Musculoskeletal Symptoms among Plantation Workers in Kerala, India

Introduction: Musculoskeletal disorder (MSD) is one of the major occupational health problems worldwide. Musculoskeletal symptoms (MSS) can indicate an underlying MSD. This paper assesses the prevalence of MSS among different plantation workers in Kerala, India. Methods: A cross-sectional survey was conducted from January to February 2021 among 83 rubber tappers, 90 cardamom plantation workers, and 87 tea pluckers (N=260). The Standardized Nordic Questionnaire (SNQ) was used to capture the MSS. MSS was compared across the three types of plantation workers, and the Chi-square test was used to test the significance. The Odds Ratios (OR) and 95% Confidence Intervals (CI) were estimated using binary logistic regression analysis.  Results: The prevalence of MSS (any regions) in the last 12 months among all participants was 87.7% and did not significantly vary between the three groups of workers. In general, the most affected regions were the low back (61%), one or both knees (47%) and shoulders (44%), respectively. Compared to rubber tappers, the odds of MSS in hips/ thighs (adjusted OR=2.38: 95% CI: 1.17-4.84) and wrists (adjusted OR=3.77: 95% CI:1.85-7.69) were significantly high among cardamom plantation workers. But the odds of MSS in elbows (adjusted OR=0.58: 95% CI: 0.31-1.07) and knees (adjusted OR=0.26:95% CI: 0.10-0.63) were low in the tea plantation workers as compared to rubber tappers. Conclusion: Though there was no variation in the overall prevalence of MSS between the three groups, there was a significant variation between the groups regarding the MSS in different body regions. Using supportive aids according to the nature of work and doing simple stretching exercises during breaks may help to improve the musculoskeletal health of plantation workers

Young women's attitude toward gender-equitable norms on domestic chores and violence domains in Trivandrum

BACKGROUND: Trivandrum is a place with better educational status for women. The aim of this study is to describe young women's attitude toward gender-equitable norms. METHODS: A cross-sectional survey was conducted in Trivandrum, using multistage cluster sampling method. Participants were 18–28-year-old married (n = 203) and unmarried (n = 104) women. The scales of domestic chores and daily life domain items and violence domain items from the compendium of gender scales were used to assess the attitude toward gender-equitable norms. Pearson Chi-square test was used to check the significance of the associations. RESULTS: The high support to gender-equitable norms on domestic chores and daily life domain was 29% and 18% and violence domain was 25% and 14% among unmarried and married women, respectively. Education was interrupted among 55% of married women due to marriage, pregnancy, childcare, and lack of resources. The ability to take final decision to work outside the home (32% vs. 45%) and in obtaining health care (65% vs. 73%) was low among married women compared to unmarried women. Higher education did not affect the attitude of young women toward gender-equitable norms on “violence domain,” but the highly educated married women showed a slightly better support for “domestic chores and daily life domain” and had a major say in taking decisions on health-care seeking and work outside home. CONCLUSIONS: In general, the support for gender-equitable norms and the freedom in decision-making are not satisfactory among young women. Education alone cannot make rapid changes in the attitude of young women toward gender-equitable norms since it is strongly connected with social norms and practices

Sosiodemografiset ja lisääntymiseen liittyvät tekijät ja seulonta kohdunkaulasyövän ja siitä selviämisen vaaratekijöinä Etelä-Intian maaseudulla

