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   Table of Contents - Current issue
July-September 2021
Volume 6 | Issue 3
Page Nos. 99-154

Online since Monday, November 22, 2021

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Noncommunicable diseases and COVID-19 in Africa: A call for universal health coverage p. 99
Davison Munodawafa, Adele Webb, Prebo Barango, David Houerto, Mosoka Fallah, Aminata Kobie
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Oil pollution and hypertension prevalence in Rivers State, Nigeria: A comparative study p. 102
John Nwolim Paul, Omosivie Maduka
Aims: This study was done to compare the prevalence of hypertension in oil-polluted and non-oil polluted communities in Rivers State Subjects and Methods: A community-based household analytical cross-sectional study was conducted on oil-polluted communities in Ogoni local government areas and nonoil polluted communities in Abua/Odua LGA both in Rivers State. An interviewer-administered structured World Health Organization STEPS instrument/questionnaire for NCD/chronic disease surveillance was used, and the sample size of 1000 participants was recruited via multistage sampling. Odds ratio (OR) and corresponding 95% confidence intervals (95% CI) we calculated through bivariate and multivariate regression analysis. Results: The prevalence of hypertension among persons resident in oil-polluted and nonoil-polluted communities was 59.8% and 46.6%, respectively. The comparison of prevalence showed statistical significance between both categories (χ2 = 16.97, P = 0.001). The regression model on crude analysis found residence (OR 1.69, 95% CI 1.32–2.17) and cigarette smoking (OR 1.65, 95% CI 1.19–2.29) were related to being hypertensive. Conclusions: The study revealed that participants who were residents in oil-polluted areas had 1.69 times higher odds of having hypertension over those in areas without oil pollution. However, moderate and vigorous physical activity reduced the chances of having hypertension by 95%, and 99%, respectively.
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Effect of nutrition education package on dietary modification and anthropometry among attendees of a noncommunicable disease clinic at a rural primary health-care facility in Delhi p. 109
Rohit Katre, Bratati Banerjee, Panna Lal, Pragya Sharma
Context: The global burden and threat of noncommunicable diseases (NCDs) constitutes a major public health challenge that undermines social and economic development throughout the world. NCDs are one of the leading causes of adult morbidity and mortality globally. The disease burden in India due to NCDs has increased from 30% to 55% between 1990 and 2016. Aims: We aimed to assess the effect of nutrition education intervention on dietary awareness, practices, and anthropometry. Settings and Design: This design was a facility-based before-and-after intervention study without control. Materials and Methods: This study was conducted in five phases: planning and recruitment, preintervention, intervention, washout, and postintervention. Data were collected using a pretested, semi-structured interview schedule under the following heads – personal, sociodemographic, and behavioral risk factors of NCDs. Anthropometric examination included weight, height, waist, and hip circumference measurement. Statistical Analysis: Collected data were entered into MS Excel and analyzed using IBM SPSS 25 for descriptive and inferential statistics. Results: There was a significant increase in mean score for dietary practices and knowledge regarding different food items in the study group. The mean number of servings of fruits and vegetables increased significantly following intervention in the study group (P = 0.001). Significant change in body mass index before and after intervention was found to be in the age group of >60 years (P = 0.041). Conclusions: The study has shown the usefulness of intervention aimed at improving dietary behavior among patients of NCDs. With growing burden, there is a need for such innovative and cost-effective measures for halting the rising burden.
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Spatial distribution and control status of hypertension in urban field practice area of a tertiary medical care institution of South India: A cross-sectional analytical study Highly accessed article p. 115
Namrata Kharat, Parthibane Sivanantham, G Dinesh Kumar, James T Devasia, Sitanshu Sekhar Kar
Background: Hypertension is a global public health issue. Geographic information systems (GIS) are increasingly being used by health-care systems as an emerging tool to address the public health burden of hypertension. Objective: The objective of the study is to describe the geographic distribution of adults with known hypertension residing in the urban field practice area of a tertiary care institution and to assess the factors associated with its control status. Materials and Methods: We conducted a cross-sectional analytical study in an urban health center (UHC) with adults with hypertension (n = 343) seeking care from the NCD clinic of UHC and private clinics were included. Geo-coding was done (n = 343) using digital GPS device by house-to-house visit and average of the three blood pressure recordings using digital sphygmomanometer taken for assessing control status (n = 277) of hypertension. A structured questionnaire was used to collect sociodemographic, risk factors distribution, and medication adherence. Geospatial analysis was done using QGIS 3.0, ArcGIS 10.2 and SPSS version 22 (IBM Corp. Armonk, NY, USA) was used for statistical analysis. Results: The geographic distribution showed clusters and hotspots in the study area. Of the 277 study participants, 57.4% (51.6–63.5) had blood pressure under control and 41% were male. Patients with age ≥60 years (prevalence ratios [PR]: 1.2, 95% CI: 1–1.6), with no comorbidity (PR: 1.3, 95% CI: 1–1.7), high medicine adherence (PR: 7.6, 95% CI: 3.9–14.6) were independent factors associated with control status. Conclusion: The study identified the clustering and hotspot areas of known patients with hypertension. Around three-fifth of known hypertensives had their blood pressure under control.
