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SHORT COMMUNICATION
Year : 2014  |  Volume : 3  |  Issue : 3  |  Page : 199-203

A study on risk factors for lifestyle diseases among patients attending fixed mobile clinic in a rural block in Tamil Nadu


1 Department of Community Medicine, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, India
2 Department of Community Medicine, SRM Medical College, SRM University, Kanchipuram, Tamil Nadu, India

Date of Web Publication13-Aug-2014

Correspondence Address:
M Logaraj
Department of Community Medicine, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai - 603 203, Tami Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.138608

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  Abstract 

Background: Chronic diseases are becoming major health problems in India including the rural population. Non Communicable Diseases (NCDs) are increasingly becoming a disease of poor and younger segments of the population. Methods: A cross sectional study was carried out among 2112 participants through our fixed mobile clinic among 30 villages to assess the risk factors for lifestyle diseases in a rural block in Tamil Nadu. Results: The proportion of study population smoking and being alcoholic was 5.7% each. More men (15.2%) smoked as compared to women (0.9%). More than half of the study population was overweight. About 19.3% had a systolic blood pressure of more than 140 mm hg and 14.8% had diastolic blood pressure of more than 90 mm hg. On an average, fruits were consumed on 2.92 days/week. Conclusion: Sound community based comprehensive behavioral and life style intervention approach should be established to reduce the modifiable risk factors of CVD.

Keywords: Lifestyle diseases, risk factors, rural block, Tamil Nadu


How to cite this article:
Logaraj M, Hegde SB, John K, Balaji R. A study on risk factors for lifestyle diseases among patients attending fixed mobile clinic in a rural block in Tamil Nadu. Int J Health Allied Sci 2014;3:199-203

How to cite this URL:
Logaraj M, Hegde SB, John K, Balaji R. A study on risk factors for lifestyle diseases among patients attending fixed mobile clinic in a rural block in Tamil Nadu. Int J Health Allied Sci [serial online] 2014 [cited 2022 Aug 10];3:199-203. Available from: https://www.ijhas.in/text.asp?2014/3/3/199/138608


  Introduction Top


India is faced with the double burden of communicable and noncommunicable diseases (NCDs). Chronic diseases are becoming major health problems in India, including the rural population. NCDs are increasingly becoming a disease of poor and younger segments of the population. World Health Organization projects that in the South-East Asia Region over the next 10 years 89 million people will die from NCDs. While deaths from infectious diseases, maternal and perinatal conditions, and nutritional deficiencies combined will decrease by 16%, deaths from NCDs will increase by 21%. An epidemiological transition is taking place in most of the states in India with a decline in communicable diseases and an increase in chronic NCDs that has resulted in more than 50% of total deaths in India in 2005 due to chronic diseases. [1] Recent studies in India from different sites show a higher risk of coronary heart disease among people with lower socioeconomic status indicating that the disease pattern is shifting from the affluent to the poor. [2],[3],[4] This study was undertaken to assess the risk factors for lifestyle diseases in a rural block in Kanchipuram district in Tamil Nadu.


  Methodology Top


A cross-sectional study was carried out among 2112 participants, through our fixed mobile clinic among 30 villages out of 143 villages in Kattankulathur block in Kanchipuram district in Tamil Nadu from March 2012 to February 2013. The villages with a population of more than 2500 were selected for the fixed mobile clinic and visited on the fixed day of every week with prior permission of village heads. Individuals over the age of 20 years who attended our fixed mobile clinic were interviewed in person with a structured interview schedule to elicit information on select sociodemographic variables, tobacco and alcohol use, dietary intake, physical activity and treatment history for diabetes and hypertension. The physical examination of all participants included measurements of height, weight and blood pressure. All individuals included in the study provided written informed consent. The study was approved by the Institutional Ethics Committee.

