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Seasonal variation of diarrheal disease, injuries, and respiratory infections among students of medical college in Western Maharashtra: Analysis of data of 07 years


 Department of Community Medicine, AFMC, Pune, Maharashtra, India

Date of Submission27-Nov-2020
Date of Decision28-Apr-2022
Date of Acceptance08-May-2022

Correspondence Address:
Arun K Yadav,
Department of Community Medicine, AFMC, Pune - 411 040, Maharashtra
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_655_20

  Abstract 


Background: Diarrheal disease, injuries, and respiratory infections form the major chunk of diseases among adolescents. Hence, this study was carried out to study the seasonal variation among these three diseases. Aim: To study the seasonal variation among three diseases. Methods: A record-based retrospective study was conducted among students of a medical college in Western Maharashtra who reported to the General OPD. The data were collected for a period of 7 years from Jan 2012 to Mar 2019. The diseases were characterized under three board headings based on the predefined criteria. Results: All 10,881 sick reports of students reported during the period were included in the study. After exclusion, the data were analyzed for 6,322 sick reports. A total of 67% of the cases were of upper respiratory tract infection (URTI), followed by injuries (19%). On analyzing the seasonal variations among the three categories, it was observed that there was an increase in the cases of diarrhea in the postmonsoon months of September and October. Injuries were maximum from August to September. The seasonal trend could be seen in URTI cases with a maximum number of cases from January to March and August to October. Conclusions: The burden of these diseases could be reduced if we take measures to detect the changes in their trend through the implementation of surveillance programs.

Keywords: Communicable disease, seasonal variation, students



How to cite this URL:
Bansal A, Yadav AK. Seasonal variation of diarrheal disease, injuries, and respiratory infections among students of medical college in Western Maharashtra: Analysis of data of 07 years. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2022 Dec 6]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=347489




  Introduction Top


College is a time of transition for young college students as they shift from their homes living with their families to living independently, often far away from their homes. Aside from adjusting to new living arrangements, entering college typically involves increased pressure to excel, the tension of new social relationships, and a heightened demand for academic autonomy and self-reliance.[1] Limited evidence exists concerning the health of young adults, most likely attributable to the fact that young adults perceive themselves to be insusceptible to infirmity. This lack of information extends into higher education sectors, places that have venues for dispensing health information/education to many young adults.[2]

Seasonality is an episodic surge in disease incidence corresponding to seasons or other calendar periods, and it describes many infectious diseases of public health importance.[3] The recognition of seasonal patterns in infectious disease occurrence dates back to the Hippocratic era. However, the mechanisms underlying the seasonality of infectious disease occurrence remain not well understood. Improved understanding will improve the exactitude of public health surveillance and epidemic conjecturing systems. Seasonal variations should be considered a major factor when exploring public health.[4]

A wide-ranging analysis of the epidemiological pattern of the occurrence of several diseases in a region arms the physicians with the required information to diagnose and treat them. It also provides a competent tool to the policymakers and managers for the formulation of policies to outwit the effect of the morbidity and mortality due to these diseases and diminish the overall burden of the ailment in the community.[5]

Adolescence is a period with its own medical health problem. The World Health Organization (WHO) has listed injuries as a major cause of mortality and morbidity among the adolescent groups. Medical students in India are enrolled in medical colleges in their late teens. This specialized group is less studied for variation in reporting of disease over a period of time. Hence, this study was conducted to study the seasonal variation of selected diseases among students.


  Methods Top


This study was carried out among students of a college in Western Maharashtra, India. All the students of the college report sick to a Primary Health Care in the institute. The records are kept meticulously. The present study is a record-based observational study carried out from Jan 2012 to Mar 2019. The data were collected regarding the self-reported health problems during the study period from the register of the consultant medical officer. Sampling was not done because complete data were taken during the study period. A data collection form was designed to extract data from the OPD register. A single researcher extracted the data from the register. It was seen that commonly three diseases – upper respiratory tract infection (URTI), diarrhea, and injuries were diagnosed. All cases of the above-mentioned diseases were included in the study. Cases having other diagnoses or incomplete data were excluded. The data were then compiled in an Excel sheet and classified into three categories to see their seasonal variation. The yearly mean temperature data and precipitation were taken from Indian meteorological sites.

