A comparison of nutritional status between children with and without disabilities: A community-based study.

BACKGROUND: Children with disabilities are expected to have poor nutritional status in comparison to children without disabilities. However, limited data on nutritional status of children with and without disabilities in rural settings in India. OBJECTIVE: To assess and compare the nutritional status of children with and without disability. METHODS: A cross-sectional study among children aged 5-15 years was conducted in the rural practise area of a medical college in Karnataka. 290 children (145 with and 145 children without disability) of similar age and sex were studied. Age and sex-specific World Health Organization (WHO) BMI centiles, 24 h dietary calorie and protein intakes were assessed and compared. Median and interquartile ranges were calculated for quantitative variables. Mann-Whitney U test was used to assess the differences in quantitative variables among the two groups. RESULTS: As per WHO BMI centiles, 33.1% with and 37.20% without disabilities were undernourished. The median calorie consumed by children with disabilities was 1169.0 (946.5-1586.0) significantly lower compared to that of children without disability, that is, 1362.0 (1167.0-1641.0). The median protein consumed by children with disabilities was 28.0 (22.5-38.0) significantly lower compared to that of children without disability, that is, 32.0 (28.0-40.0). CONCLUSIONS: Children with disabilities had similar rates of undernutrition as that of their non-disabled peers and their lesser dietary intake in terms of calories and proteins.

Estimation of time trends of incidence of prostate cancer--an Indian scenario.

BACKGROUND: With increase in life expectancy, adoption of newer lifestyles and screening using prostate specific antigen (PSA), the incidence of prostate cancer is on rise. Globally prostate cancer is the second most frequently diagnosed cancer and sixth leading cause of cancer death in men. The present communication makes an attempt to analyze the time trends in incidence for different age groups of the Indian population reported in different Indian registries using relative difference and regression approaches. MATERIALS AND METHOD: The data published in Cancer Incidence in Five Continents for various Indian registries for different periods and/or publications by the individual registries served as the source materials. Trends were estimated by computing the mean annual percentage change (MAPC) in the incidence rates using the relative difference between two time periods (latest and oldest) and also by estimation of annual percentage change (EAPC) by the Poisson regression model. RESULTS: Age adjusted incidence rates (AAR) of prostate cancer for the period 2005-2008 ranged from 0.8 (Manipur state excluding Imphal west) to 10.9 (Delhi) per 105 person-years. Age specific incidence rates (ASIR) increased in all PBCRs especially after 55 years showing a peak incidence at +65 years clearly indicating that prostate cancer is a cancer of the elderly. MAPC in crude incidence rate(CR) ranged from 0.14 (Ahmedabad) to 8.6 (Chennai) . Chennai also recorded the highest MAPC of 5.66 in ASIR in the age group of 65+. Estimated annual percentage change (EAPC) in the AAR ranged from 0.8 to 5.8 among the three registries. Increase in trend was seen in the 5-64 year age group cohort in many registries and in the 35-44 age group in Metropolitan cities such as Delhi and Mumbai. CONCLUSIONS: Several Indian registries have revealed an increasing trend in the incidence of prostate cancer and the mean annual percentage change has ranged from 0.14-8.6.

Community-based needs assessment of leprosy patients in Chamrajanagar district, Karnataka, India.

OBJECTIVES: To assess the medical, disability prevention and rehabilitation and psychosocial needs of leprosy patients. DESIGN: Community-based cross sectional study. RESULTS: 259 registered leprosy-affected people were studied. 26% of subjects had presented by voluntary reporting. The mean detection delay was 8.25 months (SD 6.45). 66.8% of the study subjects had received regular treatment. Knowledge about multi-drug therapy (MDT) was satisfactory in 44.4% whereas knowledge of reactions was highly unsatisfactory. 7.7% had leprosy reactions among which only 25 received medical care. Disability proportion was 20.1% out of which 8.5% had Grade 1 and 11.6% had Grade 2 deformity. All these disabled individuals needed skin care, 44.2% of them needed wound care and 36.5% needed joint care. There was wide discrepancy between need for self care, training received and resources available for practising the same. The extent of dehabilitation was more among subjects with visible deformities. CONCLUSION: Medical needs identified in study subjects include capacity building of patients regarding MDT & reactions, plus awareness generation in general community such that voluntary reporting is enhanced and the detection dela shortened in the district. Strengthening drug inventory and distribution systems fo uninterrupted supply of drugs is essential. There is a need to reorient health care staff regarding leprosy management and DPMR. Rehabilitation needs identified are capacity building with regard to prevention of deformity and supplies (POD tool kit for self care) for the same. It is recommended that the district heath system should conceptualise and implement an evidence-based field level disability care and prevention programme, with community-based rehabilitation approach.

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.

Disability adjusted life years for cancer patients in India.

The disability adjusted life year (DALY) has been employed to quantify the burden of diseases. This measure allows for combining in a single indicator "years of life lived with disabilities (YLD)" and "years of life lost from premature death (YLL)" . The present communication attempts to estimate the burden of cancers in-terms of YLL, YLD and DALY for "all sites" and leading sites of cancer in India for the years 2001, 2006, 2011 and 2016. The YLL, YLD and DALY were estimated by employing Global Burden of Disease (GBD) methodology using the DISMOD procedure. The published data on age, gender and site specific cancer incidence and mortality for the years 2001-2003 relating to six population-based cancer registries viz. Bangalore, Barshi, Bhopal, Chennai, Delhi and Mumbai, expectation of life by gender for urban areas of the country for 1999-2003 and the projected population during years 2001, 2006, 2011 and 2016 were utilized for the computations. DALYs were found to be lower for males (2,038,553, 2,313,843, 2,656,693 and 3,021,708 for 2001, 2006, 2011 and 2016 respectively) as compared to females (2,560,423, 2,961,218, 3,403,176 and 3,882,649). Amongst males, highest DALYs were contributed by cancer of the lung and esophagus while in females they were for cancers of breast and cervix uteri. It is estimated that total DALYs due to cancer in India combined for both genders would increase from 4,598,976 in 2001 to 6,904,358 by 2016. Premature mortality is a major contributor to disease burden. According to the present estimates, the YLL component of DALY is about 70.0%. The above described computations reveal an urgent need for initiating primary and secondary prevention measures for control of cancers.