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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 22  |  Issue : 2  |  Page : 174-179

Prevalence and risk factors of non-communicable disease and healthcare-seeking behaviour amongst the adults residing in a selected Village, Mao, Manipur


1 Nursing Student, Government College of Nursing, Medical College & Hospital, Kolkata, West Bengal, India
2 Senior Lecturer, Government College of Nursing, Medical College & Hospital, Kolkata, West Bengal, India

Date of Submission20-Dec-2020
Date of Decision05-Dec-2021
Date of Acceptance06-Dec-2021
Date of Web Publication31-Jan-2022

Correspondence Address:
Dr. Adhikari Uma Rani
Government College of Nursing, Medical College and Hospital, Kolkata - 700 073, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcn.ijcn_132_20

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  Abstract 


Non-communicable diseases (NCDs) are increasingly becoming the leading cause of morbidity and mortality worldwide. The objectives of the study were to identify the prevalence of NCDs, risk factors of NCDs and healthcare-seeking behaviour of the persons suffering from NCDs. Two hundred adults were selected by non-probability purposive sampling technique. After assessing the prevalence of NCDs through a structured questionnaire, healthcare-seeking behaviour was assessed for those adults suffering from NCDs. The tools were pre-tested and validated before data collection. The findings of the study revealed that 14.50% (95% confidence interval: 9.5–19.5) of the adults were suffering from NCDs. The most important risk factor, hypertension, was highly prevalent (56.5%). The study findings revealed a high prevalence of behavioural and clinical risk factors of NCDs. This study also revealed that only family history of NCDs was significantly associated with the occurrence of NCDs. In this study, 61.9% of the adults suffering from a NCD sought healthcare, and amongst them, 90.5% availed treatment from allopathy. Intervention programmes and creating community awareness are needed to modify risk factors.

Keywords: Healthcare-seeking behaviour, non-communicable diseases, prevalence, risk factors


How to cite this article:
Poftte M, Rani AU. Prevalence and risk factors of non-communicable disease and healthcare-seeking behaviour amongst the adults residing in a selected Village, Mao, Manipur. Indian J Cont Nsg Edn 2021;22:174-9

How to cite this URL:
Poftte M, Rani AU. Prevalence and risk factors of non-communicable disease and healthcare-seeking behaviour amongst the adults residing in a selected Village, Mao, Manipur. Indian J Cont Nsg Edn [serial online] 2021 [cited 2022 May 28];22:174-9. Available from: https://www.ijcne.org/text.asp?2021/22/2/174/336895




  Introduction Top


Non-communicable diseases (NCDs) are also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behaviours factors. NCDs disproportionately affect people in low- and middle-income countries where more than three-quarters of global NCD deaths – 32 million – occur. The main types of NCDs are cardiovascular disease (heart attacks and stroke), cancer, chronic respiratory disease (chronic obstructive pulmonary disease and asthma) and diabetes.

NCDs kill 41 million people each year, equivalent to 71% of deaths globally.[1] According to the World Health Organization, each year, 15 million people die from a NCD between the ages of 30 and 69 years; over 85% of these 'premature' deaths occur in low- and middle-income countries. NCDs contribute to around 38 million (68%) of all the deaths globally and to about 5.87 million (60%) of all deaths in India.[2]

The north-eastern region of India has a high burden of NCDs due to the food habits and high prevalence of tobacco and alcohol use.[2]

Data on the prevalence of NCDs and prevalence of the risk factors of NCDs in the rural tribal population of Mao, Manipur, are limited. A proper understanding of health-seeking behaviours in the community may reduce delay in diagnosis, improve treatment compliance and improve health. Therefore, knowledge and understanding on the prevailing status of the risk factors of NCDs and the healthcare-seeking behaviour of the community are important to create awareness. The objectives of the present study are to assess the prevalence of NCDs amongst adults, to assess the prevalence of risk factors of NCDs and to assess the healthcare-seeking behaviour of clients suffering from NCDs.


  Methods Top


We conducted a descriptive survey with adults residing in a selected village of Mao, Manipur. Following Institutional Ethics Committee approval, a total of 200 adults who can read, write and speak Mao dialogue, age ≥30−≤70 years, were selected for the study. Data were collected between October 2019 and November 2019. The study procedure was explained and informed consent was taken from the subjects at the time of selection. Purposive sampling technique was used to select subjects, excluding those adults who cannot read, write and speak Mao dialogue, pregnant women, clients with mental illness and clients suffering from life-threatening conditions.

