Epidemiology of childhood overweight & obesity in India: A systematic review.

Background & objectives: Childhood obesity is a known precursor to obesity and other non-communicable diseases (NCDs) in adulthood. However, the magnitude of the problem among children and adolescents in India is unclear due to paucity of well-conducted nationwide studies and lack of uniformity in the cut-points used to define childhood overweight and obesity. Hence an attempt was made to review the data on trends in childhood overweight and obesity reported from India during 1981 to 2013. Methods: Literature search was done in various scientific public domains from the last three decades using key words such as childhood and adolescent obesity, overweight, prevalence, trends, etc. Additional studies were also identified through cross-references and websites of official agencies. Results: Prevalence data from 52 studies conducted in 16 of the 28 States in India were included in analysis. The median value for the combined prevalence of childhood and adolescent obesity showed that it was higher in north, compared to south India. The pooled data after 2010 estimated a combined prevalence of 19.3 per cent of childhood overweight and obesity which was a significant increase from the earlier prevalence of 16.3 per cent reported in 2001-2005. Interpretation & conclusions: Our review shows that overweight and obesity rates in children and adolescents are increasing not just among the higher socio-economic groups but also in the lower income groups where underweight still remains a major concern.

A community-based study of menstrual hygiene practices and willingness to pay for sanitary napkins among women of a rural community in northern India.

Background. Hygiene-related practices of women during menstruation are of paramount importance. There is a lack of sizeable literature on menstrual practices from northern India. We documented the menstrual hygiene practices of rural women and assessed their willingness to pay for sanitary napkins. Methods. A cross-sectional study was done in villages under the Comprehensive Rural Health Services Project (CRHSP), situated in Ballabgarh, Haryana. The study participants were women in the age group of 15–45 years. Nine villages were selected randomly while the number of respondents in each selected village was decided through the probability proportionate to size sampling method. The households were selected using systematic sampling. One woman was interviewed in each household using a pre-tested questionnaire. Results. A total of 995 women were interviewed. A majority of them (62%) were unaware of the reason(s) for menstruation. The role of the health sector in providing information regarding menstruation was low as only a few women (1.5%) had got information from the auxiliary nurse midwife (ANM)/health worker (HW). For the majority of women, besides religious activities, other routine activities did not suffer during menstruation. Only 28.8% of women were using sanitary napkins and of those who did not use napkins, only one-fourth (25.3%) were willing to buy them. The mean (SD) price per napkin that these women were ready to pay was `0.54 (0.43), equivalent to US$ 0.01. Conclusion. Women in the reproductive age group should be provided with appropriate information about menstruation, and they should be told about the advantages of using sanitary napkins. Health sector functionaries should play a proactive role in the delivery of such information.

Enseñanza de salud pública durante la formación médica en la India / Undergraduate teaching of public health in medical colleges of India

Introducción: La Salud Pública, Medicina Comunitaria o Medicina Preventiva y Social, como se la conoce habitualmente en las facultades de medicina de India, es una materia importante en términos de su relevancia para la salud. Objetivo: En este estudio se intenta ofrecer una visión general de la enseñanza de Medicina Comunitaria en el nivel de programa de las facultades de medicina de India. Resultados: En la actualidad existen 299 facultades médicas en India, de las cuales egresan unos 28.000 graduados al año. Se enseña Medicina Comunitaria en todas las facultades. Hemos citado ejemplos de enseñanza innovadora y de métodos de evaluación que han sido empleados en algunas facultades de medicina en el país, así como hemos intentado aprender lecciones de los casos discutidos. Discusión y conclusiones: Se observa que los programas fuertemente basados en la experiencia comunitaria, el abordaje multidisciplinario, la participación activa de la población, la provisión de servicios de atención médica, la permanencia en el lugar de los estudiantes y los métodos de enseñanza epidemiológica por medio de situaciones de la vida real, lo que los hace interesantes y relevantes para los alumnos, son algunos de los métodos esenciales para un entrenamiento exitoso en Salud Pública de los estudiantes de pregrado. Por lo tanto, la enseñanza basada en la comunidad debería enfatizarse de manera destacada.

