Predicting risk for Non-Communicable Disease (NCDs) using Community Based Assessment Checklist (CBAC) form among Adults of Haryana
Ms.Pabalpreet Kaur 1*, Ms. Pooja Jaswal 2, Dr. (Mrs.) Jyoti Sarin 3
1 Nursing Tutor, M.M College of Nursing, MM (Deemed to be university), Mullana, Ambala
2 Assistance Professor, M.M College of Nursing, MM (Deemed to be university), Mullana, Ambala
3 Director-Principal, M.M College of Nursing, MM (Deemed to be university), Mullana, Ambala
*Nursing Tutor, M.M College of Nursing, Mullana. (Mail id: [email protected])
ABSTRACT
NCD are leading cause of premature Deaths worldwide. CBAC (Community Based Assessment Checklist) is a simple means of early identifying risk of NCDs in a community. It seems to be a cost-effective strategy for NCD prevention in developing countries and used by ASHA workers. This questionnaire collect details related to behavioral factors. A total of 168 subjects
above 30 years of age were included in this cross sectional study. The study participants were interviewed with the help of a Community Based Assessment Checklist questionnaire. That included demographic variables, behavioral risk factors; physical measurements. The behavioral related risk factors were use of tobacco, alcohol, lack of physical activity and family history of any NCDs. Physical measurements included waist circumference. Near to half (41%) of the respondents were >=50 years. Most of the
study subjects were females (70.8%). More than half (57.7%) of study participants had risk of developing any NCDs. Nearly 42.3% of respondents had score less than 4. The risk of NCD was found to be significantly associated with Age, Gender (p=<0.001), level of Education (p=<0.002), alcohol consumption, Waist circumference, and family history of hypertension, Diabetes mellitus and cardiovascular illnesses (p=<0.0001). CBAC Chart should be used by peripheral health workers for early
Risk identification of individuals and provide timely services in restricting the number of NCD cases in India.
Keywords
Non-communicable disease, Community Based Assessment Checklist.
Introduction
Non-communicable diseases (NCD) are lifestyle or behavioral related diseases which are not passed from individual to individual. They progress very sluggishly and are of long duration in nature. Non communicable diseases broadly categorized as cardiovascular disease, Cancer, diabetes mellitus, chronic respiratory disease, chronic neurologic disorders, Arthritis.1
Most of these NCDs are caused by four modifiable behavioral/lifestyle related risk factors: use of tobacco, unhealthy dietary intake, lack of exercise and consumption of alcohol. NCDs affect both rich and poor families due to which there is increased load on health-care systems. NCDs are mostly prevalent in low and middle-income countries where it contributes more than three quarters of global deaths.2
Non communicable diseases contribute 70% of all deaths globally. Every year, NCDs leads to
"premature" deaths. Cardiovascular diseases account for most of the NCD deaths, followed cancers, respiratory diseases and diabetes. Timely screening, diagnosis and prompt treatment of NCDs are key components to restrict the incidence of NCDs.3
Rapid urbanization, globalization, adoption of unhealthy lifestyles are the major forces that leads to development of major non-communicable diseases. People with Unhealthy dietary habits and lack of physical activity may present with elevated blood pressure, rise in blood glucose level, hyperlipidemia and obesity. These are termed as metabolic risk factors that can be modified and control if detected early .4
Aim
The present study was taken with the objective to estimate risk for Common NCDs among Adults of Haryana by using Community Based Assessment Checklist (CBAC) form.
Definition of variables
Common NCDs: It includes screening of all the women and men above 30 years for increased blood pressure, elevated blood glucose, Oral cancer, Breast cancer and cervical cancer.
Smokers: In present study smokers are defined as the individuals who are active smokers and those who have done smoking in last 1 year before the assessment.
Current drinker: Those who consumed alcohol in the year preceding the Survey but ≤5 (for women ≤4) standard drinks on any occasion.
Insufficient physical activity: Insufficient physical activity can be defined as when a person is not doing more than 30 minutes of moderate activity per day.
Examples of moderate intensity physical activity includes walking briskly, gardening, dancing, swimming, bicycling, volleyball, scrubbing floors, carrying water from river or well, manual grinding or pounding of cereals, manual washing of clothes.
Methods
A cross sectional study was conducted in the village Adhoya of Ambala district. Written informed consent from study participants was obtained prior to the collection of data. Total 168 families were included under the study. Eligible respondent was selected from each of the households. The reference population for the study was adults aged 30 years or above. After three times visit houses found locked were excluded from the study. All patients with established Hypertension, Diabetes mellitus or any other NCDs were excluded from the study. The study participants were interviewed with the help of a Community Based Assessment Checklist questionnaire. That included demographic variables, behavioral risk factors; physical measurements. The behavioral risk factors were intake of tobacco , alcohol, lack of physical activity and family history of any NCDs. Physical measurements included waist circumference.
Community Based Assessment Checklist (CBAC)
The CBAC is designed to early screen, identify and refer the clients at community level for any kind of NCDs. This questionnaire collect details related to behavioral factors. All women and men aged 30 years and above screened with the help of this questionnaire by ASHA workers at community level. Individual whose score is 4 and above are at a risk for developing any NCDs hence those patients should be needed to be prioritized for screening.
SPSS software package version 19.0 was used for analysis of entered data. The association between the risk factors (alcohol use, physical inactivity, and waist circumference, smoking and family history) and CBAC score was find out with the help of chi-square.
