Study of Prevalence of Non Communicable disease risk factors using WHO-STEPs approach in a Slum locality of Bhopal city, Madhya Pradesh

Introduction-

Non-communicable diseases (NCDs) are chronic conditions that progress slowly and are rarely completely curable. Non-communicable diseases (NCDs), such as diabetes and cardiovascular diseases, pose an increasing public health challenge in India, especially due to changes ir lifestyles, behaviors and the physical and social environments in cities¹. Everyyear, roughly5.8 million Indians diefrom heartand lungdiseases, stroke, cancerand diabetes.

In other words, 1 in 4 Indians risks dying from an NCD before they reach the age of 70². The four most common NCDs - cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes - are mainly caused by preventable behavioral risk factors, such as tobacco and alcohol consumption, unhealthy diet, and Insufficient physical exercise³. It is well known that a lot of diseases can be prevented by altering the life style and habits of people, and approach must be developed to identify the risks and combat them. The WHO STEP wise approach to surveillance (STEPS) is the WHO-recommended framework for NCD surveillance. STEPS offers an entry point for low and middle income countries to get started in NCD prevention and control activities. It is a simplified approach providing standardized materials and methods as part of technical collaboration with countries, especially those that lack resources⁴. This study was undertaken with the objective of studying the prevalence of risk factors for NCDs in the Anna Nagar slum locality of Bhopal city, Madhya Pradesh

Materials and methods-

The study was conducted on the population a slum of Bhopal. The sample size was 180 (calculated using the prevalence data of ICMRon NCDs) but 260 was covered. Ethical clearance was obtained from institutional ethics committee. The household were selected using systematic random sampling and Individuals from the houses were selected using KISH method as used in WHO STEPS approach. Persons aged 25 to 64 years, residing in the study area for more than 6 months and gave their voluntary consent to participate was included in the study. Critically ill patients, pregnant women were excluded, Informed consent was taken from the individual. WHO STEPS based questionnaire was used for data collection. The data included demographic information and information on theirdiet, physical activityand other NCD risk factors. Physical measurements were taken as per standard WHO protocol. Blood pressure measurement was done using mercury sphygmomanometer by the investigator. Those requiring further investigation and treatment were referred appropriately. Data were entered in MS-EXCEL and analysis will be done using EPI INFO.

Results-

In the population, male members were 53% and females were 47% respectively. Mean age was 43.67±1.3 yrs. The level of education was no formal schooling followed by primary school completed. The Illiteracy was higher amongst females, high proportion of females was housewives. The residents were predominantly Hindu by religion. 80.8% of participants were currently married followed by widows. Current smoking of tobacco product was present in 15.8% of participants, 27.1% males and 2.5% females respectively. The use of smokeless tobacco was higher than the smoked form. 60% males and 33.3% females gave positive response amounting to total consumption in 47.7%. 17.7% and 20% participants were exposed to passive smoking at work and home respectively. Also, the alcohol consumption was present amongst 54.3% males and 31.2% females respectively. The intake of fruit was poor amongst the participants. 26.5% did not consume any fruit in the whole week followed by 52.3% who consumed ≤3 serving per week. Only 21.2% consumed fruit >3 serving per week. The veggie intake was >3 serving per week in 85% individuals followed by ≤3 serving per week in 10.4% and no intake in 4.6%. 80.4% participants said they are never involved in any vigorous activity throughout the week whereas 10% were involved for ≤ 3 days per week and 9.6% were involved for >3 days per week. 34.6% participants were involved in moderate intensity work for >3 days per week, 12.7% for ≤3 days per week and 52.7% were never involved. Only 36.2% participants had normal BMI. 35.8% were obese, 17.3% were overweight and 10.8% were underweight. Obesity was more in females as compared to males. Blood pressure was measured using a sphygmomanometer and was found to be pre hypertensive in 18.1% participants, HTN1 in 10.4% and HTN2 in 31.5% participants.40% participants had normal blood pressure.

Discussion:

In the present study, 40.4% population was self employed followed by private jobs. In a similar study conducted by Tondare Μ B et al, highest number of participants were unemployed or students (34.4%), followed by farmer(22%), labourer(22%), housewife (12.9%) and skilled workers(7.9%). The difference is due to the locality as this is situated near a public sector plant and majority of the participants work as service providers in the township. Current smoking of tobacco product was present in 15.8% of participants. The findings are similar to the study conducted by Lashkar A et al in which the current smokers were 17.6%, and the study conducted by Oommen M A et al⁷ in which the current smokers were 11.6%. The alcohol consumption in the present study wasquite high, 54.3%amongst malesand 4.2% females respectively. This is not comparable to other studies. The intake of fruit was poor amongst the participants. 26.5% did not consume any fruit In the whole week followed by 52.3% who consumed ≤3 serving per week. Only 21.2% consumed fruit >3 serving per week. The veggie intake was >3 serving per week in 85% individuals followed by ≤3 serving per week in 10.4% and no intake in 4.6%. In a study conducted by Garg A et al⁸, 94.5% people consumed less than 5 servings per day of fruits and veggies whereas 34% consumed less than 3 per day. 80.4% participants said they are never involved in any vigorous activity and 52.7% were never involved in any moderate activity. The findings are similar to that of Garg Act af in which 80% participants were physically inactive. Obesity was found in 35.8% participants, similar to the findings of IMagendra K et af in which it was 31.6%. Blood pressure was found to be elevated in 18.1% participants, HTN1 in 10.4% and HTN2 in 31.5% participants. 40% participants had normal blood pressure. The findings differ from the previous studies since cut off for BP has changed recently rendering the findings incomparable.