ABSTRACT

CORRESPONDING AUTHOR:
Dr. Rafiq Mir,
Associate Professor,
I/C Head, Department of Community Medicine,
SKIMS Medical College, Bemina,
Srinagar (Jammu & Kashmir).
E-mail: dr.mmrafiq@gmail.com

ABSTRACT: BACKGROUND: Non-communicable disease is a medical condition or disease which non-infectious, of long duration and generally of slow progression. Major NCDs include cardiovascular diseases, strokes, diabetes mellitus, cancers and chronic respiratory diseases. They account for a significant part of overall mortality, morbidity & disability, result in huge economic losses to nations, are a cause of psychosocial suffering and are therefore recognized as major public health problem. OBJECTIVE: To find out prevalence and socioeconomic characteristics of NCDs in study population of block Hajin. DESIGN: Community based cross-sectional epidemiological study conducted between May to October 2013. RESULTS: Out of the total study population it was seen that the general prevalence of NCDs was 209 (34.83%) of which 125 (34.72%) were males and 125 (34.72%) were females respectively. The most common NCD was Hypertension (66.02%) followed by Diabetes (22%) and Cancers (11.96%) respectively. Age, sex, type of family, SE status were significantly associated with the occurrence of NCDs (p<0.01). CONCLUSION: The rising burden of chronic NCDs affecting older people place a heavy burden on healthcare system as a result of increased demand and access to healthcare services. Concerted effort is needed to develop strategies for the prevention and management of NCDs, especially among economically disadvantaged individuals who need these services the most.

KEYWORDS: Non-communicable disease, Morbidity, Mortality.

INTRODUCTION: A non-communicable disease is a medical condition or disease which non-infectious, of long duration and generally of slow progression. Major NCDs include cardiovascular diseases, strokes, diabetes mellitus, cancers and chronic respiratory diseases. They account for a significant part of overall mortality, morbidity & disability, result in huge economic losses to nations, are a cause of psychosocial suffering and are therefore recognized as major public health problem¹ .Non-communicable diseases (NCDs) are increasingly recognized as a major cause of mortality and morbidity across the globe. They represent the highest burden among all three major groups of non-infectious causes of disease including pre-transitional causes, NCDs, accidents and injuries.²

 Chronic non-communicable diseases (NCDs) account for approximately 63% of deaths and 43% of global disease burden (2008).By 2020, these NCDs will account for 73% deaths and 60% global disease burden. Almost 80% of NCDs occur in developing countries⁴. The burden of NCDs is also increasing in South Asia. Almost half of all deaths in Asia are now attributable to NCDs, accounting for 47% of global burden of disease.⁵ Non-communicable diseases (NCDs) are top killers in the South-East Asia Region (SEAR), causing 7.9 million deaths annually. The number of deaths is expected to increase by 21% over the next decade. In SEAR NCDs kill people at a relatively younger age compared to the rest of the world. In India 53% of deaths in 2005 is attributed to Non Communicable Diseases. Almost half of these are due to cardiovascular diseases. Cardiovascular diseases are projected to be the largest cause of death and disability in 2020.

(WHO Report -2002). Current projections also suggest that total cancer burden will double by 2026⁶. According to a recent projection, seven out of every 10 deaths in low-income countries will be from chronic NCDs by 2020⁷, which pose a serious challenge to the developing countries.⁸ WHO have been advocating policy makers to develop efficient strategies to halt ‘Tomorrow’s Pandemic’ of the chronic NCDs.^{9, 10}

The NCD epidemic exacts a massive socioeconomic toll throughout the world. It is rising rapidly in lower-income countries and among the poor in middle- and high-income countries. The NCD epidemic is thwarting poverty reduction efforts and robbing societies of funds that could otherwise be devoted to social and economic development. If common development goals are to be achieved, they must do more than raise incomes and consumption; they must free as many people as possible from disease and disability, and reduce the widening gap between the haves and have nots.¹¹

The present study was undertaken to assess the prevalence and socioeconomic characteristics of NCDs in adult population of block Hajin utilizing WHO STEPS approach. The data collected will provide the baseline information for health services planning and will help in formulating an integrated strategy on NCD prevention and control. The data could also be used to plan and evaluate health promotion and disease prevention programs.

