Hypertension subtypes and angiotensin converting enzyme (ACE) gene polymorphism in Indian population

OBJECTIVE

To find out the association of angiotensin converting enzyme (ACE) gene polymorphism with hypertension subtypes in a population from India.

METHODS

Consecutive subjects of either sex, aged > or =18 years attending in temporary field clinics arranged in various localities of Assam and Mizoram were interviewed to record information about socio-demographic characteristics, alcohol consumption and smoking. Three readings of blood pressure, height and weight of all subjects were measured. Hypertension and its subtypes were defined as per JNC-VI criteria. Fasting venous blood samples were collected to estimate blood glucose level and to extract genomic DNA followed by PCR analysis for ACE gene polymorphism.

RESULTS

A total of 916 (male=465, female=451) consecutive subjects comprising of 407 (44.4%) hypertensive subjects and 509 (55.6%) normotensive controls were included in the study. Of the hypertensive subjects, majority (69.0%) had systolic diastolic hypertension with male predominance (70.3% vs. 67.6%) which was followed by isolated diastolic hypertension (16.7%) and isolated systolic hypertension (14.3%). The predominant ACE genotype was Ins/Ins (50.0%) and Del/Del genotype showed lowest prevalence (11.4%). After adjusting confounding variables, the Del/Del genotype revealed significant association with isolated systolic hypertension.

CONCLUSION

Del/Del polymorphism of ACE gene showed significant association with ISH in our study population.

Population-specific left ventricular hypertrophy in three groups from the northeastern region of India

BACKGROUND

People living in the hills are continuously exposed to strenuous physical activity for their day-to-day work. Besides hypertension, left ventricular hypertrophy in different populations may be related to continuous physical activity.

METHODS

Electrocardiogram, blood pressure and sociodemographic information of 12 252 subjects > or = 30 years of age from three different population groups living in Mizoram (hilly) and Assam (plain) were recorded. Of them, 8058 were from Mizoram and 3180 and 1014 were Indigenous Assamese and tea garden workers of Assam.

RESULTS

Among the subjects from Mizoram the percentage of smokers (41.9%), mean (SD) BMI (21.9 [3.8]) and waist-hip ratio (0.87 [0.02]) were significantly higher than in those from other groups. Tea garden workers had a higher mean systolic blood pressure (145.2 [25.7]) and diastolic blood pressure (87.6 [13.6]). The prevalence of left ventricular hypertrophy was highest among tea garden workers (16.5%) followed by people from Mizoram (3.7%) and the indigenous Assamese (2%) people. In spite of a significantly higher prevalence of hypertension among the indigenous Assamese community than among those from Mizoram, left ventricular hypertrophy was found to be lower in the former.

CONCLUSION

High prevalence of left ventricular hypertrophy among tea garden workers was possibly related to a higher prevalence of hypertension but the higher prevalence of left ventricular hypertrophy among people from Mizoram might be related to more physical activity.

Nutritional status of adolescents among tea garden workers

OBJECTIVE

The study was conducted to evaluate growth and nutritional status using weight and height based indicators among tea garden adolescent boys and girls of Assam aged between 10-18 years.

METHODS

A cross sectional study was carried out in the tea gardens of Dibrugarh district of Assam through house to house visit. Households were selected through two stage sampling design to reach out the adolescents. Height and weight were measured using standard procedures. Body mass index (BMI) was computed from height and weight. Height-for-age below 3rd percentile values of NCHS reference was classified as stunting. BMI-for-age below 5th percentile values of WHO recommended reference was classified as thinness.

RESULTS

Total numbers of 605 adolescents (boys-291, girls-314) participated in the study. School enrollment rate was only 59.2%. Prevalence of stunting was 47.4% and 51.9% among boys and girls respectively relative to NCHS reference, which reduced to almost 30% while Indian reference data was used. Prevalence of thinness was higher among boys (59.5%) than girls (41.3%) counterparts. Mean BMI among girls was higher at all ages than boys.

CONCLUSION

Almost half of the adolescents were stunted and most of them were thin. Problem of overweight was seen in less than 0.5% of adolescents. Factors typical to underdeveloped society seems to contribute to the moderate to high prevalence of undernutrition among adolescents working in tea gardens.

