Bhupendra Narayan Mahanta

Evaluation of statin prescriptions in type 2 diabetes: India Heart Watch-2

Background Contemporary treatment guidelines advise statin use in all patients with diabetes for reducing coronary risk. Use of statins in patients with type 2 diabetes has not been reported from India. Methods We performed a multisite (n=9) registry-based study among internists (n=3), diabetologists (n=3), and endocrinologists (n=3) across India to determine prescriptions of statins in patients with type 2 diabetes. Demographic and clinical details were obtained and prescriptions were audited for various medications with a focus on statins. Details of type of statin and dosage form (low, moderate, and high) were obtained. Patients were divided into categories based on presence of cardiovascular risk into low (no risk factors, n=1506), medium (≥1 risk factor, n=5425), and high (with vascular disease, n=1769). Descriptive statistics are presented. Results Prescription details were available in 8699 (men 5292, women 3407). Statins were prescribed in 55.2% and fibrates in 9.2%. Statin prescription was significantly greater among diabetologists (64.4%) compared with internists (n=53.3%) and endocrinologists (46.8%; p<0.001). Atorvastatin was prescribed in 74.1%, rosuvastatin in 29.2%, and others in 3.0%. Statin prescriptions were lower in women (52.1%) versus men (57.2%; p<0.001) and in patients aged <40 years (34.3%), versus those aged 40–49 (49.7%), 50–59 (60.1%), and ≥60 years (62.2%; p<0.001). Low-dose statins were prescribed in 1.9%, moderate dose in 85.4%, and high dose in 12.7%. Statin prescriptions were greater in the high-risk group (58.0%) compared with those in the medium-risk (53.8%) and low-risk (56.8%) groups (p <0.001). High-dose statin prescriptions were similar in the high-risk (14.5%), medium-risk (11.8%), and low-risk (13.5%) groups (p=0.31). Conclusions Statins are prescribed in only half of the clinic-based patients in India with type 2 diabetes. Prescription of high-dose statins is very low.

Prevalence of modifiable cardiovascular risk factors among tea garden and general population in Dibrugarh, Assam, India

Introduction: Risk factors for cardiovascular disease (CVD) are multifactorial. Previous research has reported a high prevalence of CVD risk factors in tea-garden workers. This study was conducted to assess prevalence and level of modifiable cardiovascular risk factors among tea-garden and general population in Dibrugarh, Assam. Methods: A community-based cross-sectional study using the World Health Organization’s (WHO) Stepwise methodology was conducted in Dibrugarh District of Assam. A multistep random sampling was done to include adults aged 35 years and above, with an intended equal sampling from tea-garden and general population. INTERHEART modifiable non-laboratory based risk score was estimated. Salt consumption was estimated using questionnaire-based methods in both subgroups. Results: A total of 2826 individuals participated in the study (1231 [43.6%] tea-garden workers; 1595 [56.4%] general population). Tobacco consumption was higher in tea-garden workers as compared with general population (85.2% vs. 41.7% (p < 0.0001). Mean daily per-capita salt consumption was also significantly higher among tea-garden workers (29.60 vs. 22.89 g, p = 0.0001). Overall prevalence of hypertension was similar (44.4% vs. 45.2%), but among those who had hypertension, prevalence of undiagnosed hypertension was higher in tea-garden workers (82.8% vs. 74.4%, p < 0.0001). Tea-garden workers had lower BMI, were more physically active, and had a lower prevalence of diabetes mellitus and metabolic syndrome. Their INTERHEART modifiable risk score was also lower (1.44 [2.5] vs. 1.79 [2.8], p = 0.001). Conclusion: High prevalence of modifiable risk factors like tobacco consumption, high salt intake and high prevalence of hypertension indicates the need for early implementation of preventive actions in this population.

Investigation of a cholera outbreak in a tea garden of Sivasagar district of Assam

Background: In late May 2012, Bagjan division of Borbam tea estate, of Sivasagar district of Assam was affected by an outbreak of acute watery diarrhea, subsequently confirmed as Vibrio cholerae O1. Objectives: Our objective is to investigate and control the acute diarrheal disease outbreak in Sivasagar district of Assam. Materials and Methods: A physician-epidemiologist-led team did rapid outbreak investigation to confirm the outbreak and instituted treatment and control measures. Quantitative data collection was done using standard schedule and qualitative data by using key informant interview schedule. Results: Spot mapping of cases was done along the garden residential lines. About 120 suspected cases were line listed; with 1:1.23 male: female ratio. Ages ranged from 3 to 70 years (median - 40.5 years). Attack rate was 4.79% with one death; case fatality rate was 0.83%. Open air defecation was practiced by 94.6%. Rectal swabs were positive for V. cholerae O1 (Ogawa). All the piped water samples were class IV unsatisfactory for domestic use. Conclusions: There is a need to improve water and sanitation facility in the tea garden lines along with implementation of a strengthened disease surveillance system through integrated disease surveillance project covering all tea estates.

