Non-communicable Diseases In India Research Articles

Burden of non-communicable diseases in India: Findings from the ICMR-INDIAB study

Burden of non-communicable diseases in India: Findings from the ICMR-INDIAB study

Self-care practices and influencing factors among type 2 diabetes mellitus patients: A hospital-based cross-sectional study

BackgroundDiabetes mellitus (DM) is a widespread non-communicable disease in India that significantly affects the healthcare system owing to its acute and chronic complications. The traditional approach to diabetes care has focused on medical professionals, but recent research has indicated that self-care among patients is crucial. Effective self-care practices can enhance the quality of life of T2DM patients. This study aimed to evaluate self-care practices among T2DM patients at a sub-district hospital in Gujarat State, India. MethodsThis cross-sectional study included 93 T2DM patients. Self-care activities were assessed using the Summary of Diabetes Self-Care Activities (SDSCA) scale. Descriptive statistics and comparative analyses were performed. ResultsThe majority of the participants were male (55.9 %) and over 60 years of age (67.7 %). Participants demonstrated high adherence to medication regimens (mean score = 6.66 ± 0.86). However, adherence to other self-care practices was significantly lower; only 11.8 % reported good dietary behavior, 55.91 % engaged in regular exercise, and 50.5 % performed regular foot care. While 83.8 % reported good monitoring behavior, this contradicts the low adherence to blood glucose testing (mean score = 0.38 ± 0.59). Participants aged <60 years tended to report slightly better adherence to blood glucose testing than those aged ≥60 years. ConclusionThis study revealed a gap in self-care practices among T2DM patients in Gujarat. Despite good medication adherence, the patients demonstrated poor adherence to diet, exercise, and foot care. These findings emphasize the importance of customized interventions to improve self-management education and support, particularly for older adults.

Beyond Numbers: Decoding the Gendered Tapestry of Non-Communicable Diseases in India.

Non-communicable diseases (NCDs) represent a major global health challenge, particularly in low- and middle-income countries like India, with significant gender disparities in mortality and disease burden. This study aims to investigate these disparities, using data from national health surveys, to inform gender-specific public health strategies and align with global health goals. The study uses data from the Longitudinal Aging Study in India (LASI) and National Family Health Surveys (NFHS-4 and NFHS-5). The results from the Longitudinal Ageing Study in India (LASI) and National Family Health Surveys (NFHS-4 and NFHS-5) indicate significant demographic and health-related variations among 65,562 participants. Key findings show gender disparities in lifestyle habits such as alcohol and tobacco use, and differences in health outcomes across age, education, and socioeconomic status. Notably, an increase in NCD prevalence, particularly hypertension and diabetes, was observed from NFHS-4 to NFHS-5, highlighting evolving health challenges in India. The study emphasizes the importance of gender in the prevalence and management of non-communicable diseases (NCDs) in India, advocating for public health strategies that address gender differences, socio-economic factors, and urban-rural disparities to achieve health equity.

Switching pattern of healthcare services and its determinants among patients with communicable and non-communicable diseases in India

BackgroundThe current study investigates the switching behaviour and patterns among patients in India, particularly in the context of various ailments such as Non-Communicable Diseases (NCDs), Communicable Diseases (CDs), and other health issues. To evaluate people's behaviour towards accessing healthcare facilities in public and private healthcare providers separately for CDs, NCDs, and other ailments. Material and methodsThe study design is observational and cross-sectional. The study included data from NSS 71st, NSS 75th, and LASI wave-1 datasets, which provide information on the incidence of switching behaviour among patients with different types of ailments. Statistical analysis usedThe Binary logistic regression analysis has been used to examine the determinants of switching behaviour in usage of healthcare facilities. Prevalence estimates were exhibited using weighted % and 95 % confidence intervals (CI). P values < 0.05 were considered statistically significant. ResultsPresent study revealed that patients' behaviour in accessing healthcare facilities is influenced by a multitude of factors, including the nature of their ailment, socio-economic status, education, and regional disparities. Notably, patients suffering from NCDs exhibit a higher propensity for switching between public and private healthcare services, with a preference for the latter. The study found that among patients who were paying for special types of wards, there were significantly lower odds of switching behaviour. ConclusionsThe research highlights the nuanced dynamics of healthcare service utilization in India and underscores the need for tailored strategies to address the specific challenges posed by NCDs and communicable diseases while ensuring equitable and accessible healthcare services for all.

