Recalibrating the Non-Communicable Diseases risk prediction tools for the rural population of Western India.

BACKGROUND: The aim of the present study was to recalibrate the effectiveness of Indian Diabetes Risk Score (IDRS) and Community-Based Assessment Checklist (CBAC) by opportunistic screening of Diabetes Mellitus (DM) and Hypertension (HT) among the people attending health centres, and estimating the risk of fatal and non-fatal Cardio-Vascular Diseases (CVDs) among them using WHO/ISH charts. METHODS: All the people aged ≥ 30 years attending the health centers were screened for DM and HT. Weight, height, waist circumference, and hip circumferences were measured, and BMI and Waist-Hip Ratio (WHR) were calculated. Risk categorization of all participants was done using IDRS, CBAC, and WHO/ISH risk prediction charts. Individuals diagnosed with DM or HT were started on treatment. The data was recorded using Epicollect5 and was analyzed using SPSS v.23 and MedCalc v.19.8. ROC curves were plotted for DM and HT with the IDRS, CBAC score, and anthropometric parameters. Sensitivity (SN), specificity (SP), Positive Predictive Value (PPV), Negative Predictive Value (NPV), Accuracy and Youden's index were calculated for different cut-offs of IDRS and CBAC scores. RESULTS: A total of 942 participants were included for the screening, out of them, 9.2% (95% CI: 7.45-11.31) were diagnosed with DM for the first time. Hypertension was detected among 25.7% (95% CI: 22.9-28.5) of the participants. A total of 447 (47.3%) participants were found with IDRS score ≥ 60, and 276 (29.3%) with CBAC score > 4. As much as 26.1% were at moderate to higher risk (≥ 10%) of developing CVDs. Area Under the Curve (AUC) for IDRS in predicting DM was 0.64 (0.58-0.70), with 67.1% SN and 55.2% SP (Youden's Index 0.22). While the AUC for CBAC was 0.59 (0.53-0.65). For hypertension both the AUCs were 0.66 (0.62-0.71) and 0.63 (0.59-0.67), respectively. CONCLUSIONS: IDRS was found to have the maximum AUC and sensitivity thereby demonstrating its usefulness as compared to other tools for screening of both diabetes and hypertension. It thus has the potential to expose the hidden NCD iceberg. Hence, we propose IDRS as a useful tool in screening of Diabetes and Hypertension in rural India.

Health Inequalities in Under-Five Mortality: An Assessment of Empowered Action Group (EAG) States of India.

Background: The effect of childhood well-being programs is commonly interconnected with a change in mortality trends. The proportion of disparity shows that inequality in child mortality is more collective in the similarly evolved states than the poorer states in India. Objective: To estimate and compare the health inequality of under-five mortality in Empowered Action groups (EAG) states of India. Methods: Data from the National Family Health Survey (NFHS-4) was used only for the EAG States of India. Under-five mortality rates (U5MR) were calculated for associated background characteristics by using the life table method. Wealth inequality was assessed separately for all EAG states by calculating measures of concentration index (CI). Concentration curves (CC) were also plotted to see the difference in inequality. Results: Higher U5MR was observed in all EAG states compared with estimates for overall India. On comparing estimates of inequality, CI values show the substantial burden of U5MR among EAG states of India. The CC shows the lowest inequality in EAG states of India. Conclusion: The results suggested the need to receive various health strategy intercessions in agreement with the instance of ever-changing commitments of economic components to child health disparities in EAG states. Measuring the impact of determinants to wealth-related inequality in U5MR helps in lining up the interventions targeted at improving child survival.