DIETARY RISK FACTORS OF METABOLIC SYNDROME IN DIBRUGARH DISTRICT OF ASSAM

BACKGROUND As India is considered as the diabetic capital of the world, a huge burden of undiagnosed Metabolic Syndrome (MetS) is a possibility. Early intervention can be planned if MetS can be detected early along with risk factor assessment to avert cardiovascular morbidities. The aim of this study was to assess the dietary risk factor of metabolic syndrome. MATERIALS AND METHODS Community based cross-sectional study was conducted in Dibrugarh District of Assam with multistep sampling. Study area, i.e. four rural sub-centres and two urban electoral blocks were selected randomly. From the list of population of selected area, the consenting eligible were included. Sample size was 1700 population with MetS. Socio-demographic information, World Health Organisation’s STEPS questionnaire for behavioural risk factors along with dietary history, anthropometric assessment and laboratory investigations were conducted in three stages. Food frequency questionnaire was used for dietary assessment. Statistical analysis was done using rates, ratio, proportion, univariate and multivariate analysis. RESULTS MetS was 47.6% (1606 of 3372 screened). Mean age of study population was 47.1 ± 10.9 years. Behavioural risk factors like tobacco, alcohol consumption was high and significantly associated with metabolic syndrome (p= 0.000). Similarly financial stress, feeling stressed in last one year (p=0.034), lower physical activity level were also significantly associated with metS (p=0.000). Consumption of meat (p=0.000), egg (p=0.000), fast food (p=0.000), pickled vegetable (p=0.000) and sweet snacks (p=0.000) was found significantly higher amongst those with metabolic syndrome. Significant association was also seen with number of meals served per day and metS (p=0.000). CONCLUSION Dietary risk factors of cardiovascular diseases were rampant amongst persons with MetS. Dietary risk factor survey and counselling on healthy diet can be implemented in these population to give opportunity for early intervention.

Effect of Directly Observed Iron Therapy (DOIT) in Anaemia & Productivity – A Community Based Intervention Study in Dibrugarh, Assam

Title of the article: Prevalence of anaemia and associated factors amongst tea pluckers and the effect of directly observed iron therapy( DOIT) in Anaemia and Productivity in Dibrugarh District, Assam – An Action Research. Introduction There is convincing evidence that iron deficiency and anaemia causes impaired growth, developmental delay, decreased physical activity, behavioural abnormalities and impairs cognitive function. Anaemia is rampant amongst tea garden community. Therefore this study is undertaken to estimate magnitude of anaemia and associated factors among permanent workers of tea estates and to assess difference in productivity amongst working women (tea pluckers) after giving directly observed iron therapy. Materials and Method: A cross sectional study followed by quasi-experimental, interventions study. In baseline, 1168 permanent workers, included. 150 anaemic women from each tea estates selected randomly, where directly observed iron therapy (DOIT) given to one tea estate and conventional treatment to other one and assessed after three month of intervention. Productivity was compared. Results: Prevalence of anaemia was 88% and 45.7% were underweight. Majority practiced open air defecation (96.1%) and were illiterate (99.7%). Helminthiasis was common in 63.6%. Sickle cell anaemia was prevalent amongst 9.72%. DOIT improved haemoglobin level to 1.44 gm/dl from baseline after three month of intervention. (p<0.05) Conclusions: Directly observed iron therapy improved significantly the haemoglobin level and productivity. There is a need to address multifactoral causation of anaemia by integrated approach. Introduction: Anaemia is a global public health problem affecting both developing and developed countries and is an indicator of poor nutrition and health with major consequences for health, social and economic development of a population. Worldwide, at any given moment, more individuals have iron-deficiency anaemia than any other health problem.1 Nutritional anaemia is one of the major public health problems in India affecting almost 90% poor children, adolescent girls and women, considered as “female disease “causing red alert for Indian women2. Lower haemoglobin values and anaemia (< 12 g/ dl) were associated with both lower labour productivity and more days of sickness and absenteeism. Taller women with greater arm circumference were able to pluck more green leaves, earn higher wages and were absent less often 3. The major causes of Anaemia in India are low intake of Iron through the diet coupled with low bioavailability, high level of parasitic infestations and frequent infections 3.The workers of tea plantation industry migrated to Assam from states like Madhya Pradesh, Bihar, Orissa and Andhra Pradesh in the latter part of nineteenth to early twentieth century 4. These migrant workers involved in tea plucking, typically reside in the periphery of the tea estate in what is known as labour lines. Tea garden population represent 17% of Assam’s population and 27% of Dibrugarh District. Almost half of the girls were stunted and most of them were thin. Factors typical to underdeveloped society; contribute to the moderate to high prevalence of under nutrition among the girls working in these Tea Gardens 5. Almost 96% of pregnant mothers and 100% of adolescent girls are anaemic (mild to severe); similarly 55% of mothers and 46% of girls are with low BMI6. With this background in this field concerning tea garden workers indulged us to contemplate the present study with an objective to estimate the magnitude of anaemia among permanent workers of tea estates and to assess the difference in productivity amongst working population (tea pluckers) after giving directly observed iron therapy. Materials and Methods: Setting – Dibrugarh District, also known as tea Capital of Assam is selected as this is the most tea intensive District having highest number of tea estates. Two tea estates were selected from a list of 169 tea estates of the District using computerised random number. Study design: A baseline, cross sectional study was carried out, in two tea estate populations of Dibrugarh District of Assam. Human subject recruitment was done after getting clearance from Institutional ethical committee. A predesigned, pretested format, covering demographic characteristics, socioeconomic status, general physical examination, laboratory investigation of blood for Haemoglobin (by cyanomethhaemoglobin method) and stool examination for helminthic ova along with dietary survey using 24 hour recall method was used. This was followed by a quasi-experimental, intervention study. In the Intervention tea estate, directly observed iron therapy was given using iron-folic acid (IFA) tablets six days in a week by a drug provider ( supervisor), who supervised the consumption of tablets by direct observation and also did recording of tea leaves plucked from the registered, to 150 anaemic women by giving 100 mg of Govt supplied tablets and in the control tea estate the selected population of 150 anaemic women were informed about their anaemic status and advice to take conventional treatment from tea garden outpatient department. Both the group were sensitized for