The burden of non-communicable diseases in India: Why the intersectionality lens matters?

In India, structures such as caste, class and gender have been shaped by socio-historical forces such as colonialism, development, capitalism and patriarchy. Many of the forces are still at play. The intersection of such structural bases happens in a complex manner in a dynamic socio-historical environment resulting in differential power and privileges for individuals and social groups in Indian society. NCDs are chronic and social determinism shapes the lifestyle choices (e.g. diet and physical activity) that people make. Intersectional experiences result in distinct life chances, shaping exposure to risk factors (both behavioural and environmental), care seeking behaviour, and health outcomes. It is, therefore, imperative to go beyond the individual in the discourse on NCDs. It is equally necessary to understand the complexity of the dynamic and intersecting nature of inequities playing out in socio-historical contexts that shape intersectional experiences of uneven exposure to risk factors, care seeking behaviour and resultant health outcomes for social groups and population subgroups in India. The epidemiological capture of the public health discourse on NCDs in India is reflected in the research and policy articulation of it. This can be limiting, both in terms of understanding NCDs, and responding to it in policies and programmes to secure population health. The appreciation of the importance of the intersectionality lens, and its adoption in research and policy formulation on NCDs in India, will be crucial in lessening their burden and promoting the health of its people. Using the lens in the design, implementation and evaluation of programmes on NCDs can advance equity in India.

Polypharmacy, Drug Interaction, and Their Consequences in Terms of Adverse Drug Reaction among Adults Receiving Cancer Chemotherapy in a Tertiary Care Hospital in Central India

Abstract Background: Noncommunicable diseases in India are calculated to account for 63% of total mortality, and cancer is one of the principle causes up to 9% of total deaths. Objective: The objective of the study was t collect and analyze data about drugs taken by patients, which were prescribed by the doctor to combat side effects and to determine the extent of polypharmacy in patients on cancer chemotherapy Materials and Methods: A cross-sectional study in a Tertiary Care Hospital of Central India in the adult population by giving questionnaire forms to assess polypharmacy usage. Necessary statistical tests were applied. Results: A total of 40 indoor patients receiving cancer chemotherapy were included in the study. Many potential interactions between two chemotherapeutic drugs and chemotherapeutic and adjuvant drugs were studied. Positive adverse drug reactions encountered by patients had a strong correlation with these interactions. Conclusion: Drug interactions during chemotherapy are a common occurrence. The judicious use of cancer chemotherapeutic medicines and their combination with adjuvants are required to decrease the incidence of adverse drug reactions and increase the efficacy of chemotherapy.

From burden to hope: Noncommunicable diseases in India and the prospects of the gut microbiome

From burden to hope: Noncommunicable diseases in India and the prospects of the gut microbiome

A qualitative assessment of multi-sectoral action for non-communicable diseases (NCDs) in Uttar Pradesh, India

IntroductionNon-communicable diseases (NCDs) on the rise globally, especially affecting vulnerable populations in low- and middle-income countries. To tackle this, urgent and comprehensive actions are needed. The main preventable risk factors for NCDs are tobacco and alcohol use, unhealthy diet, physical inactivity, and air pollution, rooted in social determinants of health (SDOH). In India, some states are adopting a multi-sectoral approach (MSA) to manage NCDs. A qualitative assessment was conducted to evaluate MSA implementation in Uttar Pradesh, India.MethodsInductive approach i.e., grounded theory was used to understand the perceptions regarding MSA. Key-Informant Interviews (KIIs) of senior level officers from both non-health and health sectors were conducted using an interview guide. We targeted all 17 priority sectors as identified in National Multi-sectoral Action plan (NMAP) for prevention and control of NCDs in India. Data could be collected from officials of 14 sectors. Data thus collected was transcribed, translated and coded for identifying themes.ResultsThe non-health sectors expressed readiness to act but don’t have guidelines. They explained the risk factors such as behaviours; nutrition and physical inactivity associated with NCDs and also appreciated the role of MSA in prevention and control of NCD. The attitude and perception of health sector towards implementation of MSA was less promising. Their perspective was based upon the existing vertical structures, response and support they have experienced before from other sectors and from the administration. Non-health sectors uniformly emphasised that health should lead MSA as health sector has scientific knowledge and experience in operationalizing health programs.ConclusionThere is a need to have a common action platform for NCD prevention and control to bridge the gap between health and non-health sectors. A dedicated, parallel structure is essential to translate policy into practice effectively.