Prevalence of Irritable Bowel Syndrome: A Community Based Study From Northern India

BACKGROUND/AIMS: The prevalence of irritable bowel syndrome (IBS) varies from 4% to 20% in different Asian nations. Prevalence of IBS in native North Indian community is not known. METHODS: Between November 2008 to December 2009, we estimated the prevalence of IBS in a rural community of Ballabgarh block, located in Haryana state. A structured questionnaire based on Rome III module was used to collect symptoms related to IBS from all the participants in a door to door survey. A Rome III criterion was used for diagnosis of IBS. IBS was further classified based on predominance of symptoms as constipation predominant, diarrhea predominant, mixed and unspecified based on Rome III module. RESULTS: There were 4,767 participants (mean age 34.6 +/- 10.8, males 50%). Overall, 555 (11.6%; 95% CI, 10.7-12.5) had constipation, 542 (11.4%; 95% CI, 10.5-12.3) diarrhea and 823 (17.3%; 95% CI, 16.2-18.4) abdominal pain. The overall prevalence of IBS was 4% (95% CI, 3.5-4.6). The prevalence of constipation predominant IBS was 0.3% (95% CI, 0.16-0.49), diarrhea predominant IBS 1.5% (95% CI, 1.18-1.90), mixed IBS 1.7% (95% CI, 1.35-2.11) and unsubtyped IBS 0.5% (95% CI, 0.32-0.75). The prevalence of IBS was significantly higher in females compared with males (4.8% vs 3.2%, P = 0.008). However, there was no significant difference between males and females in the prevalence of different subtypes of IBS. The prevalence increased with age. CONCLUSIONS: The prevalence of IBS in a North Indian community is 4%. IBS poses a significant burden on the rural adults.

Risk factors for non-communicable disease in urban Haryana: a study using the STEPS approach.

BACKGROUND: India is in the midst of an epidemiological transition with non-communicable diseases increasing in importance. Targeting the risk factors for non-communicable diseases is recognized as an essential preventive strategy. There is lack of good quality data on prevalence of risk factors. The present study addresses this challenge in urban population of Ballabgarh town in Faridabad district of Haryana. METHODS: A total of 1263 male and 1326 female respondents were selected using multistage systematic random sampling, in 5 age groups of 10 years (15-24, 25-34, 35-44, 45-54 and 55-64). The World Health Organization's STEPS approach entails stepwise collection of the risk factor data based on standardized questionnaires (step 1), basic physical measures in step 2 and finally in 3rd step, basic biochemical investigations such as blood sugar and cholesterol. The prevalence was adjusted to the age and sex strata of urban Faridabad as per census 2001. RESULTS: The prevalence of current daily use of smoked tobacco was 22.2% (95% CI7colon; 20.0-24.6) for males and 1.4% (95% CI: 0.9-2.2) for females. In males the prevalence of current alcohol consumption was 28.9% (95% CI: 26.4-31.5). Physical inactivity was reported by 23.2% (95% CI: 20.9-25.6) of males and 52.4% (95% CI: 49.7-55.1) of female respondents. Only 8.6% of males and 4.4% of females were consuming adequate portions of the fruits and vegetables. 23.1% (95% CI: 20.8-25.5) males and 15.7% (95% CI: 13.87ndash;17.8) females were either in Stage 1 and 2 hypertension (JNC VII) or were taking anti-hypertensives. Among males, 25.4% (95% CI: 23.0-27.9) and, among females 34.9% (95% CI: 32.3-37.6) were overweight. CONCLUSION: The prevalence of tobacco and alcohol use among males and physical inactivity among females was high. Low consumption of fruits and vegetables, hypertension and overweight was equally common among both the sexes in the population studied. Thus there is an urgent need for initiating measures at the risk factor level to counter this modern day epidemic of non-communicable disorders, within this urban community.