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ORIGINAL ARTICLES
A community-based study on knowledge of diabetes mellitus among adults in a rural population of Kerala
Beteena Kurian, Mariya Amin Qurieshi, Rajini Ganesh, Kamalamma Leelamoni
July-September 2016, 1(2):59-64
DOI:10.4103/2468-8827.191925  
Background: Worldwide India leads in diabetes mellitus and within India Kerala tops the list. Keeping in view increasing the burden of diabetes mellitus in Kerala, it is highly important to know about the awareness of the disease among the general population to chalk out culturally appropriate and need oriented educational strategies. Objective: The objective of this study is to assess the knowledge of diabetes mellitus in a rural populace of Kerala. Materials and Methods: A descriptive cross-sectional study was undertaken in a rural Panchayat of District Ernakulam of Kerala wherein 343 adults were randomly interviewed from six randomly selected wards. The interview schedule had 23 items on knowledge which was assessed in four domains including general awareness of diabetes mellitus, its risk factors, complications, and lifestyle modifications. Each item was given a score. Maximum possible score was 23. Knowledge score of <9 was considered as poor, 9-17 as average and above 17 was taken as good. Data were analyzed using SPSS version 11. Descriptive analysis was done for sociodemographic variables, and t-test and ANOVA were used to ascertain the level of significance of predictors of awareness. Results and Conclusion: Mean age of the participants was 47.7 ± 15.74 years with more than half (55.7%) having completed their high school education. Mean knowledge score was 15.6. Being diabetic, having completed high school education and with family history of diabetes had significantly better knowledge score (P < 0.05). Educating the community on risk factors is the key strategy for the prevention of diabetes and delaying the onset of disease among high-risk individuals.
  6 12,750 478
Effectiveness of district health promotion model (Hoshiarpur Ambala model): An implementation experience from two districts from Northern part of India
JS Thakur, Nidhi Jaswal, Ashoo Grover, Rupinder Kaur, Gurismer Jeet, Bhavneet Bharti, Manmeet Kaur
October-December 2016, 1(3):122-130
DOI:10.4103/2468-8827.198584  
Introduction: In India, implementation of Health Promotion activities follows a vertical approach at district level. A Health Promotion project was therefore implemented for 3 years in Hoshiarpur and Ambala districts of Northern India, with objectives to develop, implement, and assess the effectiveness of integrated health promotion model. Materials and Methods: Situation analysis in two districts was followed by a state level stakeholders workshop in which detailed layout of model and a health promotion manual (Hindi, English, and Punjabi) was developed for capacity building of workforce. The effectiveness of model was assessed using mix of quantitative as well as qualitative methods. Results: The key features of model included integration and convergence within National Health Programs, multitasking, multisectoral involvement, and community empowerment, using digital media and advocacy tools. The facility assessment survey revealed improvements in implementation of activities as per annual activity calendar of IEC/BCC activities, better display of IEC material, with improved reporting, monitoring, and supervision. At community level, the awareness levels of the community members regarding communicable/noncommunicable diseases and key Reproductive and Child Health issues improved significantly (P < 0.05). Similarly, the client exit survey showed that dissemination of health information by MO/ANM increased in 3 years from 8% to 80% and 7.3% to 75% in districts Hoshiarpur and Ambala, respectively (P < 0.05). In-depth interview with key stakeholders and focused group discussion with Village Health and Sanitation Committee/Village Level Core Committee has shown their active involvement and improvements in their functioning. Based on indicative costing, per capita costs of National Health Mission for IEC/BCC/Health promotion activities need to be increased from INR 0.7 (USD 0.01) to INR 4 (USD 0.06), which requires increase in budget allocation from 1% to minimum of 4%. Conclusion: Model was found to be effective and feasible on pilot implementation. District level human and financial resources, however, must be augmented to implement health promotion activities effectively.
  6 6,319 126
REVIEW ARTICLE
Sustainable development goals and noncommunicable diseases: Roadmap till 2030 – A plenary session of world noncommunicable diseases congress 2017
Soundappan Kathirvel, Jarnail Singh Thakur Rapporteurs
January-March 2018, 3(1):3-8
DOI:10.4103/jncd.jncd_1_18  
The global epidemic of noncommunicable diseases (NCDs) was recognized by the United Nations and is addressed by the Sustainable Development Goals (SDGs) to be achieved by 2030. This review article describes the proceedings of the plenary session “SDGs and NCDs: Roadmap till 2030” of the first “World NCD Congress 2017” held at Chandigarh, India. The plenary session emphasized the need for political commitment to take up NCD agenda at the national level to prevent and reduce the premature NCD deaths. Establishing the national action plan and monitoring framework for prevention and control of NCDs are the major initial initiatives to implement the best buy NCD interventions. Primary prevention of four common and shared risk factors and health system strengthening are the important interventions to achieve the SDG goal 3.4. The implementation strategies at subnational level and engagement of sectors other than health on prevention and control of NCDs can be reviewed and further researched for effective implementation of the identified interventions.
