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   Table of Contents      
ORIGINAL ARTICLE
Year : 2018  |  Volume : 4  |  Issue : 3  |  Page : 133-136

Status of Noncommunicable Disease Screening in an Urban Resettlement Colony in Delhi, India: A Descriptive Cross-Sectional Study


Department of Community Medicine, Maulana Azad Medical College, New Delhi, India

Date of Web Publication31-Dec-2018

Correspondence Address:
Dr. Saurav Basu
Department of Community Medicine, Maulana Azad Medical College, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mamcjms.mamcjms_42_18

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  Abstract 


Background Noncommunicable diseases (NCDs) are responsible for more than two-third cases of premature mortality (30–69 years) in India. Screening for NCDs is the most effective means for detection of undiagnosed NCD cases and early treatment initiation that lowers morbidity and mortality due to these diseases. The objective of the present study was to assess the NCD screening status in an urban resettlement colony of Delhi.
Materials and Methods A community-based cross-sectional study was conducted among residents of the area. Patients with preexisting hypertension and diabetes and aged below 30 years were excluded. The patients were further screened for hypertension by taking three separate readings using an aneroid sphygmomanometer. The Indian Diabetes Risk Score (IDRS) was calculated to evaluate diabetes risk.
Results A total of 110 men and 103 women (N = 213) met the inclusion criteria. The mean (±standard deviation) age of the patients was 40 (±9.3) years. A history of previous screening for hypertension and diabetes was reported by 73 (34.2%) and 40 (35.4%) patients, respectively. A medium or high-risk of having diabetes mellitus as per the IDRS score was present in most (88.4%) patients. On current screening, nine (8.2%) men and nine (8.7%) women were identified as undiagnosed hypertension cases. Only four (3.8%) women had undergone a clinical breast exam, and just nine (8.7%) women ever had a Pap smear examination.
Conclusion The present study shows that the current strategy of opportunistic screening for NCDs has been unable to reach large segments of vulnerable and at risk populations.

Keywords: Diabetes, hypertension, India, NCDs, screening


How to cite this article:
Pangtey R, Basu S, Meena GS, Banerjee B. Status of Noncommunicable Disease Screening in an Urban Resettlement Colony in Delhi, India: A Descriptive Cross-Sectional Study. MAMC J Med Sci 2018;4:133-6

How to cite this URL:
Pangtey R, Basu S, Meena GS, Banerjee B. Status of Noncommunicable Disease Screening in an Urban Resettlement Colony in Delhi, India: A Descriptive Cross-Sectional Study. MAMC J Med Sci [serial online] 2018 [cited 2019 Oct 22];4:133-6. Available from: http://www.mamcjms.in/text.asp?2018/4/3/133/249030




  Introduction Top


Noncommunicable diseases (NCDs) contribute to 70% of the global mortality burden. Premature deaths (30–69 years) due to NCDs account for 15 million global deaths each year of which, 80% occur in low- and middle-income countries.[1] NCDs are responsible for more than two-third cases of premature mortality in India.[2]

Screening is the detection of disease in apparently healthy individuals who may lack signs and symptoms. Early detection and treatment of diabetes and hypertension prevent or delay the onset of end-organ damaging complications. However, more than half of India’s estimated 69 million diabetes patients remain undiagnosed.[3] Furthermore, a large-scale STEPS survey in North India which screened for hypertension found that nearly 28% of the cases were previously undiagnosed.[4]

The adoption of cytological screening in the developed world has resulted in a marked decline in the incidence of cervical cancer,[5] whereas mammography screening has significantly improved the survival in breast cancer patients.[6] Nevertheless, the fact that India accounts for an estimated 7.2% of global cancer incidence with 8.3% mortality is suggestive of the lack of timely screening and early detection of cases.[7]

The Indian National Program for prevention of diabetes, cardiovascular diseases, cancer, and stroke (NPCDCS) was launched initially in 2010 in selected 100 districts which has currently been extended to 616 districts of the country (2016–2017). The NPCDCS since its inception has emphasized facility-based opportunistic screening of NCDs at all levels of health care.[8] Opportunistic screening allows screening of individuals who may be at risk of NCDs but have presented to the health facility for other health concerns. A total of 35,723,660 individuals were screened for diabetes, hypertension, and common cancers at NCD clinics in India from January 1, 2017 to December 31, 2017 in which, 3006,443 diabetes, 3654,099 hypertension, and 39,635 cancer cases were diagnosed.[9]

The objective of the present study was to assess the NCD screening status in an urban resettlement colony of Delhi.


