Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 33035

AbstractMaterial and MethodsResultsDiscussionConclusionAcknowledgementReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : LC15 - LC21 Full Version

Determinants of Non Communicable Diseases: A Mixed-method Study on Its Prevalence and Perceptions among Rural Population of Muchisa, West Bengal


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/53398.16467
Sinjita Dutta, Ankita Mishra, Mausumi Basu, Meghna Mukherjee

1. Associate Professor, Department of Community Medicine, Institute of Post Graduate Medical Education And Research, Kolkata, West Bengal, India. 2. Postgraduate Trainee, Department of Community Medicine, Institute of Post Graduate Medical Education And Research, Kolkata, West Bengal, India. 3. Professor, Department of Community Medicine, Institute of Post Graduate Medical Education And Research, Kolkata, West Bengal, India. 4. Statistician cum Tutor, Department of Community Medicine, Institute of Post Graduate Medical Education And Research, Kolkata, West Bengal, India.

Correspondence Address :
Dr. Ankita Mishra,
Department of Community Medicine, 1st Floor, Academic Building, IPGME&R, AJC Bose Road, Kolkata, West Bengal, India.
E-mail: 22ankita1992@gmail.com

Abstract

Introduction: Most people with Non Communicable Diseases (NCDs) are unaware of the problem because it usually does not have any signs or symptoms in the initial stages. The measures for prevention of NCDs are not well known to the rural population which results in a huge burden on the health system.

Aim: To estimate the burden of NCDs, and its risk factors among the rural population residing in a village of Budge Budge II block, West Bengal. Also to explore their perceptions regarding determinants, complications and prevention of NCDs, and to look for the association of NCDs with the risk factors and socio-demographic characteristics.

Materials and Methods: An observational study, with cross-sectional design using mixed methods approach, was conducted on 160 residents of Muchisa, from December 2020 to March 2021. A predesigned, pretested and structured schedule, prepared on the basis of World Health Organization (WHO) STEPS framework, was used to assess the presence NCD and associated risk factors in the study population. Focused group discussion guide was employed to inquire about their perceptions. The participants were selected through cluster random sampling. The data were explored using Pearson’s Chi-square test, logistic regression and thematic analysis. A p-value of <0.05 was considered significant.

Results: Mean age of the participants was 45.0±16.8 years, and 69.4% participants were females. Total 75% of the participants suffered from at least one NCD. All the participants had at least one risk factor for NCD. Age group of 40-59 years (p-value <0.001) and 60 years or above (p-value=0.002), female gender (p-valu=0.009), and preschool education or below (p-value=0.006) were associated with a higher risk of NCD. Qualitative data analysis revealed that lifestyle modification was not perceived to be effective against NCDs.

Conclusion: Socio-demographic factors, like age, gender and education have a bearing on the risk of developing NCD. Lack of awareness about the prevention of NCDs is the challenge in addressing the problem.

Keywords

Chronic disease, Control, Prevention, Risk factors, Rural population

Non Communicable Diseases (NCDs) comprises of significant burden on community health globally. About 71% of all deaths globally can be attributed to NCDs (1). Over 85% of these "premature" deaths occur in low and middle-income countries (1). The NCDs terrorize advancement towards the 2030 Agenda for Sustainable Development, which focuses on minimizing early mortality from NCDs by one-third till the year 2030. Most NCD-related deaths are attributed to the cardiovascular diseases (17.9 million), followed by cancer (9.0 million), respiratory disease (3.9million), and diabetes mellitus (1.6 million) (1). Most individuals suffering from NCDs may develop serious complications including death without any prior warning as these diseases may have asymptomatic presentation in the initial stages. In response to the current scenario, the World Health Organization (WHO) have developed a Global action plan 2013-2020 to prevent and control NCDs (2).

As per WHO recommendations, a minimum of “150-300 minutes of moderate-intensity aerobic physical activity” or “75-150 minutes of vigorous-intensity aerobic physical activity”, or “an equivalent combination of both” every week, along with 7-9 hours of sleep per day for adults is required for substantial health benefits (2),(3). There is evidence that replacing “sedentary time” with even “light intensity physical activity” can be helpful (4). Having a minimum of “5 servings of fruits and vegetables a day”, and minimizing salt intake to less than 5 gm/day have been recognized as some of the economical means of improving health outcomes (5),(6). The target should be to achieve a Body Mass Index (BMI) between 18.5-22.9 and a waist-hip ratio of less than 0.85 for females and less than 0.90 for males (7),(8). Modifiable risk factors for the NCDs are tobacco use, lack of physical activity, unhealthy diet, and alcohol consumption (1). Raised blood pressure, overweight/obesity, hyperglycaemia, and hyperlipidaemia are the four vital metabolic changes which could be attributed to these risk factors. However, the burden of the NCDs can be effectively reduced through lifestyle modification, regular monitoring of blood pressure and sugar and compliance to medications.

