International Standard Serial Number (ISSN): 2319-8141

International Journal of Universal Pharmacy and Bio Sciences 2(5): September-October 2013

INTERNATIONAL JOURNAL OF UNIVERSAL PHARMACY AND BIO SCIENCES

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Received: 03-09-2013; Accepted: 16-09-2013 RELATIONSHIP OF NUTRITIONAL STATUS WITH MENSTRUAL DISORDERS AND IMPACT OF MENSTRUAL DISORDERS ON JOB: A STUDY AMONG FEMALE BRICK KILN WORKERS OF SOME SELECTED BRICK KILNS OF JHARKHAND Roan Mukherjee 1 1 Department of Human Physiology, Hazaribag College of Dental Sciences and Hospital,Demotand, Hazaribag 825301, Jharkhand, India. ABSTRACT KEYWORDS: This study documented the prevalence of different menstrual disorders Female, Brick kiln, Nutritional Status, Menstrual Disorders. For Correspondence: Roan Mukherjee * Address: Department of Human Physiology, Hazaribag College of Dental Sciences and Hospital,Demotand, Hazaribag 825301, Jharkhand, India. E mail: roann_lec@yahoo.com among female brick kiln workers and evaluated the association of nutritional status (in terms of BMI and haemoglobin levels) with menstrual disorders. A total of 110 (age:18-35 years ) subjects were selected at random from different brick kiln of selected districts of Jharkhand. An interview was conducted to collect information regarding menstruation. Body mass index and haemoglobin levels were determined .Percentages and Chi-square test were employed to evaluate the data. It was found that 80 (72.7 %) females had some kind of menstrual disorders. The percentage of amenorrhea, oligomenorrhea, hypomenorrhoea, dysmenorrhoea and menorrhagia were 7.3% ,14.5, 17.3 , 23.6 and 10 respectively. 80% of those with menstrual disorders and only 60 % of those with no menstrual disorders were underweight. 77.7 % of those with menstrual disorders and only 50 % of those with no menstrual disorders were anemic. 61.2 % of those with menstrual disorders and only 30 % of those with no menstrual disorders showed absence from work/job during menstruation. All these differences between those with menstrual disorders and those lacking menstrual disorders were significant using Chi-square test. It was concluded that underweight and anemia may have a role in the etiology of menstrual disorders among female brick kiln workers. Work productivity may be affected due to menstrual disorders. Interventions towards improvement in overall health status and providence of supplementary income source may lower poverty, remove malnutrition and help in preventing menstrual disorders.
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International Standard Serial Number (ISSN): 2319-8141 INTRODUCTION: The organization of work is prone to changes with ever quickening pace.There are number of emerging new influences on work related ill health. Brick kiln worker is a combination of different works. Digging out soil , carrying them and converting it to clay , clay cutting , designing, burning resulting in rock solid brick and loading those bricks on transport system for sending them to godown are some hard core milestones of brick kiln workers. All segments of work are stressful by nature. All requires exceptional skill and endurance to carry out such huge workload. Not only males but females also actively participate in brick producing. India ranks second in brick production after China. In India brick producing industry is an unorganized sector employing a large number of people, particularly from socio economically backward strata of the society. There are no definite wages in this sector and the workers are generally underpaid and live in poverty. The workers of brick industry are susceptible to develop respiratory disease, problems related to skin and other adverse effect on health 1 . The reproductive life of every female is marked by the presence of menstruation, which sometimes may be accompanied by menstrual disorders. Although study related to menstrual disorders have been carried out on Indian adolescents and adults
4,5 2,3

