Non Communicable Disease Risk Factors and their Trends in India

Prevalence and impact of endocrine disorders in advanced metastatic cancer patients undergoing cancer-directed therapy: A prospective observational study

BACKGROUND

Noncommunicable diseases (NCDs) contribute significantly to global morbidity and mortality, with cancer being one of the leading causes. In this prospective observational study, we aimed to investigate the prevalence and impact of endocrine disorders, specifically diabetes and thyroid dysfunction, in patients with advanced metastatic cancer undergoing cancer-directed therapy.

METHODS

Over 15 months, we recruited 100 histologically proven advanced metastatic cancer patients from the Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Rishikesh, and conducted institutional-based prospective observational study. All participants over 18 years of age, treatment-naive, and potential candidates for systemic chemotherapy with an expected clinical survival of at least 6 months were included in the study. Patients with prior therapy, secondary neoplasms, and those unable to complete 3 months of palliative chemotherapy were excluded. Patients were assessed for diabetes and thyroid function at presentation, after 3 and 6 months of cancer-directed standard therapy. These data were analyzed, processed, and presented as results.

RESULTS

The mean age of participants was 50.45 years, with a near-equal distribution of males and females. At baseline, 10% of the study population had preexisting endocrine disorders (2% hypothyroidism, 8% diabetes). By the end of 6 months, the prevalence increased to 18%, with females being more affected. Notably, the prevalence of new-onset endocrine disorders during cancer-directed therapy was only 3% for diabetes and 4% for thyroid dysfunction.

CONCLUSION

Analysis of sociodemographic and cancer-related characteristics showed no significant association with changes in diabetic and thyroid status at 3 and 6 months. However, substance use, particularly smoking, was associated with an increased risk of diabetes development (p < .05). Cancer type and treatment regimen did not show statistically significant correlations with endocrine dysfunction.

IMPLICATIONS

Our study highlights the importance of considering endocrine disorders in advanced metastatic cancer patients undergoing therapy. The prevalence of diabetes and thyroid dysfunction increased during cancer-directed therapy, particularly in females. Careful monitoring and timely intervention are essential to improve the quality of life for these patients. Further research is warranted to explore the long-term effects of cancer-directed therapy on endocrine health and develop tailored management strategies for this vulnerable population.

A Comprehensive Review on Trends and Patterns of Non-communicable Disease Risk Factors in India

This review explores the trends and patterns of non-communicable disease (NCD) risk factors in India, with a focus on tobacco use, unhealthy diet, physical inactivity, and air pollution. Drawing upon existing literature and data, the review highlights the substantial burden imposed by NCDs and their associated risk factors on public health and healthcare systems in India. Key findings reveal the widespread prevalence of these risk factors, particularly among certain demographic groups and in urban areas. Socioeconomic disparities also play a significant role in shaping the distribution of NCD risk factors across the population. The review underscores the importance of addressing NCD risk factors through evidence-based interventions and policies tailored to the Indian context. Furthermore, it emphasizes the need for multi-sectoral collaboration among government agencies, healthcare providers, civil society organizations, academia, industry partners, and communities to mitigate the NCD epidemic effectively. By mobilizing collective efforts and resources, India can make significant strides in preventing and controlling NCDs, thereby enhancing population health and well-being.

Root Cause Analysis of Gaps in Non-communicable Disease Monitoring in a Sub-district Hospital, Tamil Nadu: A Quality Improvement Initiative

Introduction Non-communicable diseases (NCDs) present a significant public health challenge globally, and India is deeply affected. With the largest population in the world, India struggles with a high burden of NCDs, encompassing cardiovascular diseases, diabetes, cancer, and chronic respiratory conditions. These ailments contribute substantially to morbidity and mortality, placing a strain on healthcare systems. Despite efforts through public health initiatives, NCD monitoring and management remain deficient, especially at grassroots levels. Methods At a sub-district hospital in Tamil Nadu, India, a quality improvement initiative targeted diabetes and hypertension, prevalent NCDs. Utilizing Fishbone analysis and process flow diagrams, we identified gaps in NCD monitoring. Employing the Plan-Do-Study-Act model and reorienting the patient flow, we enhanced NCD monitoring by optimizing patient health record maintenance within the hospital. Results Root cause analysis identified a lack of patient record protocols and patient loss of records as key hindrances in NCD monitoring. We revamped patient flow and implemented a robust record-keeping system, boosting access to patient health records. This initiative was embraced by healthcare providers, enhancing NCD management. Leveraging these records, we assessed control rates of diabetes and hypertension patients effectively. Conclusion The research underscores the importance of maintaining comprehensive patient health records in healthcare centers for enhancing NCD monitoring. These records serve as valuable tools for healthcare providers, aiding in the monitoring and treatment of patients with diabetes and hypertension. By leveraging these records, healthcare providers can achieve better disease control outcomes, thereby improving the overall management of NCDs.

Predictors of Multimorbidity (Defined as Diabetes + Hypertension) Amongst Males Aged 15-54 in India: An Urban/Rural Split Analysis

Objectives: This study aimed to determine which sociodemographic and lifestyle factors may act as predictors of multimorbidity (defined as diabetes + hypertension) amongst men aged 15-54 within urban and rural areas of India. Methods: Data from the latest 2019-2021 India NFHS-5 survey were utilized. Presumed cases of multimorbidity were defined as men who had DM + HTN. A total of 22,411 men in urban areas and 66,768 rural men were analyzed using mixed-effect multi-level binary logistic regression models. Results: Various predictors were found to have a statistically significant association to multimorbidity. Urban areas: Age, region of residence, wealth, religion, occupation, and BMI. Rural areas: Age, education, region of residence, wealth, occupation, caste, BMI, alcohol consumption, media exposure, and tobacco consumption. Conclusion: Departing from the broad operational definitions often studied within literature, this study provided insight into one of the most prevalent specific multimorbidities across India. The urban/rural split analyses revealed substantial differences in high-risk characteristics across both areas, which have commonly been overlooked. These findings may better inform policymakers and assist in effectively reducing multimorbidity-related burden through area-specific preventative programs.

Levels of work stress among information technology professionals during COVID-19 pandemic in an Indian metropolis

Introduction

Amid the ongoing Non-Communicable Disease and COVID-19 pandemic, understanding prevalence and characteristics associated with work stress is vital from a health and economic perspective, more so among information technology (IT) professionals.

Objective

To estimate the prevalence and factors associated with work stress among IT professionals during the coronavirus disease 2019 (COVID-19) pandemic in Bengaluru, India.

Materials and Methods

A cross-sectional study was undertaken on a convenient sample of 356 IT professionals in Bengaluru, India, between September 2020 and March 2021 to assess work stress. The weblink to TAWS-16 (Tool to Assess and classify Work Stress) was provided for IT employees to self-report their experience of work-related stressors and coping abilities in the past 6 months. The prevalence and specific prevalence of work stress were calculated. Multi-variate logistic regression was conducted to identify factors associated with work stress. Ethical clearance was obtained from the Institutional Ethics committee, National Institute of Mental Health and Neurosciences, Bengaluru. Informed consent was obtained from study subjects.

Results and Conclusion

The prevalence of work stress among IT professionals was 17.7% during the COVID19 pandemic, with higher rates among employees aged 31 years and above, among female employees, and among employees with 4-7 years of work experience. More than 80% of the professionals experienced deadline pressures, long working hours, regular multi-tasking, and difficulty in maintaining work-life balance. Based on the results, it is recommended to integrate work-stress assessment in periodical medical examination of IT employees from a health promotion and productivity improvement perspective.

Trend of risk factors for cardiovascular diseases among young and middle-aged indians: Insights from a nationally representative survey

Background

India, as a nation is witnessing epidemiological transition, which is taking place across all the states at different level, over past couple of decades. Owing to the long natural history of non-communicable diseases (NCDs), early identification of these risk factors can aid in understanding the distribution and future development of cardiovascular diseases (CVDs). Also, studying the trend of these risk factors over time can help in prediction of burden of various CVDs in future. Thus, the present study aims at understanding the trend of various risk factors for CVDs across rural and urban India, and states.

Methods

The present study was conducted using secondary data from the third, fourth and fifth round of the National Family Health Survey (NFHS) conducted in India. The surveys collected data for estimation of burden of the common modifiable risk factors of CVDs including tobacco and alcohol consumption overweight/obesity, raised blood pressure, and raised blood sugar. The analysis for the present study was done among interviewed males and females between 15 and 49 years. The weighted prevalence of these risk factors was computed and binary logistic regression was done to study the predictors for the same.

