A study on smoking habits among slum dwellers and the impact on health and economics.

To assess the impact on health from smoking with economic implications with major emphasis given to see whether passive smoking is an established outcome and if it is, how much additional burden of the disease is put on the smokers' families and consequently how much extra economic cost is put on such families, a study was conducted in a slum area of Howrah Municipal Corporation (HMC) on approximately 3000 families, which were randomly selected. Data was collected in relation to the socio-economic status, family members, housing with water and environmental sanitation, smoking habit, energy used for cooking, health awareness, follow-up of episodes of diseases of all ages, their remedial action taken and estimation of economic burden of the disease due to smoking (active and passive). There was a statistically significant difference in disease pattern between smokers' family and non-smokers' family especially with relation to chronic obstructive pulmonary disease, coronary heart disease, acute respiratory infections, common cold, hypertension and peptic ulcer (p<0.05). Also it was observed that with increasing years (1st, 2nd, 3rd years), the number of cases in each disease group gradually increased. This can be attributed to the effect of passive smoking especially when environmental conditions and socio-economic variants are same in both groups. Cost analysis of the illness episodes in the smokers' and non-smokers' families showed that there was a 3-fold difference in average annual expenditure between the families of the non-smokers and that of smokers and a 8-fold difference in work days lost. There was a 4-fold difference in annual expenditure on these diseases by the families. It is observed that when the total cost of smoking was included in the total expenditure, there was a 12-fold increase in annual expenditure between smokers' and non-smokers' families. The study conclusively proves that there are ill effects on health both from active and passive smoking. It is also demonstrated here that apart from economic implications due to direct smoking, the economic loss has been added to smokers' families due to passive smoking.

Prevalence of thalassaemia trait in the state of West Bengal.

From three districts namely, Burdwan, Midnapur (undivided) and 24-Parganas North of the state of West Bengal, a total of 2045 blood samples were drawn to test for the presence or absence of thalassaemia trait. Out of the total samples, 621 samples were from general population, 807 from focus group (Muslims and ST/SC), 370 from antenatal mothers and 247 from relatives of cases. The blood samples were first subjected to screening test ie, red cell indices and the presence of trait was confirmed by gel-electrophoresis of the samples positive in screening test. Results showed that thalassaemia trait is prevalent in the population of the state in the magnitude of 11.25%. It is mostly prevalent in close relatives of cases (thalassaemia major) in the magnitude of 55.26%, followed by scheduled tribe (29.87%) and among the Muslim population it was predominantly more. General population has a prevalence of 3.6% (males) and 5.95% in antenatal mothers. High prevalence rate is associated with illiterates (19.23%) than literates (5.55%). Highest prevalence rate ie, 20.47% (overall prevalence) is associated with age group between 0-9 years. The findings of the study are considered to be very valuable as far as future action programme is considered to reduce the prevalence rate of thalassaemia trait in the community. The action programmes like intensive counselling and IEC maybe instituted to the groups, which show high prevalence rate rather than general population to make the programme not only cost-effective but cost-efficient as well.

The prescribing habits of doctors in a metropolitan city and economic consequences of such practices.

Four thousand prescriptions were studied to observe the prescription pattern and habit of the doctors practising in the city of Calcutta. Ten most common ailments were identified and their treatment and investigations were taken into account for judging the rationality of such action. Both, estimated rational prescription cost and actual cost of the prescription were determined to identify any cost variation between prescription written rationally and irrationally.

A community based study on health impact of flood in a vulnerable district of West Bengal.

In order to ascertain the disaster vulnerability and health risks of flood in Hooghly district of West Bengal, this community based study was conducted through record analysis, interview of concerned authorities and household survey of morbidities before and after flood. Two blocks, with most of its population, were found to be the worst affected among all the disaster vulnerable blocks of the district. Incidence of diarrhoea, other enteric diseases and respiratory infections were significantly higher (P < 0.05) among the population in flood affected blocks, compared to the unaffected. The attack rate of diarrhoea in the flood affected population had increased significantly following flood (P < 0.05).

Dr. P. C. Sen Memorial Award Paper. A study of HIV infection in thalassaemia patients of rural Bengal.

Thalassaemia patients receiving repeated blood transfusions are vulnerable to transfusion related infections. HIV infection is the most life threatening of them all. Blood being the most efficient mode of transmission of HIV, increases the risk of infection even further. Although the National AIDS Control programme has laid down stringent rules regarding blood safety, it remained to be seen whether they were being followed meticulously especially in rural areas. The present study was conducted to identify the HIV status of multi-transfused thalassaemia patients attending hospital blood banks of rural Bengal. Only 3 (0.9%) of the 330 thalassaemia patients examined were found to be HIV positive. Although the situation has not reached alarming proportions, yet appropriate control measures must be adopted on a mass scale to prevent further spread of the world wide pandemic.

Impact of nutrition education on health of the mother and newborn belonging to the poor urban slum community.

To find the nutritional knowledge among mothers of one child of the poor community and to relate status of education to the nutritional health of them and the newborn and to get a thorough knowledge on the impact of nutritional education, a comprehensive study was undertaken in an urban slum area. Nutritional grading was done through scoring system. There were 47 mothers (24.1%) out of 195 having normal nutritional grade and 37 mothers (19%) having severe nutritional grade. There were 80 mothers having 'no knowledge' on maternal nutrition. 'Adequate knowledge' was found in 31 cases. Mothers (n = 80) of 'no knowledge' delivered babies of average weight 2.3 kg whereas 'adequate knowledge' mothers gave birth to babies of average weight 2.9 kg.

