponderance of 4:3. The age-standardised 1 year prevalence of migraine was 25.2 %; prevalence was higher among females than males (OR: 2.1 [1.7-2.6]) and among those from rural areas than urban (OR = 1.5 [1.3-1.8]). The age-standardized 1 year prevalence of TTH was 35.1 %, higher among younger people. The estimated prevalence of all headache on ≥15 days/month was 3.0 %; that of pMOH was 1.2 %, five-times greater among females than males and with a rural preponderance.
There is a very high 1 year prevalence of migraine in south India (the mean global prevalence is estimated at 14.7 %). Explanations probably lie in cultural, lifestyle and/or environmental factors, although the observed associations with female gender and rural dwelling are usual. Levels of TTH, pMOH and other headache on ≥15 days/month are similar to global averages, while the very strong association of pMOH with female gender requires explanation. Until another study is conducted in the north of the country, these are the best data available for health policy in a population of over 1.2 billion people.
The Journal of Headache and Pain 12/2015; 16(1):549. DOI:10.1186/s10194-015-0549-x · 2.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To address the growing burden of violence and injuries, especially in low- and middle-income countries, in 2007 the World Health Organization launched MENTOR-VIP, a global violence and injury prevention (VIP)-mentoring programme. The programme aims to develop human resource capacity through 12-month mentoring arrangements between individual VIP experts (mentors) and less-experienced injury practitioners (mentees). In this paper, we review the first five years of the programme (2007-2011) using a systems analysis and SWOT (Strengths, Weaknesses, Opportunities and Threats) frameworks, discuss programme findings and make recommendations. A well-defined programme with clear instructions, successful matching of mentorship pairs with similar interests and language, a formal accord agreement, institutional support and effective communication were identified as programme strengths. Overambitious projects, lack of funds and difficulties with communications were identified as programme weaknesses. Mentorship projects that require institutional permissions or resources could be potential threats to the success of mentorship. The study resulted in the four following recommendations to strengthen the programme: (1) institute additional steps in selection and matching mentor-mentee pair; (2) train mentors on e-mentoring; (3) conduct special orientation for mentees to the programme; and (4) maintain effective and open communication throughout the programme.
Global Public Health 02/2015; 10(4):1-19. DOI:10.1080/17441692.2014.1001766 · 0.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Road traffic injuries (RTIs) are a leading public health problem and the understanding of RTIs in rural India is limited. The present report documents the burden, pattern, characteristics and outcomes of RTIs in a rural district of India using combined data sources: police and hospital. RTIs contributed for 38% of fatal and 39% of non-fatal injuries with an annual mortality rate of 18.1/100,000 population/year. Young males were affected most and two-wheeler users and pedestrians were involved in 45% and 20% of fatal crashes, respectively. Nearly half (51%) of fatal RTIs occurred on national highways of the district; 46% died immediately at the site. Among those hospitalised, 20% were under the influence of alcohol while use of helmets and seat belts was <5%. Trauma care was deficient in the district leading to greater number of referrals. Road safety should be given high importance in rural India with a focus on safe roads, safe vehicles and safe people along with trauma care.
International Journal of Injury Control and Safety Promotion 08/2014; DOI:10.1080/17457300.2014.945465 · 0.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The young people in the age group of 10-24 yr in India constitutes one of the precious resources of India characterized by growth and development and is a phase of vulnerability often influenced by several intrinsic and extrinsic factors that affect their health and safety. Nearly 10-30 per cent of young people suffer from health impacting behaviours and conditions that need urgent attention of policy makers and public health professionals. Nutritional disorders (both malnutrition and over-nutrition), tobacco use, harmful alcohol use, other substance use, high risk sexual behaviours, stress, common mental disorders, and injuries (road traffic injuries, suicides, violence of different types) specifically affect this population and have long lasting impact. Multiple behaviours and conditions often coexist in the same individual adding a cumulative risk for their poor health. Many of these being precursors and determinants of non communicable diseases (NCDs) including mental and neurological disorders and injuries place a heavy burden on Indian society in terms of mortality, morbidity, disability and socio-economic losses. Many health policies and programmes have focused on prioritized individual health problems and integrated (both vertical and horizontal) coordinated approaches are found lacking. Healthy life-style and health promotion policies and programmes that are central for health of youth, driven by robust population-based studies are required in India which will also address the growing tide of NCDs and injuries.