Results

A declining trend of tobacco (29.2% in NFHS 3; 8.1%in NFHS 5) and alcohol consumption (14.2% in NFHS 3; 3.2%in NFHS 5) was observed from 2005 -06 to 2019-21. A rising trend of overall raised blood pressure (11.4% in NFHS 4; 12.2%in NFHS 5), raised blood sugar (6.2% in NFHS 4; 8.5%in NFHS 5), and overweight and obesity (11.4% in NFHS 3; 23.6%in NFHS 5) was observed from the three rounds of the survey. The odds of all the studied risk factors were significantly higher among older age across all the rounds of the survey. Except overweight/obesity, the odds of rest all studied risk factors was found to be higher among males compared to females. Also, higher odds of alcohol consumption, overweight/obesity, raised blood pressure, and raised blood sugar were found among the participants living in urban areas compared to rural areas, across all the rounds of the survey.

Conclusion

The present highlights the rising burden of CVD risk factors, including overweight and obesity, raised blood pressure and raised blood sugar, and a declining trend of tobacco and alcohol consumption across the country. The study also highlights the need for in-depth assessment of predictors of these risk factors using longitudinal study designs.

The Economic Cost of Rising Non-communicable Diseases in India: A Systematic Literature Review of Methods and Estimates

BACKGROUND AND OBJECTIVES

India has one of the world's highest proportions of out-of-pocket expenditure (OOPE) payments. The low share of public health expenditure coupled with the double burden of disease (communicable and non-communicable) has a direct financial impact on individual OOPE and an indirect impact in the form of decreasing life expectancy, reduced productivity, and hence a negative impact on economic growth. This systematic review aims to compare and assess the estimated economic cost of non-communicable diseases (NCDs) in India and ascertain the methods used to derive these estimates.

METHODS

This paper reviews the past 12-year (2010-22) literature on the economic impact of health shocks due to NCDs. Three databases were searched for the literature: PubMed, Scopus, and Google Scholar. Thematic analysis has been performed to analyse the findings of the study.

RESULTS

The OOPE was very high for NCDs. The increasing cost was high and unaffordable, pushing many people into financial distress measured by catastrophic payments and rising impoverishment.

CONCLUSION

The results indicate both the direct and indirect impact of NCDs, but the indirect burden of loss of employment and productivity, despite its relevance, has been less studied in the literature. A robust economic analysis will allow an evidence-based policy decision perspective to reduce the rising burden of NCDs.

Review of the unmet medical need for vaccination in adults with immunocompromising conditions: An Indian perspective

Immunocompromised (IC) populations are at increased risk of vaccine-preventable diseases (VPDs). In India, the concern of VPDs in IC populations is particularly acute due to the prevalence of crowded living situations, poor sanitation and variable access to healthcare services. We present a narrative review of IC-related disease and economic burden, risk of VPDs and vaccination guidelines, based on global and India-specific literature (2000-2022). IC conditions considered were cancer, diabetes mellitus, chronic kidney disease, respiratory disorders, disorders treated with immunosuppressive therapy, and human immune deficiency virus (HIV). The burden of IC populations in India is comparable to the global population, except for cancer and HIV, which have lower prevalence compared with the global average. Regional and socioeconomic inequalities exist in IC prevalence; VPDs add to the burden of IC conditions, especially in lower income strata. Adult vaccination programs could improve health and reduce the economic impact of VPDs in IC populations.

Areca nut and smokeless tobacco exposure induces micronucleus, other nuclear abnormalities and cytotoxicity in early chick embryo

Areca nut (AN) and smokeless tobacco (SLT) are indiscriminately consumed among the populations of Southeast and South Asian countries, even by women during the gestational period. This study aimed to investigate the genotoxic and cytotoxic potentials of AN and Sadagura (SG), a unique homemade SLT preparation, alone and in combination in early chick embryos. Fertile white leghorn chicken eggs were randomly divided into five treatment groups: vehicle control, positive control (Mitomycin C, 20 μg/egg), AN, SG, and AN+SG. AN, SG, and AN+SG were given at dosages of 0.125, 0.25, and 0.5 mg/egg. The hen's egg test for micronucleus induction (HET-MN) was performed in chick embryos to evaluate the genotoxic potential of the test agents. Furthermore, the cytotoxic potential was assessed by studying erythroblast cell populations and the polychromatic erythrocytes (PCEs) to normochromatic erythrocytes (NCEs) ratio. Our results indicated a significant increase (p < .001) in MN frequency and other nuclear abnormalities, suggesting the potential of AN and SG to cause genotoxicity. Also, AN and SG exposure alone and in combination considerably altered the erythroblast cell population (%) and the PCE to NCE ratio in all the treatment periods. Our findings established the genotoxic and cytotoxic potential of both AN and SG alone and in combination during early embryonic development in the chick embryo.

Examining chronic disease onset across varying age groups of Indian adults using competing risk analysis

In low-and-middle-income countries, people develop chronic diseases at a younger age, leading to health-and-economic loss. Estimates of the age of onset of chronic disease provide evidence for policy intervention, but in the Indian context, evidence is limited. The present study aims to explore the onset of seven chronic diseases across adults and the elderly, along with the prognostic factors of chronic disease onset. Using Wave 1 data of the Longitudinal Ageing Study in India (LASI), we estimated the statistical distributions, the median age at onset, and Loglogistic and Weibull accelerated failure time model to understand the onset of seven medically diagnosed self-reported chronic diseases across age groups. We also obtained the sub-distribution hazard ratio (SHR) from the Fine-Gray model to determine the risk of contracting selected chronic diseases in a competing risk setup. The seven chronic diseases- hypertension, diabetes, lung disease, heart disease/stroke, arthritis, neurological disease, and cancer- were developing early, especially in individuals aged 45-54 and 55-64. Arthritis risk was higher in rural areas, and physically active adults and elderly were 1.32 times (95% CI 1.12-1.56) more likely to develop heart disease/stroke. The emerging evidence of the early onset of neurological diseases in middle-aged adults (i.e., among the 45-54 age group) reminds us of the need to reinforce a balance between the physical and mental life of individuals. The early onset of chronic diseases in the independent and working-age category (45-54 years) can have many social and economic implications. For instance, it can create a greater healthcare burden when these individuals grow older with these diseases. Further, disease-specific interventions would be helpful in reducing future chronic disease burden.

Non-communicable disease management: Access to healthcare during COVID-19 pandemic in rural Kerala, India

Background

Globally, data on the coronavirus disease (COVID-19) pandemic showed a higher risk of infection and complications in people with non-communicable diseases (NCDs). In India, the prevalence of NCDs and their risk factors vary significantly between states. Compared to other states, Kerala has the highest prevalence of non-communicable diseases in the country, along with the highest proportion of the elderly population. The study evaluates the disease management patterns and changes in healthcare behaviors among adults with NCDs in Kerala during the COVID-19 pandemic.

Methods

A cross-sectional study was conducted among 410 adult NCD patients in rural Thiruvananthapuram district, Kerala. Using a semi-structured interview schedule, the present study gathered information on socio-demographic characteristics, disease patterns, healthcare utilization, and behavioral change during the pandemic.

Results

Mean age of the participants was 62 years (range: 37-88; women: 64%). The most prevalent NCD was hypertension (74%) and diabetes (65%) followed by chronic respiratory disease (12%), cardiovascular disease (11%), and cancer (2%). Nearly 76% had difficulty in obtaining consultation/medical follow-up. Around 10% relied on telecommunication and 32% reported increased stress during the pandemic. Those with low socio-economic status and with a single NCD were more vulnerable to the challenges faced during the pandemic.

Conclusion

A higher proportion of adults with NCDs faced difficulties in healthcare access and had negative healthcare behaviors during the pandemic. The findings highlight the need to ensure better healthcare for people living with NCDs during the times of pandemic.

