Cause Of Death In India Research Articles

Fetal growth and coronary heart disease in South India

Coronary heart disease is predicted to become the commonest cause of death in india within 15 years People from India living overseas already have high rates of the disease that are not explained by known coronary risk factors. Small size at birth is a newly described risk factor for coronary heart disease, but associations between size at birth and the disease have not been examined in India. We studied 517 men and women who were born between 1934 and 1954 in a mission hospital in Mysore, South India, and who still lived near to the hospital. We related the prevalence of coronary heart disease, defined by standard criteria, to their birth size. 25 (9%) men and 27 (11%) women had coronary heart disease. Low birthweight, short birth length, and small head circumference at birth were associated with a raised prevalence of the disease. Prevalence fell from 11% in people whose birthweights were 5.5 lb (2.5 kg) or less to 3% in those whose birthweights were more than 7 lb (3.1 kg), p for trend = 0.09. The trends were stronger and statistically significant among people aged 45 years and over (p = 0.03 for birthweight, 0.04 for length, and 0.02 for head circumference). High rates of disease were also found in those whose mothers had a low body weight during pregnancy. The highest prevalence of the disease (20%) was in people who weighted 5.5 lb (2.5 kg) or less at birth and whose mothers weighted less than 100 lb (45 kg) in pregnancy. These associations were largely independent of known coronary risk factors. In India, as in the UK, coronary heart disease is associated with small size at birth, suggesting that its pathogenesis is influenced by events in utero. The association with low maternal bodyweight is further evidence that the disease originates through fetal undernutrition. Prevention of the rising epidemic of the disease in India may require improvements in the nutrition and health of young women.

The Mandwa experiment, an alternative strategy.

In the early 1970s a study was set up to examine the health problems of a rural community in Maharashtra (India) state and explore ways in which the available medical technology could be applied. The study area which comprised 30000 people living in 30 villages in the Raigad district of Maharashtra state was chosen as roughly representative of the Indian population 3/4 of whom live in rural areas. The project known as the Mandwa experiment operated from 1973 to mid-1983. This article describes how it was set up what was achieved and the problems that were encountered. The first 2 years were spent looking at the structure of the community and the health problems of the people and ascertaining how the existing public and private health services worked. The most common health problem was malnutrition which with the poor water supply standard of hygiene and the strain of having to survive took a heavy toll on a population who viewed chronic illness as normal. The government primary health care service consisted of 2 subcenters and a dispensary with 10 beds. These units were understaffed and the doctors and nurses were primarily concerned with providing curative services for the leaders and rich members of the community. The only government health program that was implemented with any success was family planning and the measures used to publicize the program were resented. Most of the health problems were related to maternal and child health. The project established a small health center with 10 beds which was used chiefly for obstetric care and emergency treatment. It took about 3 years to establish the project. Appreciably increased immunization rates were achieved but this was only after the village health workers had replaced the auxiliary nurse midwives. This with better hygiene at deliveries resulted in the total elimination of tetanus the 2nd largest cause of death in India. The number of cases of leprosy detected before the project was 63 over 12 years; at the end of the project this had increased to 161 in the same population and the village health workers ability to screen for leprosy was similar to that of the trained leprosy technicians. The rate of early detection of tuberculosis was high and by visiting the patients regularly at home the village health workers ensured that treatment with streptomycin was given once the doctor had confirmed the diagnosis. Deaths from dehydration were virtually eliminated by explaining to mothers how to use oral rehydration using a homemade salt and sugar solution. For malaria the village health workers took blood smears from patients with fever and then presumptively treated them with chloroquine. Definitive treatment was provided for patients who yielded positive results on smear testing. The experience from the Mandwa project suggests that semiliterate and even illiterate villagers can be taught to prevent disease and to recognize and treat it effectively.