, no data was found on menstrual disorders

of female brick kiln workers. A few foreign studies also indicated that menstrual problems may have negative impact on working ability . However, no study was available that showed the

impact of menstrual disorders on work/ job of female brick kiln workers. The present study documented the prevalence of some selected menstrual disorders among female brick kiln workers. At the same time the study evaluated the association of nutritional status with menstrual disorders among them. It also assessed the differences in absence from work between those with menstrual disorder and those with no menstrual disorder at the time of menstruation. MATERIALS AND METHOD Females devoid of smoking habit, non pregnant and not reporting any kinds of illness were selected randomly from different brick kiln of selected districts (East Singhbhum and Hazaribag ) of Jharkhand. Height of the subjects were measured with anthropometric rod and weight were measured with human weighing machine .Body Mass Index (BMI) were calculated employing height and weight using the following formula shown below: BMI= Weight (Kg) / Height (meter) 2 . Based on the calculated BMI nutritional status of the females were decided depending on the following criteria 6

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International Standard Serial Number (ISSN): 2319-8141 Underweight (BMI <18.5) : indicating undernourishment Normal (18.5 24.9): indicating adequate nourishment Nutritional status were also assessed biochemically by determining haemoglobin content of blood
7

. Haemoglobinometer was used to determine haemoglobin levels of blood by

3

Sahlismethod in line to earlier studies

.Subjects with haemoglobin levels of < 12g/dl were

diagnosed to be anemic according to the WHO criteria 8. Interviews were conducted with individual subjects to collect information regarding menstruation. Help of trained female nurses were taken to ease the process of data collection and to make the female brick kiln workers comfortable. Normal menstruation and different menstrual disorders were identified depending on their respective features or characteristics in accordance to the available literature 2,3,9 .The features used for identification are given below: Normal menstrual cycle: Cycle that took place at approximately 28 days.Bleeding lasted for two five days .Blood loss were about 20 to 60 ml. Amenorrhoea: Absence of menstrual period for the last 3 menstrual cycle . Oligomenorrhea: In a year only four to nine cycles occurred with scanty bleeding. Hypomenorrhoea: Cycle occurred timely but bleeding were usually less than fifty ml. Dysmenorrhoea: Occurrence of pain in the supra pubic area during menstrual cycle. Menorrhagia: Occurrence of profused bleeding , generally greater than five hundred ml for more than seven days. Premenstrual syndrome (PMS): Presence of symptoms like headache, backache , irritation ,diarrhea, development of cramps, tenderness of breasts, etc. The study was conducted according to Helsinki declaration and had permission from institutional human ethical committee. Statistical Analytical Techniques: The data were presented as percentages. Chi-square test were employed to assess the following 1) Relationship between nutritional status and menstrual disorders. 2) Association of premenstrual syndrome with different menstrual disorders. 3) Relationship between absence from work and menstrual disorders. RESULTS: Among 110 females, only 30 (27.3 %) individuals had normal menstruation whereas 80 (72.7 %) had some or the other types of menstrual disorders .The different menstrual disorders found in these females are presented in Table 1.

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International Standard Serial Number (ISSN): 2319-8141 Table 1 :Distribution of different menstrual disorders (N=110). Amenorrhea Oligomenorrhea Hypomenorrhoea Dysmenorrhoea Menorrhagia 8 (7.3 %) 16(14.5 %) 19 (17.3 %) 26 (23.6 %) 11(10 %) Table 2 presents the cross tabulation of nutritional status and menstrual disorders. It shows that significant association were found among nutritional status in terms of BMI and menstrual disorders. Maximum number of individuals having some kind of menstrual disorders were found to be underweight. Conversely , individuals having no menstrual disorder had lesser prevalence of underweight among them. Table 2: Association between Nutritional status and menstrual disorders. Nutritional Status Menstrual 2 test Underweight Normal disorders P value BMI <18.5 18.5 24.9 Present 64 (80 %) 16 (20 %) (n= 80) < 0.05 Significant Absent 18 (60 %) 12 (40 %) (n= 30) The cross tabulation of anemia and menstrual disorders is shown in Table 3. It revealed significant association were present between anemia and menstrual disorders. Higher prevalence of anemic condition were seen in individuals having menstrual disorders , whereas individuals with no menstrual disorders had lesser prevalence of anemia. Table 3 :Association between anemia and menstrual disorders. Menstrual disorders Present (n= 80) Absent (n= 30) Anemic: Haemoglobin < 12g/dl Yes 62 (77.5 %) 15 (50 %) No 18 (22.5 %) 15 (50 %) < 0.01 Significant 2 test P value

