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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241723EnglishN2015December10HealthcareCHILDHOOD HIV ADMISSIONS AT A NIGERIAN TERTIARY HOSPITAL
English0107O.A. OyedejiEnglish O.B. BolajiEnglish E. AgelebeEnglish I.O. OluwayemiEnglish A.A. AremuEnglishObjective: To describe the clinical and laboratory profiles of paediatric (Human Immunodeficiency virus) HIV admissions and their outcomes post scale up era. Method: Information on the clinical profiles, immunology and outcome was obtained from the case notes of HIV infected children admitted between the year 2007 and 2010 at a Nigerian teaching hospital. Data was analyzed with the SPSS 18 software. Results: Of the 2523 paediatric admissions 42(1.7%) were HIV infected. The 42 were made up of 21 boys and 21 girls and their mean age was 3.7±2.9years. Pneumonia, septicaemia, Tuberculosis, malaria, meningitis, otitis media, osteomyelits, pharygotonsilitis and septic arthritis was the diagnosis in 10(23.8%), 10(23.8%), 10(23.8%), 7(16.7%), 1(2.4%), 1(2.4%), 1(2.4%), 1(2.4%) and 1(2.4%) children respectively. Sequelae followed all neurological and bone infections. Of the total 191 childhood deaths recorded on the paediatric wards 9(4.7%) were due to HIV. A case fatality rate of 9(21.4%) was recorded. Tuberculosis, septicaemia, bacterial pneumonia and immune reconstitution syndrome accounted for more than 60% of the deaths. Ten patients were on Highly Active Anti-retroviral Therapy (HAART) while the remaining 32 were not. No deaths were recorded among the patients on HAART in contrast to the 9 deaths amongst patients not on HAART (p = 0.04, OR = 1.41 CI= 1.12 – 1.77). Four of the 5 patients on HAART had sequelae compared with the single case of sequela amongst the 30 not on HAART (pEnglishClinical, Immunologic, Characteristics, HIV-infected, ChildrenINTRODUCTION
The disease HIV is probably the most dreaded pandemic in human history with an estimated 33.8 million people infected globally in the year 2008.[1] Sub-Saharan Africa has been disproportionately affected, accounting for 91% of new paediatric infections in the year 2008.[1] Nigeria being the most populous African nation has also had its own share of this pandemic recording 220,000 infections in the year 2007, thus making the country the second largest country in Africa with paediatric infections.[2] An improvement in the national response to this pandemic in Nigeria has recently been witnessed. This has resulted in the scaling up of diagnostic and treatment services coupled with the training of health personnel.[3] Diagnostic and treatment are also currently offered free to the citizenry. Reports on paediatric HIV admissions in Nigeria are few, with respect to the burden imposed by the disease in the country.[4,5] Furthermore, all of these studies were conducted before the scaling up of services.[4,5] Thus, a knowledge gap currently exists on paediatric HIV admissions in the scale up era. The aim of the present study is to give an update on the clinical profile, immunology and outcome of paediatric HIV infected admissions at the Ladoke Akintola University of Technology Teaching Hospital, Nigeria.
METHODS
This is a retrospective study of all paediatric HIV admissions at the Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria between 1st January 2007 and 31st December 2012. The hospital is situated in Osogbo, which is the capital of Osun state, located in the South West Nigeria. This hospital provides tertiary health services to the inhabitants of the state which was recorded to have a population of 3.2 million in 2006.[6] The inhabitants of the neighbouring states such as Ondo, Kwara and Ekiti also patronize the facility. The hospital provides free care for HIV infected children and it is supported by the government of Nigeria and the United States President’s emergency plan for AIDS relief program. All principles governing ethical research were complied with in the research. Diagnosis of HIV was based on a positive ELISA reaction and confirmed by a Western blot in children aged 18 months and older. Infections in children aged less than 18 months were established using the HIV DNA polymerase chain reaction kit. The voluntary counselling and testing method was used to diagnose all infected children with symptoms suggestive of HIV infections or those whose mothers or siblings presented with symptoms. Information was extracted from the case notes of all paediatric HIV admissions. Details obtained include age, sex, clinical presentation, diagnoses, CD4 count on admission and outcome. Chronic cough was taken as a cough persisting more than 21 days. [7] Frequent watery stools lasting more than 14 and 30 days classified as persistent and chronic diarrhoea, respectively. Generalized lymph node enlargement was lymph node enlargement involving more than 2 contiguous sites. [8] Fever lasting for more than 14 days was regarded as prolonged fever. Children whose mother were HIV positive and no other risk factors for HIV were identified were classified to be vertically infected, while those whose mothers were HIV negative with risk factors for HIV infection were classified as horizontally infected Diagnosis of tuberculosis was based on the WHO guidelines for national tuberculosis programs for children.[8] Pneumocystis jeroveci pneumonia was based on clinical and radiological features.[9] Age appropriate absolute CD4counts for severe immune suppression was used to classify the immunologic status and clinical staging on admission was based on HIV clinical staging [8] The data obtained was analyzed with PASW statistics version 18 using simple descriptive statistics such as range, mean and percentages for continuous variables. Associations for categorical variables were tested with chi–square and values less than 0.05 were regarded as statistical significant.
RESULTS
Population studied Of the 2,523 admissions in the paediatric ward (excluding neonatal ward) over the study period, forty two (1.7%) were HIV infected. A total number of 191 deaths occurred amongst these 2,523(7.6%) admissions.
Age and sex distribution The mean age of the children studied is 3.7±2.9 with their ages ranging between 2 months and 10 years. Of the 42 children studied 7(16.7%) were aged between 2 months and 1 year, while 23(54.8%) were aged between >1 – 5 years. The remaining 12(28.6%) were aged between >5 – 10 years. Twenty one boys and 21 girls were studied giving a male to female ratio of 1:1. The age and sex distribution of the children is shown in Table 1.
Clinical features The common features at presentation were fever, weight loss, cough, thrush, generalized lymph node enlargement. Prolonged fever was recorded in 20 children, while fever lasting than 20days was recorded in 15. Chronic cough was noted in 7 children, while cough persisted for less than 21 days in 14. Diarrhoea was chronic in 10, acute in 6 and persistent in 2. The 7 cases of skin rashes were made up of 2 cases of scabeitic rashes, and one case each of a chest wall furuncle, cellulitis of a finger, tinea facei, tinea unguim and a case of sebhoroheic dermatitis. The other clinical features are shown in table 2.
Mode of transmission Of the 42 children studied, the mode of acquisition of HIV was presumed vertical in 41(97.6%) and horizontal form a blood transfusion in one (2.4%). Of the 41 children presumed to be vertically infected, 38(92.7%) mothers and their babies missed out on prevention of mother to child strategies because their mothers were not aware of being HIV infected, two (4.8%) of the remaining mothers who knew there retroviral status were not aware of the PMTCT interventions and the remaining one(2.4%) mother gave no reasons. Of the total 42 admissions 40(97.6%) were previously diagnosed and registered for care at the paediatric anti-retroviral clinic prior to this study, while the remaining 2(2.4%) admissions were newly diagnosed during the course of this study.
Diagnoses and microbiologic etiologies of some diseases Pneumonia, septicaemia, malaria, pulmonary tuberculosis, disseminated tuberculosis, meningitis, bilateral chronic secretory otitis media, osteomyelits, pharygotonsilitis and right hip septic arthritis were seen in 10(23.8%), 10(23.8%), 7(16.7%), 6(14.3%), 4(9.5%), 1(2.4%), 1(2.4%), 1(2.4%), 1(2.4%) and 1(2.4%) children respectively. Table 5 shows the diagnoses in the children studied. The seven cases of malaria were uncomplicated in 4(57.1%) and due to severe anaemia, protracted vomiting and cerebral malaria in each of the remaining respective cases. Of the 10 cases with pneumonia, 3 were presumed to be caused by pneumocystis jeroveci and the etiologies of the others could not be ascertained either because of no growth bacteriological studies in 3 or inability to carry out the required tests because of financial constraints in 4 Staphylococcus aureus was recovered from the blood culture and joint aspirate of a child with septicaemia and the child with arthritis respectively. No organisms were recovered in four and the remaining 5 could not afford the blood culture investigation. Plasmodium falciparum was detected in the blood film of all the patients with malaria. Candidiasis was responsible for airway obstruction in the child with croup.
Complications and sequelae in the children admitted Bronchopneumonia was complicated with bilateral effusion and febrile convulsion in one child. In addition hearing impairments complicated the case with bilateral chronic secretory otitis media. Auto-digital amputation complicated the case of the osteomyelitis of the right index finger, while the child with the right hip arthritis developed ankylosis and shortening of the right leg. Hemiparesis complicated both cases of cerebral malaria and meningitis. In addition the child with meningitis developed facial palsy. Immune reconstitution syndrome complicated the treatment of three of the five children with disseminated tuberculosis. Table 3 shows the diagnoses and complications of the admitted children
Clinical staging and immune status. Concerning the clinical staging of HIV disease in the admitted children, 9 were in stage II, 32 in stage III and one in stage IV. No child was in stage I. The clinical staging at admission was the clinical staging at HIV infection detection. The mean CD4 count of the patients studied was 758ul. Twenty (47.6%) of the children had a severe immunosuppression (CD415%)
Nutritional status Nine(21.4%) of the 42 children were well fed and 33(78.6%) were malnourished. Amongst the 30 children aged 5years and less, failure to thrive was recorded in 20(66.7%), marasmus in 8 and under weight in 2.Stunting was recorded in 10 children, however none of the children had kwashiorkor or marasmic kwashiorkor.
Association between nutritional status and CD4 count Of the 33 children with severe malnutrition 19(57.6%) had severe immunosuppression while one(11.1%) child had immunosuppression amongst the nine well nourished. The differences between these two groups are statistically significant. (p=0.01, OR= 0.09, CI=0.01-0.82)
Drug administration HAART was administered to 12 of the 42 children. Of the 12 on HAART four(25.0%) had initiated treatment before admission and the remaining eight(75.0%) while on admission. HAART administration was initiated after the intensive phase of anti-tuberculous drugs in those co-infected with tuberculosis. Four of the 5 patients on HAART had sequelae compared with the one with single case of sequela in the 30 not on HAART (pEnglishhttp://ijcrr.com/abstract.php?article_id=379http://ijcrr.com/article_html.php?did=3791. UNAIDS/WHO. AIDS epidemic update: December 2009. Geneva, Switzerland; 2009.
2. UNAIDS/WHO. Epidemiological fact sheets on HIV and AIDS, 2008 Update. Geneva, Switzerland: UNAIDS/WHO; 2008
3. FMOH, (2007)National Guidelines for Paediatric HIV and AIDS Treatment and Care, Federal Ministry of Health, HIV AIDS division, Abuja, Nigeria. [Online] available at http://www.who. int/hiv/amds/Nigeria_paediatric_2007.pdf Accessed: 5 September 2013
4. Adejuyigbe EA, Oyelami O, Onayemi O and Durosinmi MA. Paediatric HIV/AIDS in Ile – Ife, Nigeria. Cent Afr J Med. 2003;49:74-8.
5. Oniyangi O, Awani B, Iregbu KC. The pattern of paediatric HIV/ AIDS as seen at the National Hospital, Abuja, Nigeria. Niger J Clin Pract 2006;9:153–158.
6. National population commission, Nigeria. National population commission census report 2006 [Online] available from http://www.population.gov.ng/files/nationafinal.pdfAccessed: 10 August 2012
7. World Health Organization. Guidance for National Tuberculosis programs on the management of tuberculosis in children.Geneva, Switzerland: WHO; 2006. WHO/HTM/TB/2006.371
8. WHO. Antiretroviral therapy of HIV infection in infants and children in resource limited settings: towards universal access Geneva, Switzerland: WHO; 2006.
9. Asnake S, Amsalu S. Clinical manifestations of HIV/AIDS in children in North West Ethiopia. Ethiop J Health Dev. 2005;19: 24 -29.
10. Onankpa B, Airede L, Paul I, Dorcas I. Pattern of Paediatric HIV/AIDS: a five-year experience in a tertiary hospital. J Natl Med Assoc. 2008;100: 821–825.
11. Emodi IJ, Okafor GO. Clinical manifestations of HIV infection at Enugu, Nigeria. J Trop Pediatr. 1998; 44:73-76.
12. Pol RR, Shepur TA, Ratageri VH. Clinico-laboratory profile of pediatric HIV in Karnataka. Indian J Pediatr. 2007; 74: 1071 – 1075.
13. Ferrand RA, Bandason T, Musvaire P, Larke N, Nathoo K, Mujuru H, Ndhlovu CE, Munyati S, Cowan FM, Gibb DM, Corbett EL. Causes of acute hospitalization in adolescence: burden and spectrum of HIV related morbidity in a country with an earlyonset and severe HIV epidemic: a prospective survey. Plos Med 2010;7: e1000178
14. Schoeman CS, Pather MK. The clinical spectrum and cost implications of hospitalised HIV-infected children at Karl Bremer hospital, Cape town, South Africa. SA Fam Pract 2009; 51:46- 52.
15. Puthanakit T, Aurpibul L, Oberdorfer P, Akarathum N, Kanjananit S, Wannarit P, Sirisanthana T, Sirisanthana V. Hospitalization and mortality among HIV-infected children after receiving highly active anti-retroviral therapy. Clin Infect Dis 2007; 599 – 604.
16. Gibb DM, Duong T, Tookey PA, Sharland M, Tudor-Williams G, Novelli V, Butler K, Riordarn A, Farrelly L, Masters J, Peckham CS, Dunn DT; National study of HIV in HIV in pregnancy and childhood collaborative HIV paediatric study. BMJ. 2003; 327: 1019.
17. Anderson JA. Antibiotic drug allergy in children. Curr Opin Pediatr. 1994;6:656–660. 18. Michailidis C, Pozniak AL, Mandalia S, Basnayake S, Nelson MR, Gazzard BG. Clinical characteristics of IRIS syndrome in patients with HIV and tuberculosis. Antivir Ther. 2005; 10: 417 – 422.
19. Bolton-Moore C, Mubiana-Mbewe M, Cantrell RA, Chintu N, Stringer EM, Chi BH, Sinkala M, Kankasa C, Wilson CM, Wilfert CM, Mwango A, Lew J, Abrams EJ, Bulterys M, Stringer JS. Clinical outcomes and CD4 cell response in children receiving antiretroviral therapy at primary health care facilities in Zambia. JAMA 2007; 298: 1888 – 1899.
20. Tata TE, Kumwenda NI, Hoover DR, Biggar RJ, Broadhead RL, Cassol S, van der Hoven L, Markakis D, Liomba GN, Chiphangwi JD, Miotti PG. Association of HIV-1 load and CD4 lymphocyte count with mortality among untreated African children over one year of age. AIDS. 2000;14:453-459.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241723EnglishN2015December10HealthcareCLINICAL STUDY ON THE PREVALANCE OFFUNGAL INFECTIONS IN DIABETIC FOOT ULCERS
English0813Abilash S.English N.S. KannanEnglish K.V. RajanEnglish M. PramodhiniEnglish M. RamanathanEnglishIntroduction: Diabetic lower limb wounds account for one of the commonest forms of complications with diabetes. These ulcerated lesions are easily susceptible to infections. Several studies have concluded the presence of varied microbial flora associated with the wounds. The mycology of the lesion is not given equal importance when compared to its bacterial aspect. Recent studies have shown the presence of wide range of fungal strains present in an infected foot ulcer of a diabetic patient, with Candida species accounting for the most commonly isolated strain. Aim: This study was done in an attempt to study the prevalence and spectrum of fungal infection in diabetic foot ulcers and to compare our findings with those of previous studies. Methodology: This hospital based prospective study. A total number of 100 patients with diabetic foot ulcers were included in this study. Patients already treated with anti-fungal therapy, chemotherapy, immunosuppressant, radiotherapy and corticosteroids were excluded. Detailed history of all patients was taken. These patients were evaluated with reference to clinical symptomatology and biochemical profile for diabetes mellitus. Two tissue samples, which were taken from the bed of the diabetic foot ulcer from each patient, one for microscopic examination and the other for culture sensitivity both bacterial and fungal. The patients were treated with regular dressing and antifungal therapy in addition to appropriate antibiotics as per bacterial culture sensitivity. The results were compared with other studies in literature and discussed. Results: Out of the 100 patients, evaluated 18% had positive fungal cultures, among them most common fungal strain was C albicans and secondly was C tropicalis
Conclusion: Management of diabetic foot ulcers must include antifungal antibiotics as per fungal culture sensitivity report in addition to routine bacterial culture sensitivity and other modalities.
EnglishDiabetic foot ulcer, Fungal infection, Culture and sensitivity, Antifungal antibioticsINTRODUCTION
Diabetic lower limb wounds account for one of the commonest forms of complications with diabetes. These ulcerated lesions are easily susceptible to infections. Several studies have concluded the presence of varied microbial flora associated with the wounds. The microbiology associated with diabetic foot ulcers studied from samples taken from deep tissue bed is varied. In addition, several studied have shown the researched evidence of presence of both aerobic and anaerobic bacteria associated with the infections. Even though bacteriological infections associated with diabetic foot ulcers are given prime importance, the opportunistic fungal infections are ignored. The mycology of the lesion was not given equal importance in the past when compared to its bacterial aspect due to lack of literature. However, re cent studies have shown the presence of wide range of fungal strains in an infected foot ulcer of a diabetic patient, with Candida species accounting for the most commonly isolated strain. Ideal treatment of an infected diabetes foot ulcer should encompass all the possible microbiological causes, to provide efficient and specific treatment to the surgical patient. Aims and Objectives 1. To study the prevalence of fungal infection in diabetic foot ulcers. 2. To study the spectrum of fungal strains isolated from the wounds. 3. To compare our findings with those of previous studies. MATERIALS AND METHODS This hospital based prospective study was carried out in Mahatma Gandhi Medical College and Research institute, Pondicherry during the period February 2013 to June 2014. A total number of 100 cases were studied. The study was carried out after obtaining clearance from institutional human ethics committee. All patients with diabetic foot ulcers coming to our hospital were included in this study. Patients already treated with anti-fungal therapy, chemotherapy, immunosuppressants, radiotherapy and corticosteroids were excluded. After duly obtaining an informed consent, detailed history of all patients was taken. These patients were evaluated with reference to clinical symptomotology, biochemical profile for diabetes mellitus (FBS, PPBS and HbA1C) .Two tissue samples which were taken from the bed of the diabetic foot ulcer from each patient is put in a sterile container containing normal saline and is sent to the microbiology laboratory and Microscopic examination of collected tissues were done. One of the tissue bit is soaked in 10% KOH, the other tissue bit is used for fungal culture sensitivity with Sabourauds dextrose agar supplemented with chloramphenicol and cycloheximide, incubated at 30°C and 37°C for 4 weeks. The patients were treated with regular dressing, appropriate antibiotics according to bacterial culture sensitivity till the fungal culture reports. Antifungal therapy was started as per the culture sensitivity report. The data were tabulated in a master chart using MS EXCEL. The results were compared with other studies in literature and discussed. RESULTS Among the 100 patients, the youngest patient was a 31 year old and the eldest was a 72 year old. There were seven patients in the age group of 30-39 years, 25 patients in the age group of 40-49, 35 patients in the age group of 50-59, 28 patients in the age group of 60 to 69 and 5 patients in the age group of 70 to 79 (Table 1). The highest incidence was in the age group of 5th decade. There were total of 18 female and 82 male patients (Table 2). Among the 100 patients, 18 had positive fungal cultures-12 males and 6 females (Table 3). Among the 18 fungal cultures, Candida species of fungal isolates were predominant; specifically strains of Candida albicans-16 samples and Candida tropicalis-2 samples (Table 4). Sex distribution of patients positive for C. albicans strains is shown in Table 5. Sex distribution of patients positive for C. tropicalis strains is shown in Table 6. In all patients both the strains cultured were sensitive to Fluconazole. Among the 100 patients studied, 13 patients had type 2 diabetes mellitus for less than 5 years and 32 patients had diabetes mellitus for 5 – 10 years, 10 patients had diabetes for 10 – 15 years, 12 patients had diabetes mellitus for 16-20 years and 33 patients had diabetes mellitus for more than 20 years (Table 7). Among the 100 patients, 76 were smokers and 68 were alcoholics (Table 8).