The study was given an expedited review by the ethics committee vide their letter number IEC/311 dated 16 September. The data were entered into an Excel sheet and cleaned. Descriptive statistics were used. The quantitative variables were defined as mean and SD. Statistical analysis was done using MS Excel and Stata Corp. 2019. Stata statistical software. Release 16. College Station, TX: Stata Press.


  Results Top


The total sick reports during the period were 10,881. However, the data were analyzed for 6,322 due to inclusion and exclusion criterias. The mean age and standard deviation of the students were 20.1 ± 4.4 years.

The year-wise distribution is given in [Figure 1]. In year-wise data, there was an increase in the number of cases in the year 2016. The distribution of total cases month-wise is given in [Figure 2]. The maximum number of cases were seen in September and October [Figure 2]. Of all the total cases, 67% of the cases were of URTI, followed by injuries being 19% [Figure 3]. On analyzing the seasonal variations among the three categories, it was observed that there was an increase in the cases of diarrhea in the postmonsoon months of September and October. Injuries were maximum from August to September. The seasonal trend could be seen in URTI cases with a maximum number of cases from January to March and August to October.
Figure 1: Year-wise frequency of diseases

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Figure 2: Month wise frequency of diseases

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Figure 3: Distribution of cases

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The yearly average temperature showed a constant increase over the period of the study. The precipitation was below average in 2012, 2015, and 2018 and above average in 2013 and 2016. We could not find any correlation between the yearly average temperature and precipitation.


  Discussion Top


Some of the interesting findings from the study are that there is an increase in the number of cases of URTI in 2016. The reasons for this may be an increase in the number of intake of students from 2016 onwards. We also looked for an increase in URTI cases among the general population but found no such increase in cases of URTI. The institution of preventive measures and better utilization of the facility may have led to a decrease in the number of cases after 2016 onwards.

The results of the study also showed that there was a seasonal variation in the studied three diseases viz URTI, diarrhea, and injuries among students. Diarrhea has different seasonal patterns depending on the climate and etiology of diarrhea. Bacterial diarrheal are more common in the warm season, and rainy season and viral diarrheal are more common in winter and drier cooler months in a temperate and tropical environment, respectively. In our study, the maximum cases of diarrhea were seen in September and October which could be due to the monsoon which lasts from June to October in Western Maharashtra. Dandabathula et al.[6] analyzed weekly diarrheal disease outbreaks reported in Integrated Disease Surveillance Programme (IDSP) from 2010 to 2018 and found more during May (peak summer) but predominantly maximum during July (when monsoon prevails). A study conducted in Kashmir found the prevalence of diarrhea more in summer months among children under 5 years of age. We could not find any study which has looked at seasonality among adolescents or young adults in an institution as the factors associated with diarrhea may be different in these age groups.

The rise in injuries from August to September could be due to new students joining the college in July and undertaking sports activities without proper training and coaching. Also, the wetness of the surface due to rain during the time makes the environment more injury-prone. Similar findings were reported by Kumar et al.[7] in their study. They reported that the prevalence of sports injuries was more among those who do not have coaches (P = 0.001, odds ratio (OR) 3.49) and also those who did not receive any formal training (P = 0.000, OR 2.26).