Results (Times New Roman, bold, 12)
Table 1: Characteristics of the study population
N=168
Variables f (%)
1. Age in years
30-39 52 (31)
40-49 47 (28)
>.=50 69 (41)
2. Gender
Male 49 (29.2)
Female 119 (70.8)
3. Level of Education
Non-Formal education 55 (32.7)
Primary School completed 27(16.1)
Middle school completed 37 (22.0)
High school completed 29 (17.3)
Degree/diploma 20 (11.9)
4. Religion
Hindu 135(80.4)
Muslim 07(4.2)
Sikh 26 (15.5)
5. Smoking
Never 135 (80.4)
Past/sometimes 17 (10.1)
Now 16(9.5)
6. Alcohol Use
Never 143 (85.1)
Current Drinker 25(14.9)
Yes (>150 minutes/week) 48(28.6)
No (<150minutes/week) 120 (71.4)
8. Waist circumference (Cm) < 80
Females
25 (14.9)
80-90 49(29.2)
>90 45(26.8)
<90
Males
20(11.9)
90-100 20(11.9)
>100 09(5.4)
9. Family History of High blood pressure, Diabetes and heart diseases.
No 96 (57.1)
Yes 72 (42.9)
Table 1 shows a total of 168 subjects 30 and above 30 years of age were included in the study.
Near to half (41%) of the respondents were >=50 years. Most of the study subjects were females (70.8%).The percentage of respondents with no formal education was 32.7%. This was followed by those who had completed middle school (22%). Majority of the study population (80.4%) was Hindu.
Majority of study population never smoked in his/her lifetime. Only 10% of respondents had past history of smoking whereas least (9.5) respondents are current smokers. All the females were lifetime abstainers of smoking. Nearly 15% of the male respondents were current drinker. On the other hand all the female respondents were lifetime abstainers.
Most of the subjects (71.4%) were perform physical activity less than 150 minutes/week. In terms of waist circumference more than one-fourth (26.8%) had waist circumference more than 90 cm.
Least number of males (5.4%) had waist circumference >100 cm. Near to half (42.9%) of study samples had family history of High Blood pressure, Diabetes and heart diseases.
Figure 1 shows risk of developing NCD risk in respondents. More than half (57.7%) of study participants had risk of developing any NCDs. Nearly 42.3% of respondents had score less than 4.
Figure 1: Pie chart showing NCD risk among study participants
Table 2: Chi-square value showing association of NCD with selected variables
N=168
Variables less than 4
n=71
4 or more than 4 n=97
Chi-square (df) p 1. Age in years
35.2 (2) 0.000
30-39 35 17
40-49 25 22
>=50 11 58
2. Gender
Male 11 38 11.1(1) 0.001
Female 60 59
3. Level of Education
Non-Formal education 15 40 17.4 (4) 0.002
Primary School completed 17 10
Middle school completed 11 26
High school completed 15 14
Degree/diploma 13 07
4. Smoking
Never 65 70 10.7 (2) 0.006
Past/sometimes 04 13
42.3
57.7
NCD Risk
Less than 4 4 or more than 4
Now 02 14 5. Alcohol Use
Never 69 74 14.1 (1) 0.000
Current Drinker 02 23
6. Physical Activity
Yes (>150 minutes/week) 24 24 1.6 (1) .19
No (<150minutes/week) 47 73
7. Waist circumference (Cm)
<80 23 02 49.8 (5) 0.000
80-90 25 2
>90 12 33
<90 10 10
90-100 01 19
>100 00 09
8. Family History of High blood pressure, Diabetes and heart diseases.
No 68 28 74.9 (1) 0.000
Yes 03 69
Table 2 shows that the of NCD was found to be significantly associated with Age, Gender (p=<0.001), level of Education (p=<0.002), alcohol consumption, Waist circumference, and family history of hypertension, Diabetes mellitus and cardiovascular illnesses (p=<0.0001)
Discussions
With the epidemiological transition from communicable diseases to Non-communicable diseases, CVD is a foremost cause of untimely death. Prevention of CVD is an essential component in reducing overall mortality related to NCDs. Detecting risk factors contributing towards NCDs at the earliest along with CBAC is helpful in preventing any unexpected outcome in the future. In the present study there was significant relationship was seen between age and risk of NCD (As age increases risk of NCD also increases). This findings was supported by the study conducted in Kathmandu, Nepal by Dhungana RR et al (2014).5 This result was also alike with the results of a study conducted in rural areas of north India by Bansal P et al (2016).6
Present study result showed abdominal obesity (Waist circumference) had a higher NCD risk compared with normal individuals, and was statistically significant (p=0.0000).Waist circumference (WC) was to measure the central obesity of an individual. It is one of the most simpler and practical tool to be used in community settings. Increased abdominal obesity is strongly connected with the development of cardio-vascular diseases and in future it can be used as a predictor for metabolic diseases. In present study Alcohol consumption was also a strong risk
factor associated with NCD. A cross-sectional study in Salem (Premanandh K, Shankar R (2018)) also showed that abdominal obesity and alcohol consumption were significantly associated with higher CVD risk.7 A study was conducted in rural area of Mysuru among 608 individuals aged ≥40 years also concluded that High BMI, abdominal obesity, smoking and alcohol is significantly related to Increasing the risk of CVD.8
Conclusion
CBAC is a very simple tool that can be used to screen the risk of NCDs in communities by ASHA workers. This will further help the stakeholders to plan and implement strategies (targeted interventions) among the recognized high risk population which can further restrict the burden of NCDs.
Source of Funding: No source of funding Conflict of interest: No conflict of interest
Ethical Clearance: Taken from Faculty of Nursing, MM (Deemed to be) University, Mullana, Ambala.
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