|Year : 2015 | Volume
| Issue : 1 | Page : 76-80
Post-Diwali morbidity survey in a resettlement colony of Delhi
Shantanu Sharma, Harsavardhan Nayak, Panna Lal
Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
|Date of Web Publication||11-Dec-2015|
Dr. Shantanu Sharma
Department of Community Medicine, Maulana Azad Medical College, New Delhi
Source of Support: None, Conflict of Interest: None
Background: Diwali is an occasion when many people get injured or burnt. Most of the data on morbidity profile of the communities is the hospital-based and there is a lack of community-based surveys. Materials and Methods: The present study was a cross-section survey conducted in the resettlement colony of Gokalpuri, Delhi, after Diwali in the month of November and December, 2013. A total of 406 households were interviewed with questions on demographic details, any injuries suffered post-Diwali and the treatment sought thereafter. Results: In the population of 1826 surveyed, only 148 (8.1%) suffered from any problem this Diwali. Majority of the participants (105; 70.9%) had respiratory complaints ranging from mild cough and wheeze to asthmatic attack while 24 (16.2%) suffered burns on any part of the body. Eighty four (56.7%) people who suffered any problem post-Diwali didn't do anything for the problem, rather left it to get well on its own. Only 32 persons had gone to health center for treatment. Conclusion: In the current study, prevalence of post-Diwali morbidity was 8.1%. The observed prevalence in the current study is much higher than that reported in a hospital based retrospective study by Tandon et al. from Delhi which collected data from 2002 to 2010 and where the incidence was one patient with firecracker-related injury per 100,000 population of the city.
Keywords: Burns, Diwali, firecrackers, injury
|How to cite this article:|
Sharma S, Nayak H, Lal P. Post-Diwali morbidity survey in a resettlement colony of Delhi. Indian J Burns 2015;23:76-80
| Introduction|| |
Diwali, also called Deepawali, is an ancient Hindu festival celebrated in autumn every year. It is colloquially also known as the "festival of lights," for the common practice is to light small oil lamps (called "diyas") and place them around the home. The festival spiritually signifies the victory of light over darkness, knowledge over ignorance, good over evil, and hope over despair. Firecrackers are most commonly used to celebrate it. Hence, there are a lot of cases of firecracker-related morbidities among which burns and respiratory problems are predominant.
We do not have sufficient data on Diwali-related burns in India. A study published from Delhi has shown that the number of people reporting with firecracker injuries during a period of 9 years from 2002 to 2010 has doubled from 0.81 to 1.51 per 100,000 population.  The most common sites of injuries during Diwali quoted in this study were burns of the hands, face and eyes.  Unfortunately, majority of the victims are children and young adolescents who get injured while playing with crackers unsupervised by adults. There are also instances of serious injuries caused by firecrackers to the eyes, leading to loss of vision.  In Iran, a study on firecracker-related injuries has reported that injuries were mostly lacerations and cuts (n = 17, 49%) and scratches (n = 12, 34%). However, one patient has also suffered amputation.  Trouser pocket burns were reported in 7 out of 49 (14.28%) patients admitted to a hospital in Ahmadabad.  The most common type of firecracker causing burn injury is the "anar" or "flower-pot."  Many children or even adults injure their hands trying to ignite the "flowerpot" (popularly known as "kalgash" in Assam) while holding it in their hands.  These firecrackers, which should only emanate light upon igniting, often burst accidentally, thus causing burn injuries. Excess emergency hospital admissions have been reported during Diwali-related to burns and increase in asthmatic attacks. Particulate matter and sulphur oxides aggravate common respiratory conditions like asthma and bronchitis. , Studies , on the short-term exposure to high pollution concentration suggest a higher prevalence of bronchitis, asthma, and other symptoms, and hence a related increase in emergency room visits in hospital. ,,, Besides causing air pollution, the massive amount of firecrackers used and the heavy traffic movement during Diwali also causes noise pollution that increases cholesterol levels, resulting in permanent constriction of blood vessels which increases the probability of heart attacks,  has negative effects during pregnancy period,  leads to hearing impairment,  causes severe sleep disturbances and irritation and fatigue.  A review of current literature revealed no community based surveys which had been conducted in the last few years. Hence, this pilot study was done to analyze the epidemiological data of Diwali-related morbidity and first aid measures undertaken in such cases.
