Health status of the elderly population among four primitive tribes of Orissa, India: a clinico-epidemiological study.

Primitive tribal groups (PTGs) are the most marginalised and vulnerable communities in India. Clinico-epidemiological studies on morbidity patterns among the elderly primitive tribe members are essential to recommend special intervention programmes to improve the health of the elderly in these communities. A community-based cross-sectional study was carried out among the elderly populations of four different PTGs, namely Langia Saora (LS), Paudi Bhuiyan (PB), Kutia Kondh (KK) and Dongria Kondh (DK) living in the forests of Orissa, India. Clinical and anthropometric data were collected using standard methods and haemoglobin was estimated by the cyanomethaemoglobin method. The average number of illnesses per person was 3.0. Common disabilities like vision and hearing impairment and mobility-related problems were found in considerable numbers. Gastrointestinal problems like acid peptic disease were found among 2.6% to 20% of cases. Non-specific fever was marked in 10.2% to 24.2% of individuals. The iodine deficiency disorder, namely goitre, was found among 4.2% to 6.0% of individuals. Diseases of the respiratory tract, like upper and lower respiratory tract infection, asthma, tuberculosis and leprosy, were found in small numbers. The prevalence of hypertension among males and females was 31.8% and 42.2%, respectively. The LS had the highest prevalence of hypertension (63% among men and 68% among women). With regard to anaemia status, severe anaemia was marked in 70% of males and 76.7% of females in the LS, while in other groups the prevalence of severe anaemia ranged from 15% to 33%. Although the prevalence of severe anaemia in other tribal communities is lower than in the LS, mild to moderate anaemia was found to range from 60% to 80%. The present study revealed a high prevalence of physical disabilities with both non-communicable as well as communicable diseases among the elderly primitive tribal members. This warrants the implementation of a special health care strategy to reduce suffering at this crucial age and improve quality of life.

Determination of iodine nutrition and community knowledge regarding iodine deficiency disorders in selected tribal blocks of Orissa, India.

AIM: To determine the status of iodine nutrition and knowledge of iodine deficiency disorders (IDD) in selected tribal mountainous blocks of Orissa, India. DESIGN: A community-based survey was performed, adopting the 30-cluster sampling and surveillance methodology for assessment of IDD recommended by WHO/UNICEF/ICCIDD. SUBJECTS: School-age children (6-12 years) and their mothers. METHODS: Total goitre rate (n=623) and urinary iodine excretion of children (n=530), iodine content in edible salt (n=505) and water (n=21) were measured. Community knowledge regarding IDD and awareness of iodized salt (n 20) was assessed. RESULTS: Total goitre rate was 23.6%, of which visible goiter was 6.9%. Prevalence of goiter increased with age in female and tribal children. Median urinary iodine was 38 Cmicro.Tl(-1) and 51.7% of children had urinary iodine values <100 pmicrogtl(-1) The mean iodine content for drinking water ranged from 1.22-3.6 pmicro.Tl(-1) Only 9.9% of salt samples had adequate iodine content (> or =5 ppm). Over 80% of respondents did not have knowledge of IDD and were not aware of salt iodization. CONCLUSIONS: Study results show moderate iodine deficiency with poor community knowledge of iodine nutrition. There is need to strengthen the monitoring of salt iodization and intensive education activities in the tribal areas.

Iodine deficiency in urban slums of Bhubaneswar.

