Prevalence and Factors Associated with Goitre among 6-12-year-old Children in a Rural Area of Karnataka in South India.

In India, endemic goitre is present in sub-Himalayan region and in pockets in states of Andhra Pradesh, Karnataka and Gujarat. Being a public health problem amenable for prevention, the assessment of prevalence of endemic goitre in an area helps in understanding whether the preventive strategies under National Iodine Deficiency Disorder Control Program (NIDDCP) have any impact on the control of endemic goitre. Hence, the current study was carried out to determine the prevalence, distribution and factors associated with iodine deficiency goitre among 6-12-year-old children in a rural area in south Karnataka. A cross-sectional study was conducted among 838 children, using a questionnaire adopted from Iodized Salt Program Assessment Tool and the tools prescribed by WHO for goitre survey. The prevalence of goitre in the study area was 21.9% (95% CI 19.2-24.8). There was higher prevalence of goitre among those having salt iodine <15 ppm than those with >15 ppm (P = 0.01; OR 1.59; 95% CI 1.10-2.29). In 10% of the children, urinary iodine excretion (UIE) was assessed and prevalence was higher among those with <100 µg/l of UIE than those with normal UIE, which was not statistically significant (P = 0.8, OR 1.36; 95% CI 0.62-2.96). Multiple logistic regression revealed that gender (P = 0.002; OR 1.7; 95% CI 1.21-2.35) was an independent variable associated with goitre. The study area was found to be moderately endemic for goitre based on the WHO criteria. Higher prevalence of goitre was found to be still associated with consumption of low iodized salt (<15 ppm) necessitating emphasis on monitoring of salt iodine levels in the study area. Though NIDDCP is being implemented since five decades in India, the burden of iodine deficiency disorders (IDDs) is still high demanding further impetus to the monitoring systems of the programme.

Competing Risk Approach (CRA) for Estimation of Disability Adjusted Life Years (DALY's) for Female Breast Cancer in India.

BACKGROUND: Competing Risk Approach (CRA) has been used to compute burden of disease in terms of Disability Adjusted Life Years (DALYs) based on a life table for an initially disease-free cohort over time. OBJECTIVE: To compute Years of Life Lost (YLL) due to premature mortality, Years of life lost due to Disability (YLD), DALYs and loss in expectation of life (LEL) using competing risk approach for female breast cancer patients for the year 2008 in India. MATERIALS AND METHODS: The published data on breast cancer by age & sex, incidence & mortality for the year 2006-2008 relating to six population based cancer registries (PBCR) under Indian Council of Medical Research (ICMR), general mortality rates of 2007 in India, published in national health profile 2010; based on Sample Registration System (SRS) were utilized for computations. Three life tables were constructed by applying attrition of factors: (i) risk of death from all causes ('a'; where a is the general death rate); (ii) risk of incidence and that of death from causes other than breast cancer ('b-a+c'; where 'b' is the incidence of breast cancer and 'c' is the mortality of breast cancer); and (iii) risk of death from all other causes after excluding cancer mortality ('a-c'). Taking the differences in Total Person Years Lived (TPYL), YLD and YLL were derived along with LEL. RESULTS: CRA revealed that the DALYs were 40209 per 100,000 females in the life time of 0-70+ years with a LEL of 0.11 years per person. Percentage of YLL to DALYs was 28.20% in the cohort. CONCLUSION: The method of calculation of DALYs based on the CRA is simple and this will help to identify the burden of diseases using minimal information in terms of YLL, YLD, DALYs and LEL.

Comparison of nutritional status of rural and urban school students receiving midday meals in schools of Bengaluru, India: a cross sectional study.

BACKGROUND: The objective of the study was to assess the impact of the mid day meal program by assessing the nutritional status of school students aged 5-15 years receiving midday meals in rural schools and compare them with those in urban schools in Bengaluru, India. MATERIALS AND METHODS: This cross sectional study involved a sample of 4378 students from government and aided schools. Weight and height were measured and compared with ''means'' and ''percentiles'' of expected standards as endorsed by the Indian Association of Pediatrics. Regression coefficients were also estimated to assess the rate of growth. RESULTS: In all age groups and in both sexes, the observed mean weight and height were below the expected standards. The study findings showed that 13.8% and 13.1% of the studied students were underweight and stunted, respectively (below the third percentile for weight and height for age). A higher proportion of rural students were below the third percentile for both weight and height compared with urban students (weight: 16.3% and 11.5%; height: 17.0% and 10.0%; P < 0.05 for both weight and height). Only 2.4% and 3.1% were above 97 th percentile for weight and height. The rate of growth of height for weight showed a declining trend with increasing age in all the groups. DISCUSSION: The authors believe that the magnitude of the burden of undernourished students as seen in this study would have been much greater in the absence of the midday meal program. CONCLUSION: Greater involvement of the private sector to assist the government would help augment nutrition in children and indirectly impact school performance, attendance and literacy.

Risk of cancer development in India.

Incidence as a measure of risk for development of cancer is a well accepted epidemiological concept which can be precisely defined. The present communication documents an estimate of the current probability of development of cancer for specific age groups as well as for entire life time risk at the India country level for several cancers and 'all sites together'. The published data on age specific cancer incidence rates from 12 population based registries located at various parts of the country along with the abridged life tables relating to the Indian population formed the basic material for computation. Employing life table methodology for estimates, the current probability of developing cancer of all sites from 35-64 years is 4.67% in males and 6.55% in females while life time risk was found to be 9.05% and 10.2% respectively. The greater risk in females was mainly due to the high risk of development of cancer of the uterine cervix and breast. When the age-period of 35 to 70+ years were considered, the probability percentage was found to be 9.94 % in males whereas it was 11.6% in females. According to these estimates 1 in 10 men and 1 in 8 women in India can expect develop cancer of any form, in their life span after the age of 35 years. The probability of developing tobacco related cancers from 35 to 70+ years was found to be 4.75% and 2.16% in males and females respectively. Estimation in terms of probability will be useful in evaluating the changes in the disease spectrum as a result of change in mortality experience and population structure over a period of time.