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Political economy framework and the occurrence of noncommunicable diseases. “Framing dietary practices in Ghana as the receptacle” p. 122
Brenyah Joseph Kwasi, Tannor Elliot Koranteng, Brenyah Florence, Edusei Anthony
Context: Noncommunicable diseases (NCDs) such as cardiovascular diseases, cancers, hypertension, kidney diseases, and diabetes account for sizeable proportion of global deaths. The proximate causes aside biological and genetics are behavioral risk factors include dietary practices. Unhealthy dietary practice leading to the occurrence of NCDs blamed for the drawback of social and economic development of lower- and middle-income countries. Aims: This research focuses on establishing links among the political economy framework (education, occupation, income, residential place, and mass media), dietary practices, and the occurrence of NCDs in Ghana. Settings and Design: It adopted a mixed method approach using the Ghana Demographic and Health Survey (2014), with a sample of 4122 and 32 qualitative interviews from four regions. Subjects and Methods: In-depth, key informant interviews, focus groups discussions, and secondary data were used. The qualitative arm was analyzed using the thematic content analysis. Statistical Analysis Used: Descriptive statistics and probit regression were used to ascertain the influences of the constituents of political economy using individual's dietary intakes. Results: The present study found that, differences in income levels (P < 0.05), residential place of stay (P < 0.05), and access to mass media (P < 0.05) were statistically significant to dietary practices and had major implications for NCDs occurrence. The qualitative outcome revealed that, educational and occupational status of individuals may influence dietary practices. The regression revealed that females are exposed to unhealthy dietary practices by 6.2% points. Moreover, rural dwelling had moderate influence on unhealthy dietary practices (3.3% points) than urban dwelling. Again, professionals, sales, and service categories have 5.8%, 5.7%, and 7.6% points unhealthy practices, respectively.
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The impact of project diabetes with dignity intervention on knowledge and quality of life among adults with diabetes in a rural Indian setting Highly accessed article p. 129
Gaurang P Nazar, Monika Arora, Vinay Kumar Gupta, Tina Rawal, Aastha Chugh, Surbhi Shrivastava, Prasanna Dhore, Anjali Bhatt, Shailesh R Deshpande, AG Unnikrishnan
Objective: Inadequate knowledge about diabetes leads to its under-diagnosis and sub-optimal control. We studied the impact of project diabetes with dignity (DWD) intervention on knowledge and quality of life (QoL) among adults with diabetes in a rural Indian setting. Methods: DWD was a community-based, quasi-experimental trial conducted with 416 participants (30–70 years) with diabetes across two Primary Health Centers (one intervention; one control) in Western India, over a year. The intervention involved monthly home visits, patient/caregiver, and community-based awareness-raising activities by trained accredited social health activists (ASHAs) workers. Differences in changes in knowledge about: Diabetes, symptoms, management, and complications, and QoL between participants in the intervention versus control areas, from baseline to end-line, were assessed using a questionnaire and analyzed via mixed-effects regression models. Results: About 52% of patients belonged to the intervention group. There was a significant increase in knowledge about diagnosis/management among participants in intervention group (31.48% [95% confidence interval (CI) 24.52–38.43] to 59.55% [52.52–66.58]) versus a decline in the control group (40.73% [33.40–48.07] to 27.95% [19.40–34.50]) (P < 0.001). Similar improvements in intervention group were observed for knowledge about symptoms/complications of diabetes. For QoL, percentage of patients having some self-care problems showed a higher decline in intervention group (29.46% to 6.98%) versus control group (4.85% to 3.55%) (P = 0.005). Reduction in anxiety/depression was significant in the intervention versus control group (P < 0.001). Conclusion: DWD was effective in improving QoL and diabetes knowledge which are key to prevent disease progression/complications in the intervention compared to the control group. Capacity-building of community health workers such as ASHAs, for the prevention and management of diabetes in rural settings, is recommended.
