Shooting shadows: India's struggle to reduce the burden of anaemia.

Despite several efforts by the Government of India, the national burden of anaemia remains high and its growing prevalence (between 2015-2016 and 2019-2021) is concerning to India's public health system. This article reviews existing food-based and clinical strategies to mitigate the anaemia burden and why they are premature and insufficient. In a context where multiple anaemia control programmes are in play, this article proposes a threefold strategy for consideration. First, except the Comprehensive National Nutrition Survey, 2016-2018, which measured Hb concentration among children and adolescents aged 1-19 years using venous blood samples, all national surveys use capillary blood samples to determine Hb levels, which could be erroneous. The Indian government should prioritise conducting a nationwide survey for estimating the burden of anaemia and its clinical determinants for all age groups using venous blood samples. Second, without deciding the appropriate dose of Fe needed for an individual, food fortification programmes that are often compounded with layering of other micronutrients could be harmful and further research on this issue is needed. Same is true for the pharmacological intervention of Fe tablet or syrup supplementation programmes, which is given to individuals without assessing its need. In addition, there is a dire need for robust research to understand both the long-term benefit and side effects of Fe supplementation programmes. Third and final, the WHO is in process of reviewing the Hb threshold for defining anaemia, therefore the introduction of new anaemia control programmes should be restrained.

Use of antenatal and delivery care services and their association with maternal and infant mortality in rural India.

Optimum use of antenatal care (ANC) and delivery care services could reduce morbidity and mortality among prospective mothers and their children. However, the role of ANC and delivery services in prevention of both maternal and child mortality is poorly understood, primarily because of dearth of prospective cohort data. Using a ten-years population-based prospective cohort data, this study examined the use of ANC and delivery services and their association with maternal and infant mortality in rural India. Descriptive statistics were estimated, and multivariable logistic regression modelling was used to attain the study objective. Findings revealed that consumption of ≥ 100 iron-and-folic acid (IFA) tablet/equivalent syrup during pregnancy had a protective association with maternal and infant mortality. Lack of maternal blood group checks during pregnancy was associated with increased odds of the death of infants. Caesarean/forceps delivery and delivery conducted by untrained personnel were associated with increased odds of maternal mortality. Findings from this study reemphasizes on increasing coverage and consumption of IFA tablets/equivalent syrup. Improved ANC and delivery services and increased uptake of all types of ANC and delivery care services are equally important for improvement in maternal and child survival in rural India.

Health care seeking behaviour and financial protection of patients with hypertension: A cross-sectional study in rural West Bengal, India.

BACKGROUND: Elevated blood pressure or hypertension is responsible for around 10 million annual deaths globally, and people residing in low and middle-income countries are disproportionately affected by it. India is no exception, where low rate of treatment seeking for hypertension coupled with widespread out-of-pocket payments (OOPs) have been a challenge. This study assessed the pattern of health care seeking behaviour and financial protection along with the associated factors among hypertensive individuals in rural West Bengal, India. METHOD AND FINDINGS: A cross-sectional study was conducted in Birbhum district of the state of West Bengal, India, during 2017-2018, where 300 individuals were recruited randomly from a list of hypertensives in a population cohort. Healthcare seeking for hypertension and related financial protection in terms of-OOPs and expenses relative to monthly per-capita family expenditure, were analysed. Findings indicated that 47% of hypertensives were not on treatment. Among those under treatment, 80% preferred non-public facilities, and 91% of them had wide-spread OOPs. Cost of medication was a major share of expenses followed by transportation cost to access public health care facility. Multivariable logistic regression analysis indicated longer duration of disease (adjusted odds ratio (aOR): 5.68, 95% Confidence Interval (CI) 1.24-25.99) and health care seeking from non-public establishment (aOR: 34.33, CI: 4.82-244.68) were associated with more incident of OOPs. Linear regression with generalized linear model revealed presence of co-morbidities (adjusted coefficient (aCoeff)10.28, CI: 4.96,15.61) and poorer economic groups (aCoeffpoorest 11.27, CI 3.82,18.71; aCoefflower-middle 7.83, CI 0.65,15.00 and aCoeffupper-middle 7.25, CI: 0.80,13.70) had higher relative expenditure. CONCLUSION: This study suggests that individuals with hypertension had poor health care seeking behaviour, preferred non-public health facilities and had suboptimal financial protection. Economically poorer individuals had higher burden of health expenditure for treatment of hypertension, which indicated gaps in equitable health care delivery for the control of hypertension.

