TITLE:
Socioeconomic barriers to cataract surgery in Nepal: the South Asian cataract
management study.
AUTHOR:
Snellingen T, Shrestha BR, Gharti MP, Shrestha JK, Upadhyay MP, Pokhrel RP
AFFILIATION:
Institute of Clinical Medicine, University of Tromso, Norway.
SOURCE:
Br J Ophthalmol 1998 Dec;82(12):1424-8
ABSTRACT:
BACKGROUND: Previous studies have shown that, despite an increasing availability of cataract surgery, important
socioeconomic barriers exist in the acceptance of surgery in many rural areas of south Asia. Nepal has developed a
comprehensive national network of eye hospitals but the surgical coverage for the treatment of cataract blind is still low.
AIMS: To determine the utilisation of cataract surgery and the level of physical and psychosocial impairment and the
socioeconomic barriers to surgery in a group of non-acceptors of surgery. METHODS: Of 319 cataract patients
identified in a field screening 96 non-acceptors of surgery were interviewed 1 year after an offer to undergo surgery.
The interview included questions on visual function, quality of life, and socioeconomic variables on acceptance of
cataract surgery. The quality of life questionnaire was based on the field validated protocol addressing the impact of
visual impairment on physical and psychosocial functions. The questionnaire was adapted to the local conditions after
pretesting. Data were analysed by degree of visual impairment. RESULTS: Of 319 cataract patients identified only
45.5% accepted surgery, with men accepting surgery more readily than women (RR = 1.31; 95% CI = 1.04-1.67)
because of a significantly greater acceptance of surgery in men in the non-blind group. The acceptance rate was
significantly higher in the blind group (RR = 1.74; 95% CI = 1.36-2.22) compared with those patients having impairment
of vision and severe loss of vision. Of 96 non-acceptors interviewed only a further 13% accepted surgery after a second
counselling. The most frequent reasons given for not accepting surgery were economic (48%) and logistical (44.8%)
constraints followed by fear of surgery (33.3%) and lack of time (18.8%). Half of the subjects complained of problems
with self care but only 10% needed help for their most basic every day activities. 17.7% said they needed help to visit
neighbours and 26% needed help to attend the field or market. CONCLUSIONS: It was found that in this population with
a majority of patients with severe vision loss and blind, even when offered transport and free surgery the utilisation of
cataract surgery is below 60%. Medicine tends to be prescriptive based on technological advances that it is able to offer.
Medical practice needs to develop a more holistic understanding of the needs of the communities cultivating a greater
capability to analyse the role of cultural, social, and economic factors when planning medical services for the population.
TITLE:
Leg ulceration and ethnicity: a study in west London.
AUTHOR:
Franks PJ, Morton N, Campbell A, Moffatt CJ
AFFILIATION:
Centre for Research and Implementation of Clinical Practice, Thames Valley University, Wolfson Institute of Health
Sciences, London, UK.
SOURCE:
Public Health 1997 Sep;111(5):327-9
ABSTRACT:
Little is known of the influence race has on the development of leg ulceration, with most studies being performed in
almost exclusively white populations. As part of a wider audit of leg ulcer services, health care professionals were
contacted to give details of age, sex and ethnic background of all patients who attended for treatment of leg ulceration
over a one year period in an area of west London. West London Health Care Trust provides services to a population of
275,000 of whom 53,000 have an ethnic background from the Indian subcontinent (South Asian). In all, 280 patients were
identified, of whom 264 (94%) had details of age and sex. This gave a crude ascertainment rate of 1.02 per 1000
population. Of the 264 patients, five were classified as South Asians, with one patient classified as Afro-caribbean. The
Mantel Haenzsel test demonstrated a significantly higher proportion of whites suffering from leg ulceration than South
Asians, giving an odds ratio of 4.43, with 95% confidence intervals between 1.94 and 10.13 (P = 0.0004). The expected
frequency of South Asian patients should be 23, based on rates from the white population, of which 13 would be women
and 10 men. Only five South Asian men were identified, and no Asian women with leg ulceration. Reasons for this low
ascertainment are two-fold. Either there is a real difference between the white and South Asian populations, or South
Asian patients are not presenting for treatment. Further work must be performed to determine whether this is an effect of
low prevalence, or unmet need in the community.
TITLE:
End-stage primary biliary cirrhosis in a first generation migrant south Asian
population.
AUTHOR:
Anand AC, Elias E, Neuberger JM
AFFILIATION:
Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
SOURCE:
Eur J Gastroenterol Hepatol 1996 Jul;8(7):663-6
ABSTRACT:
Primary biliary cirrhosis (PBC) is uncommonly described from Asia and it is an extremely rare cause of chronic liver
disease in India. Six first generation migrant Asian patients with PBC were seen at the Liver Unit, Queen Elizabeth
Hospital, Birmingham during the period 1982-94. All were women and their ages at presentation ranged from 31 to 63
(median 40) years. All were symptomatic for a median of 6 months prior to referral to the unit for transplantation. Itching
with or without jaundice was a common presenting feature. Diagnosis was based on raised serum IgM levels, presence
of antimitochondrial antibody (titres 100-400) and diagnostic histology. Only one patients had an associated autoimmune
disease (coeliac disease). Serum bilirubin level was above 100 mumol/l at the time of presentation in four patients. Four
of these patients with end-stage PBC are first generation migrants from south Asia, who have been resident in the West
Midlands for the past 10 to 34 years. The total south Asian population of the West Midlands is 276,754; thus, from these
four patients alone the estimated prevalence of PBC in the migrant south Asian population is at least 14 per million.
