Prevalence and some epidemiological factors of beta thalassaemia trait in Sindhi community of Nagpur City, India.

OBJECTIVE: To study the prevalence of Beta thalassaemia trait (bTT) in Sindhi community of Nagpur City and to study association between bTT and some epidemiological factors like age at menarche in females, past history of diagnosis and treatment of anaemia and the current haemoglobin concentration. METHODS: The present cross-sectional study was undertaken among 446, young, apparently healthy, unrelated (by blood) Sindhi individuals before marriage or before reproduction. Blood samples were processed for Beta thalassaemia trait (bTT) using two stage approaches. Two screening tests namely Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT) and RBC indices including Mean Corpuscular Volume (MCV) were performed on all samples and those positive for either one or both screening tests were further investigated for HbA2 level estimation by Haemoglobin electrophoresis on Cellulose acetate paper. HbA2 level of > 4.5% was taken as confirmatory of bTT. RESULTS: The prevalence of bTT in Sindhis of Nagpur was found to be 16.81%. No significant association was found between bTT & a delayed age at menarche, however a significantly higher number of trait carrier females had past history of diagnosis and treatment of anaemia while a significantly higher number of both male and female trait carriers had current haemoglobin concentration in anaemic range. CONCLUSION: The present study confirmed high prevalence of bTT in Sindhis.

Development and validation of risk scoring system for prediction of cancer cervix.

A Hospital based group matched case-control study was conducted to devise a risk scoring system for the prediction of cancer cervix at the Gynecology Clinic, Government Medical College Hospital, Nagpur, India. The study consisted of 230 cases of cancer cervix (histopathologically confirmed) and equal number of controls, group matched for age. The risk factors considered were Illiteracy, long duration of married life (>25 years), Early Menarche (<13 years), marital status (widow, separated, divorcee), multiparity (> 3), h/o abortion, h/o tobacco use, h/o passive smoking, poor genital hygiene, (grade III & IV) and low socioeconomic status. Statistical Analysis included unconditional multiple logistic regression analysis Receiver Operating Characteristic (ROC) curve analysis. The overall predictive accuracy was calculated by Wilcoxon statistic as an equivalent of area under ROC curve. Five risk factors, illiteracy, poor genital hygiene, long duration of married life, multiparity and early menarche were identified to be significantly associated with cancer cervix. These factors were given statistical weights of 13, 10, 7, 5 and 5 respectively. A total score of 21 was found to be the best cut off for prediction and the overall predictive accuracy of the risk scoring system was calculated to be 0.74(0.67 - 0.81). In case of consistent further validation using other data sets this additive risk scoring system can be used for reducing the cost of universal screening by subjecting only high-risk subjects to laboratory screening procedure (Pap smear) in population setting.

Sexually transmitted infections in long distance truck drivers.

A study was undertaken in 670 long distance truck drivers to investigate prevalence of sexually transmitted infections--STI (HIV infection, syphilis, hepatitis-B infection and gonorrhoea) in Nagpur City, Central India. Standard laboratory procedures were followed for carrying out investigations i.e. ELISA for HIV infection, VDRL for syphilis, RPHA for hepatitis-B infection and gram staining for gonorrhoea. A total of 293 (43.7%) subjects had one or more sign/symptoms suggestive of STIs. The prevalence of HIV infection, syphilis, hepatitis-B infection and gonorrhoea was observed to be 15.2%, 21.9%, 5.1% and 6.7% respectively. In conclusion, this study recognized that long distance truck drivers were at high risk for getting STIs including HIV infection.

Maternal age as a risk factor for stillbirth.

To Detect the risk of still birth in different maternal age, five year (1st January 1993 to 31st December 1997) record of Government Medical College, Nagpur were analysed. The rate of stillbirth was 2.5% (1138 stillbirth out of 46,443 deliveries) which was significantly associated with increasing maternal age (x2 = 182.3, df = 4, p < 0.001). Teenage pregnancy and elderly pregnancy were in significant risk as compared to 20-29 years age group for stillbirth (OR = 1.6, 95% C1 1.1-2.5; OR 2.6, 95% CI = 1.9-3.5 respectively).