Unfortunately, the rural population is less aware of the risk factors associated with NCDs, and have lower rates of health care utilization as compared to the urban population (9),(10),(11). The prevalence of risk factors for NCD is higher in rural West Bengal, where the percentage of smokers and alcohol users was reported to be more than 40% and 10%, respectively (12), (13). Bhattacharjee S et al., also reported that the burden of NCDs like overweight, abdominal obesity and hypertension was 29.8%, 20.2% and 17.8%, respectively, in adults of Siliguri, West Bengal (12). Even the adolescent population of West Bengal is becoming prey to these risk factors (14). A vital event surveillance study in Birbhum, West Bengal also reported that NCDs were the major cause of mortality in the area (15). This emphasizes on the need for extensive research in this area.

Objectives: Therefore, the current study purported.

• To estimate the burden of NCDs among the rural population residing in a village of Budge Budge II block, West Bengal;
• To evaluate the proportion of those possessing risk factors for NCDs; to explore their perceptions regarding determinants, complications and prevention of NCDs, and to look for the association of NCD with the risk factors and socio-demographic characteristics.

Material and Methods

An observational study with cross-sectional design and explanatory sequential mixed-methods approach (using both qualitative as well as quantitative data) was conducted on adults in Muchisa village, under Budge Budge II Block of South 24 Parganas in West Bengal, India. The study was planned in December 2020. Data Collection was initiated after approval from Institutional Ethics Committee of Institute of Post Graduate Medical Education And Research, Kolkata, West Bengal (IPGME&R/IEC/2021/126, dt-06.02.21) and the local authorities.

Data collection: The data collection for quantitative strand was for 2 weeks from 8th February - 21st February 2021 which was followed by data entry and analysis (22nd February-28th February 2021). After analysis of the quantitative data, participants were selected for the qualitative strand from among the participants of the quantitative strand. Data for the qualitative strand were collected on 4th March 2021.

Sample size calculation: The sample size was calculated using the formula (the quantitative component):

N=Z2pq/e2
Where, Z=1.96,
p=prevalence of hypertension,
q=1-p,
e=10% absolute error

Considering the prevalence of hypertension (as cardiovascular diseases are the most common cause of NCD deaths globally (1) and in India (16) to be 24.7% (17), with a precision of 5% and confidence level of 95%, the sample size was calculated as 72. After considering a non response rate of 10%, a sample size of 80 was deduced. This sample size was multiplied with a design effect of 2 (cluster sampling). Thus, the quantitative part of the study was conducted on a sample of 160 rural inhabitants.

Cluster random sampling technique

Two stage cluster random sampling technique was used to enroll the study participants.

• In the 1st stage, one cluster (Roy Para) with a population of 695 (as per April 2020 data) was selected out of the seven Paras in Muchisa village using simple random sampling technique.
• In the 2nd stage units (individuals) were selected by systematic random sampling where sampling interval was 4.

Therefore, every fourth person was selected and 14 participants were selected purposively from amongst the study participants for the focussed group discussions.

Inclusion criteria: The adults of Muchisa available during data collection were included in the quantitative study after obtaining written informed consent.

Exclusion criteria: Individuals with severe illness were excluded from the survey.

Procedure

Data were collected after ensuring anonymity and confidentiality. Initially a one-to-one interview was conducted on the selected sample population in their households using a predesigned, pretested and structured schedule. This schedule was developed by the researchers on the basis of WHO STEPS framework after expert validation, and pretesting on a sample of 30 rural people from Muchisa, who were excluded from the final sample selection process for the actual study (5).

Along with the interview, anthropometric and other measurements like blood pressure (average of three readings) and pulse rate (with the help of GVC Iron analog weighing scale, Omron HEM 712 upper arm automatic blood pressure monitor and non stretchable measuring tape) were also recorded.