OBJECTIVE: The present study aimed at assessing the population prevalence of goiter and iodine deficiency in school children of 6-12 yr living in urban slums of Bhubaneswer, the capital city of Orissa. METHODS: A cross-sectional study was performed using the 30-cluster sampling methodology and surveillance methods for iodine deficiency as recommended by WHO/ICCIDD/UNICEF. The total goitre rate (n=1248), urinary iodine concentration (UIC) (n=411) and iodine content of edible salt (n=368) were measured. RESULTS: The goitre prevalence was 23.6% (grade 1=18.9%, grade 2=4.7%) with no significant gender variation. Goitre prevalence was significantly higher in children of 10-12 yr (P=0.012) and scheduled caste and tribe (P=0.003). Median urinary iodine concentration was 50.0 microg/l with 85.7% of children having values less than 100 microg/l, indicating as biochemical iodine deficiency. Median UIC was inversely in association with gradations of goitre. Children of 10-12 yr and scheduled caste/tribe communities had significantly higher median UIC (P=0.001) than their counterpart peers. About 51% of children were consuming salt having stipulated iodine content of 15 ppm. CONCLUSION: The study indicates moderate iodine deficiency in the population, despite a mandatory salt iodization programme in Orissa that has been in force since 1989. There is a need to improve the situation through enforcing monitoring of salt iodization to ensure quality and increasing the level of awareness about the iodized salt for sustainable prevention and control of iodine deficiency.

Elimination of iodine deficiency disorders by 2000 and its bearing on the people in a district of Orissa, India: a knowledge-attitude-practices study.

A knowledge-attitude-practices (KAP) study was conducted along with a prevalence study of iodine deficiency disorders (IDD) between 1998-99 in the district of Bargarh, Orissa state, India. A total of 635 people were interviewed by a pretested structured questionnaire, adopting the probability proportional to size cluster sampling method. The aim was to assess the baseline information on the KAP of the people regarding IDD. Only 37% of the males and 29.3% of the females perceived goitre as a disease. Less than 5% of both sexes knew how goitre is caused. Only 16.4% used iodised salt regularly. The awareness and perception of IDD does not correspond with the time and effort we have spent in education of this disease. The implications of this poor knowledge about IDD and consequent poor use of iodised salt is contrasted to the optimistic target of elimination of IDD. This aspect is discussed in this paper, at a time when we are at the beginning of the new millennium.

Risk of coronary heart disease in women after menopause.

An increase in the incidence of coronary heart disease risk has commonly been reported in postmenopausal women. The study population comprised 263 adult healthy men and 237 women (104 premenopausal and 133 postmenopausal) ranging in age group of 21-70 years who were examined for coronary heart disease risk factors from Nellore district in Andhra Pradesh. Anthropometric measurements, blood pressure and serum lipids were analysed using standard procedures. There were no significant differences for anthropometric variables between postmenopausal and premenopausal women. Postmenopausal women had significantly higher levels of blood pressure, pulse rate, serum total cholesterol, triglycerides, low-density lipoprotein cholesterol and ratios of total cholesterol:high-density lipoprotein cholesterol and low-density lipoprotein cholesterol:high-density lipoprotein cholesterol as atherogenic indices than premenopausal women and the corresponding age group of male counterparts. However, the variation of high-density lipoprotein cholesterol levels between these groups were not statistically significant. The prevalence of hypertension, hypercholesterolaemia, hypertriglyceridaemia and atherogenic indices was significantly greater in postmenopausal women than in premenopausal women. This study confirms a higher prevalence of risk factors for coronary heart disease among women in older age group and suggests that when oestrogen production ceases in menopausal women, the risk of coronary heart disease increases.

Nutritional status of preschool children in the drought affected Kalahandi district of Orissa.

A community-based cross-sectional study was undertaken to determine the magnitude of undernutrition and protein-energy malnutrition among young children during 1996-97 in drought affected Kalahandi district of Orissa. A total of 751 children aged 0-5 yr were studied for anthropometry and clinical signs of nutritional deficiencies from 15 Gram Panchayats selected using probability proportionate to size sampling. There was no significant difference between boys and girls for nutritional status. According to weight-for-age, 57.1 per cent of the children were suffering from underweight (< median -2SD) and 21.3 per cent of children had very low body weights which were < -3SD of standard. Height-for-age and weight-for-height data showed that 41.8 per cent of children suffered from stunting and 27.9 per cent recorded wasting. The children below one year of age had relatively lower prevalence of malnutrition than the other age groups. The prevalence of clinical PEM in the form of marasmus was found in 0.7 per cent of children, while kwashiorkor was absent. This study showed that malnutrition is still a leading problem among preschool children of Kalahandi district and this has not improved in spite of nutrition intervention programmes which are currently in operation.