DISCUSSION
According to International Diabetes Federation’s atlas, there are about 65.1 million people in India suffering from diabetes with an alarming mortality rate of 55%1 . Approximately a quarter of all people with diabetes will develop sores or ulcers at some point during their lifetime2 . Diabetic foot ulcers (DFU) are one of the most dreaded and common complications of diabetes, which is associated with lower limb amputation and account for majority of non-traumatic amputations conducted3 . This is also associated with high morbidity and substantial health care costs4 . According to the World Health Organization and the international working group on the diabetic foot, ‘Diabetic foot is defined as the foot of diabetic patients with ulceration, infection and/or destruction of deep tissues, associated with neurological abnormalities and various degrees of peripheral vascular diseases of the lower limb’. Aetiology though being multi factorial, peripheral neuropathy and ischemia are the major factors for DFU along with several other contributing risk factors5 . Diabetes is one of the most common causes of multifocal peripheral neuropathy, which further gives rise to diabetic foot ulcers. Neuropathy in diabetic patients is manifested in the motor, autonomic and sensory components of the nervous system5,6,7,8.
Based on epidemiological study by Dyck et al, 60% 0f DFUs occur due to underlying diabetic neuropathy7 . Ischemic ulcers without significant associated neuropathy accounts for 15 to 20% of foot ulcers, and another 15-20% have a mixed neuropathic-vascular causative factor. In people with diabetes, atherosclerosis is very common. Peripheral arterial disease is responsible for the initiation of foot ulcers in up to 50% of the cases making it one of the major causative factors8 . Diabetic foot is one of the most feared complications of diabetes, which may result in repeated hospitalizations leading to amputations. It is common affecting up to 30% of Indian patients with diabetes in their lifetime9 . Another study conducted by Shahi et al in northern India claim that the prevalence of DFUs in patients with diabetes was 14.30%10. Diabetic foot ulcers associated infections are the most common cause of amputation. According to a multicenter study from India, conducted to determine the pattern and causes of amputation in diabetic patients from a sample size of 1985, 90% of the amputations were due to infection arising in the diabetic foot11. Diabetic foot lesions are responsible for more hospitalizations than any other complications of diabetes, increasing the burden on health care infrastructure and the cost of care. Among patients with diabetes, roughly about 15% develop a foot ulcer. Diabetes is the major cause of non-traumatic lower extremity amputation in our country and across the world. Foot infections in diabetic patients usually begin in skin ulceration. Most infections remain superficial, but 25% will spread contiguously from the skin to deeper subcutaneous tissues and/or bone. An infected foot ulcer precedes 60% of amputations, making infection perhaps the most important proximate cause of this tragic outcome. Because all skin wounds contain microorganisms, infection must be diagnosed clinically, that is, by the presence of systemic signs (e.g., fever, chills, and leukocytosis), purulent secretions (pus), or local classical signs or symptoms of inflammation (warmth, redness, pain or tenderness, and induration). In chronic wounds, additional signs suggesting infection may include delayed healing, abnormal coloration, friability, or foul odour12. Pathare et al13 in their ‘Microbiology of diabetic foot: Indian studies’, analysed 775 diabetic foot patients and found the infections are Polymicrobial. Averages of 3.07 organisms were isolated per case, 71.09% aerobic and 28.91% anaerobic. The fungal infection is difficult to diagnose and is a serious cause of morbidity or mortality in diabetes8 . Fungal infection among immuno-compromised patients is now a global major health concern, but the species of fungi infecting diabetic foot infections and its pathogenicity has not yet been researched thoroughly. As a result, clinicians and surgeons treating diabetic foot wounds suspect only the bacterial infections and prescribe accordingly. The deep tissue from the wound bed is not usually sent for fungal culture and sensitivity, either due to lack of literature substantiation or due to the belief that there would not be any fungal infections in the diabetic foot ulcers as they are rare occurrences. In the study conducted in India by Chellan et al14, enrolled 518 patients, among whom 382 were males and 136 females with type 2 diabetes admitted due to infections in the lowerlimb wounds. Samples from the ulcer bed of approximately 0.5 - 0.5 cm size were taken from the wound bed and cultured for fungi. Fungi were found in 27.2% (141/518) of the study population. Candida parapsilosis (25.5%), Candida tropicalis (22.7%), Trichosporonasahii (12.8%), Candida albicans (10.6%), and Aspergillus species (5.0%) were the most predominant fungal isolates. In a study by Chincholikar et al15,swabs were collected from 105 diabetic foot ulcer patients, which revealed that the fungal isolates accounted for 20.8%. Among this yeasts were predominant accounting for 94.55% and moulds comprised 5.46%. Candida tropicalis [54.55%] were most common followed by candida albicans [12.73%] among the yeasts. A study by Bansal et al16 in government medical college and hospital, Chandigarh demonstrated polymicrobial infection in 35% of the patients. In this, Pseudomonas aeruginosa [22%] and Staphylococcus aureus [19%] were predominantly isolated. Among fungal isolates candida species were most predominantly isolated. Subha et al17 conducted a study in Mysore Karnataka on 120 patients with diabetic foot infections and found that 66.66% of the isolates indicated candida sp. Yet another study was carried out by Nair S et al18 to assess the incidence of mycotic pathogens in diabetic foot ulcers. A total of 74 Type II diabetic patients with non-healing diabetic foot infections were recruited for the study. Among the diabetic patients, 65 % had yeast and mold infections. Pathogenic yeasts were noted in 77 % of the patients of which Candida species was predominant (93 %). The major Candida species isolated were C. albicans (49 %), C. tropicalis (23 %), C. parapsilosis (18 %), C. guillermondi (5 %) and C. krusei (5 %). The other yeast species isolated were Trichosporon cutaneum and T. capitatum. Trichophyton spp. was the only dermatophytic fungus found. Molds were isolated from 38 % of the infected patients of which Aspergillus species predominated (72 %). The other molds isolated were Fusarium solani, Penicillium marneffei and Basidiobolus ranarum. The duration of diabetes also plays a role in the formation of ulcer and the incidence of lower extremity amputation was more in patients who have diabetes for more than 5 years. Longer the duration of diabetes, higher are the chances of developing a non-healing ulcer. Mehamud et al19 reported that out of 120 patients, majority of patients who underwent amputation had diabetes more than 10 years (pEnglishhttp://ijcrr.com/abstract.php?article_id=380http://ijcrr.com/article_html.php?did=3801. IDF Diabetes Atlas Sixth Edition, International Diabetes Federation 2013.
2. Reiber, G., Lipsky, B., and Gibbons, G.The burden of diabetic foot ulcers. The American Journal of Surgery, 1998;176(2):5S– 10S.
3. The Diabetic Foot: Epidomology, Risk Factors And The Status Of Care; The Global Impact;Andrew Boulton, Diabetes Voice, November 2005;(50), Special Issue
4. Bowering CK Diabetic foot ulcers. Pathophysiology, assessment, and therapy. Can Fam Physician. 2001 May;47:1007-16.
5. Crawford F, Inkster M, Kleijnen J, Fahey T. Predicting foot ulcers in patients with diabetes: a systematic review and metaanalysis QJM. 2007 Feb;100(2):65-86.
6. Gerassimidis T, Karkos CD, Karamanos D, Kamparoudis A Current endovascular management of the ischaemic diabetic foot. Hippokratia. 2008 Apr;12(2):67-73.
7. Dyck PJ, Clark VM, Overland CJ, et al. Impaired glycemia and diabetic polyneuropathy: the OC IG Survey. Diabetes Care. 2012;35:584–91.
8. Clayton Jr, W., and Elasy, T. A. A review of the pathophysiology, classification, and treatment of foot ulcers in diabetic patients. Clinical diabetes, 2009;27(2):52.
9. Sunil Gupta, Management Of Diabetic Foot, Medicine Update 2012;22:287-93.
10. Shahi, S. K., Kumar, A., Kumar, S., and Singh, S. K.. Gupta S K, Singh T.B. Prevalence of Diabetic Foot Ulcer and Associated Risk Factors in Diabetic Patients From North India.. The Journal of Diabetic Foot Complications, 2012;4(3):83-91.
11. Viswanathan V. Epidemiology of diabetic foot and management of foot problems in India. Int J Low Extrem Wounds. 2010 Sep;9(3):122-6.
12. Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW et al. Diagnosis and treatment of diabetic foot infections.Clin Infect Dis. 2004;39 (7):885-910.
13. Pathare NA, Bal A, Talvalkar GV, Antani DU. Diabetic foot infections: a study of microorganisms associated with the different Wagner grades. Indian J Pathol Microbiol 1998;41:437-41.
14. Chellan G, Shivprakash S, Karimassery Ramaiyar S, Varma AK, Varma N, Thekkeparambil Sukumaran M, et al. Spectrum and prevalence of fungi infecting deep tissues of lower-limb wounds in patients with type 2 diabetes. J Clin Microbiol. 2010;48:2097– 102.
15. Cincholikar DA, Pal R B. Study of fungal and bacterial infections of the diabetic foot. Indian journal of pathology and microbiology, 2002;45(1):15-22.
16. Bansal E, Garg A, Bhatia S, Attri, A K, Chander J. Spectrum of microbial flora in diabetic foot ulcers. Indian journal of pathology and microbiology, 2008;51(2):204-8.
17. Subha KS, Isolation and Identification of Pathogens from Diabetic Foot Infections from K.R. Hospital, Mysore, Indian Journal Of Developmental Research, 2013;3(5).
18. Nair S, Peter S, Sasidharan A, Sistla S, Unni A K K. Incidence Of Mycotic Infections In Diabetic Foot Tissue, Journal of culture collections. 2006-2007;(5):85-89.
19. Mehmood K, Akhtar ST, Talib A, Talib A, Abbasi B, Siraj-UlSalekeen et al. Clinical profile and management outcome of diabetic foot ulcers in a tertiary care hospital. J. Coll. Physicians Surg. Pak. 2008;18(7):408-12.
20. Al-Maskari F, El-Sadig M. Prevalence of risk factors for diabetic foot complications. BMC Fam Pract. 2007;8:59.
21. Al-Tawfiq JA , Johndrow JA, Presentation And Outcome Of Diabetic Foot Ulcers In Saudi Arabian Patients. Adv. Skin Wound Care 2009;22(3):199-121.
22. Alwakeel, J. S., Al-Suwaida, A., Isnani, A. C., Al-Harbi, A., and Alam, A. (2009). Concomitant macro and microvascular complications in diabetic nephropathy. Saudi Journal Of Kidney Dis. Transpl. 2009;20(3):402-09.
23. Imran, S., Ali, R., and Mahboob, G. (2006). Frequency of lower extremity amputation in diabetics with reference to glycemic control and Wagner’s grades. J. Coll, Physicians Surg. Pak. 2006;16(2):124-7.
24. Unnikrishnan, A. G An approach to a patient with a diabetic foot.(vol 21, pg 134, National Medical Journal Of India 2008;21(4):201.
25. Tajunisah, I., Nabilah, H., and Reddy, S. C. (2006). Prevalence and risk factors for diabetic retinopathy--a study of 217 patients from University of Malaya Medical Centre. The Medical journal of Malaysia, Med. Journal Of Malaysia 2006;61(4):451-456.
26. Moss SE, Klein R, Klein BE The 14-year incidence of lowerextremity amputations in a diabetic population. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. Diabetes Care. 1999;22(6):951-9.
27. Nather A, Bee CS, Huak CY, Chew JL, Lin CB, Neo S, et al. Epidemiology of diabetic foot problems and predictive factors for limb loss. J Diabetes Complications. 2008;22(2):77-82.
28. Winkley K, Stahl D, Chalder T, Edmonds ME, Ismail K. Risk factors associated with adverse outcomes in a population-based prospective cohort study of people with their first diabetic foot ulcer. J Diabetes Complications. 2007;21(6):341–349.
29. Chaturvedi N, Abbott CA, Whalley A, Widdows P, Leggetter SY, Boulton AJ. Risk of diabetes-related amputation in South Asians vs. Europeans in the UK. Diabet Med. 2002;19(2):99- 104.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241723EnglishN2015December10HealthcareDISABILITY THEMED COMMUNITY DIAGNOSIS OF RURAL POPULATION IN DHULIKHEL: A DIFFERENT STANDPOINT
English1420Sumana BaidyaEnglish Bimika KhadgiEnglish Ranjeeta S. AcharyaEnglishBackground: Disability is the inability to perform an activity in the way or within the range considered normal for a human being. Disability occurs not only from musculoskeletal disorder but also from other causes such as dyspnea and urinary incontinence. This study was done to find out the prevalence of disability in three VDCs (Nayagaun, Kuttal and Nayabasti) of Dhulikhel, Kavre. Materials and Methods: Standardized Nordic questionnaire and Nottingham questionnaire with MRC grading of dyspnea were adopted after translation and pre-testing for disability due to musculoskeletal disorder and dyspnea respectively. Similarly, pretestedstructured questionnaire was adapted from Norwegian Urinary Incontinence Questionnaire to identify disability due to urinary incontinence based on. Disability ID card holders were identified through door to door survey method. Descriptive analysis was performed. Micro health program was conducted for physiotherapy interventions in the identified population. Sustainability and awareness program was organized to disseminate knowledge about need of physiotherapy in these conditions. Results: Among 1265 people surveyed in these VDCs, the total number of people identified with disabilities was 218. Among them, 15.9% (n=110) from Kuttal (N=690), 22.4% (n=70) from Nayabasti (N=313) and 14.5% (n=38) from Nayagaun (N=262) were identified with various disabilities. Among the identified cases in all three VDCs, only 5.9 % (n=13) had government disability ID card, with physical (3), hearing (2), speech (1), vision (2) and multiple disabilities (5). Apart from these people with disability card, there were disabilities caused due to dyspnea (16.5%, n=36), urinary incontinence (18.8%, n=41) and musculoskeletal problems (58.7%, n=128). The micro health program helped in improving the awareness among people about the disability and treatment through low-cost physiotherapy techniques. Conclusions: The most common disabilities among population are due to musculoskeletal followed by dyspnea and urinary incontinence. The use of cost – effective aids and physiotherapy treatments was found beneficial as it increased awareness and proved an effective tool for education about prevention of diseases. The result of our study is useful to generate information on silent disability due to urinary incontinence and dyspnea. Our findings can be helpful for effective development of physiotherapy awareness programs to increase service utilization and thereby might contribute to both prevention and management of disability in community.
EnglishDisability, Physiotherapy, Community diagnosis, NepalINTRODUCTION
Community diagnosis means the identification and quantification of the health problems in a community in reference to mortality and morbidity rates with ratios and identification of their correlates for the purpose of defining those individuals or groups at risk or those who requires health care.1 It is also used to study the environmental, social and cultural features of the society. Usually, it is a comprehensive assessment of the health status of the community in relation to its cultural, social, physical, psychological and environmental conditions. The main purpose of community diagnosis is to expose the main problems affecting the community, which is based on the evidence from the survey and observations of the team and community members.2 The focus of a community diagnosis program (CDP) is on the identification of the primary health needs and problems of the community. Disability is the condition of difficulty in carrying out daily activities routinely and in taking part in social life due to problems in parts of the body along with obstacles created by physical, social and cultural environment.3 Disabilities are an umbrella term, encompassing impairments, activity limitations, and participation restrictions.4 Disability is multifaceted, and the interventions to overcome the disadvantages associated with disability are multiple and systemic – varying with the context.5 Disability can occur due to any systemic dysfunction such as musculoskeletal, respiratory, or urinary systems. The most widely acknowledged disability is due to musculoskeletal disorders. The low back problem was prevalent (48.8%) among the agricultural workers in India, followed by wrist-hand (46.6%) problems and pain in lower extremities (28.8%).6 In a study in rural area of Eastern Nepal, the pain reported was mostly (44.0%) of musculoskeletal origin (viz. backache, multiple joint pain, generalized body ache, shoulder pain and knee pain).7 Women’s health is strongly connected to gender devaluation, especially because of the high levels of maternal malnutrition and son preference, which lead to early and multiple births at short intervals.8 As “easy” as it may be to collect and identify mortality data, it is tedious to identify information about maternal morbidities more specifically. Studying gynecological morbidities is challenging since these issues are considered a taboo topic in Nepal, which makes talking about it very difficult.9 All these factors could have led to urinary incontinence prevalence in Nepal. Urinary incontinence is a frequent complaint among Nepalese women, albeit a poorly studied one. Since pelvic floor disorders can be one of the prominent problems that women face, it has to be examined thoroughly.10 Disability in old people with chronic obstructive pulmonary disease is time and again underestimated.11 In epidemiological studies of older population, dyspnea forecasts both functional decline and mortality12, 13 possibly because of its ability to predict cardiovascular death.14 There are few data on dyspnea and its effect on quality of life. In Nepal, COPD covers for 43% of the non-communicable disease burden, and 2.56% of hospitalizations15, 16,which is one of the leading causes for elicitation of symptoms of dyspnea.The reported prevalence of dyspnea varies from 62% of people at age of 65 to 16% of age 59.17 There are various physiotherapy treatment methods for musculoskeletal disorders with symptoms of neck pain, back pain, knee pain and ankle pain. Also, there are ample evidences of dyspnea management technique 18, 19 and treatment approaches for reducing urinary incontinence through pelvic muscle strengthening exercises.20-22 Yet, there is very less awareness about the role of physiotherapy in all these conditions leading to disability and lowered quality of life (QOL) in rural population of Nepal. Hence, with the cases identified through this study, the aim was also to provide them with awareness program about cost-effective physiotherapy protocol and group education sessions. This main aim of the study was to find out the prevalence of disability in three VDCs (Nayagaun, Kuttal and Nayabasti) of Dhulikhel, Kavre. The specific objectives of the study were to find out prevalence of musculoskeletal disability and identify disability card holders, to find out the burden of disability due to urinary incontinence and dyspnea, which are one of the ignored aspects of disability. The study further aim to conduct awareness program about cost-effective physiotherapy treatment and group education sessions.
