WHO Step Research Articles

Risk factors of type II diabetes among bankers of Kathmandu Metropolitan city: A cross-sectional study

Introduction: Identifying the risk factors of type 2 diabetes (T2DM) among the most vulnerable people is crucial as it helps to prevent complications and improve health outcomes. The job of bank employees is both sedentary and accompanies high levels of mental stress, making them more susceptible to non-communicable disease like diabetes. This study aims to identify the prevalence of risk factors of T2DM among bank employees. Methods: A cross-sectional study was conducted among 348 bank employees from selected banks of Kathmandu Metropolitan City, the largest and capital city of Nepal from October to December 2020. Pre-tested, self-administered structured questionnaire based on the WHO STEP Instrument and Perceived Stress Scale was used for the data collection. Data was analyzed using SPSS version 22.0 software. Results: The mean age of respondents was 34.8±8.9 years. At least, one risk factor was present among all the respondents, whereas 22.4% having had over four risk factors. The most common risk factor was improper dietary habits (99.4%). Similarly, 84.2% of the respondents had moderate to high levels of perceived stress. Factors like age, gender, level of education, marital status, socio-economic status, and family history were associated with the risk factors of T2DM. Conclusion: The findings of this study revealed that bankers were at high risk of T2DM. This study showed an urgent need to bring the attention of the concerned authorities to promote a healthy lifestyle, create a stress-free work environment, and awareness about the risk of T2DM among bankers, coming up with public health strategies for its prevention.

Trend and projection of non-communicable diseases risk factors in Iran from 2001 to 2030

This study aims to investigate the trends and project the major risk factors of Non-communicable Diseases (NCDs) in Iran. We obtained the trend of prevalence of main risk factors related to NCDs in 30 to 70-year-old-individuals. The data were extracted from WHO STEP wise approach to NCDs risk factor surveillance (STEPS) survey. Also,the previous studies conducted at national and subnational levels from 2001 to 2016 were employed. The prevalence of risk factors was projected by 2030 using Bayesian Model Averaging (BMA) and Spatio-temporal model stratified by sex and province. The percent change for the age-standardized prevalence of smoking in men between 2001 and 2016 was calculated to be − 27.0. Also, the corresponding values for the risk factors of diabetes, hypertension, obesity and overweight, physical inactivity (PI), and mean of salt intake were − 26.1, 29.0, 70.0, 96.8, 116.6, and 7.5, respectively. It is predicted that smoking and these risk factors will undergo a change to show values of − 1.26, 38.7, 43.7, 2.36, and 15.3 by 2030, respectively. The corresponding values in women for the time interval of 2001–2016 were − 27.3, 26.3, 82.8, 1.88, 75.2, and 4.2, respectively. Plus, projections indicate that the 2030 variation values are expected to be − 25.0, 16.7, 37.5, 28.7, 26.7, and 10.9 respectively. This study showed that the prevalence of four risk factors of PI, overweight and obesity, hypertension, and diabetes is increasing in Iran. Therefor, it is necessary to carry out effective interventions to adopt a healthy lifestyle and reduce the risk factors.