  6 5,905 129
ORIGINAL ARTICLES
Determining the prevalence of and risk factors for depressive symptoms among adults in Nepal: Findings from the Dhulikhel Heart Study
Michelle S Lam, Annette L Fitzpatrick, Archana Shrestha, Biraj M Karmacharya, Rajendra P Koju, Deepa Rao
January-March 2017, 2(1):18-26
DOI:10.4103/jncd.jncd_34_16  
Context: Nepal is currently experiencing a rapid growth in noncommunicable diseases (NCDs). Depression has previously been associated with NCDs in South Asia; however, data regarding its prevalence and risk factors are lacking in Nepal. Aims: This study aims to describe the prevalence of and risk factors for depressive symptoms in a suburban population of adults within Nepal. Setting and Design: We conducted a cross-sectional analysis of baseline data collected from participants enrolled in the Dhulikhel Heart Study, a population-based, longitudinal cohort study investigating cardiovascular risk factors in Dhulikhel, a suburban town outside Kathmandu. Subjects and Methods: Baseline questionnaire data from 1073 adults age 18 years and older included the Center for Epidemiologic Studies Depression Scale (CES-D). A score of 16 or greater on the CES-D has been shown to indicate major depressive symptomatology. Statistical Analysis: Using STATA 13, we conducted Pearson's Chi-square tests and multiple logistic regressions to examine associations between the binary CES-D score and gender, age, education, marital status, body mass index, physical activity, and hypertensive status. Results: The mean CES-D score in the sample was 11.7 (standard deviation: 5.3), with 21.3% scoring 16 or greater. Age over 60 and lack of formal education were associated with increased risk of depressive symptoms. Being physically active was associated with decreased risk of depressive symptoms. Conclusions: The estimated prevalence of depression among adults in Dhulikhel was 21.3%. Significant risk factors for increased depressive symptoms included lack of formal education, age over 60, and physical inactivity.
  5 5,201 57
Input of stakeholders on reducing depressive symptoms and improving diabetes outcomes in India: Formative work for the INtegrated DEPrEssioN and Diabetes TreatmENT study
Deepa Rao, Lauren Lipira, Shuba Kumar, Rani Mohanraj, Subramani Poongothai, Nikhil Tandon, GR Sridhar, Wayne Katon, KM Venkat Narayan, Lydia Chwastiak, Viswanathan Mohan, Mohammed K Ali
July-September 2016, 1(2):65-75
DOI:10.4103/2468-8827.191979  
Context: Depression and diabetes are highly comorbid, adversely affecting treatment adherence, and resulting in poor outcomes. To improve treatment and outcomes for people dually affected by diabetes and depression in India, we aimed to develop and test an integrated care model. Aims: In the formative phase of this INtegrated DEPrEssioN and Diabetes TreatmENT (INDEPENDENT) study, we sought stakeholder perspectives to inform culturally-sensitive adaptations of the intervention. Settings and Design: At our Delhi, Chennai, and Visakhapatnam sites, we conducted focus groups for patients with diabetes and depression and interviewed health-care workers, family members, and patients. Subjects and Methods: Key informants were asked about experiences with diabetes and depression and for feedback on intervention materials. Analysis: Qualitative data were analyzed using a grounded theory approach. Results: Three major themes emerged that have bearing on adaptation of the proposed intervention: importance of family assistance, concerns regarding patient/family understanding of diabetes, and feedback regarding the proposed intervention (e.g., adequate time needed for implementation; training program, and intervention should address stigma). Conclusions: Based on our findings, the following components would add value when incorporated into the intervention: (1) engaging families in the treatment process, (2) clear/simple written information, (3) clear nonjargon verbal explanations, and (4) coaching to help patients cope with stigma.