There was an increase in the cases of URTI from August to October and January to March in the study. The new intake of students in August and an increase in contact activity at the time may lead to an increase in cases. January to March are relatively cooler and drier in Western Maharashtra. A study conducted by Wani et al.[8] in 2019 in Jammu and Kashmir (J&K) found the highest cases of URTI during winter and spring in children under 6 years of age. The various explanation has been put forward to explain the increase in acute respiratory tract viral infections in cold weather; however, none of them was confirmed.[9]

The seasonality of infectious diseases is a long-recognized but ill-understood occurrence. The apparent ubiquity of seasonal patterns of disease events suggests that this phenomenon represents a rich vein that might be mined to produce a better understanding of communicable disease transmission. Enhanced information education and communication activities targeting health and sports hygieneare recommended before the monsoon months.

However, this study has certain limitations. Firstly, it is a record-based study, and the data were taken from medical records. Because of the different medical officers treating the students at different times without standardized diagnoses, there may be few cases of those who have been misclassified. Secondly, the history and data about risk factors and hygiene factors like smoking and allergies were not available. Thirdly, we have a limitation of the granularity of the data of temperature and humidity. Thus, the role of environmental temperature and humidity could not be delineated.

Furthermore, well-designed studies that follow up with the students are needed to support the claim and study the associated factors like temperature, rainfall, sunlight, humidity, etc. This study based on the large data set gives input about the timing of public health activity to reduce the burden of the disease. The burden of these diseases would further be reduced by the implementation of surveillance programs and instituting timely preventive programs.[10],[11]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ruthig JC, Marrone S, Hladkyj S, Robinson-Epp N. Changes in college student health: Implications for academic performance. J Coll Stud Dev 2011;52:307-20.  Back to cited text no. 1
    
2.
Fletcher PC, Bryden PJ, Schneider MA, Dawson KA, Vandermeer A. Health issues and service utilization of university students: Experiences, practices & perceptions of students, staff and faculty. Coll Stud J 2007;41:482-94.  Back to cited text no. 2
    
3.
Turabian JL. The variation of seasonal diseases in family medicine depends on infectious diseases and these are mainly respiratory diseases. J Gen Pract 2017;5. Available from: https://www.omicsonline.org/open-access/the-variation-of-seasonal-diseases-in-family-medicine-depends-on-infectious-diseases-and-these-are-mainly-respiratory-diseases-2329-9126-1000309.php?aid=88880.  Back to cited text no. 3
    
4.
Ballester F, Michelozzi P, Iñiguez C. Weather, climate, and public health. J Epidemiol Community Health 2003;57:759-60.  Back to cited text no. 4
    
5.
Detels R, Beaglehole R, Lansang MA, Gulliford M. Oxford Textbook of Public Health. Oxford University Press; 2011. Available from: https://econpapers.repec.org/bookchap/oxpobooks/9780199693474.htm. [Last accessed on 2020 Jul 07].  Back to cited text no. 5
    
6.
Dandabathula G, Bharadwaj P, Burra M, Rao P, Rao S, Reddy SC. Seasonal variations of acute diarrheal disease outbreaks in India (2010 – 2018). Acta Med 2019;3:155-8.  Back to cited text no. 6
    
7.
Kumar V, Mangal A, Yadav G, Raut DK, Singh S. Prevalence and pattern of sport injuries among college students in Delhi, India. Saudi J Sports Med 2014;14:109-14.  Back to cited text no. 7
  [Full text]  
8.
Wani MA, Mayer IA, Naik S. Seasonal epidemiology of acute respiratory infection among the children in Kashmir Himalayan region-India. Int J Health Sci Res 2019;9:203-10.  Back to cited text no. 8
    
9.
Eccles R. An explanation for the seasonality of acute upper respiratory tract viral infections. Acta Otolaryngol (Stockh) 2002;122:183-91.  Back to cited text no. 9
    
10.
IMD | Home. Available from: https://mausam.imd.gov.in.  Back to cited text no. 10
    
11.
Kumari R, Nath B, Midha T, Vaswani ND, Lekhwani S, Singh B. Morbidity profile and seasonal variation of diseases in a primary health center in Kanpur District: A tool for the health planners. J Fam Med Prim Care 2012;1:86-91.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

 
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