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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 10
| Issue : 2 | Page : 53-58 |
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Assessment of morbidity profile of rural population residing in the field practice area of a Government Medical College
Bhagyashri S Bhure1, Rajendra T Ankushe2
1 Department of Community Medicine, PGI YCMH Pimpri, Pune, Maharashtra, India
2 Department of Community Medicine, S.R.T.R. GMC Ambajogai, Maharashtra, India
| Date of Submission | 02-Jun-2022 |
| Date of Decision | 25-Aug-2022 |
| Date of Acceptance | 29-Aug-2022 |
| Date of Web Publication | 16-Nov-2022 |
Correspondence Address:
Bhagyashri S Bhure
Vishwa Residency Building D402, Sant Tukaram Nagar, Pimpri-Pune
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/DYPJ.DYPJ_44_22
Background: Morbidity can be defined as any deviation from the state of normal physical and mental well-being. The health of an individual does have a direct relationship with human resources, development and economic development of a nation. The existing hospital based, disease – oriented health care model has provided health benefits mainly to the urban elite, approximately 80% of health facilities are concentrated in urban areas. The rural areas where nearly 69% of the population live, do not enjoy the benefits of the modern curative and preventive health services. Therefore the present study was undertaken with the objective to assess the health needs of the rural population in terms of morbidity. Materials and Methods: The Cross-sectional study was conducted in a village which comes under field practice area of the Department of Community Medicine. The village was selected by using lottery method out of all the villages which comes under the field practice area. All villagers in the village constituted the study population. 2270 Study population (420 families) were involved in the study. A house to house survey was done using interview technique as a tool for data collection. Predesigned questionnaire was used to record the necessary information. Data regarding socio demographic factors and any disease condition among family members was collected. Results and Conclusions: Present study comprises of 2270 study participants in all age groups. The most common morbidities more than 1% population affected (> 22 cases) were Anaemia 517(22.77%), Acute respiratory infection 260(11.45%), Diabetes and Hypertension 255(11.23%), Diarrhoea 93(4.09%), Refractory error and cataract 46(2.02%), Arthritis 44(1.93%) and Dental caries 34(1.49%). There is dual burden of communicable as well noncommunicable diseases in our study population. Keywords: Health needs, morbidity profile, rural population
How to cite this article:
Bhure BS, Ankushe RT. Assessment of morbidity profile of rural population residing in the field practice area of a Government Medical College. D Y Patil J Health Sci 2022;10:53-8 |
How to cite this URL:
Bhure BS, Ankushe RT. Assessment of morbidity profile of rural population residing in the field practice area of a Government Medical College. D Y Patil J Health Sci [serial online] 2022 [cited 2023 Mar 23];10:53-8. Available from: http://www.dypatiljhs.com/text.asp?2022/10/2/53/361369 |
| Introduction | |  |
Health is a state of complete physical, mental, and social well-being and not merely an absence of disease or infirmity to lead a socially and economically productive life.[1] Morbidity can be defined as any deviation from the state of normal physical and mental well-being. India is one of the many developing countries, which have high levels of morbidity.[2] The health of an individual does have a direct relationship with human resources, development and economic development of a nation. From the time of Alma Ata declaration to achieve “Health for All by 2000” lot of planning, effort and public expenditure had been devoted to improve the health of the people both in rural and urban areas in India. Further, the spread and accessibility of medical care has also improved substantially across the country. However, in spite of these efforts, India is one of the many developing countries, which have high levels of morbidity.[3] Due to industrialization and the persisting inequality in health status between and within States and Union Territories (due to varying economic, social and political reasons), India currently faces a “Triple burden of diseases”, which compromised of communicable diseases, emerging non-communicable diseases related to lifestyles and emerging infectious diseases.[4]
As per Census 2011, the total population of India is 1210.8 million with a decadal growth rate of 17.7 per cent. While 31.14 per cent of the population lives in urban areas, the 68.86% lives in rural areas. The existing hospital based, disease – oriented health care model has provided health benefits mainly to the urban elite, approximately 80% of health facilities are concentrated in urban areas. The rural areas where nearly 69% of the population live, do not enjoy the benefits of the modern curative and preventive health services.