  5 3,685 51
REVIEW ARTICLES
Integrating tobacco and tuberculosis control programs in India: A win–win situation
Sonu Goel, Madhur Verma, Rana J Singh, Ashok Kumar Bhardwaj
December 2018, 3(5):9-15
DOI:10.4103/jncd.jncd_15_18  
An unequivocal relationship exists between tuberculosis (TB) and tobacco use. India has made the sustained efforts to reduce the dual burden of morbidity and mortality due to these two epidemics individually. It is now being felt to integrate two national programs which are tackling these diseases for their increased efficiency. Several opportunities exist for integration which includes joint policy development and planning, integrated trainings, joint supervision and monitoring, delivering tobacco cessation services among TB patients along with partnerships, and multisectoral approaches at national and subnational levels. The opportunities are limited by challenges such as lack of leadership and political commitment, limited resources, poor intersectoral coordination, dearth of community awareness, and limited capacity of TB program staff in tobacco cessation services. It is concluded that convergence of two national programs may lead to synergistic effect in decreasing the burden of both the public health problems. This kind of successful initiative of integrating tobacco control activities with TB, the control program may subsequently pave the way toward integration of tobacco control in other national programs and primary health-care services.
  5 3,043 96
Combating corona virus disease 2019 and comorbidities: The Kerala experience for the first 100 days
Kavumpurathu Raman Thankappan
April-June 2020, 5(2):36-42
DOI:10.4103/jncd.jncd_26_20  
Kerala, a highly vulnerable state for a virus disease like coronavirus disease 2019 (COVID-19) because of the largest proportion of elderly population in India with an extremely high prevalence of most of the noncommunicable diseases and their risk factors, reported first COVID-19 case in India. Using secondary data available from various search engines and specific websites of Kerala and Government of India, a review was done. Based on the World Health Organization's warning, Kerala anticipated cases from China where the first COVID-19 case was confirmed and was able to detect and isolate the cases as soon as they landed in Kerala. The total number of active cases in Kerala peaked at 262 in the first week of April and then decreased to 16 on May 8, flattening the epidemiological curve within 100 days. The major factors that lead to the success of Kerala in managing COVID-19 are depicted in this review.
  5 2,559 113
EDITORIAL
Novel Coronavirus Pandemic may worsen existing Global Noncommunicable disease crisis
JS Thakur
January-March 2020, 5(1):1-3
DOI:10.4103/jncd.jncd_2_20  
  4 3,402 210
ORIGINAL ARTICLES
Knowledge of diabetes among diabetic patients in government hospitals of Delhi
Saurav Basu, Megha Khobragade, DK Raut, Suneela Garg
January-March 2017, 2(1):8-10
DOI:10.4103/jncd.jncd_44_16  
Background: Poor patient knowledge of recommended diabetic self-care practices is a major barrier toward attainment of good glycemic control and prevention of diabetic complications. Materials and Methods: We assessed the knowledge of diabetes self-care practices through a short 7-item pretested questionnaire among diabetes mellitus patients attending special clinics in three government hospitals. Results: The average diabetes knowledge score attained by the patients was 3.79 ± 1.77 (maximum score = 7). Lifetime treatment requirement for diabetes mellitus, plasma glucose levels for good glycemic control, and symptoms of hypoglycemia were correctly reported by 89%, 74%, and 38.5% of the patients, respectively. Low educational status and female gender were significantly associated with poor knowledge of diabetes (P < 0.05). Low level of knowledge of diabetes was a predictor of poor glycemic control but not medication adherence. Conclusion: Knowledge of diabetes in patients attending government hospitals in India is low. Future studies should explore low-cost health education interventions feasible in the Indian health-care context for improving patient knowledge of diabetes.
  4 5,606 136
Cardiovascular disease risk assessment in Nigerian adults with type 2 diabetes and metabolic syndrome using the Framingham's risk score
Ifeoma Christiana Udenze, Casmir Ezenwa Amadi
January-March 2018, 3(1):15-20
DOI:10.4103/jncd.jncd_33_17  
Background: Cardiovascular morbidity is a major burden in Nigerian patients with type 2 diabetes mellitus (DM). Aims and Objectives: The aim of the present study was to compare the cardiovascular risk scores of type 2 diabetics with those of individuals with metabolic syndrome and in healthy controls and examine the impact of glycemic control and lifestyle on cardiovascular risk. Subjects and Methods: This was a cross-sectional study of adult Nigerians with type 2 diabetes, metabolic syndrome, and age- and sex-matched controls. Written informed consent was obtained from all the participants. The Ethics Committee of the Lagos University Teaching Hospital, Lagos, Nigeria, approved the study protocol. Statistical Analysis: The data were analyzed using the IBM SPSS software version 20.0 package. Statistical significance was set at P < 0.05. Results: There was a statistically significant difference in cardiovascular disease (CVD) risk scores between the group with diabetes (20.41 ± 12.98), metabolic syndrome (10.00 ± 6.35) and the control group (6.79 ± 7.81) (P < 0.001), and also in glycated hemoglobin (HbA1c),high-density lipoproteins (HDL)-cholesterol, total cholesterol , and triglyceride concentrations between the groups (P < 0.05). CVD risk correlated positively and significantly with HbA1c, body mass index and waist circumference and negatively with the level of education (P < 0.05). Only 52.2% of the people with diabetes on treatment achieved HbA1ctarget of <7%. Conclusion: People with Type 2 diabetes had high CVD risk scores, control of CVD risk factors is not optimum in adult Nigerians. Strategies to achieve better glycemic control, weight reduction, and increase literacy levels will help achieve CVD risk reduction in adult Nigerians.