The Indian Journal of Medical Research 08/2014; 140(2):185-208. · 1.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Bloomberg Philanthropies Global Road Safety Programme in India focuses on reduction of drink driving and increase in helmet usage in the city of Hyderabad. During the early stages of implementation, perceptions of stakeholders on road safety were explored as part of the monitoring and evaluation process for a better understanding of areas for improving road safety in Hyderabad. Fifteen in-depth interviews with government officials, subject experts, and road traffic injury victims, and four focus group discussions with trauma surgeons, medical interns, nurses, and taxi drivers were conducted, analysed manually, and presented as themes. Respondents found Hyderabad unsafe for road-users. Factors such as inadequate traffic laws, gaps in enforcement, lack of awareness, lack of political will, poor road engineering, and high-risk road users were identified as threats to road safety. The responsibility for road safety was assigned to both individual road-users and the government, with the former bearing the responsibility for safe traffic behaviour, and the latter for infrastructure provision and enforcement of regulations. The establishment of a lead agency to co-ordinate awareness generation, better road engineering, and stricter enforcement of traffic laws with economic and non-economic penalties for suboptimal traffic behaviour, could facilitate improved road safety in Hyderabad.
[Show abstract][Hide abstract] ABSTRACT: Injuries rank among the leading causes of morbidity and mortality worldwide, and are steadily increasing in developing countries like India. However, it is often possible to minimize injury and crash consequences by providing effective pre-hospital services promptly. In most low-and middle-income countries (LMICs), transportation of road traffic victims, is usually provided by relatives, taxi drivers, truck drivers, police officers and other motorists who are often untrained.
The current study was conducted to understand the current practice and perception of first aid among lay first responders in a rural southern district of India.
The current cross sectional descriptive study was conducted in the southern district of Tumkur in India within three months from January to March 2011 and covered the population including all police, ambulance personnel, taxi drivers, bus and auto drivers, and primary and middle school teachers within the study area.
Nearly 60% of the responders had witnessed more than two emergencies in the previous six months and 55% had actively participated in helping the injured person. The nature of the help was mainly by calling for an ambulance (41.5%), transporting the injured (19.7%) and consoling the victim (14.9%). Majority (78.1%) of the responders informed that they had run to the victim (42.4%) or had called for an ambulance. The predominant reason for not providing help was often the 'fear of legal complications' (30%) that would follow later. Significant number (81.4%) of respondents reported that they did not have adequate skills to manage an emergency and were willing to acquire knowledge and skills in first aid to help victims.
Regular and periodical community-based first aid training programs for first care responders will help to provide care and improve outcomes for injured persons.
[Show abstract][Hide abstract] ABSTRACT: Background:
The use of non-standard motorcycle helmets has the potential to undermine multinational efforts aimed at reducing the burden of road traffic injuries associated with motorcycle crashes. However, little is known about the prevalence or factors associated with their use.
Collaborating institutions in nine low- and middle-income countries undertook cross-sectional surveys, markets surveys, and reviewed legislation and enforcement practices around non-standard helmets.
5563 helmet-wearing motorcyclists were observed; 54% of the helmets did not appear to have a marker/sticker indicating that the helmet met required standards and interviewers judged that 49% of the helmets were likely to be non-standard helmets. 5088 (91%) of the motorcyclists agreed to be interviewed; those who had spent less than US$10 on their helmet were found to be at the greatest risk of wearing a non-standard helmet. Data were collected across 126 different retail outlets; across all countries, regardless of outlet type, standard helmets were generally 2-3 times more expensive than non-standard helmets. While seven of the nine countries had legislation prohibiting the use of non-standard helmets, only four had legislation prohibiting their manufacture or sale and only three had legislation prohibiting their import. Enforcement of any legislation appeared to be minimal.
Our findings suggest that the widespread use of non-standard helmets in low- and middle-income countries may limit the potential gains of helmet use programmes. Strategies aimed at reducing the costs of standard helmets, combined with both legislation and enforcement, will be required to maximise the effects of existing campaigns.