Besides, other parameters were also recorded to estimate the burden of risk factors for NCDs among the study population:

• Fasting Blood Sugar (FBS),
• Post Prandial Blood Sugar (PPBS), and
• Glycated haemoglobin (HbA1C)

Focused Group Discussions (FGD)

The two FDG were then carried out including those identified to have a risk factor for NCDs to explore their perceptions regarding the disease, possible complications, prevention and control. The total number of participants in the qualitative strand was 14 because only a few participants turned up for the FGD session. The sessions were video graphed after taking consent from the participants.

• FDG 1: Included six participants (2 males, 4 females) who were purposively selected. Their age varied from 50-70 years.
• FDG 2: Comprised of eight female participants, with age ranging from 25-55 years.

Outcome Variables

i. Self-reported NCD
ii. Clinically diagnosed NCD (Diagnosed with the help of body mass index (7), waist hip ratio (8), blood pressure (18) and laboratory reports like FBS, PPBS, HbA1c (19).

• A participant with BMI ≥25 Kg/m2 was identified as obese.
• Hypertension was diagnosed if the average of three blood pressure measurements of a participant was recorded to be
≥140 mmHg systolic or
≥90 mmHg diastolic
• In order to diagnose diabetes mellitus,
FBS ≥7.0 mmol/L (126 mg/dL),
PPBS ≥11.1 mmol/L (200 mg/dL) or
HbA1c ≥6.5% were taken as cut-offs

Explanatory variable

i. Socio-demographic characteristics
ii. Lifestyle and behavioural factors

Operational definitions:

1. Non-communicable disease: “also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behavioural factors” (1).
2. Risk factor: “any attribute, characteristic, or exposure of an individual which increases the likelihood of developing a noncommunicable disease”. (20) As per WHO, less than <150 hours of moderate and vigorous intensity exercise per week (2); <7 hours or >9 hours of sleep per day(3),increased waist-hip ratio (males ≥0.90, females ≥ 0.85) (8);consuming <5 servings of fruits and vegetables a day (5); salt intake of more than 5 g/day (6) and BMI of 25 or more (7) are considered risk factors for NCD. Other risk factors include tobacco use, and alcohol consumption (1).
3. Rural: An area which comes under a Gram Panchayat and where “a minimum of 75% of male working population is involved in agriculture and allied activities” (21).

Statistical Analysis

Data were recorded in the Microsoft Office Excel 2010(Microsoft Corp, Redmond, WA, USA) and the analysis was performed using Statistical Package for the Social Sciences (IBM, New York City, United States of America) version 25.0. Descriptive statistical measures were employed to summarize the data. Binary logistic regression was performed to ascertain relationship between the dependent (Self-reported NCD, Clinically diagnosed NCD) and the independent variables (socio-demographic characteristics, lifestyle and behavioural factors). The dependent variables did not follow normal distribution (Kolmogorov-Smirnow test: p-value <0.001; Shapiro-Wilk test: p-value <0.0001). Data were checked for multi-collinearity, Variance Inflation Factor was found to be less than 10 and tolerance was greater than 0.1. Thus, Pearson’s Chi-square test was used to compare the study variables with respect to presence or absence of self-reported NCD. Multivariate binary logistic regression was used to test the association between the dependent and the independent factors after adjusting for potential covariate. A p-value <0.05 was considered significant. The focused group discussions were analysed thematically by the authors. The transcripts were prepared from the video recordings of the focus group. Each author individually analysed the transcripts manually, to derive themes, codes and corresponding verbatim. This was followed by a discussion among the authors to finalise the themes and codes based on common consensus.

Results

(Table/Fig 1) displays the socio-demographic characteristics of the study population. A total of 160 rural individuals were included in the study, of which 39.4% belonged to the age group of 40-59 years (mean age was 45.0±16.8 years), 69.4% were females, and 68.8% were married. All of them were followers of Hinduism, and belonged to the General Caste. About 31.3% of the sample belonged to class IV as per Modified BG Prasad Scale 2020 (22).

Total 75% of the participants suffered from at least one NCD. The percentage of the study population with hypertension and obesity was 65.6% and 35.6%, respectively. Ten participants possessed their fasting blood glucose reports at the time of data collection - five of them were identified to have impaired fasting glucose levels. Out of the total population, 65.6% were hypertensive, of which 36.2% were aware about their disease (self-reported), and 63.8% were diagnosed by the researchers (clinically-diagnosed). A total of 57 participants were obese, but only one of them was aware about this. Total 85% participants with diabetes mellitus were aware of their disease (Table/Fig 2).

