Tired out? Causes of chronic fatigue in women in Goa, India

In developed countries, chronic fatigue is linked to other unexplained physical symptoms or common mental disorders such as depression and anxiety. But in poor countries, it is often said to be due to malnutrition and anaemia. Research in Goa, India, questions this difference in approach.

Researchers from the London School of Hygiene and Tropical Medicine and Sangath, Goa, studied 2,494 women aged 18 to 50 years. More than 12 percent of them complained of chronic fatigue which was often associated with having to cut back on their daily activities. Common mental disorders and other medically unexplained physical symptoms were the strongest risk factors for chronic fatigue. Compared with married participants, single women had a lower risk, whereas divorced or widowed women had a higher risk. Other characteristics which increase the likelihood of chronic fatigue include:

• older age
• lower socioeconomic status (having less education, more than three children in the household, family debt or hunger in the past three months)
• unhappy marriage, including domestic violence and concerns about the husband’s infidelity or substance use habits
• restrictions on personal freedom and decision making, or lack of support from families.

Women with high body mass index have a reduced risk, suggesting an influence of nutrition, and possibly gender differences, in access to food. But no link was found between chronic fatigue and haemoglobin levels or frank anaemia.

These rates of chronic fatigue are similar to or higher than those seen in communities in developed countries. However, most doctors in low income countries do not ask about psychological or social factors, instead prescribing drugs (such as vitamins and nutritional supplements) to treat the symptoms. The researchers recommend that decision makers in health systems in developing countries should:

• encourage practitioners to look at the psychological and social determinants of chronic fatigue before assuming that it is the result of anaemia or a nutritional deficiency
• use the growing evidence for effective treatments for common mental disorders and medically unexplained physical symptoms to develop guidelines for the management of chronic fatigue
• discourage the practice of symptomatic treatments using nutritional supplements, many of which are not evidence based, and are expensive.

Source(s):
‘Chronic fatigue in developing countries: population based survey of women in India’, British Medical Journal 330(1190), by Vikram Patel, et al., 2005 Full document.

Funded by: Wellcome Trust Career Development Fellowship in Tropical Medicine

id21 Research Highlight: 8 December 2005

Further Information:
Vikram Patel
London School of Hygiene and Tropical Medicine
c/o Sangath Centre
841/1 Alto Porvorim
Goa, India 403521

Fax: +91 832 2411709
Contact the contributor: vikram.patel@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

Sangath Society, Goa, India

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