Fish intake and blood lipids in fish eating vs non-fish eating communities of coastal south India.

The lower blood lipid levels and lower incidence of coronary heart disease in fish eating populations has been attributed to the unusual n-3 fatty acids present in their fish diet. In order to test this hypothesis, a cross-sectional study was proposed to evaluate the lipid profile in free-living men and women of fish eating and non-fish eating populations aged between 20 to 70 years in coastal villages of the district of Nellore, in south India. The mean concentrations of total serum cholesterol and triacylglycerols were found to be lower in fish eating than in non-fish eating populations. Significant differences were observed between populations for certain age groups. The serum phospholipid content was lower in fish-eating than non-fish eating populations and the difference was found to be significant only for women. The mean total cholesterol and triacylglycerol levels were found elevated consistently as the age advanced in both sexes and populations. There were significant differences for blood lipids between men and women in some age groups. The percentile cut-off values for cholesterol and triacylglycerol were lower in fish eating as compared to non-fish eating group. Prevalence of hypercholesterolemia and hypertriglyceridemia (> or = 200 mg/dl) was significantly lower in fish eating people indicating less proneness to cardiovascular risk. The data indicate that eating of fish may have a role in ameliorating the risk of coronary heart disease.

Key role of dietary fats in coronary heart disease under progressive urbanization and nutritional transitionh.

The increased vulnerability to non-communicable diseases (NCD) of developing populations experiencing a demographic and epidemiological transitions to increased risk of NCD at a time when the battle against infectious diseases, is ongoing. Apart from population growth, the major attributes of developmental transition are confined to changes in occupational pattern in family structure, lifestyle, dietary practices and progressive ageing of population. The emergence of the NCD is significantly associated with changes in dietary pattern, in most of the countries. Coronary heart disease (CHD) is the leading cause of death in developed countries and the incidence is increasing in developing countries, including India. The disease needs awareness of the risk factors responsible for prevention. The purpose of this review is to present an overview of the role of dietary fats in growth and development and in health and disease. Although the causation of CHD is multifaceted and the risk factors associated in general are several, there are specific and important elements, such as dietary fats and lifestyle. Dietary fats are an important component as they serve a number of functions in the body. The minimum desirable and upper limits of fat intake have been given, based on recommendations of expert groups. Sources of different fats are made available worldwide and the production, consumption, storage, oxidation and nomenclature are being discussed in the light of health and disease. The relative essentiality of the omega-6 and omega-3 fatty acids is recognized in terms of pharmacologically active eicosanoid metabolism. Nevertheless, epidemiological, physiological and clinical studies have demonstrated that long-chain omega-3 fatty acids present in fish oils have quite diverse health benefits. Appropriate guidelines need to be recommended at a national level consistent with dietary habits. The ratios of balanced fatty acids, namely omega-11, omega-9, omega-6 and omega-3, should be worked out appropriately in ameliorating nutrition-related disease states. Any simple dietary modification that can lead to a substantial reduction in morbidity and mortality from CHD would be of great medical, social and economic benefit.

Arterial pressures in fish-consuming and non-fish-consuming populations of coastal south India.

It has been suggested that fish-consuming populations have lower blood pressure levels. The aim of this study was to determine and compare the mean blood pressure levels among fish-consuming populations with those among populations who do not consume fish, as a risk marker for cardiovascular disease. A cross-sectional study was conducted among 1000 healthy Indian adult men and women (aged >=20 years) randomly chosen from two representative age and sex-matched samples, one of which was fish-consuming (n = 500) and the other of which was non-fish-consuming (n = 500). The systolic and diastolic blood pressures and pulse rates were studied. The mean systolic and diastolic blood pressures and pulse rates were found to be lower in older men and women who were fish consumers in comparison with those who were non-fish consumers, and the levels increased with advancing age. The population and sex differences were significant for certain age groups. The percentile cut-off values for diagnosis of systolic hypertension showed lower prevalence in fish consumers than in non-fish consumers. The results indicate that people who ate fish regularly appeared to have a better cardiovascular risk profile than did non-fish consumers, which is of public health significance. The relationship between fish consumption and blood pressure deserves further studies in normotensive and hypertensive populations.

