Cervical cancer is ranked as the most frequent cancer in women in India and still remains a leading cause of cancer deaths because of high HPV infection rates and lack of comprehensive cervical Pap smear testing of susceptible women. There has been a regular campaign against cervical cancer for 30 years in India, but impact on the morbidity and mortality has been low, with India ranking fourth worldwide. A key challenge for cancer programs is encouraging women in the 30-55 year age group at highest risk for treatable, precancerous lesions, to seek pap smear screening camps. To increase attendance it is important to work in the community by approaching local women's groups and with their help increasing awareness, knowledge and accessibility of screening among women. In this study the investigators made an effort to increase camp attendance by involving women's groups. We assessed the effect of involvement of women groups in comparison to previous camps, the awareness, attitude and practice of the disease, and its prevention, and the HPV vaccine among the women and finally studied the Pap smear results. A camp based cross sectional study was done in Karindalam village to assess pap smear tests, knowledge, attitude and practice regarding cancer cervix and its screening method. Community level women volunteers were used to mobilise women for the camp. Quantitative data was collected through face to face interview using a pre tested questionnaire and the pap smear test done. Analysis was done with descriptive statistics using epi info. There were 319 women who attended the camp. Out of these 99.7% were ever married. In our studied population 55% of the women were married before 20 years of age and 36% had their first child before 20 years of age. Fifty percent studied up to 10 th grade and around 50% belonged to the lower class. Majority of the women had inadequate knowledge about the disease symptoms (52.7%), risk factors (76%), preventive measures (65.5%), Pap smear method (91%) and HPV vaccine (8.4%). Reasons for not doing a Pap smear test so far were inadequate knowledge about the disease and test, fear of procedure and result, non availability of the test locally, being non symptomatic, and cultural factors. The Pap smear tests identified 2 (0.6%) women with high intra epithelial lesions, 4 (1.2%), endocervicitis and 3 (1%) with bacterial vaginosisand adequate follow up was offered. The government of India has to respond to the need of the hour and strengthen information, education and communication efforts on cervical cancer along with providing widespread screening facilities.

Background: Proper waste management is a major concern of public health. It is necessary to create positive behavioural changes towards waste management among public in order to control diseases. Objectives were to determine the attitude towards solid and liquid waste management among the households of Cheruthazham Panchayat in Northern Kerala.Methods: A community based cross sectional study was conducted in Cheruthazham Panchayat, under Kalliasseri block, located in Kannur district of Kerala state from June 2017 to July 2018. A total of 400 households were studied. Multistage sampling was done. Data was collected by direct interview using a pre-tested semi-structured questionnaire. Data was analyzed using SPSS software.Results: The participants responsible for the waste management in household were women. Out of the 400 participants, 83%, 11% and 6% were Hindus, Muslims and Christians respectively. Majority of them (82%) had an educational qualification of high school and above. Most of them (82.5%) were housewives. About 47% of the study population belongs to upper middle class. Their major sources of information about solid waste management were kudumbasree class. In the study, 93.8% of the study population had above average attitude and 6.2% had below average attitude. Almost 70% had the belief that government is not doing anything to fix the garbage problem. About 97%, 88.6% and 92% were willing to do composting, segregation and recycling of waste respectively.Conclusions: Majority of the participants had above average attitude towards household waste management. Continuous awareness programmes have to be conducted on safe waste disposal and efforts should be made to sustain the supervision of household waste management.

The prevalence of hypercholesterolaemia is high in the study population.

BACKGROUND Early diagnosis of breast cancer is of extreme significance in improving the survival rates and quality of life. Unfortunately, studies have revealed that a major proportion of women from low-income countries are still not breast aware. MATERIALS AND METHODS In this study, Clinical Breast Examination (CBE) was done. In addition, we assessed the knowledge, attitude and practice of Breast Self-Examination (BSE). A cross-sectional study with quantitative method of data collection was conducted in a village in North Kerala. The study population was all women aged 20 years and above and who resided in the village for 6 months and more and they were motivated to attend the camps by community health workers from the same village. RESULTS Out of the 319 women who attended the CBE camps, 301 (94%) had heard of breast cancer and 113 (36%) had heard of it from community workers during their survey. Around 63% of the women knew at least one symptom of breast cancer while 73% did not know any risk factor. Only 234 (73%) had heard of BSE. Only 137 (43%) knew the right technique of BSE. Out of the 184 women who did BSE, 124 (67.4%) did it to examine breasts regularly, 5 (2.7%) did it because they had a family history of breast cancer, 52 (28.3%) following classes by community workers, 2 (1.1%) because their friends had breast cancer and 1 (0.5%) following a resected lump. Out of the 135 women who did not practice BSE, 36 (26.7%) did not know the method, 85 (63%) did not think it was important, 10 (7.4%) had no symptoms and 4 (2.9%) were scared of finding a lump. The women with either breast or axillary lumps (3.4%) were referred for mammography. CONCLUSION Utilisation of the services of primary healthcare facilities for opportunistic screening and health awareness classes by trained nonmedical community personnel should become main activities in our future policies. They should be trained for providing BSE training to women at their doorstep. This simple approach could reduce the burden of the disease to a significant extent.