The burden of non-communicable diseases: A scoping review focus on the context of India

The mortality rate of non-communicable diseases (NCDs) contributes more in low-income and middle-income countries, also among individuals with lower socioeconomic status in high-income countries, making NCDs a big hurdle to minimizing global and national health disparities. Among 55 million fatalities worldwide in 2019, NCDs accounted for about 41 million (71%) deaths. The purpose of this scoping review was to comprehend the available literature on the burden of NCDs in India. This review included the studies that have been published between the period of 2009-2020. For this review, 18 full-text articles have been selected. A preliminary search was done to obtain articles from the search engines such as PubMed, Google Scholar, web of science, and Scopus. Our scoping review was focused on five major NCDs which are cardiovascular, hypertension, diabetes, cancer, and stroke. In 2019, around 17.9 million individuals died from cardiovascular disease (CVD), which is accounting for 32% of all deaths. As compared to Chandigarh and Jharkhand (0.12 million and 0.96 million, respectively) Tamil Nadu and Maharashtra (4.8 million and 9.2 million, respectively) have a higher percentage of the population affected by diabetes. In India, stroke is the fifth-significant cause of disability and the fourth-leading cause of fatality, which is accounting for 3.5 percent of all disabilities. India should construct a higher-level coordinating framework and devise an overarching policy or strategy tailored to NCDs. To limit risk factor exposure, it is necessary to emphasize health promotion and preventive actions.

Carbon Nanotubes as Carriers in Drug Delivery for Non-Small Cell Lung Cancer, Mechanistic Analysis of Their Carcinogenic Potential, Safety Profiling and Identification of Biomarkers

Non-small cell lung cancer (NSCLC) is a global burden leading to millions of deaths worldwide every year. Nanomedicine refers to the use of materials at the nanoscale for drug delivery and subsequent therapeutic approaches in cancer. Carbon nanotubes (CNTs) are widely used as nanocarriers for therapeutic molecules such as plasmids, siRNAs, antisense agents, aptamers and molecules related to the immunotherapy for several cancers. They are usually functionalized and loaded with standard drug molecules to improve their therapeutic efficiency. Functionalization and drug loading possibly decrease the genotoxic and carcinogenic potential of CNTs. In addition, the targeted cytotoxic properties of the drug improve and undesired toxicity decreases after drug loading and/or conjugation with proteins, including antibodies. For intended drug delivery, a lysosomal pH of 5.5 is more suitable and effective for the slow and extended release of cytotoxic drugs than a physiological of pH 7.4. Remarkably, CNTs possess intrinsic antitumor properties and are usually internalized by endocytosis. After being internalized, several mechanisms are involved in the therapeutic and carcinogenic effects of CNTs. They are generally safe for therapy, and their toxicity profile remains dependent on their physicochemical properties. Moreover, the dose, route, duration of exposure, surface properties and degradative potential determine the toxicity outcomes of CNTs locally or systemically. In summary, the use of CNTs in drug delivery and NSCLC therapy, as well as their genotoxic and carcinogenic potential and the possible mechanisms, has been discussed in this review. The therapeutic index is generally high for NSCLC cells treated with drug-loaded CNTs; therefore, they are effective carriers in implementing targeted therapy for NSCLC.

Child marriage and health disparities in adulthood: the differential risk of untreated hypertension among young adult women in India

BACKGROUND

Hypertension is a major risk factor of cardiovascular diseases, which is the leading cause of premature mortality worldwide. While untreated hypertension heightens the risk of mortality and morbidity among hypertensive individuals, access to hypertension care in low-and-middle income countries has ties with various socioeconomic inequalities. Child brides represent a marginalized group of population who experience various socioeconomic disadvantages. This study investigates whether there exists any disparity in receiving treatment for hypertension between child brides at young adult age and their same-age peers who were married as adults.

METHODS

We obtained data on 22,140 currently married hypertensive women aged 20 to 34 years from the 2015-16 wave of National Family Health Survey (NFHS-4) of India. We estimated multilevel univariate and multivariable logistic regressions to obtain the odds in favor of not receiving treatment for hypertension. We compared the odds for child brides with those of their peers who were married as adults.

RESULTS

Among the study participants, 72.6% did not receive any treatment for hypertension. While the share was 70.6% among women who were married as adults, it was 4.3 percentage points higher (P < 0.001) among the child brides. Results from the multilevel logistic regressions reveal that adjusted odds of having untreated hypertension for child brides were 1.12 times (95% confidence interval, 1.00-1.25) that of those who were married as adults.

CONCLUSIONS

Our findings show that hypertensive women who were married as children are at greater risk of not receiving hypertension care at young adult age. Therefore, young women who got married in their childhood should be targeted for regular screening and proper referral and treatment to avoid further detrimental effects of elevated blood pressure.

Burden of communicable and non-communicable diseases-related inequalities among older adults in India: a study based on LASI survey

Background

A rising proportion of elderly in India has infused notable challenges to the healthcare system, which is already underdeveloped. On one side, NCDs are increasing among the elderly in India; however, on the other side, CDs are also a cause of concern among the elderly in India. While controlling the outbreak of communicable diseases (CDs) remained a priority, non-communicable diseases (NCDs) are placing an unavoidable burden on the health and social security system. India, a developing nation in South Asia, has seen an unprecedented economic growth in the past few years; however, it struggled to fight the burden of communicable and non-communicable diseases. Therefore, this study aimed at examining the burden of CDs and NCDs among elderly in India.

Methods

Data from Longitudinal Ageing Study in India (LASI Wave-I, 2017–18) were drawn to conduct this study. The LASI is a large-scale nationwide scientific study of the health, economics, and social determinants and implications of India's aged population. The LASI is a nationally representative survey of 72,250 aged 45 and over from all Indian states and union territories. Response variables were the occurrence of CDs and NCDs. The bi-variate and binary logistic regression were used to predict the association between communicable and non-communicable diseases by various socio-demographic and health parameters. Furthermore, to understand the inequalities of communicable and non-communicable diseases in urban and rural areas, the Fairlie decomposition technique was used to predict the contribution toward rural–urban inequalities in CDs and NCDs.

Results

Prevalence of communicable diseases was higher among uneducated elderly than those with higher education (31.9% vs. 17.3%); however, the prevalence of non-communicable diseases was higher among those with higher education (67.4% vs. 47.1%) than uneducated elderly. The odds of NCDs were higher among female elderly (OR = 1.13; C.I. = 1–1.27) than their male counterparts. Similarly, the odds of CDs were lower among urban elderly (OR = 0.70; C.I. = 0.62–0.81) than rural elderly, and odds of NCDs were higher among urban elderly (OR = 1.85; C.I. = 1.62–2.10) than their rural counterparts. Results found that education (50%) contributes nearly half of the rural–urban inequality in the prevalence of CDs among the elderly. Education status and current working status were the two significant predictors of widening rural–urban inequality in the prevalence of NCDs among the elderly.

Conclusion

The burden of both CD and NCD among the elderly population requires immediate intervention. The needs of men and women and urban and rural elderly must be addressed through appropriate efforts. In a developing country like India, preventive measures, rather than curative measures of communicable diseases, will be cost-effective and helpful. Further, focusing on educational interventions among older adults might bring some required changes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03481-x.

COVID-19 pandemic effects on the distribution of healthcare services in India: A systematic review

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has brought fundamental changes to our problems and priorities, especially those related to the healthcare sector. India was one of the countries severely affected by the harsh consequences of the COVID-19 pandemic.

AIM

To understand the challenges faced by the healthcare system during a pandemic.

METHODS

The literature search for this review was conducted using PubMed, EMBASE, Scopus, Web of Science, and Google Scholar. We also used Reference Citation Analysis (RCA) to search and improve the results. We focused on the published scientific articles concerned with two major vital areas: (1) The Indian healthcare system; and (2) COVID-19 pandemic effects on the Indian healthcare system.

RESULTS

The Indian healthcare system was suffering even before the pandemic. The pandemic has further stretched the healthcare services in India. The main obstacle in the healthcare system was to combat the rising number of communicable as well as noncommunicable diseases. Besides the pandemic measures, there was a diversion of focus of the already established healthcare services away from the chronic conditions and vaccinations. The disruption of the vaccination services may have more severe short and long-term consequences than the pandemic’s adverse effects.

CONCLUSION

Severely restricted resources limited the interaction of the Indian healthcare system with the COVID-19 pandemic. Re-establishment of primary healthcare services, maternal and child health services, noncommunicable diseases programs, National Tuberculosis Elimination Program, etc. are important to prevent serious long-term consequences of this pandemic.

Why The Knowledge of Indian School-Going Adolescents Regarding NCDs is Not Transforming into Lifestyle Changes?

