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

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Dr Mohan Z Mani

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On Sep 2018




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Prof. Somashekhar Nimbalkar
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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
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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."



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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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Calcutta National Medical College & Hospital , Kolkata




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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.
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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.
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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 : 2023 | Month : February | Volume : 17 | Issue : 2 | Page : LC10 - LC13 Full Version

Exposing the Iceberg: A Study on Risk Assessment and Chronic Morbidity due to Non Communicable Diseases among Rural Population of Kerala using STEPS Survey


Published: February 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/60515.17444
Shaliet Rose Sebastian, B Lekshmipriya, Sruthy CS Kumar, Deepak Thomas Varughese, Anoop Ivan Benjamin

1. Associate Professor, Department of Community Medicine, Believers Church Medical College Hospital, Thiruvalla, Kerala, India. 2. Undergraduate Student, Department of Community Medicine, Believers Church Medical College Hospital, Thiruvalla, Kerala, India. 3. Tutor, Department of Community Medicine, Believers Church Medical College Hospital, Thiruvalla, Kerala, India. 4. Assistant Professor, Department of Community Medicine, Believers Church Medical College Hospital, Thiruvalla, Kerala, India. 5. Professor and Head, Department of Community Medicine, Believers Church Medical College Hospital, Thiruvalla, Kerala, India.

Correspondence Address :
Shaliet Rose Sebastian,
Associate Professor, Department of Community Medicine, Believers Church Medical College Hospital, Thiruvalla, Kerala, India.
E-mail: drshalietrs@gmail.com

Abstract

Introduction: Non Communicable Diseases (NCDs) (heart diseases, chronic respiratory disease, stroke, diabetes, cancer) pose a significant public health burden especially in low and middle income countries. The increasing prevalence of NCDs will have significant implications in socio-economic and health sector and hence, needs immediate attention.

Aim: To see the prevalence of NCDs and its risk factors among residents in a rural population of Pathanamthitta district.

Materials and Methods: This cross-sectional survey was conducted among 2236 adults of both gender residing in Konni Block, Pathanamthitta over a period of six months using the World Health Organisation STEPwise approach to surveillance (WHO STEPS) survey, the Achutha Menon Centre Diabetes Risk Score (AMCDRS) and risk score to predict hypertension in primary care settings. Variables were expressed using proportions with 95% Confidence Intervals (CI). Chi-square test was used for comparison of proportions across groups. Logistic regression analysis were used to determine the predictors of morbid conditions.

Results: Total of 2236 study participants consisted of 53.8% females and 46.2% males with the mean age 47±17.5 years was included. Among them, 683 (30.7%) suffered from one or more morbidity. Around 18.1% and 19.9% of study participants suffered from diabetes and hypertension, respectively. More than 25% of the study population was at risk of developing hypertension and diabetes. Substance abuse, obesity and family history of diabetes were found to be risk factors for the development of morbidity.

Conclusion: The present study provides evidence of the growing burden of morbidity from NCDs. Increasing prevalence of multimorbidity and clustering of risk factors demand urgent and co-ordinated attention.

Keywords

Diabetes risk score, Morbidity, Risk factors, Risk score to predict hypertension, STEPwise approach

The NCDs pose a significant public health burden especially in low and middle income countries. The increasing prevalence of NCDs will have significant implications in socio-economic and health sector and hence needs immediate attention. As per the World Health Organisation (WHO), NCDs contribute towards 71% of the total number of deaths each year. Among the NCDs, cardiovascular diseases are responsible for the highest number of deaths (17.9 million deaths annually), followed by cancers (9.0 million), respiratory diseases (3.9 million), and diabetes (1.6 million) (1). Because NCDs are largely preventable, these deaths can be significantly reduced. According to the Global Monitoring Framework for NCDs to prevent and control NCDs by 2025 adopted by the World health assembly, primary prevention is the key to control the global epidemic of NCDs (2).

The WHO initiated the STEPwise approach to NCD risk factor surveillance (STEPS) in 2002 to guide the establishment of risk-factor surveillance systems in countries by providing a framework. The methodology of the approach consists of three steps namely questionnaire, physical measurements, and biochemical measurements. Each of the steps is divided into core items, core variables, and optional modules. These modules mostly cover demographics, health data and health related behaviour. Surveys are conducted under the approach to assess the burden of socio-economic, metabolic, nutritional and lifestyle risk factors (3),(4).

In a resource constraint setting like that of India, regular blood investigations may not be always feasible. Here lies the importance of cheaper screening tools to identify individuals at risk of contracting diabetes. The AMCDRS, is a risk score used in screening for Diabetes (5),(6). The AMCDRS consists of three variables- age, family history of diabetes, and waist circumference. Another example of a low cost screening tool is a risk score to predict hypertension in rural India. It is simple and can be easily administered by healthcare workers in primary healthcare settings (7). The score evaluates an individual’s risk of developing hypertension in future so that primary and secondary preventive measures like adoption of healthy lifestyle, quitting smoking, reducing waist circumference and regular blood pressure monitoring can be applied for the prevention/early diagnosis of hypertension.