To assess the prevalence of NCDs, a structured interview was conducted in addition to the analysis of records. In this study, the WHO classification of NCDs was adopted. To assess risk factors of NCDs, semi-structured interview schedule was used and this interview schedule was developed on the basis of the WHO STEPS instrument.[3] In biochemical measurements, only random blood sugar (RBS) was tested and other biochemical measurements were not performed because of logistic limitations. Measurement of risk factors was considered as per the WHO guideline. We also developed a semi-structured interview schedule for assessing healthcare-seeking behaviour of NCD clients. Formal healthcare-seeking behaviour is defined as professional help sought from healthcare services and/or healthcare providers (physicians). In this study, healthcare-seeking behaviour was the care sought by the clients suffering from NCDs. Anthropometric measurements such as height, waist circumference, body weight and measurement of blood pressure (BP) were done. BP was recorded two times with a gap of 5 min between the recordings. Average of the two readings was taken as the final BP measurement. Validity and reliability of the interview questionnaire were established before actual data collection. Validity was established by validation of its construction and content by four experts. Reliability was established through test and retest method, and the kappa coefficient was ranging from 0.9 to 1. After establishing reliability, the original English version interview schedule was translated into the local Mao and back translated to English by two independent language experts. BP was measured at the right arm after the respondent was allowed to rest for 5 min using an electronic automated BP apparatus (Omron Hem – 7121). Weight was measured using a calibrated electronic weighing scale (Omron HN – 289). Inter-rater reliability was established for anthropometric measurements and BP before final data collection. Random BP was measured using a calibrated glucometer (Accu-Chek). For data analysis, frequency and percentage distribution were computed for sociodemographic characteristics, prevalence and types of NCDs, risk factors of NCDs and healthcare-seeking behaviour of the adults suffering from NCDs. Non-adjusted and adjusted odds ratio (AOR) and 95% confidence interval (CI) were calculated for predicting the risk factors of NCDs. SPSS Statistics version 17 (2008, SPSC Inc., Chicago, Illinois, USA) software was used for statistical analysis.

Operational definitions: The definitions used for the study were based on the WHO steps survey manual and are briefly described below:

  • Inadequate vigorous activity means <150 min/week and inadequate moderate-intensity activity means <75 min/week
  • Inadequate daily intake of fruits and vegetables is <400 g/day or <5 servings/day
  • Extra salt intake was the salt taken apart from the salt added to the food. Consumption of processed food, i.e., packed and junk food
  • Current drinkers: Respondents who consumed alcohol in the previous 30 days
  • Body mass index (BMI): Categorised into 25.0–29.9 = pre-obese, 30–34.9 = obesity class I, 35.0–39.9 = obesity class II and above 40 obesity class III
  • Waist circumference: Central obesity ≥90 cm (males) and ≥80 cm (females)
  • Raised BP: Elevated: 120–129 mm/Hg, hypertension stage 1: 130–139 mm/Hg and hypertension stage 2 >140/90 mm/Hg
  • Raised RBS: >140 mg/dl.



  Results Top


Data presented in [Table 1] show that 55.5% of the adults in the study were female and 31% of the adults belonged to the age group of 31–40 years. The educational qualification of 34.5% of the adults was at secondary level, 30.5% adults were illiterate and 57.5% of them were engaged in agriculture. Fifty-three per cent of the adult's monthly income was ≤ 10,000. Only 3% of the population had a family history of NCDs.
Table 1: Frequency and percentage distribution of sociodemographic characteristics

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Data from [Figure 1] and [Figure 2] show that 14.5% of the adults were suffering from NCDs, out of which 10.50% of the adults were suffering from diabetes, 3% from cardiovascular diseases and 1% from cancer.
Figure 1: Bar diagram showing the prevalence of non-communicable diseases

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Figure 2: Bar diagram showing the types of non-communicable diseases

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[Figure 3] depicts that 15% of the adults were current smokers, 31% consumed smokeless tobacco, 18.5% have a family member who smokes and 18% were current alcohol users. In the current study, 40.5% of the adults had insufficient physical activity and 38% consumed fruits <4 days/week.
Figure 3: Bar diagram showing the percentage distribution of behavioural risk factors of non-communicable diseases amongst the study population

