Browsing by Author "Vasan, RS"

Now showing 1 - 18 of 18
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    Age- and height-specific reference limits of blood pressure for Indian children
    (NATIONAL MEDICAL JOURNAL OF INDIA, 1999) Chadha, SL; Vasan, RS; Sarma, PS; Shekhawat, S; Tandon, R; Gopinath, N
    Background. Blood pressure in childhood is the most powerful predictor of hypertension in adults. Norms for blood pressure in children are based on the age- and height-specific distribution of blood pressure in a reference sample of healthy children. Methods, We performed a cross-sectional survey of school children in the age group 5 to 14 years in south Delhi and studied the distribution of systolic and diastolic blood pressure in 8293 children (4623 boys and 3670 girls). Blood pressure was measured in all children with a mercury column sphygmomanometer using a standardized technique. The first and the fourth Korotkoff sounds were taken as indicative of the systolic and the diastolic blood pressure, respectively. Height percentiles were computed for the study sample for every one-year sex-pooled group. Multiple linear regression was then performed for every one-year group in order to estimate the 90th and 95th percentiles of systolic and diastolic blood pressure according to percentiles of height. Results. Age and height, but not gender, emerged as the principal determinants of systolic and diastolic blood pressure in multivariable linear regression analyses. Age- and height-specific 90th and 95th percentile values of systolic and diastolic blood pressure were estimated, which enabled us to categorize children into 'normal', 'high normal' and 'high' blood pressure groups. Conclusions, We present age- and height specific reference values for blood pressure of Indian children based on a large study sample. The use of these standards should aid the identification of children with high blood pressure.
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    Calculation error in estimating low HDL in women Response
    (INDIAN JOURNAL OF MEDICAL RESEARCH, 2014) Thankappan, KR; Shah, B; Mathur, P; Sarma, PS; Srinivas, G; Mini, GK; Daivadanam, M; Soman, B; Vasan, RS
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    Changing roles of grass root level workers in primary health care: an inter-district primary health centre based study from Kerala, India.
    (Health Policy and Planning, 2001) Nair, VM; Thankappan, KR; Sarma, PS; Vasan, RS
    OBJECTIVE: Multipurpose health workers (MPWs) are envisioned as key personnel in the delivery of primary health care. We evaluated their role and participation in implementing different national health programmes in Kerala, INDIA: DESIGN: Cross-sectional, community-based survey.PARTICIPANTS:We selected three out of the 14 districts in KERALA: Three-hundred and twenty-six MPWs (95 male and 231 female) from 44 randomly selected primary health centres from the three districts were questioned using a structured pre-tested questionnaire that sought information regarding the provision of health services by the MPWs to eligible beneficiaries in the community. We randomly selected 90 subcentres (30 from each district) and 750 households using a cluster sampling technique, and conducted household surveys to compare the actual delivery of services at the doorstep with that reported by the MPWS: Work sampling of MPWs was also performed to examine the fieldwork time spent by them on implementing individual national health programmes. These data were supplemented with focus group discussions and personal interviews of MPWs and household members. RESULTS: MPWs consistently 'over-reported' their performance when self-reported information was compared with that obtained from household surveys. Male MPWs concentrated on the National Malaria Eradication Programme and health education while female workers focused on the family welfare and immunization programmes. Key national health programmes (such as for tuberculosis and acute respiratory infection) were neglected by all MPWS: MPWs were aware of health problems of the elderly, but were not adequately trained nor officially expected to deliver any services in these fields. CONCLUSIONS: Grass-root level workers apportion more time to select national health programmes to the detriment of other health programmes, thereby negating their multipurpose role. Our study emphasizes the need for interventions to derive multipurpose benefits from the MPWS:
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    Changing roles of grass-root level health workers in Kerala, India
    (HEALTH POLICY AND PLANNING, 2001)
