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.

Predictors of adherence to prescribed antihypertensive medications among Hypertensive (15-49 years) in India: A secondary data analysis of National Family Health Survey 4.

Background: Adherence to medications is one of the key determinants of therapeutic control of high blood pressure and is seen as a bottleneck in our fight against hypertension control. We have little scientific evidence from India that highlights the determinants of treatment adherence. Aim: The purpose of this study was to identify the predictor adherence to the currently prescribed antihypertensive medications. Material and Methods: We did a secondary data analysis of the National Family Health Survey, 2015-2016 datasets. As there were no direct variables to measure adherence, this was derived from the responses to the survey question: "currently taking a prescribed hypertensive medication to lower Blood Pressure" among those already diagnosed as hypertensives by the physician. The other sociodemographic and household-level variables were used as independent variables for analysis. Results: The level of awareness about their hypertensive status among the 15-49-year-olds who were subjected to blood pressure measurement was 9.34% (70,267/80,3081). Of these, 70,267 participants, 65878 with valid hypertensive individual data were included in the final analysis. Among them, 26.78% are currently adhering to antihypertensive medication. Female gender (adj OR; 95% CI: 1.17 [1.09-1.24]) and non-reserved caste ([OR] 1.24; 95% [CI]: 1.18-1.32) depicted better adherence to the current treatment. The hypertensives who preferred taking treatment from shops or at home or some other place in comparison to health facilities had a significant association with adherence (adj OR: 1.64; 95% CI: [1.43-1.88]). Conclusion: The current study reported low adherence to the current antihypertensive medication. Gender, higher age group, obesity, and place of taking the treatment were strongly associated with adherence to treatment.

Is calorie intake the fundamental driver of noncommunicable diseases in India - A systematic review.

BACKGROUND: Nutrition epidemiology initially focused on few nutrients thought to be responsible for noncommunicable diseases (NCDs). The database of Indian Nutrition Survey is based majorly on calorie intake. OBJECTIVE: The objective was to compare the change in the average calorie intake from 1990 to 2012 with the emerging epidemic of diabetes and hypertension (HTN) in India since 1990. METHODS: A comprehensive search was made in National Library of Medicine's PubMed database and Google Scholar from March to August 2018, on the above-mentioned subjects. Reports of national surveys (National Sample Survey Office and National Nutrition Monitoring Bureau) were included for average calorie intake among different states from year 1990 onward. Region-wise search depicted by national nutrition surveys resulted in 277 and 587 abstracts on the prevalence of HTN and diabetes mellitus, respectively. There were 51 full-text articles and abstracts on the prevalence of HTN and diabetes from the above regions. RESULTS: The average calorie intake per capita per day in the four zones of country in rural areas decreased from 1990 to 2012. An increasing trend in the prevalence of diabetes from rural areas was observed from 1994 to 2012. The per capita average calorie intake per day in urban areas from 1999 through 2011 in all zones except the eastern part of country was on rise. There was no consistent trend in the prevalence of HTN in any of the zones. CONCLUSION: It is not just an increase in calories, but a trade-off between the demand for calories and the demand for healthy lifestyles determines the prevalence of NCDs.

Predictors of intention to quit tobacco among construction site workers in Delhi, India.

BACKGROUND: Information on predictors of quitting behavior among construction site tobacco users is scarce in India. Hence, this study was conducted to assess the intention of tobacco users toward quitting and its predictors with reference to sociodemographic profile. METHODOLOGY: A community-based, observational study was conducted on adult 172 construction site workers in a university campus of Delhi. Data were collected by an interview using the WHO-adopted, pretested, semi-structured questionnaire. Chi-square test was used for univariate analysis. Pearson's correlation coefficient and multivariate logistic regression model were used to identify the predictors. RESULTS: Of the 172 users, 73% had intention to quit. More than half of smokers (56.5%) and 81% of smokeless tobacco users intended to quit. Majority of the tobacco users who intended to quit were literate (75.0%), started tobacco use >15 years of age (75.4%), occasional tobacco users (78.9%), and less dependent on nicotine (74.4%). CONCLUSIONS: Suitable plan for quitting keeping in mind this vulnerable group of workers should be developed depending on the literacy, type of tobacco used, and nicotine dependency.

Effectiveness of Awareness Package on Occupational Health Hazards among Ragpickers of New Delhi, India.