  Materials and Methods Top


This is a part of a larger community-based cross-sectional study for profiling NCD risk incidence with factors conducted in 2015 to 2016 among 480 adult residents aged up to 65 years in an urban resettlement colony located in the North East district of Delhi.[10]

Systematic random sampling was utilized for enrollment of patients. The patients with preexisting diabetes (12%) or hypertension (21.9%) and those below 30 years of age were excluded from the current analysis (N = 213).

Data were collected using a patient-interview schedule to assess self-reported screening status for hypertension, diabetes, high blood cholesterol, breast cancer (mammogram), and  Pap smear More Details (cervical cancer). All these diseases have a high burden in India and suitable screening tests that are reliable, noninvasive, cost-effective are available for their detection. The patients were further screened for hypertension by taking three separate blood pressure readings using an aneroid sphygmomanometer. Diabetes risk was estimated in all the nondiabetic patients (N = 422) using the Indian Diabetes Risk Score (IDRS). The IDRS is a validated means of estimated diabetes risk among Indians using a composite measure which includes individual age, family history of diabetes, abdominal circumference, and physical activity and exercise levels. A score of below 30 signifies low-risk, 30 to 59 of medium-risk, and ≥60 high-risk of having diabetes.[11],[12],[13]

The patients identified at risk of diabetes, newly diagnosed cases of hypertension, and previously diagnosed hypertension cases who had never been tested for diabetes were counseled and referred to the nearby public health facilities for further management and evaluation. Health talks for promotion of regular physical activity, and avoiding and quitting tobacco smoking and alcohol use were also conducted in the area.

Ethics: Written and informed consent was taken from all the study patients. The study was approved by the Institutional Ethics Committee, Maulana Azad Medical College & Associated Hospitals, New Delhi.

Statistical analysis was conducted with SPSS software (SPSS for Windows, Version 17.0, Chicago, SPSS Inc.). Categorical data were expressed in frequency and proportions and continuous data as mean and standard deviation (SD).


  Results Top


A total of 213 patients met the eligibility criteria of which 110 (51.6%) were men, and 103 were women (48.4%). The mean (±SD) age of the patients was 40 (±9.3) years. There were 90 (42.3%) high school pass, 35 (16.4%) middle school pass, 46 (21.6%) primary school pass, and 42 (19.7%) illiterate patients suggesting a low educational profile of the study population. There was no significant difference in the educational status of the women and men.

A positive family history of diabetes was reported by 49 (23%), hypertension by 47 (22.1%), and cancer by 14 (6.6%) patients. Previous screening for hypertension and estimation of blood glucose levels for detection of diabetes was reported by 73 (34.2%) and 40 (35.4%) patients, respectively. On current screening, nine (8.2%) men and nine (8.7%) women were diagnosed as new cases of hypertension.

There were 40 (38.8%) women who had heard of breast cancer and 15 (14.6%) women who had heard of cervical cancer. Furthermore, only four (3.8%) women had undergone a clinical breast exam, and just nine (8.7%) women ever had a Pap smear examination [[Table 1]].
Table 1 Screening status of patients for noncommunicable diseases (N = 213)

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In the present study, 48 (22.5%) patients were at high-risk, 140 (65.7%) at medium-risk, and 25 (11.7%) at low-risk of having diabetes as per the IDRS. Among those identified at high risk as per the IDRS, 12 (25%) reported having been previously tested for diabetes, but among those at medium-risk, only 21 (15%) had been tested [[Table 2]].
Table 2 Prevalence of risk of diabetes (IDRS) in the study patients (N = 213)

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  Discussion Top


The present study shows that majority of adult residents aged ≥30 years in an urban resettlement colony in Delhi had never been screened for diabetes or hypertension despite nearly a quarter of the patients reported a positive family history for the same. Only one in six patients (17%) identified on the IDRS with high- or medium-risk for having diabetes reported previous screening for diabetes. Moreover, none of the obese patients including those identified at high- or medium-risk of having diabetes were previously tested for diabetes. This finding signifies the increased likelihood of missing cases of prediabetes and diabetes in the study patients that could be detected by simple screening methods.