  4 3,815 42
REVIEW ARTICLES
COVID-19 and noncommunicable diseases: Impact and the strategic approaches
JS Thakur, Ronika Paika, Sukriti Singh, Jai Prakash Narain
April-June 2020, 5(2):29-35
DOI:10.4103/jncd.jncd_35_20  
The coronavirus disease (COVID-19) has critically impacted global health systems and economies both in developed and developing world, but especially in developing countries, already struggling to address the preexisting burden of diseases with limited resources, the situation has become even more challenging. The COVID-19 pandemic is the most serious public health challenge today and is responsible for two concurrent global crises: the health crisis and an economic crisis. Only an appropriate policy response will determine the impact of pandemic on human health and economic well-being. It is clear that the pandemic will seriously undermine global efforts to attain the sustainable development goals. Among the major challenges are increased indoor time leading to increased exposure of other behavioral risk factors for noncommunicable diseases (NCDs) such as unhealthy diet, alcohol use, stress, inadequate access to essential medicines. Further travel or transport restrictions leading to inaccessibility to health care centres, early detection and laboratory testing for NCD patients and increased susceptibility in health care settings for chronic disease patients. Thus, the strategies are required to address this comorbidity which may include integration and convergence of the existing communicable and NCD programs, strengthening primary health care for universal health coverage, updating guidelines, enhancing surge capacity, and multisectoral participation. It is essential to assess the prevalent gaps, mobilization of resources, evidence-based policymaking, strengthen health systems financing and leadership and effective partnerships for addressing health disparities and inequities which are further accentuated by the COVID-19 pandemic.
  4 5,960 261
ORIGINAL ARTICLES
Productivity losses among individuals with common mental illness and comorbid cardiovascular disease in rural Karnataka, India
Farah Naaz Fathima, James G Kahn, Srinivasan Krishnamachari, Maria Ekstrand
July-September 2019, 4(3):86-92
DOI:10.4103/jncd.jncd_17_19  
Context: Common mental disorders (CMD) and cardiovascular diseases (CVDs) frequently co-occur. Productivity losses due to these diseases are substantial in high-income countries. Similar data from the developing world are lacking. Aims: This study aims to quantify productivity losses among individuals with comorbid CMD and CVD in rural Karnataka, India. Settings and Design: A cross-sectional study was done among patients with a dual diagnosis of a comorbid CMD and CVD in a district in Karnataka, India. Subjects and Methods: Three hundred and three patients were administered the iMTA Productivity Cost Questionnaire to measure losses of productivity at paid work (absenteeism and presenteeism) and unpaid work. Statistical Analysis Used: Valuation of productivity losses was done by multiplying the number of days of lost productivity by the standard value of productivity based on the minimum wage for agricultural work. Results: Among individuals with dual CMD and CVD, 76% had productivity losses. These losses were higher at unpaid (62%) than at paid work (32%). At paid work, losses due to presenteeism were greater than those due to absenteeism. The total days of productivity loss were 1204, amounting to 14.2% of the available person-days. The total productivity loss among 303 individuals with mental illness and comorbid CVD over a 4-week period amounted to 30.3 INR (0.47 USD) per person per day, representing 9.9% of total potential productivity. Conclusions: Productivity losses due to common mental illnesses and CVDs are high. There is a need to conduct more studies in this field.