Background

There is a paucity of research to demonstrate the quantification of adolescents' risk behavior toward Non-Communicable Diseases (NCD) in India. This study aims to explain the knowledge of school-aged adolescents about NCD and whether their knowledge is truly translating into lifestyle changes and if not, what are the potential underlying factors responsible for that.

Methodology

A school-based cross-sectional study was conducted on adolescents in Jodhpur district, India, in grades 6 to 12. The data was gathered via a semi-structured questionnaire. The participant's weight and height were assessed using a digital weighing machine and a stadiometer, respectively. SPSS v.23 was used to analyze the data. Univariate (chi-square) and multivariate (logistic regression) analysis were used to quantify knowledge and risk factors, and inferences were derived.

Results

A total of 1010 students participated in the study. The mean scores of knowledge and risk behavior were 32.82±6.43 (out of 40) and 9.23+2.63 (out of 30), respectively. Adolescent risk behavior and knowledge were not found to be significantly related. Physical activity, spending fewer hours sitting, not skipping breakfast, and habit of fruit and vegetable consumption were significant factors for a healthy lifestyle among them.

Conclusion

Due to differences in underlying predictors, adolescents' understanding of NCDs did not translate into healthy lifestyle modifications. These findings highlight the importance of developing tailored interventions for adolescents that target identified risk domains.

Estimates of major non-communicable disease risk factors for India, 2010 & 2015: A summary of evidence

Background & objectives

The National Monitoring Framework for the prevention and control of NCDs in India has set targets for reduction of risk factors relative to the measure recorded in 2010. Estimates for 2010 and 2015 were established using meta-analyses in the absence of a national risk factor survey till 2017.

Methods

We searched national survey reports and also articles published in English from India between 2008 and 2017 in PubMed, Google Scholar and Cochrane review databases for specific risk factors among 18-69 yr Indians. Quality of studies was evaluated using Joanna-Briggs tool, but all studies were included in analyses. Estimates for each of the eight strata by age, gender and place of residence, respectively, were generated. MetaXL was used to calculate the pooled estimate for 2010 and 2015 using a random effects model. Strata-specific estimates were combined to arrive at national estimate using population weight of each stratum. The credibility of the estimates was determined using four parameters - average Briggs score; representativeness of the contributing studies and precision and stability of the estimates.

Results

The estimates [95% confidence interval (CI)] for 2010 for different risk factors were as follows: current alcohol use, 15.7 per cent (13.2-18.2); current tobacco use, 27 per cent (21.4-32.6); household solid fuel use, 61.5 per cent (50.2-72.5); physical inactivity, 44.2 per cent (37.8-50.6); obesity, seven per cent (3.8-10.2) and raised blood pressure, 20.2 per cent (18.4-22.1). In 2015, compared to 2010, tobacco use showed a relative decline of 18 per cent, household solid fuel use of nine per cent and physical inactivity of 15 per cent. The estimates were stable for alcohol use, raised blood pressure and obesity between 2010 and 2015. All estimates varied between moderate and high degrees of credibility.

Interpretation & conclusions

The estimates are consistent with other available estimates and with current national-level initiatives focused on tobacco control and improving access to clean fuel. These estimates can be used to monitor progress on non-communicable disease risk factor targets for India.

Decomposing rural-urban differences in successful aging among older Indian adults

The modernization and shift towards urbanized lifestyles have triggered several diseases, and the context of aging varies in urban and rural settings in India. The study aimed to investigate the urban-rural differences in successful ageing among older adults in India and the contributing factors in those differences. The study utilizes data from nationally representative Longitudinal Ageing Study in India (LASI, 2017-18). The analytical sample size for the study was 31,464 older adults aged 60 years and above. Descriptive statistics and bivariate analysis were carried out to present the initial results. Multivariable logistic regression and decomposition analysis was used to find the associations between explanatory variables and successful aging and to identify the contributions of covariates that explain the rural-urban differences in successful ageing. A proportion of 32% and 24% of older adults from rural and urban areas were successful agers with an urban disadvantage. Urban-dwelling older adults had 0.67 times [95% confidence interval (CI): (0.64, 0.71)] lower unadjusted odds of successful ageing than rural older adults. Again, after adjusting for the effect of other explanatory variables, urban older adults had 0.92 times [CI: (0.87, 0.98)] lower odds of being successful agers than their rural counterparts. The major contributors to the rural-urban inequality in successful aging were differences in regional distribution (17% contribution), waist circumference (16%), working status (16%), body mass index (13%) and physical activity (8%) among rural and urban older adults. The urban disadvantage in aging successfully may reflect the higher prevalence of adverse lifestyle behaviours in urban dwellers and under-diagnosis and under-reporting of many diseases in rural areas, particularly non-communicable diseases, suggesting the need for further investigation.

Relationship between tobacco use, alcohol consumption and non-communicable diseases among women in India: evidence from National Family Health Survey-2015-16

BACKGROUND

Based on an increased prevalence of diabetes, asthma and hypertension among women in reproductive age, understanding the risk factors of non-communicable diseases (NCDs) is crucial to inform policy and program interventions to address the problem. In this study, we empirically assessed the associations of behavioural factors such as alcohol consumption and tobacco use and a variety of socioeconomic characteristics with prevalence of NCDs in adult women.

METHODS

The data were derived from the National Family Health Survey conducted in 2015-16. The effective sample size for the present paper was 699,686 women aged 15-49 years in India. Descriptive statistics along with bivariate analysis were conducted to find the preliminary results. Additionally, multivariable logistic regression analysis was conducted to find the relationship between NCDs and behavioural factors such as alcohol consumption and tobacco use. Moreover, population attributable risk was estimated in the present study.

RESULTS

It was revealed that 15.9% of women had any of the NCDs. A proportion of 0.8% of women smoked tobacco whereas 5.5% of women consumed smokeless tobacco. Also, a proportion of 1.2% of women consumed alcohol in the current study. The odds of having NCDs among women who smoked tobacco, consumed smokeless tobacco and consume alcohol were 16, 8 and 20% significantly higher than the odds of having NCDs among women who did not smoke tobacco, consume smokeless tobacco and consume alcohol respectively. The population attributable risk of having NCDs was 1.8% (p < 0.001) for women who smoked, 0.8% (p < 0.001) for women who consumed smokeless tobacco and 2.2% (p < 0.001) for women who consumed alcohol. Besides, the odds of having NCDs among overweight and obese women were 2.25 and 3.60 times greater than the odds of having NCDs among women who were underweight.

CONCLUSION

The findings revealed that smoking and using smokeless tobacco and alcohol consumption were risk factors of NCDs in women. The findings also alarm the focus of maternal and child health programs on NCDs' risk factors like maternal obesity, due to their adverse health consequences on their children too. Also, the coexistence of higher levels of tobacco use and alcohol consumption requires different strategies to address the vulnerability of women towards NCDs, including screening and early detection of NCDs especially among those who smoke or chew tobacco and consume alcohol.

Evolving Food Choices Among the Urban Indian Middle-Class: A Qualitative Study

One of the leading risk factors for an escalating obesity burden in India is non-nutritious choices. Underpinned by the nutrition transition theory, this qualitative inquiry was designed to understand the urban middle-class Indian consumers’ views about processed foods and rapidly changing food choices. The study consisted of two phases, the first phase consisted of focus group discussions pertaining to the definition and conception of processed foods and the second phase consisted of interviews regarding the changing food environment. A convenience sample of Indian consumers aged 40–65 years were recruited from Mumbai and Kochi to participate in focus group discussions (FGD1 – nine participants and FGD2 – seven participants) and semi-structured face-to-face interviews (N = 22). Both discussions and interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyze the transcribed data. Features of processed foods mentioned were chemical and physical processing, prolonged shelf life and poor nutritional quality. Factors influencing food choices and consumption of processed foods reported by participants could be categorized into changes in the socio-cultural environment and changes in the food environment. Changes in the socio-cultural environment included globalization and urbanization, long work days and sedentary living, rise in income levels and decrease in household cooking. Changes in the food environment included increased availability and accessibility of processed foods, replacement of traditional Indian diet with Western food, food as indicators of status, food advertisements and convenience. These results are consistent with nutrition transition theory and provide useful direction for public health policies aimed at promoting healthy diets.