[Show abstract][Hide abstract] ABSTRACT: Primary headache disorders are a major public-health problem globally and, possibly more so, in low- and middle-income countries. No methodologically sound studies of prevalence and burden of headache in the adult Indian population have been published previously. The present study was a door-to-door cold-calling survey in urban and rural areas in and around Bangalore, Karnataka State. From 2,714 households contacted, 2,514 biologically unrelated individuals were eligible for the survey and 2,329 (92.9 %) participated (1,103 [48 %] rural; 1,226 [52 %] urban; 1,141 [49 %] male; 1,188 [51 %] female; mean age 38.0 years). The focus was on primary headache (migraine and tension-type headache [TTH]) and medication-overuse headache. A structured questionnaire administered by trained lay interviewers was the instrument both for diagnosis (algorithmically determined from responses) and burden estimation. The screening question enquired into headache in the last year. The validation study compared questionnaire-based diagnoses with those obtained soon after through personal interview by a neurologist in a random sub-sample of participants (n = 381; 16 %). It showed high values (>80 %) for sensitivity, specificity and predictive values for any headache, and for specificity and negative predictive value for migraine and TTH. Kappa values for diagnostic agreement were good for any headache (0.69 [95 % CI 0.61-0.76]), moderate (0.46 [0.35-0.56]) for migraine and fair (0.39 [0.29-0.49]) for TTH.The survey methodology, including identification of and access to participants, proved feasible. The questionnaire proved effective in the survey population. The study will give reliable estimates of the prevalence and burden of headache, and of migraine and TTH specifically, in urban and rural Karnataka.
The Journal of Headache and Pain 08/2012; 13(7):543-50. DOI:10.1007/s10194-012-0474-1 · 2.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: WHO estimates that about 170,000 deaths by suicide occur in India every year, but few epidemiological studies of suicide have been done in the country. We aimed to quantify suicide mortality in India in 2010.
The Registrar General of India implemented a nationally representative mortality survey to determine the cause of deaths occurring between 2001 and 2003 in 1·1 million homes in 6671 small areas chosen randomly from all parts of India. As part of this survey, fieldworkers obtained information about cause of death and risk factors for suicide from close associates or relatives of the deceased individual. Two of 140 trained physicians were randomly allocated (stratified only by their ability to read the local language in which each survey was done) to independently and anonymously assign a cause to each death on the basis of electronic field reports. We then applied the age-specific and sex-specific proportion of suicide deaths in this survey to the 2010 UN estimates of absolute numbers of deaths in India to estimate the number of suicide deaths in India in 2010.
About 3% of the surveyed deaths (2684 of 95,335) in individuals aged 15 years or older were due to suicide, corresponding to about 187,000 suicide deaths in India in 2010 at these ages (115,000 men and 72,000 women; age-standardised rates per 100,000 people aged 15 years or older of 26·3 for men and 17·5 for women). For suicide deaths at ages 15 years or older, 40% of suicide deaths in men (45,100 of 114,800) and 56% of suicide deaths in women (40,500 of 72,100) occurred at ages 15-29 years. A 15-year-old individual in India had a cumulative risk of about 1·3% of dying before the age of 80 years by suicide; men had a higher risk (1·7%) than did women (1·0%), with especially high risks in south India (3·5% in men and 1·8% in women). About half of suicide deaths were due to poisoning (mainly ingestions of pesticides).
Suicide death rates in India are among the highest in the world. A large proportion of adult suicide deaths occur between the ages of 15 years and 29 years, especially in women. Public health interventions such as restrictions in access to pesticides might prevent many suicide deaths in India.
US National Institutes of Health.