National Vitamin A Prophylaxis Programme: need for change in current age strategy.

Child survival and Safe Motherhood Programme emphasises on giving vitamin A prophylaxis upto three years of age only, contrary to earlier practice of its administration upto six years of age, based on the assumption of reduction of serious manifestations of vitamin A deficiency three years of age onwards. A cross-sectional study enrolling 1094 children was done to investigate vitamin A deficiency in under six children in urban slums of Nagpur city in Central India in post CSSM scenario. Clinical as well as subclinical (detected by abnormal conjunctival impression cytology) assessment of vitamin A status was performed according to standard procedures, as per WHO recommendations. The overall prevalence of xerophthalmia was 8.7%. Only milder manifestations of xerophthalmia were observed. Significantly higher prevalence of xerophthalmia was observed in more than three years of age. Although nonsignificant, higher prevalence of subclinical vitamin A deficiency was observed in above three years of age group. In view of current age strategy for vitamin A supplementation (< or = 3 years) and observed higher prevalence of clinical and subclinical vitamin A deficiency above three years of age in this study (also endorsed by earlier studies) a call for review of current age strategy for vitamin A supplementation is warranted.

Peak expiratory flow rate (PEFR) in hairdressers.

The present cross sectional study with comparison group was undertaken to assess the lung function of hairdressers by Peak Expiratory Flow Rate (PEFR) using Wright peak flow meter. Total 385 hairdressers and 770 controls were included in the study. PEFR was observed to be reduced in hairdressers compared with controls. The difference was significant (P < 0.01) above 45 years of age. Also with increasing duration of exposure observed PEFR was reduced than expected. Above 20 years of length of service, the difference was statistically significant (P < 0.01). Smokers in hairdressing occupation had reduced PEFR than in control group, though this difference was not significant. Thus, we conclude that hairdresser's environment adversly affects their lung function and smoking may potentiate the adverse effect.

Knowledge and practices about HIV transmission among barbers of Nagpur City.

The present study was carried out in south zone of Nagpur city to assess knowledge and practices regarding HIV transmission of 375 barbers selected randomly from three different categories of saloons. A significantly large proportion of the roadside barbers were ignorant about modes of transmission of HIV, particularly through the blades. The practices observed by barbers ae found to be favourable for transmission of HIV, more so in roadside barbers. Hence it can be concluded that practices observed by barbers may favour transmission of HIV and there is a scope for educational intervention.

Teenage pregnancy outcome: a record based study.

Present record based study was undertaken in Medical record section of Government medical college, Nagpur, to assess teenage as a risk factor for pregnancy complications, outcome, and operative or assisted delivery. Five year (January 1993 to December 1997) data was scanned, which gave sample of 1830 teenage pregnancies; while equal number of subsequent partly matched controls (> 20.29 years) were taken. Results showed proportion of low birth weight baby to be significantly greater in teenagers (p < 0.001). Operative interference was significantly greater in adult pregnancies (p < 0.001). Though stillbirth and preterm delivery was more in cases, difference was not statistically significant. Similarly toxaemia of pregnancy, premature rupture of membrane, placenta previa, accidental haemorrhage though more in adult pregnancies was statistically not significant. There were no differences in cogenital anamoly and twins between cases and controls. But breech deliveries were significantly (p < 0.001) more in adults.

Risk factors for cancer cervix: a case control study.