Table 4 shows the relationship of pre menstrual syndrome (PMS) with different menstrual disorders. The prevalence of PMS was found to be highest in dysmenorrhoea followed by hypomenorrhoea , amenorrhea / oligomenorrhea and menorrhagia. Chi-square test conformed the difference to be significant.

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International Standard Serial Number (ISSN): 2319-8141 Table 4: Association pre menstrual syndrome with different menstrual disorders. Premenstrual syndrome Menstrual disorders Amenorrhea/ Oligomenorrhea (n=24) Hypomenorrhoea (n=19) Dysmenorrhoea (n=26) Menorrhagia (n=11) Yes 10 (41.7 %) No 14 (58.3 %) 2 test P value

13 (68.4 %) 21 (80.8 %) 6 (54.5 %)

6 (31.6 %) 5 (19.2 %) 5 (45.5 %)

< 0.05 Significant

The cross tabulation of absence of work and menstrual disorders is depected in Table 5.

significant association were obtained between absence from work and menstrual disorders. Individuals with menstrual disorders had greater prevalence of absence from work. In absence of menstrual disorders individuals showed lesser prevalence of absence from work. Table 5:Association of absence from work in brick kiln and menstrual disorders. Menstrual Disorders Present (n= 80) Absent (n= 30) DISCUSSION Studies have shown that in the reproductive life , many females develop menstrual disorders
10

Absence from Work /Job Yes 49 (61.2 %) 9 (30 %) No 31 (38.8 %) 21 (70 %)

2 test P value < 0.01 Significant

.In the present study on female brick kiln workers it was found that 80 % of the workers were

suffering from some or the other types of menstrual disorders. The most common menstrual disorder among these workers were dysmenorrhoea. A recent study on urban females, in which subjects were drawn from students of nursing colleges , medical colleges , working females and doctors also found dysmenorrhoea to be the most common menstrual disorder 2. But in that study, prevalence percentage of dysmenorrhoea was (53%), which is much lower than that

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International Standard Serial Number (ISSN): 2319-8141 observed among female brick kiln workers.Higher prevalence of dysmenorrhoea among female brick kiln workers may due to dietary insufficiency /undernutrition
11

imparted by their lower

socioeconomic status. Disturbances in the ovarian sex hormones leads to more prostaglandin generation in the uterus at the time of menstruation which brings about more uterine muscle contraction causing dysmenorrhea (functional) 12,13 . Hypomenorrhoea was found to be the second most commonest menstrual disorder. It was followed by oligomenorrhea and menorrhagia. Even it was observed that few (7.3 %) of the female brick kiln workers had

experienced amenorrhoea .They were so malnourished that their body refused to carry out the luxury of menstrual blood loss. This may be not surprising considering their malnourished look and marasmic appearance. It may be expected that the results of a study on prevalence of various menstrual disorders may between different populations. Since some authors are of the view that the tolerance level and the tendency of neglecting or accepting symptoms related to menstrual disturbances by individuals of a population may affect the results 3. Furthermore, in addition to financial/ economic conditions , menstruation may also be influenced by a number of other factors such as age , anthopometric dimensions , underlying diseases, contraceptive use , physical activity and even education level 2 .Variation in these factors may varry the menstrual function of a female. Studies have shown that premenstrual syndrome (PMS) may be found in association with other menstrual disorders
2,14