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The study results also found that no one was consuming high salt-containing food such as chips and pickles in a week. Only 9.5% of the respondents reported that sometimes they took salt-containing food, i.e., less than once in a week. They also reported that they never added extra salt in their diet. [Figure 4] shows that 66.5% of the adults were pre-obese, 29.5% had central obesity, 56.5% were hypertensive and 5% had RBS more than 140 mg/dl.
Figure 4: Bar diagram showing the percentage distribution of clinical risk factors of non-communicable diseases amongst the study population

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[Table 2] depicts that non-AOR with 95% CI of risk factors of NCDs in which having a family history of NCDs was three times more higher odds of suffering from a NCD 3.09 (0.54–17.71), consumption of smokeless tobacco 1.71 (0.76–3.84), consumption of alcohol 2.4 (0.99–5.83), BMI (obesity) 1.35 (0.59–3.11), central obesity 1.73 (0.78–3.82) and raised BP 3.45 (1.34–8.9) times increases the likelihood of developing NCDs. AOR was calculated with quality model binary logistic regression analysis in which only family history of NCDs was significantly associated with the occurrence of NCDs, so we can predict that persons with positive family history of NCDs have 1.23 times more higher odds of suffering from a NCD (0.77–1.693). Other risk factors of NCDs were not statistically significant with the occurrence of NCDs.
Table 2: Prevalence of non-communicable diseases risk factors and odds ratio

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Data presented in [Table 3] show that 61.9% of the persons with NCDs go for regular check-up, 90.5% availed treatment from allopathy, 52.4% did not take medications as prescribed, 71.4% of the hypertensive clients (BP >140/90) amongst the persons with NCDs monitored BP regularly and 47.6% of the diabetic clients monitored blood sugar level and only 34.5% monitored their body weight. 46.1% of the adults did not monitor their BP and blood sugar due to lack of time to go to health centre.
Table 3: Frequency and percentage distribution of healthcare-seeking behaviour of persons with non-communicable diseases

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[Table 4] shows that the reasons for not seeking healthcare amongst the persons with NCDs are no time (37.5%) and 62.5% did not have symptoms at present.
Table 4: Frequency and percentage distribution of reasons for not seeking healthcare amongst the persons with non-communicable diseases (n=8)

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  Discussion Top


We found that amongst the adults in selected village, 10.50% suffered from diabetes mellitus, 3% from cardiovascular diseases and 1% from cancer. The prevalence of diabetes was 10.50%, which was consistent with studies conducted by Rehr et al.[4] where the prevalence of diabetes was 9.2%, Aekplakorn et al.[5] 9.9% and Venkatachalam et al.[7] where the prevalence of diabetes was 8.6%. This study finding shows a comparable prevalence of diabetes mellitus amongst the adults of Northern China.[7] On the contrary, studies reported a higher prevalence of diabetes 20.8% and 16.8%, respectively.[5]

In the present study, the prevalence of cardiovascular disease is 3%. On the contrary, the prevalence of cardiovascular diseases was much higher in studies conducted by Abebe et al.[6] where the prevalence of cardiovascular diseases was 32.2% and Venkatachalam et al.[7] where the prevalence of cardiovascular diseases was 6.8%. Our study was restricted to one village, so findings may not be generalisable.

The present study revealed a high prevalence of hypertension 56% (stage 1 and stage 2) which is an alarming and key risk factor of NCDs and it is much higher than the overall prevalence of hypertension in Manipur (18.16%) reported by Shah and Afzal.[8] The finding is consistent with the prevalence percentage in Maharashtra (56.4%), Delhi (48.2%), Tamil Nadu (39.5%), West Bengal (46.5%) and Madhya Pradesh (52.0%).[9] The higher prevalence of hypertension reported in the present study (56.5%) was comparable to studies conducted in Thailand[5] and Kerala.[10]

The prevalence of current tobacco smokers (15%) and smokeless tobacco users (31%) was below the estimates of GATS for the states, i.e., 20.9% and 47.7%. However, the smokeless tobacco rate (31%) in the village was higher than the national average of 21.4%.[11] Lack of awareness about the harmful effects of tobacco and easy accessibility could be responsible for the higher prevalence of smokeless tobacco use in the present study.