All the participants possessed one or more predisposing factors for NCD. The most prevalent risk factor was having a diet deficient of fruits and vegetables (100%), followed by insufficient physical activity (88.1%) and increased waist-hip ratio (88.1%) (Table/Fig 3).

(Table/Fig 4) demonstrates the association of risk factors with NCD. The univariate analysis showed that age group of 40-59 years (OR: 4.77, p-value <0.001) and 60 years or above (OR: 6.35, p-value=0.002), female gender (OR 2.71, p-value=0.009) and preschool education or below (OR: 3.48, p-value=0.006) were associated with a higher risk of NCD.

The Quantitative analysis was followed by two focused group discussions (FGD -1, FGD -2) (total participants 14) to investigate the perceptions of the study population regarding the disease, its prevention and associated complications.

• There were six participants in FGD- 1 aged between 36 and 70 years consisting of two males and four females. Three of the participants of FGD- 1 self reported their NCDs (Participant 3 and Participant 6: hypertension; Participant 1: obesity) while the other 3 participants were clinically diagnosed to be suffering from NCD (2 obesity and 1 hypertension).
• FGD- 2 included 8 participants (one male and seven females) with ages ranging from 25-65 years. Three participants of FGD- 2 were aware of the NCDs they were suffering from and hence reported the same (Participant 3 and Participant 5: hypertension; Participant 8: diabetes mellitus). The remaining participants were clinically diagnosed to be hypertensive (Table/Fig 5).

Discussion

In India, 12.3 to 22.7% rural people aged 15 years and above are either diabetic or hypertensive. (23) The burden is higher in rural West Bengal where a minimum of 16.5% suffer from these NCDs (24).

(Table/Fig 6) depicts that the overall prevalence of hypertension was greater in the present study work compared to that reported by Bhagyalaxmi PS et al., Swaminathan K et al., and in Maldives study (27),(28),(30). The prevalence of obesity in the current study was found to be 35.6% which was higher than others studies, but comparable to the study by Pelzom D et al., from Bhutan (12),(25),(26),(29),(31),(32). Prevalence of diabetes (12.5%) was also higher than that reported by Bhattacharjee S et al., and Kokane AM et al., and Aryal KK et al., (12),(26),(32). While Sarma PS et al., reported a slightly higher prevalence (19%) than the current study (29).

A comparison of prevalence of risk factors for NCD has been shown in (Table/Fig 7). Every participant in the current survey possessed at least one risk factor for NCD which was contrary to the discovery by Sarma PS et al., in Kerala where they had reported more than 15% participants to be risk-free (29). This difference might be attributed to a higher literacy rate in Kerela as compared to West Bengal (33). The most prevalent risk factor among participants in some surveys was having a diet deficient in fruits and vegetables which corroborates to the present study findings (25),(26),(30). Other behavioral risk factors like alcohol intake and insufficient physical activity were more frequent in the present study as compared to other studies (26),(29). The percentage of smokers and alcohol users in this research were 28.1% and 15.6%, respectively, which was about half the prevalence of smokers (69.8%) and alcohol users (40.7%) compared to the study by Bhar et al., (25). Community-based interventions for screening the risk factors, behavioral change communication and awareness generation could help in curbing the disease burden.

As age was observed to influence NCD, establishment of a “Geriatric Clinic” at the nearby health centre could assist in management of NCDs in the elderly age group. Peer et al., stated an association between alcohol intake and presence of NCD which was not observed in the current study probably due to a lesser frequency of alcohol users in the settings (34).

As evident from (Table/Fig 8), while dietary modifications, medications and BP monitoring were suggested preventive methods in the present study, Idriss A et al., that health seeking practices and prayers were regarded (35). Al-Shoaibi AAA et al., from Dhaka, like the present study, reported that modulation of diet and regular medicines were protective. Notably, participants in the present survey as well as in Dhaka study knew that addiction could be detrimental to health, still they could not quit it due to lack of support from acquaintances. Most subjects in the present study as well as in the Dhaka study refrained from regular blood pressure monitoring due to the cost involved (36).

Limitation(s)

Like many studies, this survey also had certain limitations. Firstly, systematic random sampling scheme employed for selection of participants may lead to inclusion of more number of females in the study. Besides, the population was not screened for chronic diseases like diabetes which is a prevalent cause of morbidity.