    Objective: Multipurpose health workers (MPWs) are envisioned as key personnel in the delivery of primary health care. We evaluated their role and participation in implementing different national health programmes in Kerala, India.Design: Cross-sectional, community-based survey.Participants: We selected three out of the 14 districts in Kerala. Three-hundred and twenty-six MPWs (95 male and 231 female) from 44 randomly selected primary health centres from the three districts were questioned using a structured pre-tested questionnaire that sought information regarding the provision of health services by the MPWs to eligible beneficiaries in the community. We randomly selected 90 subcentres (30 from each district) and 750 households using a cluster sampling technique, and conducted household surveys to compare the actual delivery of services at the doorstep with that reported by the MPWs. Work sampling of M PWs was also performed to era mi ne the fieldwork time spent by them on implementing individual national health programmes. These data were supplemented with focus group discussions and personal interviews of MPWs and household members.Results: MPWs consistently 'over-reported' their performance when self-reported information was compared with that obtained from household surveys. Male MPWs concentrated on the National Malaria Eradication Programme and health education while female workers focused on the family welfare and immunization programmes. Key national health programmes (such as for tuberculosis and acute respiratory infection) were neglected by all MPWs. MPWs were aware of health problems of the elderly, but were not adequately trained nor officially expected to deliver any services in these fields.Conclusions: Grass-root level workers apportion more time to select national health programmes to the detriment of other health programmes, thereby negating their multipurpose role. Our study emphasizes the need for interventions to derive 'multipurpose benefits' from the MPWs.
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    Community Utilization of Subcentres in Primary Health Care-an Analysis of Determinants in Kerala
    (Indian Journal of Public Health, 2004) Nair, VM; Thankappan, KR; Vasan, RS; Sarma, PS
    The determinants of utilisation of subcentre services in a random sample of 247 subcentres from three out of 14 districts of Kerala were investigated. Physical verification of the facilities was done in a subset of 90 subcentres and household surveys of 750 households were performed in the service areas of those subcentres. About 30 per cent of the beneficiaries utilised services of the subcentres during the reference period. The relationship of selected predictor variables on utilisation of the services was found out. The district in which a subcentre was physically present was found to be the most important correlate of its utilisation.
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    Knowledge and attitude of college students in Kerala towards HIV/AIDS, sexually transmitted diseases and sexuality
    (NATIONAL MEDICAL JOURNAL OF INDIA, 2000)
    Background. Knowledge about the spread of HIV and safe sexual practices has a critical impact on the prevention of the acquired immunodeficiency syndrome (AIDS). We assessed the knowledge of and attitude towards AIDS, sexually transmitted diseases (STDs) and sexuality among college students in Thiruvananthapuram district, Kerala.Methods.We performed a community-based, cross-sectional survey of 625 randomly selected undergraduate college students (164 boys, 461 girls, age 18-22 years). We administered a pretested, structured questionnaire to assess the knowledge and attitude of the students towards AIDS, STDs and sexuality. We generated knowledge and attitude scores from the student responses, and used multivariable linear regression to study the association of these scores with select predictor variables (notably gender and place of residence).Results. All the students in our sample had heard about AIDS. However, only 45% knew that AIDS is not curable at present. Only 34% were aware of the symptoms of STDs, and 47% knew that STDs are associated with an increased risk of AIDS. In multivariable analyses, male students (p < 0.001), and urban residents (p = 0.006) demonstrated a higher knowledge of AIDS and STDs. Students from urban areas (p = 0.014) and those practising the Christian religion (p = 0.042) demonstrated more favourable attitudes towards AIDS.Conclusions. Our study identified substantial lacunae in the knowledge of and attitude towards AIDS, STDs and sexuality among college students in Kerala, The gap in knowledge between boys and girls, and between rural and urban students suggests the need for targeting girls and rural areas in the national AIDS education and awareness campaigns.
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    Knowledge and attitude of college students in Kerala towards HIV/AIDS, sexually transmitted diseases and sexuality.
