BMJ  2005;330:1190 (21 May), doi:10.1136/bmj.38442.636181.E0 (published 3 May 2005)

Primary care

Chronic fatigue in developing countries: population based survey of women in India

Vikram Patel, reader in international mental health1, Betty R Kirkwood, professor of epidemiology and international health1, Helen Weiss, senior lecturer in epidemiology and statistics1, Sulochana Pednekar, research coordinator2, Janice Fernandes, researcher2, Bernadette Pereira, researcher2, Medha Upadhye, researcher2, David Mabey, professor of communicable diseases1

1 London School of Hygiene and Tropical Medicine, London WC1E 7HT, 2 Sangath, 831/1 Porvorim, Goa, India

Correspondence to: V Patel Vikram.patel{at}lshtm.ac.uk

Objectives To describe the prevalence of and risk factors for chronic fatigue in a developing country; in particular, to determine the association of anaemia, mental health, and gender disadvantage factors with chronic fatigue.

Design Community survey.

Setting Primary health centre catchment area in Goa, India.

Participants 3000 randomly sampled women aged 18 to 50 years.

Main outcome measures Data on the primary outcome (reporting of fatigue for at least six months) and psychosocial exposures elicited by structured interview; presence of anaemia determined from a blood sample.

Results 2494 (83%) women consented to participate; 12.1% (95% confidence interval 10.8 to 13.4%) complained of chronic fatigue. In multivariate analyses, older women (P = 0.03) and those experiencing socioeconomic deprivation—less education (P < 0.001), families in debt (P = 0.09), or hunger in the past three months (P = 0.03)—were more likely to report chronic fatigue. After adjustment for these factors, factors indicating gender disadvantage (notably sexual violence by the husband; P < 0.001) and poor mental health (P < 0.001) were strongly associated with chronic fatigue. Although women with a high body mass index had a reduced risk, suggesting an influence of poor nutrition, no association was found between chronic fatigue and haemoglobin concentrations.

Conclusions Chronic fatigue was commonly reported by women in this community study from India. The strongest associations with chronic fatigue were for psychosocial factors indicative of poor mental health and gender disadvantage.


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