The present hospital based, group matched case control study was carried out at Gynaecology clinic, Govt. Medical College Hospital, Nagpur, to study risk factors for cancer cervix and investigate their independent and interactive role in the outcome of cervical cancer. The study included 230 cases of cancer cervix and equal number of controls, group matched for age. Univariate analysis included 17 hypothesised risk factors for cancer cervix and identified significance of 10 risk factors. However multiple logistic regression (MLR) analysis recognised and confirmed the significance of illiteracy, poor genital hygiene, long duration of married life, multiparity and early menarche in the ultimate outcome of cancer cervix. Estimates of Attributable Risk Proportions (ARP) and Population Attributable Risk Proportion (PARP) endorsed the etiological and preventable role of these risk factors, respectively. Considering the public health impact of elimination of these risk factors on the cancer cervix problem in this population, development of a preventive strategy based on these risk factors would be an appropriate step towards curtailment of this "Biggest Scourge of womankind".

Subclinical vitamin A deficiency in undersix children in Nagpur, India.

The present cross sectional study was carried out to estimate prevalence of subclinical vitamin A deficiency among undersix children by using conjunctival impression cytology in urban slums of Nagpur city in central India. The study population included 308 non-xerophthalmic undersix children selected randomly. Conjunctival impression cytology was performed by standard procedure. Out of 308 children 110 (35.7%) had subclinical vitamin A deficiency. Increasing prevalence of subclinical vitamin A deficiency was non-significantly associated with advancing age. Higher prevalence of subclinical vitamin A deficiency was observed in severely malnourished children. The prevalence of subclinical vitamin A deficiency observed in this study (35.7%) is much more than the criteria laid down by WHO, which warrants community wide intervention. This problem assumes more significance because they are apparently healthy and if timely vitamin A supplementation is not given, any intercurrent infection is likely to worsen the vitamin A status and result in known consequences of xerophthalmia.

Effectiveness of Bacillus Calmette Guerin (BCG) vaccination in the prevention of childhood pulmonary tuberculosis: a case control study in Nagpur, India.

A hospital-based, pair matched, case control study was carried out to estimate the effectiveness of BCG vaccination in the prevention of childhood pulmonary tuberculosis. The study included 126 incident cases of pulmonary tuberculosis (diagnosed by WHO criteria) below/equal the age of 12 years. Each case was pair matched with one control for age, sex, socio-economic status. Controls were selected from subjects attending study hospital for conditions other than tuberculosis and leprosy. The significant protective association between BCG and childhood pulmonary tuberculosis was observed (OR = 0.39, 95% CI = 0.22, 0.68). The overall vaccine effectiveness was 61% (95% CI = 32%, 78%). BCG was nonsignificantly more effective in underfives, among males and in upper-middle socioeconomic strata. The overall prevented fraction was estimated to be 47.53% (95% CI = 21.41%, 67.25%). Results of this study thus demonstrated a moderate effectiveness of BCG vaccination in prevention of childhood pulmonary tuberculosis in a Central India population.

Peak expiratory flow rate in handloom weavers.

The present cross-sectional study with a comparison group was carried out to investigate peak expiratory flow rate (PEFR) in handloom weavers and to study relationship between reduction in PEFR with age, smoking, duration of cotton dust exposure and respiratory morbidity. This study include 319 handloom weavers and equal number of individuals (group matched for age and pair matched for sex) in comparison group. The decline in PEFR was significantly associated with advancing age, longer duration of exposure to cotton dust, tobacco smoking and presence of respiratory morbidity on univariate analysis, whereas on multivariate analysis longer duration of exposure to cotton dust and tobacco smoking was found to be non significant.

Parity as a risk factor for cancer cervix.

The present hospital based, group matched case control study was carried out at Gynecology Clinic, Govt. Medical College hospital, Nagpur, to investigate role of parity in the outcome of cancer cervix. The study included 230 cases of cancer cervix and equal number of controls, matched for age. The study identified significance of multiparity, as a risk factor for cancer cervix. Estimates of attributable risk proportion (ARP) and population attributable risk proportion (PARP) endorsed etiological and preventable role of multiparity in the outcome of cervical cancer, respectively.

Infant feeding practices in urban population--a clinic based study.

