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Indian Journal of Community Medicine

Prevalence of Sickle Cell Disorders in Rural Wardha

Author(s): P. Deshmukh, B.S. Garg, N. Garg, N.C. Prajapati, M.S. Bharambe

Vol. 31, No. 1 (2006-01 - 2006-03)

P. Deshmukh1, B.S. Garg2, N. Garg3, N.C. Prajapati4, M.S. Bharambe5

Introduction

Sickle cell disorder is a group of diseases caused by a point mutation at sixth position in beta globin chain, valine substituting glutamic acid due to which in deoxygenated state, shape of erythrocytes change to sickle shape and also the fragility of cell membrane increases1.

In India, it is more common in central and southern parts of the country. It is the second most common haemoglobinopathy, next to thalassemia in India2. In 1952, Lehman and Catbush reported the presence of the disease in India among the tribals of Nilgiri Hills for the first time. Almost at the same time, Dunlop and Muzumdar reported the presence of the disease in Assam.

In 1953, Buchi confirmed presence of disease in Veddoids of South India. In 1955, Sukumaran found it in Western-India. In Maharashtra, Bankar et al reported prevalence of disease from 1.9% to 33.5% in different communities. Shukla and Solanki were the first to report the disease in Vidarbha region of Maharashtra with prevalence from 9.4% to 22.2% in non-tribal population. Ankushe reported prevalence of 5.5% from few villages of Wardha2-7.

Sickle cell disorder has remained a neglected field of research in this country and magnitude of problem has never been appreciated in spite of the fact that the sickled RBCs were detected in the blood of Indian patients as early as 1952. This was largely because most of the subsequent reports spread a misconception that the sickle gene in India was confined to the tribal population or some scheduled castes only. The present study was started in rural population of Wardha to find out the magnitude of sickle cell disorders.

Material and Methods

Study was conducted in rural area of Wardha district from April 96 to October 97. Wardha district has eight tehsils namely Wardha, Aryi, Hinbganghat, Deoli, Samudrapur, Seloo, Ashti and Karanja. Two villages from each tehsil were selected by proportional randomization.

The population was screened by holding camps in each village at evening time as in villages people are available in the evening time only after 6 p.m. The propaganda was made by distributing pamphlets, loud-speakers and by beating drums. Local leaders were taken into confindence. The population was screened by dithionite tube turbidity test (DTT or solubility test). Dithionite Tube Turbidity Test for screening

Few drops of blood were collected by bold finger prick and added to glass tube containing sodium citrate in normal saline. After mixing, it was centrifuged for 2 to 3 min. at 3000 rpm. The supernatant was discarded. 1 ml of phosphate buffer reagent was taken in a glass tube. A small quantity (about 10mg) of sodium dithionite was added to it and was mixed well to dissolve. A small drop of washed red cells was added and was mixed well to produce light pinkinsh violet colour. The test was read after 3 to 5 min. The test was read as positive, if the turbidity impaired the visibility of dark, bold lines on a white paper held against bright source of light at one inch distance. Negative test was indicated by visible lines. The positive samples were subjected for Cellulose Acetate Membrane electrophoresis at pH=8.8. The control haemoglobin samples of HbF and HbS were kept in every batch.

Results

Agewise prevalence of sickle cell disorders is shown in table I. Sexwise prevalence was 2.8% in males and 3.0% in females. The overall prevalence of SCD was 2.9%. The prevalence was maximum in Samudrapur block (7.0%) followed by 4.6% in Wardha and 3.4% in Hinganghat block.

Table I: Agewise Distribution of SCD

Age Population
screened/
enumerated
DTT positive Percentage
0-4 530 11 2.1
5-15 1547 34 2.2
16-25 1169 31 2.7
26-35 847 28 3.3
36-45 747 27 3.5
46-55 438 18 4.3
56 >/ 283 11 3.9
Total 5561 160 2.9

In all 31 castes were encountered. No case of SCD was found in Bari, Bhoi, Chambhar, Dhangar, Halba, Jain, Kalar, Khati, Komti, Koshti, Maheshwari, Mana, Muslim, Navi, Oza, Powar, Shimpi, Sonar, Sutar and Thakur. The prevalence was maximum in Matang (15.8%) followed by Pardhan (10.6%) and Gowari (5.8%). The prevalence in Bouddha, Kunbi and Teli was found to be 4.6%, 2.7% and 2.6% respectively.

Electrophoresis pattern revealed that 94.4% were Sickle Cell Traits and 5.6% were Sickle Cell Anemia.