Non-communicable diseases are the leading cause of mortality in rural Birbhum, West Bengal, India: a sex-stratified analysis of verbal autopsies from a prospective cohort, 2012-2017.

OBJECTIVES: There is a dearth of data on causes of death in rural India, which impedes identification of public health priorities to guide health interventions. This study aims to offer insights from verbal autopsies, to understand the pattern and distribution of causes of death in a rural area of Birbhum District, West Bengal, India. DESIGN: Causes of death data were retrieved from a prospective vital event surveillance system. SETTING: The Birbhum Population Project, a Health and Demographic Surveillance System, West Bengal, India. PARTICIPANTS: Between January 2012 and December 2017, all deaths were recorded. MAIN OUTCOME MEASURES: Trained Surveyors tracked all deaths prospectively and used a previously validated verbal autopsy (VA) tool to record causes of death. Experienced physicians reviewed completed VA forms, and assigned cause of death using the 10th version of International Classification of Diseases. In addition to cause-specific mortality fraction, cause-specific crude death rate (CDR) among males and females were estimated. RESULTS: A total of 2320 deaths (1348 males and 972 females) were recorded. An estimated CDR was 708/100 000. Over half of all deaths (1176 deaths, 50.7%) were attributed to non-communicable diseases (NCDs), with nearly 30% of all deaths attributed to circulatory system disorders; whereas 24.2% and 3.9% deaths were due to cerebrovascular diseases and ischaemic heart disease, respectively. Equal percent (13%) of males died from external causes and from infectious and parasitic diseases, and 11% died from respiratory system-related diseases. Among females, 12% died from infectious and parasitic diseases. Among children aged 0-4 years, 50% of all male deaths and 45% of all female deaths were attributed to conditions in the perinatal period. CONCLUSIONS: NCDs are the leading cause of death among adults in a select population of rural Birbhum, India. Health programmes for rural India should prioritise plans to mitigate deaths due to NCDs.

Double burden of malnutrition among adolescents in rural West Bengal, India.

OBJECTIVES: The aims of this study were to investigate the prevalence of underweight, stunting, and overweight among adolescents in rural West Bengal, India, and identify factors contributing to these forms of malnutrition. METHODS: This was a cross-sectional study conducted within the Birbhum Health and Demographic Surveillance System in West Bengal, India. Participants were male and female adolescents 10 to 19 y of age (N = 5521). Body mass index (BMI) was calculated using measured heights and weights and z-scores based on the 2007 World Health Organization growth standards. Information on demographic characteristics, diet, and health behaviors was collected through face-to-face interviews using a standardized questionnaire. Modified Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association between each risk factor and outcome. RESULTS: The proportion of underweight was 26.6% overall: 31.1% among boys, and 21.1% among girls. The proportion of stunting was 25% overall: 23.3% among boys and 26.9% among girls. Of the participants, 4.6% were overweight or obese: 4.1% boys and 5.2% girls. Compared with boys, girls had a reduced likelihood of being underweight (adjusted PR, 0.67; 95% CI, 0.59-0.75). Multivariate models also showed that socioeconomic status was strongly associated with all nutritional outcomes. Not having a toilet facility in one's household and poor hand hygiene were also associated with a greater likelihood of stunting. CONCLUSION: The present results suggested that adolescents in Birbhum, India are substantially affected by the double burden of malnutrition. Nutritional interventions should incorporate efforts to reduce socioeconomic inequality.

Population-level effective coverage of adolescent weekly iron and folic acid supplementation is low in rural West Bengal, India.

