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Our study aimed to describe the association between the locality, physical activity, and food habits of individual in relation to gastroenteritis of Sikkimese population. Gastroenteritis is a disorder or an infection that causes irritation and inflammation of the gastrointestinal tract. The study conducted as an assignment, found that most of Sikkimese of almost every age groups are victim of disease. The data was collected by anonymous interrogation or by self-responses from the individual upon request. All data with P<0.05 was considered statistically significant, to carry our study ahead. Our sample size was small (200). The factors like localities of an individual, working hours and food habits were taken into account. After data collection, an electronic copy was generated using Microsoft Office package and Graphpad Prism V5.01 (San Diego, California, USA). Student t-test was used to determine statistical significance. The questionnaires was generally designed simple, it was mainly based on the individuals preferences and knowledge on the various microbial infections and its treatment. With the hypothesis, assumed that non-vegetarian diet is more prone to gastroenteritis, the result were tested statistically by student (t-test) to find out whether the result are statistically significant with 95% confidence interval. The P: value is 0.6768 which is greater the 0.05, this statistical data proves that non-vegetarian diet got very less association with the gastroenteritis ,may be its because of biological variations which needs to be studied .All data with P<0.05 was considered statistically significant. Our sample size was small (200) and was not enough respondents who had suffered from gastroenteritis 54 of 200. In order to get a statistically significant result, a broader study needs to be done.
Key word: vegetarian, non-vegetarian, insignificant, urban, rural
Sikkim is situated on the north-east border of the country, is a uniquely positioned mountainous state having international bounders along three-fourth of its boundary. Sikkim is geographically diverse due to its location in the Himalayas. The climate ranges from subtropical to high, Kanchenjunga the world's third-highest peak, is located on the border of Sikkim.(1) Eighty seven percent of population lives in rural areas. Thirty six percent of population is below fifteen years old and four percent of population is aged sixty five and above. The sex ratio nine hundred and forty two females per every thousand males. Eighty one percent of house hold has electricity and eighty five percent have drinking water piped. Seventy three percent of house hold has toilet facility. Seventy nine percent of male and sixty four percent of female age six and above are literate. Eighty nine percent of children aged six to fourteen year attend schools. among house hold member aged fifteen and above twenty percent of men and eighty percent of women smoke, thirty two percentage of men seventeen percentage of women drinks alcohols and forty percentage of men and nineteen percent of women chew beetle nut/tobacco.(2). The study conducted by National family Health survey 1998-1999 the prevalence of tuberculosis, asthma, and malaria & jaundice werw1%, 5%, 1% & 2% respectively. Apart these diseases Sikkimese population also suffers from gastroenteritis, which is common in every age group. Study conducted by IDD, health and family suggested that death due to acute diarrhoea disease ( including gastroenteritis and cholera) in year 2000 were 28 among 32217 cases, in year 2001 were 8 among 41419,in year 2002 were 7 among 404119,in year 2003 were 4 among 21516,in year 2004 were 2 death among 23305.
The gastrointestinal tract or digestive tract is essentially a tubular organ of varying diameter extending from the mouth to the anus. The gut is an open ecosystem, because the lumen is essentially external to the body. The gastrointestinal tract has five major regions: mouth, oesophagus, stomach, small intestine (duodenum, jejunum, and ileum), and large intestine (cecum, colon, and rectum). Some of the regions, depending on the species, may be enlarged with or without sphincters or further compartmentalized. Such enlarged or compartmentalized regions slow down the transit of contents, allowing for microbial growth and fermentation.(3)Gastroenteritis is a disorder or an infection that causes irritation and inflammation of the gastrointestinal tract involving stomach and small intestine and resulting in acute diarrhoea.
The inflammation is caused most often by infection from certain viruses or less often by bacteria, toxins, parasites or an adverse reaction. At least 50% of cases of gastroenteritis due to food borne illness are caused by norovirus. (4) Another 20% of cases, and the majority of severe cases in children, are due rotavirus. Other significant viral agents include adenovirus(5) and astrovirus .Different species of bacteria can cause gastroenteritis, including Salmonella, Shigella, Staphylococcus, Campylobacter jejuni, Clostridium, Escherichia coli, Yersinia, Vibrio cholerae, and others.