  3 3,516 64
Co-occurring mental health and addiction disorders: The elusive path to integrated care
Avra Selick, Mary Wiktorowicz
October-December 2016, 1(3):97-104
DOI:10.4103/2468-8827.198576  
Background: Co-occurrence of mental health and addictions disorders occurs at a high rate, posing significant costs to affected individuals and society if left untreated. Although decades of research and policy reports have argued the necessity of integrated mental health and addiction services to effectively treat this population, it appears as though relatively little integration has been achieved. Methods: This exploratory study used key informant interviews to investigate the current state of integrated treatment in Ontario, Canada, potential models for integrated treatment and barriers to their implementation. Interview transcripts were analyzed inductively, and thematic analysis used to identify emerging themes. Results: Five domains were identified: organizational barriers, system barriers, historical barriers, barriers related to stigma and discrimination, and knowledge barriers. A key challenge is the absence of provincial direction and limited evidence on the relative effectiveness of the different integrated treatment models. Discussion and Conclusion: Insights from interviews with research, policy and provider experts clarify the relevant factors affecting the implementation of integrated treatment in Ontario. In identifying potential models of integration and the barriers to their implementation, further research is required to assess the relative effectiveness of the different integration models and to identify the critical organizational and system factors needed for successful implementation of integrated care. Avenues that merit further exploration are the fields of implementation science and complex adaptive systems.
  3 4,953 43
Shifting pattern of diabetes among the elderly in India: Evidence from the national sample survey organization's data, 2004–2014
V Raman Kutty, TR Dilip, AR Archana, Sandeep Gopinathan, Mala Ramanathan
April-June 2018, 3(2):67-74
DOI:10.4103/jncd.jncd_37_17  
Objective: The objective of this study was to compare the pattern and trends in the prevalence of self-reported diabetes mellitus among the elderly in India, 2004–2014. Research Design and Methods: The required data were extracted from National Sample Survey Organization's (NSSO) 60th round in 2004 and 71st round in 2014. Self-reported morbidity information of elderly with reference period of 15 days before the survey has been used for the analyses. From NSSO 2004, a total of 35,569 elderly persons were included in the study, and from NSSO 2014, a total of 28,397 elderly persons were included in the study. Age- and sex-standardized prevalence rate was calculated to make valid comparisons across two time periods. Results: The prevalence of self-reported diabetes has increased more among elderly males than among elderly females during 2004–2014.The increase in prevalence percentage is more among young old than the rest. There is a clear-cut rural–urban differential in the burden of diabetes in India. The eastern and southern regions of India marked a higher prevalence as well as increase in diabetes prevalence than the rest of the nation. Those with diabetes are also likely to be burdened by the existence of other chronic conditions such as heart disease and hypertension when compared to persons without diabetes. This burden is higher for women. Conclusion: The prevalence of self-reported diabetes appears to have increased and is higher among males. The apparent rural–urban and regional variations can be attributed to urbanization-induced lifestyle changes, increasing access to screening and treatment and reporting bias.
  3 5,287 176
Cost of care for hypertension in a selected health center of urban Puducherry: An exploratory cost-of-illness study
Sitanshu Sekhar Kar, Vinoth Kumar Kalidoss, Uma Vasudevan, Shifalika Goenka
July-September 2018, 3(3):98-103
DOI:10.4103/jncd.jncd_49_17  
Background: Among noncommunicable diseases, hypertension is one of the most important risk factors, the control of which imposes a huge financial burden on the healthcare system and the society. Objectives: The objective of this study was to measure the monthly cost incurred in care of hypertension in urban Puducherry and to estimate the total annual cost required to provide care for the adults with hypertension in a typical primary health center (PHC) of India. Materials and Methods: The study was conducted in the service area of urban health center (UHC) in Puducherry, functioning under the Department of Preventive and Social Medicine, JIPMER. A sample of 238 adults ≥ 18 years identified through a baseline survey conducted in 2014 was interviewed using a pretested semi-structured questionnaire. The questionnaire collected information on sociodemographic data, place of seeking hypertension care, and its duration and various direct and indirect costs incurred. Recall period was fixed as 1 month for OP care and 1 year for hospitalization. A prevalence-based approach was used for calculating the cost of illness. Average monthly and annual direct and indirect costs were calculated and were compared across the type of facility of care and with the presence or absence of comorbidities. The cost of care from UHC and other government hospitals were calculated from standard rates. The average annual cost from UHC was used to calculate the annual amount required to provide care of hypertension in a typical PHC of India. Results: Among the 238 participants, 73.5% (n = 175) were female, and the mean (standard deviation) age was 58 (11.7) years. Majority (72%, n = 172) took care for their hypertension from UHC, JIPMER. Half of them (n = 119) had associated comorbidities. Average monthly direct cost of care for hypertension was 223.2 (198.0–329.4) Indian national rupees. There was statistically significant difference in the cost of care among participants utilizing public and private facilities, and also among participants with comorbidities and without comorbidities. The estimation of annual cost of hypertension care for a typical PHC comes around 1.07 crores. Conclusion: The control of hypertension in a community leads to a significant load on health system; however, it is essential for preventing further catastrophic costs as a result of complications and mortality. This cost could be saved if we could prevent the population from becoming hypertensives by preventive measures, and it will further lead to reduction in mortality and morbidity and the associated costs.
