In urban India, about 35-40% of all adults have hypertension and about 10-15% have diabetes mellitus. National Program for Prevention and Control of Diabetes, Cancer and Stroke (NPCDCS) launched by Government of India has envisaged to screen all adults aged 30 years and above for presence of hypertension and diabetes mellitus in the community through population-based screening, initiate positively screened and diagnosed on drug therapy, and follow them up for treatment adherence. In this context, the current study aims to estimate burden of high cardiovascular disease (CVD) risk and to evaluate feasibility of community health workers-based strategies in reducing CVD among adults living in urban slums. We have identified and trained CHWs from within the urban slum communities in Bhopal, in chronic disease identification, skills in self-care and adherence promotion skills. At-risk individuals were linked to public health facilities as outlined under NPCDCS. Primary outcome is assessment of burden of high cardiovascular risk and its determinants. Secondary outcome is feasibility of community health worker-based adherence promotion. Between November 2017 and June 2018, CHWs in 14 urban slum clusters, screened a total of 6178 individuals out of which 4781 (77.43%) attended confirmation camp. Around 2393 (38.8%) were current tobacco users (smoking and/or smokeless), and 4697 (76.1%) has a sedentary lifestyle. Out of 758 (12.3%) known hypertensives, 354 (46.7%) had controlled hypertension whereas out of 333 (5.4%) known diabetes patients, 169 (57.5%) has controlled level of diabetes. In 813 (15%) out of 5416 and 151 (3.4%) out of 4486 adults, hypertension and diabetes was newly detected respectively. Results of this study have a potential to strengthen NPCDCS across all urban areas of the country. This manuscript describes detailed protocol of the study and presents baseline summary of CVD risk factor burden in urban slums of Bhopal.
BackgroundNumerous studies have highlighted the burden of hypertension by estimating its prevalence. However, information regarding quantum and characteristics of persons whose blood pressure converts to hypertension range from their previous state of prehypertension or normal blood pressure is crucial for any public health programme. We aimed to estimate incidence rate of hypertension and to identify risk factors for the same, so that it is useful for programme implementation.MethodsWe established a cohort of adults residing in urban slums of Bhopal, who were registered in a baseline cardiovascular risk assessment survey, which was performed between November 2017 and March 2018. Blood pressure assessment was done at least three times at baseline for diagnosis of hypertension, which was defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg on two occasions. Participants who did not have a diagnosis of hypertension were followed up during April–June 2019.ResultsOf the 5673 participants assessed at baseline, 4185 did not have hypertension of which 3199 (76.4%) were followed up after a median on 1.25 years (IQR 1.08–1.60) and a total of 170 (5.31%) individuals were detected with incident hypertension. Overall incidence rate of hypertension was 4.1 (95% CI 3.54 to 4.75) per 100 person-years of follow-up. On multivariate analysis, age (relative risk/RR 1.98; 95% CI 1.19 to 3.3, for age >60 years), being in first and second wealth tertile (T-1 RR 1.85; 95% CI 1.17 to 2.91) and being illiterate (RR 1.94; 95% CI 1.31 to 2.86) were significant predictors of incident hypertension. Individuals who had prehypertension at baseline also had a significantly increased risk of developing hypertension (RR 2.72; 95% CI 1.83 to 4.03).ConclusionsWe found that incidence of hypertension in urban slums of central India is higher with increasing age and in men. Illiteracy, lower Wealth Index and prehypertension are other determinants. We also demonstrate feasibility of establishing a cohort within the public health delivery system, driven by efforts of community health workers.
Objective Mental health care needs of urban, rural, and tribal regions of India are varied and challenging, which require region-specific approaches. A significant treatment gap calls out for a state-wise introspection of existing service delivery models to cater to the specific mental health needs. In Madhya Pradesh, key findings were noted from a camp conducted in one of the tribal districts. To establish patient-centered services, it is important to understand their mental health care needs. Materials and Methods A cross-sectional study within a mental health camp was conducted in the east-central tribal district of Madhya Pradesh by using a semi-structured interview. Statistical Analysis Treatment deficit, pathways to care, and treatment barriers were assessed for correlation with demographic and clinical variables and analyzed by using the Chi-square test and logistic regression method using SPSS version 20. Results Among 113 patients who sought help, treatment deficit was 85% with patient factors contributing 76% predominantly affecting the unmarried group of patients. Common mental illnesses (CMIs) outnumbered severe mental illnesses (SMIs) of which anxiety spectrum disorder contributed the most. SMIs still appear to remain undiagnosed till late in the course of illness. Nicotine dependence was higher in males (p < 0.001), and an increase in the dependence pattern was observed with increasing age (p = 0.001). Conclusion Rising awareness and recognition of CMIs as a common mental health concern while under-recognition of SMIs among tribal communities needs further research. Considering attribution of symptoms to unknown factors, treatment barriers revolving around patient factors, and higher nicotine dependence in males, a timely evaluation of a multitargeted intervention to establish the balance in access to mental health care among the tribal population of Madhya Pradesh is warranted.
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