Parasite like Helminthes, the parasitic gastroenteritis is caused by mixed infection with several species of stomach and intestinal worms, which results weaknesses, loss of appetite, decreased feed efficiency, reduced weight gain and decreased productivity. The widely studied is eosinophilic gastroenteritis is an uncommon inflammatory disease, first describe by kaijser in two patients with syphilis who were allergic toneoarsphemine. The symptoms of gastroenteritis can include: abdominal cramps, nausea and vomiting ,diarrhea ,loss of appetite ,weakness ,fever or chills and dehydration .The people living in the urban areas, those preferring the non-vegetarian diet and having the busy schedules of working hours are more prone to gastroenteritis. Keeping in view with above feature, we sought after whether there is any association between the localities, physical activity, food habits of individual in relation to gastroenteritis of sikkimese population. We assume people preferring non-vegetarian (animal-based diet) suffers from gastroenteritis then those preferring vegetarian diet (plant-based diet) and those having busy working schedules and based in urban locality.
Materials and Methods
Study design and participants
Data was collected from a randomly distributed population (Sample (n=200) )using a questionnaire based feedback model (appendix 1). Assuming that the greater proportion of Sikkim's population reside around the Capital, the data was sampled from around Gangtok area On 24th July 2010 to ensure adequate representation for various study parameters. The data was collected by anonymous interrogation or by self-responses from the individual upon request. People of various age groups, communities and having different food habits were taken into account.
Social , Demographic and Population characteristic.
The questionnaires was generally designed simple, it was mainly based on the individuals preferences and knowledge on the various microbial infections and its treatment. It was made simple, even an uneducated person can easily go through and answer the basic facts that he/she have come across.
The questionnaires had eleven sections, and each section had two or more than two options, which people responded either verbally or ticking the choice of their preference The questionnaires had section like gender(male/female), age group(15-25,26-35,36-45-46-55,56-65), educational qualifications (primary, secondary, senior-secondary, graduate, post-graduate, none of the above), Population source, (native , non -native ), No. of family members(1,2,3,4,>4, )Dietary preference (vegetarian ,non-vegetarian, vegan ,cafeteria style diet, none of the above),Population type (rural / urban), Average working hours (/Day) (< 3hrs,3hrs ,6hrs, >6hrs), Drinking water source (Govt. designated source Local spring/river, Not sure),History of any previous microbial infection (Malaria, Cholera ,Typhoid ,Hepatitis ,Gastroenteritis ,Tuberculosis ,Influenza ,Candidacies ,Leishmaniasis, Pneumonia , Conjunctivitis and others) and at Treatment preference was considered it had seven options (Allopathic-After consultation, Allopathic-Self prescription ,Natural medicine After consultation, Natural medicine-Self prescription, Any two of the above, Others and None. The people were convinced to go through the questionnaires by approaching in polite manner. The microbial infections symptoms were generally discussed in more broad ways to make the respondents easier to answer. They were given some time to recollect the disease.
After data collection, an electronic copy was generated using Microsoft Office package for repetitive analysis. All statistical analysis was performed using Graphpad Prism V5.01 (San Diego, California, USA). Student t-test was used to determine statistical significance. All data with P<0.05 was considered statistically significant.
1. Participants characteristics:
59% of the respondents were male and 41% were female, 44% of the respondents were in the age group of 15 to 25, 27.5% in the age group of 26 to 35, 17% of the responds were in the age group of 36 to 45, 9% of the responds were in the age group of 46 to 55 and 2.5 % of the responds were in the age group of 56 to 65. 57 % of the respondent was undergraduate, 30.5% were graduate, 4.5 were postgraduate and 7% were uneducated. 84% of the population were native and the rest 16% were non native. 45% of the respondent had more than 4 family members, 45.5% of the respondent had 4 family members and rest less than 4 family members.