Discussion

The DTT positivity was taken as a proportion of DTT positive individuals in specific group to total number of people screened in that specific group. In other studies, sickling test was used as a screening test. In the present study, solubility (DTT) test was used as a screening test, as it is a rapid method and easy to be carried out in the field setting. Bankar et al has used and ICMR network on Sickle Cell Disorders coordinated by Institute of Immunohaematology, Mumbai, have also recommended the solubility test as a screening test5.

The prevalence of the disorder was found to be 2.9%. Ankushe reported prevalence to be 5.6% from few villages of Wardha district7. Kamble reported prevalence in Wardha to be 5.7% in a clinic based study10. The differences may be attributed to the differences in study designs.

In the present study, the prevalence of sickle cell disorders was maximum in age group 46-55 yrs. and it increased with increasing age. Leikin et al in his cooperative study also had patients of sickle cell disorders which were distributed more in higher age groups4. Ankushe and Kamble also noted the similar findings7,10.

The prevalence of the disorder was 2.8% in males and 3.0% in females. As regards to sex distribution of the disorder, Wintrobe stated that sickle cell trait is more common in females12. But Samal et al did not find any such correlation. In the present study also such correlation could not be found.

The reason for the higher prevalence in few blocks may be attributed to more number of Matang, Pradhan and Bouddha population in the blocks. Prevalence of Sickle Cell Disorders in tribals was highest in Pardhan 10.6% followed by Gowari 5.8% and 3.1% in Gond. In scheduled castes, prevalence in Bouddha was 4.6% and 15.8% in Matang. In Kunbi, the prevalence was 2.7% and 25.6% in Teli. These observations support the hypothesis that the Sickle Cell Disorders are present in scheduled castes, tribals and few communities of OBCs and not found in so called higher castes; though the review of literature says it is present invariably in all castes8.

In the present study, prevalence in Gond was found to be 3.1%. Negi reported prevalence of 19.38%, Sathe reported 15.92%, and Bankar 6.6%11. Ankushe reported prevalence of 5.3% in Gond and Gowari together. In Pardhan, the prevalence was 10.6% and Ahmed reported 9.0%, Rao reported 30.5%11. In Banjara, the prevalence in this study was found to be 1.3% while Bankar has reported 5.6% prevalence5. In Bouddha, the prevalence was 4.6% in the present study. But Shukla and Solanki reported prevalence in Bouddha to be 22.22% and Ankushe reported prevalence to be 12.4% in the same caste6,7.

References

  1. Ingram VM. A specific chemical difference between the globins of normal human and sickle cell anaemia haemoglobin. Nature 1956; 178:792.
  2. Agarwal MB, Mehta BC. Sickle syndrome – A study of 44 cases from Bombay. Indian Paediatrics. 1980;17:793.
  3. Lehman H, Catbush M. Sickle cell trait in Southern India. BMJ. 1952;404.
  4. Leikin SL, Gallagher D, Kinney TR, Klug P, Rida W. Mortality in children and adolescents with sickle cell disease. Paediatrics. 1989;84:500-8.
  5. Bankar MP. Kate SL, Mokashi GD, Phadke MA. Distribution of sickje cell haemoglobin amongst different tribal groups in Maharashtra. Ind J Haematol. 1984; 2,4:224.
  6. Shukla RM, Solanki BR. Sickle Cell Trait in India. Lancet 1985; 1: 297-298.
  7. Ankushe RT. Clinico-epidemiological study of Sickle Cell Disorders in rural population of Wardha District. Thesis submitted to Nagpur University for M.D. Community Medicine 1993.
  8. Kar BC. Sickle Cell Disease in Orissa. JAPI 1991; 39:954- 960.
  9. Kate SL, Bankar MP. Cellulose acetate membrane electrophoresis: Simple rapid and inexpensive method for detection of haemoglobin variants. Ind J physical anthropology and genetics. 1976; 2:123-128.
  10. Kamble M. Clinical profile of sickle cell disease with special reference to hepatic involvement. Thesis submitted to Nagpur University for M.D. Paediatrics 1997.
  11. Rao VR. Sickling in different states of India. DST Technical Report. Health, Drinking water and genetic disease. 1991; Appendix II.
  12. Wintrobe MM. Clinical haematology. 9th Ed; 1993, 1061. Lea and Feriger, Philadelphia.

1 ,2 ,5 Department of Community Medicine M.G.I.M.S. Sewagram, Wardha (Maharashtra),

3 Department of Biochemistry, Sewagram, Wardha (Maharashtra),

4 Department of Paediatricas M.G.I.M.S., Sewagram, Wardha (Maharashtra)
E-mail: [email protected]

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