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INDIAN JOURNAL OF PUBLIC HEALTH(Quarterly Journal of Indian Public Health Association) Journal Advisory Committee Dr. Deoki Nandan Dr. Sandip Kumar Ray Dr. Ranadeb Biswas Dr. F. U. Ahmed Dr. J. Ravi Kumar Mrs. Shuva Kumari Vol. 52 No.3 July - September 2008 Editorial Board Chief Editor Dr. V. K. Srivastava Editor Dr. Samir Dasgupta Associate Editor Dr. R. N. Chaudhuri Dr. Sanjay Chaturvedi Joint Editor Dr. D. K. Raut Dr. A. B. Biswas Assistant Editor Dr. Kaushik Mishra Dr. Prabir Kumar Sen Managing Editor Dr. Dilip Kumar Das Assistant Managing Editor Dr. Rabindra Nath Sinha Members Dr. D.H. Ashwath Narayana Dr. (Lt.Col.) Atul Kotwal Dr. B. M. Vashisht Dr. N. K. Goel Dr. Prasant Kr. Saboth Dr. D. M. Satpathy Dr. Chitra Chatterjee Dr. Rabindra Nath Roy Dr. Ashok Kr. Mallick Dr. Kunal Kanti Majumdar Secretary General (Ex-officio) Dr. (Mrs.) Madhumita Dobe Indian Journal of Public Health is published quarterly by Indian Public Health Association. Manuscripts and correspondence should be addresed to : Managing Editor, Indian Journal of Public Health, 110 Chittaranjan Avenue (3rd floor), Kolkata-700073, West Bengal. Manuscripts, written in English, should be submitted in triplicate. One copy must also be submitted in electronic format to: [email protected], [email protected] Papers submitted to the journal must be accompanied by a Certificate signed by all authors. Editorial Office: 110, Chittaranjan Avenue, Kolkata - 700 073 Phone : 32913895 (033) E-mail: [email protected] / [email protected] Indian Journal of Public Health Contents Vol.52 No.3 July - September 2008 115 Editorial Injury: the most Underappreciated and Unattended Pandemic Sanjay Chaturvedi Original Article Prevalence of Risk Factors for Non-Communicable Disease in a Rural Area of Faridabad District of Haryana A. Krishnan, B. Shah, Vivek Lal, D. K. Shukla, Eldho Paul, S. K. Kapoor Epidemiology of Disability in a Rural Community of Karnataka K. S. Ganesh, A. Das, J. S. Shashi Elimination of Iodine Deficiency Disorders – Current Status in Purba Medinipur District of West Bengal, India A. B. Biswas, I. Chakraborty, D. K. Das, A. Chakraborty, D. Ray, K. Mitra Special Article Integrated Diseases Surveillance Project (IDSP) Through a Consultant’s Lens K. Suresh Short Communication Hypertension and Epidemiological Factors among Tribal Labour Population in Gujarat Rajnarayan R Tiwari Respiratory Morbidity among Street Sweepers Working at Hanumannagar Zone of Nagpur Municipal Corporation, Maharashtra Sabde Yogesh D, Sanjay P Zodpey Needle Sticks Injury among Nurses Involved in Patient Care: A study in Two Medical College Hospitals of West Bengal G. K. Joardar, C. Chatterjee, S.K.Sadhukhan, M.Chakraborty, P Das, A.Mandal . Dietary Profile of Sportswomen Participating in Team Games at State/National Level Ritu Jain, S. Puri, N. Saini Perception Regarding Quality of Services in Urban ICDS Blocks in Delhi A. Davey, S. Davey, U. Datta A Study on Delivery and Newborn Care Practices in a Rural Block of West Bengal P Das, S. Ghosh, M. Ghosh, A. Mandal . Hospitalisation due to Infectious and Parasitic Diseases in District Civil Hospital, Belgaum, Karnataka A. C. Naik, S. Bhat, S. D. Kholkute Review Article Homelessness: A Hidden Public Health Problem S. Patra, K. Anand Letter to the Editor: HIV/ AIDS Awareness through Mass Media – the Measurement of Efforts Made in an Urban Area of India Hem Chandra, K. Jamaluddin, L. Masih, K. Faiyaz, N. Agarwal, D. Kumar Undernutrition in 5-10 Year Olds: Experiences from a PHC in Pondicherry S. Sarkar, S. Ananthakrishnan 117 125 130 136 144 147 150 153 156 159 161 164 171 172 115 Editorial Injury: the most Underappreciated and Unattended Pandemic Injury accounts for 9% of global mortality and 12% of the global burden of disease in terms of disability adjusted life years (DALY) lost. They figure in the leading causes of death throughout the world and yet remain the most underappreciated pandemic. Every year, an estimated 5 million people die from injury1. Road traffic injury (RTI) alone accounts for 25% of mortality and 22% of DALY lost. Ranked 9th in terms of worldwide burden, they are projected to ascend to 3rd rank by 20202. In many parts of the world, injury related database is thin and the real load may be heavier than the estimates. For every injury related mortality, several thousand more require hospital treatment and suffer with impairments, frequently with disabling consequences. Injury affects the productive work force, youth and school-going children the most. It follows the inverted U-shaped curve with age. Almost 50% of injury related mortality is borne by 15-44 years age group. Under-five children account for 25% of drowning deaths and over 15% of fire-related deaths. Males bear the major brunt in all ages, gender difference being the highest in 15-44 years age group. Mortality from RTI and interpersonal violence is about 3 times higher among males than that in females. Reducing the burden of injury is going to be one of the main challenges for public health in this century. In terms of cost, RTI alone accounts for 1-2% of the gross national product to most of the countries. For the low and middle-income countries (LMICs), this exceeds the total developmental aid received by them. Assessment of direct and indirect costs of injury involves complex methods that are seldom free of limitations and compromises. What generates a great deal of discussion is the economic quantization of human life. Putting monetary values on pain, suffering and death is ethically unacceptable to many. The burden of injury related mortality and morbidity is comparatively very high in low and middleincome countries (LMICs). Over 90% of this burden is borne by such countries. Recent evidence suggests that victims of life-threatening but salvageable injury have six times higher probability of death in a low-income setting3. South-East Asia (SEA) alone bears 31% of the world’s burden of injury and 27% of injury related mortality. Thousands of children saved from infectious and nutritional diseases are killed or crippled by injury in this region. RTI is the biggest culprit in most of these countries - total regional share in the global burden of RTI being 34%4. It is also estimated that SEA region accounts for 57% of the global burden of burn injury and 53% of burn mortality 1. In Bangladesh and Maldives, drowning is the commonest cause of accidental deaths. India specific information base on injury is also very weak and the published data is hard to come by. The latest published review on RTI in India has estimated 2-5 million hospitalizations and over 100,000 deaths in 2005. RTI alone accounts for 1030% of all hospitalizations, being highest in the state of Tamilnadu and lowest in Nagaland5. If we take a stock of our response to this ongoing pandemic, the situation looks scary. Let us start with info-capture and surveillance. In the absence of a trauma registry system, the injury related information is not uniformly or systematically captured, analysed or disseminated in several South Asian countries, including India. Even in the tertiary care facilities – where there are functioning medical record divisions – the distal recording units, like emergency rooms, are unable to optimally utilise the provisions provided in Chapters XIX & XX of ICD-10 6 for coding and classification of injury. Several circumstantial attributes, which are essential for subsequent coding and classification, are not optimally captured in the distal recording units. Besides the 3 character alpha-numeric core code, which is mandatory for any international reporting, Chapter XX – a newer feature of ICD 10, provides an additional ‘e-code’ for all cases of injury7. This code is about the external cause of injury, and is a significant information for injury surveillance. No proximal data management facility can generate this e-code once the required information is lost at the distal capture unit. This is a huge gap in the injury surveillance process, right at the data-generation level. The initial step in this direction would be to develop sentinel units for injury surveillance in most of the tertiary and Indian Journal of Public Health Vol.52 No.3 July - September, 2008 A felt need for such a programme is to be created so that the programme gains widest possible acceptance and support. 2005.: framing the case definitions. Inj Prev.Editorial: Injury: the most Underappreciated and Unattended Pandemic 116 secondary care hospitals – before going for the goal of establishing the ‘National Trauma Registry of India’. Gururaj G. Geneva: WHO. as compared to similarly resourced governments which do not. Benefit in terms of DALY saved will go manifold. WHO. lesson 1). IJPH & Professor of Community Medicine. Foundations and fundamentals of injury prevention and control. With improved and systematic response towards injury prevention. Geneva: WHO. Strategic plan for injury prevention and control in South-East Asia. Geneva: WHO. Advocacy starts with identification of stakeholders. knowledge transfer and collaboration. 6. development of data capture process. International statistical classification of diseases and related health problems – tenth revision (ICD-10). The injury chart book: a graphical overview of the global burden of injuries. development of data collection tool. The conceptual framework of a ‘National Injury Prevention Programme’ must be inclusive in character to accommodate all the significant actors and agencies. World report on road traffic injury prevention. e. 2002. 3.000 lives campaign . 2.com Indian Journal of Public Health Vol. This collaborative network should be most visible at the district and sub-district levels. 2005. References: 1.September. The long term activities would constitute: quality assurance mechanisms. WHO. the range of reduction in the mortality alone will bear incremental rewards. New Delhi: WHO-SEARO.11:321-3. Sanjay Chaturvedi Associate Editor.21:14–20. 5. 2004. Rivara FP Mock C. injuries and disabilities in India: current scenario. Natl Med J India 2008. Governments which improve the organization of injury prevention services benefit from reduced injury related burden. University College of Medical Sciences and GTB Hospital. The next or parallel step should be to initiate and sustain a population-based programme on injury prevention.g.000.3 July . protocol. 2002. 7. The 1. In: TEACH VIP [CD-ROM]. Geneva: WHO. and safety promotion (section 1. and infrastructure. Road traffic deaths. WHO. It just needs to be effectively advocated. evaluation. 2008 . Such a national response to the problem of injury is yet to materialize in many developing countries. WHO-SEARO. (editorial). The rationale to initiate a population-based national programme on injury prevention is quite strong and visible. vol. 4. and identification and training of stakeholders. Certain short term activities can be identified and operationalized.52 No. Delhi E-mail: cvsanjay@hotmail. 1. WHO. 1992. The mean number of servings of fruits and vegetables per day was 3. Division of Non Communicable Diseases. chronic obstructive pulmonary diseases and diabetes) accounted for 42.wise tool was used as the study instrument which included behavioural risk factor questionnaire and physical measurements of height. >140 SBP and/or >90 DBP or on antihypertensive drugs was 10. aged 15-64 years. and by 2020. Centre for community medicine. Kapoor6 Abstract Background & Objectives: To estimate the prevalence and levels of common risk factors for noncommunicable disease in a rural population of Haryana. obesity. weight.3 July . raised cholesterol and glucose levels. 1Associate Professor. These are linked by common risk factors related to lifestyle like tobacco use. waist circumference and blood pressure.6% among men and none of the women reported consuming alcohol. are projected to account for 73% of deaths and 60% of disease burden1.117 Original article Prevalence of Risk Factors for Non-Communicable Disease in a Rural Area of Faridabad District of Haryana * A. unhealthy diet.7 for men and 2.9% among women. These risk factors are measurable and largely modifiable and thus continuing surveillance of the levels and patterns of risk factors is of fundamental importance to planning and evaluating preventive activities in the control of NCDs. progressive ageing of population. Division of Non Communicable Diseases. S. The prevalence of current alcohol consumption was 24. 6 Professor Emeritus. B. improving socio-economic conditions and changed life styles have caused an increase in non-communicable diseases and these are spreading to rural areas as well and these need to be documented to dispel myths that NCDs are a problem only in urban areas. Affluence. Daily smokeless tobacco use was 7. New Delhi. with one male and one female interviewed in alternate household. 2Senior Deputy Director General (NCDs).7% among men and 7. The percentage of people undertaking at least 150 minutes of physical activity in a week was 77.8% for men and 54. Results: The age adjusted prevalence of daily smoked tobacco was 41% for men and 13% for women. Clearly. All households in the selected villages were covered.2% among women. Physical inactivity. Among men 9. Centre for Community Medicine. AIIMS. Methods: The study involved a survey of 1359 male and 1469 female respondents. inactivity and overweight among women and low fruit and vegetable consumption among both sexes in rural areas. Eldho Paul5. K. Conclusion: The study showed a high burden of tobacco use and alcohol use among men. cancer.com Indian Journal of Public Health Vol. AIIMS. 2008 . Rural. 5Statistical Assistant. NCDs can no longer be regarded as a problem confined to the developed countries and urban society. D. Krishnan1. ICMR.7% of deaths in 2000 in India2.1% and 1. Centre for Community Medicine.0 compared to 15. BMI. WHO STEP. The age adjusting was done using rural Faridabad data from Census 2001. Key words : Alcohol. Multistage sampling was used for recruitment (PHCs/ sub-centres/ villages).7 for women.5% for women. The prevalence of measured hypertension. Vivek Lal3. Introduction Non. *Corresponding author: kanandiyer@yahoo. 3Junior Resident. Delhi. high blood pressure.communicable diseases (NCDs) contributed 60% of deaths and 43% of global burden of disease in the year 2002.52 No. St Stephens Hospital.e. Hypertension. Shukla4. i. New Delhi. ICMR. 4Deputy Director General. Shah2.0 % had BMI > 25. K.September. AIIMS. Community Health Departt. physical inactivity. Together NCDs (cardio-vascular diseases.2% for men and women respectively. Risk factors. Tobacco. The height was measured using adult portable stadiometer to the nearest 0. Ballabgarh run by All India Institute of Medical Sciences (AIIMS) was among the sites where it was pilot tested and later became a part of the multicentric surveillance site coordinated by Indian Council of Medical Research (ICMR). canned fruit or ½ cup of fruit juice. Three male and three female workers were trained by a team of ICMR and were regularly supervised by the investigators and ICMR team. Current alcohol drinkers were defined as those who reported to consuming alcohol within the past one year.3 July .Krishnan A et al: Risk Factors for Non-Communicable Diseases in Haryana 118 An integrated approach to risk factor surveillance is vital for NCD control. cooked. alcohol or diet. A SECA constant tension tape was used to measure Waist circumference to the nearest 0. naswar. banana or orange.1 cm. 45-54 and 55-64) and sex group. The blood pressure was measured using OMRON digital automatic blood pressure monitor. Standard procedure was Indian Journal of Public Health Vol. If need be. khaini or zarda paan daily. Surveillance of NCD risk factors as currently practiced in India has largely focused on separate risk factors like tobacco. One standard drink was equivalent to consuming one standard bottle of regular beer (285 ml). It included questions on socio-demographic status. gutka. Thereafter. All the households in the selected villages were covered. work or transport. One serving of vegetable was considered to be 1 cup of raw green leafy vegetables.WHO STEPS manual3) Current daily smokers were defined as those who were currently smoking cigarettes. Such tools have recently been developed by WHO and are being used by health planners to generate evidence for advocacy. Body mass index (BMI) was calculated by dividing the weight (in kilograms) by square of height (in meters). followed as per STEPs protocol for anthropometric and blood pressure measurements. 25-34. an additional village was selected from the same sub-center. one single measure of spirits (30 ml) or one medium size glass of wine (120 ml). All measurements were done at domiciliary level. Two PHCs were selected randomly from among a total of 5 PHCs in the block. with 250 in each age (15-24.52 No. the household was revisited a second time at least one of which was on a different day/time.September. during leisure. Definitions: (Source. 35-44. As part of this we studied a rural population of Haryana for prevalence of common risk factors of NCDs using WHO STEPS approach. Very few studies have been undertaken to assess physical activity.1 cm. We report the results of this survey here.1 kg. Comprehensive Rural Health Services Project (CRHSP). not artificially flavoured. one sub-center in each PHC was selected randomly. ½ cup of other vegetables (cooked or chopped raw) or ½ cup of vegetable juice. in Faridabad district of Haryana from April 2003 to January 2004. A total of 2500 participants were aimed at. There is a felt need to have a comprehensive look at the NCD risk factors using standard methodology to ensure comparability. ½ cup of chopped. Physical inactivity was defined as less than 10 minutes of activity at a stretch. Overweight was defined as BMI ³ 25 and < 30 Obesity was defined as BMI ≥ 30 Hypertension was defined as BP ≥ 140/≥ 90 or currently on antihypertensive drugs. The selection of the male/female was from the list of eligible in that house and was done in a random manner. One serving of fruit was considered to be 1 medium size piece of apple. The WHO STEP-wise tool was used and the behavioural risk factor Questionnaire was suitably modified and translated in local language. 2008 . If the village was small. Current daily smokeless tobacco users were defined as those who were currently using chewable tobacco products. Material and methods We conducted a survey in the rural area of Ballabgarh. One village was randomly selected from the list of villages in the sub-center. Multistage sampling was used for the purpose of recruitment. with one male and one female being interviewed in alternate households. bidis or hookah daily. data on tobacco and alcohol use. measures of dietary habits and physical inactivity. SECA digital weighing scales were used to measure weight of the individuals and was recorded in kilograms up to 0. 8) Women Daily smokeless tobacco use (n=1469) 0.0-22.95%).0).3-27.7. Among the men.3 July .6% (22.8% 4.52 No.9 yrs (IQR 5.1 and among women being 0. highest in 45-54 years age group. The same for women was 13. Thereafter there was a gradual rise to a peak of 72.6-1. The median age for starting to smoke among women was 31.5% 38.8% 47.2% (0.0% and 7. Majority of women had never attended school (56.0-40.2% respectively.8) Ever alcohol consumption (n=1359) 10.0 yrs (IQR 25. For women both smoked and smokeless tobacco use was more common in the older age group of 55-64 years.9% 1. About 38% of the men had studied up to high school. For men.4% 41.6%.9% 4.0 yrs (IQR 10. Prevalence of tobacco use and alcohol use by age & sex Age in years Daily smoked tobacco use (n=1359) 15-24 25-34 35-44 45-54 55-64 Age adjusted prevalence** 9.4% in 15.5% 34. among both men and women. The data was analyzed using SPSS for windows (version 10.5-31.4% 7. while only 10% had studied beyond 8th standard.5% 44.0).0-25.Krishnan A et al: Risk Factors for Non-Communicable Diseases in Haryana 119 Ethical clearance for the study was obtained from AIIMS.0) * None of the women reported alcohol consumption.8% 4. Khaini was the commonest form in which smokeless tobacco was consumed. as against 11. snuff and chewed tobacco was most prevalent in 25-34 years age group. 96% were housewives.1% (5.0% (26.0% 32.8% 72. Written informed consent was obtained from each participant.7% 41.4) Men* Current alcohol consumption (n=1359) 9. Smoking tobacco in the form of bidis was the most common with the mean number of bidis smoked per day among men being 6.3% 7. **95% Cl values in parenthesis Indian Journal of Public Health Vol.34 years age group.4% 0. None of the women reported consuming alcohol.3% 18. Data were entered simultaneously.1% who had never been to school. 2008 .5% 10. There was a steep rise in daily smoking of tobacco after 24 years of age from 9. The prevalence then showed a decline in the later age group.2% at 45-54 years age group.4). smoked tobacco use was Table 1. The age standardized percentages for the target age group were computed using rural Faridabad data from Census 2001.2% 29.4% 46.8-8.7) Men Daily smokeless tobacco use (n=1359) 6. An independent data entry operator did the reentry of 10 percent data and these were validated.0% (11. The prevalence of ever alcohol consumption among men was 29.0% and 1.8% of Tobacco & alcohol use (Table 1) The age-adjusted prevalence of daily smoked and smokeless tobacco use in men was 41. whereas smokeless tobacco in the forms of khaini. gutka.0).8% 20.7% 1.0% (38. The median age for starting to smoke among men was 20. while the median duration of smoking was 12.6) Daily smoked tobacco use (n=1469) 0.1% 36.3-14.4% 29.6%).0-29. The prevalence was highest in the 35-44 years age group.24 years age group to 46.0 yrs (IQR 17.1% respectively. Of the women. The results of the measurement were provided to the respondents and all case needing referral were referred to the Civil Hospital at Ballabgarh to consult a physician. Results A total of 1359 men and 1469 women were included in the survey.September. The difference between the two was maximum at the age of 55-64 years.2% 1. majority were unskilled or landless labourers (23.2% 24.6% in 25.1% 6. while the median duration of smoking was 20.0% and that of current alcohol consumption was 24.0).7% 13.6% 63.4-43. The current alcohol consumers comprised 84.2% 67.2% 34. 8) 81. The mean number of servings of fruits and vegetables per day was 3.9-21.7(19.4(76.8) Transport (n=1359) 15.7 (95% CI 2.0) 20.2) 68.5-72. Physical inactivity (Table 2) The physical inactivity was highest during leisure time and was least during transport from one place to another for both men and women. Distribution BMI & waist circumference by age & sex Age in years Mean BMI (95%CI) 15-24 25-34 35-44 45-54 55-64 Age adjusted mean 19.7% (43.1(79.9(71.3% 23.0% 98.9% for men and women respectively) and lowest in 55-64 years age group (70.0-20.14.6-21.9-84.8) for men and for women.9(22.0(21.5-21.2% (54.9% 41.4) Transport (n=1469) 54.3% (96. This was more in the age group 35-44 years for both men and women.September.5% 21.5) 20.0(20.0% 19.6-3.1% 55.5% 57. A total of 4.8% women reported to consuming this much amount. Pattern of physical inactivity by domains Age in years Leisure (n=1359) 79.9) Men Work (n=1359) 71.1% 71.0-72.5-23.5-22.0-69.0) 21.4% 97.4-59.9) Indian Journal of Public Health Vol.9).4 (95%CI 730.6) 20.8% 49.3(20. The mean number of days in a week when fruits were consumed was 2.05 (95% CI 1.7-20.6(80.9-84.36-1.6% men consumed. mean number of servings of fruits and vegetables consumed per day were similar.9) 77.7% 57.4% 85.16) for men and for women was 1.7) 77.2% and 37. This was highest in the age group 45.4(76.3(73.7% 87.1-48.7-74.8).9) 77.3-19.6) 22.4(81.9% 43.0% 20.8(76.1% 67.5% 45. The mean number of drinks consumed in the past 7 days was 12.2% (83.0) 83.2(71.1-86. while only 1.5-1192.8) 20.7-21.421.52 No.Krishnan A et al: Risk Factors for Non-Communicable Diseases in Haryana 120 Table 2.2-83.93-2.9-78.9% for men and women respectively).0) Women Work (n=1469) 74.7) 81.1% 30.4-21.0(20. 2008 . it was 2.7(19.4% 50.8% 59.8% (16.5% 87.0 (95% CI 9. in the last week.4-62. The mean duration of physical activity in minutes for all male subjects for a week was 1103.56).6-2.1% 58.0-78.7 (95%CI 3.5) 22.9-77.3) 21.5%) than for men (77.6) Men (n=1359) Mean waist circumference (95%CI) 72. Across the age groups.46 (95% CI 1. Table 3.7) 22.7) and 781.3 July .2) 15-24 25-34 35-44 45-54 55-64 Age adjusted Total (95% Cl) those who had ever consumed alcohol. Such level of physical activity was highest in the age group 35-44 years (81.9) Women (n=1362) Mean BMI Mean waist (95%CI) circumference (95%CI) 19.2-23.3(79. more than or equal to 5 drinks on any day.7) 74.54 yrs.2% 89.0) for all women.6%.9-832.4) 71.2-85.9% (57.3-98. Men were consuming more fruits and vegetables than women in any age group.3) 82.8%) among all age groups.2% 18.4% 99.7) 82.4(20.3% 97.6 (95%CI 1068.5(80. The percentage of people undertaking at least 150 minutes of physical activity in a week was lesser for women (54.7(68.9% and 72.0% 90.0(20.6% 41.9) Leisure (n=1469) 95.2.4-20.7(20.2-82.2-20. The proportion of men consuming >5 servings of fruits and vegetables per day was 6.5% 97.6(19.5% 39.4) 21. 