ABSTRACT
Background:
Peripheral neuropathy has a wide range of causes and subtle symptoms, making it difficult to diagnose. This study aimed to determine the prevalence of peripheral neuropathy among cultivators and laborers in a Center for Rural Health AIIMS (CRHA) primary healthcare center in Nutakki, Guntur District, Andhra Pradesh. The study-associated risk factors, early detection, and prevention strategies can be implemented to improve their health outcomes.
Materials and Methods:
A cross-sectional study was conducted among adult cultivators and manual laborers in the outpatient department (OPD) of the primary healthcare center in Guntur, South India. Data on demographics, lifestyle, dietary habits, and foot care practices were collected through a semi-structured questionnaire. The vibration perception threshold (VPT) was measured using a biothesiometer.
Results:
About 164 participants were enrolled in the study, with a prevalence of peripheral neuropathy of 35.98%. Cultivators had a higher prevalence (43.75%) compared to manual laborers (28.57%). Males were more likely to develop peripheral neuropathy than females (OR 1.29, P = 0.002). Lower education levels and age over 50 were associated with increased risk, particularly among cultivators. Cultivators with an age of more than 50 years had a significantly higher prevalence of peripheral neuropathy with an odd ratio (95%CI) 3.34 (1.43 to 7.75) P value < 0.005.
Conclusion:
Given the high prevalence rates of undiagnosed peripheral neuropathy among these occupational groups, such screening initiatives at primary health centers could help in the early detection, management, and prevention of peripheral neuropathy-related complications.
Keywords: Farmer, labor, peripheral neuropathy, primary healthcare
Introduction
Peripheral neuropathy involves damage to the nerves outside the brain and spinal cord, causing sensations such as numbness, weakness, tingling, and pain in the extremities. This condition can result from various factors, including diabetes, chronic alcohol use, certain infections, toxic exposures, physical injuries, and genetic disorders.[1] Those in physically demanding jobs, like farmers, are particularly vulnerable due to the repetitive strain, vibrations from machinery, and extended use of tools that can gradually harm the peripheral nerves. Additionally, farmers may face increased risks from pesticide exposure.[2]
In the United States, around 20 million individuals are estimated to suffer from peripheral neuropathy, and this number is likely even higher on a global scale.[3] While there is a lack of comprehensive data on the incidence of peripheral neuropathy in India, the prevalence is expected to be considerable due to widespread diabetes and other related risk factors.[4] A biothesiometer is a device designed to evaluate skin sensitivity to vibrations and can be used in primary care settings to identify early neuropathy signs, assess nerve damage, and determine the need for specialist referrals. It is also valuable for tracking treatment progress.[5]
Diagnosing peripheral neuropathy can be complex, with research indicating that up to 30% of cases might go undetected in primary care settings.[6] This under diagnosis can occur because symptoms are often subtle and may be mistaken for other health issues, diagnostic tests may not be familiar to many primary care providers,[6,7] and patients might delay seeking medical attention until symptoms are severe. There is a significant need for research focused on the prevalence and risk factors of peripheral neuropathy among Indian agricultural workers, particularly using biothesiometers in primary healthcare environments. This study aimed to determine the prevalence of peripheral neuropathy among cultivators and laborers and identify associated risk factors, including age, education, and occupational hazards.
Material and Methodology
The study was conducted in the outpatient department (OPD) of Center for Rural Health AIIMS, Mangalagiri (CRHA), a primary healthcare center in Nutakki, Guntur, South India. It was a community-based cross-sectional study. Data collection was done in October–December 2023. The study population consisted of adult males and females aged 20 to 60 years.
Participants were included if they had been cultivators or farmers or manual laborers for at least the past five years. Exclusion criteria included individuals who did not give consent, those with known foot ulceration or diabetic foot, patients with amputated feet, individuals with intellectual disorders, those who were very sick, pregnant women, and patients requiring surgical intervention. For the calculation of the sample size, the prevalence of peripheral neuropathy was taken to be 10.4% as reported by a study from the US.[8] The prevalence of 10.4% was chosen due to the lack of local data and its applicability to high-risk occupational groups globally. The final sample size came to be 164 after taking 5% absolute precision, 95% confidence level, and 10% non-response rate.