    (The National Medical Journal of India, 2000) Lal, SS; Vasan, RS; Sarma, PS; Thankappan, KR
    BACKGROUND: Knowledge about the spread of HIV and safe sexual practices has a critical impact on the prevention of the acquired immunodeficiency syndrome (AIDS). We assessed the knowledge of and attitude towards AIDS, sexually transmitted diseases (STDs) and sexuality among college students in Thiruvananthapuram district, Kerala. METHODS: We performed a community-based, cross-sectional survey of 625 randomly selected undergraduate college students (164 boys, 461 girls, age 18-22 years). We administered a pretested, structured questionnaire to assess the knowledge and attitude of the students towards AIDS, STDs and sexuality. We generated knowledge and attitude scores from the student responses, and used multivariable linear regression to study the association of these scores with select predictor variables (notably gender and place of residence). RESULTS: All the students in our sample had heard about AIDS. However, only 45% knew that AIDS is not curable at present. Only 34% were aware of the symptoms of STDs, and 47% knew that STDs are associated with an increased risk of AIDS. In multivariable analyses, male students (p < 0.001), and urban residents (p = 0.006) demonstrated a higher knowledge of AIDS and STDs. Students from urban areas (p = 0.014) and those practising the Christian religion (p = 0.042) demonstrated more favourable attitudes towards AIDS. CONCLUSIONS: Our study identified substantial lacunae in the knowledge of and attitude towards AIDS, STDs and sexuality among college students in Kerala. The gap in knowledge between boys and girls, and between rural and urban students suggests the need for targeting girls and rural areas in the national AIDS education and awareness campaigns.
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    Prevalence of dental fluorosis and associated risk factors in Alappuzha district, Kerala
    (The National Medical Journal of India, 1999) Gopalakrishnan, P; Vasan, RS; Sarma, PS; Ravindran Nair, KS; Thankappan, KR
    BACKGROUND:Fluorosis is considered endemic in 15 states of India. Dental fluorosis is the most convenient biomarker of exposure to fluoride. In Kerala, although the condition is reported to be endemic in the districts of Alappuzha and Palakkad, there are no systematic epidemiological studies evaluating dental fluorosis. We studied the prevalence of dental fluorosis among school children in Ambalappuzha taluk, Alappuzha district, Kerala and evaluated the contribution of potential risk factors. METHODS: We conducted a community-based, cross-sectional survey of 1142 school children (630 girls, 512 boys) in the age group of 10-17 years, using a multistage random cluster sampling technique. A pre-tested structured questionnaire was used to assess exposure to various sources of fluoride. A dental specialist examined all the children to determine the presence or absence of dental fluorosis and graded the degree of dental fluorosis using Dean's Index. The water fluoride content in the study area was obtained from the district water authority department. Bivariate associations were examined using the Chi-square and Chi-square trend tests, while multiple logistic regression was used to evaluate the association of select risk factors with the presence or absence of dental fluorosis. RESULTS: The overall prevalence of dental fluorosis in our study sample was 35.6% and the community fluorosis index was 0.69. The prevalence of dental fluorosis was higher in the urban compared to the rural areas (55.3% v. 16.8%; p < 0.001), and in girls compared to boys (39.2% v. 31.3%; p < 0.01). The prevalence of dental fluorosis was higher among children who consumed pipe water as compared to children who consumed well water (44.8% v. 12.7%; p < 0.001). We noted a step-wise increase in the prevalence of dental fluorosis with a corresponding increase in water fluoride content in different panchayats (p = 0.024). The principal factor associated with the presence of dental fluorosis was a high fluoride content of drinking water (OR 1.85, 95% Cl: 1.17-2.92). We did not observe any significant association between dental fluorosis and the intake of brick-tea, consumption of fish or the use of toothpaste. CONCLUSION: Dental fluorosis is a public health problem in the Ambalappuzha taluk. Active steps must be taken to partially defluoridate the water before distribution to reduce the morbidity associated with dental fluorosis in this area. Similar surveys are required in other parts of India to identify areas with high water fluoride content and determine the extent and manner in which defluoridation can be carried out.