A clinic based cross-sectional study was conducted at Immunoprophylaxis Clinic at Govt. Medical College, Nagpur. Mothers of 217 children were interviewed for infant feeding practices. In 62.67% of children, breast-feeding was initiated within 24 hrs. after birth. About 22% mother used prelacteal feed and 70% mothers preferred demand feeding. Prominent area of concern includes discarding of colostrum, low exclusive breast feeding rate, delayed weaning and early termination of breast feeding. Further improvement in present day infant feeding practices is possible by emphasising on the health education component of existing nutritional programmes.

Breast-feeding practices in a tribal community of Melghat region in Maharastra State.

This cross sectional study was conducted at Chitta-Ranjan Das Mobile Hospital camp stationed at Dharni, to assess the current status of breast-feeding practices in a tribal community of Melghat region of Maharashtra State, using the key Breast-feeding indicators as recommended by W.H.O. working group on Infant Feeding in 1991. The tribal mothers of 462 children in the age group of 0-24 months were interviewed for breast-feeding practices. 69.69% of the children received their first breast feed after 24 hrs. of birth, however none of the children was breast fed within 2 hrs. of birth. The exclusive breast-feeding rate was 0.22 and the predominant breast-feeding rate was 0.79. Timely complementary feeding rate was 0.22. The continued breast-feeding rates at 1 year and 2 years were 0.88 and 0.64, respectively. The ever breast-fed rate, timely first-suckling rate and exclusive breast-feeding rate were 1.00, 0.00 and 0.22 respectively. The median duration of breast-feeding was 23 months. Hence this study confirms the traditional breast-feeding practices in Indian culture.

Infant feeding practices in a tribal community of Melghat region in Maharashtra state.

1. Out of 494 infants none was breastfed within 2 hours of delivery. 36% infants received first breastfeed after 24 hours of delivery 91.2% of the mothers used prelacteal feeds. 2. Only 31.06% of the infants were weaned, out of these only 7 received complementary foods between 4-6 months. 3. Thus, it can be concluded that though breastfeeding is practiced by all mothers, there is need for early initiation of breastfeeding and proper weaning habits.

AIDS awareness among nursing students.

Nursing students are being identified as a potential risk group for the AIDS spread. Awareness regarding AIDS in this group is crucial for AIDS management and prevention. This cross-sectional study was planned and carried out to assess the awareness of nursing students regarding AIDS and to identify the areas of confusion that might serve as an important target of educational intervention. The study consisted of 204 nursing students selected from Nursing school, Govt. Medical College, Nagpur. The overall knowledge regarding etiology, risk factors, transmission, treatment and prevention of AIDS was confusing among the students. The average knowledge score was estimated to be 17.6 of 28. However, more knowledge was found to be correlated with more positive and fearless attitude towards AIDS patients.

A risk scoring system for prediction of coronary heart disease based on multivariate analysis: development and validation.

Considering the multifactorial disposition and the need of primordial prevention of coronary heart disease (CHD), a risk scoring system for the prediction of CHD was devised at Govt Medical College, Nagpur, India. In this pair-matched case-control study of 154 cases and 154 age and sex matched controls, socioeconomic status, physical inactivity, family history of CHD, type A personality characteristic, cigarette smoking, alcohol consumption, body mass index, diabetes mellitus, hypertension, total serum cholesterol and oral contraceptive use (in women) were studied for association with CHD. The additive risk scoring system based on the results of conditional multiple logistic regression identified five factors, namely, socioeconomic status, physical inactivity, diabetes mellitus, hypertension and toal serum cholesterol with statistical weights of 3,5,2,4 and 5 respectively. On back-validation using receiver operating characteristic (ROC) curve, a total score of 12 was found to be the cut off point above which there was increased risk of CHD. The overall predictive accuracy of this system-equivalent to the area under the ROC curve-was 0.7962 (95% Confidence Interval 0.7468-0.8455). On prospective validation using a separate group of 140 cases and 140 controls, the predictive accuracy was found to be 0.6964 (95% Confidence Interval 0.6341-0.7587). Future studies need to assess the risk scoring system in population based studies.