According to the India state-level disease burden initiative, over 90% of mortality in the 15-69 years age group in Kerala could be attributed to NCDs. The higher proportion of population above the age of 65 years and lifestyle changes could have led to the present increase in NCDs. Compared to other states in India, Kerala is in an advanced stage of epidemiological transition (8). The increasing proportion of elders (12.6%) and the adoption of sedentary lifestyles in Kerala might have contributed to the increase in NCDs (9). Assessment of the burden of morbidity and risk factors could be useful in planning and allocation of health resources to ensure prevention and management of NCDs. The present study was done to evaluate the burden of morbidity due to NCDs among the adult population of Konni Block, Pathanamthitta and the prevalence of risk factors for the same.

Material and Methods

This cross-sectional survey was conducted by the Department of Community Medicine, Believers Church Medical College Hospital, Thiruvalla, Kerala, India among 2236 permanent resident adults of Konni Block of Pathanamthitta district from January 2021 to December 2021. Ethical Clearance was obtained from the Institutional Ethics Committee (IEC/2020/02/121) along with consent. Sample size for the study was estimated using the formula:

N=(1.96)2 pq/L2

using the prevalence (19.2%) from a similar study (10).

Data was collected using the following instruments:

1. A short demographic questionnaire about age, gender, education, occupation of study participants.
2. A structured interview schedule based on the Malayalam version of WHO STEPS questionnaire was used to collect Socio-demographic details of the study population data regarding the use of tobacco, alcohol, vegetable and fruit intake and physical activity was also elicited (3). Anthropometric measurements taken were height, weight, waist circumference. Blood pressure was also measured using a Sphygmomanometer.
3. The Achutha Menon Centre Diabetes Risk Score (AMCDRS)- it is score used to screen for Diabetes. The score consists of eliciting information on the age and family history of the respondent along with measurement of waist circumference (6). If the total score is ≥4, he/she is at a high-risk of having diabetes and needs further follow-up and management. If the score is <4, he/she is at low risk of contracting diabetes.
4. A risk score to predict hypertension in primary care settings in rural India. This is a risk score developed to screen for hypertension. It can be administered at the grass root level by primary healthcare workers (7).

The operational definitions used in the study are given in (Table/Fig 1): (3),(11),(12),(13),(14),(15).

Community surveys were done to collect data. Information on the use of tobacco, alcohol, fruit and vegetable intake, amount of physical activity, the pattern of chronic morbidity etc., was collected. Anthropometric data on height, weight, waist circumference, blood pressure etc., were recorded.

Statistical Analysis

Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 20.0. Variables were expressed using proportions with 95% CIs. Chi-square test was used for comparison of proportions across groups. Binary logistic regression analysis was done to determine the predictors of morbidity. A 95% CI and a 5% level of significance were used to interpret statistical significance. A p-value <0.05 was considered to be significant.

Results

Socio-demographic data: The study sample consisted of 2400 participants. Out of the data collected, 164 responses were discarded due to data quality issues leaving a sample size of 2236 study participants. Mean age of the study participants was 47±17.5 years. The study participants consisted of 53.8% females and 46.2% males. The socio-demographic data of the study participants is given in (Table/Fig 2).

Morbidity pattern: A survey of the study participants to assess the morbidity pattern revealed that 686 out of 2236 study participants (30.7%) suffered from one or more morbidity. Approximately, 18% of study participants suffered from diabetes. The proportion of obesity among the study participants was 34%. The detailed morbidity pattern of the study population is depicted in (Table/Fig 3).

Risk of diabetes and hypertension: The study participants were assessed using AMCDRS to assess the risk for diabetes. The study population was also surveyed using the risk score to predict hypertension (7). The survey found that 27.1% (607) of the study population were at risk of developing hypertension and diabetes (Table/Fig 4).

Factors associated with morbidity among study population: Chi-square test was done to assess the association between the study variables and presence of morbidity among study population. Among the factors tested, family history of diabetes, hypertension and smoking were found to be significantly associated with morbidity. The results of Chi-square analysis are given in (Table/Fig 5).

Binary logistic regression of the study data was done to find out the risk factors for morbidity among the study population. Analysis revealed that family history of diabetes, smoking and alcohol consumption were risk factors for morbidity among the study population (Table/Fig 6).

Discussion

The prevalence of diabetes among the study participants in the current study was 18.1%. According to the The Indian Council of Medical Research–India Diabetes (ICMR-INDIAB) study, the prevalence of diabetes in urban areas was nearly 25% and nearly 10% in rural areas (16). Such high prevalence from a rural population in central Kerala is alarming. Another similar study found that only one-third of the diabetic patents were aware of their condition thereby, underscoring the need for screening camps (17). The present study found family history of diabetes to be a strong predictor of morbidity. Previously published studies also found older age, family history of diabetes, obesity and hypertension to be positively related with Diabetes (p-value <0.001) (18),(19). Another factor, which was found to significantly increase the risk of morbidity is obesity. This finding is supported by other studies which found that individuals with abdominal obesity had two times higher risk of diabetes (OR 2.10; CI 1.63, 2.68). Studies showed that abdominal obesity had a higher increase than generalised obesity in all the populations and its association with diabetes was more significant (20),(21).