OBJECTIVE: To assess the coverage of the adolescent weekly iron and folic acid supplementation (WIFS) programme in rural West Bengal, India. DESIGN: We conducted a population-based cross-sectional survey of intended WIFS programme beneficiaries (in-school adolescent girls and boys and out-of-school adolescent girls). SETTING: Birbhum Health and Demographic Surveillance System. PARTICIPANTS: A total of 4448 adolescents 10-19 years of age participated in the study. RESULTS: The percentage of adolescents who reported taking four WIFS tablets during the last month as intended by the national programme was 9·4 % among in-school girls, 7·1 % for in-school boys and 2·3 % for out-of-school girls. The low effective coverage was due to the combination of large deficits in WIFS provision and poor adherence. A large proportion of adolescents reported they were not provided any WIFS tablets in the last month: 61·7 % of in-school girls, 73·3 % of in-school boys and 97·1 % of out-of-school girls. In terms of adherence, only 41·6 % of in-school girls, 38·1 % of in-school boys and 47·4 % of out-of-school girls reported that they consumed all WIFS tablets they received. Counselling from teachers, administrators and school staff was the primary reason adolescents reported taking WIFS tablets, whereas the major reasons for non-adherence were lack of perceived benefit, peer suggestion not to take WIFS and a reported history of side effects. CONCLUSIONS: The effective coverage of the WIFS programme for in-school adolescents and out-of-school adolescent girls is low in rural Birbhum. Integrated supply- and demand-side strategies appear to be necessary to increase the effective coverage and potential benefits of the WIFS programme.

Incidence of Prehypertension and Hypertension in Rural India, 2012-2018: A Sex-Stratified Population-Based Prospective Cohort Study.

BACKGROUND: India is home to the largest number of hypertensive individuals, and factors responsible for the incidence of hypertension are poorly understood. This study examines predictors of transition to different stages of hypertension-incidence of hypertension, incidence of prehypertension, and incidence of prehypertension to hypertension. METHODS: Population-based survey data from the Birbhum Population Project, located in West Bengal, India were used. A cohort of 8,977 individuals (male: 3,934, female: 5,043), participated in the 2012-13 survey, and were followed up for resurvey in 2017-18. The Seventh Report of the Joint National Committee (JNC 7) guidelines were followed to define hypertension. Bivariate and multivariate Poisson regression analyses were conducted to attain the study objective. RESULTS: The incidence of hypertension, prehypertension among males (7.9% and 45.3%, respectively) is higher than that among females (5.9% and 32.7%, respectively). However, the incidence of prehypertension to hypertension is lower among males (23.6%) than among females (33.6%). Among both sexes, with age, the incidence of hypertension, and incidence of prehypertension to hypertension appeared to increase, whereas incidence of prehypertension among females increased with age. Findings indicate a diverse gradient of socioeconomic, behavioral, and anthropometric characteristics influencing the incidence of different stages of hypertension. CONCLUSIONS: With a focus on females and the richest individuals, this study proposes that an appropriate intervention be designed in keeping with the socioeconomic, behavioral gradient of incidence of different stages of hypertension. The role of anthropometric indicators in hypertension is proposed to be further studied for better population-based screening.

Sociodemographic Determinants of Preterm Birth and Small for Gestational Age in Rural West Bengal, India.

Preterm birth and small for gestational age (SGA) are major contributors to neonatal mortality in India. However, social determinates of preterm births and SGA are poorly characterized. We use population-based data from a health and demographic surveillance system (HDSS) in rural West Bengal, India, to examine risk factors for preterm birth and SGA. HDSS pregnancy cohort data for 2430 pregnant women were used in this analysis. Of 2430 pregnancies, 16% were preterm births and 38.2% were SGA. Results from logistic regression reveal that higher maternal education (≥11 years) was associated with reduced risk of preterm births and SGA. Greater wealth quintile was also associated with decreased risk of preterm births and SGA (p-value for trend: <0.05). In light of the findings, ensuring effective coverage of preterm and SGA interventions among women of low socioeconomic status will be essential to mitigate the large burden of preterm births and SGA.

Prospective cohort study of overweight and obesity among rural Indian adults: sociodemographic predictors of prevalence, incidence and remission.

