|Year : 2014 | Volume
| Issue : 1 | Page : 34-37
A cross-sectional study to analyze the need of providing services related to noncommunicable diseases under an Urban Health Center of Surat Municipal Corporation
Mamtarani Verma1, Abhay Kavishvar1, Balusamy Divakar2, Chirag Agarwal3, Gaurav Bagmar3
1 Department of Community Medicine, Government Medical College, Surat, Gujarat, India
2 Department of Pharmacology, P.D.U Medical College, Rajkot, Gujarat, India
3 Ex-Intern, Government Medical College, Surat, Gujarat, India
|Date of Web Publication||24-Jun-2014|
Dr. Mamtarani Verma
B-13 Assistant Professor Quarters, New Civil Hospital Campus, Outside Majura Gate, Surat - 395 001, Gujarat
Source of Support: None, Conflict of Interest: None
Background: As compared with all other countries India suffers the highest lost in potentially productive years of life, due to deaths from cardiovascular disease in people aged 35-64 years (9.2 million years lost in 2000). Low- and middle-income countries and by any measure, noncommunicable diseases (NCDs) account for a large enough share of the disease burden of the poor to merit a serious policy response. Objectives: (1) To identify the prevalent cases reporting NCD's under urban health center area (UHC). (2) To suggest the need of a few anti-hypertensive and anti-diabetic drugs with facilities of an electrocardiogram machine and counseling for life style modifications. Study Design: Cross-sectional study. Materials and Methods: A few residential societies having around 1000 population were arbitrarily selected from Udhna Center functioning under Surat Municipal Corporation. A house to house survey was conducted by a team of two medical students to materials collect information related to the occurrence of NCDs and other relevant information. Data were analyzed using Epi 6 software. Results: A total of 195 families having a population of 1028 were visited. Mean age of the population was 29.3 ± 17.64 years. 547 (53.3%) persons were males while 480 (46.7%) of the studied population were females. A good number of persons (46) reported having one of the chronic illnesses such as diabetes mellitus, hypertension (HT), ischemic heart disease (IHD), and cancer. The proportion of individuals suffering from such kind of illnesses was 8.6% in the adult population over the age of 30 years. Conclusion: In light of rising NCDs, UHCs are required to provide treatment for the cases of HT, diabetes and IHD as part of primary health care.
Keywords: Noncommunicable diseases, Urban health centers, Prevalence
|How to cite this article:|
Verma M, Kavishvar A, Divakar B, Agarwal C, Bagmar G. A cross-sectional study to analyze the need of providing services related to noncommunicable diseases under an Urban Health Center of Surat Municipal Corporation. J Med Soc 2014;28:34-7
|How to cite this URL:|
Verma M, Kavishvar A, Divakar B, Agarwal C, Bagmar G. A cross-sectional study to analyze the need of providing services related to noncommunicable diseases under an Urban Health Center of Surat Municipal Corporation. J Med Soc [serial online] 2014 [cited 2020 Oct 20];28:34-7. Available from: https://www.jmedsoc.org/text.asp?2014/28/1/34/135225
| Introduction|| |
As compared with all other countries India suffers the highest lost in potentially productive years of life, due to deaths from cardiovascular disease (CVD) in people aged 35-64 years (9.2 million years lost in 2000). By 2030, this loss is expected to rise to 17.9 million years, 9.4 times greater than the corresponding loss in the USA. 
Health transition is characterized by a demographic transition in the age profile and an epidemiologic transition marked by the shift in the cause of death profile with the increasing dominance of noncommunicable diseases (NCDs). , India too illustrates the phenomenon of "health transition," which positions NCDs as a major public health challenge of growing magnitude in the 21 st century. In 1990, India accounted for 19% of all deaths, 16% of all NCD deaths and 17% of all CVDs deaths in the world.  In India, alone CVDs accounted for around 2.4 million deaths, in contrast to 3.2 million deaths in all industrialized countries put together.  Technical report series 853, projections indicate that by the year 2020, there will be 470 million people aged 65 and above in developing countries, more than double the number in developed countries.  The incidence of CVDs is greater in urban areas than in rural areas, reflecting the acquisition of several risk factors such as tobacco consumption, lack of physical activity, unhealthy diet, and obesity.  Community health centers in India are providing following services: Care of routine and emergency cases in surgery and medicine, 24-h delivery services, routine and emergency obstetric and pediatric care, besides following services related to National Health Programs such as Revised National Tuberculosis Control Program, HIV/AIDS Control Program, National Vector-Borne Disease Control Program, National Leprosy Control Program, and National Program for the Control of Blindness. These all program services are aimed to diagnose and treat CDs. 
