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   2021| October-December  | Volume 6 | Issue 4  
    Online since December 31, 2021

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History of public health-distorted Indian contribution although significant for addressing noncommunicable diseases
JS Thakur, Harmanjeet Kaur
October-December 2021, 6(4):155-158
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Epidemiological transition and the dual burden of communicable and noncommunicable diseases in Zimbabwe
Prosper Nyabani
October-December 2021, 6(4):166-171
Background: The epidemiological transition model, coined by Abdel Omran in 1971, building on the demographic transition theory developed by Frank Notestein in 1945, has been largely credited for describing epidemiological situations both globally and nationally in many parts of the world. However, owing to its origins in the United States of America (USA), scholars critique the model's applicability to various geographical, socioeconomic, and epidemiological contexts, which are diversely different from the USA and vary from region to region. It was imperative to test the applicability of this model in sub-Saharan Africa (SSA), particularly Zimbabwe to ascertain versatility in describing epidemiological transitions, predicting population health status and whether the assumption of a shift from communicable diseases (CDs) to noncommunicable diseases (NCDs) could be confirmed in a low-income developing nation focusing on Zimbabwe. Methods: The study was a retrospective document review case study, using the existing framework of the epidemiological transition model, as a guiding principle, applying the model to describe the demographic and epidemiological circumstances prevailing within Zimbabwe. The researcher reviewed, compared, analyzed, and described the existing literature on population dynamics and epidemiological profile of the country for the period 1990–2020. Results: The epidemiological transition model attempts to describe the changes in epidemiological circumstances both at national and global scales. The model presumes a shift in CDs to NCDs. However, many scholars question the applicability of the model to diverse contexts, particularly within the SSA context. The Zimbabwean case was considered in light to its rising population growth, dual burden characterized by a high burden of communicable and rising NCDs. Findings from this study indicate that NCDs are on the rise in Zimbabwe. However, owing to a high burden of CDs, a dual disease burden model is the best fit to explain the epidemiological transition currently obtaining within Zimbabwe. Conclusions: Consequentially, funding streams targeting CDs should take heed of the currently obtaining epidemiological situation in the country and respond by challenging funding to public health interventions with a view to address the rising NCDs. Further, public health authorities should craft Public health policies that create supporting environments conducive for the populace to fight NCDs. Informed by the Ottawa charter, reorientation of health services to ensure more health systems responsiveness in the face of emerging NCDs is imperative. In addition, developing interpersonal skills for individuals to be able to act against NCD's risk behaviors and factors is key; at the same time, strengthening community action by capacitating community health workers to address risk behaviors and factors associated with NCDs at community level is imperative. Finally, the inadequacy of the epidemiological transition model inadvertently challenges epidemiologists to step up efforts to review, refine, and extend the model to suit SSA countries like Zimbabwe and elsewhere countries in similar circumstances.
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Underweight and overweight/obesity among middle aged and older adults in India: Prevalence and correlates from a national survey in 2017–2018
Supa Pengpid, Karl Peltzer
October-December 2021, 6(4):172-179
Background and Objective : This study aimed to estimate the prevalence and correlates of underweight and overweight/obesity among middle aged and older adults in India. Materials and Methods : The cross-sectional sample consisted of 72,262 individuals (≥45 years) from the Longitudinal Aging Study in India Wave 1 in 2017–2018. Multinomial logistic regression was used to estimate the factors associated with underweight and overweight/obesity relative to normal weight. Results : The prevalence of normal weight (18.5–22.9 kg/m2) was 36.7%, underweight (<18.5 kg/m2) 20.8%, overweight (23.0–24.9 kg/m2) 14.2%, Class I obesity (25.0–29.9 kg/m2) 20.8%, and Class II obesity (≥30.0 kg/m2) 7.4%. In adjusted multinomial logistic regression, the factors positively associated with underweight were older age (≥70 years) (adjusted relative risk ratio [ARRR]: 1.94, confidence interval [CI]: 1.75–2.14), food insecurity (ARRR: 1.19, CI: 1.07–1.33), poor or fair self-rated health status (ARRR: 1.14, CI: 1.05–1.33), and current tobacco use (ARRR: 1.42, CI: 1.31–1.53). The factors negatively associated with underweight were higher education (≥10 years) (ARRR: 0.67, CI: 0.48–0.92), high subjective socioeconomic status (ARRR: 0.78, CI: 0.67–0.92), urban residence (ARRR: 0.72, CI: 0.61–0.84), high life satisfaction (ARRR: 0.83, CI: 0.75–0.91), hypertension (ARRR: 0.64, CI: 0.58–0.69), diabetes (ARRR: 0.50, CI: 0.42–0.59), and heart disease or stroke (ARRR: 0.74, CI: 0.61–0.89). The factors positively associated with overweight/obesity were higher education (≥10 years) (ARRR: 2.09, CI: 1.87–2.33), high subjective socioeconomic status (ARRR: 1.44, CI: 1.31–1.59), urban residence (ARRR: 1.94, CI: 1.79–2.11), high life satisfaction (ARRR: 1.12, CI: 1.04–1.20), hypertension (ARRR: 1.89, CI: 1.76–2.02), type 2 diabetes (ARRR: 1.80, CI: 1.59–2.04), and raised cholesterol (ARRR: 2.75, CI: 2.11–3.58). The factors negatively associated with overweight/obesity were older age (≥70 years) (ARRR: 0.44, CI: 0.39–0.49), male sex (ARRR: 0.59, CI: 0.54–0.64), food insecurity (ARRR: 0.85, CI: 0.76–0.94), vigorous physical activity (>once/week) (ARRR: 0.91, CI: 0.84–0.99), current tobacco use (ARRR: 0.69, CI: 0.64–0.74), and heavy episodic alcohol use (ARRR: 0.70, CI: 0.58–0.85). Conclusion : One in five middle-aged and older adults in India were underweight and more than two in five were overweight/obese, confirming a dual burden of malnutrition in India.
