Prevalence of non-communicable diseases and their risk factors at a semi-urban community, Pakistan
Sajida Naseem, Umme Kulsoom Khattak, Haider Ghazanfar, Awais Irfan
The Pan African Medical Journal. 2016;23:151. doi:10.11604/pamj.2016.23.151.8974

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Prevalence of non-communicable diseases and their risk factors at a semi-urban community, Pakistan

Cite this: The Pan African Medical Journal. 2016;23:151. doi:10.11604/pamj.2016.23.151.8974

Received: 29/01/2016 - Accepted: 02/03/2016 - Published: 31/03/2016

Key words: Non-communicable diseases, epidemiology, Pakistan, life style diseases, health

© Sajida Naseem et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.panafrican-med-journal.com/content/article/23/151/full

Corresponding author: Haider Ghazanfar, Shifa College of Medicine, Shifatameer E Millat University, Islamabad, Pakistan (haidergh@gmail.com)


Prevalence of non-communicable diseases and their risk factors at a semi-urban community, Pakistan

Sajida Naseem1, Umme Kulsoom Khattak1, Haider Ghazanfar1,&, Awais Irfan1

 

1Shifa College of Medicine, Shifatameer E Millat University, Islamabad, Pakistan

 

 

&Corresponding author
Haider Ghazanfar, Shifa College of Medicine, Shifatameer E Millat University, Islamabad, Pakistan

 

 

Abstract

Introduction: Pakistan is currently facing the double burden of communicable (38%) and non- communicable diseases (49%) according to WHO NCD Country Profiles 2014. About 50% of all deaths are attributed to NCD's. The objective of this study was to determine the burden of non-communicable diseases in semi urban community of Islamabad.

 

Methods: we carried a cross sectional study to estimate the burden of non-communicable diseases in an urban setting, a community based cross sectional survey covering 1210 households was carried out over a period of three months. Households were selected through consecutive non-probability sampling, among which adult females and males who were permanent resident of the community were interviewed through a structured questionnaire in urdu language. SPSS version 21 was used to analyze the data. Descriptive statistics were calculated.

 

Results: about 38.7% individuals had High BP / IHD, 34.4% had oro-dental health problems, 24.3% were physically disabled and 14.6% had diabetes. Among the risk factors, 48.2% were tobacco user, 13.60% were drug abuser and 1.8% alcoholics.

 

Conclusion: we conclude that the prevalence of non-communicable diseases is quite high in the above setting as compared to the National indicators, which demands timely intervention to curtail the existing burden of NCD.

 

 

Introduction    Down

About 38 million people die every year due to non-communicable disease [1]. Out of this 70-80% deaths occur in low and middle-income countries [1-3]. About 18% of global deaths are attributed to elevated blood pressure [4]. Over the last decade the NCDs burden has increase resulting in a barrier to development goals including poverty reduction, human security, economic stability and health equity [5]. The increase in NCD can be due to increasing longevity and due to societal & cultural changes such as increasing tobacco and illicit drug use [6]. Pakistan is currently facing the double Burden of Communicable (38%) and Non- Communicable Diseases (50%) according to WHO NCD Country Profiles 2014.The WHO country profile (2014) shows that in Pakistan 25.3% individuals had high BP,19% had CVD diseases, 3% had diabetes, 6% had chronic respiratory diseases, 8% had cancers, 23% were tobacco smokers and 0.1% were alcohol consumers [7]. The objective of this study was to determine the burden of non-communicable diseases in semi urban community of Islamabad.

 

 

Methods Up    Down

We performed a community based cross sectional survey using a self-made questionnaire covering 1210 households in Nurpur Shahan over a period of 3 months from Dec 2014 to February 2015. Households were selected through consecutive non-probability sampling, among which adult males and females were interviewed through a structured questionnaire in Urdu language. Using WHO sample size calculator, keeping 95% confidence level, and prevalence of DM 3%, absolute precision required 1%; sample size of 1200 was calculated. Only permanent residents of Nurpur Shahan were included in this study. Residents who were less than 18 years of age were not interviewed. Informed consent was obtained from all the participants. SPSS version 21 was used to analyze the data. Mean and Standard deviation was calculated for all quantitative variables. Frequency and percentages was calculated for qualitative variable. Pearson?s chi square test was used to find association of tobacco use, drug abuse and alcohol with Non-communicable disease. A p value of less than 0.05 was considered significant. Ethics approval for this study was obtained from Shifa International Hospital review board and ethical committee.

