Iodine deficiency disorders in Car Nicobar (Andaman and Nicobar Islands).

BACKGROUND: The term 'Iodine deficiency disorders' (IDDs) reflects the spectrum of health effects due to iodine deficiency at all ages. So far, no survey for IDD has been carried out in the Andaman and Nicobar Islands (A&N). Therefore, we aimed to determine the status of IDDs at Car Nicobar Island and to assess the iodine content of salt available for consumption on the island. METHODS: The study population comprised tribal school children between 7 and 18 years of age in government schools of Car Nicobar, A&N. Children were selected from each school by the simple random sampling method using the random number table. The same sampling method was used for each school till completion of the desired sample size for that school. Casual urine samples (in screw-capped plastic bottles for iodine estimation) and blood samples (on No. 3 Whatman filter paper for TSH estimation) were collected from a randomly selected sub-sample of students. Salt samples for iodine estimation were collected from 'captains' (village headman) of each village and the headmasters of the schools and 'canteens' in government retail outlets in the villages. RESULTS: Of the 969 children surveyed, 160 (16.5%) had goitre. The prevalence was significantly more among females (23.6%) than males (9.7%). Analysis of 105 urine samples showed that the median urinary iodine excretion level was 7.0 micrograms/dl. The median TSH values in subjects was 5.7 mU/L. Fifty (82.5%) of the 54 salt samples had adequate iodine (> or = 15 parts per million). CONCLUSIONS: IDDs pose a mild-to-moderate public health problem in Car Nicobar Island. The supply of iodized salt and its iodine content was found to be satisfactory at the time of the study.

Knowledge beliefs and practices regarding iodine deficiency disorders among the tribals in Car Nicobar.

It is estimated that 1,570 million people are at risk of iodine deficiency. Because of the wide spectrum of disorders that IDD includes, and lack of any obvious association between iodine deficiency and its health effects, IDD is not perceived as a major public health problem. For any disease to be effectively controlled, awareness at all levels from community to policy makers is necessary. This study was conducted to assess knowledge, beliefs and practices regarding iodine deficiency Disorders in Car Nicobar districts of Andaman and Nicobar Islands. The population is predominantly tribals involved in coconut plantations. All the village heads of the sixteen villages and parents of 10% of the school children examined for goiter were interviewed. Initial focus group discussions were conducted as no prior knowledge about local names for goitre or other related IDD information was available. The interview schedule was designed in English which was then translated into Hindi and Nicobarese and back translated into Hindi and English. A total of 114 persons were interviewed 60 males, 54 females. The local name for goiter was "Rulo" and 44% felt that it only affected females. No one had correct knowledge of the cause of goiter. About half of the respondents believed that these swellings caused problems. Sixty three (55.3%) of respondents believed that there was treatment, of which 33 said there was medical treatment, 18 respondents said traditional treatment by "LAM-EEN" and 12 felt that both therapies are required. Majority (85%) brought salt samples from the Government canteen. They did not now whether this salt was iodised. Salt was not washed before use and storage practice was satisfactory. The awareness about IDD needs reinforcement. At present the community is a passive participant in the I.D.D. Control Programme.

Economic consequences of HIV/AIDS in India.

BACKGROUND: HIV/AIDS is one of the pressing public health problems in India. Available information indicates a rising trend of infection. The impact of HIV/AIDS on the economic front is important as it affects mainly the young, who are in the reproductive age group. We estimated the cost of productivity losses in a lifetime attributable to HIV-related mortality in India in the population of the year 1991 at current HIV infection rates. METHODS: The analysis was done from the societal viewpoint, adopting a discount rate of 5%. To estimate the loss in person-years due to HIV/AIDS, two scenarios were considered. Firstly, the population without HIV/AIDS, and secondly, the population with HIV/AIDS. The difference in person-years lived by the cohort in both populations would provide the person-years lost due to HIV/AIDS. To calculate the person-years lived in each, the life table approach was used. The demographic data from the 1991 Census were used. The population was divided into 15 five-year cohorts and the current age-specific death rates were used. Assumptions regarding HIV incidence rates in urban and rural areas in different age groups were made based on the available data and consensus of experts. The estimate was first done for a cohort of 100,000 population for rural and urban areas and then extrapolated to the population in the different age groups. To convert the person-years lost into monetary terms, minimum wages were estimated to be Rs 14,460 per annum. RESULTS: The total undiscounted life-years lost due to HIV/ AIDS by the present population of India will be 238.4 million years-123.7 million years for urban and 114.7 million years for rural areas. On an average this is 0.4 years lost per person. The life-years lost per case of HIV was 44.4 years. Assuming minimum wages of Rs 14460 as the value of one year, the total economic loss is Rs 3447 billion. The productivity loss per case is Rs 642,024 (US$ 20,710). For an estimated national per capita income of Rs 4252.4 the total economic loss is Rs 1014 billion. If a discount rate of 5% is applied for future losses then the total potential years of life lost will be 23 million-11.3 million for urban and 11.7 million for rural areas. In monetary terms this will be Rs 332.6 billion by minimum wages assumption, and 97.8 billion if the national per capita income is assumed to be the cost of one year. CONCLUSION: HIV/AIDS imposes a significant burden on the economic front. The productivity losses are likely to be an underestimate as the costs of treatment of HIV/AIDS patients, prevention programmes and labour costs have not been taken into account. To decide whether HIV/AIDS needs a high priority int he Indian context, it is necessary to have similar estimates for other important diseases such as tuberculosis and cancer.