METHODOLOGY: The study was a population based cross sectional survey of 25-64 years old in rural block Hajin. A pre tested and pre structured preform a based on modified WHO STEPS approach questionnaire was utilized. Socioeconomic status was assessed by utilizing Udai Pareek’s scale. The sample size came out to be 600 individuals. A multistage cluster sampling design was used. All the villages along with their population were enlisted. Then cumulative population was calculated. The cumulative population was divided by 30 to get cluster interval. First cluster was chosen randomly and subsequent clusters based on cluster interval.

Each cluster was divided into segments based on natural boundaries or Mohall as and one segment selected randomly was taken for HH survey. Continuous HH were surveyed till total 20 individuals are studied. If the number of individuals was less than adjacent segments were utilized. The list of all the villages of health block Hajin was made. Out of this list 30 villages were chosen randomly. From each of the villages one of the household was chosen and from each cluster 20 individuals were selected. Each house hold received a number. The individuals in each household were selected by Kish method. The study population consisted of 240 males and 360 females. The individuals were interviewed for the presence of any NCDs

RESULTS: The study was a population based cross sectional survey conducted on 25-64 years old participants in rural block area of Hajin, Bandipora (J & K) May to October 2013 for a period of 6 months.

Table 1 shows the demographic characters of study population. It was seen that out of a total of 600 study subjects 360 were females and 240 were males. Further it was observed that the participants (male and female) were somewhat equally distributed among all age groups. Our study found that the general prevalence of NCDs in study population came out to be 209(34.83%) with males accounting for 35% and females 34.72% respectively (Table 2). In the present study it was observed that the most common NCD was hypertension (66.02%) followed by diabetes (22%) and cancers (11.96%) respectively (Table3).

Regarding the Socio-demographic characteristics of study population it was revealed that the commonest NCDs among males was found to be cancers (68%) followed by hypertension(36.9%) whereas in females it was seen that commonest NCD was diabetes (65.21%) followed by hypertension (63.04%). Overall it was found that the NCDs had a significant association with the sex of the study subjects (p<0.05) (Table 4).

Regarding the distribution of NCDs as per the age of study subjects it was revealed that the commonest age group which was affected by one or the other major type of NCDs was 45-54 years (33.97%) followed by the age group of 55-64 years (27.75%) whereas less prevalence of NCDs was found in age group of 25-34 years (15.78%). Overall NCDs had a highly significant association with the age of study subjects (p<0.001) (Table 5).

As far as distribution of NCDs was concerned as per the type of family it was found that joint families (59.8%) had higher prevalence as compared to nuclear families (40.19%) respectively. Further in joint families the commonest NCDs were diabetes (78.2%) and hypertension (70.28%) whereas in nuclear families it was cancers (80%) and hypertension (29.71%) respectively. Overall the NCDs had a significant association with type of the family (p< 0.05) (Table 6).

It was observed in our study that the prevalence of NCDs was more in the upper class people (40.19%) followed by upper middle class (22.48%) whereas the prevalence was lower in lower class people (11.48%) respectively. Overall the distribution of NCDs among various socioeconomic classes was found to be significant (p<0.05) (Table7).

Regarding the distribution of NCDs as per the education status of study participants, it was found that the prevalence of NCDs was more in illiterate people of society (30.62%) followed by primary education (28.22%) and middle education people (27.75%) whereas the prevalence among high class and graduate people was less (8.13% & 5.26%).Overall the prevalence of NCDs showed an increasing trend with the decrease in the education of the people (Table 8).