Kohdunkaulan syövän esiintyvyys ja elossaololuku vaihtelee sekä maiden välillä että maakohtaisesti. Alhainen sosioekonominen asema sekä suurentaa sairastumisvaaraa että pienentää todennäköisyyttä parantua syövästä. Kun resurssit ovat rajalliset, on tehokkaaksi seulontamenetelmäksi osoittautunut niin sanottu seulo ja hoida -periaate, jossa kohdunkaula tutkitaan silmämääräisesti etikkahapon avulla (VIA-tutkimus). Tarvittaessa annetaan samalla kerralla jäädytyshoito. Tässä väitöstutkimuksessa arvioitiin VIA-tutkittujen naisten kohdunkaulan syövän vaaraa pitkän ajan kuluessa. Tutkimuksessa selvitettiin myös kolposkopia-tutkimuksen rajoituksia seulo ja hoida -ohjelmissa silloin, kun resurssit ovat niukat. Lisäksi arvioitiin, miten sosiodemografiset ja lisääntymiseen liittyvät tekijät vaikuttavat kohdunkaulan syövän vaaraan ja paranemisen todennäköisyyteen. Arvioitiin myös sitä, miten näiden tekijöiden tutkiminen seulotuilla voi vääristää tuloksia. Tutkimus perustuu Tamil Nadun osavaltiossa tehtyyn laajaan tutkimukseen, jossa kohdunkaulan syöpää seulottiin VIA-tutkimuksella maalaisväestön keskuudessa Intiassa vuosina 2000-2003. Seulonnassa positiivisen (n=3021) tai negatiivisen (n=28 255) tuloksen saaneita naisia seurattiin joulukuuhun 2012 saakka, jotta voitiin arvioida kohdunkaulan syöpävaaraa pitkällä aikavälillä. Sosiodemografiset ja lisääntymiseen liittyvät riskitekijät tutkittiin vain verrokkiryhmässä ja parantumisennustetta ja paranemiseen liittyviä sosioekonomisia tekijöitä puolestaan verrokkiryhmään kuuluneiden kohdunkaulan syöpään sairastuneiden naisten avulla vuosina 2000-2006. Seulontatiedon käytöstä johtuvaa harhaa selitettiin käyttämällä tietoja seulontasyövistä (n=67) ja verrokkiryhmän syövistä (n=165) vuosina 2000-2006. Tutkimus osoitti, että VIA-tutkimuksen negatiivinen ennustearvo on korkea jopa 12 vuotta seulonnan jälkeen. Kohdunkaulasyövän sairastumisriski oli korkein (riskisuhde=20,7; 95 % luottamusväli: 5-85,3), jos VIA-tulos oli positiivinen, mutta kolposkopiaa ei tehty tai sen tulokset olivat epäselvät. Useita kertoja (4+) raskaana olleilla kouluttamattomilla vanhemmilla naisilla (50-59 vuotta) oli huomattavasti suurempi riski sairastua kohdunkaulan syöpään kuin alle neljä kertaa raskaana olleilla, jossain määrin koulutetuilla nuoremmilla naisilla. Sosiodemografisten ja lisääntymiseen liittyvien riskitekijöiden riskisuhteet vaihtelivat tutkimusryhmän ja seulontatuloksen mukaan. Seulonta vähensi kohdunkaulan syövän esiintyvyyttä merkitsevästi naisilla, jotka olivat nuoria, kouluttamattomia, naimisissa ja asuivat tiili- tai betonirakennuksessa. Tärkein elossaololukuihin vaikuttava tekijä oli syövän levinneisyysaste. Seulonnoissa diagnosoiduista naisista 47,6 % oli elossa viiden vuoden jälkeen. Seulonnoissa diagnosoitujen, syövästä parantuneiden naisten ikä vaihteli suuresti, mutta kouluttamattomien ja koulutettujen naisten välinen ero paranemisessa pieneni tässä joukossa. Tutkimustulokset osoittavat, että valikoituneisuus sekä tutkimukseen osallistumisessa että itse seulonnassa vääristää riskitekijöiden arvioituja vaikutuksia, kun taas valintaharha ja ylidiagnosointi vääristävät ennustavien tekijöiden arvioituja vaikutuksia silloin, kun seulontatietoa käytetään sosiodemografisten ja lisääntymiseen liittyvien riskitekijöiden ja ennustavien tekijöiden tutkimiseen. Vertailevassa seulontatutkimuksessa verrokkiryhmästä saatu tieto olisi ihanteellista sosiodemografisten ja lisääntymiseen liittyvien riskitekijöiden ja ennustavien tekijöiden tutkimiseen. Tuloksia tulisi tulkita harkiten, jos arviot johdetaan seulontatiedoista. Tutkimus osoitti, että ilman kolposkopiaa toteutettu seulo ja hoida -menetelmä on tehokkain strategia silloin, kun resurssit ovat niukat. Tiedon lisääminen kohdunkaulan syövästä koulutuksen kautta, elintason parantaminen ja toimivan terveydenhuollon takaaminen voivat olla merkittävässä roolissa kohdunkaulan syövän vähentämisessä Intian maaseudulla.Cervical cancer incidence and survival widely varies between and within countries. Low socioeconomic status is associated with higher risk of cervical cancer as well as with poor survival. A single visit approach of visual inspection with acetic acid (VIA) combined with cryotherapy is established as an effective screening method in reducing cervical cancer incidence and mortality in low-resource settings. This study evaluated the long-term risk of cervical cancer