Even partial reduction of biomass fuel use may improve the respiratory health of rural women in Central India

Routine use of biomass fuels in cooking adversely affects respiratory health, but whether partial abolition of the biomass use is also detrimental is unknown. We conducted a cross-sectional study of 760 women in rural central India: 283 used non-biomass fuels (Group A), 225 biomass and other fuels (Group B), while 252 exclusively used biomass fuels (Group C). Robust multivariate analyses adjusted for age, daily cooking time, cooking experience, marital status, overcrowding and education showed that only Group C, and not Group B, had poor respiratory health. Our results indicate that even partial abolition of biomass use may be beneficial.

Prevalence and pattern of childhood morbidity in a tribal area of Maharastra

Previous studies have demonstrated that tribal children suffer from a higher rate of morbidity. Gender discrimination in the form of dietary neglect of the female children has also been noted. The community based cross-sectional study was carried out in tribal PHC Salona of Chikhaldara Block, Amaravati District, Maharashtra to study the prevalence and pattern of morbidities in children. 2603 study children between 0-72 months of age were covered in a house to house survey by the investigator. Parents of eligible children were interviewed using a pre-tested questionnaire for socio-demographic details, personal habits, past and current medical history. The prevalence of overall morbidities was 34.7% and it was higher in female as compared to male children (34.8% vs. 29.7%; chi2 = 9.3, p <0.005). Among individual morbidities, the prevalence of acute respiratory infections was the highest (25.5%) followed by acute diarrhoeal diseases (5.8%), conjunctivitis (1.5%), and skin infections (1.2%).

Cirumstances and motivations for seeking abortions: a community based study in Chandrapur District, Maharashtra

The present population based group comparison study was undertaken to study the circumstances, motivations and influencing factors for seeking abortion in women in Chandrapur District of Maharashtra. Participants of the study included 500 cases of induced abortion and the equal number of normal delivered women during the same period and in the same area as comparison group. Having two children, domestic problems and unwanted pregnancy were conditions acceptable to study subjects to terminate the pregnancy. Family and domestic problems, poor socio-economic status, short inter-pregnancy interval and completed family size were some of the important reasons quoted by study subjects for not desiring to continue the current pregnancy. Majority of the subjects felt that the decision to terminate or keep pregnancy is usually taken jointly by both the husband and wife. Family and domestic problems, poor socioeconomic status and short inter pregnancy interval were the important reasons quoted by abortion cases for seeking abortion in the current pregnancy. Only 1.80% of the cases reported failure of contraceptive method as a cause of seeking abortion services. In 78.4% of abortion cases as compared to 5.4% subjects from the comparison group, pregnancy was un-planned.

Oral submucous fibrosis: study of 1000 cases from central India

BACKGROUND

Very few reports have been published on the gender specificity of oral submucous fibrosis (OSF) in relation to habit patterns and the severity of disease in the world literature. The purpose of the study was to ascertain the gender specificity for different habits and severity of OSF.

METHODS

A hospital-based cross-sectional study on various habit patterns associated with OSF was performed in Nagpur over a 5-year period. A total of 1000 OSF cases from 266,418 out patients comprised the study sample.

RESULTS

The male-to-female ratio of OSF was 4.9:1. Occurrence of OSF was at a significant younger age group (<30 years) among men when compared with women (OR = 4.62, 3.22-6.63, P = 0.0001). Reduced mouth opening, altered salivation and altered taste sensation were found to be significantly more prevalent in women when compared with men. Exclusive areca nut chewing habit was significantly more prevalent in women (OR = 44.5, 25.4-79.8, P = 0.0001). Whereas significant increase for Gutkha (Areca quid with tobacco) (OR = 2.33, 1.56-3.54, P = 0.0001) and kharra/Mawa (crude combination of areca nut and tobacco) (OR = 6.8, 4.36-11.06, P = 0.0001) chewing was found in men when compared with women.