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    Prevalence, awareness, treatment and control of hypertension among the elderly in Bangladesh and India: a multicentre study
    (BULLETIN OF THE WORLD HEALTH ORGANIZATION, 2001) Quasem, I; Shetye, MS; Alex, SC; Nag, AK; Sarma, PS; Thankappan, KR; Vasan, RS
    Objective To evaluate the prevalence, awareness, treatment and control of hypertension among elderly individuals in Bangladesh and India. Method A community-based sample of 1203 elderly individuals (670 women; mean age, 70 years) was selected using a multistage cluster sampling technique from two sites in Bangladesh and three sites in India. Findings The overall prevalence of hypertension (WHO-International Society for Hypertension criteria) was 65% (95% confidence interval = 62-67%). The prevalence was higher in urban than rural areas, but did not differ significantly between the sexes. Multiple logistic regression analyses identified a higher body mass index, higher education status and prevalent diabetes mellitus as important correlates of the prevalence of hypertension. Physical activity, rural residence, and current smoking were inversely related to the prevalence of hypertension. Among study subjects who had hypertension, 45% were aware of their condition, 40% were taking anti-hypertensive medications, but only 10% achieved the level established by the US Sixth Joint National Committee on Detection, Evaluation and Treatment of Hypertension (JNC VI)/WHO criteria. A visit to a physician in the previous year, higher educational attainment and being female emerged as important correlates of hypertension awareness. Conclusions Our findings emphasize the need to implement effective and low cost management regimens based on absolute levels of cardiovascular risk appropriate for the economic context. From a public health perspective, the only sustainable approach to the high prevalence of hypertension in the Indian subcontinent is through a strategy to reduce the average blood pressure in the population.
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    Prevalence, awareness, treatment and control of hypertension in an elderly community-based sample in Kerala, India
    (NATIONAL MEDICAL JOURNAL OF INDIA, 2000) Kalavathy, MC; Thankappan, KR; Sarma, PS; Vasan, RS
    Background. Hypertension is one of the most important causes of cardiovascular morbidity and mortality in the elderly. With the increase in the number of elderly in India, hypertension is likely to emerge as an important public health problem, Methods. We performed a cross-sectional survey of a random sample of 357 community-dwelling elderly individuals (191 women, 166 men; mean age 70 years) in Kerala, We measured blood pressure on all study participants using a standardized technique to assess the prevalence of hypertension. We compared the variations in prevalence, awareness, treatment and control of hypertension according to age, sex and place of residence of the subjects, and examined the socio-demographic correlates of hypertension using sex-specific multiple logistic regression. Results. The overall prevalence of hypertension in our sample was 51.8% (95% CI: 46.8%-56.8%), which did not vary with sex but increased with age. Fewer than half of the hypertensive subjects were aware of their condition or were on treatment, and only a quarter of the treated hypertensives achieved adequate control of blood pressure. Rural elderly subjects were especially less likely to be aware of, and on treatment for hypertension. Smoking status and rural residence tin men) and marital status tin women) were important correlates of hypertension. Conclusions. Our findings emphasize the public health importance of hypertension in the elderly in Kerala at present, and point to a likely increase in burden of this problem in India in the near future. A National Hypertension Programme, targeted to meet the imminent public health challenge posed by hypertension seems warranted.
