Non-communicable diseases as a major contributor to deaths in 12 tribal districts in India.

Background & objectives: Non-communicable diseases (NCDs) are the leading cause of death in India. Although studies have reported a high prevalence of NCD in tribal populations, there are limited data pertaining mortality due to NCDs. Therefore, in this study we estimated the proportion of deaths due to NCDs among 15 yr and older age group in tribal districts in India. Methods: We conducted a community-based survey in 12 districts (one per State) with more than 50 per cent tribal population. Data were collected using a verbal autopsy tool from the family member of the deceased. The estimated sample size was 452 deaths per district. We obtained the list of deaths for the reference period of one year and updated it during the survey. The cause of death was assigned using the International Classification of Diseases-10 classification and analyzed the proportions of causes of death. The age-standardized death rate (ASRD) was also estimated. Results: We surveyed 5292 deaths among those above 15 years of age. Overall, NCDs accounted for 66 per cent of the deaths, followed by infectious diseases (15%) and injuries (11%). Cardiovascular diseases were the leading cause of death in 10 of the 12 sites. In East Garo Hills (18%) and Lunglei (26%), neoplasms were the leading cause of death. ASRD due to NCD ranged from 426 in Kinnaur to 756 per 100,000 in East Garo Hills. Interpretation & conclusions: The findings of this community-based survey suggested that NCDs were the leading cause of death among the tribal populations in India. It is hence suggested that control of NCDs should be one of the public health priorities for tribal districts in India.

Preparedness of primary & secondary care health facilities for the management of non-communicable diseases in tribal population across 12 districts in India.

Background and objectives: Non-communicable diseases (NCDs) are highly prevalent in the tribal populations; however, there are limited data regarding health system preparedness to tackle NCDs among these populations. We estimated the availability of human resources, equipment, drugs, services and knowledge of doctors for NCD management in the selected tribal districts in India. Methods: A cross-sectional survey was conducted in 12 districts (one from each State) with at least 50 per cent tribal population in Andaman and Nicobar Islands, Himachal Pradesh, Madhya Pradesh, Odisha and eight northeastern States. Primary health centres (PHCs), community health centres (CHCs) and district/sub-district hospitals (DHs) were surveyed and data on screening and treatment services, human resources, equipment, drugs and information systems indicators were collected and analysed. The data were presented as proportions. Results: In the present study 177 facilities were surveyed, including 156 PHCs/CHCs and 21 DHs. DHs and the majority (82-96%) of the PHCs/CHCs provided outpatient treatment for diabetes and hypertension. Overall, 97 per cent of PHCs/CHCs had doctors, and 78 per cent had staff nurses. The availability of digital blood pressure monitors ranged from 35 to 43 per cent, and drugs were either not available or inadequate. Among 213 doctors, three-fourths knew the correct criteria for hypertension diagnosis, and a few correctly reported diabetes diagnosis criteria. Interpretation & conclusions: The results of this study suggest that the health system of the studied tribal districts was not adequately prepared to manage NCDs. The key challenges included inadequately trained workforce and a lack of equipment and drugs. It is suggested that capacity building and, procurement and distribution of equipment, drugs and information systems to track NCD patients should be the key focus areas of national programmes.

The evaluation of serum levels of testosterone in type 2 diabetic men and its relation with lipid profile.

INTRODUCTION AND AIM: Type 2 diabetes mellitus (T2DM) is the predominant form of diabetes worldwide and much is known about its patho-physiology. Yet, newer aspects related to it are being constantly explored. For ages, testosterone has been known to men as the male sex hormone but now it has been shown by certain studies that it might have a role in the development of metabolic disorders like type 2 diabetes. This study was carried out to determine the relation of testosterone levels with type 2 diabetes mellitus and lipid profile in North East Indian men aged 31 to 73 years. MATERIALS AND METHODS: This case control study comprised of 40 type 2 diabetic men and 40 age matched non diabetic healthy men. Testosterone, SHBG levels and lipid profile were evaluated in both the groups along with anthropometric measurements and were statistically analysed. RESULTS: Serum total and free testosterone and Sex Hormone Binding Globulin were significantly lower in the test group than in the control group. Prevalence of type 2diabetes was five times higher in men having a total testosterone less than 8nmol/L and 5.57 times higher in those having a free testosterone of less than 0.225nmol/L. Fasting blood glucose showed a strong negative correlation with total and free testosterone. Glycated haemoglobin correlated negatively with SHBG but no such correlation was seen with total or free testosterone. Serum total and LDL cholesterol showed significant negative correlation with total testosterone and SHBG but no significant correlation was found with free testosterone. Serum VLDL, HDL and triglycerides did not show any significant correlation with total or free testosterone and SHBG levels. CONCLUSION: Low testosterone might have a role in the development of type 2 DM and to the associated altered lipid profile. This study, though a small one is among the few of its kind in India and it thrives to assist other studies related to the matter.

Serum hsCRP: A Novel Marker for Prediction of Cerebrovascular Accidents (Stroke).

INTRODUCTION AND OBJECTIVES: Strokes are caused by disruption of the blood supply to the brain. This may result from either blockage or rupture of a blood vessel. Yearly 15 million people worldwide suffer a stroke. India ranks second worldwide in terms of deaths from stroke. The incidence of stroke increases with age affecting the economically productive middle aged population. Hypertension and male sex are other risk factors for stroke. C-Reactive Protein (CRP) is an acute phase protein whose concentration rises in blood following inflammation. Formerly, assays for CRP detected its rise only after significant inflammation. However, recently developed high sensitivity assays (hsCRP) enable the measurement of CRP in individuals who are apparently healthy. Several studies indicate that hsCRP is elevated in individuals who are at risk of developing Coronary Artery Disease or Cerebrovascular events, the elevation may be found years before the first detection of vascular problems. In the absence of other biochemical markers, the present study aimed to evaluate the predictive and diagnostic role of hsCRP in stroke. MATERIALS AND METHODS: The study consisted of 50 patients of acute stroke admitted in Gauhati Medical College and Hospital. The control population consisted of two groups - 50 age and sex matched controls with hypertension (Hypertensive control group) and 50 age and sex matched controls with no obvious disease constituted the Normal control group. hsCRP levels were measured in all the groups and compared statistically. CONCLUSION: hsCRP is an acute phase reactant whose concentration rises in stroke as well as in those at risk. The rise may be identified even before the appearance of risk factors. Hence, hsCRP may be useful as a predictive and diagnostic marker in stroke.