70.5% of the respondent was non-vegetarian and 24.5% preferred vegetarian diet and 5% the rest. 40.5% of respondent were from rural areas and 59.5% of the respondent was from urban areas. The 46.5% of respondent works for more than six hours a day. 33.5% of respondent works 6 hours a day. 12.5% of the respondent works 3 hours a day and 7.5 % of respondent works less than 3 hours. 77 % uses government designated drinking water supply and 19.5 uses local springs/river for drinking water supply. Gastroenteritis, Influenza and Conjunctivitis largely dominated the type of microbial infections with values corresponding to 42%, 8.21% and 13.04% respectively of the respondent. 60.80% preferred allopathic prescribed medication while the percentages of the natural prescribed medicine and self prescribed corresponding to 14.07 and 13.06% respectively, 12.07% preferred the rest.
The relationship between dietary preference and population type with respect to gastroenteritis.
Fig: analysis of dietary preference and population type with respect to gastroenteritis
Figure 1 represents the data of diet preferred of rural and urban population with respect to gastroenteritis. The graph noticeably shows that there is less vegetarian (plant-based diet) suffering from gastroenteritis then that of non-vegetarian (animal-based diet). The comparisons between population types, by taking vegetarian into consideration showed 12.96% rural population are suffering from gastroenteritis where as 9.25% urban population are suffering from gastroenteritis.
In other hand, if we take non-vegetarian into an account, by comparing the population type rural population are less suffering then that of urban populations. (24.0% and 48.14% respectively. The other dietary preferences such as vegan, cafeteria style diet showed very little responses, as very less people preferred this kind of diet in this part of world. According to the hypothesis, the results were tested statistically by student (t-test) to find out whether the results are statistically significant with 95% confidence interval. The P: value is 0.6768 which is greater than 0.5.
The relationship between working hours with respect to gastroenteritis.
Fig2: The analysis of working hours in respect to gastroenteritis
The figure 2 noticeably shows the working hours with respect to gastroenteritis. The study analysis shows that more the working hours, the more the population are prone to the gastroenteritis. In comparisons with four time factors >3hrs shows 7.40% of gastroenteritis disease, in case of 3hrs it is 14.81%,in case of 6hrs it is 35.18% and in case of >6hrs it is 42.59%
The study clearly indicates, by taking time into consideration an individual's is more susceptible to gastroenteritis, if she/he has a busy working schedules.
The relationship between dietary preference and working hours with respect to gastroenteritis.
Fig: dietary preference and working hours with respect to gastroenteritis.
Figure 3 shows the analysis of dietary preference and working hours with respect to the gastroenteritis. By taking different working activities with respect to their diet preferences, the data clearly suggest that non vegetarian have high affinity to gastroenteritis. In case of the people working < 3hrs the non-vegetarian contributes 7.84% where as there nil vegetarian population. In case of the people working 3hrs non-vegetarian contribute 11.76% where as only 1.96 % vegetarian population. In case of the people working 6hrs non-vegetarian contributes 25.49% where as only 9.80% vegetarian populations. In case of people working >6hrs the non-vegetarian contributes 31.37% where as only 11.76% vegetarian population.
The study analysis clearly suggested that an individual preferring the non-vegetarian diet and having the hectic schedules are more prone to gastroenteritis. According to the hypothesis, the results were tested statistically by student (t-test) to find out whether the results are statistically significant with 95% confidence interval. The P: value is 0.0793 which is greater than 0.5.
By analysing the various data, the study reveals that people preferring the non-vegetarian diet and those busy with working hours and are based in urban locality are more prone to gastroenteritis. With the hypothesis, assumed that non-vegetarian diet is more prone to gastroenteritis, the result were tested statistically by student (t-test) to find out whether the result are statistically significant with 95% confidence interval. The P: value is 0.6768 which is greater the 0.05, this statistical data proves that non-vegetarian diet got very less association with the gastroenteritis ,may be its because of biological variations which needs to be studied. Non-vegetarian diet is connected with cholesterol and degenerative diseases. The people preferring, non-vegetarian diet also suffers from chronic diseases than their vegetarian counterpart .Apart from gastroenteritis meat and dairy product are also linked to many types of cancer as well as heart ailments, diabetes, obesity, gallbladder disease and hypertension. Meat and dairy products raise the acid level in human blood. All non-vegetarian food is toxic. Pork is the most toxic non-vegetarian food followed by beef, mutton, eggs, chicken and fish. About 30% of all pork products are contaminated with toxoplasmosis, a disease which is caused by parasites. A non-vegetarian diet is a poor source of carbohydrates. Carb-deficiency can lead to ketosis-a condition where the body starts breaking down fat (instead of carbs) as a source of energy.