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Poor risk factor control among stroke survivors - A cross-sectional survey p. 137
SD Shani, PN Sylaja, P Sankara Sarma, Kutty V Raman
Objectives: A cross-sectional survey was done to find out the prevalence and control status of cardiovascular risk factors among stroke survivors within a post-stroke period of 3 months to 1 year. Methodology: The data on the prevalence of risk factors were taken from past medical history and medical records. The risk factor control is defined as achieving the targeted levels of blood pressure, blood sugars and cholesterol. Data on a diet, physical activity, tobacco use, and alcohol consumption were also collected. Standard instruments were used to measure blood pressure, weight, height, and waist circumference (WC). The blood sugar and lipid values were taken from labratory reports. Results: Stroke survivors (N = 240) participated. Around 75% of the participants were obese or overweight. Normal WC was found only in 25% of the participants. Majority of the participants were not following a healthy diet (62.5%) or doing recommended physical activity (87.1%). The prevalence of diabetes (61.2%), hypertension (88.6%), and dyslipidemia (96%) were high among stroke survivors. The targeted level of diabetic control and hypertension control level was achieved by 26% and 36.2, respectively, while around 72% attained lipid control. Conclusion: The prevalence of cardiovascular risk factors is very high among stroke survivors, and it is poorly controlled.
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Evaluation of association of psychosocial stress and hypertension in adults >30 years of age: A community-based case–control study from Rural Central India p. 142
Sneha Yadav, Shreyak Garg, Abhishek V Raut
Background: Hypertension has multifactorial causation. Stress has chronically been cited as an imperative cause of hypertension among other risk factors such as sleep abnormalities. The interrelation between psychosocial stress and hypertension has been significant though the exact association remains debatable. Objective: The objective of the study was to evaluate the association of psychosocial stress and other factors such as family and social support, sleep abnormalities, physical activity, and addiction with hypertension in adults >30 years of age. Materials and Methods: Age- and sex-matched community-based case–control study with 90 incident hypertensive cases aged (>30) and 90 controls were selected from rural populations in central India. Study participants were examined and interviewed regarding their sociodemographic characteristics, psychosocial stress, family and social support, quality of sleep, addiction, and physical activity using four structured and validated questionnaires. Data analysis was done by binomial logistic regression with SPSS (version 21). Results: Psychosocial stress was significantly associated with incident hypertension (adjusted odds ratio [AOR] =8.198, 95% confidence interval [C.I.] 2.85–23.52). Participants having compromised family and social support (AOR = 3.0, 95% C.I: 1.41–6.34), poor quality of sleep (AOR = 4.429, 95% C.I: 1.78–10.96), and low physical activity (AOR = 2.92, 95% C.I: 1.22–6.98) had higher odds of developing hypertension. Sedentary occupation, lower socioeconomic status, and body mass index ≥23 kg/m2 each had an association with hypertension. Conclusion: This study highlights a significant number of undiagnosed or untreated cases of psychosocial distress in the community. Thus, calling for immediate attention toward psychosocial stress as an important etiological determinant of hypertension.
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A systematic review protocol examining the effect of environmental cardiovascular and antidiabetic agents on aquatic organisms and humans p. 149
Nanda Gamad, Shobhit Bhansali, Samir Malhotra
Context: Pharmaceuticals are released into the environment through human and industrial waste and waste due to handling. They significantly contaminate aquatic systems and through food chain, enter the body of human beings. The development of new techniques such as liquid chromatography and mass spectrometry has helped to detect and measure even the trace amounts of pharmaceutical compounds in the environment. At present, cardiovascular and antidiabetic agents are one of the most commonly prescribed drugs worldwide owing to chronicity of the diseases. However, there is a lack of knowledge regarding their effects on aquatic organisms and human beings once they are released into the environment. Aim: The aim of the study is to identify the extent and characteristics of the toxicity caused by environmental cardiovascular and antidiabetic agents on aquatic organisms and humans. Settings and Design: It will be systematic review of all original research articles which assess the environmental toxicity of one or more cardiovascular and antidiabetic drugs. Methodology: This systematic review will be conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data regarding acute and chronic toxicities caused by cardiovascular and antidiabetic drugs to fish, daphnia, algae, and humans will be collected. In addition, we will report sampling strategies and methodologies adopted to quantify drugs from the samples.
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Chronic noncommunicable diseases and post-COVID 19 syndrome: The need to create specialized centers for primary care p. 153
William Andrés Castro-Vera, Sofia Esther Fernandez-De La Rosa, José Rafael Villarreal-Escorcia, Ivan David Lozada-Martinez
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