Distress financing associated with out-of-pocket expenditure for non-communicable diseases in India

ABSTRACT Objective The objective of this study is to assess the coping mechanisms used by the households who incur out-of-pocket expenditure (OOPE) due to Non-communicable Diseases (NCDs). Also, it seeks to examine the underlying factors responsible for various coping strategy. Data and Methods Data from the 75th round of the National Sample Survey Office (NSSO) has been used for the study. Descriptive statistics, concentration index (CI), and multinomial logistic regression have been employed to do the analysis. Results Households having cancer patients have a higher rate (46.80%) of distress financing, followed by cardiovascular diseases (27.43%), chronic respiratory diseases (26.91%), and diabetes (24.77%). The result of multinomial logistic regression shows that households belonging to the other caste categories, availing healthcare at private health centre, lower economic status, lack of insurance coverage, and households with casual labour are more likely to depend upon distress financing for NCDs hospitalisation. Conclusion The issue of financing inpatient care for NCDs, specifically cancer and cardiovascular diseases, is a significant concern in India. Therefore, an increase in public expenditure and investment in public health facilities is essential to increase health seeking behaviour of people by reducing OOPE, particularly among the poor and marginalised groups.

Education and non-communicable diseases in India: an exploration of gendered heterogeneous relationships.

While the association between education and non-communicable diseases (NCDs) is well established, it remains unclear whether this association varies by gender. The aim of this study was to examine two critical research questions: whether the association of education and NCDs is conditioned by gender and, if so, what are the factors contributing to this? Data from the Longitudinal Aging Study in India Wave 1 (2017-2018) was used for the empirical analysis. The study employs bivariate, binary logistic regression and Oaxaca decomposition analyses. The results reveal that the net likelihood of having at least one chronic NCD increases with an increase in education level for men (<5y of schooling: odds ratio [OR] 1.18 [95% confidence interval {CI} 1.09 to 1.28]; ≥10y of schooling: OR 1.43 [95% CI 1.33 to 1.53]). However, for women, the result showed a contrasting pattern. The decomposition analysis revealed that the distinctive roles of marital status and working status in the diagnosis of morbidity for men and women are the key factors behind the gendered heterogeneous relationship of education and NCDs in India. The study found that it is important to acknowledge the potential impact of self-reporting bias in morbidity data while examining the relationship between education and NCDs.

Cost of Care for Non-communicable Diseases: Which Types of Healthcare Providers are the Most Economical in India's Chhattisgarh State?

Non-communicable diseases (NCDs) affect a large number of people globally and their burden has been growing. Healthcare for NCDs often involves high out-of-pocket expenditure and rising costs of providing services. Financing and providing care for NCDs have become a major challenge for health systems. Despite the high burden of NCDs in India, there is little information available on the costs involved in NCD care. The study was aimed at finding out the average monthly cost of outpatient care per NCD patient. The average cost was defined as all resources spent directly by government and citizens to get a month of care for a NCD patient. The cost borne by the government on public facilities was taken into account and activity-based costing was used to apportion it to the function of providing outpatient NCD care. For robustness, time-driven activity-based costing and sensitivity analyses were also performed. The study was conducted in Chhattisgarh State and involved a household survey and a facility survey, conducted simultaneously at the end of 2022. The surveys had a sample representative of the state, covering 3500 individuals above age of 30 years and 108 health facilities. The average monthly cost per NCD patient was Indian Rupees (INR) 688 for public providers, INR 1389 for formal for-profit providers and INR 408 for informal private providers and they managed 53.5, 34.3 and 12.0% of NCD patients respectively. The disease profile of patients handled by different types of providers was similar. The average cost per patient was lowest for the primary care facilities in the public sector. The average direct cost of NCD care for government and citizens put together was substantially higher in case of formal for-profit providers compared with public facilities, even after taking into account the government subsidies to public sector. This has implications for allocative efficiency and the desired public-private provider mix in health systems.