 

 

Results Up    Down

The mean age of the participant was 31.41 (SD 8.256) and the mean number of family member were 7.18 (SD 3.41). Mean number of earning family member was 1.51 (SD 0.93) and the mean month family income was 643 Pak Rupees (SD 3078.68). Frequency of Non-communicable diseases has been shown in Figure 1. In our study tobacco use was present in 583 (48.2%) household, drug abuse in 164 (13.6%) households and alcohol use in 22 (1.8%). This has been shown in Figure 2. Alcohol intake was found to be significantly (p<0.05)associated with stroke, oral and dental health problem, committed deliberate self-harm/suicidal ideation. Drug Abuse was found to be significant (p<0.05) associated with high blood pressure/Ischemic Heart Disease, oral and dental health problem committed deliberate self-harm/suicidal ideationand Psychiatric illness.

 

 

Discussion Up    Down

While the sample size of this study clearly does not include the entire population of Pakistan, it is a fairly accurate reflection of semi-urban community. Keeping this in mind, it is worthwhile to note that such drastic increases in frequencies of patients who smoke, drink alcohol, and have diabetes, may have happened within a small time frame; emphasizing the need for interventional programs. In this study, the biggest non-communicable disease risk factor we face is hypertension. Lloyd-Sherlock P et al performed a study in certain low to middle income countries, and also found very a very high prevalence of hypertension in these countries [8]. The aforementioned study also examined the levels of awareness each country's population had with regard to their condition; approximately 50% of people were aware, but few actually had their blood pressure under control according to the authors, thus highlighting not only an awareness problem, but also the urgent need to educate patients about the serious nature of this seemingly benign diagnosis, and how to treat it. Our study also investigated the relation of hypertension to various stress factors, for example a low monthly income. Mushtaq and Najam conducted a study which linked hypertension to psychiatric illness and stress, and found a strong positive correlation [9]. Among the stress variables outlined in the study, monthly income, number of dependents, and psychiatric illnesses like depression weighed in as the major factors contributing to hypertension. Meng L et al also tried to correlate depression, a type of psychiatric illness, to hypertension. They found that depression was indeed a risk factor for hypertension [10]. Our findings support the above. In our study, of the 464 households that reported someone in their family having high blood pressure, the majority fell under the category of relatively low income (148 had a monthly income of 5,000-10,000, and 108 between 10,000-15,000) and the general trend was that the higher the monthly income, the less the prevalence of high blood pressure. However, our research showed that psychiatric illness does not correlate well with hypertension. Of the 54 households that reported someone in their house with psychiatric illness, only 24 households also had someone with high blood pressure, as opposed to 30 with no high blood pressure. Knowing that hypertension is one of the leading causes of morbidity and mortality worldwide, tackling this is a major area of concern. The treatment of high blood pressure is impeded by a number of barriers, outlined by Khatib R et al in a meta-analysis. They found that the most common reason for lack of control was lack of knowledge of risk factors like smoking, but stress and anxiety played a role in the inability to control high blood pressure [11]. Oral hygiene and General Health go side by side. Dental Caries are the most common child hood non-communicable disease in childhood [12]. Disability-adjusted life years (DALYs) due to oral condition have increased by 20.8% between 1990 and 2010 [13]. Helen Clark has stated that "focus on oral health in overall primary health care will not only help improve oral health itself, but will also reduce the rate of cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes" [14]. In our study Oral and Dental problem was the second most common non-communicable disease. In a study done in Nigeria about one-third of the participant has dental caries [15]. The fact which is even more alarming is that most Pediatricians lack proper awareness of dental caries [16-17]. There is a dire need toformulate strategies to nip this issue in the bud.

 