among visually screened women with different triage methods, histological findings and treatment options; and explored limitations of colposcopy triage in screen and treat programmes in low-resource settings. This study also evaluated the role of sociodemographic and reproductive factors in the risk of and survival from cervical cancer, and the bias in using screening data to study the sociodemographic and reproductive risk factors and prognostic factors of cervical cancer. This research was based on a large cervical cancer screening trial by visual inspection with acetic acid (VIA) conducted during 2000-2003 in a rural population of Dindigul district, Tamil Nadu state, India. All screen positive (n=3021) and negative (n=28255) women except 67 screen-detected cervical cancer patients were followed until December 2012 to assess long-term risk of cervical cancer among VIA screened women. Sociodemographic and reproductive risk factors were determined using data from control arm, and the survival and its socioeconomic determinants were studied among women diagnosed with cervical cancer during 2000 to 2006 in control arm. Bias in the use of screening data to study sociodemographic and reproductive risk factors was explained using data from both control (n=30958) and intervention arm (n=49311) followed until December 2006. Bias in the use of screening data to study sociodemographic prognostic factors was explained using 67 screen-detected women and 165 women diagnosed with cervical cancer from control arm during 2000-2006 and followed until December 2012. The study showed a high negative predictive value for VIA even after 12 years of screening. Compared to VIA negative women, women who were with VIA positive but colposcopy negative and who had no histological confirmation showed a hazard ratio for cervical cancer of 6.5 (95%CI: 1.6 to 27.1). VIA positive women with no colposcopic evaluation or who had an inconclusive colposcopy and had no histological confirmation showed the highest risk for cervical cancer (HR= 20.7, 95%CI: 5 to 85.3). Women with older age (50-59 years), no education and higher number of pregnancies (4+) showed a significant higher risk for cervical cancer compared to women with younger age, some education, and less than four pregnancies respectively in the control population. Hazard ratios of sociodemographic and reproductive risk factors varied accordingly with study group and screening status. The benefit in terms of achieving substantial incidence reduction as a result of screening was acquired by younger, uneducated, currently married and women living in tiled or concrete houses. The observed five-year survival was 32.5% among women diagnosed with cervical cancer from control arm. Stage of disease was the most important determinant of survival (adjusted HR for mortality for stage 2 or worse cancers: 3.9; 95% CI: 1.7 to 9.1 when stage1 cancers were the reference). Observed five year survival was 47.6% among screen detected women. Variation in survival by age at diagnosis was substantial in screen-detected women. In addition, the variation in survival between uneducated and educated women was reduced in screen-detected women. The results from this study indicate that self-selection in attendance and screening itself will bias the effect estimates of risk factors, whereas selection bias and over diagnosis will bias effect estimates of prognostic factors while using screening data to study the sociodemographic and reproductive risk and prognostic factors. In a controlled screening trial, the data from control population would be ideal for studying the sociodemographic and reproductive risk and prognostic factors, and the results should be interpreted with caution if estimates are derived using screening data. The study demonstrated that a screen and treat policy without colposcopy triage will be a more effective strategy in low-resource settings. Level of education and age of women are both important factors to be considered while implementing screening, further diagnosis, treatment and follow-up in order to achieve better health outcome in low-resource settings. Creating awareness about cervical cancer through educational programmes, improvements in living standards and assuring accessibility to an efficient health care system can altogether play an important role in reducing the burden of cervical cancer in rural populations