However, such data cannot be used to give any accurate assessment of prevalence, for which a population screening
programme is required. A higher incidence in the migrant population than in their countries of origin is compatible with an
environmental aetiology.
TITLE:
Health of a Punjabi ethnic minority in Glasgow: a comparison with the general
population.
AUTHOR:
Williams R, Bhopal R, Hunt K
AFFILIATION:
MRC Medical Sociology Unit, University of Glasgow.
SOURCE:
J Epidemiol Community Health 1993 Apr;47(2):96-102
ABSTRACT:
OBJECTIVE--To compare common health experiences of a South Asian (predominantly Punjabi) population with that
of the general population, according to sex, and to related patterns of health in the fourth decade of life to the pattern of
hospital admission and mortality documented in the published reports. DESIGN AND SETTING--A cross sectional
survey with interviews and physical measures was undertaken in a two stage stratified random cluster sample in the city
of Glasgow. SAMPLE--This comprised 159 South Asians aged 30-40 years, mean age 35 (73.6% of those invited) and
319 subjects from the general population, all aged 35 years. MEASUREMENTS AND MAIN RESULTS--Body
structure, lung function, pulse and blood pressure, history of physical and mental health, results of standardised
questionnaires on mental health, angina and respiratory health, recent and past symptoms, history of accidents, and
sickness behaviour were determined. South Asians were shorter, broader, and more overweight (women); they had
lower values for forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), a faster pulse, and higher
diastolic pressure (men). Fewer South Asians had had accidents or digestive symptoms (men); more had psychosomatic
and high total symptoms (women); fewer wore glasses, had lost teeth, or had long standing illness (men) (all p < 0.01).
Women had a lower FEV1/FVC ratio (p < 0.05). CONCLUSIONS--South Asians were consistently disadvantaged
only in terms of anthropometric measures. Otherwise, the many differences were balanced, with disadvantage being
concentrated only among South Asian women. The health gap between sexes in South Asians seems higher than in the
general population. The findings show patterns of health in the fourth decade of life which are consistent with patterns of
hospital admission and mortality documented in the published reports.
TITLE:
Alcohol consumption and alcohol-related problems in Afro-Caribbeans and south
Asians in the United Kingdom.
AUTHOR:
McKeigue PM, Karmi G
AFFILIATION:
Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, U.K.
SOURCE:
Alcohol Alcohol 1993 Jan;28(1):1-10
ABSTRACT:
Data from published sources and unpublished surveys in the U.K. show that average alcohol consumption is lower in
Afro-Caribbean men and women than in native British men and women. The proportion of heavy drinkers is also low in
Afro-Caribbeans. Consistent with these consumption data, hospital admission rates for alcohol-related problems are
lower in Afro-Caribbeans than in the general population. Among South Asians (Indians, Pakistanis and Bangladeshis)
average alcohol consumption is lower than in the native British population but alcohol-related morbidity rates for some
South Asian communities are higher than for the general population. The reasons for these high morbidity rates are not
clear. Consumption is higher in Sikhs than in Hindus or Muslims, and heavy spirit drinking appears to be especially
common among Sikh men. Alcohol-related psychiatric admission rates for South Asians have risen since 1971, and
appear to be especially high in Sikh men. The high alcohol-related morbidity rates in this group are a priority for further
research and efforts at prevention.
TITLE:
Risk of tuberculosis in immigrant Asians: culturally acquired immunodeficiency?
AUTHOR:
Finch PJ, Millard FJ, Maxwell JD
AFFILIATION:
Department of Medicine, St. George's Hospital Medical School, London.
SOURCE:
Thorax 1991 Jan;46(1):1-5
ABSTRACT:
Study of the 620 Asian immigrants with tuberculosis notified in the Wandsworth area of south London between 1973 and
1988 showed a bimodal pattern of tuberculosis notifications: in 1977 there was a peak among Asians from East Africa,
and in 1981 a peak among those from the Indian subcontinent. There was a mean lag time of five years between clinical
presentation and immigration. Logit analysis showed that, although overall more men had tuberculosis than women,
glandular tuberculosis was more common among women of all groups, and pulmonary tuberculosis was more common
among Hindu women than Hindu men. Both subgroups of Asians had a substantially higher incidence of tuberculosis than
white people, particularly at extrapulmonary sites. Hindus were also at a significantly greater risk of tuberculosis at all
sites than Muslims (Hindu:Muslim risk ratio 5.5 for women and 3.7 for men). The increased susceptibility to tuberculosis
of Hindus, particularly Hindu women, may be related to a culturally acquired immunodeficiency caused by vegetarianism
and associated vitamin deficiency.
Comments:
TITLE:
Women in a south Indian fishing village: role identity, continuity, and the experience
of menopause.