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    Prevalence, Correlates, Awareness, Treatment and Control of Hypertension in Kumarakom, Kerala: Baseline Results of a Community –Based Intervention Program
    (Indian Heart Journal, 2006) Thankappan, KR; Sivasankaran, S; Khader, SA; Padmanabhan, PG; Sarma, PS; Mini, GK; Vasan, RS
    BACKGROUND, Hypertension is one of the major causes of cardiovascular morbidity and mortality. However, awareness, treatment, and control of hypertension remain major challenges worldwide. In this article, we present the baseline prevalence of hypertension from an ongoing intervention program for its control in a community-based sample in Kerala, Southern India. METHODS, We measured blood pressure, body weight, and height of 4955 individuals above the age of 30 yers (men;2159:mean-age: 50 years) and collected information on alcohol use, tobacco use, and other demographic variables using a pre-tested structured questionnaire. RESULTS, The overall prevalence of hypertension (JNC-VII) was 36.7% ( 95% CI:35.5-38.0; men: 36.0% and women 37.2% ) in multipile logistic regression analysis, a body mass index of >/=25 kg/m(2) was associated with a 1.65-fold (95% CI:1.37-1.98) prevalence of hypertension compared to a body mass index <25kg/m(2). Individuals with diabetes mellitus had 2.10 higher odds of hypertension prevalence (95% CI: 1.62-2.73) compared to people wihtout diabetes mellitus. Participants with increased waist circumference (90 cm in men, 85 cm in women) were 1.84 times more likely to be hypertensive compared to those with normal waist circumference (95% CI: 1.55-2.19). Among hypertensives, 24% were aware of the condition, 20% were on treatment, and 6.4% achieved effective blood pressure control. CONCLUSION, A higher body mass index, increased waist circumference, and self-reported diabetes mellitus were the important correlates of hypertension in our community-based sample. Our data emphasize the importance of educational interventions and appropriate lifestyle modifications that target increased body mass index and waist circumference to reduce the community burden of hypertension.
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    Prevalence, Correlates, Awareness, Treatment and Control of Hypertension in Middle – aged Urban Population in Kerala.
    (Indian Heart Journal, 2003) Zachariah, MG; Thankappan, KR; Alex, SC; Sarma, PS; Vasan, RS
    BACKGROUND:Hypertension is an important cause of cardiovascular morbidity and mortality.METHODS AND RESULTS:We conducted a cross-sectional survey of 314 middle-aged subjects (163 men; age range 40-60 years, mean 49 years) in urban Thiruvananthapuram City. Kerala, to estimate the prevalence of hypertension, examine its correlates, and assess the degree of awareness, treatment, and control of high blood pressure. Blood pressure was measured by a nurse graduate using a mercury column sphygmomanometer and a standardized technique. We used multivariable analyses to examine the sociodemographic and clinical correlates of hypertension. The overall prevalence of hypertension in our sample was 54.5% (men 56.3%, women 52.3%). The factors associated with an increased prevalence of hypertension were higher body-mass index (odds ratio for a value in the top tertile of 2.33, 95% confidence interval: 1.2-4.4), and older age (odds ratio for the age group 55-60 years of 2.65, 95% confidence interval: 1.3-5.6). An occupation involving moderate or greater physical activity was inversely associated with the prevalence of hypertension (odds ratio 0.35, 95% confidence interval 0.13-0.94). Among hypertensives, 39% were aware of the condition, while 29% were treated with blood pressure-lowering medications. Adequate control of elevated blood pressure was achieved in only 30.6% of treated hypertensives. In our community-based sample, over half of all middle-aged individuals were hypertensive, but less than a third were under treatment. Adequate control of hypertension was achieved in less than a third of the treated individuals. CONCLUSIONS:These observations re-emphasize the need for hypertension awareness programs targeting the general public and the increased use of opportunistic blood pressure screening, and underscore the importance of measures to increase the knowledge of current guidelines for the detection and treatment of hypertension among healthcare providers.