Study of health problems and nutritional status of tea garden population of Assam

BACKGROUND

Assam is the highest tea producer state in the country. There is scarcity of reliable information on health and nutritional status among tea garden population of Assam to enable initiating public health response to their health needs.

AIMS

To describe health problems and nutritional status among tea garden population of Assam.

SETTINGS AND DESIGN

Community-based cross-sectional survey in eight randomly selected tea gardens of Dibrugarh district of Assam.

MATERIALS AND METHODS

Socio-demographic and behavioral characteristics of participants were recorded. Health problems and nutritional status were assessed through medical examination, evaluation of medical records, anthropometry and laboratory investigations.

STATISTICAL ANALYSIS

Percentage prevalence; Chi-square test was applied wherever applicable.

RESULTS

Out of 4,016 participants, 1,863 were male and 2,153 were female. They were mostly illiterate and nearly 52.9% (1,197 of 2,264) of adults were manual workers in the garden. Alcohol and oral tobacco use were common. Prevalence of underweight among children was 59.9% (357 of 596) and thinness among adults was 69.9% (1,213 of 1,735). Anemia was widespread. Worm infection (65.4%, 217 of 332); skin problems; respiratory infections, including tuberculosis; filariasis were present in a significant way. Children suffered more in various diseases. Major noncommunicable diseases like hypertension, stroke were emerging in the community and were associated with modifiable risk factors like alcohol and tobacco use.

CONCLUSION

Health status of the population can be ameliorated through better hygienic practices, environmental sanitation, creating health awareness, nutritional intervention and overall improvement of socioeconomic conditions of the population.

Health problems and disability of elderly individuals in two population groups from same geographical location

OBJECTIVE

To compare morbidity, disability (ADL-IADL disability) along with behavioral and biological correlates of diseases and disability of two elderly population groups (tea garden workers and urban dwellers) living in same geographical location.

METHODS

Two hundred and ninety three and 230 elderly from urban setting and tea garden respectively aged > 60 years were included in the study. Subjects were physical examined and activity of daily living instrumental activity of daily living (ADL-IADL) was assessed. Diagnosis of diseases was made on the basis of clinical evaluation, diagnosis and/or treatment of diseases done earlier elsewhere, available investigation reports, and electrocardiography. Hypertension was defined according to JNC-VI classification. BMI (weight/height2) was calculated. Logistic regression analysis was performed to see the impact of important background characteristics on non-communicable diseases (NCD) and disability.

RESULTS

Hypertension (urban--68% and tea garden--81.4%), musculoskeletal diseases (urban--62.5% and tea garden--67.5%), COPD and other respiratory problems (urban--30.4% and tea garden--32.2%), cataract (urban 40.3% and tea garden--33%), gastro-intestinal problems (urban--13% and tea garden--6.5%) were more commonly observed health problems among community dwellings elderly across both the groups. However in contrast to urban group, serious NCDs like Ischaemic Heart Disease (IHD), diabetes were yet to emerge as health problems among tea garden dwellers. Infectious morbidities, undernutrition and disability (ADL-IADL disability) were more pronounced among tea garden dwellers. Utilization of health service by tea garden elderly was very low in comparison to the urban elderly. Both tea garden men and women had very high rates of risk factors like use of non-smoked tobacco and consumption of alcohol. On the other hand, smoking and obesity was more common in urban group. Most morbidities and disabilities were associated with identifiable risk factors, such as obesity, tobacco (smoked and non-smoked) and alcohol consumption. Educational status was also found to be an important determinant of diseases and disability of elderly population. Age showed a J-shaped relationship with disability and morbidity. Sex difference in health status was also detected.

CONCLUSION

This study highlights the physical dimension of health problems of elderly individuals. Social circumstances and health risk behaviours play important role in the variation of health and functional status between the two groups. Life-style modification is warranted to prevent onset of chronic diseases. To improve quality of life, rectification of poor health status through affordable health service for disease screening and better management of illness, nutritional improvement and greater health awareness are necessary particularly among low socio-economic group. Low-cost intervention like cataract surgery could make a difference in the quality of life of elderly Indian.