There is wide disparity in rural and urban health in India. The total birth rate in India is 20.2 (urban 16.8, rural 21.8), Death rate 6.3 (Urban 5.3, rural 6.8), Infant mortality rate 33/1000 live birth (urban 23, rural 37).[5] Still birth rate in India 4 (urban 3, rural 5), Total fertility rate 2.3 (urban 1.8, rural 2.5).[6] The major medical care problem in India is inequitable distribution of available resources between urban and rural areas, and lack of penetration to the social periphery.[7] To improve the prevailing situation, the problem of rural health is to be addressed both at the macro (national and state) and micro level (district and regional), in a holistic way, with genuine efforts to bring the poorest of the population to the center of the fiscal policies. A paradigm shift from the current ‘biomedical model’ to a ‘sociocultural model’ is required, to meet the needs of the rural population. A comprehensive revised National Health Policy addressing the existing inequalities, and working towards promoting a long-term perspective plan exclusively for rural health is the current need.[8] Therefore the present study was undertaken with the objective to assess the health needs of the rural population in terms of morbidity.
| Subjects and Methods | | |
The present study was conducted in a village which comes under field practice area of the Department of Community Medicine of a Government Medical College of Maharashtra. The village was selected by using lottery method out of all the villages which comes under the field practice area. It was a Community Based Cross – Sectional study. Duration of the study was one years (1st November 2017 to 31st October 2018). All villagers in the village constituted the study population. 2270 Study population (420 families) were involved in the study. Participants were selected by applying inclusion and exclusion criteria. The families residing in field practice area and given Consent for study were included in the study and Families residing less than 6month duration in the field Practice area were excluded. Approval for the study has been granted by ethical committee board of Government Medical College.
A house to house survey was done using interview technique as a tool for data collection. Predesigned structured questionnaire was used to record the necessary information. Before personal interview and physical examination, objective of the study was explained to participants (family members) and informed consent was taken.
Data regarding socio demographic factors such as age, sex, religion, education (< 7 years of age is excluded while assessing education), type of family, type of house, socioeconomic status was collected using predesigned and pretested proforma. For socio-economic status determination modified BG Prasad classification was used.[9] For morbidity data enquiry was made about history of any disease to the family members and detailed clinical examination was done for each member of the family necessary diagnostic tests like BP measurement, Haemoglobin estimation were performed.
Common health problems that is health problems which affect more than 1% (> 22 cases) of the study population was considered while assessing overall morbidity in all age groups combined and less frequent conditions were omitted.
Descriptive statistic (percentage) was used to summarize baseline characteristics of the study subjects.
Operational definitions for morbidity assessment
Morbidity was considered when a person is already diagnosed having any known disease or investigator diagnosed a disease based on clinical signs and symptoms and examination of the study subject.
Anaemia
Anaemia was diagnosed by clinical signs such as pallor of palpebral conjunctiva, oral mucosa and palms.
Acute Respiratory Infection
History of nasal discharge, cough, fever, sore throat, breathing difficulty, any discharge from ear alone or in combination was used in the recognition of an episode of ARI.[10]
Diarrhoea
Diarrhoea was diagnosed by history of passage of loose, liquid or watery stools more than three times a day and change in consistency and character of stool of child as narrated by mother at the time of history taking was taken as dairrhea.[10]
Diabetes Mellitus
Already diagnosed cases diabetes mellitus.
Hypertension
Hypertension was defined as systolic blood pressure ≥ 140 mm Hg and diastolic blood pressure ≥ 90 mm Hg or already diagnosed case of hypertension by physician or on anti – hypertensive treatment.[11]
Dental caries and cavity
Oral cavity examined for tooth decay, progressive decalcification of the enamel and dentin of the tooth.[12]
Refractive error
Already diagnosed cases of refractive error.
Cataract
Blurring of vision along with diminution of vision with obvious white opacity in the lens.[13]
Arthritis
Diagnosis was based on the reporting of the previous diagnosis by a doctor or having painful / stiff / swollen joints during current clinical examination.
Other [Eye infection, Skin infection]
In under five age group while assessing morbidity some eye conditions like watering, redness, itching encountered these and skin conditions like redness, itching were grouped in other category.