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Dietary approaches in management of noncommunicable diseases: A review
Janeline Lunghar, A Thahira Banu
October-December 2021, 6(4):159-165
The prevalence of noncommunicable diseases (NCDs) has increased drastically over recent decades, with 41 million deaths each year, equivalent to 71% of all deaths globally. Unhealthy food choices and food habits, excessive calories, and inactivity are apparent factors to NCDs, namely obesity, diabetes mellitus, cancer, and cardiovascular disease. Healthy dietary intake and calorie restrictions have a promising effect on longevity. Eventually, adopting these strategies may delay the onset and decrease the burden of NCDs. Recent findings proved that nutrition has a strong association with the prevalence of NCDs. American Institute for Cancer Research and the World Cancer Research Fund says 30%–40% of cancers are preventable by adopting healthy food choices, dietary restrictions, engaging in physical activity, and maintaining body mass index. This review focuses on dietary intake and dietary restrictions and finally leads to understand the vital role of gut microbiome in managing NCDs.
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Factors associated with noncompliance to hypertension treatment in adults in a district health facility in north Dayi in the Volta Region of Ghana
Stephen Manortey, Sedinam Adamaley
October-December 2021, 6(4):199-205
Context: Hypertension is known to affect more than one billion of the world's population with complications such as stroke and myocardial infarction. Compliance with hypertension therapy is the extent to which one's behavior in following a diet plan, taking medications, or making lifestyle changes corresponds to the agreed recommendations from a health-care provider. This research explores factors influencing noncompliance to hypertension treatment in the North Dayi District of the Volta Region, Ghana. Aims: To determine the prevalence of noncompliance to hypertension therapy in patients diagnosed with hypertension in the study population. 1. To evaluate the knowledge of patients on hypertension. 2. To ascertain contributing factors influencing noncompliance to the treatment of hypertension. Settings and Design: A cross-sectional study. Methodology: A cross-sectional study was conducted from January 2021 to February 2021 in the North Dayi District. A sample of 191 respondents diagnosed with hypertension for at least 1 month with or without comorbidities and on treatment were selected using the systematic sampling method. An Adherence Barrier Questionnaire was adopted to assess reliability in the responses. Bivariate and multivariate analyses were done using noncompliance to hypertension therapy as the outcome of interest. Statistical Analysis Used: Fisher's Exact, logistic regression, Cronbach's alpha analysis. Results: Data were collected from 191 study participants between the ages of 25 and 101 years with an average age estimated at (62.2 ± 13.5) years. The prevalence of nonadherence to hypertension treatment in this study was 31.4% in the North Dayi District Hospital. The reported Marital status and Default review were statistically significant predictors of adherence to hypertension treatment at a chosen 95% Confidence Level. Conclusion: The degree of non-compliance to hypertension treatment was less than fifty per cent among respondents. The data suggests that strategies should be developed to help reduce waiting times for consultation at the Hypertension Clinic by the District Hospital in collaboration with other stakeholders.