Differences in some haemostatic variables between fisheating and non-fish-eating populations.

The rare incidence of coronary artery disease in Eskimos has been ascribed to their diet of marine fish rich in n-3 fatty acids, which have an antithrombotic influence on haemostasis. In order to test this hypothesis, a crosssectional study was conducted on 1000 healthy individuals chosen randomly from coastal and inland villages in the state of Andhra Pradesh, India. A total of 500 fish-eating and 500 non-fish-eating age- and sex-matched subjects were selected based on fish-eating habits for parameters related to haemostasis. Mean cutaneous bleeding time and clotting time were decreased with advancing age in men and women of both populations.Women had more prolonged bleeding and clotting times than did men in both population groups. The platelet count was significantly lower in the fish-eating population. The mean bleeding time was observed to be prolonged significantly in men and women of the fish-eating population than that of the non-fish-eating population. However, the clotting time in the fish-eating population was significantly longer in certain age groups than in non-fish-eating population. The results indicate that fish consumption influences haemostatic function relative to a non-fish-eating population.

Traditional fish intake and fatty acid composition in fish consuming and non-fish consuming populations.

To evaluate the validity of habitual marine fish intake, the relation between fatty acid composition of serum phospholipids and dietary patterns were investigated. Dietary intake and serum fatty acid concentrations were measured in healthy subjects of coastal fish consuming and non-fish consuming populations. Amongst fish consumers, the intake of total energy (p<0.01) and carbohydrate (p<0.05) is significantly lower and protein intake higher than in non-fish consumers. The mean percentages of saturated and monounsaturated fatty acids do not show significant variation. However, in the ω-6 fatty acid series, the percent of linoleic acid, 22:4 ω-6 and 22:5 ω-6 is significantly lower in fish consumers, whereas dihomo-gamma linolenic acid is higher than in the non-fish consumers. The percentage of w-3 fatty acids in fish consumers, eicosapentaenoic acid, docosapentaenoic acid and docosahexaenoic acid are significantly greater (p<0.01) than those in non-fish consumers probably attributable to differences in fish intake. These differences in fatty acid profiles, particularly in the long-chain ω-3 series, are highlighted with the consumption of fish being a possible explanation between fish consuming and non-fish populations. The findings of this study suggest that the therapeutic efficacy of fish consumption is worthy of further study.

Fatty acid profile and the atherogenic risk in fish consuming and non fish consuming people.

Epidemiological studies have indicated a lower incidence of cardiovascular disease in populations with a high habitual intake of marine fish and fish oils, and this apparent protection may be due to the presence of n-3 fatty acids in the dietary fish. Two populations, a rish consuming one from coastal area and an inland one with non fish consuming from Nellore district or South India were selected for the present study. A total of one thousand healthy subjects were randomly chosen (500 in each population) from both sexes, aged from 20 to 70 years. The concentration of serum cholesterol, triacylglycerol and LDL-cholesterol were significantly lower in fish consumers, whereas HDL-cholesterol was higher in fish consumers than in non fish consumers. The difference between the percent quantities of the three n-3 fatty acids (eicosapentaenoic, docosapentaenoic and docosahexaenoic acids) was highly significant (p < 0.001) with a greater value in fish consumers.

Lipid profiles among fish-consuming coastal and non-fish-consuming inland populations.

Serum lipid profiles were examined in 100 individuals of fish-consuming coastal and 109 individuals of non-fish-consuming inland populations. The fish-consuming population showed lower mean serum cholesterol, triacylglycerols and significantly higher levels of HDL cholesterol and phospholipids. The bleeding time and clotting time were significantly prolonged in the fish-eating population. Thus the fish-consuming population showed lower risk factors of coronary heart disease when compared to the non-fish-consuming population.