By Shabana Tharkar, AVP – ICTPH
Set in what seems like the typical village ambience; both Alakkudi and Karambayam have become all too familiar to the ICTPH staff members, who travel frequently to these two villages. Both places share some common socio-demographic characteristics, which constitute part of the reason as to why they were chosen as field sites for our pilot. With a rich historic background and cultural heritage, Thanjavur district which was once part of the Chola kingdom, is also known as the rice bowl of Tamilnadu. The main occupation of the people in these villages is cultivation of cash crops like rice since it is the staple food in these villages. There is also evidence to show that rice is primarily consumed as the main course for all three meals a day- indicating little or no nutritional requirements from other grains. This could potentially result in acquisition of metabolic disorders, which in future, can be hypothesized and tested by the research wing of ICTPH.
The populations in both villages have high levels of literacy, with an average of above 80% who are able to read and write the local language (Tamil) – thanks to the Tamilnadu government’s education system- as well as incentivization by the noon meal scheme. In terms of health care delivery, Alakkudi has fairly reasonable accessibility and affordability- with services offered by the government sector (PHC) free of cost for minor ailments- as well as systematic referral to tertiary care centers located in Thanjavur for other complicated illnesses. Interestingly, despite free services offered by the PHC, our SughaVazhvu Rural Micro Health Centre (RMHC) is preferred by most local villagers. Clinical experience from the Alakkudi RMHC suggests that majority of cases at the outpatient department are diseases of infectious origin, deficiency disorders and geriatric illnesses.
Evidence from population studies suggests that the current epidemiological transition has resulted in escalation of chronic diseases not only in the urban metros but also in rural settings. The baseline survey conducted by ICTPH in these villages in the Thanjavur district, reported a crude prevalence estimate of 5% for diabetes and 14 % for hypercholesterolemia. These findings are suggestive of clinically submerged portions of an iceberg which may forecast a heavy disease burden in the future, due to chronic disease. Anemia was the most highly prevalent among the deficiency disorders, wherein one out of two women had hemoglobin counts below normal. Defective vision and musculoskeletal disorders were the other common problems pertaining to the villages of Alakkudi and Karambayam, as indicated in the baseline survey report. ICTPH’s initiative to conduct household surveys as well as to engage in active case-finding may largely contribute to reducing chronic disease burden through its interventions in health promotion and primary prevention activities.
It is interesting to note that in both Alakkudi and Karambayam, the daai system of home-based childbirth is outdated and virtually non-existent- as 99% of pregnant women (as indicated in our baseline survey) had antenatal check-ups and delivered either at the PHC or at a private clinic- largely owing to the decline in maternal mortality rate. The epidemiological data serves as a major source of information in understanding the population’s socio-demographic characteristics, their lifestyle changes, determinants of disease, trends, patterns, and distribution of communicable and non-communicable diseases and so on. The data additionally helps in designing preventive programs and planning intervention strategies with the objective of reducing the overall disease burden. With the availability of adequate information regarding the public health needs of the villages, ICTPH is set in establishing a fully functional clinic in Karambayam- with the dual target of providing healthcare at the clinic level (RMHC) – as well as in case detection and immediate referral for management at the population level.
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