OBJECTIVES: To assess sociodemographic predictors of prevalence, incidence and remission of overweight including obesity among adults (aged ≥18 years) in rural Eastern India. DESIGN: Prospective cohort study. SETTING: Birbhum Health and Demographic Surveillance System, West Bengal, India. PARTICIPANTS: Self-weighted sample of 24 115 adults (men: 10915, women: 13200) enrolled in 2008 were followed up for body mass index (BMI) reassessment in 2017. PRIMARY AND SECONDARY OUTCOME MEASURES: Measured BMI was categorised as: underweight (<18.5 kg/m2), normal weight (18.5-22.9 kg/m2) and overweight including obesity (≥23 kg/m2; hereinafter overweight). Incident overweight was defined as transition from normal weight in 2008 to overweight in 2017, whereas if overweight individuals in 2008 measured normal BMI in 2017, it was classified as remission from overweight. RESULTS: In 2008, 10.1% of men and 14.6% of women were overweight, whereas 17.3% of men and 24.7% of women were overweight in 2017. At the same time, in 2017, 35.6% of men and 33.3% of women were underweight. Incident overweight was 19.0% among men and 27.2% among women, whereas remission among men was higher (15.4%) than women (11.5%). Women were more likely to be overweight in 2008 and to experience incident overweight than men. For men and women, education level and wealth were positively associated with prevalence and incidence of overweight. Remission from overweight was less likely in Sainthia, a business hub in the district, as compared with Mohammad Bazar, a more rural area. CONCLUSION: A nutrition transition to higher risk of overweight is evident in this rural setting in India, especially among women and individuals with high socioeconomic status. At the same time, a high prevalence of underweight persists, resulting in a significant double burden. Culturally sensitive interventions that address both ends of the malnutrition spectrum should be prioritised.

The burden of iron-deficiency anaemia among women in India: how have iron and folic acid interventions fared?

Iron-deficiency anaemia (IDA) among women in India is a problem of major public health significance. Using data from three waves of the National Family Health Survey, this article discusses the burden of and trend in IDA among women in India, and discusses the level of iron and folic acid (IFA) supplementation and its potential role in reducing the burden of IDA. Between 2005-2006 and 2015-2016, IDA in India decreased by only 3.5 percentage points (from 56.5% in 2005-2006 to 53.0% in 2015-2016) for women aged 15-49 years. However, during the same period, of 27 states compared, IDA increased in eight: Delhi, Haryana, Himachal Pradesh, Kerala, Meghalaya, Tamil Nadu, Punjab and Uttar Pradesh; furthermore, some of these (e.g. Kerala) are states that rank among the highest on the state Human Development Index but had failed to contain the burden of IDA. Although there is a standard guideline for IFA supplementation in place, the IFA intervention appears to be ineffective in reducing the burden of IDA in India (nationally only 30.3 % of mothers consumed IFA for 100 days or more when they were pregnant), probably due to irregular consumption of IFA where the provision of screening under the National Iron+ Initiative scheme appears to be unsuccessful. To strengthen the IFA intervention and its uptake, a concerted effort of community-level health workers (accredited social health activists, auxiliary nurse midwives and anganwadi workers) is urgently needed. In addition, food-based strategies (dietary diversification and food fortification), food supplementation and improvement of health services are required to reduce the burden of anaemia among women in India.

Metabolic syndrome among rural Indian adults.

BACKGROUND & AIMS: To prevent an increasing level of mortality due to type 2 diabetes mellitus and cardiovascular disease among the rural Indian population, a management strategy of the metabolic syndrome (MetS) should be devised. This study aims to estimate the burden of MetS and its associated risk factors. METHODS: Data from the Birbhum Population Project covering 9886 individuals (4810 male and 5076 female population) aged ≥18 years were used. The burden of metabolic syndrome, as defined by the Third Report of the National Cholesterol Education Program Adult Treatment Panel, was determined. Bivariate and multivariate (logistic regression) analyses were used to attain the study objective. RESULTS: Over 10.7% of the males and 20.3% of the females were diagnosed with MetS. Irrespective of sex, older individuals, being overweight/obese (body mass index of ≥23 kg/m2) had higher probability of developing MetS, whereas being underweight is deemed a protective factor against MetS. Low physical activity among women appeared to be a risk factor for MetS. CONCLUSION: The prevalence of MetS is concerning even in rural India. Any intervention designed to address the issue could emphasize on weight loss, and physical activity, focusing on women and people at an advanced stage of life.

Underweight among rural Indian adults: burden, and predictors of incidence and recovery.

