Multicentric study on prevalence and risk factors for hypertension and diabetes in tribal communities in Western and Northern Maharashtra.

BACKGROUND AND OBJECTIVES: Although a number of studies have been conducted on the prevalence of hypertension (HTN) and diabetes on tribal populations in different parts of India, comparative tribe-specific information is very meager. The main objective of this study is to generate tribe-specific information on the noncommunicable disorders (NCDs) and associated risk factors in scheduled tribes (STs) in Coastal and Western Maharashtra. METHODS: The study was conducted on 1864 (females 960) adults (≥18 years) of both sexes in four dominant tribes in the region, namely, Bhils (748), Katkaris (560), Kokana (352), and Thakars (204), using the protocols approved by the Institutional Review Board. The study areas were geographically separated by large distances (250-500 km apart). Prevalence of overweight, diabetes, HTN, and hypercholesterolemia was measured using standard field-based techniques described in our earlier publication. RESULTS: All STs in this study are grossly underweight; the Katkaris are worst affected. The prevalence of obesity (body mass index ≥30 kg/m2), HTN (blood pressure ≥140 mmHg), diabetes (capillary blood glucose >126 mg/dl), and hypercholesterolemia (cholesterol ≥200 mg/dl) was 0.9%, 11.7%, 6.7%, and 0.6% respectively. There are no statistically significant inter-tribal differences in the prevalence of these parameters. Age and obesity appeared to be the most dominant risk factors for HTN. However, there is no clear-cut picture about the influence of risk factors on diabetes or hypercholesterolemia. INTERPRETATION AND CONCLUSION: The prevalence of NCDs is still very low in STs, probably due to near absence of the risk factors such as obesity, sedentary lifestyle, and hyperlipidemia. STs are highly endogamous, and the study areas are separated by large distances ruling out intermingling of tribes. Yet, there is no consistent inter-tribal prevalence pattern for NCDs. Although the sample size is small, the results support the view that environmental factors are likely to be more important than host genetics in the causation of NCDs.

Prevalence and risk factors of hypertension and diabetes in the Katkari tribe of coastal Maharashtra.

BACKGROUND AND OBJECTIVES: Urban and rural India are both going through health epidemiological transition and will soon face huge burden of noncommunicable diseases (NCDs). Information on the status of NCDs in tribals is limited. Although the prevalence of hypertension in scheduled tribes (STs) has been studied in several states by the National Nutrition Monitoring Bureau, tribe-specific data are very scanty. The objective of this study was to generate data on the status of hypertension and diabetes, the two objectively measurable NCDs in Katkaris, the dominant ST in the Raigad district of coastal Maharashtra. METHODS: The study was conducted in 410 adult Katkaris (women 219) of both sexes of ≥18 years of age in three adjoining tehsils of the district. Using the Institution Review Board approved protocol; information was obtained on sociodemographic parameters, educational level, dietary pattern, and substance abuse. Prevalence of overweight, hypertension, and diabetes was measured using standard field-based procedures and techniques. RESULTS: Katkaris, who are mostly landless manual laborers, subsist on a protein-poor, imbalanced diet. About half of women and one-third of men have body mass index (BMI) <18.5 kg/m2, an indication of undernutrition. On the other hand, about 2% of participants were obese (BMI ≥30 kg/m2). The overall prevalence of hypertension and diabetes was 16.8% and 7.3%, respectively. Hypercholesterolemia was recorded in about 3% of the participants. INTERPRETATION AND CONCLUSIONS: Prevalence of diabetes and hypertension in Katkaris is still lower than that of urban and rural populations, closer to the latter. This may be due to the absence of known risk factors such as obesity, sedentary lifestyle, and hyperlipidemia in this community. Fast acculturation of the STs suggests that NCDs will soon become a major health issue in them too. It is time to launch a multicentric national study to gather baseline information on the status of NCDs in STs.

Field Testing of Second Generation of Colour-Coded Rings for Detecting Slow Progress of Labour at Rural Health Centres.