MATERIALS AND METHODS
This study was conducted as a part of community- based learning where the fourth year students of BPT were sent for placement in three VDCs of Dhulikhel (see Table 1 for demographic details), with the aims of acquainting with common problems in the community and learning to conduct micro health programs. For each group, there was a faculty for supervision. The local health workers and community leaders were also involved in the project. Written consents were duly taken from District health office for conducting the survey and micro health program. The tools used included pre-tested questionnaires and written consents were taken from the participants. Study Tools For identifying the disability among rural population due to musculoskeletal problems, the questionnaire was formulated based on Standardized Nordic Musculoskeletalquestionnaire23 and pre-testing was done. This questionnaire aims at identifying the musculoskeletal symptoms which may lead to disability in completing ADLs (Activities of Daily Living) in epidemiological studies, and not developed for clinical diagnosis.24 To recognize the disability caused due to dyspnea, questionnaire were formed based on Medical Research Council (MRC) grading of dyspnea and Nottingham Extended Activity of Daily Living (NEADL) scale. The NEADL scale has higher sensitivity and negative predictive value in identifying such disability in older people.11 The MRC grading of dyspnea scale is a more cost-effective indicator of disability but not widely accepted, which is a reliable and valid method for evaluating physical impairment.25 The strong correlations between MRC scores and quality-of-life indices suggest that NEADL scale may also be cost-effective indicator of physical impairment.26 Pre-tested structured questionnaire was developed to identify disability due to urinary incontinence. The questionnaire was designed to assess the impact of urinary incontinence on Activities of Daily living and social participation. This questionnaire was adopted from Norwegian Urinary Incontinence Questionnaire.27The disability card owners were also identified through doorto door survey, where the participants were asked to show their disability card. Door to door survey method was used, where each subject were interviewed to fill the questionnaire. The survey was conducted at most of times in early morning hours when the subjects were in their houses and not yet proceeded to the fields for their daily work. The survey was conducted for two weeks by using purposive sampling method. If any family member in the house was missed in the first day, it was followed up in the next day. The snowball method was also used so as to avoid chances of missing any subjects. In this method, the respondents were asked to identify the next possible subject for the study. As a part of the project, after the survey was completed, micro health program was conducted for physiotherapy interventions in the identified population. For each sub-group of conditions identified for musculoskeletal disorders like back pain, neck pain and knee pain, group exercises were taught with the aim of raising awareness about physiotherapy and to help create a self-help group. These micro health program included education sessions with interactions and exercise sessions. Similar micro health program were conducted for sub-groups of urinary incontinence and dyspnea. Sustainability and awareness program was organized to disseminate knowledge about need of physiotherapy in these conditions. As a part of sustainability program, community leaders and school teachers and health professionals were taught about the basic physiotherapy management. Statistical Analysis Descriptive analysis was performed to calculate the percentage of various disabilities in the three VDCs, using IBM SPSS Statistics version 20. RESULTS The total population among in three VDCs is 2246, but only 1265 people were surveyed (see table 1). Among these, the total number of people identified with disabilities was 218. Among them, 15.9% (n=110) from Kuttal (N=690), 22.4% (n=70) from Nayabasti (N=313) and 14.5% (n=38) from Nayagaun (N=262) were identified with various disabilities. Among the identified cases in all three VDCs, only 5.9 % (n=13) had government disability ID card, with physical (3), hearing (2), speech (1), vision (2) and multiple disabilities (5). Apart from these people with disability card, there were disabilities caused due to dyspnea (16.5%, n=36), urinary incontinence (18.8%, n=41) and musculoskeletal problems (58.7%, n=128) (See figure 1). In Kuttal, among the total number of disabilities (N=110) identified, there were 57% with musculoskeletal problems, 20 % with urinary incontinence and 17% with dyspnea problems, whereas only 6% had been identified with a disability card. In Nayabasti, among the total number of disabilities (N=70) identified, there were 44% with musculoskeletal problems, 21% with urinary incontinence and 14% with dyspnea problems, whereas only 7% had been identified with a disability card. In Nayagaun, among the total number of disabilities (N=38) identified, there were 66% with musculoskeletal problems, 11% with urinary incontinence and 18% with dyspnea problems, whereas only 5% had been identified with a disability card. Among all cases of musculoskeletal problems in the three VDCs, there were cases of low back pain (n=67, 52.3%), multi-joint pain (n=30, 23.4%), knee pain (n=20, 15.6%), shoulder pain (n=6, 4.7%), neck pain (n=2, 1.6%), hip pain (n=2, 1.6%), ankle pain (n=1, 0.8%) (See figure 2). Whereas, there were 35.2% male and 64.8% female suffering from disability due to musculoskeletal disorders. Similarly, there were more females (72.2%) affected by dyspnea than males (27.8%). The identified population was also provided with interventions through physiotherapy treatment. For each sub-groups of disability, interventions were provided through basic physiotherapy management, ergonomic advices, group exercise and counseling sessions. Out of 218 cases, 94 cases (43.1%) were intervened with 136group treatment sessions (See figure 3). There were two intervention sessions provided for each sub-groups at an interval of 1 week. There were16 cases with disability due to dyspnea, 63 cases with disability due to musculoskeletal problems and 37 cases due to urinary incontinence that were provided with interventions. During the project, for cases of dyspnea and severe physical disability, the physiotherapy management was provided at doorstep as most of the subjects declined for coming to the community center due to severity of dyspnea.
DISCUSSION
In this study, the musculoskeletal disability is the most prevalent among all type of disability. In this study, the more than half of the populationhas low back pain (52.3%), which is similar to findings of a study, with low back pain prevalence at 60%among rural farmers in a district of India.28In another study, the lower back problem was predominant (48.8%) among the farmers and it was followed by wristhand (46.6%) problems and lower extremities pain (28.8%).6
The lower back problems among farmers might be due to strongly bent posture for a long period during performing reaping and uprooting operation during rice cultivation. It could also be due to frequent twisting of the waist and being compelled to adopt an awkward kneeling posture during performing uprooting task. When activity was held for long periods or was carried out in uncomfortable stooping postures, did appear to result in significantly higher proportions of disc diseases.29 The risk of low back disorder is increased as a function of lateral and twisting motions of trunk.30 In this study, there are more females affected with disability due to musculoskeletal problems as compared to males. In a similar study, the highest prevalence of musculoskeletal pain (31.4%) among males was in agricultural/dairy workers whereas it was noted for female agricultural workers (44.7%).31Females had high prevalence of MSD complaints than males with back pain accounting for more than 50% of the total complaints, which could be due to the extra burden of household work and taking care of child.32 This study revealed that there was higher percentage of knee related disability. During cultivation, the farmers are compelled to adopt same postures during work for a long time. The male workers work in kneeling posture during uprooting job, whereas, female workers adopt squatting posture.All these tasks are repetitive in nature, which may be related to musculoskeletal disorders (MSD).6 Similar findings were also illustrated from the study of Michelson et al. 33 Markolf et al reported that due to overloading of static load on knee joints during continuous bent posture the subjects might feel pain in the lower extremities.34 The prevalence of the dyspnea in this study is similar to a study in Australia where prevalence of dyspnea among respondents was 8.9%.35 Whereas, in a study conducted among older population living at home, there was prevalence rate of dyspnea of 32.3%, who had poorer functional status and lower quality of life.17 The prevalence and the intensity of chronic breathlessness experienced in the community has previously been reported.36 The effect of dyspnea on functional status and quality of life has been proven to be substantial. 17It could also be related to underlying psychological morbidity, which was significantly increased in dyspnea subjects. This study also showed that females were more suffering with disability due to dyspnea than males. Another study conducted in Nepal, identified a significant proportion of the COPD burden as being borne by women (six female sufferers for every ten cases of COPD).37 The causative factor could be the extensive use of firewood by women living in rural communities putting women at increased risk of exposure to indoor air pollution for comparatively long periods of time. The same finding of biomass fuel being associated with COPD has been stated by several studies conducted in Nepal and other developing countries, with women being disproportionately affected.38-40 In this study, there is evidence of disability due to urinary incontinence leading to lower quality of life. Generally, Nepalese women have three main responsibilities: reproduction and child bearing, household maintenance, and income earning. In rural areas, the women’s burden of work is considered to be 12%–22% greater than the men’s, and these women must work hard in order to gain acceptance in their husbands’ homes.41All these social factors can lead to stress on the pelvic organs and dysfunction resulting in urinary incontinence. It is already shown that the patients with urinary incontinence had inferior mental health and quality of life.42In a research in Turkey (2005), it was found out that UI had a negative impact on the quality of life of 87.2% of these patients with mild to moderate severity.43 Urinary incontinence is an important factor linked with functional decline in women living in their own homes.44 Through the survey, it was also found that the women were reluctant to talk about their incontinence problem. According to the Nepal Demographic and Health Survey 2011, 40% of Nepalese women are literate. This could have led to less awareness about importance of health care seeking for urinary incontinence. A recent study in rural Nepal determined that one perceived barrier to health carewas a woman’s feeling of shame. Thus, a “culture of silence” and “laaj” (i.e., shame about reproductive health)restricts women from talking about pregnancy and itsrelated problems.45 One of the other findings of this study was that many were not interested to make the disability identity card, citing that there is least use of it. This indicates that there is poor awareness among general population about the government systems for benefitting the differently abled populations. The Disability Protection and Welfare Act 1982 ADof Nepal46 could not bring much improvement, since its implementation has not been effective. The people are still not sensitive to the rights and entitlements of persons with disabilities. There was also poor awareness regarding physiotherapy among the rural community, which is as expected since physiotherapy is still a young profession with a history of only 30 years. There is an urgent need to change the attitudes towards physiotherapy in Nepal in order to provide high quality physiotherapy services for Nepalese people.47The micro health program was conducted to improve the awareness among people about the disability and treatment through cost-effective physiotherapy techniques. Through the intervention program, the community was provided physiother- apy treatment for each sub-group. But, the outcome was not assessed objectively in this study, which should be done in future studies. Through the sustainability program, the school health teachers were educated about the importance of physical exercise training for children.
CONCLUSIONS
The most common disabilities identified are musculoskeletal followed by dyspnea and urinary incontinence. The results of our study are useful to generate information on silent disability due to urinary incontinence and dyspnea. Our findings can be helpful for effective development of physiotherapy awareness programs to increase service utilization and thereby contribute to both prevention and management of disability in community.
ACKNOWLEDGEMENTS
The authors would like to acknowledge the students of BPT fourth year (first batch), Kathmandu University school of medical sciences (KUSMS), who were part of the community project. They would also like to acknowledge the local administration and community people for their kind support. Authors also acknowledge all the colleagues from department of physiotherapy, KUSMS. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
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Englishhttp://ijcrr.com/abstract.php?article_id=381http://ijcrr.com/article_html.php?did=3811. Hale C, Shrestha I, Bhattacharya S. Community Diagnosis Manual. 1st edi. Kathmandu, Nepal: Health learning and materials centre, TU Institute of Medicine. 1996.
2. Vaidya A, Pradhan A, Joshi S, Gopalakrishnan S, Dudani I. Acquaintance with the actuality: community diagnosis programme of Kathmandu Medical College at Gundu village, Bhaktapur, Nepal. 2008.
3. RCRD Nepal. Definition and Classification of Disability in Nepal. Nepal Government: Resource Center for Rehabilitation and Development Nepal; 2006.
4. WHO. Disabilities [20 February, 2015]. Available from: http:// www.who.int/topics/disabilities/en/.
5. Shakespeare T, Officer A. World report on disability. Disabil Rehabil. 2011;33(17-18):1491.
6. Kar SK, Dhara PC. An evaluation of musculoskeletal disorder and socioeconomic status of farmers in West Bangal, India. Nepal Medical College journal : NMCJ. 2007;9(4):245-9.
7. Bhattarai B, Pokhrel PK, Tripathi M, Rahman TR, Baral DD, Pande R, et al. Chronic pain and cost: an epidemiological study in the communities of Sunsari district of Nepal. 2007.
8. Messerschmidt L. Uterine prolapse in Nepal: the rural health development Project’s response. Journal of Nepal Public Health Association. 2009;4(1):33-42.
9. Bonetti TR, Erpelding A, Pathak LR. Listening to “felt needs”: investigating genital prolapse in western Nepal. Reproductive Health Matters. 2004;12(23):166-75.
10. Lavy Y, Sand PK, Kaniel CI, Hochner-Celnikier D. Can pelvic floor injury secondary to delivery be prevented? International urogynecology journal. 2012;23(2):165-73.
11. Yohannes AM, Roomi J, Waters K, Connolly MJ. A comparison of the Barthel index and Nottingham extended activities of daily living scale in the assessment of disability in chronic airflow limitation in old age. Age and ageing. 1998;27(3):369-74.
12. Milne J, Lauder I. Factors associated with mortality in older people. Age and ageing. 1978;7(3):129-37.
13. Vestbo J, Knudsen KM, Rasmussen FV. Should we continue using questionnaires on breathlessness in epidemiologic surveys? American Review of Respiratory Disease. 1988;137(5):1114-8.
14. Kaplan GA, Kotler PL. Self-reports predictive of mortality from ischemic heart disease: a nine-year follow-up of the Human Population Laboratory cohort. Journal of chronic diseases. 1985;38(2):195-201.
15. Bhandari GP, Dhimal M, Neupane S. Prevalence of non-communicable diseases in Nepal, Hospital based study. Nepal Health Research Council, Ramshat Path, Kathmandu Nepal. 2010:1-80.
16. Services. DoH. Annual report: Ministry of Health and Population. Kathmandu, Nepal; 2009/10.
17. Ho SF, O’Mahony MS, Steward JA, Breay P, Buchalter M, Burr ML. Dyspnoea and quality of life in older people at home. Age and ageing. 2001;30(2):155-9.
18. Nield MA, Hoo GWS, Roper JM, Santiago S. Efficacy of pursed-lips breathing: a breathing pattern retraining strategy for dyspnea reduction. Journal of cardiopulmonary rehabilitation and prevention. 2007;27(4):237-44.
19. Sassi-Dambron DE, Eakin EG, Ries AL, Kaplan RM. Treatment of dyspnea in COPD: a controlled clinical trial of dyspnea management strategies. CHEST Journal. 1995;107(3):724-9.
20. Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2010;1(1).
21. Price N, Dawood R, Jackson SR. Pelvic floor exercise for urinary incontinence: a systematic literature review. Maturitas. 2010;67(4):309-15.
22. Bø K. Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? International Urogynecology Journal. 2004;15(2):76-84.
23. Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sørensen F, Andersson G, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Applied ergonomics. 1987;18(3):233-7.
24. Crawford JO. The Nordic musculoskeletal questionnaire. Occupational medicine. 2007;57(4):300-1.
25. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54(7):581-6.
26. Mehlman MJ, Durchslag MR, Neuhauser D. When Do Health Care Decisions Discriminate Against Persons with Disabilities? Journal of health politics, policy and law. 1997;22(6):1385-411.
27. Hannestad YS, Rortveit G, Sandvik H, Hunskaar S. A community-based epidemiological survey of female urinary incontinence:: The Norwegian EPINCONT Study. Journal of clinical epidemiology. 2000;53(11):1150-7.
28. Gupta G. Prevalence of Musculoskeletal Disorders in Farmers of Kanpur-Rural, India. Journal of Community Medicine and Health Education. 2013.
29. Berkson M, Schultz A, Nachemson A, Andersson G. Voluntary strengths of male adults with acute low back syndromes. Clinical orthopaedics and related research. 1977;129:84-95.
30. Marras W, Mirka G. Trunk responses to asymmetric acceleration. J Orthop Res. 1990;8(6):824-32.
31. Bihari V, Kesavachandran C, Pangtey B, Srivastava A, Mathur N. Musculoskeletal pain and its associated risk factors in residents of National Capital Region. Indian journal of occupational and environmental medicine. 2011;15(2):59.
32. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bulletin of the World Health Organization. 2003;81(9):646- 56.
33. Michelson JD, Helgemo SL. Kinematics of the axially loaded ankle. Foot and Ankle International. 1995;16(9):577-82.
34. Markolf KL, Slauterbeck JL, Armstrong KL, Shapiro MM, Finerman GA. Effects of combined knee loadings on posterior cruciate ligament force generation. Journal of orthopaedic research. 1996;14(4):633-8.
35. Currow DC, Plummer JL, Crockett A, Abernethy AP. A community population survey of prevalence and severity of dyspnea in adults. Journal of pain and symptom management. 2009;38(4):533-45.
36. Hammond EC. Some preliminary findings on physical complaints from a prospective study of 1,064,004 men and women. American Journal of Public Health and the Nations Health. 1964;54(1):11-23.
37. Bhandari R, Sharma R. Epidemiology of chronic obstructive pulmonary disease: a descriptive study in the mid-western region of Nepal. International journal of chronic obstructive pulmonary disease. 2012;7:253.
38. Pandey M. Prevalence of chronic bronchitis in a rural community of the Hill Region of Nepal. Thorax. 1984;39(5):331-6.
39. Behera D, Jindal SK. Respiratory symptoms in Indian women using domestic cooking fuels. CHEST Journal. 1991;100(2):385- 8.
40. Dennis RJ, Maldonado D, Norman S, Baena E, Martinez G. Woodsmoke exposure and risk for obstructive airways disease among women. Chest Journal. 1996;109(1):115-9.
41. Earth B, Sthapit S. Uterine prolapse in rural Nepal: gender and human rights implications. A mandate for development. Culture, Health and Sexuality. 2002;4(3):281-96.
42. Mallah F, Montazeri A, Ghanbari Z, Tavoli A, Haghollahi F, Aziminekoo E. Effect of Urinary Incontinence on Quality of Life among Iranian Women. Journal of family and reproductive health. 2014;8(1):13.
43. Kocak I, Okyay P, Dundar M, Erol H, Beser E. Female urinary incontinence in the west of Turkey: prevalence, risk factors and impact on quality of life. European urology. 2005;48(4):634-41.
44. Omli R, Hunskaar S, Mykletun A, Romild U, Kuhry E. Urinary incontinence and risk of functional decline in older women: data from the Norwegian HUNT-study. BMC geriatrics. 2013;13(1):47.
45. NSMP. Nepal Safer Motherhood Project: Cultural issues 1997. Available from: http://www.nsmp.org/publications_reports/documents/InfoSheet10CulturalIssues.pdf. 46. HMG. The Disabled Persons Protection and welfare Act 2039 (1982). Available from: http://www.ilo.org/dyn/natlex/docs/ ELECTRONIC/15786/97320/F50058242/NPL15786.pdf.
47. Acharya R, Khadgi B, Shakya N, Adhikari S, Basnet S, Sharma S, et al. Physiotherapy awareness among clinical doctors in Nepal. Journal of Institute of Medicine. 2011;33(2).