Analysis of physical disability revealed some fascinating results. The highest frequency of physically disabled was in the age of 35 (44), followed by ages 25 (24) and 30 (22) respectively. It was expected that the elderly would be more disabled than the young adults, however that is not the case as displayed by the data. The type of physical disability present in the population in this study is not known; however, the most serious, and indeed, the one that has put Pakistan under the spotlight in recent years, is poliomyelitis. Farag NH et al report that in the time period from January 2014 to August 2014, there were 170 cases reported, rising from a number of 93 cases in the whole of 2013, and 58 in the preceding year [18]. It thus becomes necessary to ascertain the type of disability affecting so many young people, and whether it is associated with communicable disease or not. Diabetes Mellitus was found to be the 4th most common Non-communicable disease in our study. Urbanization in South East Asia has resulted in mushrooming of coronary heart disease, diabetes and respiratory diseases [19]. Diabetes is projected to be the 7thleading cause of death by 2030 [20]. Physical inactivity, overweight and obesity have significantly contributed to the increase in global prevalence of diabetes [21]. Diabetes is a well-known risk factor for cardiovascular diseases [22], blindness [23], kidney failure [24], limb amputation and premature death [25]. Cancer is the leading causes of death worldwide. The numbers of new cases of cancers are expected to increase by 70% over the next 2 decades [26]. This increase is expected to be more in low and lower middle income countries as compared to upper middle and upper income countries. Tobacco use, alcohol use, unhealthy diet and physical inactivity are the main cancer risk factors. About 40% cancer can be avoided by regular physical activity, healthy diet and avoidance of tobacco-use [27]. With proper awareness and education the prevalence of the cancer can be significantly reduced. Tobacco use and drug addiction is a rising menace and is consuming our society at an alarming rate. In our study tobacco use was found in 48.2% household. Results were similar to a study done in Delhi [28]. Tobacco use is more prevalent in rural areas as compared to urban areas [28-29]. Tobacco use is also a risk factor for communicable diseases [30]. If remained unchecked deaths related to it are projected to increase to 8 million by 2030 which accounts for 10% of all death. At least 15.3 million people have drug use disorders and harmful use of alcohol results in 3.3 million deaths each year [31].Awareness campaigns about the deleterious effects of Tobacco, drug abuse and alcohol use are the need of the hour. Volunteer members of the community can be selected and trained to lead such campaigns. This will increase the chance of community participation in such programs [32]. Along with this screening and treatment should be provided at school level to prevent and decrease the frequency of Alcohol and other drug use among children and adolescents [33]. Our study shows an alarming rate of deliberate self-harm and suicide rate. Correlating this with psychiatric illness, we can see that the majority of households reporting family members who have committed suicide or attempted some form of self-harm, in fact, do not have any previous history of psychiatric illness (p>0.05). Evidence suggests that there are other factors involved that would lead the population to commit acts of self-harm, for example unfavorable home conditions, unemployment [34], female gender [35], age [36] and physical abuse. Having a suicidal past was found to be associated with both attitudinal and stigmatizing barriers towards helps seeking and accepting attitudes towards suicide [37]. Efforts can be made in future studies to identify various factors leading to suicide in different communities and thereafter begin to do away with them. Devising, and even more so, implementing, strategies to cope with the burden of non-communicable diseases, is proving to be fairly difficult. Lack of television, internet, and even radio, in the vast majority of peripheral regions of Pakistan makes media campaigns non-feasible. In Pakistan, local health workers (especially LHW's) are a well-established concept, and therefore a more viable option would be to educate the LHW's station in each village, and provide them with the responsibility of employing the appropriate healthcare guidelines. To overcome these barriers, we must find effective large scale strategies to educate the population and eliminate risk factors in order to gain some control over the burgeoning burden of non-communicable diseases. This is especially important for low and middle income countries, which are now currently experiencing double burden due to communicable diseases and non-communicable diseases.

 

 

Conclusion Up    Down

We conclude that the prevalence of Non-Communicable diseases is quite high in the above setting as compared to the National indicators, which demands timely intervention to curtail the existing burden of NCD's. Also there is a need to update the statistics at least the regional level. There is a need for Health Awareness and Health education strategies regarding Non Communicable diseases and their risk factors.

What is known about this topic

  • About 38 million people die every year due to non-communicable disease . Out of this 70-80% deaths occur in low and middle-income countries.
  • Over the last decade the NCDs burden has increase resulting in a barrier to development goals including poverty reduction, human security, economic stability and health equity.
  • Pakistan is currently facing the double Burden of Communicable (38%) and Non- Communicable Diseases (50%) according to WHO NCD Country Profiles 2014.

What this study adds

  • We conclude that the prevalence of Non-Communicable diseases is quite high in the above setting as compared to the National indicators.
  • There is a need to educate the LHW's station in each village, and provide them with the responsibility of employing the appropriate healthcare guidelines.
  • Awareness campaigns about the deleterious effects of Tobacco, drug abuse and alcohol use are the need of the hour.

 

 

Competing interests Up    Down

The authors declare no competing interests.

 

 

Authors’ contributions Up    Down

All authors have read and agreed to the final version of this manuscript and have equally contributed to its content and to the management of the case.