Quality of mobility measures among individuals with acquired brain injury: an umbrella review

Background and objective

While several mobility measures exist, there is large variability across measures in how mobility is conceptualized, the source of information and the measurement properties making it challenging to select relevant mobility measures for individuals with acquired brain injury (ABI). Therefore, the objective was to conduct a comprehensive synthesis of existing evidence on the measurement properties, the interpretability and the feasibility of mobility measures from various sources of information (patients, clinicians, technology) using an umbrella review of published systematic reviews among individuals with ABI.

Methods

Ovid MEDLINE, CINHAL, Cochrane Library and EMBASE electronic databases were searched from 2000 to March 2020. Two independent reviewers appraised the methodological quality of the systematic reviews using the Joanna Briggs Institute critical appraisal checklist. Measurement properties and quality of evidence were applied according to COnsensus-based Standards for the Selection of Health Measurement Instrument (COSMIN) guidelines. Mobility measures were categorized using international standards with the international classification of functioning, disability and health (ICF).

Results

Thirty-five systematic reviews were included covering 147 mobility measures, of which 85% were mapped to the ICF Activity and Participation component. Results showed an acceptable overall "sufficient" rating for reliability, construct validity and responsiveness for 132 (90%), 127 (86%) and 76 (52%) of the measures, respectively; however, among these measures, ≤ 25% of the methods for evaluating these properties were rated as ‘high’ quality of evidence. Also, there was limited information that supports measure feasibility and scoring interpretability.

Conclusions

Future systematic reviews should report measures’ content validity to support the use of the measure in clinical care and research. More evaluations of the minimal important difference and floor and ceiling effects are needed to help guide clinical interpretation.

Registration information

International Prospective Register of Systematic Reviews (PROSPERO); ID: CRD42018100068.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-022-03103-4.

Lifestyle factors influencing medical and nursing student's health status at the rural health-care institute

BACKGROUND

Noncommunicable diseases (NCDs) may be influenced by lifestyle behavior, acquired during transition in student life at university. Health is a major concern globally. The developing counties are facing a double burden of disease, both communicable and NCD. This study is aimed to assess the lifestyle and its associated factors that can affect the health status of medical and nursing students.

MATERIALS AND METHODS

A community-based cross-sectional study was conducted among medical and nursing students of Sasaram, Bihar, by universal sampling. The study population consisted of 303 medical and 233 nursing students. The 536 students in the study, included 195 from rural areas and 341 from urban areas. Simple Lifestyle Indicator Questionnaire was used and Chi-square statistics was computed to determine the association of demographic variables with lifestyle behavior using Epi InfoTM 7 analysis software.

RESULTS

Mean age and body mass index were 21 ± 2.59 years and 22.12 ± 3.77, respectively. After statistical analysis utilizing the Chi-square test, it was shown that the difference was found to be nonsignificant (P > 0.05) in all the following variables, such as gender, age, marital status except in designation, and alcohol and tobacco intake which showed the difference to be highly significant.

CONCLUSIONS

The maximum number of students in the study population showed intermediate healthy lifestyle (57.1%), despite being the upcoming health-care providers of future. Fruits were rarely present in diet in 82%, no physical activity in 21.2%, and tobacco and alcohol were consumed by 11.7% and 13%, respectively. Targeted intervention for healthy diet, physical activity, stress, tobacco, and alcohol reduction can lead to healthy lifestyle. Independence and autonomy gained in the transition phase in student life needs guided supervision to raise responsible adults. It may help to assist or to plan accordingly in future to improve lifestyle of the students.

Overweight and Its Associated Factors among Women of Reproductive Age in Dire Dawa, Eastern Ethiopia, 2021: Community-Based Cross-Sectional Study

BACKGROUND

Overweight in women of reproductive age is a major public health concern in developing countries because of overconsumption of low-quality food. Currently, being overweight is a major health concern worldwide. It exposes humans to various health problems. In Ethiopia, despite the trend indicated increasing in overweight, priority is given for undernutrition. In Dire Dawa, there is scarce evidence regarding reproductive age overweight. Therefore, this study is designed to assess the prevalence of overweight and its associated factors among women of reproductive age in eastern Ethiopia.

METHODS

A community-based cross-sectional study was conducted from May 15 to June 15, 2021, in Dire Dawa, Eastern Ethiopia; a multi-stage systematic sampling technique was used to select 559 women aged 15-49 years. Data were collected through face-to-face interviews using a structured pretested questionnaire. Ninety-five percent CI was used to identify the factors associated with overweight while controlling for all possible confounders using multivariable logistic regression. Statistical significance was set at a P-value of 0.05.

RESULTS

The results of this study revealed that the prevalence of overweight was 63.1% (95% CI: 59.0, 67.2). Overweight was significantly associated with weekly discretionary calories (AOR = 3.964, 95% CI (1.131, 13.894)), contraceptive use (AOR = 2.838, 95% CI (1.443, 5.580)), and monthly family income (AOR = 3.916, 95% CI (1.352, 11.340)).

CONCLUSION

Overweight among women of reproductive age was high in Dire Dawa city. Discretionary calories per week, family monthly income, and contraceptive use were significantly associated with overweight. Developing and implementing community-based culturally sensitive, feasible, and potentially high-impact intervention to address the modifiable risk factors among women of reproductive age is critical.

Determinants of the Underlying Causes of Mortality during the First Wave of COVID-19 Pandemic in Saudi Arabia: A Descriptive National Study

Since the emergence of the COVID-19 pandemic, the mortality statistics are constantly changing globally. Mortality statistics analysis has vital implications to implement evidence-based policy recommendations. This study aims to study the demographic characteristics, patterns, determinants, and the main causes of death during the first half of 2020, in the Kingdom of Saudi Arabia (KSA). Methodology: A retrospective descriptive study targeted all death (29,291) registered in 286 private and governmental health settings, from all over KSA. The data was extracted from the ministry of health’s death records after the ethical approval. The International Classification of Diseases (ICD-10) and WHO grouping, were used to classify the underlying causes of deaths. The collected data were analyzed using the appropriate tables and graphs. Results: 7055 (24.9%) died at the middle age (40–59 year), and 19,212 (65.6%) were males, and 18,110 (61.8%) were Saudi. The leading causes of deaths were non-communicable diseases (NCDs) 15,340 (62.1%), mainly Cardiovascular diseases (CVDs) 10,103 (34.5%). There was a significant relationship between the main causes of deaths and sex (p < 0.05) and nationality (p = 0.01). Conclusion: NCDs mainly CVDs are the leading cause of death. The COVID-19 mortalities were mainly in males, and old age > 55 year. The lockdown was associated with a reduction in the NCDs and Road traffic accidents mortalities.

Ethnopharmacological, Phytochemical, Pharmacological, and Toxicological Review on Senna auriculata (L.) Roxb.: A Special Insight to Antidiabetic Property

Avartaki (Senna auriculata (L.) Roxb. syn. Cassia auriculata L.; Family- Fabaceae ) is a traditional medicinal plant, widely used for the treatment of various ailments in Ayurveda and Siddha system of medicine in India. Almost all the parts of the plant, such as flowers, leaves, seeds, barks, and roots have been reported for their medicinal uses. Traditionally, it has been used in the treatment of diabetes, asthma, rheumatism, dysentery, skin disease, and metabolic disorders. The principle phytochemicals in Senna auriculata (L.) Roxb. are alkaloids, anthraquinone, flavone glycosides, sugar, saponins, phenols, terpenoids, flavonoids, tannins, steroids, palmitic acid, linoleic acid, benzoic acid 2-hydroxyl methyl ester, 1-methyl butyl ester, resorcinol, α-tocopherol-β-D-mannosidase, epicatechin, ferulic acid, quercetin-3-O-rutinoside, quercetin, proanthocyanidin B1. The extracts from its different parts and their isolated compounds possess a wide range of pharmacological activities such as antidiabetic, antioxidant, anti-inflammatory, antihyperlipidemic, hepatoprotective, nephroprotective, cardioprotective, anti-atherosclerotic, anticancer, antimutagenic, antimicrobial, antiulcer, antipyretic, anthelmintic, immunomodulatory, antifertility, anti-venom, and anti-melanogenesis. The toxicological findings from preclinical studies ensured the safety of the plant, but comprehensive clinical studies are required for the safety and efficacy of the plant in humans. The current review article aimed to provide up-to-date information about Senna auriculata (L.) Roxb. covering its ethnomedicinal, phytochemical, pharmacological, and toxicological aspects with special emphasis on its clinical implications in diabetes.