Systematic sampling was employed for participant selection. Data collection utilized a pre-tested semi-structured questionnaire to gather information on sociodemographic characteristics, dietary practices, physical activity, and medical history including smoking, alcohol consumption, hypothyroidism, B12 deficiency, diabetes mellitus, chronic kidney disease (CKD), human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), hepatitis B, and hepatitis C in both the participant and their spouse, as well as recent mental stress. Additionally, two in-depth interviews were conducted to assess the acceptability of using a biothesiometer among mid-level healthcare providers in the primary healthcare setting. The vibration perception threshold (VPT) was measured using an advanced biothesiometer (220 V AC 50 Hz; Model Vibra: Med ABM: 100; Sun-Med Company, India) following standard procedures. Participants were asked to remove their shoes, socks, or stockings and sit with one leg crossed over the other, making the sole of their foot free and visible. The biothesiometer probe, which vibrated with amplitude proportional to the square of the applied voltage, was held at a 90° angle to the skin with firm pressure. Measurements were taken at an average of six points on both feet: the great toe, first metatarsal, third metatarsal, third and fifth metatarsal, in step, and heel. The probe was initially applied to the participant’s hand to familiarize them with the vibration sensation. Participants were then instructed to focus on their feet and report as soon as they felt the vibration. The voltage was increased from 0 to 50 V during recording, and measures were taken to ensure the participant could not see the biothesiometer controls.
Informed consent was obtained from all participants, who were also provided with an information sheet detailing the research procedures, requirements, and their rights. Blood pressure was recorded on the right arm, supported at heart level in a sitting position, using electronic sphygmomanometers. Body mass index (BMI) was estimated as body weight (kg) divided by the height squared (m²). Peripheral neuropathy was operationally defined as a VPT score greater than 15 in either foot.[9] The study variables included the presence of peripheral neuropathy and newly diagnosed peripheral neuropathy as dependent variables, with independent variables including occupation (cultivator or manual labor), morbidities, tobacco use, alcohol use, and other factors.
Eligible patients presenting to the OPD were systematically sampled using a random number selection process. After being provided with a participant information sheet that explained the study’s objectives, procedures, and participant rights, written consent was obtained from those who agreed to participate. Participants were then interviewed according to the schedule, followed by anthropometric measurements and peripheral neuropathy screening. Data collection continued until the final sample size was achieved. Ethical clearance was obtained from the All India Institute of Medical Sciences Mangalagiri, Institutional Ethics Committee [AIIMS/MG/IEC/2023-2024 / 32 dated September 13, 2023]. A patient information sheet was given to participants in the local language and informed consent was taken from participants. Data was anonymized to protect patients’ privacy and password protected in the Community and Family Medicine Department, AIIMS Mangalagiri. All coronavirus disease 2019 (COVID-19) precautions were followed during data collection. The data was entered into Microsoft Excel 2010 (Microsoft Corporation, Redmond, Washington, United States). and analyzed using IBM SPSS Statistics for Windows, Version 28.0 (2021; IBM Corp., Armonk, New York, United States). Results were expressed as mean and standard deviation for normally distributed continuous variables, median and interquartile range for non-normally distributed variables, and proportion for categorical variables. A chi-square test or Fisher’s exact test, as applicable, was used to determine differences between categorical variables and peripheral neuropathy. The Kruskal-Wallis test was used to measure variables like dietary vitamin intake and the severity of peripheral neuropathy. A multivariable logistic regression analysis was conducted to identify factors significantly associated with peripheral neuropathy, including variables with a P value less than 0.2 in the chi-square test or bivariate logistic regression analysis. A P value less than 0.05 was considered significant.