Nutritional status of Mid-Day Meal programme beneficiaries: A cross-sectional study among primary schoolchildren in Kottayam district, Kerala, India

Background: The efficiency of Mid-Day Meal (MDM) Programme in India to ensure the optimum nutritional status of its beneficiaries is rarely studied. Objective: This study assessed the nutritional status of 6–10-year-old schoolchildren who were the beneficiaries of MDM and the child-related factors affecting their nutritional status. Methods: A cross-sectional study was performed among 322 children from 12 randomly selected primary schools in one block panchayat of Kerala state. The background information was collected from children and their parents, and anthropometric measurements of the children were observed. The prevalence of undernutrition was estimated using conventional indices (stunting, underweight, and wasting) and composite index of anthropometric failure (CIAF). Logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: The prevalence of CIAF was 45.7% (95% CI: 40.3%–51.1%) and that of stunting, underweight, and wasting were 13.4% (9.7%–17.1%), 38.8% (33.5%–44.1%), and 30.7% (25.7%–35.7%), respectively. The prevalence of wasting (42.6% vs. 28.4%, P = 0.039) and severe underweight (20.4% vs. 7.1%, P = 0.002) was statistically significantly high among occasional/never users compared to regular users of MDM Programme. Children born with <2.5 kg showed an OR of 1.76 (95% CI: 0.99–3.11) for being undernourished compared to children born with normal weight (≥2.5 kg) when adjusted for age, sex, birth order, and illness in the past 2 weeks. Conclusion: This study showed a higher prevalence of undernutrition among school-age children who were the beneficiaries of MDM Programme, and this indicates the need for continuous nutritional interventions and surveillance among these children

Survival of Patients With Cervical Cancer in Rural India

Background: Patients’ survival after diagnosis of cervical cancer is indirectly influenced by socio-economic factors. We evaluated this survival and its socio-economic determinants in a rural population in south India. Methods: We assessed 165 women diagnosed with cervical cancer from the routine care control arm of a randomized screening trial conducted in rural south India. Kaplan-Meier curves were plotted to illustrate the observed survival of cancer patients. The effect of socio-economic factors was assessed using Cox proportional hazards regression analysis. Results: The 5-year observed survival was 32.5%, ranging from 9% for stage IV to 78% for stage I cancers. Women with poor socio-economic status (SES) had up to a 70% higher risk of death. Higher household income was significantly associated with poorer survival. However, most women in the higher income group were married women and housewives, hence with no personal income. Conclusion: Cervical cancer survival was disappointingly low in these rural populations of India and stage of disease at diagnosis was the strongest determinant. A higher household income is not always associated with women being empowered in terms of seeking healthcare. The study findings further stress the importance of strengthening prevention and screening opportunities to women in rural populations.Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal

Carotid endarterectomy for symptomatic carotid stenosis: differences in patient profile in a Low-Middle Income Country

Introduction: Carotid Endarterectomy (CEA) is the standard treatment for patients with symptomatic carotid stenosis. Data from Low- and Middle-Income Countries (LMIC) is sparse on CEA and its outcomes. We aimed to describe the profile of our patients, and factors associated with periprocedural cerebral ischemic events in patients with symptomatic carotid stenosis who underwent CEA in our institute. Methods: Retrospective review of patients with symptomatic carotid stenosis(50-99%) who underwent CEA between January 2011 and December 2021 was done. Clinical and imaging parameters and their influence on periprocedural cerebral ischemic events were analysed. Results: Of the 319 patients (77% males) with a mean age of 64 years (SD ±8.6), 207 (65%) presented only after a stroke. Majority (85%) had high grade stenosis (70%) of the symptomatic carotid. The mean time to CEA was 50 days (SD ±36), however only 26 patients (8.2%) underwent surgery within 2 weeks. Minor strokes and TIA occurred in 2.2%, while major strokes and death occurred in 4.1% patients. None of the clinical or imaging parameters predicted the periprocedural cerebral ischemic events. The presence of co-existing significant (50%) tandem intracranial atherosclerosis (n=77, 24%) or contralateral occlusion (n=24, 7.5%) did not influence the periprocedural stroke risk. Conclusion: There is a delay in patients undergoing CEA for symptomatic carotid stenosis. Majority have high grade stenosis and present late only after a stroke reflecting a lack of awareness. CEA can be performed safely even in patients with significant intracranial tandem stenosis and contralateral carotid occlusion