4.1 Intervention for hereditary common hemolytic disorders among the major tribals of Sundargarh district of Orissa 4.2

Transcription

1 4.1 Intervention for hereditary common hemolytic disorders among the major tribals of Sundargarh district of Orissa 4.2 Intervention programme for Cholera, Intestinal Parasitism, Vit A deficiency and Scabies amongst some primitive tribes of Orissa 55

2 Studies on Tribal Health Status: Extra-mural (ICMR Funded) Investigators: Dr. R.S.Balgir Dr. B.P. Dash Starting Date: January 2000 Closing date: December Intervention for hereditary common hemolytic disorders among the major tribals of Sundargarh district of Orissa Objectives: 1. Screening and identification of major vulnerable tribals, namely, Bhuyan, Munda and Kharia for hemoglobinopathy, thalassemia and G-6-PD deficiency. 2. Sensitisation, motivation and education through audio-visual aids like posters, charts, pamphlets for carrier detection of above genetic conditions. 3. To provide information for prospective and retrospective genetic/marriage counselling to the affected persons. 4. Imparting of relevant training to the state s local health authorities, like lab. technician, health workers, etc. 5. Periodic follow up for evaluation, intervention and clinical management of affected cases through local PHC/hospital. 6. To develop a suitable intervention package for prevention and control of hereditary disorders like hemoglobinopathy, thalassemia, G-6-PD deficiency and Rhesus blood group incompatibility. Background of the study: Hereditary hemolytic disorders like sickle cell disease, thalassemia and G-6- PD deficiency are highly prevalent among the tribal populations and lead to high degree of anemia, morbidity, mortality and fetal wastage. Tribals of Sundargarh district of Orissa, namely Bhuyan, Munda and Kharia are highly prone to hemolytic anemia, jaundice, painful crisis, etc. Since these disorders are hereditary in nature and there is no cure for them, therefore, their prevention in the vulnerable people is highly essential. Progress of work done: Last year, we studied Bhuyan tribal community and found that hemoglobinopathies (7.9%) and G-6-PD deficiency (19.0%) were major public health problems in Bhuyan tribe of Hemgiri block in Sundargarh district of Orissa. Both betathalassemia trait (10.2%) and sickle cell disorders (4.1%) were common in the community. For the first time, hemoglobin D was encountered in trait form in Khandyat Bhuyan (1.2%) community in the district, which is quite common in North-Western states of India namely, Punjab, Gujarat, Maharashtra and Uttar Pradesh. Further, for the first time in Orissa, a tribal (Paraja Bhuyan) family was detected having hereditary persistence of fetal hemoglobin (HPFH). This year, the work for this project was initiated in Lahunipara block of Sundargarh district after holding the interactive meetings with the villagers and village leaders (Sarpanch, ward members, etc), BDO, CDPO, Anganwadi workers and PHC 56

