Exploring Diabetes Prevention and Management in Chennai, India

– written by Pranati Panuganti, SURF Recipient

The Health Sciences Library

The Health Sciences Library

Many Indians like my grandmother are suffering from diabetes and other chronic diseases, which motivated me to pursue a summer internship at the Madras Diabetes Research Foundation (MDRF) in Chennai, India. My two-month stay in this urban city served a two-fold purpose: (1) To learn how food, culture, and other lifestyle practices influence the rapidly escalating prevalence of diabetes in Chennai, and (2) To analyze the effectiveness of a school-based intervention in teaching Chennai’s youth about diabetes.

At MDRF, I was a research assistant for the ORANGE study: Obesity Reduction, Awareness, and Screening for Non-communicable diseases through Group Education. Phase I of this study is a screener for diabetes risk factors in 2,000 randomly selected children from residential colonies in Chennai. During our 7:00AM field visits on Saturday mornings, my team performed anthropometric measurements, an oral glucose tolerance test, and administered a questionnaire about the child’s lifestyle practices. A trend I noticed among many participants is they do not willingly engage in sports or exercise. Rather, their physical activity seems to come from activities of daily living, such as getting to and from work.

After screening for diabetes in these colonies, select individuals with pre-diabetes or diabetes were invited to Dr. Mohan’s Diabetes Hospital for consultation. I met an 11-year old research participant who attends a boarding school where he only learns Sanskrit, and no math, science, or English. When the diabetologist asked about playtime, the boy’s eyes widened and he shook his hands to exclaim, “No! We are beaten if not studying!” I have learned this boy is one of many children in India who face barriers to healthy living stemming from illiteracy. Without being able to read and write, it is difficult for people like him to learn from intervention strategies and health promotion programs, such as pamphlets, posters, and presentations.

Phase II of the ORANGE study involved a school-based co-curriculum intervention for diabetes awareness and self-management training in children and adolescents across Chennai. I analyzed intervention results and identified several emerging themes. First, I found that students of lower socioeconomic status (SES) had trouble distinguishing non-communicable and infectious diseases. For example, many students from low SES suggested sanitation as a healthy habit to prevent diabetes. Among students of high SES, many mistakenly associate an expensive lifestyle with a healthy lifestyle. Finally, among both low and high SES students, there seems to be a lack of awareness of physical activity and an increased emphasis on diet as healthy behaviors to prevent or manage diabetes.

These issues and emerging themes call for two restructured intervention programs, one tailored towards students from low SES and one for those from high SES. This experience has taught me that improving the health of low-income populations depends on meeting the basic, grass-root needs of the people (such as clean water, clothing, and literacy), before intervening to improve diabetes prevention and management.

For more details & pictures, stop by my blog at: www.pranatiloveschennai.wordpress.com

 

Burch Fellowship Scholar – Burn Prevention in Malawi

– written by Marissa Bane, Health Policy and Management student and Burch Fellow

As a burn survivor, I had dreamed of working at the Kamuzu Central Hospital (KCH) burn unit in Lilongwe, Malawi for several years, and I was finally able to go this past summer as part of the Burch Fellows Program. The burn unit was founded in 2008 through a partnership with UNC Hospitals to help improve outcomes for burn patients. Because the unit is relatively new, they had no knowledge on burn prevention in Malawi, and they did not have the resources to research and fund a program. At first, I did not understand why it was important to research burn prevention strategies in Malawi. In the United States, we already know how to prevent burns – for example, we know not touch a hot stove or let children near a pot of boiling water. However, if we tried to implement our burn prevention strategies in Malawi, most would be completely useless and even confusing. The challenges Malawians face regarding burns are very unique, and burn prevention strategies need to be relevant to them.

Open flames are the cause of the majority of burns in Malawi.  Marissa's project aimed to educate Malawi's citizens on fire safety and burn prevention.

Open flames are the cause of the majority of burns in Malawi. Marissa’s project aimed to educate Malawi’s citizens on fire safety and burn prevention.

With the help of UNC surgeons, I created and translated a 35-question survey that was asked to the parent of each child at the burn center under eight years old. Prior studies have shown that children bear a disproportionate share of the burn injury burden, which is why this specific age range was chosen. The goal was to understand how serious burns occur for children, as well as the environment surrounding the accidents. To do this, it was important to assess other factors potentially affecting the burn accident, such as underlying health problems and bad weather. The survey consisted of five main sections, which included basic demographics of the burn patient, socio-demographics of the patient’s primary guardian, cooking style in the home of the patient, child care in the home of the patient, and information about the burn accident.

Marissa with a family in Malawi.

Marissa with a family in Malawi.

We discovered more than half the burns were cooking-related. Further, most people in Malawi are dependent upon fire for survival. They use open flames or unsafe traditional stoves several times a day for light, heat, cooking, bathing water, and manual labor. At the time of the burn, only 23 percent of mothers were with the patient. Further, 22 percent of patients had no one looking after them when they were burned. There were several other discoveries that were found to be extremely helpful when considering burn prevention in Malawi. Information collected from the study should be used to help create effective burn prevention strategies for those in sub-Saharan Africa, which is why I plan to present my findings from the study at Harvard University’s 2015 National Collegiate Research Conference, as well as produce a publication under the guidance of UNC surgeons.

I loved my time in the beautiful place I now call a second home. I learned so much during my time in Malawi and built some amazing friendships. My heart was broken by the poverty, especially the failing health care system. And while I know my research will not change everything, my hope is that I can change the life for at least one person. As a burn survivor, I know the pain and hardship a burn produces. Therefore, if I could prevent the burn of just one Malawian, I would consider my research a success. They call Malawi the “Heart of Africa,” and I now know why. I will never forget the people I met and the experiences I had.