title: Prevalence survey of dermatological conditions in mountainous north India.
abstract: BACKGROUND
  Dermatological conditions account for a substantial proportion of the global burden of disease in low and middle income countries (Bickers D, Lim H, Margolis D, et al. The burden of skin diseases: 2004. A joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. J Am Acad Dermatol 2006; 55: 490-500) and place major pressures on primary healthcare centers (Satimia F, McBride S, Leppard B. Prevalence of skin disease in rural Tanzania and factors influencing the choice of health care, modern or traditional. Arch Dermatol 1998; 134: 1363-1366). In mountainous North India, where limited resources are available for skin care, no dermatological data exists on prevalence, treatment patterns, or associations. The study aimed to measure prevalence and treatment of dermatological conditions and associated factors in Uttarakhand so to inform delivery of dermatological care and prevention programs in India.
  
  
  METHODS
  Single stage cluster randomized sampling generated seven cluster units or villages. Household members (n = 1275) from each cluster were interviewed, and where possible, examined and offered treatment.
  
  
  RESULTS
  Dermatological conditions were prevalent (45.3%), with 33% being of infectious etiology. Atopic dermatitis (9.2%), scabies (4.4%), tinea corporis (4.1%), and pityriasis alba (3.6%) were most prevalent. Multivariate analysis showed that cohabitation with animals (OR = 1.62, 95% CI-1.35, 1.95) was a predictor of any skin diseases. A health practitioner was not consulted in 64.7% of dermatological conditions, and where consulted, approximately 69% received inappropriate or ineffective treatments. Excessive spending on dermatological care was commonplace. Limitations associated with cross-sectional cluster methodology included the underrepresentation of seasonal conditions and conditions of short duration. Caste proved difficult to randomize across clusters given villages were often composed according to caste.
  
  
  CONCLUSIONS
  These results demonstrate a high prevalence of dermatological conditions and a pattern of conditions somewhat distinctive to this mountainous area of North India. These findings will assist development of appropriate and cost-effective dermatological services in these mountainous regions.
authors.affiliation: Victorian Public Health Training Scheme, Victorian Department of Health, Melbourne, Australia. nathangrills@gmail.com
authors.forename: Nathan
authors.initials: N
authors.lastname: Grills
authors.forename: Claire
authors.initials: C
authors.lastname: Grills
authors.forename: Tim
authors.initials: T
authors.lastname: Spelman
authors.forename: Mark
authors.initials: M
authors.lastname: Stoove
authors.forename: Margaret
authors.initials: M
authors.lastname: Hellard
authors.forename: Carol
authors.initials: C
authors.lastname: El-Hayek
authors.forename: Rajesh
authors.initials: R
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000829:Animals, Domestic; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003876:Dermatitis, Atopic / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010915:Pityriasis / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D012737:Sex Factors; D012871:Skin Diseases / Q000453:epidemiology* / Q000628:therapy*; D012874:Skin Diseases, Infectious / Q000453:epidemiology; D012923:Social Class; D055815:Young Adult