.The present study also reports similar findings .It showed that PMS

accompanied every menstrual disorder among female brick kiln workers. However , PMS was most common in individuals with Dysmenorrhoea . It has been said that underlying organic diseases may be responsible for dysmenorrhea in individuals having dysmenorrhea with premenstrual symptoms 14 . It has been proposed that rise in levels of prolactin , lack of vitamins and lowering of blood glucose levels may be the cause of PMS prostaglandin may also have a role in causing PMS 2 . Normal menstruation indicates proper balanced functioning of the hypothalamic - pituitaryovarian axis whereas any disturbances in menstruation reflects improper functioning of th e same axis . Dysfunction in the hypothalamic- pituitary-ovarian axis may be induced by nutritional inadequacies
14 15

. Conformation of the

influence of such factors on PMS are not available. Moreover possibly estrogen and

. Regarding the nutritional status assessment of the female brick kiln

workers in the present study, their dull look and pale appearance were some of the indicators / markers of the actual scenario . It was found that 80 % of female brick kiln workers with

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International Standard Serial Number (ISSN): 2319-8141 menstrual disorders were underweight whereas 60 % of individuals with no menstrual disorders were underweight. Thus it is prominently evident that undernutrition were more in individuals with menstrual disorders. The difference was found to be significant indicating a possible role of undernutrition in inducing menstrual disorders. An earlier study
3

on other population have

reported similar findings and it also showed significant link of anemia with menstrual disorders. Anemic condition is also a marker of nutritional status. Inadequate nutrition may cause anemia. In the present study, it was found that 77.7 % of the female brick kiln workers with menstrual disorder were found to have anemia .On the contairy, only 50 % of female brick kiln workers with no menstrual disorder were having anemia. The observation implied much higher prevalence of anemia in individuals with menstrual disorders than those with no menstrual disorders. As expected the difference were found to be significant in line to earlier findings 3. Body fat of at least twenty two percent of body weight is essential for proper menstruation to occour. Leptin stores varry with body fat. Inadequate diet may not only lower body fat but may also cause decrease of leptin levels. Leptin receptors have been identified in hypothalamus. Decrement in leptin levels may lead to menstrual problems. Additively ,inhibition of Luteinizing hormone (LH) due to production of beta-endorphins with high/ strennous physical activity level may also affect normal menstrual functioning
16

. The BMI of the female brick kiln conformed

that majority of them were undernourished hence presence of the minimal amount of body fat in these females, required for proper menstrual function is quite doubtful. Moreover, the job of female brick kiln workers comprises of hard physical labour therefore menstrual disturbances among them are not surprising. The work of female brick kiln workers are stressful by nature .Studies have shown that stress in relation to job or financial conditions have a significant relationship with menstrual disorders
3

.Stress induced corticotrophin release may affect secretion of gonadotropin hormones and
17-19

ovarian hormones. Thus menstrual disturbances may be the outcome of such hormonal fluctuation .

In the present study 61.2 % of workers with menstrual disorders and only 30 % of workers with no menstrual disorders were absent from work / job. The difference was considered significant. This particular finding implied that menstrual disorders may adversely affect working capacity of female brick kiln workers. It may be speculated that work related productivity may also be lowered. This finding corroborates with the idea that the ability to work may be restricted by