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241723EnglishN2015December10HealthcareLNW-A SYSTEM MODEL FOR A HIGH QUALITY EFFECTIVE E-LEARNING USING CLOUD ENVIRONS
English2125S. Mohan KumarEnglish Karthikayini T.EnglishHigher education sector is dreadfully in need of quality teaching and learning by the provision of Information Technology (IT) services. A worthy teaching can perceptibly a superior ingredient for worthy learning. An effective resources should be made accessible in a centralized way for lifetime knowledge. At hand there is not a superior model for a centralized system where the resources can be accessed in a de-centralized (anywhere, anytime, any device) and automated way. The proposed approach articulates a centralized system model LNW for an effective learning platform in an automated approach by integrating Google cloud products, where the students can access the resources in a de-centralized manner.
EnglishLNW(Lecture Notes Warehouse), LNSM (Lecture Notes Submission Model), LNVM (Lesson Notes Verification Model), ARCHIVES (Google Spread Sheets), Google Cloud SQL, Google App script, Google sitesINTRODUCTION
Cloud computing is commonly defined as “a model for user convenience, which contribute the computing resources(e.g. networks, storage, applications, servers, and services) on demand network access that can be rapidly implemented with minimal management effort or service provider interference” as enlightened by US National Institute of Standards and Technology (NIST). Good quality of service(Qos) level for the remote application can be achieved by cloud technology which effectively supports the use of large scale internet services. Cloud computing has many technologies such as Saas i.e. “Software as a Service”, Paas i.e. “Platform as a Service”, IaaS i.e. Infrastructure as a Service” which focuses on sharing data and computations over a scalable network of nodes [5].
SURVEY ON ATTITUDE TOWARDS INFORMATION SHARING
The academic institutions have various departments based on the stream where it’s encompassing both odd and even semesters. Earlier the teaching was confined to the physical domain of the student, teacher and the institute [1]. Mostly, it leads to excess consumption of papers in preparing the lecture notes for the similar courses for each successive year. Also, there is not a centralized approach in order to access the lesson plan documents in a federal way. “Continuing education as a lifelong learning is primary perspective of both the job workforces and technical workforces in the entire future development of the country [2]. Sheng-cheng Lin put forward the concern of collaborative course plan development via team based knowledge sharing and creating is categorized at three levels –individuals, groups and organizational levels. Self-efficacy of using IT in teaching and professional network enlargement are the two major concepts for every academician[6]. Overall teachers overall regularity to use the internet(#10=3.5) was higher than the median value(=3.0)(t=5.4,df=205,pEnglishhttp://ijcrr.com/abstract.php?article_id=382http://ijcrr.com/article_html.php?did=3821. Aman Kumar Sharma1 and Anita Ganpati “Cloud Computing: An Economic Solution to Higher Education” International Journal of Application or Innovation in Engineering and Management, Volume 2, Issue 3, March 2013.
2. Zhang Tao and Jiao Long “The Research and Application of Network Teaching Platform Based on Cloud Computing” International Journal of Information and Education Technology, Vol. 1, No. 3, August 2011.
3. Shreedhar Deshmukh, “Implementing Cloud ERP systems in Higher Educational Institutes and Universities”, PARIPEX - Indian Journal of Research, Volume : 3, Issue : 2 , Feb 2014.
4. Sunday A. Idowu and Adenike O. Osofisan “Cloud Computing and Sustainable Development in Higher Education”, Journal of Emerging Trends in Computing and Information Sciences, VOL. 3, NO.11 Nov, 2012.
5. “Cloud Computing Security” Danish Jamil Hassan Zaki, International lournal of Engineering Science and Technology (IJEST), Vol. 3 No. 4 April 2011.
6. “The reality of team-based knowledge sharing and creation in professional cyber community” sheng-cheng Lin, Proceedings of the 36thHawali International conference on system Sciences(HICSS’03), IEEE Computer society of India, 2002.
7. “Survey report of teachers attitude toward Educational Knowledge circulation” hiroshikato Kazauhikohatano, Mieko Tahakira, Takashi sakamoto, National Institute of Multimedia Education, 2004 IEEE Transactions.
8. “Students and recorded lectures: survey on current use and demands for higher education” Pierre Gorissen, Jan van Bruggen and Wim Jochems, the journal of the Association for Learning Technology(ALT), 24 Sep,2012.
9. “Design of a web-based computer network experiment teaching demonstration system” Wenjiang Jiao; Xingwei Hao, Int. J. of Information Technology and Management, 2014 Vol.13, No.1, pp.44 – 53.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241723EnglishN2015December10HealthcareA STUDY ON THE ASSESSMENT OF BMI AND ITS ASSOCIATION WITH IQ AMONG RURAL PRIMARY SCHOOL CHILDREN IN WEST BENGAL, INDIA
English2629Koushik BhowalEnglish Indrani MukherjeeEnglish Debnath ChaudhuriEnglishBackground: Malnutrition, both under and over, is a serious public health problem related to increased risk of mortality, morbidity and overall development of children. Coexistence of undernutrition and overnutrition among Indian children has been reported.
Objective: To investigate the association between body mass index and IQ of rural primary school children. Methods: A community based cross-sectional and descriptive study was undertaken in Government rural primary schools of Shimulpur, Salka, Kumarhut, Ramnagar in the districts 24 Parganas North and South, West Bengal, India among 560 children aged 6 to 8 years (class II to IV). Anthropometric measurements were taken to assess body mass index. Raven’s Progressive Matrices Test was done to determine IQ grades of these students.
Results: 28.03% and 28.75% of rural primary school children under study were wasted and severely wasted, respectively while 3.39% and 1.08% were overweight and obese according to BMI. Only 0.37% and 50.71% of rural children had 95th (intelligently superior) and 5th (intelligently impaired) percentile of IQ grades. Body mass index of children has significant positive correlation with IQ (P? 0.05).
Conclusions: Higher body mass index is associated with lower IQ grades in rural children.
EnglishBMI, IQ, Children, Rural, Primary schoolINTRODUCTION
Malnutrition is widely recognized as a major health problem in developing countries1 . Growing children in particular are most vulnerable to its consequences2 . According to Benson3 , malnutrition is a physical condition or process that results from the interaction of inadequate diet and infection and is most commonly reflected in poor infant growth, reduced cognitive development, anemia and blindness. Childhood malnutrition can be evaluated anthropometrically 4-5 which is among the cheapest and most common methods available to assess human body composition, especially in developing countries6 . Body mass index (BMI) is commonly used to quantify anthropometrics to identify individuals at risk due to its simplicity7 . BMI cut-off points are also used clinically to identify individuals for screening; determine the type and intensity of treatment; monitor individuals for effects of treatment over time8 . Child development is an important determinant of health over the life course9 and its relationship with cognitive development have grown in the last few decades. Early developmental opportunities establish a critical foundation for children’s academic success, health, and general wellbeing10. Research suggests that malnutrition alone does not cause irreversible damage to the brain but is believed to result from a complex interaction between environmental factors and malnutrition11. Nutrition is one of the crucial factors affecting cognitive development in children as many studies indicate that childhood IQ associated with childhood obesity and BMI values 12-15.
India contributes to about 5.6 million child deaths every year due to under nutrition, more than half of the world’s total16.At the same time high prevalence of overweight and obesity have important public health consequences globally17 as well as in India18. However, though there are reports19-22 available regarding the prevalence of under-nutrition and overnutrition or obesity among children in West Bengal, no attempts was made to find out association between body mass index and IQ of them.
Objectives of study
a) To determine the body mass index and IQ of them.
b) To assess malnutrition of rural primary school children in terms of body mass index.
c) To examine the association between body mass index and IQ.
MATERIALS AND METHODS
Study design and Settings
Students were randomly selected considering some inclusion criteria. These are, (i) children were apparently healthy and not suffering from any chronic diseases or physical disabilities (ii) participated in this study voluntarily. This study was carried out among four rural primary school children of Shimulpur, Salka Kumarhut, Ramnagar, West Bengal, India. A total of 560 students aged 6–8 years (280 boys and 280 girls) participated in the study.
Ethical consideration
This study was approved by the Institutional Ethical Committee of All India Institute of Hygiene and Public Health, Kolkata, Ministry of Health and Family Welfare, Govt. of India. During surveys to the schools guardian meetings were held in presence of the headmaster of the schools and the parents accompanied by their children before conducting of the study in order to give an elaborate explanation and idea of the objectives of the study. Informed written consent was also obtained from mothers of the students.
Statistical methods
Descriptive statistics were computed for all the continuous variables. SPSS, Windows version 21.0 (Chicago, USA) were used for the statistical analysis.
According to BMI for age, out of 280 boys 33.57% were severely wasted, 28.57% wasted, 34.28% normal, 2.86% overweight and 0.72% obese; out of 280 girls 23.93% were severely wasted, 27.15% wasted, 43.58% normal, 3.91% overweight and 1.43% obese; out of total 560 children 28.75% were severely wasted, 28.03% wasted, 38.75% were normal, and 3.93% overweight and 1.08 obese (Fig. 1).
According to the Raven Progressive Matrices test out of 280 boys 0.71%, 3.92%, 21.78%, 23.57% and 50.02% were intelligently superior, above the average, intelligently average, below average, intelligently impaired respectively; out of 280 girls 2.5%, 21.08%, 25% and 51.42% were above the average, intelligently average, below average, intelligently impaired, respectively; Out of total 560 school children 0.37%, 3.22%, 21.42%, 24.28% and 50.71% were intelli-gently superior, above the average, intelligently average, below average, intelligently impaired respectively (Fig.2). DISCUSSION It is important that the assessment of malnutrition should be based on outcome measures rather than input measures. The suggested outcome measures include anthropometric measures like BMI, clinical signs of malnutrition, biochemical indicators and physical activity. Outcome indicators are more closely related to health and functional capacity. Among the outcome measures, anthropometric measures are considered to have an advantage over other indicators since body measurements are sensitive to even minor levels of malnutrition whereas biochemical and clinical indicators, on the other hand, are useful only when the level of malnutrition is extreme. According to BMI 28.03% of the total children were wasted and 28.75% of them were severely wasted (figure.2). Severe wasting was found to be more in case of boys (33.57%) in comparison to girls (23.93%). Moreover, wasting was also found to be high in boys (28.57%) than girls (27.15%). The figures for wasting existed are better than those reported by some studies in India and in West Bengal25-26. Body mass index is positively correlated (P≤ 0.01) (r = 0.41) with IQ. Assessment of IQ of the children according to Raven Progressive Matrices test revealed an undesirable finding. 50.71% of them (figure.3) found to have lowest IQ grade (intelligently impaired), only 0.37% student had the highest level of IQ (intelligently superior) and only 3.22% were above the average level of intelligence grade. Study revealed that though IQ level of the students were not optimum, boys were having higher IQ grades than girls in terms of higher three IQ grades. It is interesting that while the prevalence of under nutrition was high among the study population, at the same time 4.47% of them were either overweight or obese according to BMI even in these rural areas. A study profile of the rates of overweight and obesity among children of various states of India26-28 showed that the prevalence of overweight among students was lower than those reported in those studies but still there is a situation for concern as it is observed that 30% of obesity begins in childhood and out of that 50% to 80% become obese adults29.
CONCLUSION
• This study among the rural school children reveals that the boys are more vulnerable to under nutrition but girls are more prone to overweight and obesity.
• Boys were intelligently superior to girls.
• A significant positive correlation between body mass index and IQ exists among them.
• Overweight and obesity exists in rural population in both sexes.
LIMITATION OF STUDY
In this study nutritional status of the children was assessed by anthropometry. Biochemical estimations will be able to provide a better understanding of the nutritional status and in particularly the prevalence of micronutrient malnutrition.
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=383http://ijcrr.com/article_html.php?did=3831. Black R, Allen I, Bhutta Z, Caulfield EL, de Onis M, et al. (2008) Maternal and child under nutrition: global and regional exposures and health consequences 371: 243–260.
2. Ahmad E, Khalil S; Khan Z; Nutritional status in children (1-5 yrs) (2011): A Rural Study. Indian Journal of Community Health; 23(2): 84–86.
3. Benson T (2005). Improving nutrition as a development priority: Addressing undernutrition within national policy processes in sub-Saharan Africa., Washington, DC, USA: International Food Policy Research Institute.
4. Bose K, Biswas S, Bisai S, Ganguli S, Khatun A, Mukhopadhyay A, Bhadra M (2007). Stunting, underweight and wasting among Integrated Child Development Services (ICDS) scheme children aged 3- 5 years of Chapra, Nadia District, West Bengal, India. Matern. Child. Nutr.3. (3).pp. 216–21.
5. Lee RD, Nieman DC (2003). Nutritional Assessment. McGraw Hill, New York. 262.
6. Ball SD, Altena TS, Swan PD (2004). Comparison of anthropometry to DXA: a new prediction equation for men. Eur J Clin Nutr ;58:1525–1531.
7. Bergman RN, Stefanovski D, Buchanan TA (2011), et al. A better index of body adiposity. Obesity (Silver Spring); 19: 1083- 89.
8. WHO Consultation on Obesity (2000), Geneva, 3–5 June, 1997. WHO/NUT/NCD/98.1. Technical Report Series Number 894. Geneva: World Health Organization.
9. Halfon N, Hochstein M (2002). Life course health development: an integrated framework for developing health, policy, and research. Milbank Q; 80:433–79.
10. Van Landeghem K, Curgins D, Abrams M (2002). Reasons and strategies for strengthening childhood development services in the healthcare system. Portland, ME: National Academy for State Health Policy.
11. Grantham-Mc Gregor, S. Powell, C.A., Walker, S.P. and Himes, J.H. (1991) Nutritional Supplementation Psychosocial Stimulationand Mental Redevelopment of Stunted Children: The Jamaican Study. The Lancet, 338 (8758): 1–5.
12. Qian M, Gao Y, and Wang D. (1994): Study on intelligence in simple obese children. Chin J Sch Health, 15: 216.
13. Zhang X, Li Y. (1996): Harmfulness of obesity in children to their health. Zhonghua Yu Fang Yi Xue Za Zhi; 30: 77–79.
14. Jiang A and Li A. (1997): Intelligence investigation and obesity in children. Chin J Rural Med Pharm, 4: 38.
15. Xia Q, Wang L, Wang W, An A, and Xie L.(1998): Paired study on intelligence state in simple obese children. Shanghai J Prev Med, 10:210–212.
16. Food and Agriculture Organization of the United Nation Economic and Social Department “The State of Food Insecurity in the World, (2004): Monitoring Progress towards the World Food Summit and Millennium Development Goals”. Food and Agriculture Organization of the United Nations, p. 8.
17. Obesity and overweight fact sheet, (2003) WHO. 18. Misra A, Khurana L (2008). Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab;93 (11 Suppl 1):S9–30.
19. International Institute for Population Sciences (IIPS) and Macro International (2008). National Family Health Survey (NFHS-3), India, 2005-06: West Bengal. Mumbai: IIPS.
20. Mittal PC, Srivastava S (2006). Diet, nutritional status and food related traditions of Oraon tribes of New Mal (West Bengal), India. Rural Remote Health; 6:385.
21. Chowdhury SD, Chakraborty T, Ghosh T (2008). Prevalence of undernutrition in Santal children of Puruliya district, West Bengal. Indian Pediatr; 45:43–46.
22. Bisai S, Bose K, Ghosh A (2008). Prevalence of undernutrition of Lodha children aged 1-14 years of Paschim Medinipur district,West Bengal, India. Iran J Pediatr; 18:323–329.
23. WHO Multicentre Growth Reference Study Group. Assessment of differences in linear Growth among populations in the WHO Multicentre Growth Reference Study (2006), Acta Paediatr Suppl.; 450:56–65.
24. Raven. J. et. al. (1998). Manual for Raven’s Progressive Matrices and Vocabulary Scales. Section 1: General Overview. San Antonio, TX: Harcourt Assessment.
25. Mendhi GK, Barua A, Mahanta J. et al. (2006). Growth and Nutritional Status of School age Children in Tea garden workers of Assam. J human Ecol.; 19:2:83–85.
26. Bose K, Bisai S, Mukhopadhyay A et.al. (2007). Overweight and obesity among affluent Bengalee schoolgirls of Lake Town, Kolkata, India, Maternal and Child Nutrition; 3:141–145.
27. Ramachandran A, Snehalatha C, Vinitha R, Thayyil M, Kumar CK, et al. (2002). Prevalence of overweight in urban Indian adolescent school children. Diabetes Res Clin Pract, 57: 185–190.
28. Premanath M, Basavanagowdappa H, Shekar MA, Vikram SB, Narayanappa D et al. (2010). Mysore childhood obesity study. Indian Pediatr; 47: 171–173.
29. Styne DM (2001). Childhood and Adolescent Obesity. PCNA; 48:823-847.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241723EnglishN2015December10HealthcareLIPID PROFILE AND RISK OF OBESITY AMONG URBAN ADULTS
English3033Surinder SharmaEnglish Bhuwan SharmaEnglishBackground: Dyslipidemia is a major risk factor for coronary heart disease and refers to lipid abnormalities such as high total cholesterol (TC), elevated low density lipoprotein cholesterol (LDL-C), hypertriglyceridemia, low high density lipoprotein cholesterol (HDL-C).Due to the scarcity of data, we performed a descriptive study so as to understand the pattern of lipid profile in an urban city in North India and the risk of obesity running in them.
Methods: This cross-sectional study was performed by collecting data from three private hospitals in the city from January 1, 2014 till June 31, 2014. Patients who satisfied our inclusion criteria were included in the study. Participants of the study underwent standard hematological testing along with variables about their past medical history and anthropometric measurements were taken. Data was analyzed using SPSS version 21.
Results: 636 patients were included in the study. 54% of the patients were males, 64% less than 65 years of age, 35% were overweight and 16% were obese. 33% were taking some form of lipid lowering drug. 67% had TC < 200 mg%, LDL-C < 130 mg% and HDL-C > 40 mg%. TC, LDL-C and triglycerides were found to be significantly associated with age and body mass index of the patient.
Conclusion: This was the first study in the region to look at the baseline lipid profile of patients. Assessing dietary habits, nutritional status of patients, genetic make up and environmental factors and correlating that with their lipid profile variables would be the next step and would constitute areas of future research.