Development of a Blended Physiotherapeutic Module for Young Adults with Non-Specific Chronic Low Back Pain: A Feasibility Study

Introduction: Non-Specific Chronic Low Back Pain (NSCLBP) is a prevalent non-communicable disease in India, burdening individuals psychologically and socially. Due to economic constraints, people prefer self-management rather than seeking professional advice. Therefore, their go-to search strategy for self-management is social media platforms. Many researchers have identified a lack of evidence in these social media videos. Aim: To develop and evaluate the feasibility of a blended physiotherapeutic module for young adults with NSCLBP. Materials and Methods: This feasibility study was conducted at Nitte Institute of Physiotherapy, NITTE (Deemed to be University), Deralakatte, Mangaluru, Karnataka, India from July 2023 to December 2023. This study involved three phases: identifying modifiable risk factors for exercise adherence in individuals with NSCLBP, developing a module, and evaluating its feasibility. Twenty-four young individuals with low back pain were given the blended physiotherapeutic module for four weeks, consisting of three sessions per week. The first two sessions were conducted online, and the following session was face-to-face. The data were analysed using SPSS software (SPSS Inc.; Chicago, IL) version 29.0.10. The collected data were summarised using Descriptive Statistics: frequency, percentage; mean, and Standard Deviation (SD). To compare the Quebec Back Pain Disability Scale (QBPDS) and Numerical Pain Rating Scale (NPRS) scores, repeated measures ANOVA was employed. The Bonferroni test was utilised for pairwise comparisons of QBPDS and NPRS scores. A p-value &lt;0.05 was considered significant. Results: In this study, the average percentage of individuals who performed exercises for four weeks was 22 (91.7%), indicating high adherence. There was a significant difference (p-value &lt; 0.05) in the QBPDS as well as the NPRS from baseline to weeks -2, 3, and 4. Conclusion: The developed blended physiotherapeutic module for NSCLBP individuals was found to be feasible. Positive results were identified in reducing pain and disability after two weeks. This study aids individuals struggling with physiotherapy exercises in a digitalised society, suggesting that future research could incorporate real-time movement analysis and regional language databases and software that should be validated.

Tackling non-communicable diseases in India: The role of health literacy

Tackling non-communicable diseases in India: The role of health literacy

Empowering Health Literacy: A Comprehensive Approach to Addressing Non-Communicable Diseases in India

Empowering Health Literacy: A Comprehensive Approach to Addressing Non-Communicable Diseases in India

Estimating the potential impact of a health tax on the demand for unhealthy food and beverages and on tax revenue in India.

Foods high in fat, sugar or salt are important contributors to the rising burden of non-communicable diseases globally and in India. Health taxes (HTs) have been used by over 70 countries as an effective tool for reducing consumption of sugar sweetened beverages (SSBs). However, the potential impacts of HTs on consumption and on revenues have not been estimated in India. This paper aims to estimate the potential impact of health taxes on the demand for sugar, SSBs and foods high in fat, sugar or salt (HFSS) in India while exploring its impact on tax revenues. PE of sugar was estimated using Private Final Consumption Expenditure and Consumer Price Index data while price elasticities for SSBs and HFSS were obtained from literature. The reduction in demand was estimated for an additional 10-30% HT added to the current goods and services tax, for varying levels of price elasticities. The results show that for manufacturers of sweets and confectionaries who buy sugar in bulk and assuming a higher price elasticity of -0.70, 20% additional HT (total tax 48%) would result in 13-18% decrease in the demand for sugar used for confectionaries and sweets. For SSBs, HT of 10-30% would result in 7-30% decline in the demand of SSBs. For HFSS food products, 10-30% HT would result in 5-24% decline in the demand for HFSS products. These additional taxes would increase tax revenues for the government by 12-200% across different scenarios. Taxing unhealthy foods is likely to reduce demand, while increasing government revenues for reinvestment back into public health programmes and policies that may reduce obesity and the incidence of non-communicable diseases in India.