Scabies
Diagnosed with the help of following symptoms in study participants:
Pimple-like rashes or burrows between fingers, on wrist, elbows, armpits, belt line, navel, abdomen, and/or buttocks; -Itch which is insidious and relentless and became typically worse at night; and - The presence of sores on the body due to scratching.[14]
Acne
An eruption, predominantly of the face, upper back and chest, composed of comedones, cysts, papules and pustules on an inflammatory base.[15]
Respiratory morbidities
a) This condition was diagnosed from clinical examination: presence of abnormal breathing sounds like ronchi, crepitations, on auscultations. And /or b) chronic obstructive pulmonary disease, Bronchial Asthma and Tuberculosis were accepted as diagnosed by clinician earlier with necessary investigations.
| Results | | |
Socio-demographic characteristics
The sociodemographic characteristics of the respondents are shown in [Table 1]. Present study comprises of 2270 study participants in all age groups. In under five age group total 161 (7.09%) participants present, in (6–9) years age group 137 (6.03%) study participants present, in (10–19) years age group 374 (16.47%) study participants present. In adult age group (20 -59) years 1321 (58.19%) study participants present while in geriatric group 277 (12.22%) participants were there. Of the total 2270 respondents, 1222 (53.83%) were males and 1048(46.17%) were females. Out of 2270 Study population 1954 (86.07%) were Hindus, 247 (10.87%) were Muslims and 69 (3.06%) were Buddhist. Majority of study population belongs to three generation family 881 (38.82%) remaining 786 (34.62%) belongs to nuclear family and 603 (26.56%) belong to joint family. Due to rural set up three generation families were present in high number along with nuclear and joint families. Majority of study population 1401 (61.71%) lives in kachha house, 562 (24.75) lives in pucca house and 307 (13.53%) lives in semi-pucca house highlights the Rural study set – up. In the study subject 443 (21.38%) subjects were illiterate and Effective literacy rate was (78.62%) among the study population. socio – economic class as per modified B. G. Prasad’s classification it was found that out of 2270 study population, 1246 (54.89%) belongs to Lower middle class and below while 1024 (45.11%) belongs to middle class and above. Rural study set – up could be the possible reason for such class distribution.
Age group wise morbidities in study population
[Table 2] shows the Age group wise morbidities among the study participants in that out of total 161 under five children 79 (49.06%) shows morbidity, among which acute respiratory infection 36 (22.36%) was the leading cause of morbidity followed by Diarrhoea 19 (11.80%), dental caries 8 (4.97%) and other conditions (eye infection, skin infections) 16 (9.93%). Among (6–9) years age group children 137 children were present, 66 (48.17%) children suffered from any of the illness at the time of examination. Anaemia 25 (18.24%) was the leading cause of morbidity followed by Acute respiratory tract infection 16 (11.68%), Diarrhoea 12(11.68%), Dental caries 8 (5.83%) and Scabies 5 (3.65%). Morbidity pattern in adolescent study subjects shows that out of total 374 adolescent 154 (41.17%) shows the morbidity. In which anaemia 93 (24.87%) was the leading cause of morbidity followed by Refractive error 24 (6.41%), skin problems 19 (5.08%) and dental caries 18 (4.81%). Among the adult (1321) population over all morbidity 515 (38.98%). Anaemia 301 (22.78%) was the leading cause of morbidity in this age group followed by Hypertension 116 (8.78%), Diabetes 64 (4.84%), Respiratory morbidities 18 (1.36%) and Arthritis 16 (1.22%). Morbidity pattern in geriatric population shows that among 277 geriatric population, Anaemia was the leading cause of morbidity 98 (35.37%) followed by Arthritis 28 (10.11%), Hypertension 49 (17.68%), Diabetes 26 (9.39%) and Cataract 22 (7.95%). Among all the age groups ARI was most prevalent in the pediatric age group and Anaemia was prevalent in the remaining age groups.