EnglishLipid, Population, Obesity, Dietary, Prevention, UrbanINTRODUCTION
Diseases like stroke, coronary heart disease, and diabetes are the most important cause of mortality today.1 Many times these diseases are preventable by simple measures. Cardiovascular disease remains as one of the most important public health problems in developed countries, while it is gaining foothold in developing countries like India as well. Previously conducted epidemiological studies of populations who have been followed for a long time have identified certain characteristics and lifestyles that are strongly associated with an increased risk of cardiovascular diseases. Smoking, lack of physical activity, poor dietary choice, hypertension are some of the risk factors which we know from previous studies are rick factors strongly related to increased morbidity.2 , 3 Dyslipidemia is a major risk factor for coronary heart disease and refers to lipid abnormalities such as high total cholesterol (TC), elevated low density lipoprotein cholesterol (LDL-C), hypertriglyceridemia, low high density lipoprotein cholesterol (HDL-C). 4 million deaths annually and about 50% of cases of ischemic heart disease worldwide have been estimated to be associated with dyslipidemia by the World Health Organization.4 Dyslipidemia has direct consequences on the risk of various disabling cardio- and cerebrovascular events. Due to the scarcity of data, we performed a descriptive study so as to understand the pattern of lipid profile in an urban city in North India and the risk of obesity running in them. This would be helpful because many studies have shown that modification of the plasma lipid concentrations is a useful approach in decreasing cardiovascular mortality
METHODOLOGY
Setting This cross-sectional study was conducted in the urban city of Jalandhar, Punjab, where we included patients who presented to private hospitals with in house laboratory services. We divided the city in four regions and in each region we identified four private hospitals in the city, of which three agreed to share their data with us. Institutional ethics review was obtained individually from each hospital. These three hospitals were located at approximately 7-8 kilometers away from each other, thereby covering majority of the urban population of Jalandhar. With a population of 21,93,590, 52% of which are males, Jalandhar is the fourth populous city of Punjab. The three hospitals were visited by 200-250 patients each daily in the outpatient department. Patients, who were admitted to these hospitals, mainly belonging to middle, upper-middle socioeconomic class, were usually from urban Jalandhar.
Study design We collected patient information from January 1, 2014 till June 30, 2014, from hospital records. We included all patients, aged 18 years or above, who were admitted in any inpatient ward in the included hospitals. Patients who only visited the outpatient department were not included in the study because of the lack of follow-up in these patients. After obtaining an informed consent, we collected demographic information like age, gender, body weight, any comorbid condition (present for more than a year and for which active treatment is being taken by the participant) or whether they are taking any lipid lowering drug or not. Lipid profile measurements were done using enzymatic method (Diasys diagnostic systems, Gmbh, Germany), which provides automated results. All laboratories followed standardization procedures as recommended by the World Health Organization, including the use of external control sera. All blood samples were taken early morning, after overnight fasting.
Definitions High total cholesterol (TC), high triglyceride (TG), high low-density lipoprotein cholesterol (LDL-C), and low highdensity lipoprotein cholesterol (HDL-C) were defined as TC ≥ 200mg/dL, TG ≥150mg/dL, LDL-C ≥130mg/dL, and HDL-C Englishhttp://ijcrr.com/abstract.php?article_id=384http://ijcrr.com/article_html.php?did=3841. WHO mortality database. Website http://www.who.int/healthinfo/mortality_data/en/ Accessed Oct 15, 2015.
2. Bao W, Srinivasan SR, Wattigney WA and Berenson GS (1995): The relation of parental cardiovascular disease to risk factors in children and young adults. The Bogalusa Heart Study.Circulation 91, 365–371.
3. Shaw LW (1981): Effects of a prescribed supervised exercise program on mortality and cardiovascular morbidity in patients after myocardial infarction. The National Exercise and Heart Disease Project. Am. J. Cardiol. 48, 39–46.
4. World Health Organization. Quantifying selected major risks to health. In: The World Health Report 2002 - Reducing Risks, Promoting Healthy Life. Ch. 4. Geneva: World Health Organization; 2002. p. 47-97.
5. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486-97.
6. Bhopal, R., N. Unwin, M. White, J. Yallop, L. Walker, K. G. M. M. Alberti, J. Harland, S. Patel, N. Ahmad, C. Turner, B. Watson, D. Kaur, A. Kulkarni, M. Laker, and A. Tavridou. 1999. Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Ban- gladeshi, and European origin populations: cross sectional study. BMJ. 319: 215 – 220.
7. Mahley, R. W., K. Erhan-Palaoglu, Z. Atak, J. Dawson-Pepin, A. M. Langlois, V. Cheung, H. Onat, P. Fulks, L. Mahley, F. Vakar, S. O?zbayrakci, O. Go?kdemir, and W. Winkler. 1995. Turkish heart study: lipids, lipoproteins and apolipoproteins. J. Lipid Res. 36: 839 – 859.
8. Zavaroni I, Dall’Aglio E, Alpi O, Bruschi F, Bonora E, Pezzarossa A, et al. Evidence for an independent relationship between plasma insulin and concentration of high density lipoprotein cholesterol and triglyceride. Atherosclerosis 1985;55:259-66.
9. Park H, Kim K. Association of alcohol consumption with lipid profile in hypertensive men. Alcohol Alcohol 2012;47:282-7.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241723EnglishN2015December10HealthcareMOBILE APPLICATION - CROSS DOMAIN DEVELOPMENT AND STUDY OF PHONEGAP
English3439Mathangi KrishnamurthiEnglishThere has been a significant development in the market for smart devices and its computational power in the last decade. The combination of computational power, easy portability, inherent features and the ease with which it reaches the common man has propelled this development. The need for mobile solutions has increased exponentially due to the easy and prevalent access to these smart devices. The dilemma met by those wanting to target these consumers was mainly as to which methodology to adopt. Given the fragmented Smartphone market, native development of application was found resource wise and financially not lucrative. There came a need for a “Develop One Time, Deploy anywhere anytime” solution. So this has been solved by the cross-platform mobile application development tool. Phonegap is one such popular framework which embeds HTML5 and CSS3 to provide the needed functionality. Given its generic nature, there is still some need for consideration of its performance as opposed to a native application.
EnglishSmart devices, Cross-platform development, PhonegapINTRODUCTION
There has been an immense development in the domain of mobile devices. Recent data claims 95.5% of the world population have a mobile service subscription [1].The reason for this may include, Smartphones rival the traditional resources in terms of computational power, mobility, availability, flexibility, low weight, small size and inherent features such as sensors, Global Positioning System (GPS), camera and other such features [2]. The rapid increase may be attributed to the ease of availability. In today’s fast-paced world, people are definitely inclined towards a mobile approach, therefore, the need for effective mobile solutions. Although mobile application development and traditional software development are similar in functionality, there are some major differences in these two approaches. There are some additional considerations for mobile software engineering like the battery backup, security, user experience expected, testing strategy, native and web application and context awareness. Battery consumption is a concern with applications that require continuous running and heavy graphical or computational load. Furthermore, there are different hardware configurations. For example, the smaller size severely altered the user interface and the design guidelines considered for design and development of an application.
CHALLENGES IN MOBILE APPLICATION DEVELOPMENT
Universal user interface Each platform that is device specific has some guidelines to follow for the development of the user interface [3]. Although these are predominantly similar there are some differences due to dependence on a device such as a screen size, resolution, and computational power. There are no standards to follow as with traditional software development like the Shneiderman’s “8 Golden Rules of Interface Design” [4]. Although some of them may be applicable, they cannot be standardized without some revision. In addition to the difference in screen sizes even the input methods may differ, e.g., touch interface replaced keypads.
Designing Context-Aware Mobile Application Context awareness is defined as being able to sense changes in the environment and adapting as per requirement [5]. Context sensors like location, geothermal, etc. can be utilized to provide real-time hyper-specialized context specific environment for the user. In some situations, non-functional requirements are necessary to satisfy the user. In such a scenario, a decision is made whether to deliver no functionality at all or reduced functionality.
Privacy Given the amount of user-centric and personal data being transmitted for maintaining a context sensitive environment due consideration must be provided for protection of this transmitted data.
Balancing agile and uncertainty in requirement While developing mobile applications many developers adopt an ad-hoc or agile approach. Considering the scenario, where the application is incapable of providing full or partial functionality, provisions need to be provided in the agile model of development for such situations. Requirement specification approaches like RELAX may be adopted for the self-adaption of the application [6].
Enabling Software Reuse across Mobile Platforms The code base is varied depending on the device specification and availability and cost involved in acquiring the requisite skilled resources. A myriad and duplicate code base are a nightmare for maintenance and performance, therefore there is a need for code reuse. With several different platforms being produced by various hardware producers, it becomes a difficult choice as to which methodology to follow to service a wider audience.
DIFFERENT APPROACHES TO MOBILE APPLICATION DEVELOPMENT
With the fragmentation of the smartphone market, it becomes a dilemma as to what to choose, cost over functionality or vice versa. There are several options available and the choice depends on the application and its intended audience. These methods mainly comprise of native applications, web applications and hybrid application development.
Native application development targets a specific platform and is usually developed using Software development kit (SDK) and framework. The technology differs significantly from one platform to another. IPhone uses Objective-C /C / HTML5, Android- Java /C / C++ /HTML5, Symbian- C / C++ /Java / HTML5 and Windows Phone- C#/C++/Silverlight/ HTML5 [7] [8] [9]. Given the sheer number of languages and the fragmentation of the mobile market makes native applications cost intensive. It is human resource intensive in terms of people with the specific skill set. The platform design specifics are not unique and support and maintenance become difficult [10]. Therefore, there is a need for a solution which emulates the “Develop One Time, Deploy anywhere anytime” principle. Next methodology adopted was a web application developed on the mobile termed as ‘web apps’. With recent technologies like HyperText Markup Language (HTML5)and Cascading Style Sheets (CSS3) providing a great way to develop a simple application, this method uses the browser as their runtime environment and thereby capitalizes on the good browser support of mobile platforms. But even this has some drawbacks. The device-specific hardware features such as a camera or GPS sensor cannot be accessed [11]. There is no provision for large data processing or authentication. Furthermore, it is difficult to create a native app like feel on a web application. To access the hardware feature with the benefit of code reuse of web technology a new methodology was coined, the hybrid application. Its runtime environment combines a web engine bundled in a native engine. This can further be divided into more subparts. One such popular approach is the one followed by Titanium Mobile [12]. It uses a self-contained runtime environment and does not use the web environment already present. They are bundled with the framework’s engine and deployed as native apps. Another popular method followed by PhoneGap framework is a web rendering engine with the platform specific calls diverted to the native engine.
HYBRID APPLICATIONS
ADVANTAGES OF HYBRID APPLICATION
Reduces application development cost
Enables developers with less skill set to develop a single app for all the devices that are to be supported as per the business need.
Simplifies application management
With businesses leaning towards offering mobile apps and it becoming a norm rather than a rare scenario, a deliverable product is no more the only goal. Continued support and maintenance of the code base with additional new features become necessary. This is simplified by having a single code base.
They are easier to update
Once an update or a patch is ready it can be pushed to all the users and their devices across the business enterprise.
DISADVANTAGESOF HYBRID APPLICATION
User Experience
The look and feel of the application cannot mimic the user interface features of a native interface many times. The smoothness of a native application may not be reproducible.
The web views implementation
They require distinct web view implementation per platform [13].
Performance
Performance is a major consideration while contemplating adoption of hybrid application development. Depending on the usage of the application, performance is affected ranging from slightly to adversely [14]. For example, resource intensive applications such as gaming application may be better implemented using native methodology.
Market barriers
The major market barrier for Cross-Platform Tool (CPT) vendors are low awareness of their tools and services among the global app developer community as well as among companies which have a vested interest in cross-platform app development. Only 16 CP Tools are known to 20% of the global app developer community. The rest of the 150+ tools is hardly known or unknown.
CP Tools have made some progress in raising awareness among the global app developer community. Adobe Air, PhoneGap, and Unity are some of the tools that have managed to attain visibility in the market since last year. The vast majority are still relatively unknown (not shown in the graph below).
DIFFERENT FRAMEWORK FOR CROSS PLATFORM APPLICATION DEVELOPMENT
To develop cross-platform application some tools and frameworks are utilized like Rhodes, PhoneGap, DragonRad, MoSync, Appcelerator Titanium, Sencha Touch 2, jQuery Mobile, Xamarine, Unity3D and Corona SDK. From this limited list, we will be considering a few.
Rhodes
RhoMobile Rhodes is an open source framework for crossplatform Smartphone applications, developed by RhoMobile [15]. It attempts to manage application and data to provide high productivity and portability. It provides many products like Rhodes (Develop), RhoConnect (Integrate), Rhohub (Deploy) and RhoGallery (Manage). It also provides an IDE called RhoStudio. It uses web development languages such as HTML, CSS, JavaScript and Ruby skills to build native apps for all popular operating systems: iOS, Android, Windows Phone, Windows CE and Windows 8.
Appcelerator Titanium Studio 2.0
As a self-contained runtime environment, Appcelerator Titanium Mobile follows a different approach. It provides a rich API and low-level process calls. UI manipulation occurs through JavaScript API’s. It does not utilize the web languages such as HTML and CSS. The environment for development is provided in the form of IDE Titanium Studio. It contains an SDK and the tools required for development. Inside the packaging, the conversion to native code is done by using scripting e.g. python scripts are used for android. It is a stable framework where the data can be stored either in the cloud or on the device.
Some advantages are, the native code is rendered smoothly. The development environment setup is simple and rich documentation is available. Further, it supports tablet development. Its functionalities are restricted by the API offered and the device supported count is less as compared to its peers [16].
Sencha Touch 2.0
Sencha Touch 2.0 [17] is a powerful and complex framework which can either be used as the self-contained development platform providing an access to the hardware features of the device or can be used as an add-on to a framework like PhoneGap aiding the UI development. It also offers an option to build native packages deployable on iOS and Android application market [18]. The supported platforms are iOS, Android, BlackBerry, Kindle, and Bada, with a free commercial license for application development, and a paid commercial license for OEM uses. It is overall a mature framework.
jQuery Mobile
jQuery is a unified system for all popular mobile device platforms that comprises of an HTML5based user interface. It does not create native applications. It has a broad support for the vast majority of mobile devices, feature phones, and older browsers. The application is written in HTML5 and CSS [19]. It is used in fusion with a framework like Phonegap to provide an enriched user interface. It is a mature framework.
Phonegap
PhoneGap is an open-source framework for mobile application development [20].It uses standards-based web technologies to bridge the gap between web applications and mobile devices [21]. PhoneGap makes it easy to work within a short span of time, without maintenance considerations that are part of native software development kit (SDK). The developer may use native SDK as well or use the Phonegap Build feature [22].
PHONEGAP- AN OPEN SOURCE FRAMEWORK
PhoneGap was originally created by Nitobi Software, which has since been acquired by Adobe [23]. The development now takes place in the Apache Cordova project of the Apache Foundation, of which PhoneGap is a distribution [24]. Developers implement their application using HTML and CSS for front-end development and use Javascript for constructing the business logic. The runtime environment provides access to the native hardware features through application interface (API) calls.
It can be used through an eclipse plugin or specific Software Development Kits. A new feature offered by Phonegap is the PhoneGap Build which is a cloud-based development environment. As far as deployment is concerned the binary file generated during the build cannot be published on any mobile application market. The developer obtains the final release through the pricing PhoneGap Build service. It is a mature framework [25].
ADVANTAGES
• It is an open source software. Therefore, all native wrapper source code is available facilitating customization. Broad ranges of platforms are supported. Supports seven mobile platforms (iOS, Android, BlackBerry OS, Windows Phone, HP WebOS, Symbian, Bada.)
• Apps are built predominantly using HTML, CSS and JavaScript thus leading to easy adaptation.
• Phonegap provides easy access to platform-specific features. Complex functionalities can be implemented using plug-ins.
• Launching a PhoneGap app is fast and the user interaction is smooth.
• PhoneGap Build is a service that compiles an app for different platforms on the cloud, removing the need for developers to install the platform SDKs.
• Documentation is clearly structured and comprehensive [26].
• Though Apple may reject a Web app, this does not apply to Phonegap Apps. These are distributed through usual app stores and likes.
KNOWN ISSUES AND SOLUTIONS
• It does not provide UI components, design patterns, and dev tools. This can, however, be overcome by using a support framework like jQuery Mobile or Sencha Touch 2.0 to help develop the UI [27].
• No support of multithreading, since not all of the mobile Web-Views have the implemented Web-Workers. This can be resolved through native PhoneGap plugins [28].
• All the features of the phone may not be available, furthermore accessing some of this feature is time-consuming and lead to performance issues. We can utilize plugins in some cases.
• Though the code base is same for all the platforms, there often arises a need to tweak functionality for a certain platform. This presents a problem for debugging and finding a workaround. The lag around 300ms is noted during touch events. During selection of the external library, due care should be taken for performance and click events should be avoided [29].
• Building and deploying on Phonegap may be timeconsuming as compared to a native application. • Use CSS transition and hardware acceleration to speed up the application.
• Do not wait for the data to display the UI. Employ deferred load to improve performance. Therefore, PhoneGap can be used in scenarios where the application is not expected to do resource extensive operations and when highly rich UI graphics is not needed to be rendered.
PERFORMANCE CONSIDERATION
Performance can be measured by considering a number of factors such as execution time, memory usage or battery consumption. The criteria considered here is of execution time as this directly affects the user experience. To have a comprehensive understanding of the framework and its limitations we look into different resource categories:
• Hardware access: access to the accelerometer, launch a sound notification, trigger vibrator.
• Network access: request data from GPS, request network information
• Data access: write data into a file, read data from a file, retrieve data from a content provider.
Research shows that a PhoneGap application is seldom faster in execution as compared to a native application. In most scenarios, performance decay progresses from slight to very significant. For example, resource intensive operations like accessing the GPS positioning had huge lag. The root cause of this difference may be attributed to the inner structure of the resource call to the resource or code level whereas a native method directly accesses the resource, the hybrid environment utilizes JavaScript accesses through an execution path that has at least one call-back method substantially increasing the execution time. This execution time is directly proportional to the amount of complexity in accessing the specific resource.
Though web-based implementation is usually slower than the native the performance penalty may be discounted in most scenarios.
DISCUSSION
There seems to be a myriad of discussion on the effectiveness of hybrid application development and different concerns while considering the deciding criteria for selection of one technology. Taking into consideration the nascent nature of the some technologies under consideration as compared to the some more mature frameworks PhoneGap seems to be most beneficial for relatively small size application which is akin to a web application with a few phone capabilities included. It also has a less steep learning curve as compared to some of its peer technologies. Standardization of criteria for technology selection could prove to be beneficial for a wider audience mainly including developers, stakeholders and decision makers while choosing a technology.
CONCLUSION
We are at the pinnacle of a mobile revolution and mobile applications are becoming a norm for businesses to capture a ready audience. But it is important to understand the finer points of difference between mobile application developments as compared to traditional software development. Challenges that are unique to mobile application development need be addressed. Further different approaches to mobile development based on the underlying need are to be explored. For example, if the business target is to concentrate only on the iPhone client base then a native application makes more sense than a hybrid application. The hybrid application may seem like the answer to all the developer woes of developing on the heavily fragmented mobile market with its varied platforms and hardware configurations. It comes with its own let of limitations and issues. There a number of options available for hybrid application development. Developing using a multi-platform framework is a decision to be made based on the availability of resources and the business implication. User experience is critical in determining the success of an application. A trade-off must be made between a native look and feel and a standard user interface. Phonegap as a cross-platform framework is considered and its advantages and disadvantages discussed. Performance considerations of the hybrid application are discussed on the basis of execution time.
Thus, this provides a brief overview of the points to remember before developing a mobile application.