5 51.7% 17.9) 78. while mean BMI was highest in 45-54 years age group.9 (6.5 (%) 37.6 13.8) 2.3 59.6-64.8 (71.9 ≥25.6% 19. The prevalence of underweight was similar for both men and women.1) 68.3-135.6-121.4) 71. for all age Table 5.2-111.6) 121.4-4.1 1.6 33.3 22.4) Indian Journal of Public Health Vol.1 (74.Krishnan A et al: Risk Factors for Non-Communicable Diseases in Haryana 121 Table 4 .4 (119.5 (1.0-30.5 (%) 15-24 25-34 35-44 45-54 55-64 36.6-124.5 (6.2 (127.0 (%) 0 1.9 30.3-113.0 (120.2-78.8 25.3) Age adjusted 29.7-14.0 (122.6 21.4) 123.1 (10.1) Women Mean diastolic BP (95% CI) 66.3-70.1 prevalence* (26.1-9.0—<30.0-12.5-24.5-24.8 (52.1) 113.9-58.8) 73.5) 127.4 (69.2 16.3 9. Across all age groups overweight was more common among women than men.2) BM ≥30.0 1.5 2.9 15-24 25-34 35-44 45-54 55-64 Age adjusted mean 10.6 (74.8) 75.6) 120. There was an increase in BMI among women as compared to men after 25-34 years of age group and thereafter for all age groups.3) Female (n=1362) BMI BMI 18.0 13.4 (65.September.4 (72.5 10.3) % Hypertensive (≥140/≥90 or on antihypertensive) 1.8) 76.2% 9.1 12.7-77.7-71.6) 75.7% 52.3 21.6 (118. overweight and obesity in the study subjects Age Group BMI<18.0% 8.2% 5.6 (119.0 (%) (%) 59.3 July .2 (109.4-131.0) BMI ≥30 (%) 1. After 35 years of age overweight and obesity combined was more than thinness among women while thinness was consistently more prevalent than overweight and obesity combined.6-121.9 25.1) 111.1 (2.4 30.8 69.8-110.4-125.2 32.9 (59.2) 109.7) 118.1) Men Mean diastolic BP (95% CI) 70.2 2.8 22.9) % Hypertensive (≥140/≥90 or on antihypertensive) 4.4 (70.1 3.8-73.3-79.4 55.6-9.4 (67.0 61. Both mean BMI and waist circumference was highest in 45-54 years age group for men.1 (76.0 Male (n=1359) BMI BMI 18.3 1.6) 118.4) 7.4 12.9 2.9 7.0—<30.5-114.3) 5.2-31.6-67. Prevalence of thinness.4-69.9) * 95% Cl values in parenthesis Anthropometry (Table 3 & 4) A total of 107 women were found to be pregnant and these were excluded for anthropometric examinations.5 (116. 2008 .0) 69.0 (107.2-119.0 (%) (%) 57.7-78.7 (9.8 24.52 No.6) 131.2) 72.5 56.5 (117.3 (112.6) BMI<18.4-76.5 (73. the mean waist circumference was highest in 55-64 years.2 29.3) 76.1 Mean systolic BP (95% CI) 110.5 61.9 7.9 ≥25.3% 54.2-72.8-73. obesity was more common in women.2 (73.7-120.1 (26. For women.7% 48.9% 21.8 7.9 (110.9 7. Distribution of mean systolic & diastolic BP & % hypertensive by age & sex Age in years Mean systolic BP (95% CI) 120.8 (69.1-2. 4 mmHg respectively. The difference between ever use and current use was small.6%)5.0. The mean systolic and diastolic blood pressure among men was 120. Blood pressure (Table 5) The prevalence of self. The only representative surveys are the ones conducted by the Food and Nutrition Board (i.9% in women.52 No. Again it was more common in the 54-65 years age group. This is among the first sites to use this comprehensive approach to measure the NCD risk factor burden. The prevalence of selfreported diabetes was 0. but in women our finding of 13% is much higher than that of NFHS 2 (3.6% among rural men and women respectively. but this era of transition has also brought a double burden of under-nutrition and over-nutrition in these countries12. Our study showed that women have a poorer dietary pattern than men for all the age groups.6%).7% in rural men and women respectively.4% in 15-24 years age group to 29. had also done so in the last one year indicating that few people quit alcohol. The present study showed that 1.3% among rural men and 2.0. The consumption rose to a peak of 41. A survey of tobacco use in Karnataka and Uttar Pradesh (UP) found the prevalence of ever smoking in Karnataka to be 33.7% in men and 7.Krishnan A et al: Risk Factors for Non-Communicable Diseases in Haryana 122 groups among men. A total of 2.2%.2% of men had waist circumference ≥ 102 cm. Our prevalence rates were similar to that of NFHS 2 for Haryana5 (20. which may be a reflection of their poor social status10. which reported a prevalence of 58. Similar to our study. The prevalence of current smoking was 31. Recent data from NFHS 2 identified a significant proportion of Indian women as overweight. using a BMI cutoff of >30.7% among men and 0.2% and 0. Most of the men who reported to having consumed alcohol ever in life.4 mmHg and 73.reported hypertension was 3. In UP the prevalence of ever smoking . Discussion Our study presents the burden of major NCD risk factors. in a rural area. suggesting that tobacco use once initiated.9.September.8% among men and women respectively.5% in men and 6. Tobacco use in India is high and there are considerable differences in the types and methods by which it is used. Our study showed that physical inactivity was more common among women across all domains. It was not the purpose of this survey to compare this burden with other risk factor specific surveys done by different people at different places at different times etc. 2008 .5% among women and showed an increasing trend with age. coexisting with high rates of malnutrition.3 mmHg and 69.5% in 35-44 years age group.3% and 0.3 July .7% for men and 0.3%7 for men and 1. This was against the cutoff for women of ≥ 88 cm which was seen in 13. This could be due to the fact that in rural areas bicycles or walking are the still the usual mode of transport. It is ironical that a low vegetable consumption is prevalent in a predominantly vegetarian community. A prevalence of 41% of daily smokers among men was similar to that reported by NFHS 2 for Haryana (40. some limited comparison from other surveys would be meaningful to get an insight into the burden at national level. The prevalence of ever smokers in NFHS 2 was 42. was 28. The same among women were 113.1% among rural men and 0.9% among women. The steep rise in alcohol consumption from 9.e. In our study.a finding that has also been shown by other studies 8. demographic and nutritional. Maximum physical inactivity was during leisure time while most men were physically active during transport. others have also found that khaini and bidis to be the commonest form of tobacco use 4-6.2% and Indian Journal of Public Health Vol. whereas the prevalence of hypertension (defined as BP ≥ 140/90 or currently on antihypertensive drugs) was 10.8 mmHg respectively. There was a sharp increase in prevalence of hypertension among women after 35-44 years age group. which was most commonly seen in the 55-64 years age.8% in women. Developing countries are undergoing various types of transitionsepidemiological. is continued and quitting of tobacco use is infrequent. Our study draws attention to the fact that there exists a pool of women who were overweight in rural areas.4% and 3. Earlier developing countries had a high prevalence of under-nutrition. socio-economic. District Nutrition Profiles survey) 13. and gradually declined thereafter. the survey was confined only to married women in reproductive age group and showed a prevalence rate of 2.7% in 25-34 years age group could be due to the economic independence gained during this time in life.1% for women) but lower than a previous study conducted in Punjab.5% men and 3.11. women did not report to consuming alcohol.2% for women aged 15-49 years using BMI>30. However.6% among rural women4. using WHO STEPS approach.1% women have obesity. However.8% for men and women respectively. which have reported prevalence of 0. 2. The huge male and female difference in younger age groups disappeared post menopause. Current smoking showed a prevalence of 28.5% for women. Government of India. We also acknowledge the technical guidance provided by WHO . Drug abuse in a rural population.7% prevalence of hypertension in men and 7.8% vs 3. 72:702-711. International Journal of Cardiology. 11. It is also important to study trends of various risk factors and Ballabgarh offers a sentinel site for such activity to be conducted in future. WHO. Prevalence of type 2 diabetes mellitus and risk of hypertension and coronary artery disease in rural and urban population with low rates of obesity. Journal of Epidemiology and Community Health. New York. Indian Journal of Medical Research. Cherian Varghese ( WHO India). 2003 Oct. 3. 2001. Pednekar Mangesh S. 4. Reddy K. Sinha Dhirendra N. STEPS: A Framework.52 No. International Institute for Population Sciences (IIPS) and ORC Macro. Our findings show a high burden of hypertension among elderly population.9% in women is lower than that observed in other studies14. 7. Niaz Mohammad A. V Mohan and Dr. Neki JS. The Girl Child and the Family. India: IIPS. United Nations Population Fund. 1979. Anand K. Mumbai. Women had significantly higher prevalence of hypertension than men (5. UNFPA.Krishnan A et al: Risk Factors for Non-Communicable Diseases in Haryana 123 Physical activity measurement at community level is difficult with the existing instruments and therefore these results would need to be interpreted with caution. Indian Journal of Community Medicine. BMJ. 1998.-Dec. Indian Journal of Public Health Vol. 1997. However it does appear that contrary to general impression. Singhi Monica. 2002. WHO. 5. Dr. 12. 1980. Nutritional transition: a public health challenge in developing countries. India: National Family Health Survey (NFHS-2). 56:804-805. Dr.particularly Dr. Anandalakshamy S.Reducing risks. Gupta Prakash C. Men had a higher prevalence than women in all age categories. WHO. Chaudhry K. physical inactivity is an emerging cause of concern in rural areas of India. 1998. Sundaram KR. 10. Government of India. 2. Kapoor SK. The state of world population 1997: the right to choose: reproductive rights and reproductive health.3 July . References 1.The WHO STEPwise approach to surveillance of noncommunicable diseases (STEPS). 1994. as it allows for the development of a flexible. Prashant Mathur and Dr. Thankappan.5% were found to be hypertensive15. Bajaj Sarita. promoting healthy life.communicable diseases in South Asia. Burden of non. Singh RB. 13. Sharma HK. Tobacco use in a rural area of Bihar. India. Prevalence of tobacco use in Karnataka and Uttar Pradesh.Dr. Trivedi JK. 8. Report. 2004. Ghaffar Abdul. Our finding of 10. This is contrary to our finding of lower prevalence of hypertension in women as compared to men across all age groups. Conclusion Our study confirms the high burden of NCD risk factors in rural areas and reiterates the need to address these issues comprehensively as a part of NCD prevention and control strategy. Acknowledgement This work presents the results of one of the five sites of the multi-site initiative of ICMR and the authors acknowledge the contribution of investigators of the other four sites ( Dr. The World Health Report 2002. Moshiri M. 2002. 2002. In a population-based survey carried out during 1994-1995 in Raipur Rani block in the state of Haryana. 2000. Ministry of Human Resources. 6. Prashant Joshi) in its planning and design. 4. STEPwise approach of WHO offers an entry point for low and middle income countries to initiate NCD surveillance. India Nutrition Profile.66: 65-72. Pattern of alcohol consumption in rural Punjab men. 28 (4): 167-70 Mohan D.0%). Indian Journal of Psychiatry. Srinath. 9.September.WHO. Ruth Bonita ( formerly with WHO/ HQ) and ICMR . increasingly comprehensive and complex surveillance system depending on local needs and resources3. Department of Women and Child Development. 21: 211. Geeta Menon. New Delhi. Department of Women and Child Development. 1998-1999. Ministry of HRD. Delhi. Geneva. Rastogi Shanty S. India. Further surveys are recommended based on this approach to ensure data comparability over time and between different sites. Dr. Sethi BB. GOI. 328:807-810. JC Mahanta. Jerzy Leowski WHO/ SEARO) and Dr. 2008 . KD. IPHA membership number (for members) and mobile number on the reverse of the bank draft. 2000 US$150 Rs.3 July . Bangalore .52 No. Department of Community Medicine. 1300 Rs. 2300 Rs. Jain S. BSK 2nd Stage. : Dr. 1400 US$ 125 Rs. 1000 Rs. Sharma . Bangalore . B G Parasuramalu. Recommendation letter from Head of Department / Head of Institution is compulsory. 2. 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Prevalence and determinants of hypertension in an un-industrialised rural population of North India. 3000 (29000 for 10 delegates) Rs 2000 Rs 700 Accompanying person 6 (Spouse & Children only) Pre-conference CME 1.560070. 3. 1100 Rs. 1800 Rs. 1800 Rs. payable at Bangalore. Recommendation letter from Head of Department and only for those whose papers are accepted for presentation. BK. Gupta R. Malhotra P Kumari S. Saturday& Sunday) Preconference CME Conference Venue : Kempegowda Institute of Medical Sciences (KIMS). Demand Draft shall be in the name of “53rd National Conference of IPHA”. Professor & Head Organizing Secretary . cheques will not be accepted. 1800 Rs. 1500 Rs. 3100 Rs. Bangalore. 1999 Jul. 2600 Rs. . 1994.560 070 Theme Dates : : Changing Public Health Scenario in the 21st century 8th January. J Hum Hypertens.53rd Annual National Conference of IPHA.42:24-6. place. 2009 (Thursday) 9th -11th January. 800 Rs. Gupta HP Keswani P Gupta VP Gupta . 2008 . (M) 0-99860-03467 Email: iphacon09@kimsbangalore. 1000 US$ 100 2000 (18000 for 10 Delegates) Rs 1000 Rs 300 01-11-2008 to15-12-2008 Rs. . 2500 ( 24000 for 10 delegates) Rs 1500 Rs 500 Spot 5 Rs. Registration fees Only A/c Payee Demand Draft will be accepted.org Contact Indian Journal of Public Health Vol.September.iphaonline. Or equivalent Indian currency. Das 2. Using the above formula. Methods: A community-based cross-sectional study was conducted during January-December 2004 among 1000 study subjects of all age groups selected randomly from four villages under rural field practice area of a teaching institution. 2.52 No. Manipal. Then. Community Medicine. the first folder was 1Assistant Professor. Cross-sectional. This limitation results from the conceptual framework adopted. S. After adding non-response rate of 10%. Therefore it is appropriate time to take stock of the situation of the disabled population in the country specially in rural sector where around 80% of the disabled persons reside. Besides. where prevalence was taken as 10%1. Thus 1000 subjects in all the age group were selected for this study. 3Assistant Professor. KS Hegde Medical College. Karnataka. *Corresponding author: [email protected]%. classifications and the methodology used for the collection of data on disability. Sample size was estimated for infinite population by using the formula 4pq/d2. 2008 . Community Medicine. KMC. A. Yenegudda. which covers a population of 45 000 spread over 11 villages of a Taluk in Karnataka State of India. Four villages namely Kotemattu. 80% of the disabled had multiple disabilities. Determinants. Probability proportional to sampling technique was used to select the study sample from each village. Required precision of the estimate (d) was set at 20%. Mangalore. In India. the implementation of the strategy for people with disabilities as stated in the disability act 1995 is being vigorously perused by the Ministry of Social Welfare and all other concerned ministries4. Both physical and mental disabilities are of great concrn in this area. Karnataka. 3.3 July . In each of the four centers. In view of the above context. though the data collected do not reflect the full extent of disability prevalence1.com. S. Results: The prevalence of disability was found to be 6. prevalence studies will be useful tool for developing community based rehabilitation programmes for disabled. The population covered by these four villages was 16. Community Medicine. Shashi 3 Abstract Objectives: To determine the prevalence and pattern of disability in all age groups in a rural community of Karnataka. Kidiyoor and Kadekar were selected randomly for the present study. Indian Journal of Public Health Vol. Percentage prevalence. Epidemiology. Key words: Disability. Ganesh1. the scope and coverage of surveys undertaken. Subjects were interviewed and examined using a predesigned schedule. Karnataka. the present study was conducted to determine the prevalence and pattern of disability in all age groups in a rural community of Karnataka. Chronic medical conditions are also more common among disabled. Knowledge and occupation plays a major role as determinants of disability. 2Professor. an additional 100 subjects were included. Kasturba Medical College.125 Original Article Epidemiology of Disability in a Rural Community of Karnataka *K. the definitions. Mangalore. all family folders were arranged in a serial order. the sample size was estimated to be 900. chi square test and multiple logistic regression analysis were used for statistical analysis. Materials and Methods This was a community-based cross sectional study carried out over a period of 1 year from January to December 2004. J. The study was conducted at the rural field practice area of a teaching institution. Introduction Disability is one of the major public health problems of the developing countries. If a designated person could not be contacted or not cooperative during three separate visits. So.4) 52. p Subjects No (%) 472 482 72 122 635 125 24 (5.6) 74. 954 subjects were available for the final analysis (response rate 95%).7) 44 (5. the next folder was randomly picked up and the names of all the eligible candidates of that household listed. Socioeconomic status was assessed by modified Uday Parik scale. Mental disability was assessed by Indian Disability Evaluation and Assessment Scale (IDEAS) developed by the Rehabilitation Committee of Indian Psychiatric Society6. Among them 472 (49.9 0. Total number of disabled among 7 years and above was 59. The demographic and other variables recorded were age.001* 30 (28.7%) subjects are below 6 years.5) 26 (5. Although households were taken as cluster.8 0. sex.5) 34 (7. Similarly.5) 1 (0.9) 2.4) 10 (3.5%) belonged to the age group of 15 – 59 years.8) 30 (4.2 0.4 1(0. socio-economic status.5 for windows. interviewing and examining all the individuals in the family selected with pre-tested questionnaire. Multiple Logistic Regression was performed. Indian Journal of Public Health Vol.3 0.1 74.001* 0. Considering the fact that the age. †105 (10.September.3) 0 45 (8.1) 36 (7.2 10.5%) subjects were males. * P value less than 0.6%) subjects are below 7 years.8) 17 (7.6) 23(4. we analysed the data taking individual as sampling unit. Disability below the age of 5 years was assessed based on the instrument designed on the lines of questionnaire taken from Action Aid India7.0001* Results Of the 1000 subjects enrolled into the study. education and occupation are important determinants of disability. Disability was assessed as per the criteria laid down by WHO5. 2008 .3 Literacy † (years of schooling) Illiterate 84 1-4 118 5-10 522 > 10 125 Occupation‡ Unemployed Housewife Unskilled Skilled Students Professional 104 231 311 40 161 21 19 (22. The study was conducted by making house-to-house visits.2) 1 (2. Informed verbal consent was obtained from all respondents. 635 (67.8 0 < .7) 29 (21. This procedure was repeated till the desired number of eligible persons was achieved from each centre. Chi square test was carried out to test the differences between proportions.5) 16 (7. the design effect would be minimal considering the disability characteristics that are different for members of the household.001* Socio-economic status Low 456 Middle 486 High 12 Marital Status Ever married Never married Family Type Nuclear Joint/extended 527 427 208 746 1.52 No.3 July . we analysed the data after sub categorization of each of these variables.6) 16 (13. then the subject was considered as nonrespondent. ‡ 86 (8. The data collected was tabulated and analyzed by using the Statistical Package for Social Sciences (SPSS) version 11.8) < 0. To determine the independent effect of various factors on disability.5) 0 1( 0. Table 1: Prevalence of disability according to socio-demographic variables (n=954) Variables Gender Male Female Age group (years) <5 5-14 15-59 ≥ 60 Total Prevalence χ2.Ganesh KS et al: Disability in a Rural Area of Karnataka 126 selected randomly from the random number table and the names of the eligible candidates from that household noted down. family type. marital status.05 is considered as significant. literacy and occupation. Chronic medical conditions were assessed based on the previous diagnosis. Total number of disabled among 6 years and above was 59.5) 15 (3.1 0. 8%).3%). † 105 (10. As the age advances.1-10.3-269. Also. The present study revealed that half of the disabled were unemployed.7 0. the prevalence of disability among the unemployed was very high (28.3% (12) belonged to high socio-economic status. 58. 746 (78. hearing (13/60).2% of the study subjects were ever married.7% were unskilled workers.1 0. Nearly one quarter of illiterates (22.2 1.52 No. Among ever married group.9 Occupation ‡ Professional & Skilled Unemployed Housewife Unskilled Students 15. The prevalence of disability was marginally higher among low socioeconomic and nuclear family group.6%) were disabled and those with education level of above 10th standard had very low prevalence.1 0.8 2.5 Literacy †(Years of schooling) > 10 5-10 5.8-6. diabetes mellitus and fits in 10% (6) and heart problems in 5% (3) of the disabled. the prevalence was two and half times more than never married group and the difference was found to be significant (χ2=10.Ganesh KS et al: Disability in a Rural Area of Karnataka 127 870 (92%) were literate.1-8.6) subjects are below 7 years.002* 0.3% were housewife and 16.8 0.9 0. The most common type of disability among the disabled was mental disability (22/60) followed by loco motor (17/60). As our study illustrates.0001). p=0. Also.9 0.5 95% CI P value 0.0-221. farmers and people with petty business (Table 1).7 0.11.26. the prevalence declined significantly (χ2=52.4. 2008 . Some studies had taken only the physical disability and some others mental disability. knowledge and occupation plays a major role as determinants of disability.2 0. Multiple logistic regression analysis revealed that illiteracy.001). 55.7 0.2% professionals. 28. 80% (48) of the disabled had single disability and the rest 20% had multiple disabilities.001). p= <0. About half of the study population belonged to the middle socio-economic status (51%).3% (60/954).7%) subjects are below 6 years Discussion Well documented studies to determine the prevalence and its epidemiological features are few. Also. primary schooling and unemployment had independent significant association with the disability (Table 2).3-2. while only 1.9 0.1 3.9%). Chronic medical Indian Journal of Public Health Vol.The present study showed that 40% (24) of the disabled were males and 60% (36) were females.5 0.3 * P value < 0.9 1.2%) belonged to joint/ extended family. the prevalence increased significantly (χ2=74.8-47.1 0.05 is considered as significant. By occupation.9 1-4 25.3 0.8 0.3 3.02-6. the data collected by health workers could not detect mild degrees of disability because of their limited knowledge and lack of training.1 0. Hypertension was present in 30% (18) followed by asthma/COPD in 15% (9).012* 0. The overall prevalence of disability was found to be 6. The difference in prevalence of disability between different occupation groups was found to be statistically significant (χ2=78. speech (12/60) and visual (10/60) disability.5-4.3 1.9%) and unemployed (10.003* 0. students (16.9 0.7 Illiterate 29.3 July .4 0.2%). The prevalence of disability among the elderly group (>60 years) was very high (21.September. ‡ 86 (8. As literacy level increased.6% were unskilled workers/farmers/ petty business people.001). p=0. Table 2: Correlates of disability: Multiple Logistic Regression analysis Variables Gender Male Female Age group (years) < 45 45-59 ≥ 60 Marital status Never married Ever married Odds ratio adjusted 1.8-4. 32. Majority of the disabled had joint pain and backache (35. only 4. p= <0.2% were skilled workers and 2.4 0.846.5%). both physical and mental disabilities are of great concern in this area. Others were housewife (24.8-138. 2002. Others (73.3 July .Training in the community for people with disabilities. 3. Praveen V. 10 . Ministry of Social Justice and empowerment. it is unlikely that the results are generalisable to similar settings. 1989. the disabled in this part of the country are well placed as far as the family life is concerned.censusindia. International Classification of Functioning.3%) belonged to joint/extended family. Sharma AK. Higher prevalence of mental disability and the proportion of people with multiple disabilities were observed because of detection of even mild mental disability in our study in contrast to other studies2. But in the present study. We could not interview the nonrespondents because of their non-cooperation and nonavailability during our field visits.6%4. 4. In India. Considering the fact that the population in this study had a very high literacy rate and favorable sex ratio. Similarly adjusted OR for unemployment was 15. 3. Various studies have shown that the prevalence of disabilities is found to be significantly high among the individuals suffering from chronic medical conditions11. The present study showed that 75% of the disabled were married and 25% of them were unmarried in contradiction to other studies 8. Disabled in this area are better educated when compared to the disabled people of other areas3. 2008 . The adjusted Odds Ratio (OR) for illiteracy and primary schooling (1-4) revealed that the chance of disability was 30 and 25. World Health Organization. There is an ample scope for community based rehabilitation of the disabled also. Thus Multiple Logistic Regression analysis after accounting for confounding factors showed that illiteracy. In view of the above findings it is concluded that the disabled in this area need community assistance. and occupation had significant association with the disability.8. 2001. Govt. Department of Statistics.September.10. National Sample Survey Organization. primary schooling (1-4) and unemployment were considered as significant factors in association with the disability.html.The present study showed a higher prevalence of disability in comparison to prevalence in general. Community Based Rehabilitation in Primary Health Care System. There may have been recall bias. education and occupation all might act as confounders in association of exposure variables of the study with disability.8. Our study findings are consistent with the results of other studies2.7 times respectively as compared to those with education of above 10 th standard. Data on disability. 6. 