OBJECTIVE: To study the magnitude and predictors of underweight, incident underweight and recovery from underweight among rural Indian adults. DESIGN: Prospective cohort study. Each participant's BMI was measured in 2008 and 2012 and categorized as underweight (BMI<18·5 kg/m2), normal (BMI=18·5-22·9 kg/m2) or overweight/obese (BMI ≥23·0 kg/m2). Incident underweight was defined as a transition from normal weight or overweight/obese in 2008 to underweight in 2012, and recovery from underweight as a transition from underweight in 2008 to normal weight in 2012. Bivariate and multivariable logistic regression analyses were employed. SETTING: The Birbhum Health and Demographic Surveillance System, West Bengal, India. SUBJECTS: Predominantly rural individuals (n 6732) aged ≥18 years enrolled in 2008 were followed up in 2012. RESULTS: In 2008, the prevalence of underweight was 46·5 %. From 2008 to 2012, 25·8 % of underweight persons transitioned to normal BMI, 12·9 % of normal-weight persons became underweight and 0·1 % of overweight/obese persons became underweight. Multivariable models reveal that people aged 25-49 years, educated and wealthier people, and non-smokers had lower odds of underweight in 2008 and lower odds of incident underweight. Odds of recovery from underweight were lower among people aged ≥36 years and higher among educated (Grade 6 or higher) individuals. CONCLUSIONS: The current study highlights a high incidence of underweight and important risk factors and modifiable predictors of underweight in rural India, which may inform the design of local nutrition interventions.

Preference in place of delivery among rural Indian women.

India accounts for the highest number of maternal and child deaths globally. A large body of empirical research suggests that improvement in the coverage of institutional delivery is essential to reduce the burden of maternal and child death. However the dynamics of choice of place of delivery is poorly understood. Using qualitative survey data consisting of twelve focus group discussions, conducted in a rural setting of West Bengal, India, this study aims to understand the reasons behind preferring home or institution for delivery. Findings reveal that some women who underwent an institutional delivery preferred to deliver their baby at home. On the other hand, of women who delivered their baby at home, 60% wanted to deliver their babies in institutions but could not do so, primarily due to the unwillingness of family members and misreporting of the onset of true labour pain. With the help of Accredited Social Health Activists, the village level health workers, there is need for an intervention that focuses on educating household members (essentially targeting husbands and mother-in-laws) about birth preparedness, and identification of true labour pain.

Probable psychiatric disorder in a rural community of West Bengal, India.

PURPOSE: India faces multiple challenges to mitigate a high burden of psychiatric disorders. The risk of developing psychiatric disorder among the rural Indian population is poorly investigated. This study aims to understand the factors associated with probable psychiatric disorder (PPD) among a select rural Indian population. METHODS: Data from the Birbhum population project of the society for health and demographic surveillance, West Bengal, India, were utilized. Cross-sectional data covering a sample of 31,135 respondents (male 15,384 and female 15,751) aged ≥ 16 years were used. The General Health Questionnaire-28 was administered and the responses were computed into three categories: psychological case, psychological caseness, and normal. Bivariate and multivariate ordered logit regression analyses were applied to attain the study objective. RESULTS: Of the total population, 26% of respondents were identified with PPD. People aged ≥ 60 years, females, divorced/separated/widowed individuals, the unemployed and people with no formal education, individuals from the poorest economic group, and people with a history of selling or mortgaging assets towards their healthcare expenditure had a higher prevalence of psychiatric case within their respective group. CONCLUSIONS: A high burden of PPD was estimated in the select rural community. While designing an intervention for measuring and addressing psychiatric disorders, the socioeconomic gradient of PPD could be helpful.

Hepatic steatosis is associated with cardiometabolic risk in a rural Indian population: A prospective cohort study.