Dietary habits and stomach cancer in Mizoram, India

BACKGROUND

An extremely high prevalence of stomach cancer was observed in Mizoram (India), where the population consumes uncommon food. The relation of food habits and stomach cancer was examined in this study.

METHODS

A hospital-based case-control study was conducted during 2001-2004 to determine the risk factors among 329 patients with histologically confirmed stomach cancer and 658 matched controls. Food habits were determined by personal interview.

RESULTS

An elevated risk of stomach cancer was observed with frequent consumption of sa-um [odds ratio (OR) 3.4] (sa-um is fermented pork fat, a traditional food) and with frequent consumption of smoked dried salted meat (OR 2.8) and fish (OR 2.5). Soda (alkali), used as a food additive, increased the risk of stomach cancer (OR 2.9). Helicobacter pylori infection was not found to be an independent risk factor for carcinogenesis of stomach cancer in this study. However, when H. pylori infection interacted with consumption of sa-um or smoked dried meat, it showed a significant association.

CONCLUSION

Peculiar food habits in Mizoram might be associated with the high prevalence of stomach cancer in Mizoram along with other factors. H. pylori infection might increase the risk of stomach cancer, or it may play a role as a promoter of stomach cancer in Mizoram.

Tobacco and alcohol use among the youth of the agricultural tea industry in Assam, India

A cross-sectional study was conducted to assess tobacco use (both smoking and non-smoked tobacco) and alcohol use among tea garden youths of Assam, India during the period 2002-2003. A total of 650 tea plantation youth age 15-24 years (255 males, 395 females) from eight randomly selected tea plantations, Dibrugarh District, Assam, were interviewed to collect information on alcohol and tobacco use using a pre-designed, pre-tested questionnaire. Nearly 59% of the respondents had no formal education. Fifty-eight percent of the youth used at least one substance and 27.4% were concurrent users of both alcohol and tobacco. The smoking rate was only 2.2% (4.7% in males, 0.5% in females). However, 52.5% of the study population used non-smoked tobacco (56.9% males, 49.6% females). The prevalence of alcohol consumption was 32.2% (43.9% males, 24.6% females). A higher rate of alcohol and tobacco use was found among the respondents who had no formal education or were school dropouts. A higher rate of alcohol and tobacco use were seen among respondents in whom both parents were illiterate. Working as a manual worker in the tea industry is significantly associated (p<0.01) with higher rates of alcohol and tobacco use. We recommend a vigorous campaign against tobacco and alcohol use among tea plantation youth to reduce the health risks associated with the use of these two substances.

Correlates of alcohol consumption and tobacco use among tea industry workers of Assam

An epidemiological study on alcohol and tobacco (smoking and nonsmoked tobacco) use was carried out in tea garden population of Assam, one of the largest agroindustries of India. A total sample of 2,264 individuals (male, 1,033; female, 1,231) aged 15 years and older was interviewed in 2002-2003 to collect information about alcohol and tobacco use using a predesigned and pretested questionnaire. Age-adjusted prevalence of alcohol consumption was 59.2% (male, 69.3%; female, 54%). Smoking was more common among males (13.2%) than females (2%). However, use of nonsmoked tobacco was almost as popular among female (71.9%) as among males (75.3%). More than half of the respondents (54.7%) were multiple users of alcohol and tobacco. Prevalence of alcohol consumption, nonsmoked tobacco use, and smoking among the young age group (15-24 years) was 32.2%, 52.5%, and 2.2%, respectively. Prevalence of smoking increased with age, and more than a quarter of males above 54 years were smokers. Similar age trends in the prevalence of alcohol and nonsmoked tobacco was not observed. Sociodemographic correlates, like education, occupation, and marital status, emerged as important predictors of substance uses irrespective of sex. Association of income with substance use was weak in this study, perhaps due to homogeneity of income level. Users of alcohol and tobacco were mostly illiterate, manual workers, and widows/widowers. However, smokers were more common among sedentary worker. Not withstanding the limitations of the study, the findings of the study are useful for planning interventional strategy to control alcohol and tobacco use for better health outcome.