Most common morbidities
[Table 3] shows the overall morbidity profile of study population, the most common morbidities that is more than 1% population affected (> 22 cases) were Anaemia 517(22.77%), Acute respiratory infection 260(11.45%), Diabetes and Hypertension 255(11.23%), Diarrhoea 93(4.09%), Refractory error and cataract 46(2.02%), Arthritis 44(1.93%) and Dental caries 34(1.49%).
| Discussion | | |
The present study is a cross – sectional study conducted in the field practice area of a Medical College with the main objective of finding the morbidity pattern present in a local rural population. There were very few studies which focus on the comprehensive health aspect of local rural population. This study is an attempt to look in to age wise distribution of morbidity profile.
The overall morbidity profile of study population, the most common morbidities that is more than 1% population affected (> 22 cases) were Anaemia 517(22.77%), Acute respiratory infection 260(11.45%), Diabetes and Hypertension 255(11.23%), Diarrhoea 93(4.09%), Refractory error and cataract 46(2.02%), Arthritis 44(1.93%) and Dental caries 34(1.49%).
This study shows that morbidity among geriatric population is very high 223(80.50%) followed by under-five group 79 (49.06%) which is comparable with the findings of other similar studies conducted in the past.[17],[18] This highlights the most susceptible population groups for morbidity and need to focus on them regarding various health interventions.
The most common morbidities shown by our study and study conducted in community of Kolkata by
Suman Chatterjee et al[18] were similar. In their study the most common morbidities were Pallor (16.1%), Hypertension (14.4%) Arthritis (12.7%) ARI (8.5%), Dental caries (8.5%), Fever (5.1%) Diabetes mellitus (5.1%), Acute diarrheal disease (3.4%). They found morbidity prevalence is higher among females and (16.1%) participants had pallor while in our study we found (22.77%) participants had anaemia. In the current study pallor was detected clinically; whereas, other studies mentioned anaemia; probably they adhered to Hb level this might be the cause of differences. In a similar study Dilip Kumar L[19] found most common morbidities among community of Rajasthan were Anaemia (8.4%), Acute Respiratory infections (8.8%), Fever (5.2%), Skin diseases (4.5%) Acute Diarrhoea (2.1%). In a Similar study S Gopalakrishnan[20] found most common morbidities in rural population of Tamil Nadu were illness affecting respiratory system (20%), ‘symptoms and signs’ (19%), Musculo-skeletal system (16.1%) and digestive system (11.9%). Regarding the age wise distribution of morbidity pattern, they found that the burden of illness increases with age which coincides with the findings of our study.
In a study carried out by V. D. Kshirsagar et al[21] in Rural Maharashtra revealed communicable diseases to be the commonest type of morbidity, majority (29.8%) suffering from respiratory infections. Although non-communicable diseases were also not far having the proportion being (13.7%) and this dual burden of diseases is similar to the national picture.[22] Similarly in our study the most common morbidities were due to Anaemia, communicable diseases like ARI and Diarrhoea followed by Non-Communicable diseases like Diabetes and Hypertension. The dual burden of communicable diseases and non-communicable diseases is seen in developing countries due to globalization and epidemiological transition.[23]
Unlike our study, a study done by Niranjan et al. among rural and an urban population in South India revealed Diabetes and Hypertension followed by musculoskeletal disorders were most common morbidities.[24] This might be attributed to fact that they have included both rural and urban population.
Limitations of the study
Sample number was selected purposive sampling. Similar study should be done with larger sample size to explore association between different variables which is not done by present study.
Study selected sample from the village which comes under the health facility (UHTC/RHTC) which may have some amount of selection bias in the sample. Village under the health facility may have more access to health services and their morbidity may be less compared with more remote villages. This may, to some extent, limit the external validity of the study.
Necessary investigations for assessment of various morbidities were not conducted due to financial constraints, related information was collected by history and clinical examination. This may underestimate the morbidity because early or sub-clinical cases may be missed. This may have affected the internal validity of the study.
| Conclusion | | |
The most common morbidities that is more than 1% population affected (> 22 cases) were Anaemia, Acute respiratory infection, Diabetes and Hypertension, Diarrhoea, Refractory error, cataract, Arthritis and Dental caries. Knowing morbidity patterns at a village level will be useful for health officials to render enhanced and high quality services as per the community need and also help in guiding training session for health staff.
Acknowledgement
The authors would like to thank all the participants who participated and provided valuable information for the successful completion of the study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]
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