Cardiovascular risk factors of tea garden workers from a district of West Bengal, India

INTRODUCTION:

Noncommunicable diseases (NCDs) are of major concern for both rich and poor populations nowadays. India being largest populous country of the world 1 bears the brunt of both communicable and non-communicable disease burden.² India being an agricultural country has a lot of workers in agricultural industry. Tea being one of the important industries of West Bengal. The tea garden workers are mostly local people, tribals and very poor. Although the Indian tea industry occupies a significant and distinct position in the Indian economy3 with a large number of workers not many studies are present to describe the morbidity of these poor tea garden workers.

Non-communicable diseases (NCDs) are of major concern of global importance with cardiovascular diseases (CVDs) contributing to 48% of deaths due to NCDs in India.⁴

Though studies have been conducted in urban and rural areas, data related to tribal communities is limited. The vicious cycle of poverty, undernutrition, unhygienic environment, illiteracy, and various morbidities adversely affects health status.

A study on assessing NCD risk factors among tribals of Assam using the WHO-STEPS questionnaire revealed alarming results: tobacco use, alcohol use and unhealthy diet habits were high and common which required an integrated approach to reduce the risks. 6

Considering these facts in mind, the present study was planned with the objective to know the cardiovascular risk factors of the tea garden workers.

Materials and Methods:

Study Design and Setting: The study was conducted in the tea gardens of the Alipurduar district of West Bengal, India. Three gardens were selected randomly.

Study Participants: Adult workers of the tea garden who consented were included in the study. They were mainly tribals.

Sample size and Sampling Technique: estimating the proportion of morbidity to be 0.5%.

95% confidence level, 5% absolute allowable error and 10% non-response rate. The sample size is 422 using the formula n=zα2pq/L.² Selection was done by Multi-stage random sampling technique. 150 workers from each garden were selected. 463 workers were examined in all.

Ethical Issues and Necessary Approval:

The ‘Institutional Ethical Committee’ of the Midnapore Medical College, West Bengal, India, approved the study. IEC NUMBER AND DATE (IEC /2016/ dated 29.11.16) Necessary permission from the management of the selected tea gardens were taken. Informed consent was obtained from the tea garden workers who participated.

Data Collection and Measurements:

After obtaining informed consent, trained and qualified team of doctors interviewed the tea garden workers by using a pre-tested and pre-designed semi-structured questionnaire. They also performed relevant clinical examination. All the available medical records were checked. NCDs were classified and coded as per the 10th revision of the international classification of the diseases (ICD 10) 7.

Blood pressure (BP) was recorded. Hypertension / blood pressure was classified according to the ‘JNC-8’ classification.⁸

Anthropometric measurements were measured by a digital weighing scale and potable stadiometer as per standard techniques.⁹ Body mass index [BMI] was calculated. For interpretation of BMI recommendation made by the WHO for Asians was used.¹⁰

Statistical analysis:

Statistical analysis was done in Microsoft Excel. Categorical variables were expressed in percentage and mean ± SD were found for continuous variables. Appropriate tests were done where required.

RESULTS:

Out of the 463 workers, the mean age was 37.97±13 years. 76% were female. 81.2% were tribals and more than half (55.9%) were illiterate. The average family income was 3475.59. Table 1 shows their socio-demographic and socio-economic distribution of the study participants.

TABLE 1: Socio demographic profile of study participants(N=463)
Variables		Number studied	Percentage
	Overall	463	100
Age Group (Years):	18-30	168	36.3
31-44	146	31.5
45-59	104	22.5
≥ 60	45	9.7
Sex	Male	111	24.0
Female	352	76.0
Caste	Others	87	18.8
Scheduled Tribe	376	81.2
Education	>10	80	17.3
Class 5-10	100	21.6
Class1-4	24	5.2
Illiterate	259	55.9
Monthly Income	Highest Quartile	36	7.8
Third Quartile	32	6.9
Second Quartile	84	18.1
Lowest Quartile	311	67.2

24.2% has some non-communicable diseases, which are risk factors for cardiovascular disease. They are classified as per ICD-10 coding in table 2.

TABLE 2: ICD10 coded non communicable diseases among study participants(N=463)
DISEASES	ICD 10 CODING	Number	Percentage
NCDs (Hypertension, Stroke, CVDs, Type 2 Diabetes Mellitus etc.)	I10,25,42,64; E11	112	24.2

Table 3 shows 17.3% and 6.9% of the study participants were found in stage-I and stage-II hypertension, respectively, according to the ‘JNC-8 classification’. 57.8% of them found pre-hypertensive. These figures are quite high and need urgent interventions.

