Background: Sleep is an important physiological process with many restorative functions. Insomnia defined as difficulty in falling or staying asleep which is frequent in older people. Reduced sleep quality can result in impaired daytime function which can lead to severe consequences. This study was conducted to examine sleep quality of elderly and to determine its relationship with psychosocial factors, in a rural population of Kerala. Methods: A community based cross sectional study was done by interviewing 170 people who were 60 years or above, selected by simple random sampling, after getting consent. The study tools used were Pittsburgh sleep quality index (PSQI), General anxiety disorder 7 item (GAD-7) scale, geriatric depression score (GDS 5 items) and a self designed general sociodemographic questionnaire. Data was tabulated using MS Excel and analyzed using SPSS V-20. Results: The sleep quality according to global PSQI was good for 27.6%, while it was poor for 72.4% of respondents. The mean GPSQI of the study was 8.04±4.59. Absence of toilet inside home (p=0.036), current health problems (p=0.003), multiple (>3) health problems (p=0.006), regular use of current medications (p=0.033) had a significant association with poor sleep quality. Association between general anxiety disorder and GPSQI was significant with poor sleep quality among those with severe anxiety (p=0.017). Association between GDS-5 score and GPSQI showed a significant association between symptoms suggestive of depression and poor sleep quality (p=0.014). Conclusions: Questions on sleep quality should be routinely asked by clinicians as part of general health assessment of an elderly.

Background:Self-medication involves the use of medicinal products by a consumer to treat self-recognized disorders or symptoms or intermittent or continued use of a medication prescribed by a physician for chronic or recurring diseases or symptoms. Practicing self-medication for antibiotics is a major factor fueling the emergence of drug resistance. This study would help health-care providers in creating public awareness on the dangers of antibiotic abuse.Objectives:The aim of the study was to assess the prevalence and pattern of antibiotic self-medication in an urban population of Kerala.Materials and Methods:A community-based cross-sectional study was carried out in Thrippunithura municipality, Kerala. Data were collected from 755 adults by face-to-face interview using a questionnaire after obtaining consent. Data were entered in Excel and were analyzed using SPSS.Results:The percentage of respondents who practiced antibiotic self-medication was 3.31%. Males (4.1%), graduates (3.8%), and skilled workers (8.5%) were found to practice antibiotic self-medication. Majority took self-medication for sore throat (25%). Azithromycin (39%) was the major antibiotic used. Among the respondents, 36% used doctor's previous prescription to get antibiotics. The reason for antibiotic self-medication reported by majority was convenience (41%).Conclusion:Health education must be given to graduates and professionals, highlighting the problems due to antibiotic self-medication. With danger of antibiotic resistance developing, this is a major threat that has to be addressed urgently.

Background: Dementia is the global deterioration of the individual’s intellectual, emotional and cognitive faculties in a state of normal consciousness. Dementia impacts personal, family and societal life. It reduces life span, induces caregiver’s strain at family level and over utilizes health care facility. This study was aimed at describing the risk factors attributing to dementing disorders for developing preventive measures to slow down the incidence of dementia. Methods: The study was conducted in geriatrics OPD of a tertiary hospital in South India. A total of 50 dementia patients and 50 controls aged more than 65 years were selected for the study in a period of 6 months. A semi-structured questionnaire was used to collect data. Results: 40% in the age group of 65-74 years, 61% in the age group of 75-84 years and 63.6% in the age >85 years had dementia. 43.5% of males and 55.5% of females had dementia. Multivariate analysis was done to find out the independent predictors of dementia. Among the morbidities dyslipidemia 3.93 (1.12-13.87) and COPD/bronchial asthma 4.57 (1.02-20.55), less than 5 days of fruit consumption 14.98 (38-59), hearing loss 4.67 (1.15-18.91) were found to be independent risk factors for dementia. Living alone was found to be a protective factor 0.029 (0.003-0.29). Conclusions: Our study reported various risk factors of dementia that were in agreement with findings from other studies conducted in India. Avoidable risk factors such as living alone, fruit intake and control of comorbidities such as hypertension, dyslipidemia and COPD/bronchial asthma needs more attention in old age group.

Anaemia has significant negative impact on the health of school children including poor scholastic performance and cognitive impairment. The present study was done with the objective to estimate the prevalence of anemia among school going children in Ernakulam district, Kerala and to determine a few factors associated with anemia. Hemoglobin of 880 students of 6th to 9th standard in 11 randomly selected schools of Ernakulam district was estimated using HemoCue 201 photometer. Prevalence of anaemia was expressed using frequencies and percentages. Univariate analysis for factors associated with anemia was done. Selected variables were entered into a logistic regression model. The prevalence of anemia was estimated to be 44% (95% CI 40.67-47.33). Among them 0.8% had severe anemia, 3.5% had moderate anemia and 39.7% had mild anemia. Among them 21.3% and 52.6% reported not in the habit of consuming green leafy vegetables and citrus fruits respectively, at least three times on a usual week. Anemia among children was associated with female gender (adjusted OR 1.53, 95% CI 1.16-2.04), higher age group (adjusted OR 2.24, 95% CI 1.69-2.91) and regular intake of tea/coffee along with major meals (adjusted OR 1.62, 95% CI 1.20-2.04). Anemia among school going children in Ernakulam remains a public health problem and was more among females, higher age groups (12-15 years) and those reported regular intake of tea/coffee along with major meals. The consumption of iron rich foods among the students was poor. Behavior change communication for dietary modification and universal supplementation of iron is warranted.