Conclusion

The risk factors of NCDs were highly prevalent among the study population. Inadequate fruit and vegetable intake was the most prevalent risk factor in the current study. Advancing age, female gender and lower level of education were some of the factors triggering onset of Non Communicable Diseases. The participants were unaware about the measures to prevent and effectively control chronic diseases. Most of the participants were ignorant about the role of factors other than medications in prevention and control of NCDs. The focused group participants had some knowledge about the complications which could be associated with hypertension. The participants had longing for better communication with the health professionals to help them understand the disease better. This study paves the way for future interventional studies aiming at improvement in prevention of chronic diseases.

Acknowledgement

Authors acknowledge the contribution of the following members of Department of Community Medicine, Institute of Post Graduate Medical Education And Research, Kolkata for their contribution in the study.

Authors would like to thank the ASHA workers and the residents of Muchisa for their active participation in the study.

References

1.
World Health Organization. Noncommunicable Diseases. Fact Sheets. World Health Organization, Geneva, Switzerland; 2018 Jun 1 [Cited 2020 September 30]. Available from: URL: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases.
2.
World Health Organization. WHO Guidelines on Physical Activity And Sedentary Behaviour. World Health Organization, Geneva, Switzerland; 2020 [Cited 2020 December 4]. Available from: URL: https://apps.who.int/iris/bitstream/handle/10665/336656/9789240015128-eng.pdf.
3.
National Sleep Foundation. National Sleep Foundation Recommends New Sleep Times. Washington DC; 2015 Feb 2 [Cited 2020 Dec 4]. Available from: URL:https://www.sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times#:~:text=Teenagers%20(14%2D17)%3A%20Sleep,and%20remains %207%2D9%20hours.
4.
World Health Organization. WHO Guidelines On Physical Activity And Sedentary Behaviour. World Health Organization, Geneva, Switzerland; 2020 [cited 2020 December 4]. Available from: URL: https://apps.who.int/iris/bitstream/handle/10665/336656/9789240015128-eng.pdf.
5.
World Health Organization. STEPS: A framework for surveillance. World Health Organization, Geneva, Switzerland; 2003[cited 2020 December 5]. Available from: URL: https://www.who.int/ncd_surveillance/en/steps_framework_dec03.pdf.
6.
World Health Organization. Salt Reduction. Fact Sheet. World Health Organization, Geneva, Switzerland; 2020 [cited 2020 December 5]. Available from: URL:https://www.who.int/news-room/fact-sheets/detail/salt reduction#:~:text=For%20adults%3A%20WHO%20recommends%20that,relative%20to%20those%20of%20adults.
7.
Public Health. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157-163. Available from: URL:https://www.who.int/nutrition/publications/bmi_asia_strategies.pdf. [crossref]
8.
World Health Organization. Waist Circumference and Waist-Hip Ratio. Report of a WHO Expert Consultation GENEVA.World Health Organization, Geneva, Switzerland; 2008 Dec [cited 2020 Dec 6]. Available from: URL: https://apps.who.int/iris/bitstream/handle/10665/44583/9789241501491_eng.pdf?sequence=1.
9.
Thippeswamy T, Chikkegowda P. Basic Risk Factors Awareness in Non-Communicable Diseases (BRAND) Study Among People Visiting Tertiary Care Centre in Mysuru, Karnataka. J Clin Diagn Res. 2016;10(4):OC04-07. Available from: https://doi.org/10.7860/JCDR/2016/19041.7556. PMid: 27190858PMCid: PMC4866156. [crossref] [PubMed]
10.
Shravani R, Lakshman Rao RL, Wassey Md A, Tabassum N. Awareness of Risk Factors for Non Communicable Diseases among Adolescent girls aged 15-17 years in Koti, Hyderabad. Journal of Medical Science and Clinical Research. 2018;6(4): 743-7. [crossref]
11.
