Burden of sickle cell disease in tribal students in Maa-Baadi institutions in southern Rajasthan - A pilot study

Background & objectives: Sickle cell disease (SCD), an inherited disorder of erythrocytes, is highly prevalent in the tribal population of India. The tribal population of India is approximately 100 million and it is necessary to identify the magnitude of this problem. Furthermore, the prevalence of the disease is unknown among the five million tribal people of southern provinces of Rajasthan. In this study, we intended to determine the prevalence and characteristics of sickle cell disorder among the tribal inhabitants of southern Rajasthan. Methods: This cross-sectional study was conducted among the tribal students of the Maa-Baadis and hostels situated in the five tribal sub-plan districts of Rajasthan. Maa-Baadi centres are located in every village, whereas for every four to five villages, one hostel is allocated to accommodate the tribal students. The screening for SCD was done by solubility test and electrophoresis was used for confirmation. Results: A total of 36,752 tribal students were screened from 1,006 Maa-Baadi centres and 243 hostels. The prevalence of SCD among the tribal students was 5.8 per cent. The prevalence of heterozygous and homozygous conditions was 5.61 and 0.17 per cent, respectively. Among the five sub-plan districts, the highest prevalence was observed in Sirohi district (10.5%) followed by Banswara (7.42%), Udaipur (6.53%), Pratapgarh (5.51%) and Dungarpur (1.89%). Among the four major tribes belonging to these districts, the highest prevalence was recorded in Garasia tribes (13.81%). The history of leg ulcers and the mean pulse rate were significantly high in SCD individuals. Interpretation & conclusions: SCD is a significant problem among the tribes of southern Rajasthan, with the highest prevalence among the Garasia tribe. The present study recommends that a structured screening programme targeting the entire tribal population with appropriate counselling as well as providing treatment through the existing health system is the need of the hour.

Does Co-Suffering by Ischemic Heart Disease and Tuberculosis Exist in Community Endemic for These Diseases.

Aims: Tuberculosis (TB) has been thought associated with developing atherosclerosis, a hallmark of ischemic heart disease (IHD) pathology. Animal studies and human autopsy & case studies have shown association of TB with atherosclerosis. There is paucity of data showing co-suffering by TB and IHD. The objective of the study was to explore the co-suffering by IHD and TB in community endemic for these diseases. Study Design: Retrospective secondary data analysis. Place and Duration of Study: Mahatma Gandhi Hospital, Jodhpur, Rajasthan, India between January 2011 and December 2011. Methodology: Retrospective secondary data analysis done for patients admitted with IHD at tertiary hospital in Jodhpur, Rajasthan, India; a setting endemic for TB and IHD both. Results: Study revealed 1.6% of total admitted cases of IHD were co-suffering with TB. Majority of these (68.2%) reported history of TB diagnosis and/or treatment. About one third (31.8%) cases were co-suffering with current diagnosis and/or treatment for TB. Cases co-suffering by TB & IHD were on average 7 years elder than cases of IHD. This difference in age was statistically significant (p=0.05). Conclusion: The study demonstrated that co-suffering by IHD and TB does exist in setting endemic for both these diseases. Patients older than 53 yrs (Mean age 65.63 yr - 2 SD 12.47 yr) age presenting with clinical features suggestive of IHD should be explored for the history or current status of TB. Studies on co-suffering by these are needed among patients attending peripheral health centres for validation.

Investigation of the outbreak of typhoid in a village of Thar Desert Rajasthan, India.

Background & objectives: Outbreaks of typhoid have been reported from Maharashtra, Bangalore, West Bengal and Pondicherry in India but rarely from Rajasthan. We investigated an outbreak of typhoid in a village of Thar Desert of Rajasthan. Methods: A retrospective cohort study was carried out during May-July 2007 in Varkana village, Pali district, Rajasthan, to identify the risk factor for disease. The information on outbreak was collected and then described in time, place and person characteristics to arrive at aetiological hypotheses. Results: There were 219 cases of typhoid in village. Attack rate was 104 cases per 1000 population. Maximum attack rate of 276 cases per 1000 population was noted in persons of 10-14 yr age group. Forty three serum samples were reported positive for Widal agglutination test out of 70 tested. Drinking of water from government overhead tanks was associated with disease significantly (RR= 11.1, 95% CI= 3.7-33). Two of the three water samples from government tanks were found positive for faecal contamination. Interpretation & conclusion: The outbreak of typhoid in a village affected >200 persons of all age groups and both gender. Exposure to the drinking water from government tanks was found significantly associated with the disease. Preventive and control measures undertaken after analytical epidemiological study helped in terminating the outbreak.

Childhood illnesses and malnutrition in under five children in drought affected desert area of western Rajasthan, India.

The study was undertaken to asses the impact of drought on childhood illnesses and nutrition in under five children of rural population using three stage sampling design. The study has been carried out in 24 villages belonging to 6 tehsils of Jodhpur district which was a drought affected desert district of Western Rajasthan in 2003. A total of 914 under five children (0-5 years) could be examined for their childhood illnesses, malnutrition, dietary intake and clinical signs of nutritional deficiency. Childhood illnesses observed at the time of drought were respiratory (7.5 %), gastroentrological (7.5%), and 5.6% fever (viral, malaria and jaundice), higher in males than females. Children suffered from recent and long term malnutrition were 39% and 26% respectively as per National Centre for Health Statistics (NCHS) standards. The extent of malnutrition was significantly higher in females than in males (p<0.01). Vitamin A & B complex deficiencies were 0.7% and 3/% respectively. The protein energy malnutrition (PEM) was observed in 44.4%. Overall mean calorie and protein intake deficit was observed to be very high (76.0 & 54.0 %). The comparison of present drought results with earlier studies in normal and drought conditions showed higher prevalence of PEM and deficiencies of calories & proteins in their diet. Respiratory, gastroentrological and fever were main childhood illnesses observed and were higher in males at the time of drought. PEM, vitamin A & B- complex deficiencies, anemia along with deficit in calories and proteins in their diet was observed higher in present study as compared to non desert areas, which may be due to the harsh environmental conditions in desert areas and paucity in the consumption of daily food intake. Due to inadequate consumption of daily food, the children were suffering from PEM resulting in several childhood illnesses. Effective measures making availability of adequate calories and proteins to all age groups especially to under five children through the ongoing nutrition programs needs to be ensured.

Evaluation of the mutagenic potential of chlorpyrifos (CPF) using polytene chromosomes of Anopheles mosquito.

Diverse cytogenetic tests are employed for short term screening of suspect environmental mutagens by using insects and mammals as models. In the present paper the polytene chromosomes of a mosquito Anopheles maculatus were used to evaluate the mutagenic potential of a widely used organophosphate pesticide chlorpyrifos-[o, o-diethyl-o-(3, 5, 6-trichloro-2-pyridyl) phosphothioate]. The results are based on the frequency of various structural aberrations encountered in the polytene chromosomes of the larvae treated with LC20 of chlorpyrifos (CPF). These aberrations were dominated by inversions, stickiness of the chromosomes, heterochromatinization of the bands and lack of polyteny. The frequency of various aberrations was highest in the left arm of chromosome number 2L followed by 2R, 3L, 3R, and X-chromosomes i.e. 2.10 +/- 0.44, 1.84 +/- 0.44, 1.57 +/- 0.54, 1.31 +/- 0.50, and 0.22 +/- 0.27 respectively. The susceptibility of different chromosomal arms to this pesticide was 2L > 2R > 3L > 3R > X and the regions prone to these aberrations have been marked on the polytene chromosome map of Anopheles maculatus.