2. New Delhi. (Serial online) 9 August 2004. WHO: Geneva.3. about 92% of the disabled lived with their spouse and/ or other members in the family.9. the prevalence in India was 4. Guidelines for evaluation and assessment of mental illness and procedure for certification. Disability and Health: A manual of classification relating to the consequences of disease. Age. As per population data provided by United Nations Population Fund (UNFPA) Geneva 1995. literacy.net/disability/disability_ mapgallery. Census of India 2001. 117: 139-142.7% of the disabled belonged to nuclear family. 26. 2003. Available from: URL: www. WHO: Geneva. Marginally higher prevalence of disability among females in contrast to other studies might be due to favorable sex ratio in this area 3.3. This is because of detection of even mild degrees of disability in our study. World Health Organization . we expect only a minimal effect on our prevalence estimate. Government of India: New Delhi. marital status. Government of India. World Health Organization estimates that 10% of the world’s population has some form of disability1.Ganesh KS et al: Disability in a Rural Area of Karnataka 128 conditions are also more common among disabled. Pure tone audiometry was not used while assessing hearing disability due to feasibility constraints. Indian Journal of Community Medicine 2002. Indian Journal of Public Health Vol.52 No.12. Office of the Registrar general India. It was observed by univariate analysis that the age group. References 1. Since the proportion of non-respondents was very small in our study population. A report on disabled persons. The prevalence was more common among geriatric age group. of India.91 as compared to professionals and skilled. In contrast. 5. recent National Sample Survey Organization report2 and Census data 20013 revealed prevalence as 2%. In view of the above. Ganesh KS et al: Disability in a Rural Area of Karnataka 129 7. Thomas M, Pruthvish S. Identification and needs assessment of beneficiaries in community based rehabilitation initiatives. Action Aid India, Bangalore, 1993. Noveymony MA, Raj SS. A study in the family and socio-economic conditions of the persons with disabilities in Vallioor Panchayat Union. Asian Pacific Disability Rehabilitation Journal 2003; 5(1): 14-20. Kishore MT. Psychiatric diagnosis in persons with intellectual disability in India. Journal of Intellectual Disability Research Jan.2004; 48(1): 19-24. 10. Alan MJ, Branch LG. The Framingham Disability Study. American Journal of Public Health 1981; 71(11): 1211-1216. 11. Joshi K, Kumar R, Avasti A. Morbidity profile and its relationship with disability and psychological distress among elderly people in northern states. Int. Journal of epidemiology Dec. 2003; 32(6): 978-987. 12. Dey AB, Shubha S, Kalpana MN, Jhingan HP . Evaluation of the health and functional status of older Indians as a preclude to the development of a health programme. The National Medical Journal of India 2001; 14(3): 135-138. 8. 9. Announcement We are happy to announce that the IPHA BHABAN is now ready for use. Memebers are welcome to stay at the Bhaban during their official and unofficial visits to Kolkata. The location is very close to the airport and to the Government and Non government offices at Salt Lake. It is also away from the traffic snarls and pollution. We request all members to solicit utilization of the Bhaban and spread the message to all concerned. Type of rooms AC Non AC Dormitory For members Rs. 200 per bed Rs. 150 per bed Rs. 100 per bed For non members Rs. 400 per bed Rs. 300 per bed Rs. 150 per bed Members staying for IPHA Work No charge ,, ,, AC Seminar Room: Rs. 2000/- (for 8 hours), Rs. 500/- for extra 1 hour * Branch will get 30% concession for conducting their official meetings For booking rooms / seminar hall please contact: • • • IPHA HQ, 110, Chittaranjan Avenue, Kolkata – 700073, Phone : 033-32913895. Secretary General, e-mail: [email protected] Care taker: Phone - 09433548860; E-mail: [email protected] Dr. Modhumita Dobe Secretary General, IPHA Indian Journal of Public Health Vol.52 No.3 July - September, 2008 130 Original Article Elimination of Iodine Deficiency Disorders – Current Status in Purba Medinipur District of West Bengal, India A. B. Biswas1, I. Chakraborty2, *D. K. Das3, A. Chakraborty4, D. Ray5, K. Mitra6 Abstract Background and Objectives: Towards sustainable elimination of iodine deficiency disorders (IDD), the existing programme needs to be monitored through recommended methods and indicators. Thus, we conducted the study to assess the current status of IDD in Purba Medinipur district, West Bengal. Methods: It was a community based cross-sectional study; undertaken from October 2006 - April 2007. 2400 school children, aged 8-10 years were selected by ‘30 cluster’ sampling technique. Indicators recommended by the WHO/UNICEF/ICCIDD were used. Subjects were clinically examined by standard palpation technique for goitre, urinary iodine excretion was estimated by wet digestion method and salt samples were tested by spot iodine testing kit. Results: The total goitre rate (TGR) was 19.7% (95% Cl = 18.1 – 21.3 %) with grade I and grade II (visible goitre) being 16.7% and 3% respectively. Goitre prevalence did not differ by age but significant difference was observed in respect of sex. Median urinary iodine excretion level was 11.5 mcg/dL and none had value less than 5 mcg/dL. Only 50.4% of the salt samples tested were adequately iodised (≥ 15 ppm). Conclusion: The district is in a phase of transition from iodine deficiency to iodine sufficiency as evident from the high goitre prevalence (19.7%) and median urinary iodine excretion (11.5mcg/dL) within optimum limit. But, salt iodisation level far below the recommended goal highlights the need for intensified efforts towards successful transition. Key Words: Iodine deficiency, Goitre, IDD, Urinary iodine, Iodised salt Introduction: Iodine deficiency disorders (IDD), spectrum of health consequences due to iodine deficiency are still major public health problems in many countries. One of the most common preventable causes of mental retardation in the world today is iodine deficiency1, 2. An estimated 1571 million people worldwide lives in iodine-deficient environment, and is at risk of IDD3. In India, about 167 million people are estimated to be at risk for IDD, of which 54 million have goitre and over 8 million have neurological deficits 4. Earlier 275 districts in the country have been surveyed for IDD and 235 districts have been found to be endemic5. For prevention and control of IDD iodisation of salt is widely recognised as the most effective and 1Professor, 3Associate sustainable long-term public health measure6 and is being implemented in many countries. In India, compulsory salt iodisation was initiated in 1998 but it was revoked in 2000. However, the government of India from 15th August 2005 has once again imposed the ban on sale and production of non-iodised salt. Besides this, since 1992, IDD control programme has been in operation in all the states of India, including West Bengal with the aim of eliminating IDD as a public health problem. However, International Council for the Control of Iodine Deficiency Disorders (ICCIDD), WHO and UNICEF recommend the progress of such programme in any country needs to be monitored using quantifiable indicators 7. The indicators include: 1. Proportion of households consuming effectively iodised salt (>90%); Community Medicine, B. S. Medical College, Bankura, 2Professor, Biochemistry, Medical College, Kolkata; Professor, 4Demonstrator, Community Medicine, R. G. Kar Medical College, Kolkata; 5Assistant Professor, Biochemistry, Medical College, Kolkata; 6 Health and HIV specialist, UNICEF, Kolkata, West Bengal. *Corresponding Author: [email protected], [email protected] Indian Journal of Public Health Vol.52 No.3 July - September, 2008 Biswas AB et al: IDD in Purba Medinipur, West Bengal 131 2. Urinary iodine: proportion below 100 mcg/lt (<50%) and proportion below 50 mcg/lt (<20%) and 3. Thyroid size: proportion of school children 6-12 years age with enlarged thyroid, by palpation or ultrasound (<5%). Using these indicators and prescribed methodologies by WHO, UNICEF and ICCIDD; during the recent years, studies had been done in six districts (Malda, Birbhum, Dakshin Dinajpur, North 24 Parganas, Purulia and Howrah) of the state 8-13. These studies have reported mild to moderate goitre prevalence in the surveyed districts and variable proportion of adequately iodised salts. In this context, it was decided to have more objective and scientifically valid data in other districts of the state. We thus conducted the present study to assess the status of IDD in Purba Medinipur district of West Bengal with the following objectives: to find out the prevalence of goitre among school children aged 8 to10 years in Purba Medinipur district, to determine the status of urinary iodine excretion (UIE) levels of school children aged 8 to 10 years in the district and to assess iodine content of salts at the household level in the district. Multistage cluster sampling methodology was followed for selecting the study population. We enlisted all the rural & urban population units in the district with their respective population. The 30 clusters i.e. population units (villages/urban wards) to be surveyed were selected using “probability proportional to size” (PPS) sampling method. In each identified cluster all the primary schools were enlisted and simple random sampling was used to select one school for detailed survey. From the sampling frame of all children between 8-10 years of the selected school, 80 children were selected following simple random sampling technique for inclusion in the study. If the sample could not be covered in the school, adjoining school was included to complete the sample of the cluster. Thus a total of 2400 school children were included in the study. Prior intimation was given to the identified school authority one week before the survey to ensure attendance of students. The schoolteachers and children were also briefed about the activities to be undertaken during the survey. A pre-designed pretested schedule was used for data collection. Investigators comprised of faculty members from the Department of Community Medicine, R. G. Kar Medical College, Kolkata and Depar tment of Biochemistry, Medical College, Kolkata, West Bengal. An initial training was imparted to minimise inter observer variation during the survey. Assessment of goitre: The size of the thyroid was determined clinically by standard palpation method and grading of goitre was done according to the criteria recommended by the joint WHO/UNICEF/ICCIDD (Grade 0: No palpable or visible goitre. Grade I: A mass in the neck that is consistent with an enlarged thyroid that is palpable but not visible when the neck is in normal position. It moves upwards in the neck as the subject swallows. Grade II: A swelling in the neck that is visible when the neck is in a normal position and is consistent with an enlarged thyroid when the neck is palpated) 7, 14. Goitre grades I and II together considered as the Total Goitre Rate (TGR). Estimation of urinary iodine excretion level: The recommended sample size for collection of biological specimens, such as urine, is 300 (i.e. 10 children x 30 clusters) 14. Considering 20% dropout/wastage, final sample size of urine samples was decided to be 360 Materials and Methods It was a cross-sectional, school-based study conducted during October 2006 to April 2007 in Purba Medinipur district, West Bengal. The study population was school children of 8-10 years of age. We included this age group because of their combined high vulnerability to disease, easy accessibility & representative ness of their age group in the community. This age group are recommended for assessment of IDD7. No previous data was available on prevalence of goitre in Purba Medinipur district. Thus, the sample size of children to be surveyed was based on the assumed goitre prevalence rate of 50%, 95% confidence interval (CI), a design effect of 3 and a relative precision of 10%. Using these parameters a sample size of 1200 was obtained. But as our intention was to assess the degree of severity also, we decided to double the calculated sample size; thus the final sample size was 2400 children in the age group of 8 10 years i.e. 80 per cluster in a 30 cluster sampling technique7. Indian Journal of Public Health Vol.52 No.3 July - September, 2008 1) 190 (16. d. 360 casual on the spot urine samples (0.7% and 3. West Bengal 132 (i.5% (1261) females.Kar Medical College. No children had UIE value in the moderate or severe range of iodine deficiency. The median UIE level was 11.0) 14 98 (22.7) 8 (n=805) 9 (n=785) 10 (n=810) All (n=2400) * χ2 = 12. In the present study. p=0. Thus. = 2.99.99.3)** 40 173(21. 2400 salt samples were tested with spot iodine testing kit. Overall total goitre prevalence rate (TGR) was 19.f. d. Table 1: Goitre prevalence by age and sex in Purba Medinipur district. of which16.0 ml) were collected in wide-mouthed screw capped plastic bottles (one drop of toluene was added to inhibit bacterial growth and to minimise odour) and stored in a refrigerator at 4oC until analysis.9 mcg/ dL) of iodine deficiency.55. 2008 .4%) had adequate iodine content of ≥ 15 ppm (Table 3).3% and 21. 9 and 10 years old children were17.4% respectively. In the present study.f.5mcg/dL (range = 7. Results: Characteristics of the study population: Of 2400 study children. d.5)** 18 159(20.e.5 to 1.0003). It was revealed that salt with nil iodine content was consumed by 17.1 – 21. all the study children were asked to bring about 20 gm of salt which were routinely being consumed in their respective families.3%. 32.4%) and boys (16. = 1. Prevalence of goitre: Table 1 depicts the prevalence of goitre in Purba Medinipur district.5) 48 283 (22.G. We entered the data in Microsoft Excel and analysed accordingly to find out the outcome variables. (%) 126 141 133 400 15 141(17. About 33. 76. 20. Six urine samples were wasted and finally 354 samples were available for analysis.0003 ** χ2 = 3.5%. West Bengal (n=2400) Age (Years) Male(n=1139) Goitre Grade I II TGR No. Half of the households (50.7% (95% Cl =18.3 July . Urinary iodine excretion levels for 83 (23. Overall age specific goitre prevalence among 8.7%) was significantly different (χ2 = 12. 1896/2400). p=0. 47.7)* Female(n=1261) Goitre Grade I II TGR No. p=0.4)* Combined(n=2400) Goitre Grade I II TGR No.6% children had urinary iodine above the recommended level of ≥ 10 mcg/dL (Table 2). Urinary iodine excretion level: We analysed 354 urine samples for urinary iodine excretion (UIE) levels.September. Goitre prevalence among girls (22. The data entry and analysis was done at R. Iodine content of salts: In the present study. (%) 77 84 74 235 10 87 (22.3 %).Biswas AB et al: IDD in Purba Medinipur.5 – 18 mcg/dL).136). systematic random selection was used to select 12 children from each school for urine collection. d.f. The result was expressed as mcg iodine/dL urine. Iodine content of 2400 salt samples was estimated using spot iodine testing kit.4)** 73 473(19.8% (810) of them belonged to eight. 2240/2400) and Hindu by religion (79%.0% was grade I and grade II (visible goitre) respectively.7% of the beneficiaries and another 32% consumed salt with iodine content of <15 ppm. 33. p= 0. nine and ten years of age respectively.2) 61(17. 12 children x 30 clusters).8) 24 98 (22.5% (1139) were males and 52. the difference was not statistically significant (χ2 =3. (%) 49 57 59 165 5 4 16 25 54 (13.5% (805). = 2.52 No. The Urinary Iodine Excretion (UIE) level was measured by wet digestion method15. among those who were clinically examined.7% (785).2) 75 (20. = 1. Kolkata. Assessment of iodine content of salt: In each cluster.136 Indian Journal of Public Health Vol.4%) of the children were in the mild range (5 – 9.55. Most of the children were from rural area (93.f. and none had concentrations <5 mcg/dL. West Bengal 133 Table 2: Urinary Iodine Excretion levels in the study population in Purba Medinipur district.0 5. 12. In Purba Medinipur district. 76.4% of the children were consuming adequately iodised salt (≥ 15 ppm). 2008 . we found a desirable value for both these two indicators. consumption of iodine from sources other than iodised salts needs also to be studied.7% of goitre respectively8-13. 11. median urinary iodine (11.22 reflecting a transition from iodine deficient to iodine sufficient state.6 Table 3: Iodine content of salts at household level in Purba Medinipur district. while the prevalence of goitre indicates the long-term iodine status in a population23. 18. median urinary iodine values less than the recommended level was reported from three districts in other states (Lakhimpur Kheri and Mainpuri in Uttar Pradesh and Gaya in Bihar) 16 and also from Purulia district of West Bengal 12. Discussion: In the present study. because urinary iodine excretion level reflects the current iodine status. These results indicate that current iodine deficiency does not exist in Purba Medinipur district. 13 and also other states 17. 67. which is far below the recommended goal of > 90% coverage 7. Median UIE level (11. 70%. 13. which was not at all unexpected as analysis of salt samples also revealed around 50% of the children consumed noniodised/inadequately iodised salt. Similar median values of urinary iodine in the desirable range of ≥ 10 mcg/dL were also observed by most of the studies in other districts of West Bengal 8-11.9 ≥ 10 Number 0 83 271 Percentage 0 23. The WHO/UNICEF/ICCIDD have also recommended that no iodine deficiency be indicated in a population when median urinary excretion level is 10 mcg/dL or more i. Dakshin Dinajpur. Malda. North 24 Parganas. 13.7 31. more than 50% of the urine samples have UIE level of ≥ 10 mcg/ dL and not more than 20% of the samples have UIE level of less than 5 mcg/dL7. Overall. revealed prevalence of 11.4 76. signifying that the district Purba Medinipur is mildly endemic for iodine deficiency. 8.4%) district 9.e.Biswas AB et al: IDD in Purba Medinipur.9 50.3%.September. 12.6% of the children had UIE levels in the ranges of optimal iodine nutrition (≥ 10 mcg/dL).7% indicates that the Purba Medinipur district is mildly endemic for IDD.4%. the recommended parameters are to be interpreted cautiously. North 24 Parganas.6%. We found.2%) and Purulia (33.5 mcg/dL) was more than the minimum Conclusion: High TGR of 19.0 – 9. For monitoring progress towards elimination of IDD. 25.4 recommended level of 10 mcg/dL. West Bengal (n = 2400) Iodine content of salts (ppm) Nil < 15 ≥ 15 Number Percentage 424 767 1209 17. 80% and 85% in Dakshin Dinajpur. only 50. Urinary iodine concentrations are the most reliable indicator of IDD. Birbhum. Observation in Purba Medinipur corroborates with most of the other districts in the state. but much higher proportion was reported from other districts viz. However. less proportion was found in Birbhum (37. There may be discrepancies between urinary iodine concentrations and prevalence of goitre. recent studies in six other districts of the state viz.52 No. West Bengal (n = 354) Urinary Iodine Excretion levels (mcg/dL) < 5. However. 20. Compared to this. 17 . as has been followed in the present one. Howrah and Malda respectively 10.22. Analysis of the urinary iodine excretion in the present study indicated inadequate intake of iodine by a substantial proportion of children.1%.3 July . However. But. But less than 5% TGR was found in 9 out of 15 districts studied in 11 states by an Indian Council of Medical Research (ICMR) study 16. Purulia and Howrah using standard methodology. Findings of high TGR and optimal urinary iodine excretion have been reported in most of the earlier studies in India 8-11. an overall goitre prevalence rate of 19.5 mcg/dL) reflects no Indian Journal of Public Health Vol.9% and 13.6%.7% was found. Das DK. Mukhopadhaya S and Chatterjee S.4%) is far below the recommended goal of >90%.S. Editors: H. 7. Kolkata. Biswas AB. Das DK. Nandy S. India. Shrivastava P and Sen S. Persistence of Iodine Deficiency in Gangetic Flood-Prone Area. Journal of Tropical Paediatrics 2006. Interpreting these two indicators together. Chakraborty I. S. J Health Popul Nutr 2002 Jun. WHO. In: Hetzel BS.3 July . 52 (4): 288 . Assessment of iodine deficiency disorders in Purulia district. 14. S.80. 49(2): 68-72. 1-8. India. Iodine deficiency disorders among school children of Malda. West Bengal.O. West Bengal. Iodine deficiency disorders among school children of Birbhum. clinical profile and diagnosis. regular monitoring at household and retailer level through involvement of different sectors need to be strengthened. Manner VMG. West Bengal.developing country concern. Manickam P. Assessment of iodine deficiency disorders in Howrah district. P. Sachdev. for a billion – the nature and magnitude of the iodine deficiency disorders. However. 11. awareness generation for both sale and consumption of iodised salt. Current Science 2004. Kumar S. West Bengal. West Bengal. Asia Pacific Journal of Clinical Nutrition 2006. 1998. eds. Ramakrishnan R. Biswas AB. 2008 . WHO. 1995. 1987: 111. Amsterdam. Sen TK. 15(4): 528 -532 12. SEA/NUT/138. Biswas AB. In: Hetzel BS. West Bengal for their financial and other support to carry out the study smoothly. In: Nutrition in children . Panna Choudhury. Acknowledgements We acknowledge the support and cooperation of the district authorities. New York. Biswas S. Eds. pp 15 – 20. 20 (2): 180183. Department of Health and Family Welfare as well as Department of Primary Education. it may be concluded that the district Purba Medinipur is in a state of transition from iodine deficiency to iodine sufficiency. Towards sustainable elimination of IDD. Government of West Bengal and UNICEF. Eliminations of iodine deficiency disorders in South East Asia. 3. Department of Paediatrics. Chakraborty I. Das DK.O. S. New Delhi. Majumder P and Saha S. Indicators to monitor progress of National Iodine Deficiency Disorders Control 2. pp 3 -29. The school authorities and children of the surveyed schools deserve special mention for their help and much needed cooperation during actual conduct of the study. Pandav CS. 8. Joint WHO/UNICEF/ICCIDD Consultation: Indicators for assessing iodine deficiency disorders and their control programmes. Control of iodine deficiency disorders by iodination of salt: strategy for developing countries. References : 1. India. 245 – 254. (Personal Communication). 1996. Geneva. Indian Journal of Public Health Vol. 46 – 50. 87 (1): 78 . Hetzel BS. Stanbury JB. Hutin Y.Biswas AB et al: IDD in Purba Medinipur. Oxford University Press. Elsevier. 1997.125. Biswas AB. 6. Iodine deficiency disorders epidemiology. Roy RN. The conquest of iodine deficiency disorders.S. 13. adequately iodised salt consumption at the household level (50. Roy RN. Chakrabarty I. Kapil U.The prevention and control of iodine deficiency disorders. 9. 10. Iodine deficiency . Saha I. We express our sincere gratitude to the Department of Health and Family Welfare. Biswas AB. 5. West Bengal 134 existence of current iodine deficiency. The state of the world’s children: focus on nutrition. Ramji S. Chakraborty I. Goitre in India and its prevalence. India. Das DK. Ray S and Kunti SK. 1992. Indian Journal of Public Health. Moulana Azad Medical College. April-June 2005. Delhi. Oxford University Press.September. Biswas AB. disorders among school children of Dakshin Dinajpur district. United Nations Children’s Fund. Chakraborty I. Das DK. Purba Medinipur district. West Bengal. Chakraborty I.52 No. West Bengal.292. Journal of Medical Sciences and Family Planning. Das DK. and Mitra J. 1998. for a billion. Dunn JT. Sarkar GN. 4. West Bengal 135 Programme (NIDDCP) and some observation on iodised salt in West Bengal. Kapil U. Bangalore -560 070. 8:18-20. Banashankari 2nd stage. Bhardwaj AK. Indian Journal of Public Health 1995. Madhumita Dobe Secretary General. Dunn JT. Assessment of iodine deficiency in district Bikaner. J Paediatr 2004. 19. Methods for measuring iodine in urine. Ind. Indian Public Health Association Headquarter Secretariate Registration under Society Act No. Journal of Tropical Pediatrics. 2009 at 6 PM at Meeting Hall of Kempegowda Institute of Medical Sciences (New Campus). 23. Assessment of iodine deficiency in district Hamirpur. and Joubert G. Tandon M and Pathak P. Sharma TD. 35: 831-836. A joint publication of WHO/UNICEF/ICCIDD. Sharma TD. . Micronutrient deficiency disorders in 16 districts of India: part 1 report of an ICMR task force study – district nutrition project. New Delhi. Singh P . Elimination of iodine deficiency disorders in Delhi. Tandon M. Chittaranjan Avenue. Sebotsa MLD. Singh P Dhilon BS and Saxena BN. 35:1008-1011. Kapil U. Toteja GS. Editorial: Current status of Iodine Deficiency Disorders Control Programme. Jooste PL. Sohal KS. Gutekunst R and Dunn D. 39 (4): 141-147. Current status of prevalence of goitre and iodine content of salt consumed in district Solan. Himachal Pradesh. IPHA Indian Journal of Public Health Vol. Goindi G. Kapil U. 81 (1): 28 – 34.September. Kapil U.22. Indian J Matern Child Hlth 1997. 21. Bulletin of the World Health Organiztion 2003. Himachal Pradesh. Kolkata-700073 Notice for 53rd Annual Central Council Meeting The 53rd Annual Central Council Meeting of the IPHA will be held on 8th January. Sohal KS. (Please reconfirm the exact venue and time from the organizers of the conference) Sd/Dr. Kapil U.Biswas AB et al: IDD in Purba Medinipur. 16. October 2000: 264 – 266. 17.52 No. ICMR. Prevalence of goitre and urinary iodine status of primary school children in Lesotho. Rajasthan. 22. Kapil U. 36:1253-1256. 1993. 20. Sethi V. Indian Paediatrics 1998. pp 1. Crutchfield HE. Sharma TD. Himachal Pradesh. Pathak F. 1823. 2001. S/2809 of 1957-58 110. 