BACKGROUND/OBJECTIVES: While adiposity and hepatic steatosis are linked to cardiovascular risk in developed countries, their prevalence and impact in low-income countries are poorly understood. We investigated the association of anthropomorphic variables and hepatic steatosis with cardiometabolic risk profiles and subclinical cardiovascular disease (CVD) in a large rural Indian cohort. METHODS: In 4691 individuals in the Birbhum Population Project in West Bengal, India, we performed liver ultrasonography, carotid ultrasound and biochemical and clinical profiling. We assessed the association of hepatic steatosis and anthropomorphic indices (BMI, waist circumference) with CVD risk factors (dysglycemia, dyslipidemia, hypertension) and subclinical CVD (by carotid intimal-medial thickness). RESULTS: Rural Indians exhibited a higher visceral adiposity index and pro-atherogenic dyslipidemia at a lower BMI than Americans. Individuals with any degree of hepatic steatosis by ultrasound had a greater probability of dysglycemia (adjusted odds ratio, OR=1.67, 95% CI 1.31-2.12, P<0.0001) and pro-atherogenic dyslipidemia (OR=1.33, 95% CI 1.07-1.63, P=0.009). We observed a positive association between liver fat, adiposity and carotid intimal-medial thickness (CIMT) in an unadjusted model (ß=0.02, P=0.0001); the former was extinguished after adjustment for cardiometabolic risk factors. CONCLUSIONS: In a large population of rural Indians, hepatic steatosis and waist circumference were associated with prevalent cardiometabolic risk and subclinical CVD at lower BMI relative to multi-ethnic Americans, though the association of the former with subclinical CVD was extinguished after adjustment. These results underscore the emerging relevance of hepatic steatosis and adiposity in the developing world, and suggest efforts to target these accessible phenotypes for cardiometabolic risk prevention.

Physiological and behavioral risk factors of type 2 diabetes mellitus in rural India.

BACKGROUND: The dynamics of physiological and behavioral risk factors of diabetes in rural India is poorly understood. Using data from a health and demographic surveillance site of Birbhum district in West Bengal, India, this study aims to assess the risk factors associated with type 2 diabetes mellitus. RESEARCH DESIGN AND METHODS: A total of 7674 individuals aged ≥18 years participated in a cross-sectional study. Venous plasma glucose method was used for measuring and reporting glucose concentrations in blood, categorized as individuals with diabetes, pre-diabetes or impaired, and normoglycemic. Aside from a set of physiological and behavioral risk factors, a range of socioeconomic confounders of diabetes was computed. Bivariate analysis with χ(2) test, and multivariate ordered logit regression methods were deployed to attain the study's objective. RESULTS: Overall 2.95% and 3.34% of study participants were diagnosed as individuals with diabetes and pre-diabetes or impaired, respectively. Compared to the poorest, the richest have higher probability (ß: 0.730; 95% CI 0.378 to 1.083) of being diagnosed with diabetes. As compared to people with normal body mass index, overweight/obese people are more prone to being diagnosed with diabetes (ß: 0.388; 95% CI 0.147 to 0.628). With a decreasing level of physical activity, people are more likely to be diagnosed with diabetes. CONCLUSIONS: To curb the level of diabetes, this study recommends a culturally sensitive, focused intervention for the adoption of physical activity with more traditional dietary practices, to control the level of overweight/obesity. Attention should be paid to relatively older patients with diabetes or adults with pre-diabetes.

Sex differences in the risk profile of hypertension: a cross-sectional study.

OBJECTIVE: To assess the socioeconomic and behavioural risk factors associated with hypertension among a sample male and female population in India. SETTING: Cross-sectional survey data from a Health and Demographic Surveillance System (HDSS) of rural West Bengal, India was used. PARTICIPANTS: 27 589 adult individuals (13 994 males and 13 595 females), aged ≥18 years, were included in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: Hypertension was defined as mean systolic blood pressure (SBP) ≥140 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg, or if the subject was undergoing regular antihypertensive therapy. Prehypertension was defined as SBP 120-139 mm Hg and DBP 80-89 mm Hg. Individuals were categorised as non-normotensives, which includes both the prehypertensives and hypertensives. Generalised ordered logit model (GOLM) was deployed to fulfil the study objective. RESULTS: Over 39% of the men and 25% of the women were prehypertensives. Almost 12.5% of the men and 11.3% of the women were diagnosed as hypertensives. Women were less likely to be non-normotensive compared to males. Odds ratios estimated from GOLM indicate that women were less likely to be hypertensive or prehypertensive, and age (OR 1.04, 95% CI 1.03 to 1.05; and OR 1.08, 95% CI 1.07 to 1.09 for males and females, respectively) and body mass index (OR 1.64, 95% CI 1.38 to 1.97 for males; and OR 1.32, 95% CI 1.08 to 1.60 for females) are associated with hypertension. CONCLUSIONS: An elevated level of hypertension exists among a select group of the rural Indian population. Focusing on men, an intervention could be designed for lifestyle modification to curb the prevalence of hypertension.

Tobacco use and self-reported morbidity among rural Indian adults.