ACKNOWLEDGEMENTS
I would like to take this opportunity to thank our project guide and Head of the Department Dr. Emmanuel M. for his valuable guidance and for providing all the necessary facilities, which were indispensable in the completion of this paper. I would like to extend a special thanks to my external guide Abhijeet Gadgil for the stellar infrastructure and motivation and Amol Kulkarni, for histireless efforts and expert guidance.Iwould like to acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. I am also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=385http://ijcrr.com/article_html.php?did=3851. Global mobile statistics 2014 Part A: Mobile subscribers; handset market share; mobile operators, http://mobiforge. com/research-analysis/global-mobile-statistics-2014-parta-mobile-subscribers-handset-market-share-mobileoperators?mT (accessed 2-11-2014)
2. Ramzi N. Sansour, Nidal Kafri, Muath N. Sabha, “A Survey On Mobile Multimedia Application Development Frameworks”.
3. J. Dehlinger and J. Dixon, “Mobile Application Software Engineering: Challenges and Research Directions”, Department of Computer and Information Sciences, Towson University.
4. B. Shneiderman, “Designing the user interface,” 1987.
5. A. Battestini, C. Del Rosso, A Flanagan, M. Miettinen, “Creating Next Generation Applications and Services for Mobile Devices: Challenges and Opportunities”, The 18th Annual IEEE International Symposium on Personal, Indoor and Mobile Radio Communications (PIMRC’07).
6. J. Whittle, P. Sawyer, N. Bencomo, B. H.C. Chengand J. Bruel, “RELAX: Incorporating Uncertainty into the Specification of Self-Adaptive Systems”, 2009 17th IEEE International Requirements Engineering Conference.
7. V.C. Kulloli , A. Pohare#2, S. Raskar#2, T. Bhattacharyya , S. Bhure, “Cross Platform Mobile Application Development”. International Journal of Computer Trends and Technology (IJCTT) - volume4 Issue5–May 2013.
8. To program for which smartphones? http://www.scriptol. com/programming/mobile.php(accessed 5-12-2014)
9. 5 Key Programming Languages for Mobile Developers, http://www.appia.com/blog/key-programming-languagesfor-mobile-developers(accessed 2-11-2014)
10. G. Vitols, I. Smits And A. Zacepins, “Issues of Hybrid Mobile Application Development with PhoneGap: a Case Study of Insurance Mobile Application”, Databases And Information Systems H.-M. Haav, A. Kalja and T. Robal (Eds.) Proc. of the 11th International Baltic Conference, Baltic DBandIS 2014.
11. H. Heitk¨otter, S. Hanschke, and T.A. Majchrzak, “Evaluating Cross-Platform Development Approaches for Mobile Applications”, Department of Information Systems University of M¨unster, M¨unster, Germany.
12. Seven Cross-Platform Mobile Development Tools, https:// www.udemy.com/blog/cross-platform-mobile-development/(accessed 1-11-2014)
13. Native Versus Hybrid Mobile App Development, http://appscend.com/blog/native-versus-hybrid-mobile-app-development/(accessed 20-11-2014)
14. L. Corral, A. Sillitti, G. Succi, “Mobile multiplatform development: An experiment for performance analysis”, The 9th International Conference on Mobile Web Information Systems (MobiWIS).
15. RhoMobile, http://rhomobile.com/rhoelements.html (accessed 23-11-2014)
16. Appcelerator, http://www.appcelerator.com/(accessed 23- 11-2014)
17. I. Dalmasso, S. K. Datta, C. Bonnet, N. Nikaein , “Survey, Comparison and Evaluation of Cross Platform Mobile Application Development Tools”, Mobile Communication Department, EURECOM Sophia Antipolis, France
18. Sencha Products, http://www.sencha.com/products/(accessed 24-11-2014)
19. Touch 2.0.2 Sencha Docs,http://docs.sencha.com/ touch/2.0.2/#!/guide/getting_started(accessed 25-11-2014)
20. JQuery mobile, http://jquerymobile.com/(accessed 28-11- 2014)
21. J. M. Wargo, “PhoneGap Essentials-Building Cross-Platform Mobile Apps”, ISBN 978-0-321-81429-6 (pbk.:alk. paper)
22. Phonegap ,http://phonegap.com/(accessed 10-12-2014)
23. Adobe® PhoneGap™ Build, Package mobile apps in the cloud. https://build.phonegap.com/(accessed 12-12-2014)
24. Adobe: “Adobe Announces Agreement to Acquire Nitobi” (2011), http://www.adobe.com/aboutadobe/pressroom/ pressreleases/201110/AdobeAcquiresNitobi.html(accessed 12-12-2014)
25. Apache Cordova, http://incubator.apache.org/cordova/(accessed 20-12-2014)
26. PhoneGap: API reference, http://docs.phonegap.com/ en/1.8.0/index.html(accessed 10-12-2014)
27. Using PhoneGap for Hybrid App Development, http://www. sitepoint.com/using-phonegap-for-hybrid-app-development/ (accessed 5-1-2015)
28. PhoneGap: How to Create One App for All Platforms, http:// mobidev.biz/blog/phonegap_how_to_create_one_app_for_ all_platforms (accessed 5-1-2015)
29. Top 10 Performance Techniques for Phonegap Application, http://coenraets.org/keypoint/phonegap-performance/(accessed 13-2-2015)
30. Cross-Platform-Tool-Benchmarking-Report-2014, research2guidance, research2guidance, OranienburgerStrasse 27, 10117 Berlin, Germany
31. Phonegap Architecture http://www.mammoth.com.au/blog/ cross-platform-mobile-development-phonegap-vs-xamarin (accessed 13-2-2015)
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241723EnglishN2015December10HealthcarePREVALENCE OF CONDOM USE AND ASSOCIATED FACTORS AMONG FEMALE SEX WORKERS IN KARACHI, PAKISTAN
English4046Atif M.English Khalil R.English GulSEnglish Bilal B.EnglishAs they have multiple sex partners, female sex workers are at a higher risk of sexually transmitted infections, including human immunodeficiency virus. Consistent and correct use of male condoms can reduce this risk. However, condom use among female sex workers is a complicated issue.
Objectives: The purpose of this study was to determine the revalence of condom use and to evaluate the factors associated with its use among female sex workers in Karachi, Pakistan.
Methodology: A mixed method study was conducted in Karachi, Pakistan. Quantitative data were collected from 200 female sex workers (FSWs) through a structured questionnaire, while Qualitative methods comprised40 in-depth interviews of every 5th female sex worker participating in the cross sectional survey, and Focus-group discussions. The information on socio-demographic characteristics, prevalence of condom use, factors associated with use of condoms, knowledge and awareness about STIs and HIV/AIDS was gathered. The data were analyzed using SPSS 18 and frequencies with percentages were calculated for all qualitative variables.
Results: Average age of the participants was 27.9 ± 6.5 years. More than one third had no formal education with 85% reporting a monthly income of more than 8000 PKR[Mean; 16615 ± 10867 PKR]. Nearly half (52%) had spent 4 or fewer years in sex work. The average number of clients per day was 3 ± 1.5 per sex worker. FSWs attached to a brothel were 6 times more likely to use acondom in comparison with street based FSWs. Whereas, FSWs aged younger than 35 years were 2.7 times more likely to use a condom in comparison to older FSWs. Factors found to be associated with not using a condom included being in the sex work for more than 05 years, having sex with non-paying partners, alcohol use, non-availability of condoms, not being associated with a service delivery program and lack of knowledge that condoms can protect against HIV.
Conclusion: The study revealed that the prevalence of condom use among female sex workers was low. FSW’s lack of negotiating power for condom use was a major reason for its non-use. Other factors associated with not using condoms included not being attached to a brothel, being over 35 years old, more than 05 years in sex work, having sex with nonpaying partners, use of alcohol, unavailability of condoms, no exposure to a service delivery program and no knowledge about condom being protective against HIV.
EnglishCondom use, Female sex workers, Commercial sex workersINTRODUCTION
Sexually transmitted diseases (STDs), including HIV/AIDS, are a major public health problem.1 Globally, there were about 36.9 million people living with HIV at the end of 2014. 2 Young women aged 15 to 24 years are 1.6 times more likely to be living with HIV/AIDS than young men. 3 Among them, female sex workers (FSWs), being a high-risk group, bear a disproportionately large burden of HIV infection worldwide.1 Research data shows that when used consistently and correctly, male condoms protect both partners from STDs, including HIV.4,5Condom effectiveness for STD and HIV prevention has been demonstrated by both laboratory and epidemiologic studies.6,7 Evidence of condom effectiveness is also based on theoretical and empirical data regarding STD transmission, the physical properties of condoms, and the protection provided by condoms.8,9,10,11,12 It has been estimated that condoms have prevented around 50 million new HIV infections since the onset of the epidemic. 13 The control of sexually transmitted diseases, including HIV, among sex workers and their clients in urban areas in developing countries, is considered a valuable and cost-effective intervention to reduce the spread of HIV. 14High risk populations include female sex workers as they have multiple sex partners and engage in unsafe sex. However, condom use among female commercial sex workers is a complicated issue. Experiences from research conducted with FSWs have reported that the choice of using a condom is dependent on several socio-economic, personal and work related factors associated with the sex worker.15These factors can act as a barrier to condom use and lead to unsafe sexual practices among sex workers putting them, their clients and the population at large at a risk of getting infected, especially with HIV, which can lead to significantly higher rates of HIV infection within a country.15 Pakistan, like many other countries in South Asia, has a well-developed commercial sex industry, which is illegal, highly complex and involves a large number of people in a variety of sites. 16Pakistan’s sex industry is very poorly documented and operates largely underground because it is illegal. 17Majority of studies conducted in Pakistan, together with anecdotal evidence are suggestive that the sex industry has and is moving out of traditional sites and concentrations in red light areas and becoming dispersed throughout cities, increasingly operating in private houses where they may use mobile phones or have managers and/or pimps who act as clearly defined authorities and as intermediaries between the sex worker and client. 15,16,17 To effectively address the HIV/AIDS epidemic among sex workers and their clients a multi-faceted approach is required. With HIV/AIDS beginning to change its course from a “low-prevalence epidemic” to “concentrated epidemic” in Pakistan, FSWs form one of the core groups which could play a major role in spreading the virus among the high risk groups as well as to the general population. In 2011, the HIV prevalence was estimated to be 0.63%among FSWs in Pakistan. 16This is, at best, a very conservative figure as it is difficult to accurately measure the size of the sex industry in Pakistan because of its hidden nature and wide geographic distribution of FSWs.15However, it is important to explore the unsafe sexual behaviors in high risk groups such as FSWs to inform policy and programs for STI/HIV prevention. Thus, the purpose of this study was to determine the prevalence of condom use and the factors associated with its use among female sex workers in Karachi, Pakistan.
SUBJECTS AND METHODS
A mixed method approach incorporating both a cross sectional survey followed by qualitative techniques were used among female sex workers during March 2015 to June 2015 in Gulshan-e-Iqbal town, Karachi, Pakistan. A WHO sample size calculation softwarewas used to calculate the required sample size. A minimum sample size of 200 was required while taking 5% bound on error of estimation, 95% confidence level, and assuming 50% prevalence of condom use among sex workers. 100 street based and 100 brothel based female sex workers were selected conveniently through a chain referral process and interviewed for the study. For qualitative assessment, in-depth interviews and focus group discussions were conducted with every 5th FSW who participated in the cross sectional survey. Principal Investigator herself conducted face-to-face interviews and data was recorded on a pre-coded questionnaire. A total of 40 in-depth interviews were conducted and each interview lasted about 60 to 90 minutes. All the questionnaires were field edited after each interview to check for legibility, missing fields and any illogical responses. SPSS version 18 was used to analyze the data. In order to identify any type of errors during data entry, 5% of the fields were randomly checked against the physical questionnaires. Mean with standard deviation was calculated for age (in years) while frequency with percentages was calculated for qualitative scale variables such as factors associated with use/non-use of condoms, and knowledge and awareness about STIs and HIV/AIDS. The “use of a condom at the last sexual intercourse” was the dependent variable for the study. Focus Group Discussions Focus Group Discussions with ‘hard to reach’ population of female sex workers and their managers is a very valuable technique to obtain insightful and complex information. A total of three focus group discussions were held. Groups comprised six to eight participants, ideal group range being six. A semi-structured, open-ended focus group guideline/ questionnaire was developed for conducting the sessions. All focus groups followed the same discussion guide that allowed comparisons between various responses of the different groups. The guideline contained eight open-ended questions, designed to discuss effusively during time period of two hours with each group. However, the respondents were allowed to converse for more time, till it was considered appropriate and constructive for generating data. The notes were taken in the local language, in order to retain the literal sense of the responses. The notes were later expanded, immediately after the focus group concluded.
ETHICAL CONSIDERATIONS
Informed verbal consent was obtained prior to the interview. Participation was voluntary and no coercion was used in the data collection process. They were fully informed of the nature of the study and the use of the data. They were free to withdraw from the interview at any time or refuse to answer any particular question. Participants were also ensured of confidentiality. No personal identifying information was obtained for any part of the investigation. Participants were offered information and referral to health and social services available in the community.
RESULTS
A total of 200 sex workers comprising 100 street based and 100 brothel based female sex workers(FSWs) participated in the cross-sectional survey. 144 (72%)FSWs interviewed were full time female sex workers(FSWs), while 56 (28%) reported that they were involved in sex work on a part time basis. Average age of the participants was 27.9 ± 6.5 years. Nearly half (99) 49.5% of the female sex workers(FSWs) were less than 25 years of age. 85% of the female sex workers(FSWs) had a monthly income of more than Rs.8000 income [Mean; 16615 ± 10867 PKR per month]. Prevalence of condom use was defined as the use of a condom on the last sexual intercourse. Based on this definition, 116 (58%) female sex workers(FSWs)had not used a condom, while 84 (42%) reported condom use during the last sexual intercourse. 172 of 200 (86%) respondents had heard about HIV/AIDS. 78% of the respondents knew that HIV is transmitted through sex and 56% knew that condoms can prevent its transmission. (see Chart 1) More than half (104) 52% of the female sex workers(FSWs) were into this profession since less than 5 years, whereas (54) 27% had 5 to 8 years of experience. About 55% of the female sex workers(FSWs) reported 30 or more clients in the last one month. 62% of the female sex workers(FSWs) got clients without involvement of a pimp, whereas 44% said they had to share the money with either a pimp or an auntie. Female sex workers(FSWs) attached to a brothel were 6 times more likely to use a condom in comparison with street based female sex workers(FSWs). Almost 85% participants had their last sexual intercourse with a paying customer. About 42% used alcohol during their last sex encounter. Duration of last sex was up to an hour in (152) 76% subjects, 36 (18%) spent 2 to 3 hours, while 12 (6%) of the respondents reported that they were paid for a full night.
Regarding service delivery programs, 31% respondents had heard about some services provided for sex workers and 10% of them had utilized these services at least once (see Chart 1) 90%of the female sex workers(FSWs) who were using condoms reported that they could easily access condoms, whereas only 33% of the non-users had access to condoms. While about 44% of the non-users felt no need to use a condom. The in-depth interviews and focus-group discussions correlated various factors associated with condom use among female sex workers. As a proxy to determine the negotiating power of the study subjects, they were asked if they could convince clients for the use of a condom. The responses were categorized into three themes; • They could easily convince clients to use condoms, • They had some difficulty in convincing clients to use condoms • They were unable to convince their clients for using a condom, 27% of the female sex workers(FSWs) reported that they were unable to convince the client to use a condom. Despite availability of condoms, the in-depth interviews revealed various reasons for not using them. The main reason for not buying condoms was that the female sex workers(FSWs) did not feel safe while carrying condoms on their person. Some expressed the fear of being stigmatized or harassed if found buying or carrying condoms. Table 1 lists the consequences of insisting condom use on the FSW’s part, the most common being the fear that the client would get angry. 35% of the participants considered that the female sex workers(FSWs) had no say in deciding whether to use a condom or not.
Table 2 lists the various reasons associated with the FSW agreeing or not agreeing to use a condom. Majority of the FSWs wanted to use a condom to avoid pregnancy, while the most common reason to refuse condom use was the fear that it causes allergy and pain.
DISCUSSION This study aimed to assess the prevalence of condom use among FSWs and factors associated with its use. Less than half (42%)of the participating FSW reported using a condom during their last sexual intercourse. This was despite the fact that a majority of them were aware of HIV transmission through sexual route. Studies from Uganda18 and Ethiopia19 have also found that despite high levels of knowledge about using condoms as protection against HIV, consistent condom use among FSWs was low. Another study from Indonesia reported that only 12% FSWs reported using a condom although 78% knew the benefits of using one. 20It seems that just having knowledge did not always translate into safe sexual behavior. The study participants were of a unanimous opinion that all girls in commercial sex work knew about condoms and had used them at some occasion during sex work. However, only one third of the participants had heard of health service delivery programs and a mere 10% had actually ever used such services. Sex workers comprise a highly stigmatized and marginalized group in our society, 16 which makes them highly vulnerable to HIV infection by decreasing their likelihood of accessing and participating in any health or social services for STD and HIV prevention. Therefore, FSWs may not be able to take advantage of health services even where they are available. A study in India has reported that exposure to an HIV intervention for FSWs resulted in a higher prevalence of condom use. 21Another study from Pakistan 16 also found that exposure to service programs was associated with increased prevalence of condom use. FSWs reported that condoms were easily available, but they expressed fear of being stigmatized if someone caught them buying or carrying condoms. Especially if a policeman checked their bag it could mean either an arrest or losing a share of their income. Moreover, most of them also feared that their families might find out about their profession if condoms were found in their possession. Thus even though availability of condoms was not a problem per se, purchasing them and carrying them was. Although a fair proportion of the respondents knew that condoms protect them from contracting any disease from their clients, this did not appear to be a major reason for condom use. The main reason quoted for using a condom was to avoid pregnancy. The consistency of condom use also decreased as the number of clients increased. Studies in Ethiopia 19, India22, and Cambodia23have also reported that as the number of clients for a FSW increased the odds of using a condom decreased. FSWs’ lack of negotiation power was found to be a major factor that discouraged condom use with clients. The common theme for not pushing for condom use was the fear of losing a client lest the client got angry or opted for another girl. About half of the participants believed that the FSW did not have any say in deciding whether to use a condom or not. Even where the FSWs tried to negotiate condom use, the final decision was made by the client. This shows that knowledge alone cannot ensure practice unless these workers are empowered to negotiate with clients. Even when the FSW had a condom available, failure to negotiate its use with a client meant unsafe sex. A study in China 24also reported that FSWs lacked the ability to negotiate condom use with their clients and the authors advocated that services and programs should also be directed towards the community at large in addition to specific programs for the sex workers.24Studies from Congo25, Nepal 26, and Nigeria27 have also reported that FSWs’ lack of ability to negotiate condom use with their clients was a major reason for unsafe sex. Research is needed to explore factors that impact FSW’s ability to negotiate condom use, and interventions must be designed to address these factors. The present study showed an association of condom use with age and number of years spent in sex work. Older and more experienced FSWs were less likely to use condoms. The reason may be that they are less open to change and continue with the same practice that they have been following for a long time. Association of condom use with age and duration of work have also been reported by other studies. 18, 19, 25Moreover, FSW who perceived condoms to be protective against STD/HIV were more likely to use them. It is very important to create awareness of STD and HIV/AIDS transmission among the sex workers and the general population, as the clients of the sex workers act as the bridging population in transmitting STI/HIV. The fact that girls working through brothels were more likely to use condoms in comparison to those operating through streets is an important finding. Previous studies have reported that brothel based FSWs are more likely to use condoms probably because the brothels provide the condoms28 thus sparing the FSW the embarrassment of buying them, and they seem to have better negotiating skills as compared to street based FSWs.29 Any interventions must be tailored to address the particular category of the FSWs, therefore, contextual factors need to be researched further. Research has shown that FSWs are more likely to use condoms with their commercial partners/clients in contrast to their regular partners.21,26In the present study the prevalence of condom use decreased with non-paying partners or the girls’ boyfriends and husbands. Studies have found that familiarity and closeness with the male partner decreased condom use 21,26,27 thus putting them at risk of acquiring STI/HIV. Interventions need to target the regular partners of FSWs as well as their paying clients.