Results
The study included 164 participants with a response rate of 95%. In the present study, 99 (60%) were males and 65 (40%) were females. The majority of the study participants, about 90 (54.88%), belonged to the age group 50 to 60 years. The mean age of the study participants was 51.26 years (standard deviation, SD 9.23). The minimum age was 23 years and the maximum age was 60 years for the studied participants. Of the total, 66 (40.24%) males were cultivators/farmers and 51 (31.10%) females were cultivators/farmers. Out of 164 study participants, more than two-thirds (62.8%) of them were educated up to primary standard or less. Among males who studied for graduation or higher was eight (4.88%). On the other hand, only two (1.22%) of females had studied graduation or higher. The mean individual income and family income of the study participants were INR 14810.43 (SD 7649.438) and INR 223597.56 (SD 10159.295), respectively. The average family size was 3.3 (SD 1.622) members. Nearly 83.5% of the study participants had a nuclear family. The mean per capita income was INR 8523.08 (SD 4662.17). Using the revised modified BG Prasad socioeconomic classification scale, January 2023, it was found that 42.07% of the study participants belonged to the lower class (INR >9098 and above) and 38.41% to the lower middle class (INR 4549–9097) [Table 1].
Table 1.
Demographic characteristics of study participants, categorized by age, occupation, and education level (n=164)
| Domain | Category | Female | Male | Total | |||
|---|---|---|---|---|---|---|---|
|
|
|
|
|||||
| n | % | n | % | n | % | ||
| Age | Less than 30 yrs. | 3 | 1.8 | 2 | 1.2 | 5 | 3.0 |
| 31 to 40 yrs. | 9 | 5.5 | 11 | 6.7 | 20 | 12.2 | |
| 41 to 50 yrs. | 28 | 17.1 | 21 | 12.8 | 49 | 29.9 | |
| More than 50 yrs. | 25 | 15.2 | 65 | 39.6 | 90 | 54.9 | |
| Occupation | Cultivators | 14 | 8.5 | 66 | 40.2 | 80 | 48.8 |
| Manual Laborers | 51 | 31.1 | 33 | 20.1 | 84 | 51.2 | |
| Education Status | Illiterate | 19 | 11.6 | 24 | 14.6 | 43 | 26.2 |
| Less than Primary school | 8 | 4.9 | 17 | 10.4 | 25 | 15.2 | |
| Primary school | 10 | 6.10 | 25 | 15.2 | 35 | 21.3 | |
| Middle School | 6 | 3.7 | 21 | 12.8 | 27 | 16.7 | |
| High School | 20 | 12.2 | 4 | 2.4 | 24 | 14.6 | |
| Intermediate/Above | 2 | 1.2 | 8 | 4.9 | 10 | 6.1 | |
| Socioeconomic Status (BG Prasad) | Upper | - | 2 | 1.2 | 2 | 1.2 | |
| Upper Middle | 8 | 4.9 | 7 | 4.3 | 15 | 9.1 | |
| Middle | 8 | 4.9 | 7 | 4.3 | 15 | 9.1 | |
| Lower Middle | 21 | 12.8 | 42 | 25.6 | 63 | 38.4 | |
| Lower | 28 | 17.1 | 41 | 25.0 | 69 | 42.1 | |
About 18 (22.5%) participants suffered from diabetes mellitus only and 23 (28.75%) suffered from hypertension only. In addition, 31 (38.75%) had both diabetes and hypertension. Likewise, 10 (6.09%) participants suffered from existing neurological pathologies, and seven (4.26%) peripheral neuropathy. The mean duration for diabetes mellitus was 9.1 years with an SD of 7.2 and the mean duration for hypertension was 7.1 years with an SD of 6.8. Likewise, the mean duration for existing neurological pathologies was 6.1 years with a standard deviation of 6.2. Of the total participants with morbidities, 27 (16.46%) were taking treatment from government health facilities and 50 (30.49%) from private health facilities [Table 2]. A total of 96 (58.54%) study participants have muscles that are weak/sore, followed by 77 (46.95%) having cramped legs and arms, 60 (36.59%) having troubled eyesight, 56 (341.5%) feeling tired or dull, etc. [Table 3].
Table 2.