2008 . Indian Paediatr1999. Assessment of iodine deficiency disorders using the 30 cluster approach in district Kangra. Dannhauser A. 71 (3): 211 – 212. Tandon M. 18.3 July . Sohal KS. 15. Indian Paediatr1998. in. Given the surveillance challenges in India. high poverty levels. Introduction Three years of implementation of IDSP has taught many lessons. syndrome case. First. These five activities must be addressed at the national level and cannot be left up to individual states/districts. interpretation to recognize warning signal of outbreak. poor sanitation. and video conferencing links for communication and training. It has traditionally been difficult to monitor disease burden and trends in India.20@gmail. and reporting of largely aggregate data rather than individual case reporting. electronic data transmission. analysis. *Correspondence: ksuresh@airtelmail. This article looks at the implementation challenges of each of the activities originally planned under IDSP and the changes that occurred over this period as observed by Health (Child) Consultant. having a small list of priority conditions. Keywords: Surveillance.136 Special Article Integrated Diseases Surveillance Project (IDSP) Through a Consultant’s Lens *K. The project is planned to be implemented all over the country in a phased manner with a stress on 14 focus states for intensive follow-up to demonstrate successful implementation of IDSP.com Indian Journal of Public Health Vol. epidemic.52 No. third. develop a system which allows availability of quality test kits at district and state laboratories and /or culture facilities at identified laboratories and a national training program to build capacities for performing testing and obtaining high quality results. public health action. New Delhi. laboratory confirmed case. a simplified battery of laboratory tests and rapid test kits. The project also includes activities that are relatively high technology. In the course of implementation. fueled by factors including a large population. promote surveillance through major hospitals (both in public and private sector) and active surveillance through health system staff and community. probable case. diagnose. 2008 . encourage use of IT infrastructure for data transmission. Summary India has long experienced one of the highest burdens of infectious diseases in the world. The National Institute of Communicable Diseases chosen to provide national leadership may have to immediately address five issues. Suresh1. even more difficult to detect. and institute public health action. consultations and epidemiological investigations. rapid test kits. build capacity for data collation. such as computerization. ksuresh. the project seeks to accomplish its goals through. and problems with access to health care and preventive services. there must be a process established by which an appropriate quality assurance program can be implemented and fifth. routine communication (E-mail etc) and videoconferencing for troubleshooting.3 July . analysis. a few 1Public practical modifications have been affected. second. fourth. In an effort to improve the surveillance and response infrastructure in the country. in November 2004 the Integrated Disease Surveillance Project (IDSP) was initiated with funding from the World Bank. and control outbreaks until they had become quite large. many of which are syndrome-based at community and sub center level and easily recognizable at the out patients and inpatients care of facilities at lowest levels of the health care system.September. The realization of operational ease has led to relocating the administrative unit located in the ministry of health and family welfare (under a Joint secretary) to National Institute of Communicable Diseases (NICD) under the leader ship of its Director in 2006-07. Call Center 24x7 (unique NO: 1075) is functional since beginning of 2008 and videoconferencing with most of the state headquarters is established. The project depended on state for technical human resources {complimenting only information technology (IT) and support staff on contractual basis}. Project Implementation: Project implementation has been lagging by about a year. Making IDSP as part of National Rural Health Mission has the biggest gain of 2007-08. This arrangement facilitated utilizing the services of about half dozen officers (epidemiologists. desegregation of data by age and gender were noted. Most states were visited 1-2 times as against expected quarterly visits. Training of phase I districts have been completed and those in phase II are near completion. Administrative Structure of IDSP: In January 2007 the project was restructured to provide nearly half of the total credit (SDR 21.Suresh K: Integrated Disease Suveillance Project 137 the consultant in the course of his association with the project since March 2006. state and district level. and Entomologists) under NRHM at central. Prepare national guidelines for disease surveillance. Under the project surveillance units have been established at national. The quality of review. Coordinate timely transport of specimens to the regional. select priority conditions for surveillance. However the electronic online data entry. Coordinate Quality Assurance Surveys: Base line quality of laboratories has been completed and internal quality standards along with waste management guideline have been shared. Establish and operate a Central Surveillance Unit (CSU): Central Surveillance Unit will support and complement the state surveillance units (SSUs): Central surveillance unit by now is well established and supported by dedicated NICD officers to the state for periodical visits. and standard case definitions for each of them and methods for surveillance: This task was completed in 2006. An effort to enhance coordination with national disease control programs has begun with rationalization of fever reporting forms with the National Vector Borne Diseases Control program. The operational manuals have been prepared and to a large extent the planned training of the health staff has been completed in these 23 states.September. trouble shooting and facilitating action needs to be improved. Third phase states started activities only in later part of 200708. The first national epidemiological annual report (2006) is ready and the one for 2007 is getting ready. microbiologists and statistical officers) to support dedicated National Program Officer in ensuring enhanced technical support. Adaptation of information technologies is taking shape. national and international laboratories: This task is happening as it used to before IDSP through NICD Microbiology section Analyze data. While it created a good opportunity for the professionals (especially Public Health /Epidemilogists). identify epidemiological trends and prepare national epidemiological situation reports: The data is being received from about 250 districts of phase I &II states and periodical analysis is being done since third quar ter of 2007-08. Microbiologists.52 No. improved state’s oversight and trouble shooting.53 million) for urgent financing requested by Government of India (GOI) for Avian Influenza pandemic prevention and control. Revision of syndromic (‘S’) and probable (“P”) forms by including only select priority specific conditions and eliminating desegregation of data by age and gender recently would facilitate surveillance.3 July . recruitment of qualified people and their orientation for the project activities is going to be challenge for the coming years. but some implementation hurdles like difficulty in collecting passive surveillance data. analysis and transmission have not yet begun. Lack of ownership and quick turn over of the state staff was a challenge and hindering the pace of the progress of the project during first three years. 2008 . leading to creation of 766 dedicated professional positions (Epidemiologist. The quality of training by Indian Journal of Public Health Vol. Supplies of phase one is complete and that for phase II and III is decentralized. state and district levels in 23 states covered under first two phases and the process is underway in phase III states. sub-district and major hospital surveillance is not really established. nurses and pharmacists. v) Implement periodical non-communicable disease surveys/and or their risk factors A.52 No. pharmacists and laboratory technicians and male health workers in sub center and are planning for the same in the 2008 activities. While most SSUs in phase I & II have been able to send monthly collated surveillance information from The SSU’s have been supporting outbreak investigations and specimen transportations. It has been very difficult to get public health consultant and the financial consultants at state level. Gujarat and Karnataka were able to complete the training of all the staff involved in surveillance activities in 2007 and demonstrate the utility. rural health staff @ one worker per sub-center and @ one doctor per PHC because of administrative convenience and no efforts were made to train hospital and dispensary doctors. transport specimens. laboratory coordination. However. All the states in phase I have completed the training as per their PIP whereas most in phase II are nearing completion of training of staff as envisaged in PIP All the states had initially given high priority to .September. non governmental organizations (NGOs) and community. Indian Journal of Public Health Vol. office assistant and accountant). The major hurdle has been the continuity in the State technical officers. and involvement of private sector. alcohol consumption etc) to mount national/state specific advocacy and behavior change communication strategies. attention to surveillance activities. Therefore the district. State-level: i) Establish state surveillance unit (SSU): Each State will establish a SSU headed by technical officer. supported by 3 technical consultants (training. quality of laboratory services etc.Suresh K: Integrated Disease Suveillance Project 138 master training institutes has been evaluated externally and suitable actions being taken on the recommendations. set up) right. Most of the state level officers are struggling in settling their own house (Govt. SSUs are still not in a position to support data analysis as the requisite software is not yet developed by the National Informatics Center (NIC). doctors. It is also a fact that this level officer has many other responsibilities and hence not able to give more than 20-25% of his/her time for IDSP As far as . 2008 . However large numbers of districts are sending weekly reports directly to the CSU also. iii) SSU will prepare and send weekly/monthly summaries of the disease situation to CSU. only about half of them are sending weekly summaries to the CSU. The surveys would capture behavioral variables (like smoking. All states by now have realized the need for training of staff involved in IDSP from hospitals. laboratory coordination and involvement of private sector etc are not getting priority. The key recommendations include more hands on training particularly in filing up the forms of reporting. ii) The emphasis is on integration of disease surveillance activities. The project has envisaged periodical household surveys by states (one third of states each year by rotation) once in 3-4 years. and outbreak investigations. the contractual posts are concerned majority of them are filled up in Phase I and II but there is big turn over due to temporary nature of the post and low pay package. better participatory teaching approaches. As it is a senior level post quick turn over is seen due to superannuation / promotion. finance and procurement ) and 4 support staff from project (data entry operators-2. Realizing the limitation States like Tamil Nadu. vi) Oversee the implementation of IDSP monitor . Integrate and strengthen disease surveillance at State and Districts level: their districts. iv Train state and district level staff. more exposure to real field situations and better involvement of the microbiologists/laboratory technicians.3 July . Negotiations between NICD and Indian Council of Medical Research (ICMR) took longer time than expected and the actual survey was delayed and likely to be completed by September 2008 for the first generation of 8 states. All the states in phase I and II have already established the SSU’s and most in phase III also have established the SSU’s. vi) Support districts in data analysis. September. Most of the districts are able to input the data online. District Vector Borne Diseases control Medical officers or a Deputy Chief Medical (Additional /Assistant) officer of Health at the District Chief Medical office (District Health and Family Welfare Office) has been given additional responsibility of IDSP This again is an impediment for the progress . Community Level: i) Notify the nearest health facility of a disease or health condition selected There is no official formalization of community reporting. The staff (doctors. iv) Initiate investigation of suspected cases/outbreaks & institute public health action. ii) Support health workers during outbreak investigations Most communities do support during outbreak investigations for fear of spread of disease. One thirds of the district are able to involve private sector that too on a small scale. Majority of the districts surveillance units with medical colleges have not been able to negotiate with them for a productive partnership for surveillance and improved diagnostic capabilities.Suresh K: Integrated Disease Suveillance Project 139 Due to quick turn over of both the regular state surveillance officer (SSO) and the contractual technical staff the mechanism of oversight and monitoring of the laboratory services is poor. Karnataka. and involvement of private sector. national tuberculosis control program ( NTCP) etc. vi) Responding promptly to the information provided by the community. On outbreak investigation public health action is invariably taken. office assistant and accountant). NGOs and community. Analyzing surveillance data and feedback during monthly meetings and on visit to the peripheral units has started in states like Gujarat. Integrating the surveillance at the district level is a distant dream due to different developmental status of vertical programs like national vector borne disease control program (NVBDCP). though sometimes community does report to the nearest PHC. Indian Journal of Public Health Vol.3 July . Investigation of suspected cases and out breaks has been initiated in majority of the districts. ii) Analyzing the sur veillance data from the peripheral institutes and providing feedback. It is also a fact that most of these officers do not have public health background. Tami Nadu.52 No. Training of the health staff at the primary health center (PHC)s and sub-centers has been completed in phase I & near completion in phase II. Lack of qualified microbiologists at the district level (except in Karnataka and Maharashtra) has left the oversight and coordination responsibility of laboratories loose. Identifying the outbreak from routine reporting (based on alert of more than expected cases) and taking investigation is still wanting. The system of recording the community information and responding is yet to be developed. Community mobilization and empowerment of community participation for containment measure is still a distant dream. 2008 . Uttarkhand. v) Support for collection and transport specimens to laboratory networks The specimen collection and transportation in a district is mainly done by the district staff. iii) Community mobilization and empowerment for community par ticipation in containment measures. laboratory coordination. pharmacists and lab technicians etc) at the district and sub-district hospitals was taken up in late 2007 and being intensified in 2008. Use of call center is limited to health staff only. of the project as the officer is able to give about one thirds of his time only.The emphasis is on integration of disease surveillance activities. All the states in Phase I &II and some in phase III have established DSU by now. supported by one microbiologist and 4 support staff from project (data entry operators2. iii) Train sub-district health staff District level: i) Establish district surveillance unit (DSU): Each State will establish a DSU in each district headed by medical graduate with a background of Public health. dengue. there is also great diversity of capability and capacity in laboratory services. L3= Regional/State laboratories will carry out all tests to confirm L1 and L2 results and for some state specific diseases (e. testing of human specimens should be limited to those tests for which high quality rapid assays are available (e. TB.g. KFD. internet and www: Real-time on line entry of data at the district level is happening in phase I & II districts.. Peripheral health centers and sub-centers are often performing microscopy (AFB and malaria) should be left at that level. States like Maharashtra and Karnataka have capability and have already embarked on building laboratory capacity for IDSP Where laboratory services . 1. A process for quality assurance needs to be established at each site identified for laboratory strengthening. The laboratories and other stakeholders (medical colleges) are yet have similar facilities. at the Indian Council for Medical Research and at Medical Colleges around the country. They would also have oversight responsibility of L1 laboratories. there is a need to improve quality and to address fundamental problems in the system related to procurement and subsequent distribution of supplies. Presently. In general. there is no place that assures quality of rapid diagnostic kits IDSP had envisaged 4 levels of laboratories namely: L1 = Peripheral laboratories that will have diagnostic facilities for Malaria. iii) Rapid dissemination of health alerts to public. Videoconferencing facilities are established in state headquarters and the CSU is interacting with states periodically. management and analysis of surveillance data using computers. The mechanisms of quality assurance and control of laboratory information is being developed. analysis and links to action: i) ‘Real-time’ on-line entry. Presently. laboratory services exist in a number of categorical programs with limited coordination and. Improve laboratory Support: Currently.3 July . L4= Central and L4 reference laboratories for routine work and specific outbreak investigations.Suresh K: Integrated Disease Suveillance Project 140 Strengthen data quality. TB. leptospirosis). iv) Quality assurance sur veys of laboratory information purchased within the country. 2008 . Collation. Converting state units as teaching ends is under consideration. 3. limited testing should be offered at the district level. DSU and laboratories and other stakeholders E-mail services between CSU. through 24X7 call ser vice center (1075). There is no focal point within this mixture of laboratories to ensure services are available where needed and assure quality of testing. SSU. Typhoid and chlorination of well water and fecal contamination of water. culture should be limited to those laboratories designated as “state” laboratories or facilities where there is a very clear demonstration of sufficient volume of specimens to retain the necessary skills. ii) Email services between CSU. They would also have culture facilities for bacteria and viruses along with drug sensitivity studies. The upgrading of laboratories at the state and district level to improve laboratory support for providing on time and reliable confirmation of suspected cases. As would be expected in a country of great diversity. SSU and DSU are established but need to stabilize.g. L2= District Public health laboratories will carry out tests for Malaria. For example.52 No. analysis using computers and internet is waiting for the development of appropriate software. compounding the problem. health staff and civil societies Rapid dissemination of health alerts to public health staff and civil societies is being developed. there is no apparent perceived need for coordination or leadership at the national level.September. laboratory capacity in India for diagnosis of infectious diseases is fragmented with some capacity at the National Institutes of Communicable Diseases. exist. Typhoid and chlorination of well water and fecal contamination of water primarily to confirm results from L1. and for quality control. monitoring drug resistance The introduction of quality assurance system for laboratories: Establishing External Quality Assurance System (EQAS): 2. Anthrax etc). Indian Journal of Public Health Vol. Leptospirosis. At the district level. Frequent turn-over of state and district surveillance officers also slowed down the effective implementation of surveillance activities. More importantly. The GOI has created positions of epidemiologists. the training under IDSP has to cater to larger need of epidemiologists and Microbiologists able to organize and oversee IDSP activities at state and district level. obtaining information regularly from the larger public hospitals and private sector from the urban areas still remains a challenge for the IDSP The . Scaling down the laboratory strengthening component to make 50 public health laboratories functional during the next 6 months appears to be doable task. on one side there is good opportunity for public health qualified professionals. Vertical programs like NVBDCP and NTCP had supported L1 laboratories up gradation in entire country in last few years. Therefore from 2006 no money is released for renovation unless a definite need is ascertained.Suresh K: Integrated Disease Suveillance Project 141 Based on three years’ experience and challenges in establishing the Public Health laboratories it is now agreed that under IDSP apart from state Public Health Laboratories and specialized laboratories (L3&L4) only 50 District laboratories (2 per focus state and 1 in rest of the states each)will be strengthened to take up Public Health laboratories responsibilities. the ability to analyze and act on the information being generated is critically lacking especially at the district level. Two weeks Field Epidemiology training has been field tested in 2007. Indian Journal of Public Health Vol. The enhanced reporting and investigation of outbreaks by IDSP is an important accomplishment of the project. Revised laboratory strengthening plan of action under IDSP is addressing the regional and referral laboratories. The challenge now is to take to scale both the training. states used the money for renovating and minor additions to physical structure of all laboratories in the districts.52 No. Special emphasis is required on seeking such information from the health providers and different options such as giving mobile telephones to the sub center (SC) reporting units should be explored. Way Forward: Infrastructure strengthening: Despite recent improvements. Training for Disease Surveillance and Action: The project aims to train both in formal and informal sector for disease surveillance.has been strongly recommended by the Bank as well as Centre for Disease Control (CDC) teams that recently reviewed the project. specific training for disease control. the original plan for laboratory strengthening has been revised focusing on making 50 public health laboratories functional and link each district to such labs. and warrants recognition. It is decided to train the Microbiologist and a lab.3 July . Microbiologist and entomologists under the National Rural Health Mission (NRHM). technician from each of the 50 identified laboratories in quality assurance and specific disease tests. and special training of state/district surveillance officers in epidemiology and specialized training in laboratory work. due to limited availability of microbiologists. This would involve training epidemiologist and microbiologists and rapid response team members at the SSU and DSU. However it will be important to further strengthen IDSP capacity for early outbreak detection by emphasis on prompt outbreak reporting to the district surveillance officer.which was not originally envisaged under the project . Piloting of disease surveillance in 4 metro cities needs acceleration to provide lessons for scaling-up urban surveillance in other cities. a specialized cadre of epidemiologists . data management and communications.September. In addition to the routine program trainings as listed above. The challenge is to fill in these posts urgently with motivated people and arrange for their induction training with necessary field epidemiology and microbiology training. Microbiologists and Entomologists. I. NICD need to identify some more regional institutions to take up 2 weeks field epidemiology training in addition to the training of trainers (TOTs) they are already handling. on the other it is going to become a challenge. In the first phase. initiative started to rationalize the weekly reporting forms needs to be implemented to reduce the burden of nonspecific conditions on the surveillance system. Outbreak response: 1. Similarly. It was observed that most of the money was distributed (based on average per unit) without considering the needs of individual laboratories. 2008 . To address this. With GOI sanctioning of 766 posts of epidemiologists. The states need to promote utilization of existing laboratory investigations routinely and also make efforts to improve diagnostic capabilities in these facilities. IDSP should consider 4. media scanning can also be done by a contracted service. and public health response. Conditions to be reported under IDSP IDSP should continue to refine strategies for improving the interpretability of data by emphasizing a) reporting units/data sources most likely to provide usable and impor tant information. 