Tobacco use and stomach cancer in Mizoram, India

The incidence of stomach cancer in India is lower than that of any other country around the world. However, in Mizoram, one of the north-eastern state of India, a very high age-adjusted incidence of stomach cancer is recorded. A hospital-based case-control study was carried out to identify the influence of tobacco use on the risk of developing stomach cancer in Mizoram. Among the cases, the risk of stomach cancer was significantly elevated among current smokers [odds ratio (OR), 2.3; 95% confidence interval (95% CI), 1.4-8.4] but not among ex-smokers. Higher risks were seen for meiziol (a local cigarette) smokers (OR, 2.2; 95% CI, 1.3-9.3). The increased risk was apparent among subjects who had smoked for >or=30 years. The increased risk was significant with 2-fold increase in risk among the subjects who smoked for >or=11 pack-years. The risk increased with increasing cumulative dose of tobacco smoked (mg). Tuibur (tobacco smoke-infused water), used mainly in Mizoram, was seemed to increased the risk of stomach cancer among current users in both univariate and multivariate models (OR, 2.1; 95% CI, 1.3-3.1). Tobacco chewer alone (OR, 2.6; 95% CI, 1.1-4.2) showed significant risk. Tobacco use in any form [smoking and smokeless (tuibur and chewing)] increased the risk of stomach cancer in Mizoram independently after adjusting for confounding variables.

Perceptions of unmarried young women regarding family size, sexually transmitted diseases at residential regional institutes in northeastern India

This study sought to assess the knowledge and attitudes of young unmarried women regarding family size and sexually transmitted diseases, including HIV, in three residential regional institutes of northeastern India. The data is expected to help in reinforcing various methods of Information, Education and Communication (IEC) implementation. A representative sample of 574 female students, 16-25 years of age, were interviewed by a pretested questionnaire to assess their knowledge of the determinants of family size and sexually transmitted diseases. Of the participants, 48.43% stated that the suitable age for marriage is > 18 years old for women. More than half the respondents stated that the interval between child birth should be 3-5 years. Most of the respondents (96.17%) were of the opinion that both parents are responsible for determining the number of children. Knowledge of STDs and HIV was found in 91.8% and 74.04% of respondents, respectively.

Hypertension in the native rural population of Assam

BACKGROUND

Recent studies have reported an increasing prevalence of hypertension in India. However, there are few epidemiological data with regard to the occurrence of hypertension in the native population of Assam.

METHODS

Three thousand one hundred and eighty individuals (1441 men and 1739 women), > or =30 years of age and from 25 villages of 5 districts in Assam were selected by the stratified random sampling method. They were interviewed and their blood pressure measured along with other anthropometric variables. Hypertension was defined according to the Sixth Report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure (JNC-VI).

RESULTS

The overall prevalence of hypertension was 33.3%. Among the patients with hypertension, 21.6% were aware of their illness. The determinants of hypertension were age, intake of extra salt in the diet, body mass index and waist-hip ratio (derived by multiple logistic regression analysis with backward elimination of non-significant factors). Multivariate analysis showed that females had a higher risk of hypertension than males.

CONCLUSION

The prevalence of hypertension in the native population of Assam is high. Implementation of an effective awareness programme with lifestyle modifications is necessary to control the cardiovascular disease burden in this population.

Hypertension in the elderly population of Assam

BACKGROUND

With the increase in life-expectancy and modification of lifestyle cardiovascular disease especially hypertension is emerging as a major public health problem in the elderly people of Assam. The Geriatric population needs priority in assessment of the disease burden. With this background this study was undertaken with an objective to know the dimension of the hypertension prolem in elderly people of Assam and relevant factors associated with it.

METHODS

Eight hundred and eighty eight elderly participants 60 years and above (males 500, females 388 from three randomly selected areas were interviewed to collect information on dietary habit and socio-demographic variables and clinically examined for blood pressure and athropometric parameters using standardized technique. Statistical analysis was performed using the Epi Info and SPSS software.

RESULTS

To overall age adjusted mean systolic blood pressure (SBP) was 150.52 (95% CI 148.81-152.23) and diastolic blood pressure (DBP) was 88.22 (95% CI 87.39-89.05). Overall prevalence of hypertension was 63.63% (95% CI 59.8-66.2), 64.2% in males and 62.89% in females. Isolated systolic hypertension was detected in 13.2% males and 10.31% females among the hypertensives. 26.90% of the hypertensives were aware of their increase in blood pressure. Determinants of hypertension derived by multiple logistic regression analysis were age, intake of extra salt, alcohol and body mass index (BMI).