Distribution of various morbidities among studied participants (n=164)
| Diagnosis | Frequency | Percent |
|---|---|---|
| Diabetes Mellitus | 18 | 22.5 |
| Diabetes Mellitus and Hypertension | 31 | 38.75 |
| Diabetes Mellitus and Hypertension, hypothyroidism | 3 | 3.75 |
| Diabetes Mellitus, Hypertension, Neurological disease | 3 | 3.75 |
| Diabetes Mellitus, Anemia | 2 | 2.5 |
| Diabetes Mellitus, Neurological disease/peripheral neuropathy | 1 | 1.25 |
| Hypertension | 23 | 28.75 |
| Hypertension, Hypothyroidism | 3 | 3.75 |
| Hypertension, Anemia | 2 | 2.5 |
| Hypertension, Neurological disease/peripheral neuropathy | 3 | 3.75 |
| Hypothyroidism | 2 | 2.5 |
| Hypothyroidism, Anemia | 1 | 1.25 |
| Anemia | 2 | 2.5 |
| Neurological disease/peripheral neuropathy | 3 | 3.75 |
| Chronic Kidney Disease | 1 | 1.25 |
Table 3.
Distribution of study participants by signs and symptoms of Vitamin B deficiency (n=164) [multiple responses]
| Signs/Symptoms of Vitamin B deficiency | Frequency | Percent |
|---|---|---|
| Having troubled eyesight | 60 | 36.59 |
| Eyes dry or stinging | 46 | 28.05 |
| Skin itchy/dry | 21 | 12.80 |
| Feeling tired or dull | 56 | 34.15 |
| Eating less food | 22 | 13.41 |
| Muscles weak/sore | 96 | 58.54 |
| Cramped legs and arms | 77 | 46.95 |
| Having trouble remembering things | 27 | 16.46 |
| Is the wound taking longer than usual to heal | 12 | 7.32 |
| Are the bones aching/sore | 52 | 31.71 |
| Having trouble walking? Can’t stay upright | 39 | 23.78 |
| Mood swings all the time | 41 | 25.00 |
Most of the study participants followed the basic foot care measures as given in Table 4. Of the total, 152 (92.68%) washed their feet each day in warm water with mild soap of which 106 practiced it daily, 146 (89.02%) checked their feet daily for cuts, cracks, splinters, and blisters and visited the doctor if symptoms in foot persist for more than a week each [Table 4].
Table 4.
Proportion of participants following the basic foot care measures (n=164) [multiple responses]
| Basic Foot Care measure | No. of participants practicing | Frequency | |||
|---|---|---|---|---|---|
|
|
|
||||
| n | % | Daily | Weekly | Monthly | |
| Checking feet for cuts, cracks, splinters, and blisters | 146 | 89.02 | 111 | 33 | 2 |
| Apply oil or lotion to all parts of the feet to keep it moisturized | 54 | 32.93 | 28 | 21 | 5 |
| Washing feet each day in warm water with mild soap | 152 | 92.68 | 106 | 41 | 5 |
| Trimming of toenails and smoothening of edges of nails | 127 | 77.44 | 18 | 65 | 44 |
| Use of soft and dry socks with shoes or sandals for good support to feet | 124 | 75.61 | 94 | 28 | 2 |
| Checking shoes for unwanted objects before wearing | 119 | 72.56 | 79 | 34 | 6 |
| Moving feet when sitting for long durations or moving toes and ankles every few minutes | 128 | 78.05 | 55 | 51 | 22 |
| Going to home on barefoot | 130 | 79.27 | 122 | 6 | 2 |
| Visiting doctor if symptoms in foot persist for more than a week | 146 | 89.02 | 64 | 18 | 61 |
The VPT was assessed by biothesiometer among the study participants. The mean measurement for the great toe on the left foot was 12.66, with a SD of 10.44. The median was 9, and the interquartile range was from 6 to 15. The mean VPT was highest in the heel (Left) followed by heel (Right) [Table 5]. A total of 20 (25%) of cultivators and 9 (10.71%) of manual laborers had severe peripheral neuropathy. About 11 (13.75%) of cultivators and 13 (15.48%) of manual laborers had mild peripheral neuropathy [Table 6].
Table 5.