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    Risk Factor Profile for Chronic Non-communicable Diseases: Results of a Community-Based Study in Kerala, India
    (Indian Journal of Medical Research, 2010) Thankappan, KR; Shah, B; Mathur, P; Sarma, PS; Srinivas, G; Mini, GK; Daivadanam, M; Soman, B; Vasan, RS
    BACKGROUND & OBJECTIVES: Kerala State is a harbinger of what will happen in future to the rest of India in chronic non-communicable diseases (NCD). We assessed: (i) the burden of NCD risk factors; (ii) estimated the relations of behavioural risk factors to socio-demographic correlates, anthropometric risk factors with behavioural risk factors; (iii) evaluated if socio-demographic, behavioural and anthropometric risk factors predicted biochemical risk factors; and (iv) estimated awareness, treatment and adequacy of control of hypertension and diabetes, in Kerala state.METHODS:A total of 7449 individuals (51% women) stratified by age group, sex and place of residence were selected and information on behavioural risk factors; tobacco use, diet, physical activity, alcohol use, measured anthropometry, blood pressure was collected. Fasting blood samples were analysed for blood glucose, total cholesterol, high density lipoprotein cholesterol and triglycerides in a sample subset.Using multiple logistic regression models the associations between socio-demographic and anthropometric variables with biochemical risk factors were estimated.RESULTS: The burden of NCD risk factors was high in our sample. Prevalence of behavioural and each of the biochemical risk factors increased with age, adjusting for other factors including sex and the place of residence. The odds ratios relating anthropometric variables to biochemical variables were modest, suggesting that anthropometric variables may not be useful surrogates for biochemical risk factors for population screening purposes. INTERPRETATION & CONCLUSIONS: In this large study of community-based sample in Kerala, high burden of NCD risk factors was observed, comparable to that in the United States. These data may serve to propel multisectoral efforts to lower the community burden of NCD risk factors in India in general, and in Kerala, in particular.
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    Risk factors for acute ischemic stroke in young adults in South India.
    (Journal of Neurology, Neurosurgery and Psychiatry, 2007) Lipska, K; Sylaja, PN; Sarma, PS; Thankappan, KR; Kutty, VR; Vasan, RS; Radhakrishnan, K
    BACKGROUND: Stroke is a leading cause of death and disability in developing countries, afflicting individuals at a young age. The contribution of established vascular risk factors to ischaemic stroke in young adults has not been evaluated systematically in Indians. METHODS: We conducted a case control study in 214 South Indian patients with first acute ischaemic stroke that occurred between the ages of 15 and 45 years, 99 age and sex matched hospital controls and 96 community controls. We compared the prevalence of the following risk factors: smoking, elevated blood pressure, high fasting blood glucose and abnormal lipids. RESULTS: Compared with community controls, stroke patients had a higher prevalence of smoking (multivariable adjusted odds ratio (OR) 7.77, 95% CI 1.93 to 31.27), higher systolic blood pressure (OR per SD increment of 1.88, 95% CI 1.01 to 3.49) and fasting blood glucose (OR per SD increment of 4.55, 95% CI 1.63 to 12.67), but lower high density lipoprotein (HDL) cholesterol (OR per SD increment of 0.17, 95% CI 0.09 to 0.30). Compared with hospital controls, stroke patients had a higher prevalence of smoking (OR 3.95, 95% CI 1.61 to 9.71) and lower HDL cholesterol (OR per SD increment 0.27, 95% CI 0.17 to 0.44). The presence of > or = 3 metabolic syndrome components was associated strongly with stroke (OR 4.76, 95% CI 1.93 to 11.76; OR 2.09, 95% CI 1.06 to 4.13) compared with community and hospital controls.CONCLUSIONS:\Key components of the metabolic syndrome and smoking are associated with ischaemic stroke in young South Indian adults. Our observations underscore the importance of targeting adolescents and young adults for screening and prevention to reduce the burden of ischaemic stroke in young adults.
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    Socioeconomic and Demographic factors associated with birth weight: results of a community based study in Keral
    (Indian Pediatrics, 2000) Radhakrishnan, T; Thankappan, KR; Vasan, RS; Sarma, PS