Standard methods were used to measure weight and height. [5] Body mass index was calculated and standard cut-offs for Asian adults were used to define overweight and obesity. [6]

Blood pressure was recorded in the sitting position in the left arm to the nearest 1 mm Hg using an electronic Omron blood pressure measuring device (Omron Corporation, Tokyo, Japan). Two readings were taken: first one before starting the interview and the second one at the end of the interview and the mean of the two readings was used for analysis. Hypertension was classified using the Joint National Committee-7 criteria. [7]

All current smokers and user of smokeless tobacco, current daily smokers and past daily smokers and users of smokeless tobacco (within 1 year) were included as smokers and users of smokeless tobacco, respectively. Similarly, all current alcoholics and those who had quit alcohol <1 year before the assessment were considered alcoholics. Based on the physical activity the participants were classified into light work, moderate work, and heavy work.

Data were entered into Microsoft Excel spread sheet and analyzed using standard statistical software packages. Descriptive data were presented as measures of central tendency and dispersion. Chi-square test was used for analyses of categorical variables.


  Results Top


A total of 2112 participants over the age of 20 years formed the study population with the mean age being 43.51 years (standard deviation [SD] ± 14.64). The study population comprised of 66.4% (1403) women and 33.6% (709) men with one third of them (32.6%) were illiterate and nearly 43.4% were homemakers [Table 1]. Most of the participants belonged to nuclear families (1790, 84.8%). Majority of the participants were Hindus (2031, 96.2%). A total of 172 participants were known hypertensive (8.14%) and a total of 125 participants were known diabetics (5.9%). A significantly higher proportion of men (15.2%) smoked tobacco compared to women (0.9%) (χ2 = 182; df = 1; P < 0.001). However, a significantly higher proportion of women (8.8%) used smokeless tobacco when compared with men (6.3%) (χ2 = 3.97; df = 2; P < 0.04). As age increased, prevalence of smoking and using smokeless tobacco also increased and this was found to be statistically significant (smoking, χ2 = 10.7; df = 4; P = 0.030) and (smokeless tobacco, χ2 = 22.2; df = 4; P < 0.001). More men were alcoholics (16.1%) compared with women (0.4%) and this difference was also statistically significant (χ2 = 215; df = 1; P < 0.001).
Table 1: Sociodemographic profile of the study population

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[Table 2] depicts more than half of the study population was overweight (53.3%). Among those who were overweight, 716 individuals were obese (33.9%). A significantly higher proportion of women were overweight and obese when compared to men (χ2 = 10.6; df = 3; P = 0.014). Mean systolic blood pressure of the study population was 125.16 mm Hg (SD ± 18.80). Of the 408 participants (19.3%) who had a systolic blood pressure of more than 140 mm Hg, 304 (14.4%) had Stage 1 hypertension and 104 (4.9%) had Stage 2 hypertension. A significantly higher proportion of men were systolic hypertensive compared to women (χ2 = 13.1; df = 3; P = 0.004). Furthermore, as age advanced, the prevalence of systolic hypertension increased and this trend was found to be statistically significant (χ2 = 226; df = 12; P < 0.001) [Table 3]. Mean diastolic blood pressure of the study population was 77.94 mm Hg (SD ± 10.80). Of the 312 participants (14.8%) who had a diastolic blood pressure of more than 90 mm Hg, 238 (11.3%) had Stage 1 hypertension and 63 (3.5%) had Stage 2 hypertension. A significantly higher proportion of men were diastolic hypertensive compared to women (χ2 = 15.8; df = 3; P = 0.001). Furthermore, as age advanced, the prevalence of diastolic hypertension increased and this trend was found to be statistically significant (χ2 = 69.7; df = 12; P < 0.001) [Table 3]. On an average, fruits were consumed on 2.92 days/week. Close to one-third of the study population, consumed fruits on more than 3 days/week. Similarly, on an average, vegetables were consumed on 4.57 days/week. More than two-thirds of the population (73.6%) consumed vegetables for more than 3 days/week. There is no statistical difference between men and women, in the number of days of consumption of fruits and vegetables. The mean number of servings of fruits and vegetables in one particular day was 0.42 and 0.67 for males and 0.41 and 0.64 for females. Physical activity was rated by typical work/day they do. As the rural block is adjacent to the sub urban of Chennai most these unskilled worker's work was rated as moderate physical activity because most of them are employed as an office assistant, watch man, shops, company, sweepers and so on. Only 3.4% of the study participants were involved in heavy physical activity and 96.6% were involved in light to moderate physical activity.
Table 2: Risk factor levels in the study population distributed by gender