Summary of statistics of vibration perception threshold using biothesiometer among the study participants (n=164)
| Site | Minimum | Maximum | Mean | Std. Deviation | Median | IQR |
|---|---|---|---|---|---|---|
| Great Toe (L) | 2 | 50 | 12.66 | 10.44 | 9 | 6 to 15 |
| 1st Metatarsal (L) | 1 | 50 | 12.53 | 10.56 | 8 | 6 to 15 |
| 3rd Metatarsal (L) | 1 | 50 | 12.46 | 10.52 | 8 | 6 to 15 |
| 5th Metatarsal (L) | 1 | 50 | 12.55 | 10.53 | 8.5 | 6 to 15 |
| In step (L) | 1 | 50 | 13.09 | 10.74 | 10 | 6 to 15 |
| Heel (L) | 2 | 50 | 13.54 | 11.04 | 10 | 6 to 15 |
| Great Toe (R) | 2 | 50 | 12.35 | 9.88 | 10 | 6 to 14.75 |
| 1st Metatarsal (R) | 2 | 50 | 12.34 | 10.16 | 8 | 6 to 15 |
| 3rd Metatarsal (R) | 2 | 50 | 12.43 | 9.96 | 9 | 6 to 15 |
| 5th Metatarsal (R) | 2 | 50 | 12.66 | 10.18 | 10 | 6 to 15 |
| In step (R) | 1 | 50 | 12.79 | 10.09 | 10 | 6 to 15 |
| Heel (R) | 2 | 50 | 13.28 | 10.48 | 10 | 6 to 15 |
*L is left and R is Right
Table 6.
Prevalence of peripheral neuropathy among study participants (n=164)
| Site | Right foot | Left foot | Both foot | Total Study Participants | |
|---|---|---|---|---|---|
| Peripheral neuropathy Present in Cultivators | n=80 | 7 | 5 | 23 | 35 |
| % | 4.27 | 3.05 | 14.02 | 21.34 | |
| Peripheral neuropathy Present in Manual Laborers | n=84 | 3 | 2 | 19 | 24 |
| % | 1.83 | 1.22 | 11.59 | 14.63 | |
| Total | n=164 | 10 | 7 | 42 | 59 |
| % | 6.10 | 4.27 | 25.61 | 35.98 |
The unadjusted and adjusted odds ratios for factors associated with peripheral neuropathy in the study participants. The dependent variables were age, sex, literacy status, occupation, socioeconomic status, tobacco, alcohol use, diabetes mellitus, etc. The adjusted odds ratios for factors associated with peripheral neuropathy in the study participants were calculated using multiple logistic regressions with entry and removal probabilities of 0.05 and 0.20, respectively. On multivariate analysis, the males had a higher prevalence of peripheral neuropathy compared to females with an odd ratio (95%CI) of 1.29 (1.13 to 1.63) and a P value of 0.002. Study participants with an age of more than 50 years had a significantly higher prevalence of peripheral neuropathy with an odd ratio (95%CI) 3.34 (1.43 to 7.75) P value < 0.005 [Table 7].
Table 7.
Distribution of various risk factors with peripheral neuropathy among study participants (n=84)
| Variable | Category | Peripheral Neuropathy | Unadjusted OR (95% CI) | P | Adjusted OR (95% CI) | P | |
|---|---|---|---|---|---|---|---|
|
| |||||||
| Present | |||||||
|
| |||||||
| n | % | ||||||
| Gender | Female | 15 | 9.15 | 2.67 (1.32 to 5.37) | 0.005* | 1.29 (1.13 to 1.63) | 0.002 |
| Male | 44 | 26.83 | |||||
| Education Status | Below primary school | 39 | 23.78 | 0.80 (0.41 to1.55) | 0.513 | . | . |
| Primary school or above | 20 | 12.20 | |||||
| Socioeconomic Status | Less than middle | 8 | 4.88 | 1.89 (0.78 to 4.52) | 0.149 | 1.20 (0.43 to 3.36) | 0.724 |
| Middle or above | 51 | 31.10 | |||||
| Age in years | Less than 50 | 12 | 7.32 | 3.99 (1.90 to 8.37) | <0.001* | 3.34 (1.43 to 7.75) | 0.005 |
| 50 or more | 47 | 28.66 | |||||
| Use of Pesticide | Present | 3 | 1.83 | 1.75 (0.45 to 6.73) | 0.411 | . | . |
| Absent | 56 | 34.15 | |||||
| Use of footwear at work | Present | 52 | 31.71 | 1.89 (0.62 to 5.66) | 0.253 | . | . |
| Absent | 7 | 4.27 | |||||