According to Alman Ala in a report on "action plan for the global strategy for the prevention and control of CDs 2008-2013."  NCD prevention and control programs remain dramatically under-funded at the national and global levels and have been left off the global development agenda. Despite impacting the poorest people in low-income parts of the world and imposing a heavy burden on socioeconomic development, NCD prevention is currently absent from the Millennium Development Goals. However, in all low- and middle-income countries and by any measure, NCDs account for a large enough share of the disease burden of the poor to merit a serious policy response. 
Further Jamison et al. have mentioned in his study that in addition to attending to the "unfinished agenda" of communicable, maternal and child health disorders, commensurate research and action in the field of NCDs are also warranted. 
The aim of this study was to find out how many individuals are suffering from NCDs such as hypertension (HT), diabetes mellitus (DM) in a population of around 1000 under one Urban Health Center (UHC) of Surat Municipal Corporation (SMC) when enquired by house to house visit and what are the different types of health services available to such patients from a well-operating municipal UHC in periods of relatively low occurrence of infectious diseases? As there are lesser number of such studies, which highlights the area utilizing UHC run by SMC for primary health care are published.
| Materials and Methods|| |
A cross-sectional survey was carried out among few residential societies having a population around 1000 people. It was purposively selected from Udhna UHC functioning under SMC. It was a middle class locality having well-built households with basic amenities like safe drinking water supply and sewerage system from an area of UHC. These households were equipped with facilities such as LPG, refrigerator, at least two-wheeler vehicle, television, and telecommunication (observations only, no data). The study was conducted during February 2008. A house to house survey was carried out by a team of two medical students to identify persons reporting NCDs by asking them a few questions in addition to basic family details. The information was collected by using interview technique with the help of a pretested semi-structured questionnaire.
- Is there anybody having (chronic or NCDs like) HT, DM, heart disease or cancer?
- Is there anybody having (CDs like) malaria, tuberculosis (TB), diarrhea like that?
Study is intended to identify known cases of HT, DM and other NCD's as a part of need assessment. Number of patients declared in this study would be definitely a gross underestimate for all such conditions. Instead of specific case definitions for disease, only names were asked to people to identify the number of cases. Thus, these methods yield a few known cases and perhaps miss many. Nonetheless, the number derived will reflect the need to provide medical services related to NCDs which in fact doesn't exist.
Study was designed as a cross-sectional study.
Inclusion and Exclusion Criteria
It was a house-to-house survey covering each and every individual.
Cases Definitions for Diabetes Mellitus, Hypertension and Other Noncommunicable Diseases
The diseases have been recorded as they have been presented by people (no strict case definitions were required).
This is a kind of study assessing the need for planners and administrators. No ethical issues would be important. This is a kind of exploration. All these conditions are not known to carry any social stigma for any individual/community in general.
In accordance with the objectives, to suggest the magnitude of problems (proportions/percent) have been calculated for different variables. Finally, the data were entered and analyzed using Epi 6 software (January 2001, developed by Centre For Disease Control and WHO).
| Results|| |
A total of 195 families having a population of 1028 were visited. Age range of the population was 15-73 years and median age was 29 years. 547 (53.3%) persons were males while 480 (46.7%) of the studied population were females. Of the population 92.9% people were literate while 7.1% were illiterate. The proportion of people having primary (1-7 th standard), secondary (8-10 th standard), higher secondary and graduation or above education was 27%, 32%, 13.7%, and 20.2%, respectively. A good number of persons (46) reported having one of the chronic illnesses such as DM, HT, ischemic heart disease (IHD), and cancer. The proportion of individuals suffering from such kind of illnesses was 10.3% in the adult population over the age of 30 years. The proportion of DM was 4.9%, HT was 4.3%, and IHD was <1%. Eighty percent of this group had their youngest child <15 years. The area under UHC has a substantial number of individuals likely to have chronic diseases. These people have good literacy level and stay as nuclear families. NCD is a problem among families in which the children are too young and can be considered dependents (dependent:independent = 1:2). Cases having NCDs are referred to Municipal Medical College or Government Medical College, but are not entertained in UHC.
| Discussion|| |
The prevalence of NCDs is showing an upward trend in the most countries and India is not an exception.  According to Kishore estimated cases of HT in India are 100 million with prevalence of 2.3-15.4%. Prevalence of DM is 2.1 (1972)-12.1 (2001). CVDs will be the leading cause of DALYs in 2020.  Prevalence of HT in a well-planned study, which screened all persons aged 20-60 years and suggested World Health Organization criterion for diagnosis at Rohtak (taken to represent urban population) was 59.9 and 69.9 per 1000 in males and females, respectively.  In a study done by Undhad et al. in an urban area of Surat the prevalence of HT was 69.5%.  Our study shows the prevalence of HT of 4.3% which falls in range suggested by Kishore but <6.49% found in a study in Rohtak. Our study shows the prevalence of DM of 4.9%, which is also in the range suggested by Kishore. In the study by Undhad et al. the prevalence of HT is 69%, which is quite high as compared to our and other study findings because the study population was bank employees, which is totally different studied population group. Almost all diseases/conditions identified, and more particularly the National Health Programs in which government investment was substantial, namely, malaria and other vector-borne diseases, TB, leprosy, reproductive health and childhood conditions, there is a paucity of high-quality epidemiological information and validated data for arriving at any baseline estimations on prevalence or incidence. A literature review threw up evidence of a large number of diseases, which were considered to be lifestyle related and affecting the rich were seen to be affecting the poor as well and increasingly so. The nonavailability of good quality data has been a major handicap in arriving at reliable estimations of the disease burden, affecting our ability to formulate appropriate policies and provide adequate budgets.  Hence, we tried to provide some baseline data on the prevalence of NCDs in our study population.