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Table 3: Levels of risk factors in the study population distributed by age

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  Discussion Top


In our study, nearly 15% of the men and <1% of women were smokers with overall prevalence of 6%. In India, about one-fourth of men were smokers with a total prevalence of 13.9%. [8] The prevalence of smoking was around 13% among rural respondents in Tamil Nadu. [9] In our study, the proportion of smokeless tobacco users was around 8%, while it was 14% among rural respondents in Tamil Nadu [9] and a higher percentage of 32% was by reported by Bhagyalaxmi et al. in rural Gujarat. [10]

The prevalence of alcoholism in this study was around 6% with a prevalence of 16.1% among men and 0.4% among women. Nearly, 41.5% of men and 0.1% of women in Tamil Nadu take alcohol. [11] In our study, the reason for lesser overall prevalence of smoking, use of smokeless tobacco and alcoholism compared to studies done in India and Tamil Nadu could be because to two-third of the participants were women and the study was done among health seekers.

In this study, almost one-fourth of the participants had either diastolic or systolic hypertension or both. Similar findings with a prevalence ranging nearly from one-fourth to one-third of population were reported by multiple studies conducted elsewhere in India. [12],[13],[14],[15],[16] In the present study the differences in prevalence of hypertension among men and women was statistically significant. Similar finding was reported by NCDs Risk Factors Survey conducted in Tamil Nadu with statistically significant difference in the prevalence of hypertension among men and women. [9] In this study as the age advances the prevalence of hypertension increased both for diastolic and systolic hypertension and this was statistically significant. Similar finding of significant association with age was reported by multiple studies conducted elsewhere. [17],[18],[19]

In our study, over half of the population were overweight and over one-third of them were obese, with about half and one-third of men being overweight and obese and more than half and one-third of women being overweight and obese. Indian Council of Medical Research reported that the prevalence of obesity was 22.6% in Tamil Nadu. [9] In this study, overweight was significantly higher among women as compared to men.

Even though two-third of the study population consumed vegetables on more than 3 days/week, the consumption of fruits was low (two-third consumed fruits on <3 days/week). According to the NCD Risk Factors Survey, the number of days of fruits and vegetables consumption in rural Tamil Nadu population was 2 days and only 1% of population consumed five or more servings of fruits and vegetables per day. [9] As the study had been done among health seekers in the fixed mobile clinic conducted in the rural block in Tamil Nadu it cannot be extrapolated to the larger population.


  Conclusions Top


To conclude, nearly 6% of the participants were smokers, almost 16% of the men were alcoholics, over half of the participants were overweight and one-fourth of the participants had either diastolic or systolic hypertension. Our findings revealed a need for initiation of a population based program at primary level on lifestyle modification in the prevention of risk factors of chronic NCDs. A sound community based comprehensive behavioral and lifestyle intervention approach should be established to reduce the modifiable risk factors of cardiovascular disease. In addition, we should design a strategy to incorporate primordial prevention in the school education in advocating healthy lifestyles.

 
  References Top

1.Srinath Reddy K, Shah B, Varghese C, Ramadoss A. Responding to the threat of chronic diseases in India. Lancet 2005;366:1744-9.  Back to cited text no. 1
    
2.Gupta R, al-Odat NA, Gupta VP. Hypertension epidemiology in India: Meta-analysis of 50 year prevalence rates and blood pressure trends. J Hum Hypertens 1996;10:465-72.  Back to cited text no. 2
    
3.Blas E, Kurup AS, editors. Equity, Social Determinants and Public Health Programmes. Geneva: World Health Organization; 2010. Available from: http://www.whqlibdoc.who.int/publications/2010/9789241563970_eng.pdf. [Last cited on 2014 May 06].  Back to cited text no. 3
    
4.Jeemon P, Reddy KS. Social determinants of cardiovascular disease outcomes in Indians. Indian J Med Res 2010;132:617-22.  Back to cited text no. 4
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5.World Health Organization. WHO STEPS Surveillance Manual: The WHO STEP wise Approach to Chronic Disease Risk Factor Surveillance. Geneva, Switzerland: WHO; 2005. Available from: http://www.whqlibdoc.who.int/publications/2005/9241593830_eng.pdf. [Last cited on 2014 Feb 18].  Back to cited text no. 5
    