  1,204 42 -
Adherence of chronic disease care during COVID-19 pandemic: Results from eastern India
Surama Manjari Behera, Somen Kumar Pradhan, Sanghamitra Pati, Priyamadhaba Behera, Srikanta Kanungo, Binod Kumar Patro
October-December 2021, 6(4):180-186
Background: With the advent of the COVID-19 pandemic, prevention and control of noncommunicable diseases (NCDs) have become even more critical as NCDs are major risk factors for patients with COVID-19. Therefore, this study was planned with the following objectives: (i) To assess adherence with chronic disease care among patients with NCDs. (ii) To determine the factors associated with adherence with chronic disease care among patients with NCDs during COVID-19 nationwide lockdown. Materials and Methods: This was a hospital-based cross-sectional study conducted in the NCD prevention clinic of All India Institute of Medical Sciences, Bhubaneswar, during July 2020–August 2020. A total of 210 patients were studied. Patients were interviewed both at the clinic and telephonically; those who had scheduled visits did not make it. Out of 210 patients, 105 participants were interviewed face to face in the hospital in the NCD prevention clinic. The other 105 patients were interviewed telephonically who did not attend the clinic during follow-up. Results: All the participants (210) had diabetes mellitus, and 44.8% of participants had accompanying hypertension. One-fourth of participants could not follow the dietary practices advised by the doctor during the lockdown. Similarly, 42% of participants could not maintain moderate-intensity physical activity (30 min) during the lockdown period. The period prevalence of nonadherence to prescribed drugs/medicines in our sample was 45.71% (95% confidence intervals [CI] 38.84–52.71). Participants with more than one NCDs had a 52% less chance to stop the drugs/medications during the national lockdown period than participants with one NCD (adjusted odds ratio 0.48, 95% CI 0.27–0.83). Conclusions: The continuum of chronic disease care of NCD patients has been affected by COVID-19 nationwide lockdown. Appropriate planning and provision of chronic disease care are essential during the lockdown and similar situations.
  1,036 46 -
Exploration of barriers to self-care practices among diabetic patients attending chronic disease clinic in an urban slum
Anuradha Kunal Shah, Sandeep Akhilesh Mishra, Prabhadevi Ravichandran
October-December 2021, 6(4):193-198
Background: Glycemic control in diabetes can be achieved by adopting self-care practices. It also leads to reduction of complications and improvement in the quality of life. Identification of barriers to adopting these practices can help devise strategies to overcome them. This study was conducted to understand the self-care practices among diabetics and the barriers affecting those practices among diabetics in the urban slum area. Materials and Methods: This qualitative study using Focus Group Discussions (FGDs) was conducted in a chronic disease Outpatient clinic in Mumbai, in November 2020. Four FGDs with 32 participants were conducted. Thematic analysis of the transcripts was done. Results: Three major themes were identified – living with diabetes, practices to maintain glycemic control, and potential barriers. Barriers for self-care practices were - confusing advice provided by family and doctors, feeling rejected (stigmatized), lack of motivation for exercise, complications of diabetes, lack of family cooperation, lack of knowledge on foot care, physical constraints, nonavailability of medications, lack of social and financial support, suboptimal knowledge regarding diabetes, and misconceptions. Conclusions: Motivating diabetic patients for regular physical activity by starting from simple indoor exercises to outdoor exercises are necessary. Counseling the family members on the complications of diabetes due to inappropriate dietary practices should be advocated. Improvement in doctor-patient communication and providing information on the foot care practices is the need of the hour.
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Clinical inertia in lipid screening and prescribing statins for primary prevention: Experience from a low-to-middle income country
Anne Thushara Matthias, Mathotage Satheisha Nihari Padmasiri, Batheegama Gamarachchige Gayasha Kavindi Somathilake, Nethrani Sameera Wijesekara Pathirana
October-December 2021, 6(4):187-192
Introduction: Most adults who should be screened for dyslipidemia do not undergo lipid testing in low- to middle-income countries due to lack of resources and clinical inertia. Those eligible for statin therapy for cardiovascular disease (CVD) prevention are under treated possibly due to clinical inertia. This study aimed to find out the present lipid screening practices and prescribing of statins for primary prevention in a low- to middle-income country. Methods: This study was conducted at medical wards of Colombo South Teaching Hospital in patients with a first-time acute coronary syndrome (ACS), who have not been on treatment with statins and not diagnosed with dyslipidemia prior to this admission. Eligibility for lipid screening was assessed using U.S. preventive services task force recommendations. CVD risk prior to ACS was assessed by QRISK2 score. Lipid profile was done within 24 h. Results: Out of 125 participants, 70.4% had a QRISK2 >10 and were eligible for statins prior to their first episode of ACS. Eighty-four percent have not had a lipid screening and 91.4% were not aware of the need for it. 54.4% were not aware that the elevation of certain types of cholesterol leads to ACS. Of 125 patients (100 males/25 females), mean age 55.78 (26–82). Body mass index >23kg/m2 in 65.6%. 65.6% had some lipid abnormality. Total cholesterol >200 in 29.6%, low-density lipoprotein cholesterol >130 in 28.8%, triglyceride >150 in 31.2%, high-density lipoprotein cholesterol suboptimal in 67.2%. Discussion: Lipid screening is suboptimal. Most patients who were eligible for statins based on their CVD risk prior to their first episode of ACS, were not receiving statins prior to their first ACS. Patients should have their CVD risk estimated and statins should be given to eligible patients for prevention of ACS.
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