The current alcohol use which we found in the present study (18%) was lower than the national average (32%).[12] On the contrary, the prevalence of alcohol use in men was higher amongst the tribal adults of rural Siliguri in Darjeeling (65%)[13] and even higher amongst the Mishing tribes of Assam (81%).[11] The low prevalence of alcohol consumption in the present study may be because of the sampling technique which was not randomised.

In the current survey, it was found that 38% of the population consumed fruits <4 days per week, which is less than the recommended daily consumption of fruits by the WHO.[14] The low intake of fruits (80%) was also reported in a study conducted by Tushi, et al. amongst the rural tribal population of Mokokchung, Nagaland.[2]

Despite good physical activity level, high prevalence of pre-obesity 66.5% and obesity 29% with 95% CI (33.35–37.45) was reported in the current study. The high prevalence is consistent with a study conducted by Thakur et al. in Haryana in which 35.2% with 95% CI (32. 6–37.7) were overweight and obese.[12] These findings are consistent with the studies conducted by Augustine and Kimbro[13] where 27.12% of the males were obese.

The odds of developing NCDs amongst the adults who consumed tobacco was 1.71 times more than adults who did not consume tobacco (non-AOR: 1.71, 95% CI [0.76–3.84]) in the present study. This is consistent with a study conducted by Chhaya, et al. in which male faculties who consumed tobacco had two times higher odds of developing NCDs (OR = 2.96 and 95% CI: 1.49–5.14).[15]

The research study highlighted a significant association between positive family history and prevalence of NCDs. Binary logistic regression depicted with AOR in the present study revealed that participants with positive family showed higher odds of developing NCDs (AOR = 1.23, 95% CI [0.77–1.693]). This is consistent with a study conducted in sub-Saharan Africa by Ekpenyong et al.[16] in which positive family history showed a statistically significant association with developing NCDs.

The present study revealed that 61.9% of the persons suffering from NCDs sought healthcare. On the contrary, a study conducted in Karnataka by Hegde et al. reported that 91.7% of the elders suffering from NCD sought some form of healthcare. This may be explained that healthcare-seeking behaviour depends on awareness and availability of healthcare facilities.[17]

In the present study, 90.5% of the persons suffering from NCDs availed treatment from allopathy. This finding is consistent with the study conducted by Karinja et al.[18] where the majority of the respondents 86% seek treatment from allopathy. A study conducted by Aboyade et al.[19] in South Africa reported that 30% of the persons with NCDs used traditional herbal medicine. On the contrary, none availed treatment from AYUSH and 9.5% from other local medicine in the present study.

On the basis of the above discussion, it is evident that there is a high prevalence of NCDs and its risk factors amongst the adult population. The prevalence of behavioural risk factors is distributed differently amongst different groups of people depending on their geographical region, culture and food habits. The present study finding also revealed that only family history of NCDs was significantly associated with the occurrence of NCDs which may be due to the sampling technique used, i.e., non-probability purposive sampling technique and small sample size.

This study has limitations too. First, in clinical risk factors, cholesterol, fasting blood sugar and HBA1c levels could not assessed as risk factors as testing facility was not feasible for the investigator.

Second, because of purposive sampling technique, many people with NCDs may be not included in this study.


  Conclusion Top


There was a high prevalence of hypertension which is a risk factor for NCDs amongst the adults. Most of the behavioural and clinical risk factors were observed to be alarmingly high amongst the adults. Despite being physically active, a considerable proportion of respondents were obese and were having central obesity. This study also revealed that only family history of NCDs was significantly associated with the occurrence of NCDs. Hence, screening along with awareness programmes of NCDs is of utmost important.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Non-Communicable Diseases Country Profiles; 2018. Available from: https//www.who.int/en/newsroom/fact-sheets/detail/non-communicable.diseases. [Last accessed on 2019 Oct 11; Last accessed on 2019 Oct 11].  Back to cited text no. 1
    
2.
Tushi A, Rao SR, Pattabi K, Kaur P. Prevalence of risk factors for non-communicable diseases in a rural tribal population of Mokokchung, Nagaland, India. Natl Med J India 2018;31:11-4.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
WHO. STEP Wise Approach to Non-Communicable Disease Risk Factor Surveillance (STEPS); 2018. Available from: https//www.who.int/ncds/surveillance/steps/riskfactor/en. [Last accessed on 2019 Oct 11].  Back to cited text no. 3
    
