A Report on Epidemiological Investigation of Unusual Increase in Chronic Renal Failure Cases, Canacona Taluka, South Goa, Goa State

A Report on Epidemiological Investigation of Unusual Increase in Chronic Renal Failure Cases, Canacona Taluka, South Goa, Goa State

(13^th - 17^th June 2002)

Executive Summary

A Central team consisting of Epidemiologist and Microbiologist from NICD and Nephrologist from R.M.L. Hospital visited Canacona Taluk of South Goa from 13^th to 17^th June 2002 to assess the extent and probable cause of unusual increase in chronic renal failure (CRF) cases in the area. The salient observations are as follows:

1.    The state of Goa, administratively divided into North Goa & South Goa, has a total population of 13, 43,998 (census 2001). North Goa has seven Talukas and South Goa has Five Talukas. The Canacona Taluka falls under South Goa and has a population of 43,912 (census 2001). Canacona Taluka has two parts mainly i.e. the coastal area predominantly inhabited by Pagi community whose primary occupation is fishing and the hilly area predominantly inhabited by Velip community whose primary occupation is farming. The major crops grown in the hilly areas include cashew nuts and rice. There exists a barter system between there two communities, the pagi community gets rice in exchange of fish and vice-a-versa. The places from where the CRF cases are being reported in Canacona Taluka are Lolien, Anjadip, Cotigao, Poenguinin, Gaodngrem, Canacona, Agonda, Cola and Canacona town.

2.    The Review of data from Nephrology Unit of Goa Medical College (GMC), Goa was carried out. The increase from the year 2001 is contributed by change in admission policy of Nephrology unit of GMC where patients transferred from medicine, surgery and other wards are also being shown as admitted. The analysis of CRF cases in relation to the population of this Taluka with the other Talukas of South Goa was done. It was observed that the admission rate of CRF cases from Canacona Taluka was 5.9 per 10,000 population whereas in other Talukas of South Goa the admission rate of CRF cases varied from 1.0 to 2.3.

3.    The review of laboratory tests carried out by one of the private laboratories in Canacona during the month of May 2002 was studied. The results revealed that out of 99 sera screened for renal function tests, 27 samples had abnormal level of serum creatinine and blood urea. The team has collected 15 serum samples from the patients for further analysis.

4.    As per the available record at CHC, Canacona, there are 37 cases of CRF in Canacona taluka. Further analysis indicated that the majority of these cases were in the age group of 40-60 years with predominance of females. The data at Nephrology Unit at GMC, Goa also indicated similar trend. Majority of these cases were from coastal parts of Canacona Taluka affecting mainly the Pagi, Velip and Catholic community. 

5.    Out of 37 cases of CRF recorded at Canacona Taluka, 17 cases were examined by the team. Out of these 17 cases only in four cases the etiology of the disease could be established which included hypertension, renal stones and Polycystic Kidney Disease (PKD). In rest of the 13 (76.4%) cases no etiological diagnosis could be established. Further the history, clinical and available laboratory investigation data revealed that these cases of unknown aetiology are most probably of Chronic Interstitial Nephritis (CIN).  The renal failure in 11 (84.6%) cases was of slow progressive type of more than 3 years duration – pre End Stage Renal Disease (ESRD). Among these CRF cases, two cases had presentation in the form of bilateral contracted kidneys without any evidence of deranged biochemical renal functions. Four (30.7%) out of the 13 CRF cases had reported clear-cut family history of death due to CRF in last 10-20 years.