Economic gradient of onset of disability in India

Background

Disability in India is associated with increasing non-communicable diseases, rising longevity, and increasing accidents and injuries. Though studies have examined prevalence, patterns, and socioeconomic correlates of disability, no attempt has been made in estimating age of onset of disability in India.

Objective

This paper investigates the economic gradient of age of onset of locomotor, visual, hearing, speech, mental retardation, mental illness, and other disabilities in India.

Method

We use nationally representative data of 106,894 disabled individuals from the 76th round of National Sample Survey (NSS), 2018. Descriptive statistics, kernel density, Kaplan-Meier survival curves, and linear regression models are used in the analysis.

Result

The disability rate in India was 2184 per 100,000 persons. The disability rate was highest for locomotor (1353) followed by hearing (296), visual (234), speech (228), mental retardation (158), and mental illness (131). Over 85% of mental retardation and 80% of speech disabilities occur at birth, while 82% of locomotor and 81% of visual disabilities occur after birth. Among those who had disability after birth, the median age for mental retardation was 2 years followed by mental illness (28 years), speech (29 years), locomotor (42 years), visual (55 years), and 56 years for hearing disability. Adjusting for socioeconomic covariates, the age of onset of locomotor and speech disabilities among the poorest individuals were 7 and 11 years earlier than the richest, respectively.

Conclusion

The economic gradient of onset of locomotive and speech disabilities are strong. The age of onset of disability was earliest for mental retardation followed by mental illness and speech disability.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10826-5.

White paper on smokeless tobacco & women's health in India

Smokeless tobacco (SLT) use is widespread across many nations and populations, and India shares more than three-quarters of the global burden of SLT consumption. Tobacco use in India has been largely viewed as a male-dominant behaviour. However, evidence from medical, social and behavioural sciences show significant SLT use among women and young girls. This paper highlights key dimensions of SLT use among women in India including prevalence and determinants, the health effects arising from SLT use and cessation behaviours. The paper concludes by providing recommendations with the aim of setting research priorities and policy agenda to achieve a tobacco-free society. The focus on women and girls is essential to achieve the national targets for tobacco control under the National Health Policy, 2017, and Sustainable Development Goals 3 of ensuring healthy lives and promote well-being for all.

The prevalence of risk factors associated with non-communicable diseases in Afghan refugees in southern Iran: a cross-sectional study

BACKGROUND

Refugees are highly vulnerable to many health-related risks. Monitoring non-communicable diseases (NCDs) is of overriding importance in these populations. This study aimed to investigate the prevalence of risk factors for NCDs amongst Afghan refugees in a refugee camp located in southern Iran.

METHODS

This cross-sectional sturdy was conducted in 2018. Risk factors such as inadequate nutrition, physical inactivity, tobacco smoking, obesity and overweight, hypertension (HTN), elevated fasting plasma glucose (FPG), and dyslipidaemia were assessed. Data were gathered with a modified WHO STEPS procedure. Prevalence and age-standardized prevalence and their 95% confidence intervals (CI) were estimated.

RESULTS

The estimated prevalence were 94% for inadequate fruit/vegetable consumption, 18% for physical inactivity, 9% for tobacco smoking, 3% for FPG, 20% for HTN, 51% for central obesity, 24% for overweight, 19% for obesity, and 69% for dyslipidaemia.

CONCLUSIONS

Except for inadequate fruit and vegetable intake and dyslipidaemia, the prevalence of other NCD risk factors was low among Afghan refugees in Iran. Raising awareness about healthy diet and its importance and the provision of more affordable fruit and vegetables are two effective measures toward improving the health of refugees in Iran.

Out-of-Pocket, Catastrophic Health Expenditure and Distress Financing on Non-Communicable Diseases in India: A Systematic Review with Meta-Analysis

Objective:

The aim of this systematic review is to determine pooled estimates of out-of-pocket (OOPE) and catastrophic health expenditure (CHE), correlates of CHE, and most common modes of distress financing on the treatment of selected non-communicable disease (cancer) among adults in India.

Methods:

PubMed, Scopus and Embase were searched for eligible studies using strict inclusion and exclusion criteria. Data was extracted and pooled estimates using random effects model of meta-analysis were determined for different types of costs. Forest plots were created and heterogeneity among studies was checked.

Results:

The pooled estimate of direct OOPE on inpatient and outpatient cancer care were 83396.07 INR (4405.96 USD) (95% CI = 44591.05-122202.0) and 2653.12 (140.17 USD) INR (95% CI = -251.28-5557.53), respectively, total direct OOPE was 47138.95 INR (2490.43 USD) (95% CI = 37589.43-56690.74), indirect OOPE was 11908.50 INR (629.15 USD) (95% CI=-5909.33-29726.31) and proportion of individuals facing CHE was 62.7%. However, high heterogeneity was observed among the studies. Savings, income, borrowing money and sale of assets were the most common modes of distress financing for cancer treatment.

Conclusion:

Income- and treatment-related cancer policies are needed to address the evidently high and unaffordable cancer treatment cost. Economic studies are needed for estimating all types of costs using standardised definitions and tools for precise estimates. Robust cancer database/registries and programs focusing on affordable cancer care can reduce the economic burden and prevent impoverishment.

Morbidity compression or expansion? A temporal analysis of the age at onset of non-communicable diseases in India

While there is evidence of morbidity compression in many countries, temporal patterns of non-communicable diseases (NCDs) in developing countries, such as India, are less clear. Age at onset of disease offers insights to understanding epidemiologic trends and is a key input for public health programs. Changes in age at onset and duration of major NCDs were estimated for 2004 (n = 38,044) and 2018 (n = 43,239) using health surveys from the India National Sample Survey (NSS). Survival regression models were used to compare trends by sociodemographic characteristics. Comparing 2004 to 2018, there were reductions in age at onset and increases in duration for overall and cause-specific NCDs. Median age at onset decreased for NCDs overall (57 to 53 years) and for diabetes, hypertension, heart disease, asthma, mental diseases, eye disease, and bone disease in the range of 2-7 years and increased for cancer, neurological disorders, some genitourinary disorders, and injuries/accidents in the range of 2-14 years. Hazards of NCDs were higher among females for cancers (HR 1.51, 95% CI 1.19-1.90) and neurological disorders (HR 1.18, 95% CI 1.06-1.32) but lower for heart diseases (HR 0.88, 95% CI 0.79-0.97) and injuries/accidents (HR 0.87, 95% CI 0.77-0.99). Hazards were greater among those with lower educational attainment at younger ages and higher educational attainment later in life. Unlike many countries, chronic disease morbidity may be expanding in India for many chronic diseases, indicating excess strain on the health system. Public health programs should focus on early diagnosis and prevention of NCDs.

Profile of risk factors for Non-Communicable Diseases (NCDs) in a highly urbanized district of India: Findings from Puducherry district-wide STEPS Survey, 2019-20

INTRODUCTION

Rapid urbanization and industrialization drives the rising burden of Non-Communicable Diseases (NCDs) worldwide that are characterized by uptake of unhealthy lifestyle such as tobacco and alcohol use, physical inactivity and unhealthy diet. In India, the prevalence of various NCDs and its risk factors shows wide variations across geographic regions necessitating region-specific evidence for population-based prevention and control of NCDs.

OBJECTIVE

To estimate the prevalence of behavioral and biological risk factors of NCDs among adult population (18-69 years) in the Puducherry district located in Southern part of India.

METHODOLOGY

We surveyed adults using the World Health Organization (WHO) prescribed STEPwise approach to NCD surveillance (STEPS) during February 2019 to February 2020. A total of 2560 individuals were selected from urban and rural areas (50 clusters in each) through multi-stage cluster random sampling method. STEPS instrument was used to assess behavioral and physical measurements. Fasting blood sample was collected to estimate biochemical risk factors (Diabetes, Hypercholesterolemia) of NCDs.

RESULTS

Among men, alcohol use 40.4% (95% CI: 37.4-43.4) was almost twice higher compared to tobacco use 24.4% (95% CI: 21.7-26.9). Nearly half of the population was physically inactive 45.8% (95% CI: 43.8-47.8) and obese 46.1% (95% CI: 44-48.1). Hypertension and diabetes mellitus were present among one-third 33.6% (95% CI: 31.6-35.5) and one-fourth 26.7% (95% CI: 24.1-29.1) of the population which were significantly higher among men (37.1% vs 30.8% and 31.6% vs 23.2% respectively). Physical inactivity and overweight/obesity increased with increasing education levels. Tobacco and alcohol use was more common among men, whereas physical inactivity with obesity and hypercholesterolemia was higher among women.