TABLE 3: Classification of blood pressure as per JNC 8 criteria(N=463)
Variables	Number	Percentages
Classification of Blood Pressure#	Normal	84	18.1
Prehypertension	267	57.7
Stage-I	80	17.3
Stage-II	32	6.9

Table 4 shows the risk factors of cardiovascular disease. 5.2% were overweight despite heavy work. 47.7% had a diet with less than 5 servings of fruits and vegetables. Their main diet was rice and potatoes. Tobacco and alcohol users were 67.2%and 57.1 % respectively. Waist circumference and waist-hip ratio was abnormal for 24.4 % and 20.3% respectively.

TABLE 4: Some Risk factors of non-communicable disease among study participants (N=463)
BMI	< 18.5	176	38.0
	18.5- 22.9	263	56.8
	>22.9	24	5.2
Waist circumference	NORMAL	350	75.6
	ABNORMAL	113	24.4
Waist hip ratio 2	NORMAL	369	79.7
	ABNORMAL	94	20.3
TOBACCO EVER USERS	YES	311	67.2
NO	252	32.8
ALCOHOLEVER USERS	YES	269	58.1
NO	194	41.9
DIETLESS THAN 5 SERVINGS OF FRUITS AND VEGETABLE	YES	221	47.7
NO	242	52.3

DISCUSSION:

This cross-sectional descriptive study among tea garden workers revealed that most of the workers were female. (76%, 352 out of 463). 81.2% were tribals i.e. hailing from marginalised communities with low literacy (55.9% illiterate) and poverty. Their mean family income was Rs. 3475.59 ± 1840.10 and 67.2% were in lowest income quartile. A study on tea garden workers of Assam,11 a neighbouring state of West Bengal, India also reiterates similar findings of inadequate wages (75% had wages less than 6100 per month) and 68.33% up to middle school education. The Assam study had workers mostly from other backward classes. (58.33%)

36.1% of the study population were undernourished which is comparable with a study in northern part of West Bengal (36.4%).¹² A cross sectional study conducted to assess the BMI of tea garden workers revealed that 74.95% of female workers had BMI less than normal. 13Another study reveals 69.9% undernutrition.¹⁴

Although the majority of workers were females, addiction was quite prevalent 67.2% for tobacco and 57.1 % for alcohol. Another study of Assam revealed addiction to tobacco at 73% and alcohol at 50% among tribal female.⁶ A study among tea garden worker in 2013 revealed Tobacco consumption was higher among tea garden workers as compared with general population (85.2% vs. 41.7%).⁵

Regarding diet 52.3% revealed consumption of less than 5 servings of fruits and vegetables; their main diet was carbohydrate based with rice and potatoes. A study in 2016 to assess cardiovascular risk factors among tribals of India, 43.4% were hypertensive.⁴ Although it was beyond the scope of this study to evaluate their dietary pattern, it is an important finding and requires further investigations. The probability of developing CVD is associated with unhealthy dietary patterns including less intake of fruits and vegetables. 15,16,17,18

In terms of cardiovascular risk factors in the present study, 24.2% were diagnosed as hypertensive and 57.7% were pre-hypertensive, revealing the iceberg of hypertension. They hardly knew about their hypertensive status.

A study by N. C Hazarika also revealed that hypertension among tea garden workers is large, despite the community not being obese, 60.8% were hypertensive in the said study.¹³

A study by P.K. Borah in 2018 among Tea Garden workers revealed high (60.8%) prevalence of hypertension (HTN), which may be due to consumption of extra salt.¹⁹ A mixed method study in 2021 on health care utilization of tea garden workers revealed a multitude of barriers inhibiting healthcare services utilisation in spite of 47.3% and 15.3% having non-communicable and communicable diseases respectively.²⁰

In the present, hypertension prevalence was lower than other tribal population in India, although similar to general population of India. Similar findings are seen in another study in 2013 among tea garden workers, here prevalence of hypertension was similar (44.4% vs. 45.2%) to general population but among those who had hypertension, prevalence of undiagnosed hypertension was higher in tea garden workers (82.8% vs. 74.4%)5

CONCLUSIONS:

From the study it can be concluded that risk factors of cardio vascular disease are prevalent among these tribal population mostly female tea garden workers in spite of undernutrition, poverty, and heavy work. The iceberg of hypertension is something to worry and require timely strategies Tobacco and alcohol use, two of the major cardiovascular risk factors were high and awareness generation is the need of the hour.

References

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