| Materials and Methods|| |
It was a community based survey carried out in Gokalpuri and adjoining slums. Gokalpuri is a resettlement colony located in Northeast Delhi at 28°42' 12" N; 77°17' 0" E. It, along with the adjoining slums, covers a total population of about 49,000. Using the prevalence of firework morbidity in the population from a previous study  of 1 per 1 lakh population, the sample size was calculated to be around 0.1 million for this cross-sectional study. Due to time and resource constraints, a smaller sample size of 400 households was used for convenience. A total of 406 households were selected for interview using simple random sampling technique. A list of all houses with their house numbers was prepared and then the houses for interview were selected using random number table. If any selected house was found locked, then the subsequent house was taken for interview. The survey was conducted by a team of two investigators in the months of November and December 2013. An adult member present at the time of survey in the family was interviewed. Apart from demographic details, the questionnaire included questions on any symptoms related to any organ system and the treatment for the complaint sought for (Annexure 1). The questionnaire was validated before the start of the study on 25 subjects from the same community with Cronbach's alpha value of 0.61. It was a rapid short survey to analyze general morbidity and services sought by the community.
Data from the questionnaires was entered in MS-Excel and analyzed using SPSS 17 software (Chicago, IL, USA). Chi-square test was applied wherever required to find out any significance in the differences.
Approval from the institutional ethics committee was taken. The purpose of the study was explained to the participants before they were included in the study. The participants were assured about privacy and confidentiality of the information provided by them.
| Results|| |
Among the total 406 respondents, 348 were males while 58 were females. Mean age of the respondents was 40 ± 12 years. Sixty percent of the respondents were employed in private sector, 41 (10.1%) were employed in government sector, 37 (9%) were running their own family business, 27 (7%) were housewives and others were either labourers (5%), teachers (1.2%) or drivers (1.5%) etc. More than two-thirds of the respondents (287; 71%) were educated up to high school or above. Only about 7% (31) respondents were illiterate and 6% educated up to primary level. Mean number of family members per family was 5 ± 1.5. Out of the population of 1826 (including all members in the 406 households) covered by the survey, only 148 (8.1%) suffered from any problem this Diwali [Table 1].
Thirty four out of 148 (23.0%) suffered burns on any part of the body. Regarding the treatment sought, 4 (2.7%) people who suffered burns post-Diwali didn't do anything for the problem and instead let it heal on its own whereas 18 (52.9%) had applied home remedies like antiseptic cream, toothpaste etc. but none received tetanus immunization. Among the others, 11 (32.3%) had gone to private doctors for the problem and 1 (2.9%) was admitted in the hospital for 9 days as per the history told by him. "Flowerpot" (" anaar") was the most common offending agent for burns (13; 38.2%) followed by bomb (9; 26.5%), " diya" or candle (6; 17.6%) and "chakari" (6; 17.6%). Out of the 34 subjects who suffered from burns, majority (20; 58.8%) had burns on hand, 4 (11.8%) had on hand and foot both while 6 (17.6%) had on foot only, 2 (5.8%) had it on face and 1 (3%) each on head and neck.
