Verbal autopsy of 80,000 adult deaths in Tamilnadu,South India

Background

Registration of the fact of death is almost complete in the city of Chennai and not so in the rural Villupuram district in Tamilnadu, India. The cause of death is often inadequately recorded on the death certificate in developing countries like India. A special verbal autopsy (VA) study of 48 000 adult (aged ≥ 25 yrs) deaths in the city of Chennai (urban) during 1995–97 and 32 000 in rural Villupuram during 1997–98 was conducted to arrive at the probable underlying cause of death to estimate cause specific mortality.

Methods

A ten day training on writing verbal autopsy (VA) report for adult deaths was given to non-medical graduates with at least 15 years of formal education. They interviewed surviving spouse/close associates of the deceased to write a verbal autopsy report in local language (Tamil) on the complaints, symptoms, signs, duration and treatment details of illness prior to death. Each report was reviewed centrally by two physicians independently. Random re-interviewing of 5% of the VA reports was done to check the reliability and reproducibility of the VA report. The validity of VA diagnosis was assessed only for cancer deaths.

Results

Verbal autopsy reduced the proportion of deaths attributed to unspecified and unknown causes from 54% to 23% (p < 0.0001) in urban and from 41% to 26% (p < 0.0001) in rural areas in Tamilnadu for adult deaths (≥ 25). The sensitivity of VA to identify cancer was 95% in the age group 25–69.

Conclusion

A ten day training programme to write verbal autopsy report with adequate feed back sessions and random sampling of 5% of the verbal autopsy reports for re-interview worked very well in Tamilnadu, to arrive at the probable underlying cause of death reliably for deaths in early adult life or middle age (25–69 years) and less reliably for older ages (70+). Thus VA is practicable for deaths in early adult life or middle age and is of more limited value in old age.

     

Heavy Metals in Airborne Particulate Matter of Urban Coimbatore

Exposures to airborne metals are known to cause physiological responses in organisms and wide-ranging health effects in humans. Hence determination of metals in particulate matter is important from a toxicological perspective. In the current study heavy metals associated with respirable (RSPM) and nonrespirable (NRSPM) fractions of suspended particulate matter were estimated in air samples from six stations in Coimbatore, India, during March 1999 to February 2001. The mean quantity of heavy metals in RSPM was in the order Zn > Cu > Pb > Ni > Cr > Cd. Concentrations of these heavy metals were in the range of BDL (below detectable level) to 2147 ng/m3 in RSPM. The highest level of lead (2147 ng/m³) was recorded at an industrial station. The station also had the highest mean value (481 ± 544.3 ng/m³), suggesting the importance of industrial operations in determining the ambient concentrations of lead. Significant positive correlation among metals excepting lead and copper suggests that they originate mostly from a common source. Air samples of urban and industrial areas showed higher concentrations than residential (Urban) and suburban areas.     

城市道路路面尘土污染研究现状分析

分析了我国高校及研究机构对城市道路路面尘土污染的研究现状、路面尘土污染的危害、路面尘土污染量的采样方法、路面尘土污染引起的扬尘量估算等内容,提出了在城市道路路面尘土污染领域应根据我国城市道路的基本情况,发挥各学科的优势,开展深入的科学研究工作。     

Spatio-seasonal variation in ambient air pollutants and influence of meteorological factors in Coimbatore,Southern India

Air quality is used worldwide to confirm the current status of air pollution level and associated health risks to the public. Several air pollutants reach very high concentrations in many regions across India. In this study, air pollutants were measured in an urban city of Coimbatore, Tamil Nadu, Southern India, during 2013 to 2014 based on season and location, and the influence of meteorological factors. Air pollutants (PM₁₀, PM_2.5, SO₂, NO₂, CO, and O₃) across eight locations including industrial, residential, traffic, and commercial areas were assessed. The results showed that PM₁₀, PM_2.5, and CO were the most serious pollutants and their average concentrations ranged from 65.5 to 98.6 μg/m³, 27.6 to 56.9 μg/m³, and 1.58 to 8.21 mg/m³, respectively, among various locations. Significantly higher concentration of air pollutants was recorded in industrial areas followed by traffic and commercial areas. Comparatively higher mean concentration of O₃ (2.22?±?0.75 μg/m³) and CO (7.73?±?1.86 mg/m³) was recorded during the summer season, whereas the concentration of PM₁₀ (80.3?±?24.4 μg/m³), PM_2.5 (45.1?±?17.7 μg/m³), SO₂ (7.86?±?1.55 μg/m³), and NO₂ (13?±?1.81 μg/m³) was higher in southwest monsoon. Ozone (O₃) and CO positively correlated with temperature and negatively correlated with relative humidity. The level of PM₁₀, PM_2.5, and CO concentrations exceeded the National Ambient Air Quality Standards (NAAQS) guidelines. The present study’s results emphasize the need of effective air pollution control in Coimbatore. Precautionary measures to be taken to avoid exposure of air pollutants to the public and minimize pollutants. This study further suggests an investigation on the adverse impact on human health and environment using appropriate risk analysis techniques.     