2008 . etc. Doctors in Hospitals with large load of outpatients do not generally demand for investigations to arrive at a diagnosis. results of systematic investigation. it will also be important to improve coordination between IDSP and epidemiology cells/response units. It will also require links to SSU (DSU) for promptly evaluating the information. ARI Acute Gastroenteritis (leaving cholera) etc. Line listing of cases with positive laboratory tests. medical colleges. information about clinical presentation of rare conditions. This will require expanded and standardized recording of information about outbreaks investigated: the number of cases and deaths. to relevant SSU (for follow-up) and CSU (for information and to recognize cross-state outbreaks). Strengthen laboratory diagnosis of cases 1 1. or national units.g. 3. state. Promote reporting of laboratory confirmed data using laboratory investigations reporting forms (Lto L5 forms). as they create a large burden of data collection on the system. However. timeliness of detection and response. L4 and L5) needs streamlining. III. In addition to enhancing detection and prompt reporting of outbreaks. This will require strategic marketing of the system to the providers and health personnel in the area covered by the call center. Media scanning can detect possible outbreaks. Indian Journal of Public Health Vol.g. Revision of P form may consider dropping non-specific and high volume conditions e. Information from calls should be routed simultaneously. diphtheria anti-toxin) and initiating appropriate actions. and adding a column for type of specimen {a cerebrospinal fluid (CSF) or blood culture result is quite different from sputum} will improve the utilization. and the proposed revision of S form to eliminate age and sex breakdown of cases will further minimize burden. private hospitals. access to limited therapy—e. ID hospitals) should report a revised list of conditions using more specific case definitions. but the data are difficult if not impossible to interpret. II. fever.52 No. including epidemiologic characterization and determination of source(s). also. In some states. IDSP should invest substantial efforts to assure the proposed Call Center is effectively implemented. Keeping vigilance on the quality of investigations in these laboratories by external quality assurance mechanism is equally important.Suresh K: Integrated Disease Suveillance Project 142 2. as well as identify rumors which need addressing. c) encouraging laboratory confirmation and laboratory repor ting and d) encouraging consistency in reporting 2. b) enhancing specificity of case definitions. any items noticed can be routed immediately to the appropriate (and possibly multiple) district.g. 3.September. The benefit of a contracted service is systematic. other reporting units (PHC’s. 1. Routine specimen transportation (from outbreaks and hospitals) to the laboratories both in public and private sector system (especially L3. expedited access to reference diagnostic tests. 3. prompt scanning which is not contingent on public health personnel. 2. Continued collection of S form data from subcenters reinforces community engagement with IDSP so that outbreaks at the village level will be recognized and reported through IDSP reporting channels.3 July . web pages. and giving feedback to the provider (e. determining the quality of outbreak investigations should be an essential evaluation component of the project. 4. Although it can be the responsibility of an SSU to systematically monitor local newspapers. for a single SC data collection burden is not too high. hospitals. causative agent. not sequentially. Sentinel Reporting Units 1. At the present. 3. New Delhi November 2006 & May 2007. the World Bank. there will be even greater oppor tunities for frequent communication without difficult travel. 4. the World Bank. and other salmonella species. so that at least some surveillance information is available for these areas. Project Implementation Plan 2004-09. IPHA Indian Journal of Public Health Vol. In addition. Sd/Dr. getting the districts operational will be critical to realize the full impact for IDSP Videoconferencing should . KIMS Hospital Campus. New Delhi November 2007. but it may be particularly important in states that are less advanced in their IDSP activities. V. June 7 2004 The World Bank. or can be supported to have. thus efficiently providing “sentinel” information about a large area. Madhumita Dobe Secretary General.3 July . 2008 . (Please reconfirm the exact venue and time from the organizers of the conference).Puram. References: 1.NICD 2007 Integrated Disease Surveillance Program Annual report. Rapid completion of the network (both for data transmission and for videoconferencing) is urgently needed. 2. Once the system is operational at districts. V. better laboratory and clinical diagnostic facilities. IDSP Mid-Term Evaluation. K. New Delhi-11003 Integrated Disease Surveillance Program Annual report. GOI. they are likely to have. Bangalore . MOH &FW (Department of Health) Nirman Bhavan New Delhi 110001. Targeting reporting units such as strategic hospitals and laboratories is a reasonable priority in all sites. so one may need to accept some degree of duplication in order to have information on the number of laboratory confirmed cases. Indian Public Health Association Headquarter Secretariate Registration under Society Act No. IV.52 No. S/2809 of 1957-58 110. Project appraisal Document. be viewed as an “essential public health tool” for surveillance and for outbreak management. 6. Chittaranjan Avenue. 2009 at 6 PM at Kuvempu Kalakshetra Auditorium. rotavirus.Suresh K: Integrated Disease Suveillance Project 143 collecting reports of positive tests for Hib. 2.September.560 004. These sources are likely to draw more severely ill patients from a large population. Kolkata-700073 Notice for 53rd Annual General Body Meeting The 53rd Annual general Body Meeting of the IPHA will be held on 9th January.Commissioner HFW&ME Gujarat 2007 IDSP Aid Memoirs. Integrated Diseases Surveillance Project. linkage of reports from clinical and laboratory sources is not feasible (outside of the individual patient record).R. 5. Continue to implement initiatives such as urban surveillance and sentinel ID hospitals to target large and strategically located hospitals for special attention as reporting units. 5.Road. pneumococcus. WHO classification of hypertension was taken as operational criteria and data was collected in pre-designed. For the purpose of ever smokers the current smokers and ex-smokers were added together. cardiovascular diseases are recognized as major public health problems by WHO1. The present cross-sectional study was carried out in 2005 among the labourers of different tribes of Chhotaudepur region of Gujarat. Similarly those who reported to have taken alcohol at least once in last one month were considered as current alcohol users. but very few studies have been carried out among labour population especially in India. World is in the stage of epidemiological transition and the non-communicable diseases are overtaking the communicable diseases. Body weight was measured on the weighing scale. Rathwa and Damor tribes.3 July .in. National Institute of Occupational Health. This phenomenon is not only seen in developed countries but is also evident in the developing countries like India. Indian Journal of Public Health Vol. Gujarat. pretested schedule.September. wearing minimum outerwear (as culturally appropriate) and without any footwear. This was followed by measurement of blood pressure. Subjects having hypertension were refereed to the Primary Health Centre of Chhotaudepur for fur ther management. mostly being engaged in labour work. Finally average of two readings was taken. With this background the present study was carried out to find out the prevalence of hypertension as well as different cardiovascular risk factors and to assess association of different risk factors with hypertension if any.52 No. 2008 . and only smoking was found to have significantly associated with it. pre-tested schedule was used to collect data regarding demographic characteristics and different risk factors like smoking and alcohol.co. Height was measured using a non-stretchable tape with 1Scientist C. For the present study all those who have smoked at least one cigarette or bidi in the last one-month period were considered as current smoker while those who have left smoking since ≥1 year were considered as ex-smokers. Blood pressure measurement was done twice on each subject using mercury sphygmomanometer. *Corresponding author: [email protected]%. Overall magnitude of hypertension was found to be 16. Occupational Medicine Division. Two blood pressure readings were obtained on left arm after the subject had rested for at least 5 minutes in a seated position using mercury sphygmomanometer. Ahmedabad. SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg and/or treatment with anti-hypertensive medication were labeled as hypertensive2. From the sampling frame of labour population aged 20 years and above.144 Short Communication Hypertension and Epidemiological Factors among Tribal Labour Population in Gujarat * Rajnarayan R Tiwari1 Summary A cross sectional study was carried out in 2005 to find out the magnitude of hypertension among 154 tribal labourers of Gujarat belonging to Naika. One argument towards this can be non exposure to risk factors like decreased physical activity and obesity among the labourers by virtue of their occupation but other side of the coin suggests that the risk factors like smoking and alcohol consumption is increasing among the lower socio-economic strata. 10 minutes apart. Pre-designed.000 tribal population. The selected villages have about 30. Among the major non-communicable diseases. Though several studies have been carried out among the workers with sedentary lifestyle to assess the risk factors for NCD. height and weight. 154 study subjects were included by simple sampling random technique in the present study. 5 kg/m2 was found to be 38. Similar finding (prevalence 5.1.3 ± 3. 2008 . The distribution of hypertension according to the risk factors is shown in Table 1. There is a plethora of studies suggesting the tobacco smoking as an important and independent risk factor for hypertension and cardiovascular diseases11. 1.05 However a study among tribal “Oraon” population of Orissa revealed lower prevalence of hypertension (4.52.9%. being highest in those over 50 years of age9.025. Percentages were calculated and chi-square test was done using Epi Info software.0) 13 (15.df. 38. Thus to summarize. Out of 154 subjects. It is likely that a systematic and larger study may give better understanding of the prevalence and the underlying risk factors among these workers. >0.5 kg/m2. 8. 1. mean age being 31.5) 9 (25.1% were male while 40. 59. The mean BMI for the females was found to be 19. Majority of the study subjects belonged to less than 25 years of age.September. Body mass index was calculated by dividing the weight in kilograms with the square of height measured in meters.9%. Overall magnitude of hypertension was found to be 16. with the head positioned so that the top of the external auditory meatus was level with the inferior margin of the bony orbit. Body mass index Overweight-pre-obese 9 Non-obese 145 * Included only males the subject in an erect position against a vertical surface.>0.1 years. Although the magnitude of hypertension is age related. <0. p-value 132 22 91 63 35 56 5 86 0.05 0.017. Magnitude of smoking is higher in this study and smoking has been found a significant factor for the occurrence of hypertension.7) 6 (10. Only 9 (5. Recent studies have shown that Asian Indians are particularly susceptible to non-communicable diseases.2% in 1970 to 26.6/1000 population)4. This can be attributed to the epidemiological transition and changing lifestyles.1) 26 (17.Tiwari RR: Hypertension among Tribal Labour Population 145 Table 1: Distribution of hypertension according to different risk factors Risk Factors Age (in years) <45 ≥45 Sex Male Female Smoking history *Ever smokers Never Smokers Alcohol use *Present Absent Number Hypertensives No (%) 23 (17. 1. All the hypertensive subjects were non-obese and this could be due to very low magnitude of obese in the study population.52 No. but the non-significant association of age with hypertension in present study can be attributed to comparatively young age group of study population.9% were female.6) 15 (16.5% have taken alcohol.7) 1 (20.5% of the subjects were ever smokers while only 5.9% in 20007.05 0. this study reveals that the magnitude of hypertension in the tribal labour workers is comparable to the magnitude found in the other Indian studies.05 3.1% which was lower than 47.8%) was also noted by Chadha SL et al5 among Gujaratis residing in Delhi. In the present study the overall magnitude of hypertension was found to be 16.407.2%.4) 3 (13.5) 11 (17.4%) subjects were overweight-pre-obese. >0. Comparison with studies shows that there is a clear increase in magnitude of hypertension in urban Indians from 6.8% and 42.7% as reported in NFHS survey.7±10. Except for smoking all other factors were found to be non-significant.9) χ2. However the mean BMI of the females was similar to that reported in NFHS survey data while the proportion of those females having BMI<18. In contrast a study among primitive tribes of Orissa reported prevalence of hypertension among males and females as 31. respectively6. WHO classification of obesity was used for the categorization3.10. Indian Journal of Public Health Vol.3 July . Indian J Clin Practice 2001:10-25. Published online on 10 April 2008. Gopinath N. http://www. In the official website of WHO. Babu BV. Kerketta AS. 6. Obesity: Preventing and managing the global epidemic. Gopinath N. Sundaram KR. Singh RB. http:// www. Dilip Kumar Das Managing Editor.com/ content/6g424u36581868wq/ last visited on 10th July 2008.springerlink. 42: 878-80. Epidemiological study of coronary heart disease in Gujaratis in Delhi (India). 14: 749-763. 600/. Ramachandran K. Essential hypertension: evaluation and treatment. Chadha SL. 8. For Special issues rates would be negotiable. Integrated NCD management and prevention. 1995. Swain PK. IJPH Indian Journal of Public Health Vol. urinary sodium and body weight in the ‘Oraon’ rural and urban tribal community. WHO Technical Report Series No. J Assoc Physicians India 1971. 2000. 2008 . 10. Malhotra SL. Radhakrishnan S.@ Rs. 4.52 No. Indian J Med Res 1990. Bulliyya G. Suh IL. für Gerontologie und Geriatrie. 92: 424-30. New Delhi.Tiwari RR: Hypertension among Tribal Labour Population 146 References: 1. 19:211-224. 6: 421435. Anand MP Billimoria AR. World Health Organization. Geneva. The rates are suggested as follows: For general issues . Subscribe the Indian Journal of Public Health Annual (4 issues) Subscription Rate: Subscription Category Individual Institutional In India Rs. Nayak RN. Studies in arterial blood pressure in the North and South India with reference to dietary factors in its causation. Ind J Med Res 1992.who.per copy for individual and @ Rs.per year Rs. WHO Technical Report Series No. editors. 11. 9. World Health Organization. India: A clinico-epidemiological study. Ramachandran K.500/per copy for Institution. Anand MP Epidemiology of hypertension. Dash SC. Hypertension: . 96:115-121. J Assoc Physicians India. J Hum Hypertens 2000. 5. J Am Acad Nurse Pract 1994. Publishers / subscription agencies may have 10% discount. 1994. WHO.int WHO. Geneva. Noel H. In: . an international monograph. Blood pressure profile. Dr. Epidemiological study of coronary heart disease in urban population of Delhi. 2000/. Health status of the elderly population among four primitive tribes of Orissa. Singh VP et al.per year Foreign Countries SAARC Countries Other Countries $ 50 per year $ 200 per year $ 100 per year $ 300 per year Minimum subscription should be for one year. Hypertension and stroke in Asia: prevalence. 894. 3. control and strategies in developing countries for prevention.200/.September. Epidemiology and prevention of Cardiovascular diseases in elderly people. 853. Zeitschrift 7.3 July . Without subscription. Mohapatra SS. Chadha SL. Kaul U. 2. individual or institution may have issues of the journal on request subject to availability. microorganisms. Nagpur. The problem is further compounded by various socioeconomic factors like habit of smoking. Therefore this study was undertaken to find out the proportion of chronic respiratory morbidity among the street sweepers and the role of various associated risk factors. occupational history.g.September. cooking fuel and pets. Pretested proforma was used to record the necessary information such as socio-demographic factors. toxins and vehicle exhaust than the recommended norms1-3. Various risk factors studied were age. the 1Department of Preventive and Social Medicine. Unconditional multivariate logistic regression revealed that risk of having chronic respiratory morbidity among street sweepers was 4.52 No. smoking habit. 95 % CI = 1. The present study was designed as a crosssectional study with a comparison group. Therefore a need was felt to study the proportion of chronic respiratory morbidity and the role of various risk factors contributing to chronic respiratory morbidity in this occupational group. Sanjay P Zodpey1 Summary Due to the occupational exposure street sweepers are very much vulnerable to develop the chronic diseases of respiratory system. Due to this occupational exposure they are very much vulnerable to develop the chronic diseases of respiratory system such as chronic bronchitis. street sweepers and comparison group (Class IV workers working in the office buildings). The study was undertaken during November 2003 to January 2005. The study group comprised of all the street sweepers working in Hanumannagar Zone of Nagpur Municipal Corporation (N=273). asthma. International Classification of Diseases version 10 (ICD 10) was used to make the final diagnoses e. Proportion of chronic respiratory morbidity (chronic bronchitis. area of residence.e. 2008 . Maharashtra *Sabde Yogesh D1.75. etc4-8.50) times higher than that in the comparison group and the risk increased significantly with increasing length of service (OR = 1. poor housing conditions. Government Medical College and Hospital.3 July . Corresponding author: ysabde@yahoo. past and present medical history & findings of clinical examination. Maharashtra. J44) defined as presence of a chronic productive cough on most of the days for three months. Street sweepers are exposed to significantly more amount of dust. type of house. asthma and bronchiectasis) was higher (8. in patient in whom other causes of chronic cough have been excluded (Other causes of chronic cough were excluded by sputum microscopy and chest X-ray). in each of the two successive years. socioeconomic status. length of service. etc.147 Short communication Respiratory Morbidity among Street Sweepers Working at Hanumannagar Zone of Nagpur Municipal Corporation. Chronic bronchitis (ICD No.1%).1%) among street sweepers compared to comparison group (2.24 to 14. sex. bronchial asthma and bronchiectasis. India. Standard clinical methods were used and opinion was sought from specialists of Government Medical College Nagpur to confirm the diagnosis. The study included two groups: study group i.24 (95 % CI of OR = 1. Nagpur (N =142).81). As occupational exposure to dust is known to cause chronic respiratory morbidity like chronic bronchitis.09 to 2. the difference being statistically significant.com Indian Journal of Public Health Vol. The comparison group included all the class IV workers working in the office buildings of Nagpur Municipal Corporation. 7) 0. viz.4) (comparison group) working in office ≥30 12 1 (8.3 July .1%).5214 bronchiectasis. The factors which were significant in Final Model 1 at α = 0.0346) among street sweepers (5.4) 0 0. Of Subjects Morbidity Subjects Morbidity these. age. Length of Service (years) There were a total of 273 street 0-9 80 3 (3.9%) as J41 Chronic bronchitis 16 (5. length of service. Indian Journal of Public Health Vol. house. unconditional multiple logistic regression (MLR) analysis was carried out to estimate the adjusted odds Table 2: Distribution of chronic respiratory morbidity ratios (OR) for the abovementioned risk according to age and length of service factors for chronic respiratory morbidity.9156 bronchial asthma and J49 Bronchiectasis 1 (0.8) 1 (0.September.19 103 7 (6. (χ2) test was applied to test the significance. Nagpur and 142 class IV employees 20 . goggles.1) Zone of Nagpur Municipal Corporation. sex. All of them χ2 test for linear trend p < 0. STATA version 8 ≥50 36 5 (13.9) again tested at α = 0. (%) No (%) were identified and included in the Final Model 1. Proportion of chronic respiratory morbidity area of residence.1) 45 2 (4.Sabde YD et al: Respiratory Morbidity among Street Sweepers at Nagpur 148 Table 1 shows the distribution of various respiratory morbid ICD code Morbid Street Comparison conditions among the subjects. socioeconomic status. The other chronic respiratory morbidity included J00 URI 20 (7. the difference being significant statistically (p = 0.0157).25 No.3) 10 (7) 0. cooking fuel and pets. it was found that the proportion was more among street effect of various risk factors on the occurrence of sweepers (8. It Conditions sweepers group P value was observed that the proportion (n=273) (n=142) of chronic bronchitis was No. While considering chronic respiratory morbidity * Statistically significant collectively. the factors significant at α = 0.9) 2 (1.4%).9) significant risk factors. devices like masks. In the This increase was statistically significant when chi second step.8) 48 1 (2. while working. The chi-square increased with increase in age and length of service.8) 35 1 (2.6) 69 2 (2. occupation. smoking habit.05 Age group (years) 20 . etc.4) 0.3613 group (1.52 No. chronic respiratory morbidity was studied in detail. Bivariate analysis was initially done to study the effect of various risk factors associated with respiratory None of the 273 street sweepers was using protective morbidity.1%) than the comparison group (2.49 114 11 (9.29 19 0 13 0 were then included in Final Model 2 and 30 . Street sweepers Comparison group The Full Model of MLR comprised of all (n=273) (n=142) the risk factors included in the study. (%) significantly more (p = 0.8) 42 0 sweepers working in Hanumannagar 10 .05.05 Table 1: Distribution of respiratory morbid conditions among the study subjects participated in the study.3) 7 0 buildings of Nagpur Municipal Corporation. Nagpur.29 78 11 (14.9) 25 0 was used for the analysis of the data.0346* compared to the comparison J45 Bronchial asthma 5 (1. (%) No. 2008 .39 104 6 (5. The factors thus identified were considered to be the 40 . Kromhout H.50) and that for increasing length of service was 1. Ind J of Occup and Environ Med 2004. 2. Murthy NNS. 8(2):11-16. Dudkiewicz B. Thus it is recommended to use protective devices for these street workers to ward off respiratory morbidity. Respiratory symptoms among Danish waste collectors. Gaseous organic emissions from various types of household waste. Nagaraj C. Int J Occup Med Environ Health 2002. 2004. Gehl J. Ann Agric Environ Med 1997. occupation as street sweeper (p = 0.156).021) and increasing length of service (p = 0. These findings were supported by the fact that none of the street sweepers used masks during sweeping. increasing length of service (p = 0.52 No.152). Raaschou-Nielsen O et al also found a significantly higher proportion of chronic bronchitis and asthma in Copenhagen Street Cleaners compared with Cemetery Workers5. 4.204). bronchial asthma and bronchiectasis) was significantly higher among street sweepers than the comparison group subjects. None of the other hypothesized risk factors were found to be significant at α (level of significance) = 0. Cyprowski M. 2008 . and Heederik D. 6. These findings were in agreement with the study conducted among Danish Waste Collectors. Meer G. In full model of unconditional multiple logistic regression analysis (MLR). These factors were lower socioeconomic status (p = 0. 8. 7. Arch Environ Health 1995. Nielsen ML.3 July . 15(3):289301. Ivens UI.019). Hansen J. Nielsen M. References: 1. we identified the risk factors having p value less than 0.8%) was significantly more than that among park workers4. Diggikar UA. Jayanthkumar K.021). Douwes J. 3. The higher proportion of chronic respiratory morbidity among the street sweepers having longer length of their service as a street sweeper could be because of the increasing duration of occupational exposure. A study of morbidity and mortality profile of sweepers working under Banglore City Corporation. Poulsen OM et al. Kerkhof M. Würtz H. Szarapinska-Kwaszewska J. Health status of street sweepers with reference to lung function tests [Dissertation]. where the propor tion of chronic bronchitis (7. Thus the findings of the present study revealed that the proportion of chronic respiratory morbidity (chronic bronchitis.09 to 2.25 in full model of MLR.05.24 (95% CI = 1. Shivram C. 50(3):20713. However to include the marginally significant risk factors in the final reduced model. Environ Health 2004. Ann Agric Environ Med 1997. Heederik D. Tarkowski S. 3:6. 4: 69–74. Ann Agric Environ Med 1997.4:17–19 Wilkins K.Sabde YD et al: Respiratory Morbidity among Street Sweepers at Nagpur 149 square test for linear trend was applied (p<0. Occupational exposure to organic dust associated with municipal waste collection and management. 4:87–89. Trafficrelated air pollution: exposure and health effects in Copenhagen street cleaners and cemetery workers.019).24 to 14. The Odds Ratio for occupation as street sweeper was 4. it was found that the occupation as street sweeper was significantly associated with the proportion of chronic respiratory morbidity (p = 0. Indian Journal of Public Health Vol. and smoking habit (p= 0. occupation as street sweeper (p = 0.75 (95% CI = 1. Towards an occupational exposure limit for endotoxins. Raaschou-Nielsen O. In the final model of multiple logistic regression analysis it was observed that the p value was significant for two factors viz. These results indicated a duration response relationship between the occupational exposure and the outcome as chronic respiratory morbidity. 