AUTHOR:
George T
AFFILIATION:
SOURCE:
Health Care Women Int 1996 Jul-Aug;17(4):271-9
ABSTRACT:
A study was conducted of the experience of menopause among middle-aged women in a fishing village on the
southwest coast of India. These women live in a harsh environment with a standard of living that would be considered
economically deprived by an outsider. The women have established their identity as fish sellers. Although they reported
experiencing some of the physiological symptoms of menopause typically reported in Western literature, the symptoms
were not cause for complaint, and none of them sought medical treatment for them. Nor did these women go through an
identity crisis at midlife; they continued to identify themselves as well-established fish sellers, not as redundant, aging
housewives. Furthermore, menopause gave them much more time and freedom to pursue their fish-selling business.
This paper posits that their continuity in identity accounts for their freedom from the psychological symptoms some
Western women experience at midlife.
TITLE:
Risk factors for development of bronchial asthma
in children in Delhi
AUTHOR:
Chhabra SK; Gupta CK; Chhabra P; Rajpal S
AFFILIATION:
SOURCE:
ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY 1999, Vol
83, Iss 5, pp 385-390
ABSTRACT:
Background: Information on the magnitude of the
problem of childhood asthma in India and the
factors influencing its occurrence is
inadequate.Objective: To measure the prevalence of
asthma in schoolchildren in Delhi and study the
factors determining its occurrence.Methods: A
questionnaire-based study carried out in nine
randomly selected schools in Delhi. The age range
was 5 to 17 years. The questionnaires were
distributed to all the children (n = 21,367) for
answering by either parent. The key questions
relate to complaints of recurrent wheezing in the
past, during the immediate last 1-year, and also
wheezing exclusively induced by exercise or colds.
In all, 19,456 questionnaires were received back
(response rate 91%). Out of these, 18,955 were
complete and analyzed.Results: The prevalence of
current asthma was 11.9% while past asthma was
reported by 3.4% of children. Exclusive
exercise-induced asthma was reported by 2.1% while
that associated with colds by 2.4% of children.
Boys had a significantly higher prevalence of
current asthma as compared with girls (12.8% and
10.7%, respectively). Multiple logistic regression
analysis showed that male sex, a positive family
history of atopic disorders, and the presence of
smokers in the family were significant factors
influencing the development of asthma while
economic class, air pollution (total suspended
particulates), and type of domestic kitchen fuel
were not.Conclusions: The prevalence of current
asthma in children in Delhi is 11.9%. Significant
risk factors for its development are male sex, a
positive family history of atopic disorders, and
the presence of smokers in the family.
TITLE:
HIV-infected workers deported from the Gulf
States: impact on southern Pakistan
AUTHOR:
Shah SA; Khan OA; Kristensen S; Vermund SH
AFFILIATION:
SOURCE:
INTERNATIONAL JOURNAL OF STD & AIDS 1999, Vol 10,
Iss 12, pp 812-814
ABSTRACT:
HIV prevalence is still very low in Pakistan, but
its south Asian location and subgroups with
recognized lifestyle risk factors suggest that
Pakistan will experience expanded diffusion of HN.
We report the frequency of HIV infections
identified by the AIDS Control Programme on the
Sindh province of Pakistan. Most HIV-positive
cases currently reported to the Sindh AIDS Control
Programme are found among Pakistani workers
deported from the Gulf States and among
foreigners. The 58 returned workers with HIV
represent 61 to 86% of reported cases in any given
year during the 1996-1998 period. Five wives of
returning workers have been identified with HIV.
Expatriate workers in the Gulf States are tested
for HIV routinely, unlike other subgroups in
Pakistan. Considering the risk of HIV/AIDS due to
regular introduction of HIV from returned workers,
and the Limited awareness surrounding sexual
health and HIV/STD transmission issues in
Pakistan, intervention programmes targeted at
overseas workers need to be implemented to control
the expansion of the HN epidemic in Pakistan.
TITLE:
Household members of hepatitis C virus-infected
people in Hafizabad, Pakistan: infection by
injections from health care providers
AUTHOR:
Pasha O; Luby SP; Khan AJ; Shah SA; McCormick
JB; Fisher-Hoch SP
AFFILIATION:
SOURCE:
EPIDEMIOLOGY AND INFECTION 1999, Vol 123, Iss 3,
pp 515-518
ABSTRACT:
Household members of people with hepatitis C are
at increased risk of HCV infection. The prevalence
and routes of transmission of HCV to household
members in Hafizabad, Pakistan were investigated.
Household members of 24 index cases were given a
risk factor questionnaire, tested for HCV
infection, and the risk factors between the
infected and uninfected were compared. Twelve of
74 household members (16.2 %) were seropositive
for HCV antibody. This was 21/2 times the rate of
infection in the general population (OR = 2.8; P =
0.01). None of the routes of transmission studied
within the household was associated with an
increased risk. Household members who received
more than 4 injections per year were 11.9 times
more likely to be infected than those who had not
(P = 0.016). In Hafizabad, the greatest risk for
HCV infection to household members of infected
people is injections given by health-care workers
rather than household contact with infected
persons.