INTRODUCTION: An innovative appropriate technological tool of colour-coded rings based on cervicographic principles was developed to monitor deliveries. OBJECTIVES: To study efficacy, feasibility and acceptability of colour-coded rings for monitoring active phase of labour. MATERIALS AND METHODS: All consecutive deliveries occurring at selected primary health centres from Pune, Satara and Kolhapur Districts of Maharashtra, during 15 months period were included in the study and matched control groups. Training of medical officers and nurses from both study and control area was undertaken in routine natal and post-natal care. In addition, training of use of colour-coded rings was given to health workers from the study area. RESULTS: There were 6705 live births from study area and 6341 from control area. Perinatal mortality rate for study area was 15.9/1000 LB while that was 23.9/1000 LB for control area (p < 0.01). The cause-specific perinatal mortality due to birth asphyxia for the study area was 4.2/1000 LB while that was 8.5/1000 LB for control area (p = 0.0019). CONCLUSION: Higher use rate of colour-coded rings associated with reduction in cause-specific mortality rate due to birth asphyxia in study area indicated that use of colour-coded rings is effective, feasible and acceptable option to cervicography under field conditions.

Field Testing of Appropriate Technological Tool of Individualised Color Coded Any Day Neonatal Growth Monitoring Charts for Neonatal Care at Primary Health Care Level.

OBJECTIVE: To field test the Individualised Color Coded Any Day (ICCAD) growth monitoring charts at primary health care level in three districts of Maharashtra. METHODS: The present study was conducted in three districts of Maharashtra - Pune, Satara and Kolhapur and included newborns with weight ≥ 1500 g born during 1st May 2010 to 30th July 2011. Talukas were matched based on mortality and coverage indicators and put in study (ICCAD use) and control area (ICCAD non-use) from every District. Health centres were selected from each taluka where facilities of expert obstetric and pediatric services did not exist but number of deliveries conducted was high. Data was collected during neonatal period. Three patterns of ICCAD charts; 1500 g to 1999 g, 2000 to 2499 g and ≥2500 g; developed from daily weight record of 430 newborns for 30 d were used. Outcome measures were neonatal mortality rate (NMR) and weight gain in study and control groups. RESULTS: There were 6705 live births from study and 6341 from control area. The NMR of study area (6.3/1000 live births) was significantly lesser as compared to control area (10.6/1000 live births). Birth weight group specific NMR of birth weight between 1500 to <2000 g and ≥2500 g was significantly lower in study area as compared to control area. There was improvement in mean gain weight of 15 g, 43 g and 89 g for respective birth weight groups in ascending order. CONCLUSIONS: This innovative appropriate technological tool based on translational research of ICCAD neonatal growth monitoring charts appears to have benefited the decision of type of care.

A study of some clinical variables in predicting outcome after acute myocardial infarction.

The univariate analysis of age, previous myocardial infarction, systolic blood pressure, diabetes, smoking, etc, accounted their association with increased mortality in acute myocardial infarction (AMI). Thus, the study was undertaken to determine the significance of some such variables among hospitalised AMI cases by applying univariate statistical techniques. Two years retrospective data of 208 hospitalised AMI cases was collected from patients' records. Impact of each study variable on outcome, survival and non-survival, was assessed by Student's 't' test while association between risk factor and outcome was estimated by Chi-square test. Twenty-five per cent of non-survival was observed in AMI cases. Non-survival was high among those, whose age was more than 60 years (t = 4.37, p < 0.001) and who were village dwellers (t = 3.69, p < 0.001). The non-survival in previous myocardial Infarction (MI) and diabetes cases was 28% and 30% respectively. Thirty per cent of cases with previous MI and hypertension together as common risk factors did not survive. On admission significantly low systolic blood pressure (t = 3.23, p < 0.01), high pulse rate (t = 4.88, p < 0.001) and high blood sugar (t = 2.55, p < 0.05) was observed among non-survivals. There was large variation in explaining survival/non-survival on the basis of each variable, separately. Involvement of single variable in determination of prognosis assuming non-influence of other variable(s), may result in improper determination of prognosis.