CONCLUSION

High prevalence with inadequate awareness and control of hypertension in the elderly group of population call for an immediate implementation of active public health programme in the state.

Differences in blood pressure level and hypertension in three ethnic groups of northeastern India

A cross sectional study on hypertension was done on 294 subjects aged 30 years and above. 150 households were selected randomly representing 50 households from each locality inhabited exclusively by the rural Mizos, indigenous rural Assamese and the tea-garden workers respectively, in the northeastern region of India. Blood pressure was measured by sphygmo-manometer in sitting posture. Anthro-pometric measurements were taken using standard procedure for measuring height, weight, waist and hip girth. Information on age, sex, ethnicity, literacy, alcohol intake, smoking pattern, physical activity, occupation, amount of salt consumption was collected using a standard and pre-tested questionnaire. Significant differences were observed in both the systolic and diastolic blood pressure levels among the three different ethnic groups selected for this study (p < 0.0001). Multiple regression analyses indicated that in Mizos, age, waist circumference and alcohol intake were independently associated with increase in systolic blood pressure whereas smoking was found to be negatively associated with systolic blood pressure (R2 = 0.391, p < 0.001). Factors, which were the best predictors of diastolic blood pressure, were age and body mass index [(kg/m2) (R2 = 0.227, p < 0.001)]. In the rural Assamese population, the best predictors of systolic blood pressure were age and waist circumference (R2 = 0.263, p = 0.018). For the diastolic blood pressure, age, alcohol intake and body mass index were important correlates (R2 = 0.131, p < 0.001). In the tea garden community, important predictors of systolic blood pressure were age, gender and marital status (R2 = 0.187, p < 0.001). On the other hand, age and alcohol intake were best predictors for diastolic blood pressure (R2 = 0.09, p < 0.001).

Hypertension and its risk factors in tea garden workers of Assam

BACKGROUND

Hypertension is emerging as a major public health problem in India. The diversity and heterogeneity of distribution of the population makes it difficult to arrive at the precise prevalence. In Assam, reports from hospitals in tea gardens reveal a high prevalence of hypertension among workers in tea gardens. However, no systematic study has been carried out in this population.

METHODS

We selected, by systematic sampling, 1015 individuals (512 men and 503 women) 30 years or more in age, who were interviewed and clinically examined for hypertension. Blood pressure of all the study participants was measured using a standardized technique. Crude and adjusted odds ratios were estimated by unconditional simple and multiple logistic regression analyses. Mantel-Haenszel chi2 analysis was also used to test for the association of potential risk factors with hypertension after controlling for co-variables in a stratified analysis. Risk factors considered for hypertension included age, gender, marital status, occupation, alcohol consumption (locally prepared), extra salt intake, smoking history, khaini (a form of tobacco quid containing a mixture of tobacco and lime) intake, body mass index and waist-hip ratio.

RESULTS

The overall prevalence of hypertension was 60.8%. Increasing age, consumption of locally prepared alcohol, intake of extra salt in food and beverages and the habit of taking khaini were found to increase the risk of hypertension. Multivariate logistic regression models showed that the independent determinants of hypertension were age, gender, consumption of locally prepared alcohol and intake of extra salt. Gender-specific and age-stratified analyses showed the association of increased risk with intake of khaini in women only, while consumption of locally prepared alcohol was an important risk factor for hypertension in both men and women.

CONCLUSION

The disease burden of hypertension among workers in tea gardens is large, despite the community not being obese. Interventions directed at these workers as well as studies to determine the reasons for the high prevalence of hypertension are required.