| Current smoker or smokeless tobacco user | Present | 3 | 1.83 | 4.67 (1.33 to 16.38) | 0.009* | 5.34 (0.97 to 29.42) | 0.054 |
| Absent | 56 | 34.15 | |||||
| Past smoker or smokeless tobacco user | Present | 4 | 2.44 | 3.32 (1.05 to 9.97) | 0.033* | 2.02 (0.41 to 10.03) | 0.38 |
| Absent | 55 | 33.54 | |||||
| Current Alcohol use | Present | 12 | 7.32 | 0.86 (0.38 to 1.93) | 0.725 | . | . |
| Absent | 47 | 28.66 | |||||
| Self-reported Stress | Present | 15 | 9.15 | 1.17 (0.56 to 2.42) | 0.366 | . | . |
| Absent | 13 | 7.93 | |||||
| Diabetes mellitus | Absent | 33 | 20.12 | 1.79 (9.28 to 3.48) | 0.081 | 0.72 (0.32 to 1.59) | 0.42 |
| Present | 26 | 15.85 | |||||
| Hypertension | Absent | 35 | 21.34 | 0.98 ( 0.52 to 1.89) | 0.973 | . | . |
| Present | 24 | 14.63 | |||||
| BMI | Normal | 15 | 9.15 | 0.61 (0.29 to 1.22) | 0.157 | 0.55 (0.24 to 1.24) | 0.15 |
| Abnormal | 44 | 26.83 | |||||
| Vitamin B deficiency ≥3 symptoms/signs | Present | 38 | 23.17 | 0.94 (0.48 to 1.81) | 0.843 | . | . |
| Absent | 21 | 12.80 | |||||
Discussion
In the present study among cultivators and manual laborers attending an OPD in a primary health center in Southern India, the prevalence of peripheral neuropathy was found to be 35.98% using a biothesiometer; of this, 31.71% was newly detected peripheral neuropathy. The prevalence of peripheral neuropathy among cultivators was recorded at 43.75%, while manual laborers had a prevalence of 28.57%. Similarly, a study from Guntur district Andhra Pradesh found the prevalence of peripheral neuropathy to be 21.6% (95% CI: 14.11–29.0) among the general population using biothesiometer.[10] Likely were the findings as per the study by Pradeepa et al.,[11] nearly half of the participants (47%) had peripheral neuropathy, however, their study population is diabetes mellitus cases. Neuropathy prevalence was calculated to be at about 47% [95%, CI: 40–54], which is related to the longer duration of the disease (OR: 2; 18 [CI: 95%,1;18–4;04]) for uneducated people.[12] Similarly among patients of diabetes mellitus, as per the results of the study by Bansal et al.,[13] the prevalence of peripheral neuropathy was 29.2% without any significant gender differences. As per the study done by Koopman et al.,[14] when age was considered, the effect of peripheral neuropathy was not statistically significant, with 21.5% of people with undiagnosed diabetes having positive screening test results compared to 10.1% of those without diabetes. Subsequently, according to the conclusion of a systematic review by Kirthi et al.,[15] ≥10% prevalence of peripheral neuropathy in pre-diabetes, although with figures varying widely between 2% and 77%, was in part due to diagnostic methodology. This was higher than the background prevalence of peripheral neuropathy reported in the general population of 1%–3% (increasing to 7% in the elderly); pre-diabetes was common in patients with peripheral neuropathy, and it occurs in approximately 40% of patients with idiopathic etiology. While there is abundant literature on peripheral neuropathy in relation to diabetes mellitus, there appears to be a gap in the literature concerning peripheral neuropathy specifically among cultivators and manual laborers. The present study results underscore the necessity for screening programs targeting peripheral neuropathy among cultivators and manual laborers in agricultural countries like India.