6.World Health Organization. The Asia Pacific Perspective: Redefining obesity and its treatment. Regional Office for the Western Pacific, International Association for the study of Obesity and International Obesity Task Force; Feb 2000. Table 2.2. p. 18. Available from: http://www.wpro.who.int/nutrition/documents/docs/Redefiningobesity.pdf 6. [Last cited on 2014 Feb 18].  Back to cited text no. 6
    
7.United States Department of Health and Human Services. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Institutes of Health, National Heart, Lung and Blood Institute and National High Blood Pressure Education Program; Aug 2004. Classification of Blood Pressure. Table 3. p. 12. Available from: http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf 7. [Last cited on 2014 Feb 18].  Back to cited text no. 7
    
8.World Health Organization. Non Communicable Diseases Country Profiles 2011: Report. Geneva, Switzerland. p. 92. Available from: http://www.whqlibdoc.who.int/publications/2011/9789241502283_eng.pdf. [Last cited on 2014 Feb 21].  Back to cited text no. 8
    
9.Ministry of Health and Family Welfare, Government of India. National Institute of Medical Statistics, Indian Council of Medical Research (ICMR). IDSP Non-Communicable Disease Risk Factors Survey, Tamil Nadu, 2007-08. New Delhi, India: National Institute of Medical Statistics and Division of Non-Communicable Diseases, Indian Council of Medical Research; 2009. Available from: http://www.icmr.nic.in/final/IDSP-NCD%20Reports/Tamil%20Nadu.pdf. [Last cited on 2014 Feb 21].  Back to cited text no. 9
    
10.Bhagyalaxmi A, Atul T, Shikha J. Prevalence of risk factors of non-communicable diseases in a District of Gujarat, India. J Health Popul Nutr 2013;31:78-85.  Back to cited text no. 10
    
11.International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS-3), 2005-06, India: Key Findings. Mumbai: IIPS; 2007. Available from: http://www.measuredhs.com/pubs/pdf/SR128/SR128.pdf. [Last cited on 2014 Feb 21].  Back to cited text no. 11
    
12.Das SK, Sanyal K, Basu A. Study of urban community survey in India: Growing trend of high prevalence of hypertension in a developing country. Int J Med Sci 2005;2:70-8.  Back to cited text no. 12
    
13.National Nutrition Monitoring Bureau Technical Report No. 24: Diet and Nutritional Status of Population and Prevalence of Hypertension among Adults in Rural Areas. Hyderabad: NNMB, National Institute of Nutrition; 2006. Available from: http://www.nnmbindia.org/NNMBReport06Nov20.pdf. [Last cited on 2014 Feb 21].  Back to cited text no. 13
    
14.Chow CK, Naidu S, Raju K, Raju R, Joshi R, Sullivan D, et al. Significant lipid, adiposity and metabolic abnormalities amongst 4535 Indians from a developing region of rural Andhra Pradesh. Atherosclerosis 2008;196:943-52.  Back to cited text no. 14
    
15.Kannan L, Satyamoorthy TS. An epidemiological study of hypertension in a rural household community. Sri Ramachandra J Med 2009;2:9-13.  Back to cited text no. 15
    
16.Bharati DR, Nandi P, Yamuna TV, Lokeshmaran A, Agarwal L, Singh JB, et al. Prevalence and covariates of undiagnosed hypertension in the adult population of Puducherry, South India. Nepal J Epidemiol 2012;2:191-9.  Back to cited text no. 16
    
17.Basu G, Biswas S. Epidemiology of hypertension and its risk factors in a village of West Bengal. Indian J Res Rep Med Sci 2013;3:13-7.  Back to cited text no. 17
    
18.Gupta R, Misra A, Vikram NK, Kondal D, Gupta SS, Agrawal A, et al. Younger age of escalation of cardiovascular risk factors in Asian Indian subjects. BMC Cardiovasc Disord 2009;9:28.  Back to cited text no. 18
    
19.Raina DJ, Jamwal DS. Prevalence study of overweight/obesity and hypertension among rural adults. JK Sci 2009;11:1-4.  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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