Lack of healthcare, proper nutrition, increasing prevalence of NCDs

Srinagar: The routine life for Fatima (name-changed), a 45-year-old Gujjar woman from Kupwara district of North Kashmir became highly taxing after she found herself complaining of increased thirst and urination.

The doctor at the peripheral hospital prescribed her some analgesic and antiemetic drugs, but to no avail.

Last week, she developed searing stomach pain and recurrent bouts of vomiting. Following this, she was rushed to SMHS Hospital, Srinagar.

“After thorough examination, she was diagnosed with long standing diabetes and immediately put on insulin,” the doctor treating her said.

Similarly, another middle-aged Gujjar woman from Gurez was reported to the SMHS Hospital, Srinagar with general swelling throughout the body.

On examination she was clinically found to be in heart failure. Surprisingly, her echo test (this test diagnoses problems that affect the heart) came out to be normal.

“This was her first visit with such complaints. On further evaluation, it was found that she has been visiting peripheral hospitals with complaints of getting tired easily, cold intolerance and constipation for the last two years,” the doctor examining her said.

Subsequently, her Thyroid Stimulating Hormone test, (A TSH test is done to find out if your thyroid gland is working the way it should) came out to be about 35.

“The test reports showed she has been a case of long standing hypothyroidism. Currently she is on hormonal replacement therapy of Thyroxine and is doing fine,” the doctor said.

Of late, Gujar-Bakarwal tribes have found themselves increasingly at the receiving end of non-communicable diseases. A non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another.

NCDs include strokes, thyroid disorders, diabetes, heart diseases, cancers, chronic kidney disease, osteoarthritis, osteoporosis, Alzheimer’s disease, cataracts, and others.

A recent study titled, “Thyroid Function, Urinary Iodine, and Thyroid Antibody Status Among the Tribal Population of Kashmir Valley: Data from Endemic Zone of a Sub-Himalayan Region,” shows that 33 percent of population suffers from various thyroid disorders and 30 percent show iodine deficiency.

The study conducted in October 2020, estimated the prevalence of thyroid disorders and evaluated urinary iodine concentration (UIC) and thyroid autoantibody status among Gujjar and Bakerwal tribes of Kashmir valley.

A total of 763 subjects from the five districts– Anantnag, Pulwama, Ganderbal, Kupwara, and Srinagar were evaluated for the study.

“33 percent of the tribals had some form of thyroid dysfunction, (including 24.1% subclinical and 6.8% overt hypothyroidism) while as 30 percent had urinary iodine concentration less than 100 micrograms which means they had iodine deficiency in them,” the study shows.

Dr Tajali Sehar, co-author of the study and Scientist-B, Department of Clinical Research, said Gujar-Bakarwals are mostly concentrated in the mountainous regions of the valley.

“Their housing, sanitation, health care facilities are very low sub-standard than other sections of population. They carry behavioural risk factors including less nutritious diet, skipping meals, and increased tobacco use, which makes them susceptible to non-communicable diseases,” she said.

She noted that they were trying to find the prevalence of non-communicable diseases among the tribal population of Kashmir as there was no data with respect to Non-Communicable Diseases (NCDs) like thyroid, diabetes, hypertension, and vitamin D deficiency in them,” she said.

These studies are being conducted at the Department of Endocrinology, SKIMS under the Tribal Health Programme, headed by Prof Mohd Ashraf Ganie and have been funded by Department of Science and Technology, Government of India.

Dr Tajali pointed out that the burden of the non-communicable diseases is immense.

“The tribals already have less access to healthcare and remain unaware of the risk factors related to NCDs. It can lead to the significant disability and premature death, having long term consequences on people’s health and finances, pushing the families into poverty,” she said.

She noted that NCDs are also affecting a relatively younger population.

“This is likely to be due to malnutrition early in life, which paradoxically increases the risk of NCDs and an unhealthy lifestyle in early adulthood. This means the younger population in tribals needs to be screened for chronic diseases,” Dr Tajali said.

As a follow up to these findings, the doctor explained that they are now focusing on the community based intervention.

“This intervention will help it to curb the rise of life-threatening complications in the tribals. We have started with few villages in some districts—Pulwama, Anantnag and Ganderbal and will slowly extend to other districts,” she said.

 

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