Ghosh S. Equity in the utilization of healthcare services in India: evidence from National Sample Survey. Int J Health Policy Manag. 2014;2(1):29-38. Available from: https://dx.doi.org/10.15171/ijhpm.2014.06 PMid: 24596902PMCid: PMC3937944. [crossref] [PubMed]
12.
Bhattacherjee S, Datta S, Roy JK, Chakraborty M. A Cross-sectional Assessment of Risk Factors of Non-Communicable Diseases in a Sub-Himalayan Region of West Bengal, India Using who Steps Approach. J Assoc Physicians India. 2015;63(12):34-40.PMid: 27666902.
13.
Srivastav S, Mahajan H, Goel S, Mukherjee S. Prevalence of risk factors of noncommunicable diseases in a rural population of district Gautam-Budh Nagar, Uttar Pradesh using the World Health Organization STEPS approach. J Family Med Prim Care. 2017;6(3):491-497. Available from: https://dx.doi.org/10.4103%2F2249-4863.222027. PMid: 29416995PMCid: PMC5787942. [crossref] [PubMed]
14.
Kala S, Bhattacherjee S, Biswas R, Mukherjee A, Datta S. Prevalence of Risk Factors of Non-communicable Diseases among Adolescents of a Rural Area in Darjeeling District of West Bengal. J Assoc Physicians India. 2021;69(10):11-12. PMid: 34781655.
15.
Rai RK, Barik A, Mazumdar S, Chatterjee K, Kalkonde YV, Mathur M, et al. Non-communicable diseases are the leading cause of mortality in rural Birbhum, West Bengal, India: a sex-stratified analysis of verbal autopsies from a prospective cohort, 2012-2017. BMJ Open. 2020;10(10):01-12. [crossref] [PubMed]
16.
World Health Organization. Noncommunicable diseases country profiles 2018. Noncommunicable diseases and mental health. World Health Organization, Geneva, Switzerland; 2020 [Cited 2020 September 27]. Available from: URL: https://www.who.int/nmh/countries/en/#I.
17.
Dutta A, Ray MR. Prevalence of hypertension and pre-hypertension in rural women: a report from the villages of West Bengal, a state in the eastern part of India. Aust J Rural Health. 2012;20(4):219-25. Available from: https://doi.org/10.1111/j.1440-1584.2012.01287.x. PMid: 22827431. [crossref] [PubMed]
18.
US Department of Health and Human Services. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. United States: National Institutes of Health; 2004. 12 p. Report No.: 04-5230.
19.
World Health Organization. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia - Report of a WHO/IDF Consultation. World Health Organization, Geneva, Switzerland: 2006. 12 p.
20.
Bonita R, de Courten M, Dwyer T, Jamrozik K, Winkelmann R. Surveillance of risk factors for noncommunicable diseases: The WHO STEPwise approach. Summary. Geneva, World Health Organization; 2001 [cited 2020 December 5]. Available from: URL: https://www.who.int/ncd_surveillance/media/en/269.pdf.
21.
Infocus. Rural India: Where is it? Dhanlaxmi Bank; 2010 [Cited 2020 Dec 26]. Available from: URL: http://www.dhanbank.com/pdf/reports/InFocus-December%201,%202010.pdf.
22.
Debnath DJ. Kakkar R. Modified BG Prasad Socio-economic Classification, Updated-2020. Indian J Comm Health. 2020;32(1):124-125. Available from: https://doi.org/10.47203/IJCH.2020.v32i01.024. [crossref]
23.
National Family Health Survey 2019-2020 (NFHS -5). State Fact Sheet - West Bengal. India: Ministry of Health and Family Welfare, Government of India (International Institute for Population Sciences); 2021.
24.
National Family Health Survey 2019-2020 (NFHS -5). India Fact Sheet. India: Ministry of Health and Family Welfare, Government of India (International Institute for Population Sciences); 2021.
25.
Bhar D, Bhattacherjee S, Das DK. Behavioral and biological risk factors of noncommunicable diseases among tribal adults of rural siliguri in Darjeeling District, West Bengal: A cross-sectional study. Indian J Public Health. 2019;63(2):119-127. Available from: https://doi.org/10.4103/ijph.IJPH_326_18. PMid: 31219060. [crossref] [PubMed]
26.