  3 5,205 186
REVIEW ARTICLE
Noncommunicable disease research
Luke Allen
October-December 2016, 1(3):131-133
DOI:10.4103/2468-8827.198586  
Research is an essential component of the fight against noncommunicable disease (NCD) as it provides the evidence for effective prevention and control interventions. While the biological causes and manifestations of NCDs have been studied in depth, we are still trying to understand the best ways of implementing effective control policies. Exploring which interventions work in different settings is fundamental to the attainment of international targets set out in the Global Action Plan and the Sustainable Development Goals. The vast majority of NCD research comes from high-income countries and interventions that work in these settings are not necessarily effective in the Global South. Translational research is needed alongside wider engagement with social scientists: the most significant drivers of NCD epidemics are political, social, economic, and behavioral. Collaborative research spanning these domains is required for the development of effective, evidence-based NCD prevention, and control policies. This short article provides an overview of the role research has to play in the global NCD response and highlights areas in need of investment.
  3 5,330 111
REVIEW ARTICLES
Overview of national strategies on noncommunicable disease and adolescent health in South-East Asia Region countries
JS Thakur, Neena Raina, Priya Karna, Preeti Singh, Gursimer Jeet, Nidhi Jaswal
July-September 2016, 1(2):76-86
DOI:10.4103/2468-8827.191989  
Research shows that risk factors for noncommunicable diseases (NCDs) are associated with behaviors that either begin or are reinforced during adolescence. Yet, focus on this age group in national NCDs policies globally or regionally in South-East Asia Region (SEAR) has not been adequately addressed. This overview of strategies to prevent NCDs among adolescents in SEAR countries provides a benchmark against which policy response can be assessed and strengthened. We reviewed all publically available documented strategies issued by governments in the 11 SEAR member countries of the World Health Organization on NCDs, published between January 1, 2002, and December 31, 2015. NCDs are currently a policy priority in many of the countries with school-based campaigns on healthy lifestyles; alcohol and tobacco-free environment and public ban on advertisements glamorizing unhealthy food among others. However, major challenges such as lack of specific focus on adolescents, lack of recognition of all major risk factors in national policies/programs, weak surveillance, unavailability of age disintegrated data, inefficient program management, low community awareness, and absence of multistakeholder policies persist. Of the countries reviewed, only 54.5% (6/11) proposed a policy that addressed all four of the main NCD risk factors - alcohol and tobacco use, physical inactivity, and obesity. This review demonstrates the disconnection between NCDs, adolescent health, and national policies.
  3 5,974 129
Is the COVID-19 pandemic an opportunity to advance the global noncommunicable disease agenda?
Jacob Kumaresan, Bolanle Bolaji, Jennifer Prince Kingsley, Nalini Sathiakumar
April-June 2020, 5(2):43-49
DOI:10.4103/jncd.jncd_28_20  
More than 70% of the annual global deaths are due to noncommunicable diseases (NCDs), and 80% of these deaths occur in low- and middle-income countries. Most of these deaths are in people <70 years of age and can be prevented and controlled by addressing a set of modifiable risk factors, namely tobacco use, alcohol misuse, unhealthy diets, physical inactivity, and obesity. Recognizing the global burden of NCDs, the world's leaders adopted several policy instruments such as the NCD Global Action Plan, the Framework Convention on Tobacco Control, and the global monitoring framework on NCDs. In 2015, the UN General Assembly included reduction of premature mortality from NCDs by one-third by 2030 as target 3.4 of the Sustainable Development Goals (SDGs). Assessment of this target in 2018 found some progress with tobacco control, but the overall progress was inadequate. The global pandemic of coronavirus disease 2019 (COVID-19) has brought NCDs to the forefront. Preliminary data indicate that persons with NCDs are extremely susceptible to COVID-19 and its complications including death. Focus on controlling the pandemic has led to delays in the diagnosis, treatment, and management of NCDs. This pandemic has exposed the weaknesses of the health-care systems, exacerbated the inequalities within societies, and disproportionately affected the vulnerable groups. In the process of recovery and in future planning, governments and leaders need to take proactive actions toward the prevention and control of all avoidable deaths from NCDs if the SDG target 3.4 is to be achieved by 2030.