5.81). Interaction of atopy and smoking on respiratory effects of occupational dust exposure: a general population-based study. Krajewski JA. Pune University.05) (Table 2). Nagraj C et al at Bangalore7 and Diggikar UA at Pune 8 also detected higher proportion of respiratory morbidities among the street sweepers. Breum NO.September. Schouten JP . 150 Short Communication Needle Sticks Injury among Nurses Involved in Patient Care: A study in Two Medical College Hospitals of West Bengal *G. Kolkata. in 52. body fluids and potentially contaminated instruments or wastes. North Bengal Medical College. Das5. 1Associate Professor. Darjeeling.000 to 8.3 July . showed that 61.1% hepatitis B immunoglobulin and none of them received post exposure prophylaxis for HIV. Community Medicine. Chatterjee2. 3Assistant Professor. hepatitis C (HCV) and HIV through occupational injuries during their professional activities1 . The anonymity of the respondents was ensured.com.9% remained unreported to appropriate authorities.00.K.4% of them sustained at least one Needle Stick Injury (NSI) in last 12 months. The data analysis was done using suitable descriptive statistics (rates.S. Upon approval by the administration and getting lists of total 725 such nurses from the nurses’ authorities. 5Assistant Professor. With a random start. After review of literatures on similar studies and getting inputs from experts in epidemiological studies the draft questionnaire was prepared. 92.000 needle stick injuries occur annually among the health care workers. Community Medicine. especially who are exposed to blood. The nurses themselves reported data on their experience in the last 12 months period. 2Assistant Professor. All India Institute of Hygiene & Public Health.280. P. S. Medical College. A.Mandal6 Summary A hospital-based retrospective study on a sample of 228 nurses involved in patient care.September.00. located in a rural area of Darjeeling district and the city-based N. 6Principal. K. The risk of needle stick injury per 1000 nurses per year was calculated as follows: The cumulative incidence of needlestick injuries among all nurses in last 12 months ÷ total number of nurses studied x 1000. and as a result more than 1000 of them contract hepatitis C or HIV.5. The final questionnaire for data collection was prepared after the draft questionnaire was pre-tested among the student nurses. Indian Journal of Public Health Vol. The study period was from May 2004 to April 2005. Medical College & Hospital. *Corresponding author: gkjoardar@rediffmail. Percutaneous injury is the most common method of exposure to blood borne pathogens6. Community Medicine. the detail information about the most recent injury was elicited. ratio and proportion). 2008 . 2. NRS Medical College. in two medical college hospitals of West Bengal. The most affected category of health care workers is the nurses who are involved in 42% to 74% of the reported needlestick injuries1.R. Kolkata. are at high risk of contracting serious blood-borne infections like hepatitis B (HBV) . West Bengal. The study places were North Bengal Medical College & Hospital. The health care workers who deal with patients. C. Joardar1. In case of multiple injuries. Kolkata. one-third of the nurse population was selected for the study.Sadhukhan3.52 No.9% events hand gloves were worn by the nurses. This hospital-based retrospective study was conducted among the nurses involved in patient care to quantify the incidence and risk of needle stick injuries during patient care in the hospital setting and to asses certain aspects of their practice profiles during and after such events. Out of the most recent injuries among 140 nurses. MCH. every third subject from the list was selected by systematic random sampling technique. M.Chakraborty4. In the USA approximately 6. only 5% of those nurses received hepatitis B vaccine. The inclusion criterion was to work in hospital setting uninterruptedly for last 12 months. The risk of such injuries per 1000 nurses per year was found to be 3. 4Professor. Thus a total of 228 nurses comprised the sample size. 280.1) 5(3.7) 75 (53.all of them found non-reactive. and none were tested for hepatitis-C. 7-9.4% (140) experienced at least one needle stick injury in the last 12 months.6% of those nurses were tested for hepatitisB and two were tested positive (HBsAg +ve). 2.7% of the source patients were tested for both HIV and hepatitis-B. Out of the total 228 nurses studied.9% had worn gloves in their hands during the procedures involved.52 No. It was revealed that 92. 10-12 and 13 to ≥ 15 injuries. Regarding specific protection against hepatitis B infection. Lee et al1. Chaudhary and Agarwal from Lucknow (India) observed that 53% of health care workers experienced at least one injury within 0 . only 5% of them received hepatitis-B vaccine and 2.1%. 15. Regarding certain aspects of their practice profiles it was observed that out of those 140 nurses (with their recent injuries).6% were associated with disposable needle & syringe devices. 9. 9. did not draw blood Devices involved Disposable needles Reusable needles Suture Needles Reporting of injuries Reported Not reported Practice during the procedure Used gloves Hand washing after the injure Washed hands with soap & water Received post-exposure prophylaxis Hepatitis B vaccine Hepatitis B immunoglobulin Anti Retroviral Therapy for HIV Tests done on source patients For HIV For Hepatitis B For Hepatitis C Tests done on nurses themselves For HIV For Hepatitis B For Hepatitis C No.9) 129 (92.3% of those injuries were not reported to the appropriate authorities.1% had their hands washed with soap and water after the events. and in almost one-third of the events they were unaware of the reporting procedure. 92.6) 0 of NSI per 1000 nurses per year came to 3.9) 74 (52. Similar studies in different areas of the world showed variations in the proportions of health care workers sustaining needle stick injuries during patient care in the hospital settings. The frequency distribution of the injuries showed that 21. only 5. Compared to 92% non-reporting of injuries (to appropriate authorities).3 July . Regarding post-injury laboratory testing. 52. the present study observed much higher value of 3280 compared to 448 as observed by Jennifer M. 2008 . The cumulative incidence of the needle injury events during the last 12 months was 748. 53.6) 29 (20. Regarding the reasons of non-reporting. in the last 12 months.5% nurses in last one year1. The injured nurses had no knowledge regarding the test results of the source patients. Only 3.1% (n=48) of the nurses were fully immunized with hepatitis B vaccine. and the risk Indian Journal of Public Health Vol.8%. Table no.7% of those nurses sustained 1-3.0) 3 (2. and none for hepatitisC.7) 8 (5. it was observed that only 21. 4-6. as far as the knowledge of the injured nurses.6%. it was revealed that in more than half of the events the nurses had not enough time.7) 10 (7.7) 36 (25. 61.7) 0 3 (2.3% of them drew blood.1) 0 8 (5. Regarding the risk of needlestick injuries per 1000 nurse per year. (%) 118 (84. A study in the USA showed that at least one needle stick injury occurred among 27.1) 130 (92.September. respectively.1% hepatitis-B immunoglobulin. 1 shows that out of 140 most recent injuries all were puncture in nature and 84.Joardar GK et al: Needle Stick Injuries among Nurses 151 Table 1: Profiles of the most recent needle stick injuries and certain aspects of practice among the nurses experiencing the injuries (n=140) Profile Character of injury Puncture.1% for HIV . 70% to 78% non-reporting were observed among nurses in the USA.3) 12 (15.2% and 5. where reporting of all such events is a national mandate1.1) 7 (5.6 years period 8.7% were associated with reusable needles and 25. 20. A study in three tertiary care hospitals in south India showed that 75% of the health care workers sustained at least one injury in last 12 months 7 .7% with suture needles. drew blood Puncture. November. Chaudhary R. strict adherence to universal safety precautions and universal immunization for them with appropriate vaccine(s) like hepatitis-B vaccine.3 July . New Delhi. 21(5): 741-747. Harrison’s Principles of Internal Medicine. Reproductive & Child Health. Bavi P Shenai S. Module for Medical Officers (Primary Health Care) MO (PHC). Rele M.R. 16th edition: 1076-1139.S. Medical College & Hospital. Mc Graw Hill. Current Medical Research & Opinion 2005. ThPeC7488. Journal of Hospital Infection 2003. Fauci. 18th edition: 167 – 175 and 271 281. 2005. Int Conf AIDS 2004 Jul 11-16. 6. Acknowledgement The authors acknowledge their thankfulness to authorities of North Bengal Medical College & Hospital. Lee. none received post exposure prophylaxis (PEP) for HIV 8.Joardar GK et al: Needle Stick Injuries among Nurses 152 The source analysis in a study among 380 health care workers who sustained needle stick injuries (in a tertiary care hospital in Mumbai) observed that 6. Jabalpur (India). 20 (4): 206-207. Dastur F. 3. There is lots of scope in improving their awareness and practices as how to minimize this risk and adverse consequences of such injuries through appropriate IEC activities (including in-service training).52 No. 2008 . Agarwal P Prevalence of Needle . M/s Banarasidas Bhanot. 5. Ghag S. HIV/AIDS Prevention & Awareness (2006). 8. Occupational exposure to sharps and splash: Risk among health care providers in three tertiary care hospitals in south India. 3. References: 1. Tetali S. Needle stick injury in acute care nurses caring for patients with diabetes mellitus. Rodrigus C.September. Kolkata for their support and help 7. National Institute of Health & Family Welfare. Darjeeling and N. Anthony S. 60 (4): 368-373. .Botteman. 2005. 15: abstract no. The nurses involved in patient care in the hospital settings are at great risk of sustaining needle stick injuries and acquiring dreaded blood borne infections like HIV.5% positive for hepatitis B 9. India. Marc F. Sushrutanagar. turbadkar D. Munirka. 2. Park K. 9. Indian Journal of Occupational & Environmental Medicine 2006. Integrated Skill Development Training. William J. A similar study.9% and 3. Clinton Foundation HIV/ AIDS Initiative in association with Indian Medical Association: 45-66 and 111-142. Mehta A. 4. L ars Nicklasson et al. Jennifer M.2% of the sources were positive for hepatitis-B.1%. Physician’s Guide. among 38 health care workers in Mumbai observed that 26. hepatitis-B and hepatitis-C as a consequence of their occupational exposures. Stick injury (NSI) and its knowledge among health care workers in a tertiary care hospital in north India. National AIDS Control Organization. A study conducted in Lucknow observed that out of the 79 health care workers who sustained needle stick injuries. Risk of needlestick injuries in health care workers – A report. Park’s Text Book of Preventive & Social Medicine. Mathur M. Indian Journal of Medical Microbiology 2002. Chaudhary P L. 2002: 489-516. 10: 35-40. HIV and hepatitis-C. Needle stick injuries in a tertiary care centre in Mumbai. Indian Journal of Public Health Vol. Human Immunodeficiency Virus Disease: AIDS & Related Disorders. H. respectively 6. Clifford Lane.3% of the sources tested positive for HIV and 10. Institute of Home Economics. We planned a cross-sectional descriptive study during September 2006 to February 2007. Moreover. It becomes necessary to generate awareness among sports personnel regarding proper nutrition practices. In this perspective.com Indian Journal of Public Health Vol. 2008 . The equation for success in sports is complex. football and kabaddi. Players between 18-25 years of age. Mean energy intake was found to be 1471 + 479 Kcal. In recent times there has been a great emphasis on various aspects of nutrition for sportsmen but a very little attention has been paid to sportswomen. Puri2.3 July . Saini3 Summary A cross sectional study was conducted to assess dietary profile of 100 Delhi based national / state level sportswomen. N. bonafide students of Delhi University Colleges and willing to participate in the study were purposively selected for ease in follow up from Sports Authority of India training centers where camps and practice sessions were organized on regular basis. volleyball and kabaddi at state or national level. This is largely due to lack of opportunities for women in athletic participation and lack of interest and expertise in this area. playing at state or national level. The household measures were then converted to raw food amounts based on the values given by Raina et al3. there is paucity of data on nutrition education interventions among Indian sportsmen2. macronutrients and micronutrients 1Research Nutritionist. hockey. Institute of Home Economics. The energy. The mean macronutrients and micronutrient intakes of all the subjects were much lower than the recommendations. The sample consisted of 100 college sports women participating in different team games – hockey. and especially of sportswomen. participating in team games – volleyball. health status and dietary habits. Improper food choices were also observed in majority. football. Department of Foods and Nutrition. Importance of nutrition in sports should reach all sports personnel to maximise their performance1.September. Proper nutrition forms the foundation for physical performance as it provides both the fuel for biologic work and chemicals for extracting and using potential energy contained within this fuel. The available research findings do not provide adequate information regarding diet pattern and nutritional profile of Indian sportspersons. The subjects were asked to report the food intake over the past 24 hours. University of Delhi. 3Senior Lecturer. S. Food also provides essential elements for the synthesis of new tissues and the repair of existing cells. which included the foods consumed as well as the quantity in household measures. With the Commonwealth Games in 2010 being held in New Delhi. *Corresponding author: jainritu84@gmail. Dietary assessment was done using 24hour dietary recall and food frequency questionnaire. the present study was undertaken in an attempt to study the dietary profile of sports women participating in team games at state or national level. Public Health Nutrition and Development Centre. Physical Education. A pre-tested structured questionnaire was used to gather information on lifestyle patterns.153 Short Communication Dietary Profile of Sportswomen Participating in Team Games at State/National Level * Ritu Jain1. University of Delhi. aged 18 – 25 years. Nutrition thus plays an important role in attaining a high level of achievement in sports. Only 24 percent of the sports women met the recommendations of 60 – 65 energy percent from carbohydrates and 87 percent were consuming more than 25 energy percent from fat. 2Reader.52 No. having training period of atleast one year. it is important to meet the gap in nutrition research in sportswomen and formulate plans for nutrition intervention. It was observed that the mean energy. lifestyle related information.3 (166. paranthas (49%).28-1211. green leafy vegetables (67%).9-114.44 (0.4) 50.20-326. 47 percent of the subjects never took any sports drink for rehydration. Physical activity profile of the subjects was studied by means of 24-hour activity record method.e. The data collected was subjected to qualitative and quantitative analysis using a statistical package for social sciences (SPSS. Items like rice (57%). 60 percent were national level players.9 (3.05) 487.02±0.4) 10.3-26.3 July .8±20. Most frequently consumed beverages by the subjects include tea/ coffee. Pulses either whole or washed constituted an integral part of their daily meal.8) 207. Correspondingly. Table 1 depicts the mean intakes of different nutrients by the study sportswomen.0). Protein foods consumed included pulses. The mean and standard deviations were calculated for energy intakes and intake of other nutrients.79 (72.28 (3. 51 percent of the respondents never took aerated drinks as they provide only empty calories. other vegetables (62%) and seasonal fruits and vegetables (72%). protein.49) 8.8 (82. Even though participating in sports.40) 76. Results Of 100 subjects enrolled. fat. 87 percent and 99 percent of the subjects had their intakes of thiamin.8±246.95 (7.1 ± 16. root vegetables (65%). only 24 percent of the sports women met the recommendations of 60 – 65 energy percent from carbohydrates with 71 percent consuming less than 60 energy percent from carbohydrates.33±488.52) 1. 87 percent of the respondents were consuming more than 25 energy percent from fat.20-2. However.Jain R et al: Dietary Profile of Sports Women 154 contents were then calculated based on Nutritive Value of Indian foods4.3 (15. 24-hour activity record and 24-hour dietary recall were done for the same day to find out the energy balance. Table 1: Mean intakes of various nutrients by the sports women (n=100) Nutrient Energy (kcal) Protein (g) Fat (g) Carbohydrate (g) Calcium (g) Iron (mg) Thiamin (mg) Riboflavin (mg) Niacin (mg) Vitamin C (mg) Vitamin A (mcg) Mean + SD (Range) 1471 ± 479 (629-3429) 46. Data also revealed that 67 percent.9-127. 22 percent of the subjects did not perceive themselves as fit. 2008 .43 (0.September.52 No.1±3. All subjects reported to be consuming vegetables and fruits daily including a variety of these foods in their menu i. Further analysis revealed that 95 percent of subjects used to eat chapatti daily. butter and refined oil were also used daily. riboflavin and niacin respectively lower than one-third of recommended values. It was found that 74 percent subjects met the protein recommendations of 10 – 15 energy percent. health profile and dietary patterns. Energy expenditure for most of the players exceeded their intake thus putting them into negative energy balance. The total daily energy expenditure was calculated using Satyanarayan codes5 that involves estimation of energy expenditure of 9 groups of activities. Almost all the subjects took one or the other beverage to rehydrate themselves after their practice as well as competitions. juices and aerated drinks.7) 609. We tried to further categorize the intakes into the levels of macronutrient adequacy.9-455. Mean vitamin C and calcium intakes of majority of subjects were higher than the ICMR7 recommendations for normal adult female but were lower than the values given by Rao8 for Indian sports people. biscuits (50%) and bread (43%) were consumed frequently.4) 1. Percentages and frequencies of distribution were calculated for the general information.13±0.96±69. carbohydrate and micronutrients intakes of all the respondents were found to be much lower when compared with NIN recommendation 6.93) Indian Journal of Public Health Vol.6±68.4 (14. animal foods and milk and milk products like curd paneer etc.2-1271.36-2. Version 9. Around 60 percent of subjects skipped atleast one of the meals and 40 percent subjects reported changes in their menstrual cycle that could be due to arduous exercise training.28±3. Ghee.33-22. For 15% subjects protein constituted >15 energy percent and the rest (11%) < 10 energy percent. while only 7% subjects met the recommendations of 20 – 25 energy percent from fat. 43: 79103. Thus in order to maximize the physical performance. Decreasing the amount of training or increasing energy intake and body weight restores regular menstrual cycles10. Decreased spinal mineral content in amenorrheic women. NIN / ICMR Recommended dietary intakes for Indian sports men and women. In: Update Growth. Jaffe R. Satyanarayana K. 1985.N. Ramasastri BV and Balasubramanian SC. Chengappa RK. New Delhi for her encouragement and useful discussions during the course of preparation of this paper. J Clin Nutr. 2008 . statistician and the respondents for their cooperation in completion of the work. 1996. Orient Longman 2002. 7. In fact 20 percent of respondents had less than three meals a day. Bhatia. Indian Council of Medical Research. Faulty food choices. Genant H. R. Basic food preparation-a complete manual. Ind J Nutr Dietet 2002. Director.September. their menstrual irregularities could be addressed if their energy intakes were improved in the future as regular menstruation helps to maintain bone mineral density9 and thus women who do not menstruate regularly may have a higher risk for the development of a stress fracture. References: 1. 43: 293 – 303. 5. They repor ted that these three meals included the refreshment provided to them by the camp organizers. Nutritive value of Indian foods. it is imperative to develop information booklets for these players to generate awareness regarding proper nutrition practices. 8. Turksoy . Someswara Rao M. Rao BSN. Fisher E. Varanasi. Gopalan C.Jain R et al: Dietary Profile of Sports Women 155 The findings revealed that many of the subjects were initiated into sports in their early childhood even though it may not be the same sport that they are pursuing at present. the author wishes to express sincere thanks to lecturers in physical education of the selected colleges. Sheila Vir. Since most of the subjects have reported sub optimal energy intakes. 9. 1988. Venkataramana Y. 31 percent of them skipped breakfast.D. 43: 197 – 206. pp 197-205 [K. Diet and bone status in amenorrheic runners. The author is also grateful to Dr. 43: 910. 251:626. Nutrient Requirements and Recommended Dietary Allowances for Indians. JAMA 1984. Raina U et al. Quantitative assessment of physical activity and energy expenditure pattern among rural working women. 3. 1986. Cann C. Nutrition knowledge. Nutrient requirements of sportsperson and athletes. Subhadra K. Sarawathi G.52 No. Ind J Nutr Dietet 2005. 2.3 July . Information could also be elaborated with special reference to the particular game keeping cost factor in mind. preference for junk foods could be the reason and therefore counseling for proper food choices at low cost becomes imperative. Catsos P Meredith C. attitude and practices of competitive Indian sportsmen. Centre for Public Health Nutrition. editors]. Indian Journal of Public Health Vol. India: Banaras Hindu University. Reprint 2004. Indian Council of Medical Research. It was found that the dietary energy was being derived from fat rather than from carbohydrate as fried snacks and namkeens was consumed frequently. Kelkar G. Agarwal and B. Evans W. Third Edition. Meti R. Only 44 percent of the subjects enrolled for the study have regular meals. Am. 4. 10. Impact of nutrition education and carbohydrate supplementation on performance of high school football players. Anuradha A and Narasinga Rao BS. Martin M. Acknowledgements With a deep sense of gratitude. 6. Nelson M. Proc Nutr Soc India. 1990. September.in Indian Journal of Public Health Vol. In Delhi total 28 ICDS blocks are existing. Out of 200 respondents interviewed. 16. With immense success in the initial years it was periodically expanded to the extent that in the Tenth Five Year Plan ICDS scheme was universalized in the whole country1. Meerut. had been launched in 1975 in only 33 blocks on experimental basis. It depends on many factors and one of them is client’s satisfaction. NIHFW. Respondents were comprised of pregnant women. Education and Training Department. 200 beneficiaries were included from 20 AWCs in a period of one and half month. among 200 women respondents selected through stratified random sampling technique.5% (33) pregnant women and 11% (22) lactating women. The cross-sectional community based study was conducted during July-August 2004. 72. till they make sub sample size of 10. followed by the poor quality of the food distributed (66.5% (145) were mothers of the children. The good quality of the services is necessary for acceptability of a programme in a community as it determines how beneficiaries would perceive about the services and make further demand. 5 in rural areas and remaining in urban slums of nine districts. At each AWC. Therefore. It not only enhances the credibility of a worker at the ground level but also generate the demand for the services.7%) and irregular pre school education (57. thus a total of 20 AWCs were included. Davey2. 52. Datta3 Summary The good quality of the services is an important determinant for acceptance of a programme in a community. Client rated quality as ‘very good’ when they found three elements viz Doctors. utilization of services by the beneficiaries and their satisfaction towards services of the AWCs. S. New Delhi *Corresponding author: [email protected] Short Communication Perception Regarding Quality of Services in Urban ICDS Blocks in Delhi * A. lactating mothers and mothers of the children registered with the anganwadi centers. From each zone one ICDS block was selected randomly and five anganwadi centers were selected from each block by systemic random selection technique. For client’s satisfaction critical factor is the quality of services. Though AWCs have long standing reputation among community by its existence but how far it is successful to satisfy the expectations of the end users through its services is not clear. Respondent women were interviewed to ascertain their opinion on various aspects like approachability of AWC. In this paper perception for the quality of the services was assessed through the exit interview of the beneficiaries at the Anganwadi centres (AWCs). Government of Uttar Pradesh. the present study was undertaken to assess perception of the beneficiaries for the quality of the services provided from AWCs.52 No. recognized as the world’s most unique largest community based outreach system for women and child development. But merely increasing the infrastructure/ availability of the services does not increase the utilization of the services from the centre. Facilities and Workers to be of good quality2. The study blocks running in the urban areas are divided into four geographical zones by arbitrary lines. U. every third respondents was interviewed in depth at the exit by open-ended interview schedule.5% respondents were dissatisfied for the services provided from the AWC for one or more reason. 