DISCUSSION: Our study was conducted in order to find out the prevalence and socio-demographic characteristics of NCDs in adult population of health block Hajin following WHO STEP wise protocol. The main objective of the study was to establish a baseline that would be used to identify the risk factors and in measuring the impact of risk factor reduction interventions.

In our study it was revealed that prevalence of NCDs was 34.83% (males 35%, females 34.72%). A total of 66.2%, 22% and 11.96% were suffering from hypertension, diabetes and cancers. However in a study by Mehan et al ¹² it was revealed that about 32.2% and 6.6% of the subjects were found to have diabetes and hypertension respectively. Further it was revealed in their study that there were more males (33.9% versus 30.8%) with diabetes and hypertension as compared to females (8.9% versus 4.6%) whereas in a study by Mufunda et al¹³ it was found that the prevalence of hypertension among the study participants was 15.9% out of which 17% were males 15% were females. In another study from urban Rajasthan prevalence of diabetes was 14.7% in men and 14.2% in women. In a study in Iran by Asgari F et al ¹⁴ it was observed that out of major NCDs 25.2% had hypertension and 7.7% had diabetes in age group 25-64 years.

Commenting on socio-demographic characteristics of NCDs in our study population it was found the variables like age, sex, type of family and socioeconomic status were significantly associated with occurrence of NCD show ever in a study by Mehan MB et al ¹² it was found that there was no significant association between these risk factors and prevalence of NCDs. These results are contrary to the results of our study. In a study by Asgari et al ¹⁴ it was found that the prevalence of NCDs increase with increasing age and was prevalent among women and urban dwellers.

CONCLUSION: The risk factors of today are diseases of tomorrow. Hence identifying these risk factors in population occupies central place in surveillance system. Therefore public health strategies have to be driven by the motive of identifying prevalence and socio-demographic characteristics in populations and countries need to know the profile of risk factors of populations in different settings.

REFERENCES:

1. Parks Textbook of Community Medicine, 22^nd edition;
2. World Health Organization. Preventing chronic disease: a vital investment. Geneva: WHO; 2005.
3. Ministry of Health and Medical Education. National burden of disease and injury in the I.R. Iran. Tehran: Under-Secretary for Health; 2007.
4. WHO (World Health Organization). Preventing chronic diseases: a vital investment. WHO global report. Geneva: WHO; 2005.
5. Ghaffar A, Reddy KS, Singhi M. Burden of non-communicable diseases in South Asia. BMJ 2004; 328: 807-10.
6. WHO Report-2002 Burden of Non communicable diseases.
7. Boutayeb A. The double burden of communicable and non-communicable diseases in developing countries. Trans R Soc Trop Med Hyg 2006; 100: 191-9.
8. Yach D, Kellog M, Voute J. Chronic diseases: an increasing challenge in developing countries. Trans R Soc Trop Med Hyg 2005; 99: 321-4.
9. WHO (World Health Organization). The report of the third global forum on CHRONIC NCDSS prevention and treatment. Geneva: WHO; 2004.
10. WHO (World Health Organization). Global strategy for the prevention and control of non -communicable diseases. Report by the Director General. A53/4. Fifty-third World Health Assembly, May 2000. Geneva: WHO; 2000.
11. Equity, social determinants and public health programmes. Geneva, World Health Organization, 2010.
12. Mehan, Somila, Surabhi, Gautami T. Solanki Risk factor profile of non-communicable diseases among middle income free living urban population of India.http://www.ijddc.com 2010;59:169-176.
13. Mufunda, G Mebrahtu, A Usman, P Nyarango, A Kosia, Y Ghebrat, A Ogbamariam, The prevalence of hypertension and its relationship with obesity: results from a national blood pressure survey in Eritrea; Journal of Human Hypertension (2006) 20, 59–65.
14. F Asgari, H Aghajani, M Haghazali, H Heidarian. Non-Communicable Diseases Risk Factors Surveillance in Iran. Iranian J Publ Health, Vol. 38, Suppl. 1, 2009, pp.119-122