CONCLUSIONS

There is a marked difference in literacy, socioeconomic status, areca nut chewing habits, symptoms and disease severity in women when compared with men in the central Indian population.

Factors responsible for delayed immunisation among children under 5 years of age

Although immunisation coverage has increased substantially in recent years, still a sizable proportion of children are not being immunised at appropriate time. The present hospital based, pair matched, case control study was carried out at immunoprophylactic centre of Government Medical College and Hospital, Nagpur, to identify risk factors associated with delayed immunisation among children. This study included 139 children with a delay of more than 90 days for scheduled primary immunisation and equal number of matched control (for dose) receiving immunisation at appropriate time. The study identified significant association of family size [Odd's ratio (OR) = 7.3, 95% confidence interval (CI) = 1.5-35.6], number of children < 5 years (OR = 3.17, 95% CI = 1.1-9.9), sex (OR = 3, 95% CI = 1.2-7.4), paternal education (OR = 3.7, 95% CI = 1.6-8.5), maternal education (OR = 4, 95% CI = 1.5-10.9), socio-economic status (OR = 3.7, 95% CI = 1.1-13.2) and distance from health centre (OR = 4.7, 95% CI = 1.2-17.6) with delayed immunisation. Negligence (56%) and unawareness (22.7%) of parents were main reasons for delayed immunisation. Hence more stress on identified risk factors in the study will indirectly help in reducing the frequency of delayed immunisation.

A prediction model for moderate or severe dehydration in children with diarrhoea

A hospital-based unmatched case-control study (387 cases and 387 controls) was carried out at the Government Medical College Hospital, Nagpur, India, to devise and validate a risk-scoring system for predicting the development of moderate or severe dehydration in children, aged less than five years, with acute watery diarrhoea. On unconditional multiple logistic regression, 12 risk factors--infancy, minority religion, undernutrition, not washing hands by mother before preparation of food, frequency of stools > 8/day, frequency of vomiting > 2/day, measles in previous 6 months, withdrawal of breast-feeding/other feedings, withdrawal of fluids during diarrhoea, not giving oral rehydration solutions (ORS), home available fluids and both during diarrhoea--were significant. Based on regression coefficients, these factors were ascribed statistical weights of 5, 5, 4, 4, 22, 9, 11, 13, 5, 5, 5, and 7 respectively. The receiver-operating characteristic curve suggested a total score of 48 to be the best cut-off for predicting the development of moderate or severe dehydration. At this cut-off, the sensitivity, specificity, positive predictive value, Cohen's kappa, and overall predictive accuracy were 0.81, 0.81, 0.81, 0.61, and 0.86 respectively. If substantiated by further validation, this system can be used for predicting the development of dehydration at the earlier stage, thereby reducing the mortality associated with life-threatening dehydration.

Dehydrational crisis from severe diarrhoea and risk of age-related cataract

A group matched hospital based case-control study of 463 cases and equal number of controls was carried out at Government Medical College and Hospital, Nagpur to evaluate role of severe dehydrational crisis in age-related cataract development. The overall relative risk of age related cataract in relation to dehydrational crisis from severe diarrhoea was estimated to be 3.10 (2.28-4.20). The overall estimates of attributable risk per cent and population attributable risk per cent were calculated to be 0.67 (0.56-0.76) and 0.26 (0.18-0.35) respectively. In conclusion this study identified significant role of dehydrational crisis from severe diarrhoea in cataractogenesis.