Among the nonburns injuries (114; 77.0%), respiratory complaints ranging from mild cough and wheeze to asthmatic attack (100; 87.7%) were most common while, 3 people (2.6%) had physical injuries, 5 (4.4%) complained of difficulty in hearing, 5 (4.4%) had irritation and itching in eyes, only 1 (0.8%) reported to have headache due to noise of crackers. For the respiratory problems, most of people didn't do anything while 6% used home remedies like steam inhalation, ginger tea and honey [Table 2].
| Disscusion|| |
India with a population over 1.2 billion is a socially and culturally diverse country. And in each of the festival and celebrations, firecrackers play an important part. Display of fireworks with loud explosives, crackers, etc., during Diwali celebration causes burns and enormous though short-lived air pollution. But, some patients get burn injuries due to careless handling of the earthen lamps or candles used during the festival. Lighting of the earthen lamps at the floor level and use of flowing garments by the victims are the cause of the disaster in several such cases. Most of the data collected from previous studies is hospital based and not community based. True and accurate morbidity related data can only be obtained through community based active surveillance whereas hospital based passive surveillance adds to sampling bias. In the current study, prevalence of post-Diwali morbidity was 8.1%. The observed prevalence in the current study is much higher than that reported in a hospital based retrospective study by Tandon et al.  who report and incidence of one injury per 1,00,000 population of the city. In this study, 73.02% of the victims were 5-30 years old. More than two-third (67.7%) of the participants had respiratory complaints ranging from mild wheeze, cough to asthmatic attacks. Similar studies done nationally  and internationally , to assess the impact of firecrackers have reported the harmful effects of sulphur dioxide, nitrogen oxides and suspended particulate matter in causing respiratory problems like asthma, chronic bronchitis and heart attacks. A 30% to 40% increase in the cases of wheezing, respiratory diseases, exacerbation of bronchial asthma, and bronchitis patients of all ages and gender were reported during the Diwali festival in a study in 1997.  Majority (90.87%) of them sustained less than 5% total body surface area burns. The most common offending agent in the current study was the "flowerpot" (38.2%) followed by bombs (26.5%) similar to the study by Bhupendra et al.  which reported and incidence of 70% (84 cases) due to "flower pot" ("kalgash") and 19.1% (23 cases) due to bombs. However, hospital based studies would reveal only those cases which are severe or moderate in grade and hence mild cases would be missed. In contrast, this community based study reported a high prevalence compared to the previous studies due to the fact that it also included mild injuries and hence revealed the true morbidity profile.
Incongruent with the results of study from Delhi,  a study conducted in KEM Hospital Mumbai  reported a decline in the prevalence of firecrackers-related injuries over a period of 10 years from 2000 to 2010. The study from Mumbai  emphasized on the role of mass awareness campaigns by government and nongovernment organizations  in achievement of such a decline in prevalence. There are evidences from other studies ,, as well highlighting the role of such awareness campaigns along with proper legislation and strict implementation in preventing firecrackers-related injuries. Community based awareness campaigns need to be organized disseminating information about effects of firecrackers on health, ways of prevention from firecracker injuries and the management to be sought after. And also the existing legislations , need a strict enforcement and implementation to bring this menace under control.
The quality of the firecrackers sold in the market should also be standardized and the people in general should be encouraged to follow the precautions while celebrating the festival of lights. Information, education, and communication is necessary to spread awareness about this issue. Judicious use of information technology can make a big difference in easy and instantaneous dissemination of knowledge by developing websites or applications to provide information on firecrackers and their risks.
Smart phones are a popular mode of communication and its penetration in rural as well as urban areas in the country can be utilized to provide advice about the do's and don'ts in the form of messages and ringtones about careful usage of firecrackers while enjoying the festivity.
Incorporation of episodes on Diwali festival in television serials and reality shows could educate people on prevention of accidents while playing with firecrackers.
| Limitations of the Study|| |
The smaller sample size of the current study limits its external validity. Since it was a rapid short survey, information on other problems faced post-Diwali like waste management, noise pollution and current knowledge and attitude levels in the community about the prevention and management of common ailments faced could not be collected. Due to recall bias, minor ailments suffered by some members of the family might have been missed. Based on the data from the questionnaire, causation could not be established. The same study would be conducted every year by the department of community medicine to look for trends of post-Diwali morbidity with more sample size, a detailed questionnaire to assess for other problems, and the impact of the awareness regarding preventive measures spread through the current study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]