Epidemiology of Non-Communicable diseases in Rural Areas.

E N D I R A – Epidemiology of Non-communicable Diseases in Rural                                           Areas.

 Introduction- With the increase in life expectancy non-communicable diseases ( NCD ) has out stripped infectious and nutrition related diseases as the major cause of morbidity and mortality in present day India.

The prevalence of the so called life style related diseases, cancer and respiratory diseases are on the increase. The age of onset of these disease conditions is at a much earlier age than what is seen in the West.

The reasons for this are many and would include

-       rapid urbanization and industrialization

-       rural to urban area migration

-       changing diet patterns especially in urban areas

-       increasing tobacco and alcohol use and from an earlier age

-       sedentary life styles specially so in urban areas

-       stresses of daily living in a competitive world specially so after the opening up of the economy and globalization

-       pollution

-       increasing prevalence of obesity

-       lack of awareness of the disease conditions and their potential consequences

An individual admitted with a cerebro-vascular accident who is less than 45 years of age is more likely to be a male from the lower socio-economic strata ( SES )and a tobacco abuser. What was previously considered a domain of the rich is increasingly being seen in the lower SES.

 Aim -The aim of the ENDIRA group was to look at the NCD profile of a population of 100,000 individuals in a rural area.

This was coupled with an intervention by way of an audio-visual presentation documenting the ills related to tobacco and alcohol. The CD was presented in all the high schools of the respective panchayats. For an adult audience there were two other AV presentations on Diet & Exercise and Yoga& Meditation. The rationale being that educated children could pressurize their parent to quit tobacco and alcohol more effectively.

 Methods- Five adjacent panchayats namely Mookkannoor (13 wards ), Karukutty(16 wards), Manjapra(13 wards), Thuravoor(14 wards) and Kalady were identified. The panchayats are all located in Ernakulam district of central Kerala.

After an initial briefing of the panchayat committee and grant of permission, a training/orientation of the ASHA’s ( Accredited Social Health Activist ) and Kudumbashree workers is done. The ASHA’s are shown as to how to fill the questionnaire. The survey books, three( 150 pages each ) in all are given with a measuring tape and a weighing machine are what comprise a kit. It was demonstrated to the ASHA’s as to how to take the height and weight and how to make the entries.Telephone number of the PI was given to each individual ASHA in case she had any queries during the course of the survey.

In parallel a video presentation called N2T-A ( no to Tobacco & alcohol ) was shown to the school and PTA representatives of higher secondary schools in the panchayat. Permission was taken from the school authorities to screen the video for their higher secondary classes, namely Std V11-X.

The data was entered on a program written such as to be able to run a search on each of the individual conditions entered or on any combination.

 The survey was started after clearance from the ethics committee of the MAGJ Hospital, Mookkannoor.

 The details of a single family are entered on a single page.

Names of the individual family members, respective age, sex, educational status, height in cm, weight in kg along with the “ House name “, telephone number, ward number and name, Panchayat APL/BPL status are entered.

The importance of the “ House “ is in the fact that in Kerala the initials of an individual represent the name of the house he belongs to and not to the village like in some other parts of the country. One is identified by the house one belongs to. For example PP George would be Pynadath Poulose George in which the first P –Pynadath stands for his house name by which he is identified.

The disease conditions questioned for include

Diabetes mellitus- present/absent/do not know, when detected (year), mode of treatment whether diet/OHA/insulin

Hypertension- yes/ no/DNK and duration if yes. Duration is always entered as the year in which it was picked up.

Dyslipidaemia- Yes/No/DNK, duration if yes.

Alcohol consumption in pegs per week, country liquor or Indian made foreign liquor.

Use of tobacco products yes/No. usage per day, duration

Amount of non vegetarian food items bought in a month this when entered in the data sheet was entered per week. The amount of meats excluded fish.

Type of oil used by the household and the amount used per month.

   Whether the individual has undergone any surgery, and the body part operated upon.

Presence of any chronic respiratory conditions, duration.

Presence of cancer and where if yes.

H/O death due to cancer in the family.

H/O snake bite, any death due to snakebite in the family.

H/O CAD in the family and duration.

H/O CVA in the family and duration.

 Details of a single individual are entered as a single entry on the data sheet.

 The weighing machines and the tapes were calibrated before and after use. The details of individuals were verified by

-       medical camps conducted at the end of data entry of each panchayat, where fasting blood sugar and cholesterol were checked for

-       every 25th family was contacted by telephone if possible and the details entered tallied, in the rare instance that the family could not be contacted the next family on the list was contacted

-       individuals from the surveyed areas seen as out patients were cross checked for the veracity of details entered

     DISCUSSION

 Extrapolation of the data to the state and national levels would very much help health authorities in planning for expenditure on health at both central and state levels.

More intervention by way of educating the public should help decrease the incidence of lifestyle diseases and the complications secondary to it.

‘ CATCH THEM YOUNG†should be our motto. This could mean two things

Firstly early detection of the life style diseases before they actually manifest, for example as pre-HTN, an impaired glucose tolerance or as borderline dyslipidaemia.  Appropriate life style changes by way of

-       weight reduction

-       regular exercise

-       cutting down on the red meats and the quantity consumed

-       abstinence from alcohol and tobacco use

-       plenty of green leafy vegetables and  fruits

-       cutting down on salt consumption

-       yoga and meditiation

should all go a long way in making our community a healthier community.

 Secondly it could also mean educating the children at an impressionable age about what a healthy living really is. About the ills related to tobacco, alcohol etc.

The aim is to create a women & child lobby who would stridently protest about continued alcohol and tobacco use and would in time make the government ban the use of tobacco products.

 Dr Jaideep C Menon

Cardiologist, MAGJ Hospital

Mookkannoor 683577

 Mob 094473-52684