Non-communicable Diseases in India: The Growing Public Health Challenge and the Role of Health Insurance

Objective: The purpose of this study is to investigate the connection between non-communicable diseases (NCDs) and out-of-pocket (OOP) medical expenses in India. Methods: The study utilized information from the National Sample Survey (NSS) conducted in 2018 to examine the prevalence of NCDs and their relationship with OOP health expenditures. Results: There is a significant association between NCDs and higher OOP health spending in India. For individuals with NCDs, the average health expense per hospitalization episode was INR 19,420, with 89.3% covered by OOP payments and only 10.7% supported by health insurance. Additionally, the prevalence of NCDs varied by state, with Uttar Pradesh, Maharashtra, Bihar, West Bengal, and Madhya Pradesh experiencing the highest burden of NCDs. Conclusions: The study underscores the urgent need for a comprehensive and multi-sectoral strategy to address the growing burden of NCDs in India. This strategy should encompass NCD prevention, early identification, and management. Policy initiatives should focus on reducing the financial strain of NCDs on Indian households, potentially through increased public health spending, enhanced insurance coverage, and specialized programs targeting NCD prevention and management.

Behavioral Activation for Comorbid Depression in People With Noncommunicable Disease in India: Protocol for a Randomized Controlled Feasibility Trial.

The increasing burden of depression and noncommunicable disease (NCD) is a global challenge, especially in low- and middle-income countries, considering the resource constraints and lack of trained human resources in these settings. Effective treatment of depression in people with NCDs has the potential to enhance both the mental and physical well-being of this population. It will also result in the effective use of the available health care resources. Brief psychological therapies, such as behavioral activation (BA), are effective for the treatment of depression. BA has not been adapted in the community health care services of India, and the feasibility of using BA as an intervention for depression in NCD and its effectiveness in these settings have not been systematically evaluated. Our objective is to adapt BA for the Indian NCD context and test the acceptability, feasibility, and implementation of the adapted BA intervention (BEACON intervention package [BIP]). Additionally, we aim to test the feasibility of a randomized controlled trial evaluation of BIP for the treatment of depression compared with enhanced usual care. Following well-established frameworks for intervention adaptation, we first adapted BA (to fit the linguistic, cultural, and resource context) for delivery in India. The intervention was also adapted for potential remote delivery by telephone. In a randomized controlled trial, we will be testing the acceptability, feasibility, and implementation of the adapted BA intervention (BIP). We shall also test if a randomized controlled feasibility trial can be delivered effectively and estimate important parameters (eg, recruitment and retention rates and completeness of follow-up) needed to design a future definitive trial. Following the receipt of approval from all the relevant agencies, the development of the BIP was started on November 28, 2020, and completed on August 18, 2021, and the quantitative data collection was started on August 23, 2021, and completed on December 10, 2021. Process evaluation (qualitative data) collection is ongoing. Both the qualitative and quantitative data analyses are ongoing. This study may offer insights that could help in closing the gap in the treatment of common mental illness, particularly in nations with limited resources, infrastructure, and systems such as India. To close this gap, BEACON tries to provide BA for depression in NCDs through qualified NCD (BA) counselors integrated within the state-run NCD clinics. The results of this study may aid in understanding whether BA as an intervention is acceptable for the population and how feasible it will be to deliver such interventions for depression in NCD in South Asian countries such as India. The BIP may also be used in the future by Indian community clinics as a brief intervention program. Clinical Trials Registry of India CTRI/2020/05/025048; https://tinyurl.com/mpt33jv5. DERR1-10.2196/41127.