Cost of health services provided at a primary health centre.

BACKGROUND. Information on the cost of health services is essential for good planning and management and leads to an efficient use of resources. Very little information on this is available in India. We estimated the distribution of costs incurred on the Primary Health Centre, Chhainsa, Haryana by the type of service provided and their average unit costs. METHODS. We calculated the total costs incurred in running the primary health centre for one year using standard costing methods. This cost was apportioned under different heads on the basis of time and space utilization. The number of activities carried out, between April 1991 and March 1992, was obtained from the monthly reports of the centre maintained by the health assistant and supervised by the medical officer. RESULTS. The total cost incurred for one year was Rs 777,020 (US$ 24,250). Curative care accounted for 32% of the total costs followed by communicable disease control (17%), child care (17%), maternal care (11%) and family welfare (10%). An expenditure of Rs 24 was incurred on each outpatient. The cost of giving full primary immunization to a child was estimated at Rs 131, while Rs 127 was incurred on providing antenatal, natal and postnatal care to each pregnant woman. Tuberculosis-related activities in the community cost Rs 3 per head per year and malaria-related activities Rs 2 per head per year. The cost incurred annually on family welfare services to an eligible couple was Rs 19. CONCLUSIONS. Our findings suggest that the cost estimates from this primary health centre are comparable with the estimates from other developing countries. These cost estimates may be used to determine user fees by health agencies or for premiums for community health insurance schemes.

Factors influencing prevalence of breastfeeding in a resettlement colony of New Delhi.

Influence of some family and maternal characteristics on prevalence of breastfeeding was studied in a cross sectional study using WHO suggested methodology. 547 mothers with children less than three years of age were interviewed with the help of a schedule. Age and parity of the mother, sex of the child, length of urban stay, mother's going for work did not influence the prevalence of breastfeeding. Prevalence was higher among illiterate mothers and mothers belonging to lower socio-economic status. The mothers from higher socio-economic status initiated breastfeeding earlier. More mothers from higher socio-economic status and those with better education thought that supplementation was needed before the child was 4 months old and felt that breastfeeding was needed for less than two years.

Breast feeding practices in a resettlement colony and its implications for promotional activities.

The mothers of 547 children less than three years of age were interviewed for breastfeeding practices using WHO suggested methodology in a resettlement colony of South Delhi. Only 1.8% of children were never breastfed. Prelacteal feeds were given in 90.9% of infants. More than half received their first breastfeed on 3rd day or later. Among children under three months of age, one third were already receiving top milk. 68.4% of mothers felt that the child should be breastfed for as long as possible. Demand feeding was practised by 95% of the mothers. Most of the mothers did not seek privacy to breastfeed their children. The need to identify desirable and undesirable infant feeding practices prevalent in an area has been stressed so that appropriate promotional activities can be carried out more effectively.

Supplementary iron dose in pregnancy anemia prophylaxis.

This study was conducted to determine the optimum dose of supplemental iron for prophylaxis against pregnancy anemia. One hundred and ten pregnant women were randomly allocated to three groups: Group A receiving equivalent of 60 mg, group B 120 mg and Group C 240 mg, elemental iron as ferrous sulphate daily; the content of folic acid was constant in all the three groups (0.5 mg). These women had at least consumed 90 tablets in 100 +/- 10 days. Blood was drawn at the beginning and at the end of the treatment. Fifty percent were anemic (less than 11 g/100 ml). The hemoglobin levels rose similarly in all groups and the differences were statistically not significant. Fifty-six percent had depleted iron stores (serum ferritin value less than 12 micrograms/l) at the beginning of the study. Following therapy a statistically significant increase in iron stores was observed in group B and C as compared to group A. The difference between group B and C was not significant. The side effects increased with increasing doses of iron; 32.4%, 40.3% and 72% in group A, B and C respectively. Based on these findings, the authors advocate that optimum dose of iron should be 120 mg instead of 60 mg as is currently being used in the National Nutritional Anemia Prophylaxis Programme.