UNLABELLED: Aim To measure the prevalence of self-reported morbidity and its associated factors among adults (aged ⩾15 years) in a select rural Indian population. BACKGROUND: Self-reporting of smoking has been validated as population-based surveys using self-reported data provide reasonably consistent estimates of smoking prevalence, and are generally considered to be sufficiently accurate for tracking the general pattern of morbidity associated with tobacco use in populations. However, to gauge the true disease burden using self-reported morbidity data requires cautious interpretation. METHODS: During 2010-2011, a cross-sectional survey was conducted under the banner of the Health and Demographic Surveillance System, Birbhum, an initiative of the Department of Health and Family Welfare, Government of West Bengal, India. With over 93.6% response rate from the population living in 12 300 households, this study uses the responses from 16 354 individuals: 8012 smokers, and 8333 smokeless tobacco users. Smokers and smokeless tobacco users were asked whether they have developed any morbidity symptoms due to smoking, or smokeless tobacco use. Bivariate, as well as multivariate logistic regression analyses were deployed to attain the study objective. Findings Over 20% of smokers and over 9% of smokeless tobacco users reported any morbidity. Odds ratio (OR) with 95% confidence interval (CI) estimated using logistic regression shows that women are less likely to report any morbidity attributable to smoking (OR: 0.69; CI: 0.54-0.87), and more likely to report any morbidity due to smokeless tobacco use (OR: 1.68; CI: 1.36-2.09). Non-Hindus have higher odds, whereas the wealthiest respondents have lower odds of reporting any morbidity. With a culturally appropriate intervention to change behaviour, youth (both men and women) could be targeted with comprehensive tobacco cessation assistance programmes. A focussed intervention could be designed for unprocessed tobacco users to curb hazardous effects of tobacco use.

Alcohol Use-Related Problems Among a Rural Indian Population of West Bengal: An Application of the Alcohol Use Disorders Identification Test (AUDIT).

AIMS: To examine alcohol use and related problems among a rural subset of the Indian population. METHODS: The Alcohol Use Disorders Identification Test (AUDIT) was used as part of Health and Demographic Surveillance of 36,611 individuals aged ≥18 years. From this survey data on 3671 current alcohol users were analysed using bivariate and multivariate ordered logit regression. RESULTS: Over 19% of males and 2.4% of females were current alcohol users. Mean ethanol consumption on a typical drinking day among males was estimated to be higher (96.3 gm) than females (56.5 gm). Mean AUDIT score was 11 among current alcohol users. AUDIT showed in the ordered logit regression estimated alcohol use-related problems to be low among women, Scheduled Tribes and unmarried people, whereas alcohol use-related problems registered high among Muslims. CONCLUSION: This rural population appears to be in need of an effective intervention program, perhaps targeting men and the household, aimed at reducing the level of alcohol use and related problems.

Socio-economic disparities in tobacco consumption in rural India: evidence from a health and demographic surveillance system.

AIMS: India houses over 275 million tobacco users, with 164 million users of only smokeless tobacco, 69 million exclusive smokers, and 42 million users of both smoking and smokeless tobacco. This study aims to examine the socio-economic factors associated with types of tobacco use in a selected rural Indian population. METHODS: A cross-sectional study was conducted with surveillance data from the Birbhum Population Project (BIRPOP). Total respondents of 29,783 individuals (16,038 men and 13,745 women) aged ≥15 years were surveyed between October 2010 and January 2011. Apart from bivariate analyses, a binary logistic regression was applied to estimate the adjusted odds ratio for socio-economic factors (religion, social group, education, occupation, and wealth quintile) associated with current tobacco use, current smokeless tobacco use, and current bidi use among men and women. RESULTS: Nearly 22% of men and 26% of women were using smokeless tobacco. While 46% of men were smoking bidi, only 4% of women reported smoking bidi. Overall, men are more likely to use tobacco. Irrespective of gender, with increasing years of education, people are less inclined to use tobacco, and unemployed people are less likely to use tobacco. With increasing income, the odds of smokeless tobacco use and the odds of smoking bidi are higher among women and men, respectively. CONCLUSION: The BIRPOP study indicates that irrespective of gender and income, raising the level of awareness through household-based health education could be an effective intervention to minimise the level of tobacco use.