  3 2,460 50
EDITORIAL
World NCD Federation guidelines for prevention, surveillance, and management of noncommunicable diseases at primary and secondary health-care settings
JS Thakur, Sanjay Bhadada
April-June 2018, 3(2):43-44
DOI:10.4103/jncd.jncd_26_18  
  2 2,465 102
ORIGINAL ARTICLES
Examining depression and quality of life in patients with thalassemia in Sri Lanka
Priya Patel, Paul Beamish, Tricia L da Silva, Dewmi Kaushalya, Anuja Premawardhena, Shehan Williams, Arun V Ravindran
January-March 2019, 4(1):27-33
DOI:10.4103/jncd.jncd_49_18  
Background: With more effective treatments and improved outcomes in thalassemia, there is increasing focus on its psychological sequelae. Most published data on this topic are from high-income countries and much less so from low- and middle-income countries, where thalassemia is more prevalent. Aim: The aim of this study was to systematically evaluate the psychiatric morbidity and quality of life in relation to demographic- and illness-related variables among Sri Lankan patients with thalassemia. Methods: This cross-sectional investigation was conducted at the University of Kelaniya Teaching Hospital in Sri Lanka. Patients with all forms of thalassemia, over 12 years of age, and in stable medical condition (n = 120) were recruited. Assessment tools included a general demographic questionnaire, the Beck Depression Inventory-II, and the World Health Organization Quality of Life Measure–Brief. Statistical analysis was conducted using linear regressions, Chi-squares, and analyses of variance. Results: Lack of family support, longer duration of inpatient admission, and female gender were associated with higher depression scores and reduced quality of life. Environmental and social quality of life were positively correlated with levels of peer support in males, while increased support from religion correlated with lower depression scores and higher satisfaction with environmental and psychological quality of life in women. There was no association between the type of thalassemia and either depression or quality of life measures. Conclusion: Several factors may influence the psychological state and well-being of patients with thalassemia in Sri Lanka. Specific service innovations (some gender-specific) may help to address these factors to improve treatment outcome and well-being.
  2 2,792 48
The “missing window of opportunity” for preventing diabetes: Amixed method study on postpartum screening for diabetes among women with gestational diabetes mellitus in Kerala, India
K Sakeena, TK Sundari Ravindran
July-September 2017, 2(3):78-84
DOI:10.4103/jncd.jncd_28_17  
Background: The prevalence of gestational diabetes mellitus(GDM) is ranging from 15.9% to 17% in Kerala. Women with GDM and their offsprings are at increased risk of developing type2 diabetes mellitus in their later life. Hence, postpartum screening and follow-up of the women with GDM along with nutritional and lifestyle modification support are extremely important in Kerala. This study revealedthe clients' and providers' perspective on the postpartum diabetes screening among GDM mothers. Objectives: The study aimed to assess timely postpartum diabetes screening rate and factors associated with postpartum diabetes screening among women with GDM who had recently delivered at selected hospitals in Malappuram district, Kerala. The study also assessed the clinicians' perspective on postpartum diabetes screening of women with GDM. Materials and Methods: Across-sectional study was done among 200 women with GDM, who had delivered in selected hospitals in Malappuram districts between 9weeks and 6months before the survey using a pretested validated interview schedule. In-depth interview was carried out to explore the clinicians' perspective on postpartum diabetes screening of women with GDM. Results: Timely postpartum diabetes screening rate among respondents was 29%. The age-adjusted multivariate logistic regression analysis result had a significant P value for the health-care provider's advice with an adjusted OR of 3.2(1.4–6.9). About 6% of the women with GDM received appropriate and adequate postpartum follow-up. Conclusion: There is an urgent need to enforce adherence to national guidelines for postpartum diabetes screening and establishment of registration and follow-up of women with GDM through public health-care delivery system.