Epidemiology of malaria outbreak (April/May, 1999) in Titabor Primary Health Centre, district Jorhat (Assam)

An investigation was undertaken of a malaria outbreak in the Primary Health Centre Titabor, district Jorhat, Assam during May/June 1999. The fever rate in the community since March 1999, was 44.4 per cent with an average case load of 2.5 per family. The fever cases peaked in the third week of May. Slide positive and slide falciparum rates in mass blood survey, in the study village were 16.1 and 14.5 per cent respectively with 90 per cent infection of Plasmodium falciparum. Males (SPR 17.5%) suffered relatively more than females (SPR 14.7%). Malaria prevalence was significantly less in individuals above 15 yr of age (SPR 11.0%) as compared to those below 15 yr (SPR 22.9%). Prevalence of malaria as well as mosquito densities in different clusters of the village were inversely related to the distance from the forested Naga hills. Anopheles minimus and A. dirus were collected in good numbers with comparatively higher densities of the former. Several factors like unusual climatic conditions, inadequate surveillance, unsatisfactory laboratory services and inadequate indoor residual insecticide spray were instrumental for the outbreak.

Prevalence of communicable disease among restaurant workers along a highway in Assam, India

105 workers of 29 roadside restaurants along a highway in Assam were interviewed for their habits, educational status and were examined for their hygienic status and presence of communicable diseases (STDs,TB etc). Most of them were young, males with 40% literacy; more than half were unmarried. About 30% of them were alcoholic and smokers and 2.9% were addicted to cannabis. The hygienic conditions of the workers were poor. More than one third had sexual contact with multiple sex partners or commercial sex workers and 2% were engaged in homosexual activity. Most of them did not use condom. 25.7% of them had genital lesions suggestive of sexually transmitted disease, 11.8% showed gram negative diplococci in urethral smears and 5.1% were VDRL reactive. Skin infections followed by gastrointestinal disorders and respiratory tract infections were other prevalent problems. 70.6% were positive for intestinal parasites and 22.2% were sputum positive for acid fast bacilli. However all the collected blood samples were negative for HIV.

Distribution of potential dengue vectors in major townships along the national highways and trunk roads of northeast India

Surveys were conducted in some townships along the national highways and trunk roads of northeast India to detect breeding of Aedes mosquitos in used/waste tire dumps piled outdoors by the tire repairing shops during summer season of 1996-1997. The breeding of both the potential vectors of dengue, viz. Aedes aegypti and Ae. albopictus were detected, prevalence rate being in the range of 30.0-88.0 (CI = container index value). The preponderance of Ae. aegypti was considerably much higher than that of Ae. albopictus and all the urban and semiurban areas coming up along the side of the roads were observed to be infested with Ae. aegypti. With respect to transmission of dengue, this study clearly indicates that waste tire dumps in every urban agglomeration should receive primary attention in view of their relative contribution to the abundance and dispersal of these vector mosquitos.

Tobacco use in Mizoram, India: sociodemographic differences in pattern

A study on tobacco use was carried out in Aizawl district of Mizoram, India, to assess the prevalence and pattern of tobacco use. An area served by two Sub-health Centers representing town and village population were selected for a household survey. 375 people (age 10 years and above) were interviewed about their habits of taking tobacco. Use of tobacco was high among males (56.6%) and females (45.7%), but the high prevalence of smoking among males (42.3%) and chewing among females (27.9%) indicates the existence of sex differences in tobacco use pattern. Age and occupation had significant association with tobacco use but influence of education was very low and its association was not significant. Mean age for start of tobacco chewing and smoking for males and females varied significantly. However, the mean age of start for adolescent and young age (10-29 years) tobacco users was 17.2 years (SD +/- 2.3). Though there are some limitations to this study, these findings revealed differential patterns of tobacco use which is valuable information for prevention effort.

Project study on Japanese encephalitis vaccination at Gogamukh, Assam

The aim of the study was to apprise the benefit derived from vaccination against Japanese encephalitis (JE) in Assam. The study was conducted during 1988-1989 with special emphasis on serodiagnosis. Out of total of 22,441 vaccinations, 12,935 belonged to the age group of 5 to 15 years and the rest to 16-25 years. Second and third doses of vaccination were given at 7-14 days and 35-40 days, respectively to 17,336 and 14,605 persons. The protective antibody titre of the blood sample from 5% of the targeted population was assessed. Neutralising antibodies were positive in 245 out of total 261 persons tested before vaccination and was negative in 16. Following vaccination neutralising antibodies were seen in all samples. Even in persons with pre-existing antibodies, a rise in titre was seen after vaccination.