The awareness of breast and cervical cancer that are the two most common cancers in Indian women was very low with most women patients reporting absence of screening through clinical breast examination or Pap smear test. In contrast, another study conducted in Delhi, in a population of younger women, found nearly half (49.1%) the women were practicing self-breast examination.[14] The difference observed is probably due to the lower educational attainments of the women patients in the present study.

A study in an urban area of Delhi reported 94.5% (n = 580) patients at risk of having diabetes as per the IDRS which is similar to our study (88.2%).[15] Another study from Maharashtra found 45.4% (n = 763) patients at high risk of having diabetes which is much higher compared to our study (22.5%).[12] The comparatively lower proportion of patients at high risk of diabetes in our study is probably due to the relatively higher levels of physical activity reported by our patients compared to the other studies and the younger population. Our study findings indicate the need to accelerate NCD screening efforts among vulnerable populations in underserved areas, as a sizable proportion of them fail to avail of opportunistic screening. The Indian NPCDCS has therefore envisaged a population-based screening strategy for combating common NCDs by utilizing the services of frontline health workers and the paramedical health staff from the primary healthcare level.[16] Nevertheless, there needs to be greater emphasis on the role of primary care physicians for NCD management, especially in low resource settings.[17] It is well established that primary care physicians when sufficiently trained and motivated can provide effective, equitable, and patient-centered NCD prevention and control services.[18],[19] Primary care and family physicians can enhance the acceptability of NCD screening services by sensitizing patients and their families toward the need for early detection for protection against common NCDs and their complications. Moreover, they have a pivotal role in patient education for enhancing awareness of NCDs and the impact on health, associated risk factors, and the adoption of healthy lifestyles for their prevention. As the private sector constitutes the dominant healthcare service provider in India, the feasibility of public–private partnership for NCD management, especially at the primary care level, also warrants exploration.

There are certain limitations to our study. First, screening status was based on the patient’s self-report and not validated from existing medical records. During screening through blood examination for multiple disease conditions, it is possible that the patients may lack awareness of certain diseases for which they were screened like hypercholesterinemia. Another limitation was that our study did not ascertain the reasons for the reported absence of disease screening in the patients, which could be due to lack of awareness or attitudes shaped by lack of perceived susceptibility to the common NCDs. Finally, we did not assess the blood glucose levels in our patients.

In conclusion, the present study shows that the current strategy of opportunistic screening for NCDs is yet to cover large segments of vulnerable and at-risk populations. This implies the need to effectively strategize augmenting the NCD screening coverage by reaching the unreached and ensuring universal health coverage.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Non communicable diseases. Fact sheet. Geneva: WHO. 2018. Available from: http://www.who.int/mediacentre/factsheets/fs355/en/. [Internet] [Cited June 1, 2018].  Back to cited text no. 1
    
2.
World Health Organization. NCD country profiles. Geneva: WHO; 2014. Available from: http://apps.who.int/iris/bitstream/10665/128038/1/9789241507509_eng.pdf?ua=1. [Internet] [Cited June 1, 2018].  Back to cited text no. 2
    
3.
International Diabetes Federation. IDF diabetes atlas. 6th ed. Brussels: International Diabetes Federation; 2015.  Back to cited text no. 3
    
4.
Tripathy JP, Thakur JS, Jeet G, Chawla S, Jain S. Alarmingly high prevalence of hypertension and pre-hypertension in North India—Results from a large cross-sectional STEPS survey. PLoS ONE 2017;12:e0188619.  Back to cited text no. 4
    