2Medical Officer. total sample size of the respondents was 200. Out of 145 1Senior Resident in Subharti Medical College. 2008 .6%). Integrated Child Development Services (ICDS) scheme. 3Reader. The most common reason mentioned was the not easy accessibility of the AWC and less space available at the AWC (68.co.3 July . Davey1.1%) from AWCs. Thus. 3% of the AWWs were not able to monitor growth of the children4.7%).7) 60 (57. the most common reason being non-accessibility of the AWCs and inadequate space to run AWCs (68. only 42. 47.6% women told they were given health and nutrition education and 5.9) 45 (42.5%) had mentioned various reasons (Table 1).6) 72 (68.September.5% by ANM.4%) dissatisfied respondents due to poor quality of food and 20 of 72 (27.6% mothers told growth monitoring was done of their children in last 6 months. For the 104 children of the preschool age group. indicating their poor approachability in the community. 28. Regarding utilization of services for the children all the mothers mentioned that they received supplementary nutrition from the AWCs. Rest of the 105 dissatisfied beneficiaries (52.6%).3% mothers mentioned about utilization of services for preschool education from the AWCs.2%) and pre-school education was the least common reason (1.Davey A et al: Quality of Services in ICDS in Delhi 157 children (for whom mothers are taken as respondents). 56. Benjamin et al3 reported growth monitoring was rare phenomena in Ludhiana district and Sharma A et al in the national evaluation of the ICDS services had observed that 36. However. Only 15.3% (41) were in the age group of less than 3 years and 71.6) 70 (66. Other studies6. health education (11. 2008 .5% (95) of the respondents were satisfied with the services provided from the AWCs.52 No. Roy S et al had also concluded in their interventional study that lack of conceptual curiosity and skills of the AWWs also limit play way activities at the AWCs 5. Further analysis revealed that. None of pregnant and lactating women had ever received tablet iron and folic acid from the AWCs in last one year and had never been provided antenatal or postnatal care. 20% from neighbors.8%) dissatisfied respondents due non Table 1: Distribution of the respondents by their satisfaction for services provided from AWC (n=200) Variables Satisfied with the services Yes No Reasons for non satisfaction Non-accessibility Less space at AWC Poor quality of food Irregular pre school education No frequent change in recipe No immunization at center Numbers (%) 95 (47. Irregular services of pre school education could be due to secondary emphasis for the monitoring of the AWW performance as primary importance is given to their growth monitoring activities and supplementary nutrition distribution and may be due to non availability of space and lack of education and teaching aids at the AWC. Only 23.5) 72 (68. 44% respondents (88) were illiterate and 56% (112) were literate. 23% said from their mother in law.7% respondents said that their frequency for visit was once in 3 months. Only 5% women came to know about the AWCs through AWWs. Pre school education could be the neglected component of the services delivered from AWC. 22 of 70 (31. immunization services (51. Benjamin et al had also observed less dispensing of Iron and Folic Acid to the pregnant and lactating women by the AWWs in the Ludhiana district 3. 89% of the respondents had mentioned that AWW had visited them in last one year. Reasons for visit were reported to be polio vaccination (69%). however all the mothers.3 July . Overall drive against Polio might have influenced the worker to go house to house. Majority of the respondents (70%) were staying in the area since more than 5 years.1%) mentioned by the respondents. who were not satisfied with the pre school services.5% utilized AWCs for immunization services. Overall.7% (104) in the age group of 3-6 years.8%). 94. but not regularly. nutrition services (11. were satisfied with the overall functioning of the AWCs. 51.5 % of the pregnant and lactating women were mainly utilizing the services for the supplementary nutrition. 12% by helpers and 2.9) accessibility.5% said by themselves. 7 also reported distance/unapproachable state as reasons for non-utilization of services. 37. When beneficiaries were asked about how they came to know about the AWC running in their areas.9 % had utilized services for immunization purposes from the AWCs. so did the respondents mention it as the least common reason.1) 45 (42. were also not Indian Journal of Public Health Vol.5) 105 (52. Health and Population: Perspective and Issues. Nutrition and Food. 3. Parmar P. 4. Madhumita Dobe Secretary General. The certificate can also be collected from the HQ Secretariat at Kolkata personally or through your authorized representative.3 July . Benzamin AI. 6. 1992. Govt. 2002. 28 (1): 25-29. Indian Journal of Public Health 1984. 38:721-731. the Certificate will be sent to you. 7. The impact . Sd/Dr. 5 (1): 20-22. Panda P and Zachariah P Maternal . Jain M. of Rural Health Services in Agra. Indian Journal of Maternal and Child Health 1994 Jan-March. p 341-346. 2.52 No. 1994. Indian Journal of Community Medicine 2006. of India.K. Misra S. Voluntary Health Association of India. and Child Health Services in Dehlon block of Ludhiana district: Results of the ICDS evaluation survey. References: 1.Davey A et al: Quality of Services in ICDS in Delhi 158 satisfied with the services of AWCs. IPHA Indian Journal of Public Health Vol. Qualitative assessment of health seeking behaviour and perception regarding quality of health care services among rural community of district Agra. Agnihotri S P Pandy D N. Bangalore – 560070. Tenth Five Year Plan. Attention All the newly enrolled Life Members of Indian Public Health Association Dear Sir / Madam You are aware that the 53rd All India Annual Conference of IPHA is going to be held from 9th to 11th January 2009 at Kempegowda Institute of Medical Sciences (KIMS). but need to focus to raise satisfaction level of the end users by developing good rapport through periodic survey and delivering optimum level of services. The findings of the present study also indicated that client’s satisfaction about quality influenced the acceptance and utilization of services. Karnataka. 2008 . Nandan D. Therefore. Roy S. function of the AWWs should not be restricted to the distributing of supplementary nutrition to beneficiaries only. you are unable to attend the conference at Bangalore. 17(1-2): 67-85. 31 (3): 140-143. During the conference Life Membership Certificate (MIPHA Scroll) will be distributed. Indian Pediatrics 2001.September. 5. Nandan D. Sharma A. pp 53-57. Sundram. Impact of the intervention programme on the knowledge. State of India’s Health. In case. content and skills of AWW and selected conceptual skills for the pre school. National consultation to review the existing guidelines in ICDS scheme in the field of Health and Nutrition. N R S Medical College. More than one-third of the deliveries (36.5% deliveries and 4. High proportion of newborns. The block had 19 subcenters and have a population of 1.5%. M. S. Singlestage random sampling was used for selection of the mothers. 138 (83.159 Short Communication A Study on Delivery and Newborn Care Practices in a Rural Block of West Bengal *P. supplies and infrastructures since 19722. Several interventions have been adopted to address the unmet needs for Basic Reproductive and Child Health Services. There are considerable local variations in delivery and newborn care practices adopted by the community and interventions must take into account the prevailing practices in the area. Bath-after-delivery was found higher (32. Skilled birth attendance was available in only 14% deliveries (nurse 10. 3Ex-Professor. All 19 subcentres were taken and from each sub-centre 10 mothers were selected randomly. 78. Similar high proportion of home deliveries were observed in other studies like one in Jamnagar.8% deliveries were by friends. Birth-weight was not Professor. Majority of the deliveries. was given prelacteal feeding. attitude and practice of the community as well as the availability and accessibility of the services. 25 mothers denied providing information. 40 – 70% of neonatal deaths are seen during 1st week of life and majority occurs at home.6% deliveries were conducted at home and untrained persons attended 36.in Indian Journal of Public Health Vol.000. 83. were conducted at home. Mandal4 Summary A cross-sectional study was conducted in a rural block of the State of West Bengal to generate area specific data on the proportion of home deliveries and certain newborn care practices prevalent in that area. The health system should urgently address the deficiencies in the delivery and newborn care practices in the study area.4% and doctors 3.0%) in a study in Egypt6. The respondents were mothers. 1Assistant The study was conducted in Basirhat – 1 block of North-24 Parganas district of West Bengal.8%) deliveries took place at government health facilities (Table 1).September.co. Sample size was estimated to be 144 to provide coverage estimate at 95% confidence level and 8% error margin at 40% previous coverage level. to identify the different categories of care providers and to find out the prevailing practices regarding some essential components of newborn care.52 No. Das1.6%).3% deliveries.3 July . Ghosh3. Untrained dais attended 31.6% newborns were given bath within 24 hours of delivery.3%) were conducted by untrained persons. Ghosh2. Birthweight was not recorded in 38. relatives and unqualified practitioners. *Corresponding author: palash_kal@yahoo. The present study was conducted in a rural block of West Bengal to assess the proportion of home deliveries. A.58% newborns. 59. 2Assistant Professor. Only 26 (15. Bath within 24 hours of delivery was given to 17. neonatal morbidity and mortality are considerably high in our country and neonatal mortality accounts for two-third of the infant deaths. Presently in our country only 34% births occur in health institution3 and 42% deliveries are assisted by skilled attendants4. Kolkata. Community Medicine.18%. 17. The study was done through house-to-house survey among 165 mothers who delivered in last six months. who delivered live babies in the last six months (January to June 2005). In spite of all this. West Bengal. Gujrat5. Neonatal care practices depend on the knowledge. 4Principal. It is highly relevant to generate area specific data regarding some of the key delivery and newborn care practices at the community level to initiate appropriate intervention. Finally 165 mothers were studied. Psychiatry.6%) (Table 1). 2008 . A good number of neonatal morbidity and mortality is attributed to improper delivery and newborn care practices1. 2000. 1998-99.ch/ IAMANEH_ISMANEH_Cairo_ 2006 Anmol K Gupta.6%) were low birth weight (Table 2). Dineswas K Dhadwal. Indian Journal of Community Medicine 1998. Ministry of Health and Family Welfare. Suda Yadav. recorded in 63 (38. 5. 3. H. International Institute of Population Science.8%) and honey (51. Breast-feeding was initiated within half-an-hour in 42.6) 83 (81.1%). In 25. Home Neonatal Care Practices in Rural Egypt during 1st Week of Life Md.4) (13.6) 129 (78.6) (10. Reproductive and Child Health Module for Health Workers Female (ANM). it was initiated between halfan-hour to one hour and in 32. Honey was found predominant prelacteal food in another study done at hilly district of North India6 (46.Das P et al: Delivery Practices in Rural Block of West Bengal 160 Table 1: Place of delivery and assistance during delivery (n=165) Factors Place of delivery Home Health Centre Hospital Nursing Home Provider Type: Doctor Nurse Trained Dai Untrained Dai Others Number 138 4 22 1 6 17 62 52 8 (%) (83. Nirman Bhavan.7) (31. New Delhi.6) (2. New Delhi.8) 29 (17. Among 102 (61.6%). 4. Key findings. Rajesh K Sood.52 No. 2000. sugar water (9.1) 84 (51. This was similar (33. National Population Policy. Rajesh K Sharma. A Study on Neonatal Mortality in Jamnagar District of Gujrat. National Family Health Survey (NFHS-2).1% beyond one hour.4% infants.September.6) (3. Varieties of prelacteal feed observed. Bombay.2%) newborns. Surender K Ahluwalia.6) 32 (80.2%). Hussein et al http:/ /www.5%. SS Nagar. USA. Deonar. The practice of prelacteal feeding was found to be highly prevalent (78. Newborn feeding practices were studied and it was found that breast-feeding was almost universally Indian Journal of Public Health Vol. BS Yadav.4) 19 (18.4) 102 (61. 6.2) 70 (42. 19 (18. 134.14%) but sugar water was found to be dominant prelacteal food in Egypt study6. Indian Journal of Community Medicine 1997.79%) among the study population. Breast Feeding Practices in Rural and Urban Communities in a Hilly District of North India. 2008 .5) 53 (32. UNICEF .1) 16 (9.4) 42 (25. New York. References: 1. The state of the World Children 2004. 2001. 23 (3):130-135. 22 (1) : 33-37.8%) newborns where birth weights were recorded. National Institute of Health and Family Welfare.33%) to study done in Jamnagar district of Gujrat5 but very high in comparison to the study result (4.4) (49.0) 14 (2. The health system must urgently address the issues by adopting appropriate behaviour change communication strategies. such as plain water (17. 7. The present study identified several deficiencies in delivery and newborn care practices in the study area. Table 2: Newborn care practices: Bathafter-delivery and birth weight (n=165) Practices Bath-after-Delivery Bath given Bath not given Do not know Birth Weight LBW Normal Total Birth Weight not taken Initiation of breast feeding Within ½ hour ½ .1 hour After 1 hour Prelacteal feeding Honey Sugar water Plain water Total Number (%) 29 (17.gfmer.5) (4. Ajay Vatsayan.8) 63 (38. of India.8) practiced (98.2) 2.0%) obtained from a hilly district of North India7.3 July .4) (0. Govt. 5% of these admissions were from the productive age group of 20-54 years.0 software.g. diagnoses are coded as per International Classification of Diseases.September. 8506 patients were admitted due to infectious and parasitic diseases. Tuberculosis and intestinal infectious diseases represent more than three-fourth of the overall burden in terms of hospital bed days. Bhat1. S. Belgaum based on ICD-10 diagnosed codes devised by WHO. In New Zealand. The most frequent cause was intestinal infections (44. Out of the 21 causes of infectious and parasitic diseases. This is a retrospective study carried out at DCH. and duration of the service provided (expressed in days of hospital stay). 57. Hospital discharge records are important source of data which can provide important information and serve as an essential tool for decision making. Globally waterborne and sanitation-related infections are one of the major contributors to diseases burden and mortality5. This study attempts to find out the distribution of hospitalisation due to infectious and parasitic diseases. 8506 patients admitted were due to infectious and parasitic diseases. Belgaum.0%) followed by tuberculosis (35. 10th Revision (ICD-10). viruses and protozoa are the most common and wide spread health risk associated with drinking water3. The hospital also has a outpatient department (approximately 377000 consultations annually) and a community health department. Indian Council of Medical Research. D. If any patient was readmitted after discharge this was considered as a new patient. frequency of admissions due to the condition. DCH is a major government multi-specialty hospital in Belgaum district having 740 beds and is attached to a medical college.4%). Out of 95655 admissions.3 July . The multiple co-infected patients are included in the frequency distribution based on the primary infection and not counted in other co-infection categories. Tuberculosis is the most important disease in terms of hospital bed days (59.com Indian Journal of Public Health Vol. Karnataka.7%). S. As per World Health Organization (WHO) there are 21 classifications under certain infectious and parasitic diseases 2. C. From discharge certificates two things were noted e. Infectious diseases kill more than 11 million people a year and diminish the lives of countless others6. Nehru Nagar. rates of some infectious diseases continue to remain high for a developed country and there are also large inequities in the distribution of this burden4. Belgaum. Belgaum. Virtually all deaths due to infectious diseases occur in low-and middle-income countries. Kholkute1 Summary To assess the burden of infectious and parasitic diseases on hospital services at District Civil Hospital (DCH) Belgaum. a retrospective study was carried out using discharge records concerning 8506 inpatients due to infectious and parasitic diseases among 95655 patients admitted for all causes during the reference period 2000-2003. Furthermore it is an indicator of early warning signal for impending health problems1.161 Short communication Hospitalisation due to Infectious and Parasitic Diseases in District Civil Hospital. Out of 95655 patients admitted during the four years reference period (2000-2003). Naik1. Data was collected during 2005-06 and analysis made using Statistical Package for Social Sciences (SPSS) version 13. In District Civil Hospital (DCH). The admissions by age showed that proportion of 1Regional Medical Research Centre. *Corresponding author: ashokcnaik@yahoo. 2008 . Karnataka *A.52 No. Infectious diseases caused by pathogenic bacteria. only 5 contributed maximally towards hospital admission. September. intestinal infections with 21. Other bacterial diseases (Septicemia. Although male admissions are more in all the 5 infectious diseases. Leprosy. The present study reveals that the total load in all age groups of intestinal infectious diseases was 44% where as in case of children below 5 years this was higher (72% of 1084 admissions).6% and high ALOS of 13 days.52 No. The total number of children below 5 years admitted was 1084.6 34. evaluation of hospital services and epidemiological studies. etc).6%.9 44. B25–B49. Diarrhea. 2008 .6) 3623 (4.3%) compared to the above four categories of infectious diseases with PMR of 1.1%.6% was the second highest.4) 699 (8. Belgaum. but PMR was considerably high (34%).3) Other Infectious Diseases* 592 (7. In a similar study conducted in Uganda.9%.4) 4746 (5.9) HIV diseases (B20–B24) 380 (4. tuberculosis was the major contributor with 59. gastroenteritis and fever (96%) were more commonly reported among the 9 categories of intestinal infectious diseases in the DCH. Tetanus.Naik AC et al: Burden of Infections & Parasitic Diseases in a District Hospital of Karnataka 162 Table 1: Different parameters for the five leading causes of admissions in District Civil Hospital. HIV and protozoal diseases. Considering the number of bed days occupied disease wise. ALOS=Average length of stay. HIV patients occupied 4.9%.1% of bed days with ALOS of 10 days.3) 312 (10.3) 89375 (100.5%) number of patients.4 100.4% of admissions with a PMR of 44. The admission for tuberculosis was 10.9) 10 (3. etc) also contributed a significant number of bed days with 7.2) 53354 (59.5%.7) 6572 (7.9% compared to other infectious diseases. Even though contribution from other bacterial diseases was only 5.7%) was more commonly reported among 11 categories of protozoal diseases and in 3. other bacterial diseases (Septicemia. however PMR was 7.1% and PMR was very high with 70. Malaria (85.0 Intestinal Infectious Diseases (A00–A09) 3740 (44. Leprosy.5) 53 (13. but it provide important information for planning. The next category was the PMR=Proportional mortality rate. other bacterial conditions also contributed 10.2% of bed days occupied with ALOS of 5 days.7%. childhood diseases as a whole account for less than 15% of the total burden.4% with PMR of 11.0) *Other Infectious Diseases=A20–A28. The highest number of admissions was due to intestinal infectious diseases (72%) with PMR 10. Although hospital data has some limitations.001).1) 2176 (2. A50–B19. Causes Admissions No (%) Bed days No (%) 18904 (21.0) Tuberculosis (A15–A19) 3013 (35. a statistically significant difference between male and female admissions was observed (p<0.7% and average length of stay (ALOS) per patient was 18 days.5) Protozoal Diseases (B50–B64) 280 (3.4) 238 (47.0) ALOS(days) 5 18 13 10 8 8 11 Deaths No (%) 48 (1.0 7. In case of children. Protozoal diseases contributed least (3.4 5.1% cases HIV-TB co-infection was found.2) PMR (%) 6. Percentage of admissions due to HIV was only 4.6 1. Most productive age group (20-54 years) constituted the maximum (57. However the study referred above was carried out after a war and famine while the present study was conducted in normal situation. Tetanus. Using the percentage of hospital bed days (related to both frequency of admission and duration of stay) as a proxy of a condition’s relative burden on hospital services. B65–B99. Tuberculosis with 35.2%.4% (Table-1). Intestinal infectious diseases contributed maximum of 44% with proportional mortality rate (PMR) of 6.6) 38 (6. in case of tuberculosis and intestinal infections. it was observed to be more than one-fourth of the total burden1. Among the 21 classification of infectious and parasitic diseases. These diseases are Indian Journal of Public Health Vol.0) Total 8506 (100.3 July .4) Other Bacterial Diseases (A30–A49) 501 (5. only five contributed towards 93% of burden on hospital services namely intestinal infections. admissions below 5 years of the children constituted 12. tuberculosis. Infectious diseases caused by pathogenic bacteria. However study undertaken in USA has found ALOS for TB patients is 14 days8 which is comparable to our results. Belchad for support in data entry. Mckee M.Naik AC et al: Burden of Infections & Parasitic Diseases in a District Hospital of Karnataka 163 caused by contamination of human/animal feces and pathogenic microorganisms in drinking water. Further. Merriman B. World Health Organization. 8. http:/ /www. http:// www. The integration of preventive and curative care. 1999. Burden of TB on hospital services can also be considerably reduced by proper awareness about DOTS (Directly Observed Treatment Short-course). 17 (no. Atun RA. Jakubowiak. 3. Hansel NN. Climate change and waterborne and vector-borne diseases. Shankar V. 7. and protozoa are the most common. Lukwiya M. Disease Control Priorities Project.dcp2. Report on Infectious Diseases. Chest 2004. J. NZMA 2002. Journal of Applied Microbiology 2003. 1994. References: 1. Hospitalization for Tuberculosis in the United States in 2000: Predictors of In-Hospital Mortality. The Increasing Burden of Infectious Diseases on Hospital Services at St. implementing health education programs. Haponic EF. 4. improving the accessibility of health facilities and the availability of effective treatment. Hunter PR. 6. TB patients require labor intensive care and a high volume of laboratory. International Statistical Classification of Diseases and Related Health Problems.1):98-103. The percentage of admissions due to HIV was only 4. Accorsi S. 5. Clair FM. tenth revision (ICD-10). European Journal of Public Health 2006. Belgaum for permitting to utilize the data. Burden of intestinal infections can be reduced by providing potable water and proper sanitary measures. Coker RJ.int/infectious-disease-report (Accessed on 06/03/2007). 126: 1079-1086. Trop. World Health Organization.org (Accessed on 08/03/2007). 7. HIV patients ALOS was 10 days compared to tuberculosis (18 days) and other bacterial diseases (13 days). Geneva: World Health Organization. The interesting observation in the present study is HIV-TB co-infected patients admission was 3. Keshav Rao of district civil hospital. Infectious diseases. Reform of tuberculosis control and DOTS within Russian public health system: an ecological study. Marx FM. Hyg. Am. 2001. World Health Organization. It is expected that the burden of TB shall be reduced in future as DOTS strategy is being implemented in Belgaum district since 2002.2%)8. Uganda. 2008 . Gulu. the burden of TB in terms of use of hospital services is much higher than its burden in terms of number of admissions. radiology and ancillary services. Fabiani M.1% of the infectious and parasitic diseases which is comparable to the hospital data from USA (3. Changes in Individual Behavior Could Limit the Spread of Infectious Diseases. Mary’s Hospital Lacor. Mattei PD. A re-appraisal of the burden of infectious disease in New Zealand: aggregate estimates of morbidity and mortality.September.3 July . the present study clearly suggests that intestinal infectious diseases and tuberculosis cause maximum burden on hospital services at DCH. are also crucial for controlling infectious diseases. There is an urgent need to control this disease to reduce the hospital burden. Belgaum compared to 57 days in Lacor Hospital. 2. Uganda and 86 days in Russia1. Onek PA.who. Indian Journal of Public Health Vol. Michael B.52 No. Diette GB. Thus. The ALOS for TB patients was 18 days in DCH. viruses.5% of the total admissions. Vinayak Upadhya and Mr. Belgaum which can be reduced by proper and timely interventions. 2006. 4): 154-158. Disease Control Priorities Project. Declich S. Martin T. 64(3. 