FSWs informed that condom use was difficult with clients who were drunk. So the girls did not use condoms when the clients were too intoxicated or under the influence of alcohol. Studies have reported that FSWs find it difficult to negotiate condom use where a client has been drinking 30or under the influence of drugs. 25 The present study did find that FSWs with access to condoms were more likely to use them as compared to those with no access. This means that access to condoms needs to be increased to encourage more consistent use. A study in Congo has also reported that access is an important factor in determining condom use. 25
CONCLUSION
The prevalence of condom use among female sex workers was low despite a high percentage having knowledge about condom use as a protective measure against HIV and STDs. Major barriers to consistent use of condoms included lack of negotiating power of the FSWs and limited access to health and social programs. Other factors associated with not using condoms included, not being attached to a brothel, being over 35 years old, more than 05 years in sex work, having sex with nonpaying partners, use of alcohol, low access to condoms, and no knowledge about condom being protective against HIV. There is a need to improve FSW’s access to health services and counseling regarding safe sex. Interventions also need to target the clients of sex workers and the general population.
LIMITATIONS
There are limitations to this study. Since FSWs are a hard to reach group so non-probability convenient sampling was used for recruitment. The study only included two categories of FSWs, brothel based and street based; therefore, it may not be generalizable to all categories of FSWs.
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
SOURSE OF FUNDING
There is no source of funding for this manuscript.
CONFLICT OF INTEREST
We have no pecuniary or other personal interest, direct or indirect, in any matter that raises or may raise a conflict with our duties as researchers.
Englishhttp://ijcrr.com/abstract.php?article_id=386http://ijcrr.com/article_html.php?did=3861. Shannon, K, Strathdee, SA, Goldenberg, SM et al. Global epidemiology of HIV among female sex workers: influence of structural determinants. Lancet. 2014.
2. WHO. HIV/AIDS. Factsheet No. 360. 2015. Available at: http://www.who.int/mediacentre/factsheets/fs360/ en/
3. Women and HIV/AIDS: Confronting the Crisis. Geneva, Switzerland and New York, NY: Joint United Nations Programme on HIV/AIDS, United Nations Population Fund, and United Nations Development Fund for Women; 2004.
4. UNAIDS. The public health approach to STD control. UNAIDS Best Practice Collection. Technical Update. May, 1998.
5. Richard A. Crosby et al. Associations Between Sexually Transmitted Disease Diagnosis and Subsequent Sexual Risk and Sexually Transmitted Disease Incidence Among Adolescents. Sexually Transmitted Diseases , Vol. 31, No. 4, p.205–208. April 2004.
6. Fitch J Thomas et al. Condom Effectiveness: Factors That Influence Risk Reduction. Sexually Transmitted Diseases, Vol. 29. No. 12, p.811-817. December 2002.
7. Pinkerton SD. Abramson PR. Effectiveness of condoms in preventing HIV transmission. Social Science and Medicine. 44(9):1303-12, 1997 May.
8. Holmes KK, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bull World Health Organ 2004;82:454-461.
9. CDC (2006). Sexually Transmitted Diseases Treatment Guidelines, 2006. Morbidity and Mortality Weekly Report, 55(RR-11).
10. Steiner, Cates, and Warner (1999). The real problem with male condoms is non-use. Sex Transm Dis, 26(8): 459-62.
11. Warner, Stone, Macaluso, Buehler, and Austin (2006). Condom use and risk of gonorrhea and Chlamydia: A systematic review of design and measurement factors assessed in epidemiologic studies. Sex Transm Dis, 33(1): 36-51.
12. Weller and Davis (2001). Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database Syst Rev; 3:CD003255.
13. UNFPA, WHO and UNAIDS: Position statement on condoms and the prevention of HIV, other sexually transmitted infections and unintended pregnancy. 2015; Available at: http://www.unaids.org/en/resources/presscentre/featurestories/2015/july/20150702_condoms_prevention
14. M Laga, M Alary, F Behets, J Goeman, Prof P Piot,N Nzila, A.T Manoka, M Tuliza, M St Louis, Condom promotion, sexually transmitted diseases treatment, and declining incidence of HIV-1 infection in female Zairian sex workers, Volume 344, No. 8917, p246–248, 23 July 1994. Retrieved from: http://www.thelancet. com/journals/lancet/article/PIIS0140-6736(94)93005-8/abstract
15. Emmanuel F, Thompson LH, Athar U, et al. The organization, operational dynamics and structure of female sex work in Pakistan. Sex Transm Infect. 2013;89(Suppl 2):ii29–ii33.
16. Mishra, S, Thompson, LH, Sonia, A, Khalid, N, Emmanuel, F, and Blanchard, JF. Sexual behaviour, structural vulnerabilities and HIV prevalence among female sex workers in Pakistan. Sex Transm Infect. 2013; 89: ii34–ii42.
17. WHO. STI/HIV.Sex work inAsia. 2001; Available at: http:// www.who.int/hiv/topics/vct/sw_toolkit/sex_work_asia.pdf
18. Matovu JKB, Ssebadduka BN. Knowledge, Attitudes and Barriers to Condom Use among Female Sex Workers and Truck Drivers in Uganda: a Mixed-Methods Study. Afr Health Sci. 2013;13(4):1027–1033.
19. Masresha Molla Tamene, Gizachew Assefa Tessema, Getahun Kebede Beyera. Condom utilization and sexual behavior of female sex workers in Northwest Ethiopia: a cross-sectional study. The Pan African Medical Journal. 2015;21:50.
20. Family Health International (2001). What drives HIV in Asia? A summary of trends in sexual and drug-taking behaviours. Arlington: Family Health International.
21. Deering, KN, Boily, MC, Lowndes, CM et al. A dose-response relationship between exposure to a large-scale HIV preventive intervention and consistent condom use with different sexual partners of female sex workers in southern India. BMC Public Health. 2011; 11: S8
22. Hemalatha R, Kumar RH, Venkaiah K, Srinivasan K, Brahmam G. Prevalence of and knowledge, attitude and practices towards HIV and sexually transmitted infections (STIs) among female sex workers (FSWs) in Andhra Pradesh. The Indian journal of medical research. 2011;134(4):470.
23. Bui TC, Markham CM, Tran LT, Beasley RP, Ross MW. Condom negotiation and use among female sex workers in PhnomPenh, Cambodia. AIDS and behavior. 2013;17(2):612-622.
24. Jie W, Xiaolan Z, Ciyong L, Moyer E, Hui W, Lingyao H, et al. (2012) A Qualitative Exploration of Barriers to Condom Use among Female Sex Workers in China. PLoS ONE 7(10): e46786. doi:10.1371/journal.pone.0046786
25. Kayembe PK, Mapatano MA, Busangu AF, et al. Determinants of consistent condom use among female commercial sex workers in the Democratic Republic of Congo: implications for interventions. Sex Transm Infect 2008;84:202–6.
26. Ghimire L, Smith WC, van Teijlingen ER, Dahal R, Luitel NP (2011) Reasons for non- use of condoms and self- efficacy among female sex workers: a qualitative study in Nepal. BMC Womens Health 26 11: 42.doi: 10.1186/1472-6874-11-42.
27. Pattern of condom use and perceived risk of HIV infection among female sex workers in selected Brothels in Ogun State, Nigeria Adeneye A.K.1, Adeneye A.A.2, Mafe M.A.1, Adeiga A.A.3 Int. J. Public Health Epidemiol. 2013; Vol 2(5); pp. 090- 100.
28. Larios SE, Lozada R, Semple SJ, Roesch S, Orozovich P, Fraga M, et al. An exploration of contextual factors that influence HIV risk in female sex workers in México: the Social Ecological Model applied to HIV risk behaviors. AIDS care. 2009;21(10):1335– 1342.
29. Alam N, Chowdhury ME, Mridha MK, Ahmed A, Reichenbach LJ, et al. (2013) Factors associated with condom use negotiation by female sex workers in Bangladesh. Int J STD AIDS 24:813.
30. Nemoto T, Iwamoto M, Colby D, et al. HIV-related risk behaviors among female sex workers in Ho Chi Minh City, Vietnam. AIDS Educ Prev. 2008;20:435–453.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241723EnglishN2015December10HealthcareTENSION PNEUMO PERITONEUM - A CASE SERIES
English4749H.C. SrikantaiahEnglish A.C. AshokEnglishTension pneumo peritoneum is encountered as a complication of diagnostic and or therapeutic endoscopy is which large volume of intraperitoneal air under pressure cause changes in hemodynamic and respiratory compromise. It is usually iatrogenic. Like tension pneumothorax, it requires urgent surgical intervention. Immediate needle decompression followed by definitive surgical intervention is the ideal recommended plan of surgical treatment.
EnglishMassive pneumo peritoneum, Perforation, Distension of abdomen, Exploratory laparotomyINTRODUCTION
Tension pneumo peritoneum is synonymously known as valvular pneumo peritoneum or abdominal tamponade. The abdominal signs and symptoms seen in patients with a pneumo peritoneum are usually due to peritoneal irritation resulting from soiling by gastrointestinal tract contents (bile in our cases). Tension pneumo peritoneum is a surgical emergency and fatal if there is delay in treatment or access to operative intervention. The most common causes are perforated gastric1 or duodenal ulcers6 , or trauma. Iatrogenic causes are following Endoscopic retrograde cholangio-pancreatography (ERCP)6 and Per-cutaneous endoscopic gastrostomy (PEG) 3 placements. This is common because of use of compressed air and over distension with gas during endoscopic procedures2 . Perforation can present as a complication of upper gastrointestinal (UGI) endoscopy and or colonoscopy7 even though the estimated percentage is less than 1%. The most common clinical feature of perforation is visualization of an extra intestinal structure during endoscopy. Some patients complain of intense abdominal pain and tenderness during or immediately after endoscopy whereas some several hours after the procedure therapeuticordiagnostic2 . In patients with acute distress, complaints of dyspnoea in addition to abdominal pain and fullness of abdomen, tension pneumo peritoneum should be suspected. However, some patients do report shoulder pain particularly left shoulder from referred diaphragmatic irritation as after any laparoscopic procedure. On the contrary, hemodynamically stable patients, radiological investigations such as plain x-ray erect abdomen, ultrasonography and contrast enhanced computerized tomography will be required to establish diagnosis and probably pin point etiology and help plan corrective surgical treatment. Once pneumo peritoneum has been diagnosed, therapy should be immediate. Exploratory laparotomy remains the standard surgical approach; simple closure is possible if the perforation is small and without significant soiling and or inflammation. Larger perforations necessitate resection and anastomosis. Laparoscopic repair can be attempted depending on the expertise of the surgeon.
MATERIAL AND METHODS
This study is a prospective analysis of 10 cases of pneumo peritoneum caused due toiatrogenic small bowel injury with perforation during upper gastro-intestinal endoscopy (UGI) procedures – Endoscopic retrograde cholangio-pancreatography (ERCP)6 and dilatation of strictures.Tension pneumo peritoneum was diagnosed in patients with -a) History of endoscopy (UGI -upper gastro-intestinal endoscopy; ERCP- Endoscopic retrograde cholangiopancreatography) in the last 24 hours before presentation. b) Increasing pain abdomen and abdominal distension. c) Dyspnea. d) Hypotension and tachycardia. With absolute aseptic precautions, percutaneous needle decompression was performed using 18G needle4. This was positioned 2cms below the umbilicus and pneumo peritoneum confirmed before subjecting the patient for definitive surgical intervention. Upon confirming pneumo peritoneum, patients were operated upon mid-line laparotomy was performed under general anaesthesia. Patients who had under gone Endoscopic retrograde cholangio-pancreatography (ERCP) had perforation in the Duodenum 2-Duodenum 3 junction. Perforation closure was done and thorough peritoneal lavage given. All patients made uneventful recovery. Of the 10 patients enrolled in our study, eight patients had been investigated for obstructive jaundice because of choledocholithiasis – ERCP was done, Duodenum2-Duodenum 3retro-duodenal perforation was identified, Kocherisation of the duodenum and closure of the perforation was done. All the patients made an uneventful recovery. One patient had a stricture in the 2nd part of duodenum; upper gastro-intestinal endoscopy followed by pneumatic dilatation of the stricture was done. Patient developed features of peritonitis and were operated upon, perforation closure was done. Post-operative recovery was uneventful. One patient who had undergone Gastro-Jejunostomy in the past for a cicatrized duodenal ulcer was referred for choledocholithiasis; Endoscopic retrograde cholangio-pancreatography (ERCP) was done, resulting in a large tear in the Gastro-Jejunostomy stoma. Patient required immediate exploration. A large perforation with bilious contamination was seen. Common bile duct exploration with Roux-en–Y Gastro-Jejunostomy was performed. Patient made an uneventful recovery.
RESULTS
Between January 2011 and March 2015, ten patients with iatrogenic bowel perforation were admitted/referred to the accident and emergency/surgery department. The patients mean age was 55-75 Years, range 35-75 years.
DISCUSSION
All the 10 patients mentioned in this study recovered well without any complications. They were referred by the Department of Gastro-enterology and were investigated appropriately and given the best of immediate surgical care.
CONCLUSION
Pneumo peritoneum is a life threatening complication. It requires immediate intervention and definitive surgical management. A high index of suspicion of perforation with peritonitis should be suspected for patients who have undergone Endoscopic retrograde cholangio-pancreatography (ERCP)6 and dilatation of strictures. Urgent needle decompression followed by identification of the site of perforation and urgent surgical repair will prevent fatality. Laparotomy should be performed immediately and the primary cause dealt with. Laparoscopy in experienced hands should be considered as an option.
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in the references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Ethical clearance: Ethical clearance was not required or sought as this study was a descriptive and not an analytical study.
Englishhttp://ijcrr.com/abstract.php?article_id=387http://ijcrr.com/article_html.php?did=3871. Ortega–carnicer J, Ruiz–Lorenzo F, ceres F.Tension pneumo peritoneum due to gastric perforation. Resuscitations 2002, 54(2); 215-216.
2. Canivet JL, Yans T, pirets, et al. Barotrauma induced tension pneumo peritoneum. Acta Anaesthesiol Belg. 2003, 54(3) 233- 236.
3. Kealey WD, McCallion WA, Boston VE, Tension pneumo peritoneum,a potentially life-threatening complication of percutaneous endoscopic gastro jejunostomy. J pediatric gastroenterol Nutr. 1996; 22(3); 334-335.
4. Chiapponi et al. Emergency percutaneous needle decompression for tension pneumoperitoneum.BMC Gastroenterology 2011, 11:2-5. 5. Stapfer, Selby et al. Management of duodenal perforations after ERCP and sphincterotomy.Annals of surgery 2000, 232(2) 191- 198.
6. M Ercan, E.B Bostancia T.Dalgie etal surgical outcome of patients with perforation after ERCP. Journal of Laparoendoscopic and advanced surgical techniques, 2012 (224): 371-7.
7. Korman LY, Overholt BF, Box T, Winker CK; Perforation during colonoscopy in endoscopic ambulatory surgical centers.
8. Cotton PB, Garrow, Gallagher J, Romagnuolo J, Risk factors for complications after ERCP: A Multivariate analysis of 11497 procedures over 12 years. Gastrointest Endosc 2009; 70:80-88.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241723EnglishN2015December10HealthcarePREVALENCE AND PATTERN OF LOCOMOTOR DISABILITY IN RURAL PUDUCHERRY
English5053Suganthi S.English Kandaswamy M.EnglishIntroduction: In India 18.5 million (1.8%) of the people are disabled. The main estimate for disabled persons in Puducherry has been by the National Sample Survey Organization (NSSO). This survey, though it gave the overall prevalence of disabilities and by type, did not capture the socio demographic profile of the people with disabilities. Further, a decade has passed since the survey. Have there been any changes in the prevalence of disabilities? Hence the present study was carried out to know the prevalence and pattern of locomotor disability and to bring more public health benefit to the disabled population. Aims and Objectives: 1. To study the prevalence of locomotor disability in rural Puducherry 2. To study the Pattern of locomotor disability. Subjects and Methods: The study was designed as a cross sectional survey of the selected population using a questionnaire developed for the purpose. The sampled population was enumerated by a house to house survey from March 2012 to February 2013. Disabilities were classified according to the WHO International Classification of Impairments, Disabilities, and Handicaps (1980) and information regarding pattern and causes of locomotor disability were obtained. Results: Totally 70 were found to be disabled giving an overall prevalence rate of 17 per 1000 population. Locomotor disabilities were the most common with a prevalence of 9.1per 1000 followed by visual and hearing disabilities (2.9 per 1000). Locomotor disability was significantly more among males when compared to females (p value < 0.5). The prevalence of locomotor disability was higher among illiterates (15.9 per 1000) .The leading cause of locomotor disability was congenital (18.9%) and residual palsy (18.9%).
Conclusion: The rates found in this study were comparable to national figures. An important finding is the absence of disabilities in the younger age groups due to leprosy and polio reflecting on the impact of the respective programmes of elimination. However there is increase in the prevalence of stroke especially among the young, disabling arthritis, and road traffic accidents leading to disabilities.