The Lancet 06/2012; 379(9834):2343-51. DOI:10.1016/S0140-6736(12)60606-0 · 45.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Injuries affect the lives of thousands of young people and their families each year in India. With the gradual decline of communicable and nutritional diseases, injuries will be a leading cause of mortality, morbidity and disabilities and the success achieved so far in child health and survival is in jeopardy. Available data indicate that among children less than 18 y, 10-15 % of deaths, 20-30 % of hospital registrations and 20 % of disabilities are due to injuries. Based on available data, it is estimated that injuries result in death of nearly 1, 00,000 children every year in India and hospitalisations among 2 million children. Road Traffic Injuries (RTI's), drowning, falls, burns and poisoning are leading injury causes in India. Drowning and burns are major causes of mortality in less than 5 y, while RTIs, falls and poisoning are leading causes in 5-18 y. A shift in the occurrence of suicides to younger age groups of 15-20 y is a matter of serious concern in recent years. More number of males, those in rural areas, and majority of poor income households are affected due to injuries.Child injuries are predictable and preventable. Children have limitations of size, development, vision, hearing and risk perceptions as compared to adults and hence are more susceptible and vulnerable to injuries. Thus, it is important to make products and home - road and school environments safer along with greater supervision by parents and care givers. The key approaches include vehicle and product safety, environmental modification, legislation and enforcement, education and skills development along with availability of quality trauma care. Child injury prevention and care requires good quality data, building human and financial resources, strengthening policies and programmes based on evidence and integrated implementation of countermeasures along with monitoring and evaluation. Child injury prevention and control is crucial and should be an integral part of child health and survival.
The Indian Journal of Pediatrics 06/2012; 80(S1). DOI:10.1007/s12098-012-0783-z · 0.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the availability and coverage of publicly available road safety data at the national and state levels in India.
We reviewed the 2 publicly accessible data sources in India for the availability of data related to traffic injuries and deaths: (1) the National Crime Records Bureau (NCRB) and (2) the Ministry of Road Transport and Highways (MORTH). Using the World Health Organization (WHO) manual for the comprehensive assessment of road safety data, we developed a checklist of indicators required for comprehensive road safety assessment. These indicators were then used to assess the availability of road safety data in India using the NCRB and MORTH data. We assessed the availability of data on outcomes and exposures indicators (i.e., number of crashes, injuries, deaths, timing of deaths, gender and age distribution of injuries and deaths), safety performance indicators (i.e., with reference to select risk factors of speeding, alcohol, and helmet use), and cost indicators (i.e., medical costs, material costs, intervention costs, productivity costs, time costs, and losses to quality of life).
Information on outcome indicators was the most comprehensive in terms of availability. Both NCRB and MORTH databases had data for most of the need areas specified by the WHO under outcomes and exposure indicators. Regarding outcome and exposure indicators, data were available for 81 and 91 percent of specified need areas at the national level from NCRB and MORTH databases, respectively. At the state level, data on outcome and exposure indicators were available for only 54 percent of need areas from either of the 2 sources. There were no data on safety performance indicators in the NCRB database. From the MORTH database, data availability on safety performance indicators was 60 percent at both national and state levels. Data availability on costs and process indicators was found to be below 20 percent at the national and state levels.
Overall, there is an urgent need to improve the publicly available road safety data in India. This will enhance monitoring of the burden of traffic injuries and deaths, enable sound interpretation of national road safety data, and allow the formulation effective road safety policies.
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Headache disorders are common in a neurological setting. They impose a significant burden on the population, affecting all ages and both sexes. Primary headache disorders, including migraine are often neglected due to their frequent and common occurrence, the episodic nature of the illness and individualized remedial measures. Little is known of the impact of the migraine on the individuals’ health and the degree of psychological distress they undergo. Hence, this study is an attempt towards assessing the psychological distress among the patients suffering from migraine.
1. To assess the profile and characteristics of patients suffering from migraine
2. To assess the psychological distress of patients suffering from migraine
Methodology: Individuals suffering from migraine attending OPD at a tertiary care centre (NIMHANS) were selected. The patients were interviewed by trained personnel using a structured questionnaire. The results were analyzed using SPSS 16.0. Quantitative variables were summarized through mean, median with SD/IQR. Mann Whitney U test was applied wherever appropriate. The level of significance was fixed at 5%.
Results: A total of 238 patients participated in the study whose age ranged from 15 to 71 years of which 155 were females. Duration of migraine ranged from few months to 30 years. 66 (27%) migraine patients had aura, of them 87.7% had visual aura. 161 (68%) had throbbing or pulsating headache, 170 (72.3%) presented headache on both sides. Physical activity aggravated the headache in 191 (80.6%) patients, 118 (49.8%) throw up vomiting and 200 (84%) have photophobia during the attack. 91 (38.2%) migraine patients had a MIDAS score of Grade IV severity and 26 (11.1%) had a GHQ score of ≥2. A statistically significant association was found between mean number of years of migraine and MIDAS scores (P=0.039) and mean MIDAS score and GHQ sore (P=0.035).