 

 

Figures Up    Down

Figure 1: frequency of non-communicable diseases

Figure 2: risk factors for non-communicable disease

 

 

References Up    Down

  1. World Health Organization. Non-communicable diseases Fact sheet Updated January 2015 Geneva, Switzerland: World Health Organization; 2015. [Accessed on 1 February 2015} Available at: http://www.who.int/mediacentre/factsheets/fs355/en/. Google Scholar

  2. Abegunde DO, Mathers CD, Adam T, Ortegon M. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet. 2007 Dec 8; 370(9603): 1929-38. PubMed | Google Scholar

  3. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006 May 27; 367(9524): 1747-57. PubMed | Google Scholar

  4. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380(9859): 2224-2260. PubMed | Google Scholar

  5. Beaglehole R, Bonita R, Horton R, Adams C, Alleyne G et al. Priority actions for the non-communicable disease crisis. Lancet. 2011 Apr 23; 377(9775): 1438-47. PubMed | Google Scholar

  6. World Health Organization. Non-communicable diseases country profiles 2014. Pakistan. Geneva, Switzerland: World Health Organization; 2014 [Accessed on 1st February 2015) Available at: http://www.who.int/nmh/countries/pak_en.pdf?ua=1. Google Scholar

  7. Degenhardt L, Whiteford HA, Ferrari AJ, Baxter AJ, Charlson FJ, Hall WD et al. Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010. Lancet. 2013 Nov 9; 382(9904): 1564-74. Google Scholar

  8. Lloyd-Sherlock P, Beard J, Minicuci N, Ebrahim S, Chatterji S. Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control. Int J Epidemiol. 2014 Feb; 43(1): 116-28. PubMed | Google Scholar

  9. Mushtaq M, Najam N. Depression, anxiety, stress, and demographic determinants of hypertension disease. Pak J Med Sci. 2014 Nov-Dec; 30(6): 1293-8. PubMed | Google Scholar

  10. Meng L, Chen D, Yang Z, Zheng Y, Hui R. Depression increases the risk of hypertension incidence: a meta-analysis of cohort studies. J Hypertens. 2012 May; 30(5): 842-51. PubMed | Google Scholar

  11. Khatib R, Schwalm JD, Yusuf S, Haynes RB, McKee M, Khan M et al. Patient and healthcare provider barriers to hypertension awareness, treatment and follow up: a systematic review and meta-analysis of qualitative and quantitative studies. PLoS One. 2014 Jan 15; 9(1): e84238. PubMed | Google Scholar

  12. Beaglehole R, Benzian H, Crail J, Mackay J. The oral health atlas: mapping a neglected global health issue. Brighton, UK: Myriad Editions for the FDI World Dental Federation; 2009. Google Scholar

  13. Marcenes W, Kassebaum NJ, Bernabé E, Flaxman M, Naghavi A, Lopez A et al. Global burden of oral conditions in 1990-2010: a systematic analysis. J Dent Res. 2013; 92(7): 592-7. PubMed | Google Scholar

  14. Statement by Helen Clark. UNDP Administrator: UN Summit on non-communicable diseases side event: putting teeth into the NCDs. [Accessed on 18th March 2015] Available from:http://www.undp.org/content/undp/en/home/presscenter/speeches/2011/09/19/statement-by-helen-clark-undp-administrator-un-summit-on-non-communicable-diseases-side-event-putting-teeth-into-the-ncds/. Google Scholar

  15. Olabisi AA, Udo UA, Ehimen UG, Bashiru BO, Gbenga OO, Adeniyi AO. Prevalence of dental caries and oral hygiene status of a screened population in Port Harcourt, Rivers State, Nigeria. J Int Soc Prev Community Dent. 2015 Jan-Feb; 5(1): 59-63. PubMed | Google Scholar

  16. Olatosi OO, Sote EO, Akinsola OJ, Oredugba FA, Adenaike AS. Prevention of dental caries: knowledge, practice and opinion of paediatricians in Lagos. West Afr J Med. 2013 Jan-Mar; 32(1): 52-6. PubMed | Google Scholar

  17. Murthy GA, Mohandas U. The knowledge, attitude and practice in prevention of dental caries amongst pediatricians in Bangalore: a cross-sectional study. J Indian Soc Pedod Prev Dent. 2010 Apr-Jun; 28(2): 100-3. PubMed | Google Scholar

