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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 35  |  Issue : 4  |  Page : 212-216

Morbidity profile of elderly outpatients attending selected sub-district Siddha health facilities in Tamil Nadu, India


1 Department of Preventive and Social Medicine, Pondicherry Institute of Medical Sciences, Puducherry, Tamil Nadu, India
2 Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Tamil Nadu, India
3 General Duty Medical Officer, Government Hospital, Erode, Tamil Nadu, India
4 Department of Preventive and Social Medicine, Sri Manakula Vinayagar Medical College, Puducherry, Tamil Nadu, India

Date of Web Publication10-Aug-2016

Correspondence Address:
Palanivel Chinnakali
Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0257-7941.188178

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  Abstract 

Background: Recently, under National Health Mission alternate systems of Medicine are mainstreamed in public health care system. Effective action plan generation, logistic arrangement and roll out of these alternate systems of Medicine needs understanding on profile of morbidities among attendees who come to these facilities.
Objectives: This study was planned to report profile of morbidities, age and sex differentials in specific morbidities among geriatric attendees in secondary level siddha health facilities.
Materials and Methods: A facility based cross sectional study was conducted among elderly person (60 years and above) attending Siddha outpatient department (OPD) from two of the randomly selected sub district level siddha facilities in Erode district, Tamil Nadu, India. Information on socio-demographic variables like age, gender, education and clinical profile (diagnosis) were collected from records already maintained in the siddha OPD. Morbidities were summarized in terms of proportions based on age and gender. Age and sex specific differentials on specific morbidities were compared using 'z' test.
Results: Of 2710 patients who visited these two siddha facilities during the reference period, 763 (28.1%) patients were elderly. Arthritis (45.2%), neuritis (8.8%), diabetes (6.6%), bronchial asthma (5.2%), hemiplegia (3.7%) were the top five morbidities diagnosed and treated among elderly attending the siddha OPD. There was a predilection towards elderly male for morbidities such as bronchial asthma and hemiplegia compared to elderly female. Similarly, higher proportions of lumbar spondylosis, hypertension and fungal skin diseases were reported among aged 80 years or more compared to elderly aged 60-79 years.
Conclusion: Elderly constitute more than one fourth of outpatients load from siddha health facilities. Degenerative diseases like arthritis and non-communicable diseases were the common morbidities in this age group. Geriatric clinics and mobile clinics under siddha system may help in improving health care services.

Keywords: Aged, AYUSH, morbidity, outpatients, primary health care


How to cite this article:
Selvaraj K, Srinivasan M, Duraisamy V, Ramaswamy G, Venugopal V, Chinnakali P. Morbidity profile of elderly outpatients attending selected sub-district Siddha health facilities in Tamil Nadu, India. Ancient Sci Life 2016;35:212-6

How to cite this URL:
Selvaraj K, Srinivasan M, Duraisamy V, Ramaswamy G, Venugopal V, Chinnakali P. Morbidity profile of elderly outpatients attending selected sub-district Siddha health facilities in Tamil Nadu, India. Ancient Sci Life [serial online] 2016 [cited 2021 Sep 28];35:212-6. Available from: https://www.ancientscienceoflife.org/text.asp?2016/35/4/212/188178


  Introduction Top


Indian systems of medicine represent a way of healthy living with unique cultural history of having influences from other civilizations like Germany (homeopathy), Greece (Unani), also at the same time from our sages who gave us Ayurveda, Siddha and Yoga. Under National Rural Health Mission (NRHM), Ayurveda, Yoga, Unani, Siddha, Homeopathy (AYUSH) facilities are being setup in Primary Health Centres (PHCs), Community Health Centres (CHCs) and district hospitals headed by the qualified AYUSH physicians. Siddha system of Medicine being based on the principles of prevention of diseases rather than curative care, this indigenous system is popular in South Indian states. With the rise in lifestyle related disorders, there is a need for holistic approach for prevention and management of chronic, non-communicable and systemic diseases and hence Siddha system is gaining importance.[1]

Unlike other health systems, the ultimate focus of siddha system is to achieve immortality by preventing or slowing down the degeneration process in the body.[2] Elderly population comprising of about 9% of total population of India [3] and is projected to 17.3% by 2051 forms a significant proportion of health care consumers in the public health care system in India.[4] Apart from communicable diseases, non-communicable and degenerative diseases are common among elderly thereby increasing the risk of poly pharmacy and subsequent adverse drug reactions.[5] Majority of the age related health problems among elderly are treated through life style modifications in siddha. Geriatric medicine, a relatively recent field under allopathy, has been practised by Siddha physicians in the name of moopuiyal for centuries.[6]

With increase in life expectancy in India leading to rise in elderly population and the continued integration of Siddha system of medicine at all levels of health care, it is important to know the patterns of diseases or symptoms for which care is sought in Siddha facilities. Though literature on morbidity profile of patients attending allopathy is available, there are very few studies on profile of patients attending siddha facilities and those few were conducted at research institutes.[6] Information of morbidity profile at sub-district levels is not available and this will help in planning for health care delivery including the manpower recruitment and training, drug procurement, infrastructure and community based or outreach services. Hence this study was planned to report profile of morbidities, age and sex differentials in specific morbidities among geriatric attendees in secondary level siddha health facilities from Tamil Nadu.