4.
Rehr M, Shoaib M, Ellithy S, Okour S, Ariti C, Ait-Bouziad I, et al. Prevalence of non-communicable diseases and access to care among non-camp Syrian refugees in northern Jordan. Confl Health 2018;12:33.  Back to cited text no. 4
    
5.
Aekplakorn W, Chariyalertsak S, Kessomboon P, Assanangkornchai S, Taneepanichskul S, Putwatana P. Prevalence of diabetes and relationship with socioeconomic status in the Thai population: National Health Examination Survey, 2004-2014. J Diabetes Res 2018;2018:1654530.  Back to cited text no. 5
    
6.
Abebe SM, Andargie G, Shimeka A, Alemu K, Kebede Y, Wubeshet M, et al. The prevalence of non-communicable diseases in northwest Ethiopia: Survey of Dabat Health and Demographic Surveillance System. BMJ Open 2017;7:e015496.  Back to cited text no. 6
    
7.
Venkatachalam J, Purty AJ, Singh Z, Abraham SB, Narayanan S, Sathya GR, et al. Prevalence of non communicable diseases (NCDs) in a rural population of South India. Int J Contemporary Med 2014;2:55.  Back to cited text no. 7
    
8.
Shah A, Afzal M. Prevalence of diabetes and hypertension and association with various risk factors among different Muslim populations of Manipur, India. J Diabetes Metab Disord 2013;12:52.  Back to cited text no. 8
    
9.
Global Adult Tobacco Survey Face Sheet India, 2017. Fact Sheet; 2017. Available from: http://Who.int/tobacco/surveillance/Surveygats/GATS-India-2016-17. [Last accessed on 2019 Sep 19].  Back to cited text no. 9
    
10.
International Institute of Population Sciences and Macro International. National Family Health; 2007. Available from: https://www.iipsindia.ac.in/. [Last accessed on 2019 Sep 19].  Back to cited text no. 10
    
11.
Misra PJ, Mini GK, Thankappan KR. Risk factor profile for non-communicable diseases among Mishing tribes in Assam, India: Results from a WHO STEPs survey. Indian J Med Res 2014;140:370-8.  Back to cited text no. 11
[PUBMED]  [Full text]  
12.
Thakur JS, Jeet G, Pal A, Singh S, Singh A, Deepti SS, et al. Profile of risk factors for non-communicable diseases in Punjab, Northern India: Results of a State-Wide STEPS Survey. PLoS One 2016;11:e0157705.  Back to cited text no. 12
    
13.
Augustine JM, Kimbro RT. Associations and intervening mechanisms between family structure and young children's obesity. J Fam Issues 2017;38:2277-302.  Back to cited text no. 13
    
14.
Healthy Diet. World Health Organization; 2018. Available from: http://www.who.int. [Last accessed on 2019 Sep 19].  Back to cited text no. 14
    
15.
Chhaya J, Devalia J, Kedia G. Prevalence of risk factors and its association with non-communicable disease among the faculty members of teaching institute of Ahmedabad city, Gujarat: A cross-sectional study. Int J Sci Stud 2015;3:159-62.  Back to cited text no. 15
    
16.
Ekpenyong CE, Udokang NE, Akpan EE, Samson TK. Double burden, non-communicable diseases and risk factors evaluation in sub-Saharan Africa: The Nigerian experience. Eur J Sustain Dev 2012;1:249.  Back to cited text no. 16
    
17.
Hegde SK, Agrawal T, Fathima FN, Amar DS. Factors associated with health seeking behaviour regarding non-communicable diseases among elderly in a rural community in Karnataka (India). Indian J Gerontol 2015;29:22-32.  Back to cited text no. 17
    
18.
Karinja M, Pillai G, Schlienger R, Tanner M, Ogutu B. Care-seeking dynamics among patients with diabetes mellitus and hypertension in selected rural settings in Kenya. Int J Environ Res Public Health 2019;16:2016.  Back to cited text no. 18
    
19.
Aboyade OM, Beauclair R, Mbamalu ON, Puoane TR, Hughes GD. Health-seeking behaviours of older black women living with non-communicable diseases in an urban township in South Africa. BMC Complement Altern Med 2016;16:410.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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