Study shows how tobacco is consuming rural India

Mouth ulcers and Trismus remain the common symptoms with addiction to tobacco chewing and smoking among the rural population of western Uttar Pradesh and eastern Rajasthan

Study shows how tobacco is consuming rural India

Oral Cancer is one of the most common cancer topping the cancer registries in India. About 200,000 new cases of head neck cancer are detected every year in the country. Oral cancers are typically detected in their advanced stages. In India, 60 percent to 80 percent of patients are suffering from advanced disease as compared to 40 percent in developed countries. About 240 million people in India consume tobacco in any form of which 195 million are males and 45 million are females which accounts for about one fifth of world tobacco consuming population, noted a research report, “A comparative analysis of the effects of non-smoked tobacco on oral mucosa over smoked and alcohol use in northern Indian population” conducted by Nayati Charitable Trust, a part of Nayati Healthcare.

According to the findings of a research, the primary symptoms were mouth ulcer (5.6 percent) followed by trismus (difficulty in mouth opening – 1.0 percent), dysphagia (difficulty in swallowing – 0.7 percent), ear discharge and hoarseness of voice at 0.5 percent. The overall proportions of tobacco chewing and smoking were 12.5 percent and 10.7percent respectively, only 2.5 percent individuals were addicted to alcohol. This study showed significant association of mouth ulcers and difficulty in mouth opening as common symptoms with addiction to tobacco chewing and smoking.

The prevalence of tobacco smoking in the age-group 55-64 years was found to be 14.4 percent, tobacco chewing and alcohol consumption in the age-group from 25-34 years was 15.6 percent and 4.2 percent respectively. The prevalence of smoking (17.8 percent) and tobacco chewing (19.7 percent) was higher among males as compared to the addiction pattern in females, the study noted.

The research report further states, the prevalence of mouth ulcers (20.7 percent among smokers and 27.8 percent among tobacco chewers) was significantly related with smokers and tobacco chewers. The prevalence of trismus (26.1 percent among smokers, 53 percent among tobacco chewers and 8.7percent among alcoholics) has been showing significant association with all types of addictions. Hoarseness of voice (20.3 percent among smokers, 25.4 percent among tobacco chewers) was significant with smokers and tobacco chewers. Percentage of ear discharge (23.2 percent among tobacco chewers) was significant with tobacco addiction only.

According to the Nayati findings, prevalence of mouth ulcers among males was found to be 24.6 percent, who were addicted to smoking and 24.7 percent for who were addicted to tobacco chewing alone. However, higher prevalence rate of 32.8 percent was reported for those, who are addicted with both smoking and tobacco chewing. The prevalence of mouth ulcers among males was reported to be 12.5 percent, in subjects, who used to consume alcohol alone. However, 13.6 percent males were addicted with both tobacco chewing and alcohol. 6.3 percent of males were addicted with both smoking and alcohol consumptions, which might be due to the lesser numbers in the combined users of alcohol and smoking.

The prevalence of oral mucosal lesions, submucous fibrosis and trismus in younger age may be due to the habit of Gutkha chewing. Gutkha consumption increases the oral mucosal disorders. Genetically gender has no association with oral mucosal lesions, SMF (Submucous fibrosis) and trismus, but the findings suggest that males are more prone to have oral mucosal changes as well as SMF and trismus in comparison to female, the study further noted.

If detected early, these mucosal changes and premalignant lesions can be handled in clinics and the presentation of an advanced malignancy can be prevented, thus reducing the financial burden on the society and this will be a boon to the policy makers. As this study revealed, these oral mucosal changes are commonly associated with tobacco chewing rather than smoking and alcohol. Addiction to tobacco in any form starts from early life especially tobacco chewing and ultimately they land up in mucosal changes and invasive disease in later part of life. The results of this study can be used for creating awareness among the population regarding the hazards of tobacco use and its outcomes so that the financial burden on society can be reduced. More number of studies needs to be conducted all over India to understand the prevalence and the biological behaviour of these premalignant lesions and its progression to invasive diseases, the study observes.

Oral Mucosa is the pink coloured covering inside the mouth, and it covers most of the oral cavity apart from the teeth. Tobacco habit in any form is responsible for oral mucosal or oral premalignant changes which have high propensity to undergo malignant transformation later. Detection of these oral mucosal changes in early stage is primarily important in decreasing there conversion into frank malignancies or oral cancer.

Oral cavity contains the mouth, teeth, gums, the bony roof, the floor of the mouth under the tongue, and cheeks. It is prone for myriad of changes with advancing age as well result of environmental and life style related factors like consumption of tobacco – smoke or smokeless) – and alcohol. Since oral cavity is an easily accessible site of examination, the visual screening method of examination is fairly straight forward, and it can be easily done by trained healthcare professionals at the community level.

In order to find out and compare the association of oral mucosal changes with non-smoked tobacco over smoked tobacco and alcohol, Nayati Charitable Trust organised community-based outreach health camp, specifically in unscreened population of western Uttar Pradesh and eastern Rajasthan. Findings are based on the screened individuals, who came for the general health screening at camps. However, the persons with severe health issues and having oral cavity cancer were excluded from participation in the study.

A total of 106 health screening camps were organised in the western Uttar Pradesh and eastern Rajasthan between April 2015 and June 2017 in 13 locations of these regions including Agra, Aligarh, Etah, Firozabad, Hathras, Jaunai, Kasganj, Kosi Kalan, Mursan, Vrindavan, Bharatpur, Dholpur and Mathura. As many as 11,145 individuals ranging from 5 to 96 years were screened by health professionals of Nayati Healthcare. The 6,356 (57 percent) were male and 4,789 (43 percent) were female.

The Changing Face of Rural India