The present study revealed that the prevalence of hypertension among 2236 study participants was 19.9%. Another similar study from rural India revealed a prevalence of hypertension to be 31.5% (95% CI: 27.1-35.9) (22). Another reason for the increased risk of cardiovascular events among the Indian population is dyslipidaemia. The prevalence of dyslipidaemia among the study population was found to be 9.8%. The ICMR-INDIAB Study to assess the prevalence of dyslipidaemia in urban and rural India revealed that 13.9% had hypercholesterolaemia and 29.5% had hypertriglyceridemia (23). A lower prevalence of dyslipidaemia in the present study could be due to the fact that the study population was a rural community following a healthy lifestyle. Approximately, 86% of the study participants were involved in regular physical activity and fruits and vegetables were a part of the daily diet among 97% of the study population. Previously published study findings involving 8 year follow-up data of healthy middle-aged men and women, were found to be associated with an increased risk of death from any cause (relative risk among men 3.4, 95% CI 2.0 to 5.8, and among women 4.7, 95% CI 2.2 to 9.8) (24).

Another important finding of the present study was that smoking and alcoholism increased the risk of developing morbidity. This finding is in line with the data from a similar study which found that compared to men who only smoked but did not drink, men who smoked and drank more than 15 units a week had high all-cause mortality {relative rate=2.71 (95% CI 2.31-3.19)} (25). Assessment of risk using AMCDRS and risk score to predict hypertension reported that 27.1% and 37.2% of study participants were at risk of developing diabetes and hypertension, respectively. Hence, primary prevention has become the need of the hour. Randomised Controlled Trials (RCTs) have tested array primary prevention strategies, including lifestyle modifications and pharmacotherapy for those at risk, which have proven efficacious (26). Such risk assessment scales enable effective screening of individuals at the primary care level and ensure timely identification of ‘at risk’ individuals and appropriate follow-up and treatment.

Limitation(s)

Due to resource constraints, the quantification of risk factors could not be done (for example: number of cigarettes smoked). Social desirability bias may have underestimated the prevalence of behavioural risk factors in the study population.

Conclusion

The present study provides evidence of the growing burden of morbidity from NCDs. Increasing prevalence of multimorbidity and clustering of risk factors demand urgent and co-ordinated attention. An integrated approach consisting of health promotion, risk reduction, regular screening programmes, and provision of effective care would be a sustainable and cost effective method to reduce the morbidity due to NCDs.

Acknowledgement

The authors express sincere thanks to the Institution for its support, to all teaching and non teaching staff of the Department of Community Medicine and Rural Health Centre who helped in the implementation of this project.

References

1.
World Health Organization. Noncommunicable Diseases (NCD). (2019). Available online at: https://www.who.int/gho/ncd/mortality_morbidity/en/.
2.
United Nations Sustainable Development Knowledge Platform. Transforming our world: The 2030 Agenda for Sustainable Development. New York, NY: United Nations Department of Economic and Social Affairs; 2015. Available at: https:// sustainabledevelopment.un. Org/post2015/transforming our world.
3.
World Health Organization. WHO STEP wise approach to surveillance (STEPS). Available at: http://www.who.int/chp/steps/en. Accessed August 10, 2015.
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Armstrong T, Bonita R. Capacity building for an integrated non communicable disease risk factor surveillance system in developing countries. Ethn Dis. 2003;13(suppl 2):S13-S18.
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Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas G, Mini GK, et al. Risk factor profile for chronic non communicable diseases: Results of a community-based study in Kerala, India. Indian Med Res. 2010;131:53-63.
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Sathish T, Kannan S, Sarma PS, Thankappan KR. Achutha Menon Centre Diabetes Risk Score: A type 2 diabetes screening tool for primary health care providers in rural India. Asia Pac J Public Health. 2015;27(2):147-54. [crossref] [PubMed]
7.
Sathish T, Kannan S, Sarma PS, Razum O, Thrift AG, Thankappan KR. A risk score to predict hypertension in primary care settings in rural India. Asia Pac J Public Health. 2016;28(1 Suppl):26S-31S. [crossref] [PubMed]
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ICMR, PHFI, IHME. India: Health of the Nation’s States-The India State-Level Disease Burden Initiative. New Delhi: ICMR, PHFI, IHME, 2017.
9.
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DOI and Others

DOI: 10.7860/JCDR/2023/60515.17444

Date of Submission: Sep 29, 2022
Date of Peer Review: Nov 08, 2022
Date of Acceptance: Dec 06, 2022
Date of Publishing: Feb 01, 2023

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: Oct 04, 2022
• Manual Googling: Nov 25, 2022
• iThenticate Software: Dec 05, 2022 (25%)

ETYMOLOGY: Author Origin

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