Evaluation of Chromosome Aberrations in Subjects Exposed to Environmental Tobacco Smoke in Tamilnadu,India

Numerous expert panels have concluded that there is sufficient evidence to classify involuntary smoking (or passive smoking) as carcinogenic to humans. The aim of this study is to establish whether passive smoking increases the frequency of chromosomal aberrations (CA) in peripheral blood lymphocytes compared to controls in Tamil Nadu, India. In the present study, CA increased with an increase in environmental tobacco smoke (ETS) and active smoke exposure period in passive smokers quantified on the basis of serum cotinine levels. The passive subjects were compared with healthy normal controls to validate the results. In conclusion, these data are compatible with the current knowledge on the mechanisms of carcinogenesis of tobacco-related cancers, occurring not only in active smokers but with a high biological plausibility also in passive smokers.     

Organochlorine pesticides in commercial marine fishes of Coimbatore, India and their suitability for human consumption

Organochlorine pesticide residues were determined in 10 species of fishes caught at Cochin and Rameshwaram coast, and sold in Coimbatore, Tamil Nadu, India. Species were selected on the basis of their regular availability throughout the year and commercial value. A total of 389 fishes were analyzed for organochlorine residues and their suitability for human consumption was evaluated. Results show varying levels of residues of hexachlorocyclohexane (HCH), DDT, heptachlor epoxide, endosulfan and dieldrin. Among the 10 species, high concentration of pesticide residues were recorded in Sardinella longiceps, Carangoides malabaricus, Chlorophthalmus agassizi, Saurida tumbil and Rastrelliger kanagurta. The variation in total organochlorine residues among species and between places was not significant (P>0.05). Only five species of fishes showed monthly variation in residue levels and there was no significant correlation between the body size and residue levels in the tissue. About 22% of the fishes exceeded the maximum residue limits (MRL) of total HCH prescribed by FAO/WHO for fish products. The calculated dietary intake of total HCH through consumption of C. malabaricus, C. agassizi and S. longiceps exceeded the maximum acceptable dietary intake (ADI) limits prescribed for human consumption. The present study recommends continuous monitoring of environmental contaminants in marine fishes to assess the possible impact on human health.     

Risk factors associated with rural and urban epidemics of leptospirosis in Tiruchirappalli District of Tamilnadu,India

Aim

The study sought to determine the risk factors involved in Leptospira infection in rural settings and the relative severity of the disease in comparison with the urban environment in Tiruchirappalli district, Tamil Nadu, India.

Subject and methods

During an upsurge of leptospirosis, 621 suspected blood samples were obtained from patients and screened by MAT and IgM ELISA. To set up an age-matched case control study, 1,230 seronegative control samples were also included in the study. The case-control analysis was carried out using unconditional logistic regression and all P-values were two-sided.

Results

From 621 suspected cases, 214 (74 %) from rural and 196 (59 %) from urban settings had a laboratory-confirmed diagnosis of leptospirosis. The highest antibody titres were identified against Leptospira interrogans serovar Canicola both in rural (35 %) and urban (38 %) settings. Increased infection risk was observed for cases in the age group of 20–40 years and 10–40 years in rural and urban settings respectively. In rural settings, the risk of leptospiral infection was found to be significantly (P?<?0.0001) associated with people having cattle at their house and those involved in wet cultivation. Among urban cases, building workers and people living in house dwelling near water bodies were significantly (P?<?0.0001) associated with leptospiral infection.