  18. Farag NH, Alexander J, Hadler S, Quddus A, Durry E, WadoodMZ et al. Progress toward poliomyelitis eradication--Afghanistan and Pakistan, January 2013-August 2014. MMWR Morb Mortal Wkly Rep. 2014 Oct 31; 63(43): 973-7. PubMed | Google Scholar

  19. Angkurawaranon C, Jiraporncharoen W, Chenthanakij B, Doyle P, Nitsch D. Urbanization and non-communicable disease in Southeast Asia: a review of current evidence. Public Health. 2014 Oct; 128(10): 886-95. PubMed | Google Scholar

  20. World Health Organization. Diabetes. Fact sheet N°312Updated January 2015. Geneva, Switzerland: World Health Organization; 2015. [Accessed on 18 March 2015} Available at:http://www.who.int/mediacentre/factsheets/fs312/en/. Google Scholar

  21. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011 Feb 12; 377(9765): 557-67. PubMed | Google Scholar

  22. Morrish NJ, Wang SL, Stevens LK, Fuller JH, Keen H. Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia. 2001; 44 Suppl 2: S14-S21. PubMed | Google Scholar

  23. Global data on visual impairments 2010. Geneva, World Health Organization, 2012. Google Scholar

  24. Global status report on non-communicable diseases 2010. Geneva, World Health Organization, 2011. Google Scholar

  25. Roglic G, Unwin N, Bennett PH, Mathers C, Tuomilehto J, Nag S et al. The burden of mortality attributable to diabetes: realistic estimates for the year 2000. Diabetes Care. 2005; 28(9): 2130-2135. PubMed | Google Scholar

  26. World Health Organization. Cancer. Fact sheet N°297 Updated Febraury 2015. Geneva, Switzerland: World Health Organization; 2015. [Accessed on 18 March 2015} Available at:http://www.who.int/mediacentre/factsheets/fs297/en/. Google Scholar

  27. Epping-Jordan JE, Galea G, Tukuitonga C, Beaglehole R. Preventing chronic diseases: taking stepwise action. Lancet. 2005 Nov 5; 366(9497): 1667-71. PubMed | Google Scholar

  28. Chadha SL, Gopinath N, Shekhawat S. Urban-rural differences in the prevalence of coronary heart disease and its risk factors in Delhi. Bull World Health Organ. 1997;75(1):31-8. PubMed | Google Scholar

  29. 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 Mar;31(1):78-85. PubMed | Google Scholar

  30. Lin HH, Ezzati M, Murray M.Tobacco smoke, indoor air pollution and tuberculosis: a systematic review and metaanalysis. PLoS Med. 2007 Jan; 4(1): e20. PubMed | Google Scholar

  31. World Health Organization. Management of Substance Abuse. Facts and figures. Geneva, Switzerland: World Health Organization; 2015. [Accessed on 19 March 2015} Available at:http://www.who.int/substance_abuse/facts/en/. Google Scholar

  32. Kpormegbe SK, Ahorlu CK. The role of community participation in intermittent preventive treatment of childhood malaria in south-eastern Ghana. Ghana Med J. 2014 Jun; 48(2): 58-65. PubMed | Google Scholar

  33. Benningfield MM, Riggs P, Stephan SH. The Role of Schools in Substance Use Prevention and Intervention. Child Adolesc Psychiatr Clin N Am. 2015 Apr;24(2):291-303. PubMed | Google Scholar

  34. Fountoulakis KN, Savopoulos C, Apostolopoulou M, Dampali R, Zaggelidou E, Karlafti E et al. Rate of suicide and suicide attempts and their relationship to unemployment in Thessaloniki Greece (2000-2012). J Affect Disord. 2015 Mar 15; 174: 131-6. PubMed | Google Scholar

  35. Kanchan T, Menon A, Menezes RG. Methods of choice in completed suicides: gender differences and review of literature. J Forensic Sci. 2009 Jul; 54(4): 938-42. PubMed | Google Scholar

  36. Kanchan T, Menezes RG. Suicidal hanging in Manipal, South India - victim profile and gender differences. J Forensic Leg Med. 2008 Nov; 15(8): 493-6. PubMed | Google Scholar

  37. Reynders A, Kerkhof AJ, Molenberghs G, Van Audenhove C. Help-seeking, stigma and attitudes of people with and without a suicidal past. A comparison between a low and a high suicide rate country. J Affect Disord. 2015 Jun 1; 178: 5-11. PubMed | Google Scholar

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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