  Materials and Methods Top


Study design and study setting

A facility based cross sectional study was conducted among elderly person attending Siddha hospital in Erode district located in the Western part of Tamil Nadu, India. Main occupations in the district were agriculture, handlooms and livestock rearing. Under National Rural Health Mission, 37 hospitals are offering siddha services in the district and most of these hospitals provide allopathic system of care as well.[7] Average number of out-patients in siddha facilities would be 75-130 patients per day. Out-patient departments function from 7.30 am-12.00 noon and from 3.00 pm to 5.00 pm. Each hospital is managed by qualified siddha practitioner supported by siddha pharmacist and other general support staff.

All public hospitals, primary health care centres and Rural Dispensary provide outpatients services during day time. Apart from public health system, private practitioners (both qualified and unqualified) also provide care to the public in Siddha system of Medicine. This study was conducted in two of the randomly selected hospitals from sub-district level siddha health facilities in Erode (Andhiyur and Bhavani Government Hospitals).

Study population

All elderly population (60 years and above) who attended the Siddha outpatient department (OPD) in the siddha hospitals during June 2014 to July 2014 were included. Both new and old cases (patients) attending the OPD were included.

Study variables and study tools

Information on socio-demographic variables like age, gender, education and clinical profile (diagnosis) were collected from records already maintained in the siddha OPD. For the study purpose, diagnosis of the participants was recorded as reported in the siddha OPD register or patients' outpatient record. Later, morbidities were categorized as per the classification recommended by Directorate of Indian Medicine and Homeopathy under the Ministry of Health and Family welfare, Tamil Nadu.

Data entry and data analysis

Data were single entered and analysed using EpiData software (version 3.1 for data entry and version 2.2.2.182 for analysis, EpiData Association, Odense, Denmark). We used proportions to summarize the morbidity profile stratified by age groups and gender. Age and sex specific differentials on specific morbidities were compared using 'z' test. Statistical significance was considered at 0.05 level.

Ethical approval

The study protocol was reviewed and approved by JIPMER Scientific Advisory Committee and Human Institute Ethics Committee. Administrative approval was obtained from the District Medical Officer (Siddha), Erode district.


  Results Top


Of 2710 patients who visited these two siddha facilities during the reference period, 763 (28.1%) patients were elderly. Among elderly, majority (94%) belong to age group between 60–79 years, 58% were males and 66% had no formal education [Table 1]. Majority of the elderly (86.7%) came to these siddha facilities for follow-up care.
Table 1: Sociodemographic characteristics of elderly outpatients attending Siddha hospitals in Erode District, Tamil Nadu (n=763)

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Morbidity profile of the study participants and distribution by gender are shown in [Table 2]. Of 763 elderly, arthritis (45.2%), neuritis (8.8%), diabetes (6.6%), bronchial asthma (5.2%), hemiplegia (3.7%) were the top five morbidities. Arthritis (40%), bronchial asthma (7.9%), neuritis (7.2%) were the top three morbidities among the males, whereas in females, arthritis (52.5%), neuritis (11%) and diabetes (6.3%) were the common morbidities.
Table 2: Ten most common causes of elderly outpatients attending Siddha hospitals in Erode District, Tamil Nadu (n=763)

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Morbidity profile stratified by age groups was shown in [Table 3]. Among 60-79 years age group, arthritis, neuritis, diabetes were the most common morbidities, whereas in elderly >80 years or more arthritis, lumbar spondylosis and hypertension were the most common morbidities Elderly women compared to men had higher morbidities such as arthritis [females (52.5%) vs. males (40%), P < 0.001], anaemia [females (2.2%) vs. males (0.4%), P = 0.002], cervical spondylitis [females (3.8%) vs. males (0.4%), P < 0.001]. Elderly men had higher morbidities of bronchial asthma [females (7.9%) vs. males (1.6%), P < 0.001], hemiplegia [females (6.1%) vs. males (0.3%), P < 0.001] compared to elderly women.
Table 3: Ten most common causes of elderly outpatients attending Siddha hospitals across different age groups in Erode District, Tamil Nadu (n=1720)

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When compared with elderly aged between 60 – 79 years, elderly >80 years or more were increasingly suffering from conditions such as dysuria [>80 years (2%) vs. 60-79 years (0.6%), P = 0.25], lumbar spondylosis [≥80 years (8%) vs. 60-79 years (2.1%), P = 0.001], fungal disease [>80 years (4%) vs. 60-79 years (1.5%), P = 0.18], hypertension [≥80 years (6%) vs. 60-79 years (0.3%), P = 0.18], diarrhoea [≥80 years (2%) vs. 60-79 years (0.3%), P = 0.18].


  Discussion Top


This study showed that arthritis, neuritis and diabetes were the common morbidities for which elderly sought care at secondary level siddha health facilities. More than two fifths of the elderly visited siddha hospitals for the management of arthritis.