CONCLUSION

We found high prevalence of various NCDs and its risk factors among the adult population of Puducherry district.

Telemedicine during COVID-19 in India-a new policy and its challenges

During the COVID-19 pandemic, a countrywide lockdown of nearly twelve weeks in India reduced access to regular healthcare services. As a policy response, the Ministry of Health & Family Welfare which exercises jurisdiction over telemedicine in India, rapidly issued India's first guidelines for use of telemedicine. The authors argue that: guidelines must be expanded to address ethical concerns about the use of privacy, patient data and its storage; limited access to the internet and weaknesses in the telecom infrastructure challenge widespread adoption of telemedicine; only by simultaneously improving both will use of telemedicine become equitable; Indian medical education curricula should include telemedicine and India should rapidly extend training to practitioner. They determine that for low- and middle-income countries (LMIC), including India, positive externalities of investing in telemedicine are ample, thus use of this option can render healthcare more accessible and equitable in future.

A pilot evaluation of Swasthya Pahal program using SMAART informatics framework to support NCD self-management

BACKGROUND

Empirical research acknowledges the capability of mHealth and eHealth interventions for ensuring high-quality and tailored healthcare to individuals. People living with various health conditions get access to a wide range of healthcare services through digital interventions. The aim of the study is to examine the usefulness of Swasthya Pahal, a community-based Health for all program, aimed to enhance screening and self-management of diabetes, hypertension, and obesity among police personnel.

METHODS

A convenient sample of 64 individuals aged 18 years and above present at the Police Sanchar Training Centre, Dehradun, Uttarakhand were enrolled over 2 days in January 2020. The Swasthya Pahal pilot program was approved by the Uttarakhand State Police authorities. Individuals' health data was recorded using an interactive, bi-lingual, touch screen, computer-based program. Subjective data was collected and self-reported information was gathered about (I) socio-demographics, (II) health behaviors, (III) clinical status, and (IV) Knowledge, Attitudes, and Practices (KAP). Objective data assessments included measurements such as weight, blood pressure, and blood sugar levels using a series of physiological sensors. Additional information gathered at 1 month follow up included modifications that individuals made in their self-management of diabetes and hypertension, diet, physical activity, alcohol consumption, and smoking. Information was gathered related to individuals' interest in receiving SMS based health messages.

RESULTS

The average age of study participants was 37 (SD =8) years, 88% were males, and 42% had graduate education. Hypertension (31%) was found to be the most common family history. Thirty-six percent of individuals were presently smokers or consumed alcohol. Sixty-two percent of them self-reported doing some form of exercise. Walking, jogging and yoga were the most common exercise types. Eighty-seven percent of them were not receiving any treatment to self-manage hypertension. Based on the JNC 8 criteria, 37% of the individuals were hypertensive. Fifty of the 64 individuals expressed interest to receive SMS message, 64% of them expressed keenness to receive weekly SMS messages. Messages related to diet, physical activity, sleep, and smoking and alcohol consumption were perceived as important.

CONCLUSIONS

The Swasthya Pahal program using the SMAART informatics framework is a useful tool to enhance screening and self-management of non-communicable diseases (NCDs) among police personnel.

Continuum of care for non-communicable diseases during COVID-19 pandemic in rural India: A mixed methods study

Background:

COVID-19 pandemic has resulted in disruption to routine health services delivery as strict lockdowns were implemented in India and health workforce redeployed for COVID-19 focused responses. We assess the perceptions about COVID-19, the impact of the lockdown on access to health services and continuum of care for Non-communicable diseases (NCDs) among a cohort of adults in rural India.

Methodology:

Since 2018, we have been following up a cohort of persons with non-communicable diseases in a high NCD burden region in Srikakulam District of Andhra Pradesh under the STOP CKDu study. We conducted this mixed methods study, administered through a structured telephonic questionnaire and interview to determine the awareness, perceptions and their compliance to ongoing treatment schedules.

Results:

Overall, 68% of the participants exhibited adequate knowledge of symptoms of COVID-19, while 43% were not aware of the mode of transmission of the virus. In all, 822 (36.1%) participants reported at least one NCD condition. Among them, 115 (14%) missed their follow-up visit, 110 (13.4%) reported facing challenges in medication procurement and 11.6% either developed new complaints or experienced worsening of pre-existing symptoms. A total of 233 (28.5%) used a telemedicine facility and took telephonic advice from (private) physicians. As the access to medicines was restricted due to the lockdown, majority of the respondents were depending on rural medical practitioners (RMPs) for the procurement of medication.

Conclusion:

Our finding implies the need for the future guidelines on adaptation of telehealth approaches within health systems to maintain the continuum of care, digital health tools to facilitate the patient's appointments including virtual follow-up visits for those with NCDs coupled with regular engagement by frontline healthcare workers at the local levels, evidence informed public health messaging taking into consideration the social and behavioural aspect and uninterrupted essential primary healthcare services.

A research agenda for non-communicable disease prevention and control in India

Background

Non-communicable diseases contribute to 62% of total deaths in India; of concern are the preventable premature deaths, which account for a staggering 48% of mortality. The objective of this study was to establish a consensus research agenda for non-communicable disease prevention and control that has the potential to impact polices, programmes and healthcare delivery in India.

Methods

To develop a non-communicable disease research agenda, we engaged our community collaborative board and scientific advisory group in a three-step process using two web-based surveys and one in-person meeting. First, the Delphi methodology was used to generate topics. Second, these ideas were deliberated upon during the in-person meeting, leading to the prioritisation of 23 research questions, which were subjected to Strength, Weakness, Opportunities and Threat analysis by the stakeholders using the Snow Card methodology with the scientific advisory group and community collaborative board. This step resulted in the identification of 15 low effort, high impact priority research questions for various health outcomes across research disciplines based on discussion with the larger group to reach consensus. Finally, the second web-based survey resulted in the identification of 15 key priority research questions by all stakeholders as being the most important using a linear mixed effect regression model.

Results

The final set of 15 priority research questions focused on interventions at the individual, community, systems and policy levels. Research questions focused on identifying interventions that strengthen healthcare systems and healthcare delivery, including models of care and improved access to non-communicable disease screening, diagnosis and treatment, determining the impact of government policies, assessing the effectiveness of prevention programmes (e.g. tobacco, environmental improvements), and testing research tools and resources to monitor non-communicable diseases at the population level.

Conclusion

To produce the evidence base for selecting and implementing non-communicable disease programmes and policies in India, investments are needed. These investments should be guided by a national research agenda for the prevention and control of non-communicable diseases in India. Our findings could form the backbone of a national research agenda for non-communicable diseases in India that could be refined and then adopted by government agencies, the private sector, non-governmental and community-based organisations.

Patterns of behavioral risk factors for non-communicable diseases in Vietnam: A narrative scoping review

This review describes both magnitude and patterns of major behavioral risk factors for NCDs. Positive changes in tobacco use were identified, though this is far to meet the established expectation. Harmful alcohol consumption was reported, especially for males. Only small proportion of the population consumed an adequate amount of fruits and vegetables daily. Average salt intake was approximately doubled, in comparison to WHO's recommendations. Physical activity has shifted gradually negatively, but future trends are unpredictable. An organized surveillance system should be developed initially with adequate tools and public resources to maintain and ensure sustainability over time.

Descriptive profile of risk factors for cardiovascular diseases using WHO STEP wise approach in Madhya Pradesh

BACKGROUND

Periodic information on risk factor distribution is critical for public health response for reduction in non-communicable disease (NCDs). For this purpose, the WHO has developed STEPs wise approach. State representative population-based STEPS survey was last conducted in 2007-08 in seven states of In India. Since then no such work has been reported from low ETL states. This survey was carried out to assess the prevalence of risk factors associated with NCDs and the prevalence of NCDs in the low ETL state of Madhya Pradesh using the WHO STEPs approach.

METHODS

A total of 5680 persons aged 18-69 years were selected from the state of Madhya Pradesh using multi-stage cluster random sampling. Using the WHO STEPs approach, details were collected on demographics, STEP 1 variables (tobacco consumption, alcohol consumption, physical activity, diet), STEP 2 variables (weight, height, waist circumference, blood pressure) and STEP 3 variables (fasting blood glucose, blood cholesterol).