EnglishDisability, Locomotor, PrevalenceINTRODUCTION
Disability means a range of conditions such as activity limitations, participation restriction and impairments. World Health Organization (WHO) defines impairment “as a problem in body function or structure; activity limitation as a difficulty encountered by an individual in executing a task or action and participation restriction as a problem experienced by an individual in involvement in life situations”. According to WHO1 “disability is just not a health problem but a complex phenomenon of interactions between an individual’s physical characteristics and the society in which he or she lives” The trend in the recent past is an inclination from medical understanding towards social understanding. Disability affects vulnerable people like women, older people, poor and highly prevalent among low income countries. Disability patterns are influenced by existing trends in health and environmental factors like road traffic accidents, diet, substance abuse and disasters. 1 Around 15% of population in the world is living with disability and 110 million (2.2%) people have very significant difficulties in functioning according to World Health Survey. 1 According to the Global Burden of Disease 975 million (19.4%) persons live with disability and around 190 million (3.8%) have severe forms of disability namely blindness, quadriplegia, and severe depression. 95 million (5.1%) children (0–14 years) have disabilities according to the Global Burden of Disease and 13 million (0.7%) of them has “severe disability”.1 prevalence of disability in Southeast Asia ranges from 1.5 – 21.3% of the total population. 2 In India 18.5 million (1.8%) of the people were disabled. 10.63 %of them have more than one type of disability according to National Sample Survey(NSS) 58th round on the disabled persons which included mental disability also. The data available indicates that people with disability are subject to multiple deprivations. The disabled people suffer from poverty, low literacy and unemployment more than the general population. Social marginalization and inaccessibility to medical services are prominent and they get exaggerated with the difference in rural /urban, gender and caste.3 The main estimate for disabled persons in Pondicherry has been by the NSSO. This survey, though it gave the overall prevalence of disabilities and by type, did not capture the socio demographic profile of the people with disabilities. Further, a decade has passed since the survey. Have there been any changes in the prevalence of disabilities? Hence the present study was carried out to know the current prevalence and pattern of disability and the extent to which their health needs are met so that public health benefits are brought to the disabled population. AIMS AND OBJECTIVES 1. To study the prevalence of locomotor disability in rural Puducherry. 2. To study the Pattern of locomotor disability
METHODOLOGY
The study was conducted at Kuruvinatham village selected by simple random sampling method from Bahour commune panchayat, located 20 kilometers southern to Pondicherry and 7 kilometers from the institution with a total population of 5787.
Sample size-calculated by using the formula,
The prevalence of disability in Tamilnadu was 2% in NSSO survey 2002 and the sample size using the prevalence value came too small hence the whole population in the village was selected for the study. The study was designed as a cross sectional survey of the selected population using a questionnaire developed for the purpose. The sampled population was enumerated by a house to house survey from March 2012 to February 2013 Children below 3years were excluded as it is difficult to assess the disability among them and persons above 60 years were excluded as old age related disability would increase the prevalence rate. After explaining the purpose of the study and obtaining written informed consent, the demographic details like name, age, sex, address, education, occupation, income, type of house and type of family for all members between 3 and 60 years of age in each household were collected from the head of household or a responsible person available in the house. The respondent was then asked if any member of the family had any disability. Disabilities were classified according to the WHO International Classification of Impairments, Disabilities, and Handicaps (1980)4 and information regarding pattern and causes of disabilities like hearing, visual, and speech, locomotor and mental were obtained. Besides the proforma details people with disabilities were further probed with direct face to face depth interview and information like extent of disability, age at onset of disability, educational and occupational status were obtained. Mop up rounds of survey were conducted to cover those houses which were missed during the initial round.
Statistical analysis: Chi square test, Proportions
RESULTS
Table 1 show that the prevalence per 1000 was highest in the age group of 51 – 60 years. No trend was observed with age. Locomotor disability was the predominant type for all age groups except the youngest.
The prevalence of disability was higher among males than females. Locomotor disability was significantly more among males when compared to females (p value Englishhttp://ijcrr.com/abstract.php?article_id=388http://ijcrr.com/article_html.php?did=3881. World Health Organization .World report on disability. WHO 2011. [Online] [cited2013September]. Available from http://whqlibdoc. who.int/publications/2011/9789240685215_ eng.pdf.
2. Mont D. Measuring disability prevalence. Disability and development team. The World Bank human development network social protection. 2007. [Online] [cited 2013 April]. Available from http://worldbank.org/DISABILITY/Resources/ Data/20070606DMont.ppt.
3. Government of India. Disabled Persons in India, 58th Round National Sample Survey Organization, Ministry of Statistics and Programme Implementation, Report No.485 (58/26/1) 2003. [Online][cited 2012 February]. Available from: URL: http://mospi.nic.in/rept%20_%20pubn/485_final.pdf.
4. World Health Organization. International Classification of Impairments, Disabilities, and Handicaps: A manual of classification relating to the consequences of disease. Geneva: World Health Organization, 1980. [Online][Cited 2012 February]. Available from http:// whqlibdoc.who.int/publications/1980/9241541261_eng.pdf
5. World Health Organization. Global Burden of Disease Report. Geneva: World Health Organization, 2004. [Online][Cited 2013 September].Available from http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part3.pdf.
6. Government of India. Census of India: Census and You – Disabled Population [Online] [cited 2012 February]. Available from: URL: http://censusindia.gov.in/Census_And_You/ disabled_ population.aspx
7. Pati. R.R. Prevalence and pattern of disability in a rural community in Karnataka. Indian J Community Med .2004; 29(4):1-12.
8. Ashok. N.C, Zama S Y, Kulkarni P. A comparative study of prevalence and factors associated with disability in an urban and rural area of Mysore. MedicaInnovatica.2013 June; 2(1).64-8.
9. Borker S, Motghare DD, Kulkarni MS, Venugopalan PP. Prevalence and causes of locomotor disability in the community staying near the Rural Health Centre in Goa: a community-based study .Indian J Community Med. 2010 July; 35(3): 448–9.
10. Srivastava DK, Khan JA, Pandey S, Pandey R, Shah H. Prevalence of physical disability in rural population of district Mau of Uttar Pradesh. India during May 2007. Global J of medicine and public health .2007 May; 1(6):1-9.
11. Kar N .Pattern and causes of rural Based locomotor Disabled, Indian J Physical Medicine and Rehabilitation.2002 April; 12:24-27.
12. Government of Puducherry: Health Statistics 2011. [Online] [Cited September 2013].Available from: health.puducherry.gov. in/PSHM%20.../Health%20Statis.htm
13. Government of India. NLEP – Progress Report for the year 2012-13, Central Leprosy Division Directorate General of Health Services NirmanBhawan, New Delhi. Available from nlep.nic.in/pdf/ Progress%20report%2031st%20March%202012-13.pdf.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241723EnglishN2015December10HealthcareA SOCIOLOGICAL STUDY ON THE ROLE OF GRAM PANCHAYATS IN WOMEN EMPOWERMENT IN KARNATAKA STATE
English5458Kavya C. N.English Manjunatha S.EnglishToday, in India the problem of rural poverty is increasing very rapidly. There are a very few ways to eradicate rural poverty in India. Through giving economic opportunities for the village people, particularly to the women in rural regions, has been proved very fruitful to reduce the poverty in rural India. Providing economic support and decision making power to women through these Gram Panchayats bring empowerment, further this strengthens the whole society in general. Hence, the present study is placed in this context to examine the role of Gram Panchayats in empowering women in Karnataka state and also to understand the social, educational, economical and political empowerment of women members of Gram Panchayats in Karnataka state. The primary data has been gathered from the method of field survey in the district of Hassan in Karnataka state. In the present study, based on the analysis and discussion on the empowerment of women through panchayat system and rural development in Karnataka state, major findings of this study have been explained in detail.
EnglishWomen eEmpowerment, Gram panchayat, Rural developmentINTRODUCTION
In India it is evidently apparent that half of the women population are either working in unorganized sector or non income sectors. In the 21st century the overall development of Indian society mainly relies on the improvement in status of women. If their situation do not improve then the whole of concept of development is futile. Women empowerment doesn’t merely indicate growth in their economic sphere, but also regarding social and political fields. In this direction to achieve complete empowerment of women many attempts have been made by both government and non-governmental organizations. In the process of decentralization of power three tier panchyath system has been implemented in India. At the local level, Gram Panchayths have been found increasingly helpful in bringing women empowerment, particularly in Karnataka state. Hence, this study is placed in this context to examine the role of Gram Panchayats in empowering women in Karnataka state and also to understand the social, educational, economical and political empowerment of women members of Gram Panchayats in Karnataka state. Background for the Study The empowerment of women is crucial for the development of rural India. Bringing women into the mainstream of development is a major concern for the government of India. Therefore, the programmes for the poverty alleviation have a women’s component to ensure flow of adequate funds to this section. The constitutional 73rd amendment, Act 1992 provides for reservation of selective posts for women. Thus, women members and chairpersons of panchayaths, who are basically new entrants in panchayaths, have to acquire the required skill and be given appropriate orientation to assume their rightful roles as leaders and decision makers. To impart training for elected representatives of panchayath raj institution is primarily the responsibility of the state governments / union territory administrations. The empowerment of women means for them to have the necessary to undertake a number of tasks either individually or groups, so that they have further access to and control of society resources. Empowerment is recognized as an essential strategy to strengthen the well-being of individuals, families and communities. Empowerment can enable women to participate, as equal citizens, in the economic, political and social sustainable development of the rural communities. Panchayath Raj is an ancient institution as antique as India. In fact, it has been the backbone of Indian villages since the beginning of recorded history. Gandhiji dreamt of every village a republic under the Panchayath raj system of local selfgovernment administered by a council or ‘Panchayath’ duly elected by the people of the villages in a democratic manner. The Rural development and Panchayath Raj department is responsible for the implementation of various centrally sponsored and state schemes for poverty alleviation, employment generation, sanitation, capacity building, women’s social and economic empowerment apart from provision of basic amenities and services. The Panchayath Raj system has three – tier structure. i)Zilla Panchayth ii)Taluk Panchayath iii)Gram Panchayath. In 1992, the 73rd amendment to the constitution was enacted and it brought about a number of fundamental changes in the Panchayath Raj system. Gram Panchayath is one of the parts of Panchayath Raj system. It was aimed at the development of a planned village which is taken for counting to play its role at the level of villages these Gram Panchayaths was given prominence to make special works with regards to the development of villages. As according to the Karnataka panchayath act 1993 district commissioner announced that those villages which consist of 5000 to 7000 of population in a village or a village group is called as Gram Panchayath. In the Gram Panchayath area for every 400 people one elected member with other members were included. Likewise there is a separate reservation in places for scheduled castes, scheduled tribes, and backward class and for women. This study is about Empowerment of Gram Panchayath women members through Panchayath Raj institution. For these we are trying to give findings through the sociological perspective. Objectives of the Study The study aims at accomplishing the following objectives: 1. To examine the role of Gram Panchayats in empowering women in Karnataka state. 2. To understand the social, educational, economical and political empowerment of women members of Gram Panchayats in Karnataka state. Methodology In the present study fifty women members of Gram Panchayats were selected with the use of simple random sampling method in Hassan taluk of Karnataka state. Through the direct interviews I have collected primary data from the preselected sample. The following table provides information on the overall profile of panchayath system in Hassan taluk.
RESULTS AND DISCUSSION
1. Age classification: The above data show that 10% of respondents are in the age group of 21-30. In that maximum number that is 70% of respondents are in the age group of 41-50. Only 20% of respondents are in the age group of 51-60.
2. Religion classification: From the above table we can notice about 90% of respondents are belongs to Hindu religion and 10% of respondents are belongs to Muslim religion.
3. Caste classification: In the Hindu religion 60% of them are vokkaliga, 20% of scheduled castes, 10% of scheduled tribes and remaining 10% of respondents belongs to other castes, who are elected as members, president, and vice-president through reservation.
4. Educational Qualification: If educational qualification is considered 40% of illiterates are there because of their poor economic condition through they are not get education. 40% of respondents had primary education and they were not get education more that because of their non interest and due to lack of co-operation by their family. 10% of respondents got high school education and the remaining 10% of them educated up to PUC level.
5. Marital status: 90% of respondent were married, and only 10% of respondents were widows.
6. Family structure: There is a decrease in the numbers of joint family we find 10% of respondents live in joint family and 90% of respondents are having nuclear families.
7. Position in Gram panchayath: 80% of respondents were elected as members in Gram panchayat. 10% of them were vice president and others 10% of them were president.
The above table deals with the opinion of women members of Gram panchayath about empowerment aspects.
• Self confidence is one of the basic requirements of women members of Gram panchayath. In that 84% of respondents are opined that their self confidence is increasing after the membership of Gram panchayath. But 16% of respondents are facing lack of self confidence due to the cause of social attitude towards women members.
• Every person should have good respect from the family and society. In that our 80% of respondents are opined that they are getting good respect from the family and society as members of Gram panchayath. Before the members of Gram panchayath they were facing lack of respect from family and society. But now they are getting good respect from family and society. 20% of respondents are opined that though they are members of Gram panchayath they can’t get respect from family and society because of male dominancy.
• Power and opportunities can change our living conditions like food, shelter, life style, etc. likewise women members of Gram panchayath are also not exceptional from this. 70% of respondents are opined that their living conditions are changing through membership of Gram panchayath. But 30% of respondents though they are members of Gram panchayath their living conditions are not changing because of more poverty.
• Decision making is not an easy task it is full of risk, if a person took wrong decision it may affects their whole life. So while taking decisions they must be careful. So as per concerned to this our 76% of respondents are opined that their self decision making is increasing through the membership of Gram panchayath. But 24% of respondents are opined that they are facing lack of self decision making due to the reason of dependency on their family and husband.
• Every human being should have ability to solve their problems. 72% of respondents are opined that after the membership of Gram panchayath their ability increasing to solving and actively facing any problems. But 28% of respondents are opined that they are facing lack of ability to solving their problems due to the reason of lacking of self confidence and they are depended on their family.
• Family is one of the important units of the society. Family co-operation is essential criteria to achieve anything. In that 88% of respondents are opined that they had good family co-operation to actively participate in Gram panchayath and they fully supportive to them. But 12% of respondents are opined that their family members do not co-operative to them. Because they involved in their own work, due to this reason their family members do not fully supportive to them.
• Education is one of the basic activities of people in all human societies. Education creates an opportunity for each and every person to enlighten themselves by acquiring knowledge. Likewise women members of gram panchayaths are also not exceptional from this. Day by day education is gaining more and more importance. So in that our 100% of respondents are opined that as members of Gram panchayath they had awareness about importance of the education.
• Education means not only formal education, informal education is also can give more knowledge to us. 82% of respondents are opined that general awareness of education is increasing through membership of Gram panchayath. But 18% of respondents are opined that they are facing lack of general awareness of education due to the reason of illiteracy.
• 70% of respondents are opined that after the membership of Gram panchayath their ability is increasing to grasping knowledge about society like crimes, women harassment, awareness of politics, leadership qualities, corruption, etc. but 30% of respondents are facing lack of ability to grasping knowledge about society. Due to the reason of lacking of awareness and low level of participation in society.
• As for as utilization of power is concerned 40% of respondents are not having full freedom to used their power. They have to take permission by their husband or son even though there is a lacking in support of the officers and president. 60% of respondents are opined that they well know about using power and they having opportunity to utilize the power.
• 80% of respondents are opined that as members of Gram panchayath they are involve in solving problem of public, like women harassment, dowry problems, eradication of poverty, against alcoholism, etc. but 20% of respondents are not able to solving problem of public, because of their hesitation and lack of knowledge to solving problems of public.
• 100% of respondents are opined that as members of Gram panchayath they gave prominence to Women organizations like sthri shakthi sangha, self-help groups, etc. Women organization can improve the status of women.
• 72% of respondents are happy and satisfied with their membership of gram panchayath. But 28% of respondents are not satisfied with their membership in Grampanchayath.
• 86% of them opined that they can achieve anything without any inferiority complex as women who are required for society and country. 14% of them due to the lacking of education they are still under the family control made them to have feeling of inferiority complex.
• 100% of respondents are opined that as members of Gram panchayath they involving and actively participating in rural development process.
Major Findings of the Study
The major findings are as follows.
• Women self confidence is increasing through membership of Gram panchayath.
• After the membership of Gram panchayath they getting good respect from family and society.
• Women had awareness about importance of the education. And also they are all encouraging to women education. • They are all involving in public organizations and they giving prominence to women organizations.
• They are all involving in rural development process. • After the membership of Gram panchayath also women are facing some problems with respect to their living condition, economic condition, utilization of power etc.
• Even though elected by election full power was not given to them.
Major Suggestions
• The basic approach should be to inculcate the confidence among women and bring about an awareness of their own potential for development.
• Family support should be need for women members of Gram panchayath.
• For better performances of women participation three factors are required.
• They should be need of equality
• They should be need of efficiency
• They should be need of empowerment
• Opportunity should be given to them of utilize their power in Gram panchayaths.
• Interference of husband or son should be avoided in misusing the power of women.
• Higher officers should be give power support them.
• Training facilities should be given to them by government.
• Media support is essential for women members of Gram panchayath.
CONCLUSION
Our present study which is focused on empowerment of Gram panchayath women members through Panchayath Raj institution which deals with the social, Educational, economical, political empowerment of women members. Through this study we can find maximum women are empowered through Panchayath Raj institution. But some women are not more empowered in this way it is because of their lack of education, non co-operation by their family members and even non co-operation by their higher officers. They should be change their notion about women and give more importance to women empowerment. If women are empowered then the rural society is also become developed society.
Englishhttp://ijcrr.com/abstract.php?article_id=389http://ijcrr.com/article_html.php?did=3891. Doddamani: Empowerment of Women Representatives in Panchayati Raj Institution in Gulbarga District in Karnataka. Journal of Research in Agriculture and Animal Science, Vol.2, Issue 3, 2014, ISSN: 2321-9459.
2. Helen Tierney, women’s studies Encyclopedia, Revised and Expanded Edition, Rawat publications, New Delhi, 2008.
3. Imam Uddin Ansar: Women Participation in Panchayati Raj Institutions: A Case study of Barak Valley. International Journal of Humanities and Social Science, Volume–III, Issue-II, October 2014, ISSN: 2278-5264.
4. Jasprit Kaur Soni, Women Empowerment Synchronizing the Gender Power, Author Press, Delhi, 2011.
5. Lakshnikumari M., The Role of Women in Society, Sterling Publishers Private Limited, New Delhi, 1997.
6. Manjunatha S, The Role of Women Self – Help Groups in Rural Development of Karnataka State, India, International Research Journal of Social Sciences, 2013.
7. Murty C.S.V, Indian Society, Himalaya Publishing Hose, Mumbai, 2006.
8. Nakkiran.S, Gender Issues in Cooperatives, Abijeet Publications, Delhi, 2009.
9. Odeyar D. Heggade, Empowering Women in India, Arjun Publishing House, Mysore, 2006.
10. Raj Kumar and Pankaj Sharma: Women Empowerment in Panchayati Raj Institutions – A Case study of Solan and Kandaghat (Himachal Pradesh) India. International Journal on Arts, Management and Humanities, 3(2): 21-24, 2014, ISSN: 2319-5231.
11. Rural Development and Panchayath Raj Department, Manual for Information under right to Information Act – 2005.
12. Savita Bhatt, Empowerment and Social Work Participation, Adhyayan Publishers and Distributors, New Delhi, 2010.
13. Simmi Agnihotri and Vijay Singh: Women Empowerment through Reservation in Panchayati Raj institutions in Himachal Pradesh. Indian Journal of Public Administration, Vol. LX. No.3, July 2014.
14. Suchitra Das: Women Participatation in Panchayati Raj: A Case Study of Karimgnaj District of Assam. International Journal of Humanities and Social Science Studies, Volume–I, Issue-I, July 2014, ISSN: 2349-6959.
15. Vikas Nandal: Participation of Women in Panchayti Raj Institutions: A Sociological Study of Haryana, India. International Journal of Humanities and Social Sciences, Vol.2 (12), October 2013, ISSN: 2319-3565.