5.
Sankaranarayanan R, Budukh AM, Rajkumar R. Effective screening programmes for cervical cancer in low- and middle-income developing countries. Bull World Health Organ 2001;79:954-62.  Back to cited text no. 5
    
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Mayor S. UK improves cancer control (news). BMJ 2003;326:72.  Back to cited text no. 6
    
7.
Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C et al. GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide: IARC CancerBase No. 11 Lyon, France: International Agency for Research on Cancer 2013.  Back to cited text no. 7
    
8.
Directorate General of Health Services. Ministry of Health & Family Welfare, Government of India National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). 2017. Available from: http://dghs.gov.in/content/1363_3_NationalProgrammePreventionControl.aspx. [Internet] [Cited June 1, 2018].  Back to cited text no. 8
    
9.
Central Bureau of Health Intelligence. Director General of Health Services, Ministry of Health & Family Welfare. National Health Profile: 2018. Government of India. 2018. Available from: http://www.cbhidghs.nic.in/index1.php?lang=1&level=1&sublinkid=75&lid=1135. [Internet] [Cited June 1, 2018].  Back to cited text no. 9
    
10.
Pangtey R, Meena GS, Banerjee B, Gupta PK. Prevalence of behavioral risk factors of chronic non communicable diseases in an urban area of Delhi. Int J Sci Res 2017;6:262-4. doi: 10.15373/22778179.  Back to cited text no. 10
    
11.
Mohan V, Deepa R, Deepa M, Somannavar S, Datta M. A simplified Indian Diabetes Risk Score for screening for undiagnosed diabetic subjects. J Assoc Physicians India 2005; 53:759–63.  Back to cited text no. 11
    
12.
Pawar SD, Naik JD, Prabhu P, Jatti GM, Jadhav SB, Radhe BK. Comparative evaluation of Indian Diabetes Risk Score and Finnish Diabetes Risk Score for predicting risk of diabetes mellitus type II: A teaching hospital-based survey in Maharashtra. J Fam Med Prim Care 2017;6:120-5.  Back to cited text no. 12
    
13.
Khan MM, Sonkar GK, Alam R, Mehrotra S, Khan MS, Kumar A et al. Validity of Indian Diabetes Risk Score and its association with body mass index and glycosylated hemoglobin for screening of diabetes in and around areas of Lucknow. J Fam Med Prim Care 2017;6:366-73.  Back to cited text no. 13
    
14.
Dahiya N, Basu S, Singh MC, Garg S, Kumar R, Kohli C. Knowledge and practices related to screening for breast cancer among women in Delhi, India. Asian Pac J Cancer Prev 2018;19:155-9.  Back to cited text no. 14
    
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Acharya AS, Singh A, Dhiman B. Assessment of diabetes risk in an adult population using Indian diabetes risk score in an urban resettlement colony of Delhi. J Assoc Physicians India 2017;65:46-51.  Back to cited text no. 15
    
16.
National Health Mission. Operational guidelines: Prevention, screening and control of common non-communicable diseases: Hypertension, diabetes and common cancers (part of comprehensive primary care). 2016. Available from: http://www.nicpr.res.in/images/pdf/guidelines_for_population_level_screening_of_common_NCDs.pdf. [Internet] [Cited June 1, 2018].  Back to cited text no. 16
    
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World Health Organization. Management of noncommunicable diseases in primary health care. 2018. Available from: http://www.emro.who.int/noncommunicable-diseases/publications/questions-and-answers-on-management-of-noncommunicable-diseases-in-primary-health-care.html. [Internet] [Cited June 1, 2018].  Back to cited text no. 17
    
18.
Kane J, Landes M, Carroll C, Nolen A, Sodhi S. A systematic review of primary care models for non-communicable disease interventions in sub-Saharan Africa. BMC Fam Pract 2017;18:46.  Back to cited text no. 18
    
19.
Demaio AR, Nielsen KK, Tersbøl BP, Kallestrup P, Meyrowitsch DW. Primary health care: A strategic framework for the prevention and control of chronic non-communicable disease. Glob Health Action 2014;7:24504.  Back to cited text no. 19
    



 
 
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