Background: High blood pressure is prevalent all over the world and is one of the major causes of cardiovascular morbidity and mortality. In considerable proportion of cases the disease tends to be asymptomatic for prolonged time, hence also labelled as “silent killer”. Awareness, treatment, and control of hypertension remain major challenges worldwide. The objective of this study was to determine the prevalence, awareness, treatment and control of hypertension in Northern Kerala. Methods: A community-based cross-sectional study among 687 subjects aged ≥20 years was conducted from March 2017 to July 2017. Data was collected by personal interviews, followed by anthropometric and blood pressure measurements. Diagnosis of hypertension was based on Joint National Committee (JNC) VIII guidelines. Results: The prevalence of hypertension (JNC VIII) was 48.2% with a 95% confidence interval ranging from 44.46% to 51.94%. Prevalence among males: 58.1% and females: 44.5%. Among the total hypertensives, 38.7% were aware. Of these, 94.5% taking treatment, 47.1% achieved adequate blood pressure control. Advancing age, current diabetic status, body mass index, and family history of hypertension were identified as risk factors for hypertension by multivariate logistic regression. Conclusions: High prevalence of hypertension was observed in the population. The low levels of awareness and control underscores the large gap between evidence and practice that needs to be bridged, for effective control of hypertension. This calls for plan to adopt preventive and control strategies and promote the health of the population.

Abstract:Introduction: Males and females respond differently to infection, which again is modified by the 'stage of life cycle' they belong to. This knowledge however is often neglected during surveys/ studies or while deliberating protocols for disease control. Materials and methods: Data collected without segregation of sexes in separate age groups may thus be biased, confounding conclusions and disease control strategies formulated based on them. We analyzed results of IgM ELISA tests for chikungunya virus (CHIKV) released by Kerala State Institute for Virology and Infectious Diseases (KSIVID) done in 2007 during last epidemic caused by the virus in Kerala, and found two interesting epidemiological trends relating to sex based dimorphism in host response to CHIKV. Results: The 'proportion' of seropositive females over males increased steadily from near puberty, to become one of clear female predominance in reproductory age group, and then waning through middle age, reverting to original proportions, by menopause. From a situation where IgM positive males and females about equally represented, during the early epidemic, the proportion of positive females increased through mid-epidemic period, almost 'eclipsing' the male segment and then waned during post-epidemic period, the ratio tending to revert to original proportions. Conclusions: We seek to emphasize the importance of collecting and analyzing data separately for males and females categorized in different stages of life cycle (as per guidelines of W.H.O.) in studies/ epidemiological surveys.

Introduction: Sexes respond differently to infection, which further is modified by the 'stage of life cycle' they belong to. Materials and methods: We studied a cohort of patients admitted in our hospital diagnosed with dengue during the year 2014-2015 and found significant dimorphism in response of males and females in different age categories to infection; this appeared to modify the disease process from infection to progression/outcome. Results: Females in reproductive age category were found to be more inclined to developing uncomplicated dengue (DF). Severe dengue was found to occur in males and females past middle age-males appearing to be more prone to developing complications. Possible reasons based on available knowledge are discussed. Conclusions: Dimorphism in response to infection in the sexes in different stages of their lifecycle was found to modify disease process from infection to progression and outcome of dengue.

Background: Kangaroo Mother Care (KMC) is a practical low-cost intervention which is very cost effective in developing countries for babies weighing less than 2500 g. This study is aimed to evaluate the knowledge, attitude and practices about KMC in the post-natal mothers of low birth weight (LBW) and preterm babies before and after a teaching session by a trained staff in a tertiary care center in North KeralaMethods: A cross sectional descriptive study of 201 mothers whose neonates were admitted in Neonatal intensive care unit (NICU) of tertiary care centre from June 2014 to June 2015. Mothers were interviewed at enrolment to assess their knowledge of KMC and were then oriented on its practice. Data about their perceptions, attitudes and practices of KMC were recorded before they were discharged from the hospital.Results: At recruitment (95.4%) mothers didn’t know about KMC. 80% of mothers could follow the verbal instructions in first sitting. 92.8% of mothers reflected photo exhibition would have been better than verbal explanation, 91.8% of mothers thought that KMC is beneficial for their babies and 89% thought that it was beneficial for them too. At discharge 99% were willing to continue KMC at home with 93.1% willing to practice at night. 100% would recommend KMC to other mothers. All of them were practicing intermittent KMC and believed that other family members especially grandmothers could also be KMC providers as well.Conclusions: Maternal knowledge of KMC was low before enrolment, but after initiation mothers were happily practicing KMC in hospital with assurance to continue same from home and involve other family members in KMC care.