Conclusion

The findings of the present study identified ideal niches for the transmission of leptospires in the rural and urban settings. Identification and understanding the potential risk factors in different environments would help to identify the source of contamination. This also identifies the need for more public health assistance.     

北京某城区居室内空气污染现状及其影响因素

目的调查北京市某城区居室内空气污染现状,初步探讨影响室内空气中甲醛和氮氧化物(NOx)浓度的室内因素。方法在北京市西城区随机抽取463位居民进行室内环境状况问卷调查,从被调查者中随机抽取91户家庭,入户监测其室内空气中甲醛和NOx浓度。采用多元线性模型进行回归分析,筛选出与室内空气中甲醛、NOx浓度密切相关的室内因素。结果室内空气中甲醛日平均浓度为0.049mg/m3,超标率为13%,装修过的家庭卧室空气中甲醛浓度(0.058mg/m3)明显高于未装修家庭(0.034mg/m3),差异具有高度显著性(P<0.001);卧室和厨房空气中NOx日平均浓度分别为0.053和0.090mg/m3,超标率分别为9%和48%,其浓度差异具有高度显著性(P<0.001);装修与否、每月天然气用量、排烟渠道通向入选卧室空气中甲醛浓度回归方程;居室净高、吸烟与否入选卧室空气中NOx浓度回归方程;使用面积、居室净高、采样时间内开火做饭次数入选厨房空气中NOx浓度回归方程。结论该城区居民室内空气中甲醛和NOx污染较严重,家庭装修与卧室空气中甲醛浓度关系最密切,天然气燃烧是厨房空气中NOx和卧室空气中甲醛的重要来源,吸烟是卧室空气中NOx的重要来源之一。     

Probability Mapping to Determine the Spatial Risk Pattern of Acute Gastroenteritis in Coimbatore District,India, Using Geographic Information Systems (GIS)

Background:

Maps show well the spatial configuration of information. Considerable effort is devoted to the development of geographical information systems (GIS) that increase understanding of public health problems and in particular to collaborate efforts among clinicians, epidemiologists, ecologists, and geographers to map and forecast disease risk.

Objectives:

Small populations tend to give rise to the most extreme disease rates, even if the actual rates are similar across the areas. Such situations will follow the decision-maker''s attention on these areas when they scrutinize the map for decision making or resource allocation. As an alternative, maps can be prepared using P-values (probabilistic values).

Materials and Methods:

The statistical significance of rates rather than the rates themselves are used to map the results. The incidence rates calculated for each village from 2000 to 2009 is used to estimate λ, the expected number of cases in the study area. The obtained results are mapped using Arc GIS 10.0.

Results:

The likelihood of infections from low to high is depicted in the map and it is observed that five villages namely, Odanthurai, Coimbatore Corporation, Ikkaraiboluvampatti, Puliakulam, and Pollachi Corporation are more likely to have significantly high incidences.

Conclusion:

In the probability map, some of the areas with exceptionally high or low rates disappear. These are typically small unpopulated areas, whose rates are unstable due to the small numbers problem. The probability map shows more specific regions of relative risks and expected outcomes.     

Dietary Pattern of Schoolgoing Adolescents in Urban Baroda,India

Diet plays a very important role in growth and development of adolescents, during which the development of healthy eating habits is of supreme importance. There is a dual burden of undernutrition and overnutrition in this age-group. The study assessed the food habits, food preferences, and dietary pattern of schoolgoing urban adolescents in Baroda, India. Both quantitative and qualitative methods were used in this study. A quantitative survey was carried out using a pre-tested self-administered structured questionnaire among 1,440 students from class 6 to 12 in 7 English medium and 23 Gujarati medium schools. Focus group discussions, 5 each with adolescent boys and girls, were held, along with 5 focus group discussions with teachers of Gujarati and English medium schools. Nearly 80% of adolescents had consumed regular food, like dal, rice, chapati, and vegetables, including green leafy vegetables. Nearly 50% of them had consumed chocolates, and about one-third consumed fast foods. Nearly 60% of adolescents had their breakfast daily while the remaining missed taking breakfast daily. Nearly one-third of adolescents were missing a meal once or twice a week. A large majority had consumed regular foods. However, more than half of them had consumed chocolates, soft drinks, and over one-third had taken fast foods.Key words: Adolescents, Dietary pattern, Nutrition, Urban, India     