Prevalence and Associated Factors of Tobacco Smoking in Jumla, Nepal

Introduction: Globally, tobacco consumption is a major risk factor for mortality with an estimated five million deaths every year. Mortality due to cardiovascular diseases, cancer and respiratory conditions are the main cause of smoking. The rate of becoming smoker of teenagers increase day by day and 33% of them are believed to die due to consumption of tobacco. Almost 90% of them start smoking before the age of eighteen. The objective of this research is to study the prevalence, associated factors and behavior of cigarette smoking. Methods: A descriptive cross-sectional study design was used to find the prevalence of smoking and other associated factors. A sample of 345 students were recruited purposively from the selected school and a self administered questionnaire were used to collect the data in 2020 using WHO step survey. Data were entered in EPI data and Univariate and bivariate analysis was done using SPSS16. Logistic regression was used to find the associated factors. P value less than 0.05 was considered as statistical significant. Results: Among 318 students, 65% were male. The average age of the students was 18.03±1.65 years with the range of 15 to 25 years. The prevalence of smoking was estimated 23.3% (male=31.9% and female = 7.2%). The mean age of initiation of smoking was 16.5 years. Presence of parental smoking and smoking status was significantly associated (P < 0.05). Alcoholic habit was the predictor of smoking (p<0.05). Peer pressure (83.7%), exam load (55.8%), frustration (51.2%) family environment (43%), advertisement (34.9%), pleasure (26.7%) and curiosity (22.1%) were the main reason of starting smoking. They had the knowledge of harmful effects of smoking i.e. cause cancer (91.8%), chronic bronchitis (65.70%), laryngeal cancer (42.10%), heart disease (34.3%). Conclusion: The prevalence of smoking was remarkably high in college students. Thus, it is important to address this preventable problem.

Head and neck cancer pain

Background: Pain is a condition that often occurs in patients with head and neck cancer. Pain in patients with malignancy occurs mostly due to metastatic processes. Method: This research is a cross-sectional descriptive study to measure variables using the VAS, BPI, HADS, and LANSS questionnaires. Result: 127 subjects met the inclusion and exclusion criteria. Most patients with were male (63.8%), with the most ages being in the 46–55 year group (33.9%). Most patients were in stage III (48%), with the most diagnosed being nasopharyngeal malignancy (42.5%). About 60.6% of patients have received pain management according to WHO Step 2 and most suffered from neuropathic pain (65.8%) with the most pain intensity being moderate pain (53.5%). Pain interfered most with activities (91.3%) and as many as 64.6% experienced depression. Conclusion: A description of pain in head and neck patients is needed for good management of malignancy and pain management.

Optimum Radiation Dose for Palliation in Head and Neck SCC: A Phase III Randomized Controlled Trial (OPRAH)

Palliative radiotherapy has been used to alleviate symptoms in locally advanced (T4b) head and neck Squamous cell carcinoma, but optimum dose is still debated. The trial has been designed to determine if high palliative radiation dose (30 Gy/ 5#/ 5 days) improves progression free survival compared to low palliative dose (20 Gy/ 5# 5 days). The secondary objective was to compare toxicity rates profile between the two radiation doses (CTCAE version 5) and compare Quality of life between the two arms with QOL - HN35 questionnaire. This is a prospective randomized phase III randomized controlled trial. We hypothesized that by increasing the dose per fraction and total dose there would be an improvement in PFS without difference in late toxicity and QOL. The present study will also perform an exploratory analysis of effect of palliative radiotherapy on immune function and its effect on survival. Considering median PFS 2.5 months in 20 Gy arm we assumed that PFS will improve by 1.25 months (total PFS 3.75 months) in 30 Gy arm. To reach the hypothesis with 90% power and alpha error of 0.05, attrition rate of 10% sample size calculated was 286. Patients with cT4b disease of larynx/ Hypopharynx/ Oropharynx/ Oral cavity not amenable to surgery, Carotid encasement > 180 degree, histologically proven squamous cell carcinoma, Age > 18 years and < 75 years ECOG PS 0-2 were eligible. Until December 2022, we completed accrual of 239 patients. Median age: 53 years (Range: 29-70 years); Gender: Male: Female = 9: 1 (214: 25). 145 patients had history of smoking, 87 had additional history of tobacco chewing. 67 patients had history of alcohol consumption, 13 patients had history of smoking, tobacco and alcoholism. All patients had stage IVA or Stage IVB disease. Primary site was oral cavity in 58%, Oropharynx in 19%, larynx in 10% and hypopharynx in 8% cases. 72.3% patients had a PS of 1, 21.7% had PS 2 at presentation. Prior to RT requirement of analgesic was: No pain medicine: 5; WHO step I:173, WHO step II: 52, WHO step III:14. All patients received conformal radiation with 6 MV linear accelerator. Target volume was GTV plus 1 cm margin to form CTV and 5 mm expansion to generate PTV. Out of 239 patients 67 patients had a disease progression. Mucositis is the commonest side effect affecting most of the patients and improve with best supportive care. High dose palliation appears to be equally well tolerated. However, the impact of such dose escalation will be established if final analysis reaches the pre-defined endpoint.