The study found the prevalence of peripheral neuropathy, emphasizing significant gender and age disparities. Males had a higher prevalence of peripheral neuropathy compared to females, with an odds ratio of 1.29 and a statistically significant P value of 0.002. Moreover, individuals over the age of 50 showed a marked increase in prevalence of peripheral neuropathy, with an odds ratio of 3.34 and a P value of less than 0.005. The study by Darivemula et al.,[16] concludes the association with age, sex, duration of diabetes, hemoglobin A1C (HbA1c) value, hypertension, and BMI which was not so in the present study. In the present study, there was no significant difference in peripheral neuropathy among participants belonging to normal and obese categories as per the BMI. However, as per the study done by Oh,[17] those with higher visceral fat area, fat mass, and higher BMI were more prone to peripheral neuropathy. These findings underscore crucial public health implications, highlighting the need for targeted screening and intervention strategies. Specifically, public health initiatives should prioritize older adults and males for early detection and management of peripheral neuropathy to mitigate progression and improve quality of life. This evidence can guide resource allocation and policy development to address these disparities effectively within the healthcare system.
The study highlights critical insights into the risk factors and prevalence of peripheral neuropathy, particularly emphasizing the impact on the feet, as supported by Katulanda et al.[18] The analysis by Clair et al.[19] identified smoking as a significant risk factor for peripheral neuropathy, with smokers exhibiting higher odds than non-smokers. In alignment with these findings, our study observed a notably higher prevalence of peripheral neuropathy among cultivators who were current smokers or users of smokeless tobacco, evidenced by a P value of 0.015. Interestingly, this association was not significant across the broader participant pool, suggesting potential occupational or lifestyle factors at play. These findings underscore substantial public health implications, particularly the need for targeted interventions among specific subgroups, like cultivators. Public health campaigns must emphasize the risks associated with tobacco use, both smoking and smokeless, and promote cessation programs. By addressing these risk factors, public health initiatives can potentially reduce the burden of peripheral neuropathy and improve health outcomes in vulnerable populations.
The current study offers a contrasting perspective on foot care awareness within the diabetic community compared to earlier findings by Taksande et al.[20] While previous research indicated a lack of awareness regarding annual foot examinations and self-examination’s importance, our study found that most participants were informed about foot care and actively engaged in daily practices. This proactive approach to foot care likely contributes to delaying the onset of complications, although this aspect was not explicitly explored. Additionally, the role of healthcare workers is pivotal, as highlighted by Begum et al.,[21] who identified inadequate information, ignorance of consequences, and lack of guidance from providers as barriers to effective foot care. By enhancing awareness and providing clear instructions on foot care, family physicians can play a crucial role in preventing complications, ultimately improving quality of life of patients. These findings have substantial public health implications, emphasizing the need for targeted educational programs and improved communication strategies within healthcare systems.
Conclusion
In this current study, conducted among cultivators and manual laborers seeking care at an OPD within a primary health center in Southern India, peripheral neuropathy was identified in 35.98% of the participants using a biothesiometer. Specifically, among cultivators, the prevalence of peripheral neuropathy was 43.75%, while among manual laborers, it was 28.57%. Given the high prevalence rates of undiagnosed peripheral neuropathy among these occupational groups, such screening initiatives at primary health centers could help in early detection, management, and prevention of peripheral neuropathy-related complications. Implementing biothesiometer-based screening programs in primary healthcare centers could improve early detection and reduce neuropathy-related complications in high-risk groups like cultivators and laborers.
Authors’ contributions
AG contributed to the conception or design of the work; SKK and MT acquired data for the work, AG and MS analyzed the data, AG and SKK wrote the first Manuscript Draft. All authors critically reviewed and revised the manuscript. AG and RA approved the final draft. Authors declare the manuscript has been read and approved by all the authors, that the requirements for authorship have been met, that each author believes that the manuscript represents honest work, and that information is not provided in another form, and AG is to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Conflicts of interest
There are no conflicts of interest.
Acknowledgments
I would like to express my deepest gratitude to the Institute for giving me the chance. Their expertise and encouragement were invaluable in shaping this work. I am deeply grateful to the healthcare professionals, medical officers, staff, and patients at CRHA, Primary Healthcare Center, Nutakki for participating in the study.
Funding Statement
Indian Council for Medical Research: STS 2023-07284.
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