Conclusion: A significant psychological distress is noted among patients suffering from migraine.
[Show abstract][Hide abstract] ABSTRACT: Sleep-related disorders (SRDs) though frequent, are under-reported and their implications are often neglected. Objective: To estimate SRDs in an apparently healthy South Indian population.
Data was collected by administering a questionnaire including Sleep Disorders Proforma, Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index (PSQI) to 1050 apparently healthy attendants/relatives of patients attending a tertiary healthcare institution.
The mean age of the respondents was 35.1±8.7 years with even gender distribution (male: female; 29:21), work hours were 7.8±1.33 h and had regional representation from the southern Indian states. The majority of the respondents did not report any significant medical/psychiatric co-morbidities, hypertension was noted in 42.6%, in one-fourth, the body mass index (BMI) was >25, and in 7.7% the neck size was >40 cm. Daily tea (70.3%) and coffee (17.9%) consumption was common and 22.2% used tobacco. Average time-to-fall-asleep was 22 min (range: 5-90 min), average duration-of-actual-sleep was 7 h (range: 3.5-9.1 h) with the majority (93.8%) reporting good-quality sleep (global PSQI ≤5). The reported rates of SRDs varied between 20.0% and 34.2% depending on the instrument used in the questionnaire. Insomnia, sleep-related breathing disorders (SRBD), narcolepsy, and restless legs syndrome (RLS) were reported by 18.6%, 18.4%, 1.04% and 2.9%, respectively. Obesity was not strongly associated with SRBD. in 51.8% of subjects with SRBD BMI was <25 kg/m 2 . Of the respondents with insomnia, 18% had difficulty in initiating sleep, 18% in maintaining sleep and 7.9% had early morning awakening. Respondents attributed insomnia to depression (11.7%) or anxiety (2.5%). Insomnia was marginally high in females when compared to males (10.3% vs. 8.3%) and depression was the major reason. RLS, which was maximal at night, was responsible for delayed sleep onset (74.2%). Other SRDs included night terrors (0.6%), nightmares (1.5%), somnambulism (0.6%), and sleep-talking (2.6%). Family history of SRDs was present in 31.4% respondents. While, only 2.2% of the respondents self-reported and acknowledged having SRD, health-seeking was extremely low (0.3%).
SRDs are widely prevalent in India. Considering the health implications and poor awareness, there is a need to sensitize physicians and increase awareness among the public.
Neurology India 01/2012; 60(1):68-74. DOI:10.4103/0028-3886.93601 · 1.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To estimate fall-related mortality by type of fall in India.
The authors analysed unintentional injury data from the ongoing Million Death Study from 2001-2003 using verbal autopsy and coding of all deaths in accordance with the International statistical classification of diseases and related health problems, tenth revision, in a nationally representative sample of 1.1 million homes throughout the country.
Falls accounted for 25% (2003/8023) of all deaths from unintentional injury and were the second leading cause of such deaths. An estimated 160,000 fall-related deaths occurred in India in 2005; of these, nearly 20,000 were in children aged 0-14 years. The unintentional-fall-related mortality rate (MR) per 100,000 population was 14.5 (99% confidence interval, CI: 13.7-15.4). Rates were similar for males and females at 14.9 (99% CI: 13.7-16.0) and 14.2 (99% CI: 13.1-15.4) per 100,000 population, respectively. People aged 70 years or older had the highest mortality rate from unintentional falls (MR: 271.2; 99% CI: 249.0-293.5), and the rate was higher among women (MR: 281; 99% CI: 249.7-311.3). Falls on the same level were the most common among older adults, whereas falls from heights were more common in younger age groups.
In India, unintentional falls are a major public health problem that disproportionately affects older women and children. The contexts in which these falls occur and the resulting morbidity and disability need to be better understood. In India there is an urgent need to develop, test and implement interventions aimed at preventing falls.
Bulletin of the World Health Organisation 10/2011; 89(10):733-40. DOI:10.2471/BLT.11.086306 · 5.09 Impact Factor