94:37S-46S. We thank Mr. 115:1-8. Acknowledgments We wish to thank District Surgeon and Mr. In other words. The huge difference between Uganda and Russian studies compared to Indian and USA studies could be treatment policy for TB patients. This paper attempts to discuss the issues in the context of homelessness starting from the definition used to methodology of estimation of their numbers as well as their health problems and health care needs. However. adequate dwelling. Homelessness among youth leads to increased crime and substance use related disorders and is of public concern. and health systems” in different combinations. Initial health impairments and disabilities can lead to homelessness and a vicious cycle of deprivation. Health care providers need to acknowledge that there are an unknown. and often definition has been affected by services and social support provided to them.52 No. 1Centre This paper tries to review issues related to homelessness in general and specifically in the Indian context. The existing number of shelters is inadequate and as there are multiple barriers. Health in homelessness state is compromised by physical environment including hazards of street life. shelter. There is no special health or social programmes or services for this subsection of the society. lack of facilities to maintain personal hygiene1 and increased risk of infectious diseases through crowding. census. poor nutrition. which affects not only the people who are homeless but the whole society. A wider definition of homelessness is the absence of a personal.164 Review Article Homelessness: A Hidden Public Health Problem *S. between studies. homelessness is likely to increase.3 July . Homeless Assistance Act of 19873 of USA defined ‘homeless’ to mean: An individual who lacks a fixed. This problem is not well recognized among the public health professionals. which prevent them to have proper access to the existing health care system. causes. We also did manual search for articles published in un-indexed journals. barriers Introduction Homelessness has major public health implications for not only those affected but also for the general population. Key words used for search were “homeless people. and adequate night-time residence. AIDS etc. Patra1.com Indian Journal of Public Health Vol. regular. There is lack of data on the health problems of homelessness from India. We need to recognize homelessness as a public health problem and attempt to target this group for special care in order to promote equity in health system. New Delhi. An inadequate information base has affected the public health response to homelessness. homelessness is not recognized as a public health problem. Key words: Homeless. and reviewed different research articles both published as well as unpublished. *Corresponding Author: somadattap@gmail. negligence towards disease and enforced lifestyle2.September. 2008 . number of persons who become homeless as a result of a residual impairment and disability and also as being victim of social and economic inequity. but large. health problems. permanent. K. With the changing social and economic scenario. We did a review of literature by searching through electronic database like Pubmed and Indmed and google. Anand1 Summary: Homelessness is a problem. or who has a primary night-time residence that is a supervised for community Medicine. Definition of Homelessness There is wide variation in the definition of homelessness. between countries. Homeless people are potential reservoirs of infectious diseases like tuberculosis. All India Institute of Medical Sciences. victimized persons (domestic violence). regular sleeping accommodations for human beings. Some strategies for enumerating are: one-night counts or point in time.476 persons in the country4. followed by a desire for economic independence. 2008 . beating by parents or relatives.943. or ordinarily used as. In a study. There are 447. as the name suggests is an oxymoron. In India the method adopted was point in time estimation. Point-in-time counts method attempts to count all the people who are homeless on a given day or during a given week. disability. railway platforms. Due to both these reasons. substance use disorders and behavioral problems23-31 are also very high among this subsection of the society (Table 2). magnitude of the problem of the homelessness is likely to be unreliable by point in time method. adaptations of area probability designs. lack of compliance and consistent follow-up often results in disease progression. Counting the Homeless By very nature of their mode of living it is very difficult to enumerate the homeless. their home. Even if the condition is detected and treated. Enumeration of the houseless households was done on the night of 28th February. In Baltimore study2 average number of problems per person in men were 8. and premature death 22. Other persons at risk are single women with young children and unskilled workers9 and people who are victims of natural disaster. has been defined as those who do not live in buildings or census houses but live in the open on roadside. mental health problems. Insufficient research has been done to look for the factors compelling children to make street. Underestimation was to the tune of 63% in Brazil. and flyovers etc where such households were generally found. Remaining 10% are abandoned and neglected children with no family ties10. A uniform definition of homelessness is essential in order to have recognition of the condition and policy towards homelessness.3 July . Capture-recapture methods overcome problems of ascertainment by calculating the size of the unobserved population and completeness of survey.552 houseless households consisting of 1.2. in India. Identifying people who are at risk of homelessness There are a certain subgroups of persons who are of high risk for becoming homeless.3 and in women it was 9. In pediatric homeless population. under flyovers and staircases. This section clearly highlights that there is Indian Journal of Public Health Vol. pavements. and persons who lack sufficient social support 8. service-based designs5. racial discrimination. Another important methodological issue is regardless of the time period over which the study was conducted. Chronic diseases often go unrecognized and untreated21. windshield street surveys. have mental disability. sexually transmitted diseases and chronic diseases12-21 (Table 1). The Census of India (2001) uses the notion of ‘houseless population’.September. railway platforms etc. or those released from prison.Patra S et al: Homelessness: A Hidden Public Health Problem 165 publicly or privately operated shelter designed to provide temporary living accommodations or a public or private place not designed for. morbidity. defined as persons who are not living in ‘census houses’ but are in houseless households. There are many people who experience homelessness at a particular point of time but do not remain homeless. persons with drug and alcohol addiction or health problems. it was found that the most common reason for running away from home was. both parents dead. or in open in places of worship. 2001 when the enumerators on basis of pre identified areas visited places of worships. Health problems of homeless people Studies on health of homeless have found that there are high prevalence of premature death and diseases like respiratory tract disease. extrapolations from partial counts. in hume pipes.52 No. argument with parent etc11. These include persons who live in poverty. many people will not be counted because they are not in places researchers can easily find. Besides physical health problems. Houseless household. The plant-capture method was used to estimate the number of homeless people in southern Manhattan as part of the 1990 US decennial census6 and to estimate number of street children in Brazil7. are to be treated as houseless household 4. we find 90% of street children are working children who live with their families. and prejudices and frustrations on part of health care professionals8.52 No. and 5. India Sao Paulo. Brazil Respiratory Problems Hwang et al15 WHO20 Ropers R etal21 Hwang et al16 1997 1999 1987 1997 Boston London. menstrual irregularities. San Franscico US Boston little data from India on health problems of homeless. Hwang et al15 Hwang et al16 Sexual Health Hwang et al15 Ray Sk etal17 1997 2001 Boston Kolkata. chronic diseases 40% reported at least one chronic health problem Heart disease and cancer were the leading causes of death among persons 45 to 64 years of age health problems and pressure to fulfill needs like obtaining food. 3. were found to cause death in homeless persons 25 and 30 percent of population were reported to be infected with TB. 30.Patra S et al: Homelessness: A Hidden Public Health Problem 166 Table 1: Summary of selected studies on health problems of homeless Domain Authors/ Reference Year Place of Study Major Findings Premature-death MMWR12 MMWR13 Hibbs et al14 1987 1991 1994 1997 2000 Atlanta San Francisco Philadelphia Boston Toronto Median age at death: black men 43.6% for previous hepatitis B infection. Barriers to health care seeking Homeless people are also plagued by multiple internal and external barriers to obtain effective primary care32.7% for syphilis. but 3.September. clothing and shelter as well as lack of self-esteem and feelings of worthlessness. Internal barriers include denial of Indian Journal of Public Health Vol. and 2. Pneumonia and influenza.3% for acute infection by hepatitis B virus. External barriers include unavailable or fragmented health care services.7 for aged 25 to 44 years. 2008 . Prevalences were 1.3 July .3% consistently used condoms. The data are mainly from the western world especially US for many of the health conditions.8% for HIV. 3. One-fifth of homeless adults who had not obtained needed medical care stated that this was due to inability to pay for medical services33.3 for aged 45 to 64 years higher compared to general population AIDS was the leading cause of death among persons 25 to 44 years of age Health problems of women were leucorrhoea.3 for men aged 18 to 24 years.3% and injecting drugs by 3% of them. India Talukdar A et al18 2007 Brito VO et al19 2007 Kolkata. Consistent use of condoms was referred to by 21. white men 53 years Average age at death was 41 years Age-adjusted mortality rate 4 times that of general population Average age at death : 47 years Mortality rate ratios were 8. infertility and STDs and 3/4th of this illness was uncared for. 90% of married homeless men visited Commercial Sex Workers. Available health care facilities: In India we have only shelters for homeless people. p < .9% vs 2.8%) compared to domicile population.5% of the adolescent met lifetime criteria for Post Traumatic Stress Disorder.0%. having experienced serious physical abuse and/or sexual abuse etc.Patra S et al: Homelessness: A Hidden Public Health Problem 167 Table-2: Summary of selected studies on psychosocial and behavioral aspects of homeless Domain Authors/ Reference Year Place of Study Major Findings Substance use disorder and high-risk behavior Shaffer D et al23 1984 New York MMWR13 1991 San Francisco UNDP24 2002 14 states of India Kramer CB et al25 Violence Hwang et al15 Kramer CB et al25 2008 Seattle 70% of the runaways were using illegal drugs Drugs or alcohol were detected in 78% of the study population. Homeless adolescents confront further hurdles stemming from Indian Journal of Public Health Vol.52 No.7% of women 35. Dissociative behavior is widespread among these youth and may pose a serious mental health concern Major mental illnesses were present among 42% of men and 48.8% vs 11.001) 26. These include lack of knowledge of clinic sites. Homeless people have more severe injuries(13. Similar reasons were also found by Heath Need Assessment Survey team of Aashray Adhikar Abhyan 34. Significant correlates were age of adolescent.9% of study children reported to experience physical abuse. P < . Hyderabad (65%). India Australia San Franssico Texas Seattle Baltimore USA Rew L et al29 2003 Mental Health Problems Tyler et al (30) 2004 William R Breakey (2)1989 Whitbeck LB et al (31) 2007 Homeless people frequently lack identification or other documentation to prove indigent status in order to qualify for free or reduced services in mainstream health care settings. and poisoning were the leading causes of death among persons 18 to 24 years of age.6% vs 12.September. the capital of India. In Delhi. assault by burning (17. injuries. being female.8% and drug (59. Mumbai (54%) and Delhi (39%) reported a higher prevalence More abuse of alcohol (80.4% vs 12.3 July . their age and developmental stage.001). By any estimate over 1 lakh people 1997 2008 Boston Seattle Physical Abuse and Victimization Banerjee SR26 2001 Rosenthal D et al27 Kushel MB et al28 2003 2003 Calcutta. Incidence of involuntary sex among homeless young people is considerably higher than in the general population Housing is associated with lower rates of sexual assault among women Sixty percent of the sample reported sexual abuse. 2008 . Homicide. there is a total of 22 temporary and 12 permanent shelters with a capacity of 400034. Out of all substance dependents about 1/4th was homeless. Ahmedabad (83%).2%. fear of not being taken seriously and fears of police or social services involvement36. Often the homeless people are denied services because of their appearance35. For this reason even if needed they are denied treatment under national programmes like RNTCP (Revised National Tuberculosis Control Programme). Institute of Human Behaviour and Allied Sciences34 it was found that homeless population considered visit or these places unfruitful for want of proper identity document and lack of support to guide them through cumbersome procedure. all that we have are mostly supported by voluntary organizations. which are compelling people to lead a life of homeless. Ashray Adhikar Abhiyan (a NGO) counted 52. comprehensive (both curative and preventive component). There is need to improve accessibility and availability of health services in order to serve homeless population. They also need to focus on operational aspects of certain programmes (eg. drug and alcohol treatment etc39. An attitude of dignity is essential when working with people. The Health Care for the Homeless (HCH). in India 5. the magnitude of homelessness. There is urgent need of proper definition and development of proper methodology to have a proper estimate of their number. Fourth. Second there is lack of studies on health problems of homeless people in India. Conclusion In conclusion high mortality and morbidity rate among homeless population are caused by preventable and treatable conditions but health care providers need to be aware of the unique difficulties faced by this subsection. we suggest that 1. The issue of homelessness and health system has not been addressed at all in India. program USA 38 emphasizes a multi-disciplinary approach to deliver services. More or less the shelters just provide physical protection and are not linked to any health intervention programs of the government. Indian Journal of Public Health Vol.3 July .4 lakh at present”37. in cer tain areas of Delhi alone. the shortage of facilities and the legal complications to provide them treatment.765 homeless people. Recommendations In view of all these conditions. Effort should be taken to see that homeless people can also avail this opportunity and its counterpart in urban area needs to be implemented. A national study to provide reliable data on health problems and health care needs of homeless people. Provide motivational training to health providers (Health Workers. immunization and special services for women including family planning. Development of guideline to have a programme. It should include mental health and substance abuse problems. is under defined. affordable (free). 3. and Supervisors) to be more sensitive towards this group. we do not have any proper existing health care services and programmes for homeless. 2008 . many feared past hostile experiences of discrimination and neglect. In one survey undertaken by Aashray Adhikar Abhyan. combining aggressive street outreach with primary care. In June 2000. Third. Even Delhi Development Authority (DDA) admits that at least 1% of the population is homeless. Linking the programme with programmes like National Rural Employment Guarantee (NREG) Act41 which for rural area provides employment opportunities. Medical care facilities for the homeless are inadequate for a number of reasons: first. behavior of the homeless and the inability of the providers to deal with such people. 6. RNTCP) which need to be modified to include this particular group and also to have effective control on the disease. 2. health care services. at this stage we have to learn from the experience of other countries. 4. which should be accessible (outreach services).September. i. 1. The National Urban Health Mission40 should look in to these aspects and identifying and caring for homeless could be one of the activities based incentives identified for the Urban Social Health Activist (USHA).Patra S et al: Homelessness: A Hidden Public Health Problem 168 are homeless in Delhi. who are homeless. mental health and substance abuse services.e.52 No. Medical Officers. antenatal and perinatal care. Public health professionals also need to focus into those social and economic issues. Thus. This programmes should also have preventive component like screening for acute and chronic health problems. Fifth. In Philadelphia and New York City a pilot project has started with aim to identify neighbourhoods from where a disproportionate number of homeless come and focus on activities like job training. (20): 10. 2001. Chatterjee T. O’Connell JJ.a glimpse. Macchia I. In: Wood D. Mitra J. 126:625-8 16. Morb Mortal Wkly Rep. Gurgel CRQ. Nestadt G. 2(1): 37-8. Brazil. USA. of India. 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While NGOs and community-based organizations have a critical role to play in implementing these interventions amongst the various population groups. 2003 Jan – Mar. etc. It has been proved by many studies that the main source of information for AIDS awareness in the student is mass media 2-5 . which connect the city to the railway stations. Indian Journal of Public Health Vol. role plays etc. length network were covered to study informative hoarding. This was quite an astonishing revelation because hospitals are the main places where considerable amount of awareness can be generated through posters. Traveling through various routes in Lucknow revealed the fact that very few banners / hoardings are devoted for the purpose of spreading AIDS awareness. 2. banners & posters displayed providing information about HIV/AIDS. The objectives were to find out the level of efforts made through the mass media to develop the awareness of HIV / AIDS amongst the general population by Best Media Practices and to find out the level of contribution made by hospital and the public places for HIV/AIDS awareness. NGOs etc to develop the awareness through mass media for urban population of Lucknow. network area) only 4 hoardings of AIDS were found. Mass media such as Television. only two hospitals were found to be actively involved in HIV/AIDS awareness through posters/ banners etc. Preferred source of information on AIDS awareness among high school students from selected school in Zimbabwe: Journal of Advance Nursing. the government must shoulder the overall responsibility for planning. In addition to this there was one phone– in program on AIDS. 4 programs on AIDS were telecasted by Doordarshan and only 1 on general health including Kalyani I & II programs. Anochie L. 3 Hindi daily editions and 1 Urdu daily edition. National AIDS Control Organization (NACO) in collaboration with WHO and other international agencies is dedicated and made many efforts to develop the awareness among the people but still prevalence is growing day by day. Lucknow. Sihlangu RH. banners and hoardings. 50 km. during November – December 2005. India intended to conduct a study of efforts made by the government. Growing threat of HIV/AIDS to the people has become a great concern of India and other developing countries.52 No. The number of healthcare hoardings was unexpectedly low. 6 programs on AIDS were broadcasted in the month of November 2005. care. health seminars / programmes. NACO. 12 (1). 1992 April. Hoardings. Seven newspapers were considered. Ikpeme E. airport.171 Letter to the Editor HIV/ AIDS Awareness through Mass Media – the Measurement of Efforts Made in an Urban Area of India Dear Editor. References: 1.) Of 143 contents of different health related issues 52 (27%) were on HIDS/ HIV awareness. Print Media. 50 km. road shows. In view of above.3 July .September. surveys. It indicates that newspaper print media is contributing reasonably adequate for HIV/AIDS awareness. Uttar Pradesh. 27-31. camps. and facilitating the various HIV/AIDS prevention. 17 (4): 507. Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS) and Uttar Pradesh Hospital and Health Administration Reforms Society (UPHHAR). are the first source of information and most effective modes of communication between the media and the general population where as health care providers are less source of information1. out of which 3 were English daily editions. awareness about HIV / AIDS. AIDS awareness and knowledge among primary school children in Port Harcourt Metropolis: Niger Journal of Medicine. Hospital Administration. mobilizing. Only 04% (2 out of 48) efforts have been made by the hospitals to develop the AIDS/ HIV awareness in comparison to other health matters. all widely circulated in the city of Lucknow. Uttar Pradesh. All these were scanned thoroughly for a period of one month (8th November 2005 to 8th December 2005) for the contents such as: general health awareness.13. and treatment services in the country. central government health programmes and miscellaneous (these include articles on rally’s. On the primary channel of All India Radio. coordinating. Radio. The awareness of HIV/AIDS is the prevention of the infection/ disease. 2008 . Ndlovu RJ. Out of the five hospitals visited. Out of the 6 routes covered (approx. The study revealed that only 5% (7 out of 132) contribution is made by the hoarding/ banner on road for HIV/ AIDS awareness in comparison to other health related matters. bus stands covering approx. There is an urgent need to significantly scale-up public health interventions in relation to HIV/AIDS awareness that work (both in terms of coverage and quality) to make a meaningful impact. Six major pre-identified routes. 3) 38(27.8) 129(33. Maswanya E et al. S. So. Hem Chandra.1) 7(9.1) 27(40. Carducci A et al.e. Lucknow.08) Kliegman: Nelson textbook of pediatrics. 2. S.com Indian Journal of Public Health Vol. Japan. Masih.52 No. Jamaluddin. of Paediatrics. attitude and behaviors among Italian male young people: European Journal of Epidemiology 1995 Feb. Mettupalayam. Each child was considered once in spite of multiple visits. significantly greater proportion of children in 5-10 years had severe malnutrition i.2) 14(19. But. in Pondicherry town.7) 5(7. this study needs to be extended to the community to assess the overall scenario. Sanjay Gandhi Post Graduate Institute of Medical Sciences and Uttar Pradesh Hospital and Health Administration Reforms Society.6) 189(49. AIDS related information. Sarkar1. underweight was measured as percentage of the median of NCHS standard.9) 5(2. Child health care in India focuses on the under-fives under national programmes of ICDS and CSSM.1) 38(17. Health Education. drew attention to the needs of adolescents (10-19 years) also. Uttar Pradesh.4) 61(38.September. Faiyaz. 11 (1): 23-31. Women in 13 states have little knowledge of AIDS: National Family Health Survey Bulletin 1995 Oct. Knowledge and attitude towards AIDS among female college student in Nagasaki.pdf (last accessed on 8.00094). References: 1. D. We recommend continuum of care from under-five through 5-10 years to the adolescents by strengthening the school health services. without follow-up or accountability. Profile of the Union Territory of Pondicherry. 2007.5. 5. N.9) 31(43. 4. Kumar Hospital Administration.5) 5-10 yrs Figures in parentheses are row percentages In the union territory of Pondicherry.6) 111(50) 68(30. which in India is very inadequate. 15 (1): 511. 2000 Feb.3 July . K. Weight for age was used to measure undernutrition. This being a primary care centre. Weights of all children less than 10 years was measured by the physicians using a baby weighing machine (pan type) for infants and a personal weighing scale for others in the months of August and September 2007.7) Total 158 222 380 72 66 138 <5 yrs 78(49. We observed that a higher proportion (58%) of 5-10 year old children were malnourished as compared to under-fives (50%). Saunders: Philadelphia. this population is not representative of the children in the community as this was hospital based. K.. This age group is supposed to be addressed by the school health programme. However.3) 8(2. India Correspondence: [email protected]/pdfreports/Gender%20 Profile Pondicherry. Puducherry. < 60% of the expected weight for age (χ2 = 10. Res. The deprivation in nutrition will have longterm implications such as poorer work capacity and reproductive performance in adulthood2.94.Chandra H et al: HIV/ AIDS Awareness through Mass Media 172 3. According to IAP classification. though not statistically significant. PKMC&RI. (2): 1-4. Table 1: Undernutrition in 5-10 year olds as compared to under-fives Age groups F M Total F M Total >80% % of expected weight for age 71-80% 61-70% <60% 16(10. But there remains a gap in delivering health care to 5-10 years old children.nic. 18th ed.8) 18(27. most children in both age groups had minor ailments. Lihiri s et al. L. The total number of children observed was 518. Launch of RCH programme in 1997. p = 0. one of the top achievers of human development in the country having low infant and child mortality rates 1 we compared the nutritional status of 5-10 year old children with underfives attending out patient clinic of Primary Health Centre (PHC). of Community Medicine.1) 54(14. p 228.9) 58(42.4) 16(24.2) 30(21. India Undernutrition in 5-10 Year Olds: Experiences from a PHC in Pondicherry Dear Editor. http:// ncw. 2Dept.1) 20(27.6) 12(8.7) 3(1. Ananthakrishnan2 1Dept. 2008 . Agarwal.