  2 3,179 93
Effectiveness of “percutaneous coronary intervention care program” on selected variables among patients undergoing percutaneous coronary intervention
Poonam Sharma, Sandhya Ghai, Manoj Kumar Rohit, Monika Dutta
October-December 2018, 3(4):126-133
DOI:10.4103/jncd.jncd_33_18  
Objective: The study was conducted to assess the effectiveness of “percutaneous coronary intervention (PCI) care program” among patients undergoing PCI. Subjects and Methods: A quasi-experimental design was adopted, and purposive sampling technique was used to enroll the patients in the experimental and control groups. Different tools were used to collect the data, which include numerical pain and comfort rating scale, Barthel Index for activities of daily living, assessment for the presence of vascular complications, modified CADEQ-SV questionnaire, State-Trait Anxiety Inventory scale, self-structured satisfaction scale, and PCI manual. Results: There was a significant decrease observed in state anxiety (P < 0.001), pain level at 12 h (P = 0.03), discomfort within 12 h (P < 0.001) and 24 h (P = 0.002), improving knowledge regarding coronary artery disease (CAD) (P < 0.001), and activities of daily living as well as significant increase in satisfaction level (P < 0.001) among patients undergoing PCI in the experimental group than the control group. Conclusion: The study concluded that this program was effective in reducing anxiety, pain, and discomfort and increased satisfaction level, knowledge regarding CAD, and independence in self-care activities for PCI patients.
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Association between medication adherence and blood pressure control in urban hypertensive patients in central India
Ratinder Jhaj, Pushp Raj Gour, Sweta Kumari, Shweta Sharma
January-March 2018, 3(1):9-14
DOI:10.4103/jncd.jncd_29_16  
Introduction: Cardiovascular and renal complications associated with hypertension (HTN) can be reduced if blood pressure (BP) is well controlled. However, a large percentage of patients fail to achieve target BPs, largely due to poor medication adherence. We conducted a cross-sectional study of patients of HTN to assess patient adherence to treatment and the association between medication adherence and BP control. Methodology: The study was a cross-sectional survey of adult hypertensive patients of either sex who had been on antihypertensive therapy for the past 3 months. Medication adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS-8). Level of control of BP was evaluated using the BP goals recommended by the Eighth Joint National Committee (JNC-8). Results: Out of a total of 200 patients, only 29.5% of patients had achieved their target BP as per JNC-8 recommendations after a minimum of 3 months of antihypertensive therapy. The average adherence score on the MMAS-8 was 6.47 (±1.8). A high adherence was found in 39% of patients, while 32.5% of HTN patients had a medium score and 28.5% had low adherence scores. There was a significant correlation between medication adherence and BP control. Only 1.5% of patients with low adherence score and 11.5% with medium score had achieved their target BP while 16.5% with high had done so. Conclusion: Higher medication adherence scores were associated with better BP control. However, the percentage of patients with controlled HTN on treatment was low as was the proportion of patients with a high medication adherence score.
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PUBLIC HEALTH INNOVATION
m-STEPS: Developing and implementing a smart innovative android tool for noncommunicable disease risk factor (STEPS) survey in India
JS Thakur, Gursimer Jeet, Jaya Prasad Tripathy
July-September 2016, 1(2):91-93
DOI:10.4103/2468-8827.192018  
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REVIEW ARTICLE
Universal health coverage: Current status and future roadmap for India
Atul Sharma, Shankar Prinja
July-September 2018, 3(3):78-84
DOI:10.4103/jncd.jncd_24_18  
Universal health coverage (UHC) has been recognized as the most important immediate goal for global health. Attempting to achieve this goal for the country, the Government of India, has been taking measured steps, trying to ensure equitable access to high-quality affordable health-care services for all citizens. This article attempts to identify the success of these efforts through a baseline situation assessment of UHC dimensions in India, followed by a critical analysis of what is being done to fulfill the gaps, and finally propose a health policy roadmap for UHC with implications at national and state level. Literature review presents a varied scenario with respect to the coverage of key services essential for service packages, reflecting need for significant improvement. Large-scale inequities in health-care service delivery and health indicators have been observed, with poor financial risk protection of the community from catastrophic spending on health care. Various reasons for this were identified, such as low public investment in health services, poor health-care service delivery system, poor quality of services offered to the community, and lack of robust financial protection mechanisms. The study proposes a contextual restructuring of the health system, initiating with an increase in financial investments in public health-care sector. This should be supplemented with health system strengthening by improving overall service availability for the community with optimal quality and at low cost. Private sector service provisioning should be regulated by developing and implementing strong accountability measures. The governance capacity of public sector should be augmented to improve success rates of the demand-side financing schemes. Health technology assessments should become the mainstay of taking decisions on benefit package. A holistic multipronged approach constituting all these changes is required if health coverage has to be made universal in the country.
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* Source: CrossRef