Kokane AM, Joshi R, Kotnis A, et al. Determinants of behavioural and biological risk factors for cardiovascular diseases from state level STEPS survey (2017-19) in Madhya Pradesh. Peer J. 2020;8:e10476. Available from: https://doi.org/10.7717/peerj.10476. PMid: 33354427PMCid: PMC7733649. [crossref] [PubMed]
27.
Bhagyalaxmi A, Atul T, Shikha J. Prevalence of risk factors of non-communicable diseases in a District of Gujarat, India. J Health Popul Nutr. 2013;31(1):78-85. Available from: https://doi.org/10.3329/jhpn.v31i1.14752. PMid: 23617208 PMCid: PMC3702362. [crossref] [PubMed]
28.
Swaminathan K, Veerasekar G, Kuppusamy S, Sundaresan M, Velmurugan G, Palaniswami NG. Noncommunicable disease in rural India: Are we seriously underestimating the risk? The Nallampatti noncommunicable disease study. Indian J Endocrinol Metab. 2017;21(1):90-95. Available from: https://doi.org/10.4103/2230-8210.196001. PMid: 28217505 PMCid: PMC5240088. [crossref] [PubMed]
29.
Sarma PS, Sadanandan R, Thulaseedharan JV, Soman B, Srinivasan K, Varma RP, et al. Prevalence of risk factors of non-communicable diseases in Kerala, India: Results of a cross-sectional study. BMJ Open. 2019;9(11):01-10. Available from: https://doi.org/10.4103/2249- 4863.137617. PMid: 25161966 PMCid: PMC4139989.
30.
Aboobakur M, Latheef A, Mohamed AJ, Moosa S, Pandey RM, Krishnan A, et al. Surveillance for non-communicable disease risk factors in Maldives: results from the first STEPS survey in Male. Int J Public Health. 2010 Oct;55(5):489-496. Available from: https://doi.org/10.1007/ s00038-009-0114-y. PMID: 20063111. [crossref] [PubMed]
31.
Pelzom D, Isaakidis P, Oo MM, Gurung MS, Yangchen P. Alarming prevalence and clustering of modifiable noncommunicable disease risk factors among adults in Bhutan: a nationwide cross-sectional community survey. BMC Public Health. 2017;17(1):975. Available from: https://doi:10.1186/s12889-017-4989-x. PMid: 29268747PMCid: PMC5740865. [crossref] [PubMed]
32.
Aryal KK, Mehata S, Neupane S, Vaidya A, Dhimal M, Dhakal P, et al. The Burden and Determinants of Non Communicable Diseases Risk Factors in Nepal: Findings from a Nationwide STEPS Survey. PLoS One. 2015;10(8):01-18. Available from: https:// doi:10.1371/journal.pone.0134834. PMID: 26244512PMCid: PMC4526223. [crossref] [PubMed]
33.
Khurana K. International Literacy Day 2020: Andhra Pradesh worst, Delhi 2nd best - State wise literacy rate in India. Times Now [Internet]. 2020 Sep 8 [cited 2020 Dec 26]; Education News. Available from: URL: https://www.timesnownews.com/education/article/ international-literacy-day-2020-andhra-pradesh-worst-delhi-2nd-best-state wise-literacy-rate-in-india/649224.
34.
Peer N, Steyn K, Lombard C, Gwebushe N, Levitt N. A high burden of hypertension in the urban black population of Cape Town: the cardiovascular risk in black south Africans (CRIBSA) study. PLoS One. 2012; 8(11): e78567. Available from: https://doi.org/10.1371/journal.pone.0078567. [crossref] [PubMed]
35.
Idriss A, Diaconu K, Zou G, Senesi RG, Wurie H, Witter S. Rural-urban health-seeking behaviours for non-communicable diseases in Sierra Leone. BMJ Global Health. 2020 Feb 1;5(2):e002024. Available from: https://doi.org/10.1136/bmjgh-2019-002024. PMid: 32181002PMCid: PMC7053783. [crossref] [PubMed]
36.
Al-Shoaibi AAA, Matsuyama A, Khalequzzaman M,et al. Perceptions and behavior related to noncommunicable diseases among slum dwellers in a rapidly urbanizing city, Dhaka, Bangladesh: a qualitative study. Nagoya J Med Sci. 2018;80(4):559-569. Available from: https://dx.doi.org/10.18999%2Fnagjms.80.4.559. PMid: 30587870PMCid: PMC6295424.

DOI and Others

DOI: 10.7860/JCDR/2022/53398.16467

Date of Submission: Nov 26, 2021
Date of Peer Review: Jan 12, 2022
Date of Acceptance: Mar 16, 2022
Date of Publishing: Jun 01, 2022

Author declaration:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 29, 2021
• Manual Googling: Feb 22, 2022
• iThenticate Software: May 18, 2022 (17%)

Etymology: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com