BACKGROUND: Ragpickers are informal workers who collect recyclable materials to earn a small wage on daily basis. They work in vulnerable conditions and awareness regarding occupational and environmental hazard is essential for them. OBJECTIVE: To study the effectiveness of awareness program on various occupational health hazards among the ragpickers. MATERIALS AND METHODS: This interventional study was conducted from May through October 2016 among the ragpickers living near field practice area of Department of Community Medicine and those living in slum areas around HAHC Hospital, New Delhi, India. The awareness regarding occupational and environmental health hazards was assessed using a pretested and predesigned pro forma. Snowball sampling technique was used to select the ragpickers from the various areas. Health awareness and education package was designed for the ragpickers. The package was delivered by medical officers and health workers. A posttest assessment was done 2 weeks after the awareness activity. RESULT: Among 150 ragpickers, there was significant improvement in knowledge immediate post training on knowledge of occupational hazard and hygiene. CONCLUSION: Efforts should be put to develop training materials on occupation and environmental health and injury issue relating to waste management.

Prevalence and correlates of nicotine dependence among construction site workers: A cross-sectional study in Delhi.

INTRODUCTION: Workers represent half the world's population and are major contributors to economic and social development. Tobacco consumption in construction site workers has been considered a big challenge. OBJECTIVES: (1) To assess the prevalence of nicotine dependence among tobacco users. (2) To study the correlates of nicotine dependence among the construction site workers. METHODOLOGY: A cross sectional study was conducted using a predesigned and pretested structured proforma. The study was conducted among all construction site workers aged 18yrs and above in campus of Hamdard Institute of Medical Sciences and Research and associated HAH centenary hospital, New Delhi. Karl Fagerstrom Nicotine Dependence Questionnaire was used to assess dependence on nicotine. RESULTS: The mean age of construction site workers was 32.04±11.6 years. Among the workers, majority (91%) were tobacco user. Among the users, 60% found it difficult to refrain from smoking/chewing in places where use of tobacco is not allowed (e.g. hospitals, government offices, cinemas, Libraries etc). 55% of the users smoked or chewed tobacco during the first hours after waking than during the rest of the day. On multivariate analysis, the factors which were found to be significantly associated with nicotine dependence were lower income group (OR 2.57, CI:1.66-3.99), smokeless tobacco use (OR 2.36, CI:1.30-4.27) and lower education (OR = 2.86 (95% CI 1.97-4.16) for illiterate). DISCUSSION: The prevalence of tobacco use (91%) among construction workers is very high compared to that in the general population. Recognition of construction sites as work places and proper implementation of law is needed.

Effect of Community-based Behavior Change Communication on Delivery and Newborn Health Care Practices in a Resettlement Colony of Delhi.

BACKGROUND: Neonatal morbidity and mortality in India continue to be high. Among other reasons, newborn care practices are major contributors for such high rates. OBJECTIVE: To assess the effect of behavior change communication (BCC) package among pregnant women regarding neonatal care. MATERIALS AND METHODS: Semistructured and pretested schedule was used to interview 200 multigravidas on various aspects of neonatal care. Based on the preliminary data, BCC package was designed and implemented in intervention block in the community. Follow-up was done to find out change in their behavior. STATISTICAL ANALYSIS: Data were analyzed using Epi info and Fischer exact test and chi-square test were applied in the baseline data. A P value of less than 0.05 was considered significant. Effect of the BCC package is given in terms of relative risk. RESULTS: BCC package increased 1.76 times higher number of deliveries conducted by trained dais in intervention group. There was significant improvement in using sterile cord tie (P = 0.01), applied nothing to the cord (P < 0.0001) and giving bath to their baby within 6 h of birth (P = 0.02) in intervention group as compared to nonintervention group. Significant difference was found between the two groups with regard to breastfeeding practices of baby. Harmful practices were reduced in the intervention group. Significant improvement was found in intervention group as compared to nonintervention group with regard to knowledge of danger signals, physiological variants, management of breastfeeding-related problems, and awareness of skin-to-skin technique for the management of hypothermic baby. CONCLUSION: Inadequate knowledge and adverse practices regarding neonatal care among mothers in study areas were found. BCC package had favorable impact on behavior of mothers for neonatal care in intervention group.