Transferable plasmid-mediated drug resistance among non-O1 Vibrio cholerae and rough strains of Vibrio cholerae from Tamilnadu, India

A total of 289 non-O1 Vibrio cholerae (NVC) strains and 20 rough V. cholerae (RVC) strains isolated in an endemic area were tested for antibiotic resistance and for transferable R-plasmids. Twenty three per cent of NVC and 40% of the RVC isolates were found to be resistant to one or more drugs. Eight NVC and four RVC strains possessed multiple drug resistance, varying from four to eight drugs. The common spectrum found in NVC isolates were chloramphenicol and streptomycin (CS) or chloramphenicol, streptomycin, tetracycline and ampicillin (CSTA). Resistance to sulphamethoxazole (Su) and to trimethoprim (Tm) was encountered infrequently. In RVC isolates in addition CSTASuTm determinants, resistance markers to aminoglycosides kanamycin, gentamicin and neomycin were also found. Eighteen of the 27 V. cholerae strains with two or more resistance determinants transferred them en bloc to Escherichia coli K12. The level of resistance in the recipient strain was equal to or greater than that of the donor vibrio strains. Most of the strains possessing solitary resistance markers were unable to transfer them. beta-lactamase production could be demonstrated in 92.8% of the ampicillin resistant strains. None of the strains was resistant to nalidixic acid or furazolidone. The results emphasize the importance of antimicrobic susceptibility determination of V. cholerae isolates, regardless of the serotypes, before commencing chemotherapy.     

Respiratory Disease in Relation to Outdoor Air Pollution in Kanpur,India

ABSTRACT

This paper examines the effect of outdoor air pollution on respiratory disease in Kanpur, India, based on data from 2006. Exposure to air pollution is represented by annual emissions of sulfur dioxide (SO₂), particulate matter (PM), and nitrogen oxides (NO_x) from 11 source categories, established as a geographic information system (GIS)-based emission inventory in 2 km × 2 km grid. Respiratory disease is represented by number of patients who visited specialist pulmonary hospital with symptoms of respiratory disease. The results showed that (1) the main sources of air pollution are industries, domestic fuel burning, and vehicles; (2) the emissions of PM per grid are strongly correlated to the emissions of SO₂ and NO_x; and (3) there is a strong correlation between visits to a hospital due to respiratory disease and emission strength in the area of residence. These results clearly indicate that appropriate health and environmental monitoring, actions to reduce emissions to air, and further studies that would allow assessing the development in health status are necessary.

[Supplementary materials are available for this article. Go to the publisher's online edition of Archives of Environmental & Occupational Health for material on emission of SO₂, PM, NO_x from various sources, and total number of inhabitants, total number of patients in grid squares covering the Kanpur city.]     

Transferable plasmid-mediated drug resistance among non-O1 Vibrio cholerae and rough strains of Vibrio cholerae from Tamilnadu, India.

A total of 289 non-O1 Vibrio cholerae (NVC) strains and 20 rough V. cholerae (RVC) strains isolated in an endemic area were tested for antibiotic resistance and for transferable R-plasmids. Twenty three per cent of NVC and 40% of the RVC isolates were found to be resistant to one or more drugs. Eight NVC and four RVC strains possessed multiple drug resistance, varying from four to eight drugs. The common spectrum found in NVC isolates were chloramphenicol and streptomycin (CS) or chloramphenicol, streptomycin, tetracycline and ampicillin (CSTA). Resistance to sulphamethoxazole (Su) and to trimethoprim (Tm) was encountered infrequently. In RVC isolates in addition CSTASuTm determinants, resistance markers to aminoglycosides kanamycin, gentamicin and neomycin were also found. Eighteen of the 27 V. cholerae strains with two or more resistance determinants transferred them en bloc to Escherichia coli K12. The level of resistance in the recipient strain was equal to or greater than that of the donor vibrio strains. Most of the strains possessing solitary resistance markers were unable to transfer them. beta-lactamase production could be demonstrated in 92.8% of the ampicillin resistant strains. None of the strains was resistant to nalidixic acid or furazolidone. The results emphasize the importance of antimicrobic susceptibility determination of V. cholerae isolates, regardless of the serotypes, before commencing chemotherapy.