In light of rising NCDs, UHCs are required to provide treatment for the cases of HT, diabetes and IHD as part of primary health care. It has been believed and observed that patients of NCDs who can be effectively treated/managed at UHC or any such primary health care setting usually overload tertiary health care settings thus to control the burden of simple cases on tertiary health care centers including medical college it is prudent that these cases shall be managed at peripheral centers.
This center (UHC) should be equipped with an electrocardiogram (ECG) machine, and trained staff for dietary counseling and lifestyle modifications and treatment for DM, HT and IHD.
Unlike CDs, which have multiple individual control programs, NCDs have to be addressed under a common program as most of the interventions are overlapping thus making a focused, integrated, well-resourced campaign of prevention, early detection and treatment, a very plausible success. Differences in CDs and NCDs have to be kept in mind. NCDs are having gradual onset, multiple etiology, long natural history, prolonged treatment and follow-up, a multidisciplinary care approach, which affects the quality of life.
In our study, we found that most of the services available at the UHC give importance to treatment of CDs. The general outpatient department is of approximately 75 patients/day and for 6 h a day/six days a week. There is one in-charge medical office of UHC, one pediatrician as a visiting consultant daily 1 h/day, one lab technician for testing of Sputum acid-fast bacilli and project surveillance and maintenance plan, one HIV/AIDS counselor. Leprosy clinic and DOTS center run at UHC 6 h a day for 6 days a week. Most of the services available there give importance to treatment of CDs. Services pertaining to NCDs are insufficient both in terms of checkup by a physician and available medicines. For CVS problems out of anti-hypertensive drugs only atenolol tablets are available, isosorbitrate and ECG machine is not available. Anti-diabetic drugs and insulin are not available. Urine albumin/sugar testing facility is there but is infrequently used. Moreover, there is no physician to provide such services. These diseases need daily medicines and such medicines might be required life-long. These medicines are not cheaper. For instance, special investigations for CVD such as coronary angiogram, nuclear imaging, computerized axial tomography scan, magnetic resonance imaging and even basic investigations such as ECG, X-ray, echocardiography facilities are less available in the most part of the country and are not affordable by the majority patients even if available at all. After diagnosis, subsequent treatments for CVD patients are also very expensive. For example, the average cost of treatment for an acute episode of heart disease is approximately $250/year, equivalent to nearly the annual income of families in India below the poverty.  More than 40% of Indians who are hospitalized either borrow heavily or forced to sell their assets to cover medical expenses.  It has been seen that hospitalized patients in India spend an average 58% of their total annual expenditures for the care.  Hence, if we see from the perspective of macroeconomics and health  our study population will also need medication, investigation, and some special procedures.
There is a need of providing training to care providers for NCDs as they are more trained for the control of CDs. Even majority of patients having NCDs have to go to private for treatment due to lack of services at community health centers. The existing personnel in primary health care service (physicians, nurses, and paramedics) need to be retrained to equip them with the knowledge and skills required for delivering the essential elements of chronic care.  UHC's should have a board showing that services related to NCDs are available here. This communication is intended as a need assessment exercise. Well-recognized recommendations although vague, can be applied in the initial phase.
Limitations of the Study
- There is no specific study or secondary data available on the incidence of NCDs with these UHCs.
- Respondents were not able to recollect information regarding previous episodes of CD illness.
| Conclusions|| |
Health care delivery system in UHC, we studied is incompatible to respond to CVD treatment at present. Urgent upgrading of the infrastructure regarding the following is required:
- Training of health care personnel to provide preventive and surveillance activities.
- Community awareness programs regarding CVD risk behavior and lifestyle factors.
- Provision of laboratory facilities and basic cardiovascular drugs at the UHC level.
To deal with all these actions aptly, it is necessary to integrate CVD health care adequately in national programs along with a strong commitment and determination from the government.
Recognizing our existing knowledge and public health potentials, today's need is to decrease exposure to major risks from an unhealthy diet, physical inactivity and the resultant preventable morbidity. Gujarat State has a sound health infrastructure. Early detection and prompt treatment (secondary prevention), facilities to take care off the effect of NCDs can be provided in an urban area.
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