A study conducted at Siddha Research Institute, Tamil Nadu had reported musculoskeletal disorders including arthritis (43.7%), skin diseases (8.3%), respiratory infections (6.9%), diabetes (6%) and bronchial asthma (2.7%) as common morbidities.[6] The present study also reported that arthritis was the commonest morbidity. However due to differences in age groups included in the study and also study setting (tertiary care setting), comparison of the findings should be done with caution. Similarly, studies from allopathic health facilities also reported muscular skeletal disorder (45%) as one of the common morbidities among elderly.[8],[9]

In our study, elderly population constituted 28% of all outpatients attending siddha health facilities compared 10%-15% attendance at allopathic health facilities which may be due to preference of elderly towards siddha system.[10],[11] Also, it may be due to the general perception that siddha system of treatment will be more appropriate for degenerative conditions like arthritis.

Available literature from community based studies suggests that morbidities are common in elderly women compared to elderly men.[12],[13] Considering this, we would expect higher proportion of elderly women seeking care. In the present study, only two fifths were elderly females which are comparable with 35% reported by the study conducted at siddha research institute.[14] Exact reasons for the low proportion in this study were not known. Difference in health seeking behaviour and preference for providers may be the reasons. Morbidities like bronchial asthma and hemiplegia were more common among men and these may be attributed to the higher prevalence of smoking and alcohol among men.

The study has following strengths that this is the first study on morbidity profile of outpatients attending secondary level siddha health facilities and we used a standard classification of diseases recommended by Directorate of Indian Medicine and Homeopathy. Also, we used siddha physician reported diagnosis. The study was conducted only in two selected sub-district hospitals in the state of Tamil Nadu and cannot be generalized to other facilities.

This study has few implications. First, since elderly form a substantial proportion of outpatients, management of elderly morbidities should be emphasized in the training curriculum of siddha physicians. Second, to give more attention, separate geriatric siddha clinics can be started. Third, to reduce frequent visits of elderly to the hospitals, mobile siddha clinics or community based health services by training existing field workers may be pilot tested. Fourth, morbidity profile will help in planning manpower recruitment and training and drug procurement depending upon the morbidity profile. Moreover, this knowledge has a role to focus areas of training for health care providers and mainstream AYUSH care under National Program for Health Care of Elderly.


  Conclusion Top


Elderly constitute more than one fourth of outpatients seeking care from siddha health facilities. Degenerative diseases like arthritis and non-communicable diseases were the common morbidities in this age group. Geriatric siddha clinics and mobile clinics may help in providing better services.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Patil SB, Patil MS, Chittam KP, Wagh RD. A review on ayurveda and siddha: Indian systems of medicine. Pharma Sci Monit 2014;5:40-9.  Back to cited text no. 1
    
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Irudaya RS. Population ageing and health in India. Mumbai: Centre for Enquiry into Health and Allied Themes (CEHAT); 2006.  Back to cited text no. 4
    
5.
Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf 2014;13:57-65.  Back to cited text no. 5
    
6.
Kannan M, Natarajan S, Sathiyarajeswaran P, Meenakshisundaramurthy K. The health status of geriatric population attending the special siddha geriatric clinic of a research institute. Int J Health Pharm Sci 2012;1:36-41.  Back to cited text no. 6
    
7.
Links – Health & Family Welfare Department, Govt. of Tamil Nadu. Available from: . [Last cited on 2015 Jul 28].  Back to cited text no. 7
    
8.
Subhaprada SC. A cross sectional study of morbidity pattern among geriatric patients attending outpatient department of a primary health centre, Kurnool, Andhra Pradesh. Int J Curr Med Appl Sci 2015;6:39-43.  Back to cited text no. 8
    
9.
Dar AK, Lone AH. Prevalence of musculoskeletal disorders in patients visiting Government Unani Hospital and AYUSH centres in Kashmir, India: A preliminary study. Int J Res Ayurveda Pharm 2013;4:475-78.  Back to cited text no. 9
    
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Lamichhane DC, Giri BR, Pathak OK, Panta OB, Shankar PR. Morbidity profile and prescribing patterns among outpatients in a teaching hospital in Western Nepal. Mcgill J Med 2006;9:126-33.  Back to cited text no. 10
    
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Dharmaratne S, Agampodi S, Dassanayaka S, Kumarihami P, Ratnayake A, Wickramathilake S. Disease burden assessment beyond in-patient data: A morbidity profile assessment of outpatients. Int J Prev Med 2012;3:730-2.  Back to cited text no. 11
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12.
Gupta I, Sankar D. Health of the elderly in India: A multivariate analysis. J Health Popul Dev Ctries 2003. Available from: Last accessed on 2016 May 31].  Back to cited text no. 12
    
13.
Joshi K, Kumar R, Avasthi A. Morbidity profile and its relationship with disability and psychological distress among elderly people in Northern India. Int J Epidemiol 2003;32:978-87.  Back to cited text no. 13
    
14.
Mubarak H, Kumar AR, Masilamani G. Prevalence of siddha clinical conditions among geriatric population in Puducherry, cross-sectional study. Int J Health Pharm Sci 2012;1:1-7.  Back to cited text no. 14
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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