3 doctor. We selected three villages, namely, Badjal, Budhabhuin and Kuliposh Colony belonging to Paudi Bhuyan primitive tribe in consultation with above authorites. A houseto-house census was taken and all the households in the villages were numbered and pedigrees were drawn. Clinical examination of subjects was done, medicines were distributed to the ailing persons and blood samples were collected for laboratory investigations. Out of coverage target of 500 population of Paudi Bhuyan primitive tribe, 381 were covered and blood samples were collected. The samples were analysed for total hemoglobin, HbA 2, fetal hemoglobin, HbS, G-6-PD deficiency, β-thalassemia, other hemoblobinopathies like HbD and HbE and ABO and Rh blood groups, by standard methods. Results: The study carried out in three villages, namely Badjal, Budhabhuin and Kuliposh Colony in Lahunipara block of Sundargarh district in Northern Orissa, it is shown that G-6-PD deficiency (13.6%) was the major genetic and public health problem in Paudi Bhuyan primitive tribe. The G-6-PD deficiency was found to be common in males (7.9%) and females in heterozygous (5.0%) and homozygous (0.8%) forms. Although β-thalassemia was prevalent among the Paudi Bhuyan tribe, the frequency is very low (2.1%). Higher prevalence of β-thalassemia among other major scheduled tribes in Orissa like, Paraja (8.5%), Santhal (8.0%), Lodha (6.6%), Bhatra (6.6%), Kondh (6.3%), Saora (6.2%) and Munda (5.2%) was shown by us earlier. The usual clinical signs and symptoms like pallor, joint pains and abdominal pains were observed in these subjects. The frequency of Rhesus negative blood group was very low (0.3%) among the Paudi Bhuyan primitive tribe of Lahunipara Block in Sundargarh district of Orissa. In general, among the tribal populations of Orissa, the frequency of Rhesus negative blood group is low as compared to general populations of India. The preponderance of blood group B over A was found among the scheduled tribes of Orissa. The frequency of blood group O (23.0%) is lower as compared to A (31.0%) and B (33.1%) in Paudi Bhuyan. The knowledge, attitude and practices (KAP) studies among the Paudi Bhuyan primitive tribals showed that the people are unaware of the hereditary health problems. As per their perception, the common health problems were: malaria, cough, cold and asthma (breathlessness). Among the other health problems were: weakness, body ache or joint pains, but they were not aware of the cause of these symptoms. They do not feel any necessity of treatment. However, if the illness persists, they go to local quack and occasionally to PHC for treatment. Further intervention along with sensitisation, motivation for carrier detection and bringing awareness in Paudi Bhuyan tribe is in progress. 57

4 Status: Extramural (I.C.M.R.) Investigators: Dr. G.P. Chhotray Dr. B.B. Pal Starting date: February 2000 Closing date: January Intervention programme for Cholera, Intestinal Parasitism, Vit A deficiency and Scabies amongst some primitive tribes of Orissa Objectives: This community based pilot study have been undertaken in 4 primitive tribes viz., Bondo, Didayi, Juanga and Kondha with the following objectives. 1. A comprehensive assessment of health status and epidemiological profile in respect of cholera, intestinal parasitism, Vit-A deficiency and scabies will be performed in 4 identified primitive tribes such as Didayi, Bondo, Kondha and Juanga out of 13 primitive tribes residing Koraput, Dhenkanal, Phulbani and Keonjhar districts of Orissa. 2. Demographic profile studies reflecting the morbidity and mortality patterns arising out of these disease and their clinical evaluation. 3. To assess the awareness of health, health culture and related behaviour to carry out intervention programme with a view to enhance their acceptability. 4. To plan and execute various intervention programmes among these beneficiaries with a view to augment the existing health care delivery system in those areas. 5. To formulate and develop a module with aim of educating and training the medical and paramedical workers at PHC level in health care delivery system a future strategy for timely detection and management of these diseases. Progress: During the period under report total 1528 (Bondo : 313, Didayi : 331, Juanga : 518 and Kondha : 366) individuals belonging to all age and sex groups in the selected study villages were clinically examined to assess the morbidity pattern arising out of cholera, intestinal parasitism, vitamin A deficiency and scabies. Laboratory investigations were performed to identify the aetiological agents. Diarrhoea including cholera: Total 204 rectal swabs (Bondo 83, Didayi 16, Juanga 11 & D / K.Kondha 94) were collected from diarrhoeal patients admitted in the hospital as well as from the community. Of the total rectal swabs analysed 93 (45.6%) samples were found to be culture positive for various enteropathogens like E.coli (45.1%) and Shigella sps. (0.5% Shigella flexneri type 6). Of the total E.coli isolates 74% were non pathogenic and 26% were pathogenic (6.52% Entero Pathogenic E.Coli (EPEC), 4.3% Entero Toxigenic E.Coli (ETEC) and 15.2% Entero Aggregative E.Coli (EaggEC). Suitable intervention during diarrhoeal outbreak (ORS and antibiotics) were administered to cases having mild to moderate signs / symptoms. Community based IEC activities were undertaken in all the study villages. The rectal swab analysis shows a remarkable decline in the isolation of V.cholerae from 2001 to 2004 (Fig 1). This may be due to timely intervention and IEC activities under taken in the community. 58