Treatment-seeking behaviour among 15–49-year-olds with self-reported heart disease, cancer, chronic respiratory disease, and diabetes: a national cross-sectional study in India

BackgroundEighty per cent of India´s non-communicable disease (NCD) mortality is due to four conditions: heart disease, cancer, chronic respiratory disease, and diabetes, which are primarily cause-amenable through treatment. Based on Andersen’s behavioural model of health services use, the current study aimed to identify the predisposing, enabling, and need factors associated with treatment-seeking status among people self-reporting the four main NCDs in India.MethodsCross-sectional study using secondary data. Usual residents aged 15–49 who self-reported cancer (n = 1 056), chronic respiratory disease (n = 10 534), diabetes (n = 13 501), and/or heart disease (n = 5 861) during the fifth National Family and Health Survey (NFHS-5), 2019–21, were included. Treatment-seeking status was modelled separately for each disease using survey-adjusted multivariable logistic regression.Results3.9% of India´s 15–49-year-old population self-reported ≥ 1 of the four main NCDs (0.1% cancer, 1.4% chronic respiratory disease, 2% diabetes, 0.8% heart disease). The percentage that had sought treatment for their condition(s) was 82%, 68%, 76%, and 74%, respectively. Greater age and having ≥ 1 of the NCDs were associated with greater odds of seeking disease-specific treatment. People in the middle or lower wealth quintiles had lower odds of seeking care than the wealthiest 20% for all conditions. Women with diabetes or chronic respiratory disease had greater odds of seeking disease-specific treatment than men. Muslims, the unmarried, and those with health insurance had greater odds of seeking cancer treatment than Hindus, the married, and the uninsured.ConclusionPredisposing, enabling, and need factors are associated with treatment-seeking status among people reporting the four major NCDs in India, suggesting that multiple processes inform the decision to seek disease-specific care among aware cases. Successfully encouraging and enabling as many people as possible who knowingly live with major NCDs to seek treatment is likely contingent on a multi-pronged approach to healthcare policy-making. The need to improve treatment uptake through accessible healthcare is further underscored by the fact that one-fifth (cancer) to one-third (chronic respiratory disease) of 15–49-year-olds reporting a major NCD have never sought treatment despite being aware of their condition.

Factors influencing adherence to non-communicable disease medication in India: secondary analysis of cross-sectional data from WHO - SAGE2.

Background: Non-communicable diseases (NCDs) are a leading cause of death globally and disproportionately affect those in low- and middle-income countries lower-middle-income countries. Poor medication adherence among patients with NCDs is prevalent in India due to lack of initiation, missed dosing or cessation of treatment, and represents a growing healthcare and financial burden. Objective: This study aimed to identify factors influencing medication adherence in adults with NCDs in India. Methods: We performed a cross-sectional study, conducting secondary data analysis on the second wave of the World Health Organisation's 'Study on global AGEing and adult health (SAGE)', a survey that collected data from predominantly older adults across India. Bivariate analysis and multivariate logistic regression modelling were conducted to specifically interrogate the reasons for lack of initiation and cessation of treatment. Reporting of this study was informed by the STROBE guidelines. Results: The average medication adherence rate was 51% across 2,840 patients with one or more NCDs, reflecting non-initiation and lack of persistence of treatment. The strongest factor significantly predicting non-adherence to medication across these components was multimorbidity (odds ratio 0.47, 95% CI 0.40-0.56). Tobacco use (OR = 0.76, CI 0.59-0.98) and never having attended school (OR = 0.75, CI 0.62-0.92) were significantly associated with poor medication adherence (p < 0.05) while rural living (OR = 0.70, CI 0.48-1.02), feelings of anxiety (OR = 0.84, CI 0.66-1.08) and feelings of depression (OR = 0.90, CI 0.70-1.16) were factors lacking statistically significant association with medication adherence on multivariate analysis. Older age (OR = 2.02, CI 1.51-2.71) was significantly associated with improved medication adherence whilst there was a weak association between increased wealth and improved medication use. Limitations: The SAGE2 survey did not capture whether patients were taking their medication doses according to prescribed instructions-as a result our findings may under-estimate the true prevalence of medication non-adherence. Conclusion: Our analysis provides evidence that poor medication adherence in India is multifactorial, with distinct socioeconomic and health-system factors interacting to influence patient decision making. Future large-scale surveys interrogating adherence should assess all components of adherence specifically, whilst public health interventions to improve medication adherence should focus on barriers that may exist due to multimorbidity, comorbid depression and anxiety, and low educational status.

Does gender-equality concern with non-communicable diseases in India?

Does gender-equality concern with non-communicable diseases in India?