RESULTS

We found that 9.4% individuals smoked tobacco, 15.3% were overweight/obese, 22.3% had hypertension, and 6.8% have diabetes mellitus. As compared to women, men were less likely to be overweight or obese, but more likely to smoke tobacco, and have diabetes mellitus. Hypertension was also more common in men. Overall, about a fourth of all adults had three or more risk factors for cardiovascular disease.

CONCLUSION

The survey shows that a large section of the population from Madhya Pradesh is either suffering from NCDs or have risk factors which predispose them to acquire NCDs. This state representative survey provides benchmarking information for behavioural and biological risk factor distribution for recently scaled up National Programme for the Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS).

Strengthening Primary Health-Care Services to Help Prevent and Control Long-Term (Chronic) Non-Communicable Diseases in Low- and Middle-Income Countries

The prevalence of long-term (chronic) non-communicable diseases (NCDs) is increasing globally due to an ageing global population, urbanization, changes in lifestyles, and inequitable access to healthcare. Although previously more common in high- and upper-middle-income countries, lower-middle-income countries (LMICs) are more affected, with NCDs in LMICs currently accounting for 85–90% of premature deaths among 30–69 years old. NCDs have both high morbidity and mortality and high treatment costs, not only for the diseases themselves but also for their complications. Primary health care (PHC) services are a vital component in the prevention and control of long-term NCDs, particularly in LMICs, where the health infrastructure and hospital services may be under strain. Drawing from published studies, this review analyses how PHC services can be utilized and strengthened to help prevent and control long-term NCDs in LMICs. The review finds that a PHC service approach, which deals with health in a comprehensive way, including the promotion, prevention, and control of diseases, can be useful in both high and low resource settings. Further, a PHC based approach also provides opportunities for communities to better access appropriate healthcare, which ensures more significant equity, efficiency, effectiveness, safety, and timeliness, empowers service users, and helps healthcare providers to achieve better health outcomes at lower costs.

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Association of frequency of television watching with overweight and obesity among women of reproductive age in India: Evidence from a nationally representative study

Background

For women of reproductive age, overweight and obesity are an established risk factor for several medical complications. To address the increasing rate of obesity in India through public health awareness programs, the association between common behaviors and overweight and obesity needs to be investigated. This study aims to determine whether there is any association between the frequency of television watching and overweight and obesity among women of reproductive age (15–49 years) in India.

Methods

This is a cross-sectional study that utilized data from the National Family Health Survey (NFHS-4), which utilized a nationally representative sample from all 29 states and 7 union territories of India. The survey itself followed a two-staged stratified random sampling technique. The primary outcome of interest was overweight (23.0 kg/m² to <27.5 kg/m²) and obesity (≥27.5 kg/m²), measured by using the Asian body mass index cut-off. The major explanatory variable was the frequency of television watching, measured in days per week. Sample weight of NFHS-4 was adjusted during the analysis. Multilevel ordered logistic regression was conducted to identify the factors associated with overweight and obesity. To show the strength of association, both the unadjusted Crude Odds Ratio (COR) and the Adjusted Odds Ratio (AOR) were reported with a 95% confidence interval (CI). A p-value<0.05 was considered statistically significant.

Results

The analysis included weighted data from 644,006 Indian women of reproductive age (15–49 years). Among the respondents, 33.5% were overweight or obese (BMI ≥23.0 kg/m²). The prevalence of overweight and obesity increased with age (p-value <0.0001) and almost half of the women aged 35–49 years were either overweight or obese (48.6%). The prevalence was significantly higher among those living in an urban area compared to a rural area (urban 46.5% vs. rural 26.5%; p-value <0.001). The prevalence of overweight and obesity increased with the frequency of watching television and was the highest among the individuals who reported watching television almost every day (p-value <0.0001). Women watching television almost every day had 24% (AOR: 1.24, 95% CI: 1.21–1.26; p-value <0.001) increased odds of being overweight and obese compared to their counterparts who never watched television.

Conclusions

This study found that the likelihood of being overweight and obese significantly increased with the frequency of watching television; likely due to physical inactivity during leisure time. Further studies should examine the physical activity and food habits of this target group. Public health promotion programs in India should raise awareness regarding the harmful effects of the sedentary lifestyle associated with watching television.

Digital interventions for people living with non-communicable diseases in India: A systematic review of intervention studies and recommendations for future research and development

BACKGROUND

A high burden of non-communicable diseases (NCDs) is contributing to high mortality and morbidity in India. Recent advancements in digital health interventions, including mHealth, eHealth, and telemedicine, have facilitated patient-centered care for NCDs.

OBJECTIVE

This systematic review aims to evaluate the current evidence on digital interventions for people living with NCDs in India and the outcomes of those interventions.

METHODS

We adopted PRISMA guidelines and systematically reviewed articles from MEDLINE, CINAHL, PsycINFO, ERIC, and Scopus databases with following criteria: journal articles presenting digital intervention(s) used by people with at least one of the NCDs, reporting health outcomes following the intervention, studies conducted in India among Indian population.

RESULTS

Among 1669 articles retrieved from multiple sources, only 13 articles met our criteria. Most (n = 7) studies were conducted in southern states of India; eight studies included patients with diabetes, followed by neuropsychiatric disorders and other NCDs. Five studies recruited participants from tertiary hospitals; six interventions used text-messaging for delivering health services, and 10 studies reported randomized controlled trials. All the studies reported positive health outcomes following the intervention, including better self-management, increased patient-provider communication, improved medication adherence, and reduced disease symptoms. Most studies scored moderate to high in quality assessment checklist of Downs and Black.

CONCLUSION

Current evidence suggests a low number of interventions with positive outcomes. Future research should explore avenues of advanced technologies ensuring equitable and sustainable development of digital health interventions for people living with NCDs in India.

Physical activity, sitting, and risk factors of cardiovascular disease: a cross-sectional analysis of the CARRS study

We aimed to estimate the associations between substituting 30-min/day of walking or moderate-to-vigorous physical activity (MVPA) for 30 min/day of sitting and cardiovascular risk factors in a South Asian population free of cardiovascular disease. We collected information regarding sitting and physical activity from a representative sample of 6991 participants aged 20 years and above from New Delhi, India and Karachi, Pakistan enrolled in 2010-2011 in the Center for cArdio-metabolic Risk Reduction in South Asia study using the International Physical Activity Questionnaire (short form). We conducted isotemporal substitution analyses using multivariable linear regression models to examine the cross-sectional associations between substituting MVPA and walking for sitting with cardiovascular risk factors. Substituting 30 min/day of MVPA for 30 min/day of sitting was associated with 0.08 mmHg lower diastolic blood pressure (β = -0.08 [- 0.15, - 0.0003]) and 0.13 mg/dl higher high-density lipoprotein cholesterol (β = 0.13 [0.04, 0.22]). Substituting 30 min/day of walking for 30 min/day of sitting was associated with 0.08 kg/m² lower body mass index (β = -0.08 [- 0.15, - 0.02]), and 0.25 cm lower waist circumference (β = -0.25 [- 0.39, - 0.11]). In conclusion, substituting time engaged in more-active pursuits for time engaged in less-active pursuits was associated with modest but favorable cardiovascular risk factor improvements among South Asians.

Role of World Health Organization Framework Convention on Tobacco Control Global Knowledge Hub on Smokeless Tobacco

Smokeless tobacco (SLT) is a recognized public health challenge, having over 350 million users globally, concentrated particularly in South-East Asia. A need for research on curbing major challenges in regulating SLT use has been long felt and subsequently highlighted in several sessions of the Conference of Parties (COP) of the Framework Convention on Tobacco Control (FCTC). The sixth session of COP established a knowledge hub on SLT at the Indian Council of Medical Research- National Institute of Cancer Prevention and Research India, with a mandate to (i) generate and share expertise, information and knowledge; (ii) promote and facilitate communication among Parties, organizations and stakeholders; and (iii) support the Convention Secretariat in contributing to technical aspects of SLT control. The hub disseminates scientific evidence through an interactive website and publications and supports national and international partners in SLT research. The hub is a contributor to many events/conferences and has conducted several workshops on SLT control, including an inter-country meeting on SLT policy implementation status, which brought together representatives from across the globe, and framed recommendations for policy reform. The hub is dedicated to interaction and collaboration with relevant tobacco control organizations to generate evidence, support and policy orientation in line with its mandates and recommendations under the World Health Organization FCTC.