PIP: The Urban Health Center in the urban slum of Chetla is tasked with providing comprehensive services to poor residents living in the area. Findings are reported from a study conducted to assess the nutritional knowledge of poor mothers and to link educational status with the nutritional health of mothers and newborn infants; to compare the degree of malnutrition with prevailing grades of nutritional education; and to assess the impact of education upon the birth weight of newborns. The center has both clinic and community-based nutritional services. Maternal nutritional grading was determined using a scoring system. According to that system, 47 (24.1%) of the 195 mothers had a normal nutritional grade and 37 (19%) were of a severe nutritional grade. 80 mothers were determined to have no knowledge of maternal nutrition, while 31 had an adequate degree of knowledge. The 80 unknowledgeable mothers delivered infants of average weight 2.3 kg, while mothers with adequate knowledge bore infants of average weight 2.9 kg.

Community perception about disaster preparedness and response programme in four states of India.

It is well felt that community participation, local planning, development of self reliance and manpower resource within the community itself can strengthen the effort of disaster preparedness and response. The present study was intended to bring out the salient features about perception and opinion of community leaders and community members about existing preparedness programme and appropriateness of mitigatory exercise against flood disaster in four eastern states of India viz. West Bengal, Bihar, Assam and Orissa. Many snags at the implementation level, in terms of co-ordination, directives, logistics and knowledge gap were noted, which should be dealt with due care for successful disaster preparedness programme.

Study of the impact of epidemiological factors on intelligence of rural children of 3 to 6 years age group belonging to low socio-economic status.

There are many factors which affect intelligence as well as physical growth of children, although genetic factor plays a prime role but social, environmental and psychological factors influence significantly the physical growth and intelligence of the child and the same can be improved through intervention. Community based studies are therefore useful to understand effect of these factors for future planning. The present study was therefore undertaken in Burdwan district of West Bengal with the objectives of studying level of intelligence of children of 3 to 6 years age group and impact of the factors related to the level of intelligence of these children. 72 children of 3 to 6 years age group were studied, of which 2/3 were either normal or having Grade-I undernutrition and the rest were either Grade-II or Grade-III. A significant positive association was found between DST IQ score (Bharat Raj) and the nutritional grade. Non-formal education also was found to have significant bearing on the IQ level. No significant relationship was however found between DST IQ score and the religion indicating culture independence of the scoring system.

PIP: During January-December 1991 in India, door-to-door visits were made at 59 households with at least one child 3-6 years old in the field practice area of Burdwan Medical College in West Bengal. The researchers wanted to examine the intelligence level of the children and the effect on their intelligence of associated factors such as nutrition, socioeconomic status, and environment. There were 72 children 3-6 years old. Mean family size was 6.9. The houses were in poor condition. 47.5% of families defecated in open fields. 36.11% of the children had either grade II or grade III malnutrition. 66.7% of the children had a Developmental Screening Test (DST) IQ score within the normal range (85-115). 30.6% had borderline scores (68-84). Two children were mildly retarded (52-67). Neither religion nor socioeconomic status influenced the IQ level. The proportion of normal IQ children who have had nonformal schooling was much greater than that of normal IQ children who have not had nonformal schooling (88.6% vs. 45.9%; p 0.01). Children of normal and grade I nutritional status were more likely to have a normal IQ level than those with grade II or grade III malnutrition (75% and 77.3% vs. 57.1% and 20%, respectively; p 0.05). Nonformal education had a significant independent effect on the IQ level (Z = 3.03; p 0.05), while nutritional status did not have a significant independent effect (Z = 1.39; p 0.05). There was a positive significant association between DST IQ score and sitting height (r = 0.27; p 0.05) and head circumference (r = 0.27; p 0.05). These findings indicate the need for a balanced diet and nonformal education to foster child development, especially intelligence, during the first six years of life.

Measuring the interactions of the determinants of health.

Considering environmental sanitation and health care services as most important determinants of health, this study was undertaken to know their impacts in an urban slum area of Calcutta. The families were studied in-depth and detail in relation to their health status in the form of morbidities and utilisation of preventive and promotive services. The health service impact was mainly assessed through comparative study between these who availed the services and to these who did not. Similarly, environmental sanitation services impact on health was measured through comparing the slum group with those who lived in Pucca houses. The criteria of priority decision on determinants was attempted through analysis of cost of these services and comparing their beneficial effects on health.

PIP: The study was undertaken in urban slums of Calcutta and at the Urban Health Center, Chetla (UHC), a field practice area of the All India Institute of Hygiene and Public Health, Calcutta. The first community received only health care services but no environmental sanitation services, the second one received only environmental services but no health care services, the third community had both health care and environmental services, and the fourth had none. Each of the 4 groups consisted of 80 families. Those who took advantage of the UHC health care services were compared to those who did not. Similarly, the impact of environmental sanitation services on health was measured through comparing the group who lived in pucca houses (multistoried flats). 2 groups each in pucca houses and slums primarily used UHC comprehensive health care services, while the groups who did not take advantage of UHC services used hospitals (88% in pucca houses and 96% in slums) and private practitioners (24% in pucca houses and 11% in slums). The incidence of sickness per 100 persons in 2 residential areas was significantly higher among slum dwellers in all ages and sex groups (79% for males [p 0.05], 83.5% for females, and 81.1% for children) as compared to those residing in pucca houses (59.8%, 54%, and 57.2%, respectively). For all ages taken together, females suffered comparatively more than males among slum dwellers, whereas this was the reverse among pucca house residents. The incidence rates were significantly lower among beneficiaries of UHC than among those who did not use the services except for the age group 5 years. The sickness rate was around 63% for all ages vs. around 74% of those not using UHC. Analysis of variance substantiated that both type of residence and utilization of UHC had a significant impact (p 0.01) on the morbidity rates and the average duration of sickness per person, but the effects of utilization of services was not more than 3 times that of residence.