Sawnet: Miscellaneous Abstracts

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
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
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
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
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.