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International Standard Serial Number (ISSN): 2319-8141 menstruation , especially by menstrual pain 5. Another study 4 on Nigerian working women also concluded that menstrual disorders and related discomfort may negatively impact job performance. The present had some limitations. The association of factors, other than nutritional status that possibly affected menstrual function of female brick kiln workers were not investigated in this present study. Furture studies should explore association of other factors with menstrual disorders in female brick kiln workers. CONCLUSION The findings of the present study are consistent with an earlier Indian study 3 on other population ,which showed the presence of significant relationship of BMI and anemia with menstrual disorders. It may be suggested that overall -health and gynaecological check -ups of female brick kiln workers should be carried out at regular intervals to safeguard the health of female workers and to prevent menstrual disorder induced absence from work. In addition , in brick kilns generally poor sanitation facilities are available , improvements in sanitation facilities may even lower the tendency of individuals with no menstrual disorder from being absent from work at the time of menstruation. Supplementary source of income like tailoring, needlecraft, poultry raising and dairy farming 1 may improve the socioeconomic status of female brick kiln workers, which may help them to ensure proper nutrition. This in turn may prevent undernourishment induced menstrual disorders in female brick kiln workers. Studies of this kind may be intriguing to the policy framing bodies of the government. ACKNOWLEDGEMENT: I am thankful to all the participants of the study .I also express my sincere gratitude to Dr Amol Chatterjee, Ex- Medical Officer, West Bengal Health services, for helping in the process of diagnosis of menstrual disorders. REFERENCES: 1. Santha R Athena C, (2013),Socioeconomic Status of Brick Workers in Coimbatore. Language in India,13:99-104. 2. Deliwala KJ, Shah HH, Shah BS, Goswami HM, Shah PK and Patil S,(2013), Evaluation of Menstrual Problems Among Urban Females of Ahmedabad. J. of Clin. Res. Lett., 4(1)49-53. 3. Mohite RV, Mohite VR, Kumbhar SM, Ganganahalli P, (2013),Common Menstrual Problems among Slum Adolescent Girls of Western Maharashtra, India. JKIMSU , 2(1):89-97.

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International Standard Serial Number (ISSN): 2319-8141 4. Ayotunde L, Orji EO, Ajibike L,(2007),Menstrual Disorder Among Young Female Workers and its Implication on Job Performance (Case Study of Obafemi Awolowo University, Nigeria). IFE PsychologIA , 16 (1) 2007: 224-238. 5. Omidvar S, Begum K ,(2011),Menstrual Pattern Among Unmarried Women From South India. Nat. Sci. Biol. Med., 2(2): 174179. 6. Kapoor S, Verma D, Bhasin P, Dhall M and Bhardwaj S ,(2012), Skinfolds as

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RHM, 8(15), 142-147. 11. Fujiwara T, Nakata R, (2004), Current problems of food intake in young women in Japan: their influence on female reproductive function. Reprod. Med. Biol., 3: 107-14. 12. Lundstrom V, Green K, (1978), Endogenous Levels of Prostaglandin F2 and Its Main Metabolites in Plasma And Endometrium of Normal and Dysmenorrheic Women. Am. J. Obstet. Gynecol., 130:640-646. 13. Dawood MY, (1981), Dysmenorrhea and Prostaglandins: Pharmacological and Therapeutic Consideration. Drugs , 22: 42. 14. Fujiwara T and Nakata R, (2007),Young Japanese College Students with Dysmenorrhea Have High Frequency of Irregular Menstruation and Premenstrual Symptoms. Open Med. Inform. J., 1, 8-11. 15. Cerin A, Collins A, Landgren BM, Eneroth P,(1993), Hormonal and Biochemical Profiles of Premenstrual Syndrome. Acta Obstet. Gynecol. Scand. , 72: 33743. 16. Olyai R and Thaker S,(2009), Exercise:Adolescent Menstrual Dysfunction and Skeletal Problems. SAFOG, 1(3):49-53.

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International Standard Serial Number (ISSN): 2319-8141 17. Beck LE, Gevirtz R, Mortola JF, (1990), The Predictive Role of Psychosocial Stress on Symptom Severity in Premenstrual Syndrome. Psychosom. Med. ,52:536-543. 18. Chrousos GP, Torpy DJ and Gold PW,(1998),Interactions Between the HypothalamicPituitary-Adrenal Axis and The Female Reproductive System: Clinical Implications. Ann. Intern. Med.,129(3):229-40. 19. Chrousos GP, Gold PW ,(1992), The Concepts of Stress and Stress System Disorders: Overview of Physical and Behavioral Homeostasis. JAMA, 267:1244 1252.

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