Background: Domestic accidents are important worldwide public health problems which require increased attention. A domestic accident means an accident that takes place at home or its immediate surroundings. Domestic accidents can result in disability and loss of productivity. The aim of the study was to find the prevalence of domestic accidents in a rural area and the various epidemiological factors associated with it. Methods: A community based cross sectional study was done in a rural area of Kerala. The study period was April-May 2016. Face to face interview with a responsible adult informant was done to collect information from 403 households consisting of 1826 individuals using a semi-structured questionnaire after getting consent. Data was tabulated using MS Excel and analysed using SPSS version 20. Qualitative variables expressed as percentages and association found out using Chi square test.Results: The prevalence of domestic accidents in the community was found to be 10.5% (9.14 – 11.95, 95% CI). Majority of the victims were females (66%). Falls were the most prevalent type of domestic accident (33.5%) and it was found to be significantly associated with age, educational status, place of occurrence and activity during accident. First aid kits were available only in 38.2% of houses. Conclusions: Increased awareness, specially among female population is needed to reduce domestic accidents. Take extra care of the extreme ages as they are more vulnerable to falls. It is essential that every house has a first aid kit.

Neglected tropical diseases (visceral leismaniasis, lymphatic filariasis) and malaria are endemic in northern states of India. Kerala has become a hub of construction activities employing a large number of migrants from these endemic states. Studies on morbidity pattern among migrants in Kerala are lacking. It is essential to look into the burden of these infections among migrant laborers who can act as reservoirs and are a threat to native population. A cross sectional study was done among migrant laborers in Ernakulam district, Kerala. After getting informed consent, a questionnaire was administered to each participant to collect sociodemographic details and 5 ml of blood was collected for detection of antigens using rapid diagnostic tests (RDT). Of the 309 migrants tested, none of them were positive for leishmaniasis, while 3.8% were positive for malaria and 3.6% for filariasis. With 2.5 million migrant laborers in Kerala, the magnitude of the problem in absolute numbers is enormous. Active surveillance and treatment is needed to prevent the reemergence of these diseases in Kerala.

Context: Urban population in India is growing exponentially. The public sector urban health delivery system has so far been limited in its reach and is far from adequate. Aims: This study aims to estimate routine immunization coverage and associated factors among children (12–23 months and 60–84 months) in the urban Kochi Metropolitan Area of Kerala. Settings and Design: A cross-sectional study was conducted in Kochi Metropolitan area. Materials and Methods: A cluster sampling technique was used to collect data on immunization status from 310 children aged between 12 and 23 months and 308 children aged between 60 and 84 months. Statistical Analysis: Crude coverage details for each vaccine were estimated using percentages and confidence intervals. Bivariate and multivariate analysis were conducted to identify factors associated with immunization coverage. Results: Among the children aged 12–23 months, 89% (95% CI 85.5%-92.5%) were fully immunized, 10% were partially immunized, and 1% unimmunized. Less than 10 years of schooling among mothers (OR 2.40, 95% CI 1.20–4.81) and living in a nuclear family (OR 1.72, 95% CI 1.06–3.14) were determinants associated with partial or unimmunization of children as per multivariate analysis. The coverage of individual vaccines was found to decrease after 18 months from 90% to 75% at 4–5 years for Diphtheria Pertussis Tetanus (DPT) booster. Bivariate analysis found lower birth order and belonging to the Muslim religion as significant factors for this decrease. Conclusion: Education of the mother and nuclear families emerged as areas of vulnerability in urban immunization coverage. Inadequate social support and competing priorities with regard to balancing work and home probably lead to delay or forgetfulness in vaccination. Therefore, a locally contextualized comprehensive strategy with strengthening of the primary health system is needed to improve the immunization coverage in urban areas.

This retrospective study is looking into the long-term morbidity after endometrial cancer staging surgery and compares the longterm morbidity of patients who underwent open staging surgery vs. robotic approach. One hundred twenty-nine patients who underwent staging surgery for endometrial cancer from January 2014 until June 2017 were included in the analysis. Morbidities occurring 1 month after surgery-vault complications, incisional hernias, vault dehiscence, and lymphedema-were looked into. There were no statistically significant differences between the long-term complications in both groups (vault infection 5.1% vs. 1.4%, vaginal cuff dehiscence 1.6% vs. 0%, incisional hernia 6.8% vs. 0%, and lymphedema 11.8% vs. 10% in open vs robotic groups respectively). But as far as clinical significance was concerned, patients who underwent robotic staging surgery had a significant decrease in vaginal cuff complications and incisional hernia. Our study shows that robotic-assisted surgery can reduce even long-term morbidity in patients undergoing surgery for endometrial cancer.