Tobacco consumption practices and risk of oro-pharyngeal cancer: a case-control study in Central India

A hospital based, group matched case control study was conducted with the objective to assess the association between tobacco consumption practices and risk of development of oro-pharyngeal cancer in Central India. The study included 123 cases of oro-pharyngeal cancer, diagnosed on the basis of histopathology at three tertiary care centers in Nagpur city. Each case was matched for age and sex with two hospital controls: one selected from non-cancer patients and another from patients having cancer of other sites. Tobacco chewing (OR=7.98, 95% CI 4.11-13.58) and tobacco smoking (OR=2.25, 95% CI 1.22-3.70) were found to be significantly associated with oro-pharyngeal cancer on unconditional multiple logistic regression analysis. Further analysis revealed a dose-response relationship between increasing frequency, duration and retention time of tobacco in mouth and risk of oro-pharyngeal cancer. Other risk factors which were also found to contribute significantly in the outcome of oro-pharyngeal cancer in the study population were: use of traditional/local substances (eg pan, betel nut, lime) with or without tobacco, use of tobacco containing material for teeth cleaning, type of smoking (eg bidi, chillum, cigarette) and outdoor occupations. High values of estimates of attributable risk percent (ARP) and population attributable risk percent (PARP) confirmed the positive impact of reduction or elimination of the tobacco consumption practices on reducing the risk of oro-pharyngeal cancer in the population of Central India.

Risk factors for cataract: a case control study

The present study was designed as a hospital-based, group-matched, case-control investigation into the risk factors associated with age-related cataract in central India. The study included 262 cases of age-related cataract and an equal number of controls. A total of 21 risk factors were evaluated: namely, low socioeconomic status (SES), illiteracy, marital status, history of diarrhoea, history of diabetes, glaucoma, use of cholinesterase inhibitors, steroids, spironolactone, nifedipine, analgesics, myopia early in life, renal failure, heavy smoking, heavy alcohol consumption, hypertension, low body mass index (BMI), use of cheaper cooking fuel, working in direct sunlight, family history of cataract, and occupational exposure. In univariate analysis, except marital status, low BMI, renal failure, use of steroids, spironolactone, analgesics, and occupational exposure, all 14 other risk factors were found significantly associated with age-related cataract. Unconditional multiple logistic regression analysis confirmed the significance of low SES, illiteracy, history of diarrhoea, diabetes, glaucoma, myopia, smoking, hypertension and cheap cooking fuel. The etiological role of these risk factors in the outcome of cataract is confirmed by the estimates of attributable risk proportion. The estimates of population attributable risk proportion for these factors highlight the impact of elimination of these risk factors on the reduction of cataract in this population.

Risk factors for development of dehydration in children aged under five who have acute watery diarrhoea: a case-control study

OBJECTIVE

To identify factors for development of dehydration in under five year olds with acute watery diarrhoea.

DESIGN

Hospital based unmatched case-control study.

SETTING

Diarrhoea Treatment Unit, Government Medical College Hospital, Nagpur, India.

PARTICIPANTS

The study included 387 cases of diarrhoea having severe or moderate dehydration and 387 controls suffering from diarrhea with mild or no dehydration.

RISK FACTORS

The study included infancy, female sex, religion, residing in urban slums or rural area, under nutrition, cessation of breast feeding during diarrhoeal episode, fluid intake decrease/stopped during diarrhoea, ORS not received, home available funds (HAF) not received, both ORS and HAF not received, non-washing of hands by mother before preparation of food, after defaecation, after disposal of faeces, history of measles in the previous six months, frequency of stools > 8/d, frequency of vomiting more than twice per day and temperature more than 99 degrees F, as risk factors for development of dehydration.

STATISTICAL ANALYSIS

Univariate analysis included OR, 95% CI for OR and Chi-square test. Multivariate analysis was carried out by unconditional multiple logistic regression (MLR).

RESULTS

This study identified the significance of infancy, religion, severe undernutrition, non-washing of hands by mother before preparation of food, frequency of stool > 8/d, frequency of vomiting > 2/d, history of measles in previous six months, withdrawal of breast feeding during diarrhoea, withdrawal of fluids during diarrhoea and not giving ORS, HAF or both during diarrhoea, in the outcome of development of moderate or severe dehydration.

CONCLUSIONS

Timely intervention in the preventable risk factors included in this study may prevent the development of moderate or severe dehydration in the children suffering form acute watery diarrhoea.