5 Fig 1 Yearwise situation of rectal swab analysis of V.cholerae in different studied tribes (Study in. Kondha tribe was initiated in and Juanga in Intestinal Parasitism: Microscopic examinatin of 1528 stool samples collected among the 4 primitive tribes from all age and sex groups revealed that 41.6% of Bondo, 36.7% of Didayi, 36.4% of Kondha and 34.8% of Juanga tribe had intestinal parasites infestations belonging to both protozoa and helminthes. Helminthic infestion was observed among 34.7%, 25.4% and 21.8% of Bondo, Didayi, Kondha and Juanga respectively in age group of children less than 14 years. Amongst adults of more than 14 years these were found in 20.2%, 19.8%, 21.3% and 20.6% respectively in above communities. Hook worm (19.4%) was observed to be the commonest helminthic infection followed by round worm (8.8%) and trichuris (1.4%). Amongst the protozoal infection, E.histolytica was the commonest infection (10.8%) followed by Giardia (3.2%). Repeat stool examination conducted after 4 months of administration of appropriate antiprotozoal / antihelminthic treatment in selected individuals revealed a significant decrease in the worm burden (Fig 2). Fig 2 : Prevalence of Intestinal Parasitic infections before and after intervention. 59

6 Vitamin A deficiency: The prevalence of Vitamin A deficiency (VAD) among preschool (0-5 years) and school going children (6 14years) was studied by examining the clinical signs / symptoms of VAD such as night blindness, bitot s Spot and conjuctival xerosis. The results of the VAD for the period under report is depicted in Table 1. Table 1: Vit A deficiencies among studied tribes Tribe Age Group Night Blindness Conjuctival Xerosis Bitot s Spot Bondo (n = 158) (11.4%) (25.9%) (8.4%) (n = 133) (7.5%) (21.8%) (7.5%) Didayi (n = 182) (2.7%) (24.2%) (13.7%) (n = 220) (2.7%) (21.4%) (10.9%) Juang (n = 67) (6.9%) (12.4%) (3.4%) (n = 181) (3.7%) (17.0%) (4.3%) Kandha (n = 67) (7.4%) (17.9%) (14.9%) (n = 430) (4.0%) (10.8%) (4.8%) 60 When reassessed among the preschool children, the prevalence of night blindness decreased from 11.2% to 7.4% in Bondo, 2.6% to 2.3% in Didayi, 7.8% to 5.7% in Juanga and 7.6% to 5.2% in Kandha; conjuctival xerosis was reduced from 24.8% to 17.2% in Bondo, 24.1% to 18.3% in Didayi, 18.4% to 13.2% in Juanga and 14.6% to 9.8% in Kandha and bitot s spot was reduced from 9.2% to 6.4% in Bondo, 13.8% to 9.2% in Didayi, 13.9% to 9.4% in Juanga and 4.8% to 2.9% in Kandha; while amongst the school going children the night blindness was reduced from 7.6% to 5.4% in Bondo, 2.7% to 2.1% in Didayi, 3.6% to 2.1% in Juanga and 4.2% to 2.6% in Kandha, conjuctival xerosis was reduced from 21.6% to 15.2% in Bondo, 19.3% to 13.8% in Didayi, 12.3% to 8.8% in Juanga and 16.8% to 11.4% in Kandha and Bitot s spot reduced from 7.1% to 4.3% in Bondo, 9.8% to 5.2% in Didayi, 7.8% to 5.1% in Juanga and 5.9% to 3.8% in Kandha studied tribes. Scabies: The clinical examination revealed that 21.3% of Bondo 12.2% of Didayi, 17.3% of Kondha and 12.8% of Juanga children (<14 years) were having infected / non infected scabies, while among the adults (>14 years) 20.2% of Bondo, 3.4% of Didayi, 12.7% of Kondha and 9.3% of Juanga were having infected / non infected scabies. A follow up examination of the patients after appropriate intervention (both drug intervention and IEC) revealed that the disease has been reduced from 20.3% to 9.5% in Bondo, 12.5% to 6.8% in Didayi, 14.8% to 8.6% in Juanga and 14.2% to 7.8% in Kandha population.