Animal-based diets are high in saturated fat, excessive protein and cholesterol, leading to heart disease and stroke According to the WHO, about 8 to 15 % of the calories we eat every day should be protein; however, in India the recommended protein intake is 10 to 20 per cent. Meat contains no essential nutrients that cannot be obtained in higher quality directly from plant sources.Vegetarian diet has several advantages over non-vegetarian diet from the fact that it is not always linked with diseases like gastroenteritis. Vegetarian diets includes fibre, which helps reduce cholesterol levels in the body, and for another, it contains strong anti-oxidants. Powdered Moringa Oleifera (drumstick tree) leaves contains 20 types of amino acids, including all the essential ones which non-vegetarian food contains.
The protein content of these leaves is twice that of milk and its quality rivals that of milk and eggs. Apart from these amino acids, it also contains vitamin A, B, B1, B2, B3, B6, C, E, K, Omega-6 fatty acid, folate, several minerals, 46 types of anti-oxidants, 36 anti-inflammatory compounds-all natural. It also has essential oils and fibres. Vegetarian Diet: Detoxifies: A veggie diet contains dietary fibre (bottle gourd, pumpkins, spinach, cabbages), which flushes toxins out of the body. A diet containing only eggs, fish and mutton is a poor source of fibre.
The main reason for apt vegan diet is self-preservation. The consumption of animal products causes the pH of the body to become acidic, leading to cellular degeneration and the onslaught of disease. On a vegan diet, one is far less likely to get gastroenteritis (bacterial infection such as E coli, camphylobacter and salmonella). By this study, the factors like physical activities and locality of an individual also contributed to the disease conditions. Our study data noticeably showed, an individual having busy working schedules and those residing urban areas are more in number related with gastroenteritis then the individual residing in rural areas and having less busy working schedules. With the hypothesis, assumed that more the working hours, an individual is more prone to gastroenteritis, the result were tested statistically by student (t-test) to find out whether the result are statistically significant with 95% confidence interval.
The P: value is 0.0793 which is greater the 0.05, this statistical data proves that working hours got very less association with the gastroenteritis. An individual with busy schedules tends to have random timing for food ingestion, which could be one of the factors for gastroenteritis, an individual residing in an urban areas tends to prefer, processed food, junk food which could result in gastroenteritis. Moreover foods that we get in urban areas are not as hygienic as that of rural areas because of food adulterations. This study also revealed that the numbers of rural people with vegetarian diet are more prone to gastroenteritis then that of urban areas (which did not counterpart with our hypothesis), 12.96% and 9.25% respectively.
Our study clearly showed that the people living in urban areas, those preferring non-vegetarian or animals based diets over plants -based diet and having busy working schedules are much more associated with gastroenteritis. The data analysis was done on the bases of samples (n=200) collected from a randomly distributed population using a questionnaire based feedback model.
Assuming that the greater proportions of Sikkim's population reside around the Capital, the data was sampled from around Gangtok area; ensure adequate representation for various study parameters. The data was collected by anonymous interrogation or by self-responses from the individual upon request. The study analysis of various data, Student t-test was used to determine statistical significance noticeably it suggested the P.value:0.0793 for the relationship between dietary preference and working hours with respect to gastroenteritis, which is insignificant. The other data noticeably suggested the P. value: 0.6768 for the relationship between dietary preference and population type with respect to gastroenteritis, which also an insignificant value.
All data with P<0.05 was considered statistically significant. Our sample size was small (200) and was not enough respondents who had suffered from gastroenteritis 54 of 200. In order to get a statistically significant result, a broader study needs to be done. Many respondents who could not properly recall their medical history. So, further research can be done in future days, as very less comparative works has been done on gastroenteritis in Sikkim.
Sikkim development report (planning commission, govt. of India) academic foundation.
Indian society of health administrators, strengthening health system in north-eastern states,1995-1996
International institute of population sciences, national family welfare survey, 1998-99 Mumbai, India 2000
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