Clinical assessment of etiological risk factors of chronic kidney disease in patients admitted for dialysis to a tertiary care hospital

Background: Chronic kidney disease (CKD) is defined as a reduced glomerular filtration rate, increased urinary albumin excretion, or both, and it is an increasing public health problem with a prevalence of 8–16%. However, there is a paucity of such studies evaluating risk factors among dialysis patients in India and also there could be associated setting specific varied contributory factors. Hence, we have undertaken this study to assess common risk factors in CKD patients admitted for dialysis to a Tertiary Care Hospital. Aims and Objectives: To assess the clinical presentation and the common risk factors in CKD patients admitted for dialysis to tertiary care hospital. Materials and Methods: The present study was cross-sectional study in which 100 CKD patients admitted to the dialysis unit of tertiary care hospital were included on the basis of predefined inclusion and exclusion criteria and were analyzed as regards the history of illness, environment, and physical behavior was collected based on various pre-validated questionnaires (The WHO STEP wise approach to chronic disease risk factor Surveillance questionnaire for NCDs, dietary questionnaire, environmental/occupational questionnaire, and patient history questionnaire) in a face-to-face interview with participants and their family members. Etiological Risk Factors and clinical assessment of patients were studied. P&lt;0.05 was taken as statistically significant. Results: 49 (49%) of the study participants were from the age group of 41 to 60 years with the mean age of the 51.9±12.3 years. There was a male ponderance with M: F ratio being 1:0.61. The most common underlying condition responsible for end-stage renal disease (ESRD) was hypertension (25%) followed by diabetes mellitus (21%), glomerulonephritis (18%), analgesic nephropathy (15%), and renal stones (8%). CKD of unknown etiology was present among 7% and polycystic kidney 6%. Common clinical presentation in studied cases was anorexia (61%) followed by easy fatigability (58%) patients, Facial puffiness (49%), weakness (45%), and oliguria (44%). Conclusion: Male gender, advancing age, and occupational exposure to nephrotoxic metals were the baseline risk factors. Hypertension and diabetes mellitus were the two most common comorbidities among ESRD patients which are the important risk factors for progression to ESRD.

Prevalence of Noncommunicable Diseases in Urban Slum and Risk Factors Associated with it: A Cross-Sectional Study

ABSTRACT Introduction: A community-based cross-sectional study was planned in urban slum area of a city to study risk factors of noncommunicable diseases. Material and Methods: WHO step protocol was used to assess the risk factors of noncommunicable diseases and data were entered in Google forms. In total, 1168 people participated in the study. Results: Eight hundred and forty people opted for random blood sugar test and only 569 people participated in physical examinations. A total of 3.5%, 2.7%, 0.5%, and 0.2% persons were found to be suffering from hypertension, diabetes, ischemic heart disease, and stroke, respectively. Smoking was found in 3.3% and alcohol in 4.3% individuals. In terms of physical activity, 56.8% males and 45.6% females were found to be physically active. Only 18.9% individuals were found to have blood pressure within normal range. Deranged random blood sugar, that is, &gt;200 mg%, was found in 4.6% persons during time of survey. Conclusion: This study concludes increase in rapid industrialization and run for earning daily livelihood, putting people at risk of noncommunicable disease. People are not attentive about their health.

Cardiovascular disease risk assessment among adults attending HIV Clinic at Korle-bu Teaching Hospital

Background: The risk of developing chronic cardiovascular diseases (CVDs) is a significant public health concern for people living with HIV (PLWH). This recognition has been in place for over a decade. The lack of resources in some settings means that most older PLWH will receive limited care, requiring further research to identify CVD risk and accurate estimation methods. Such research enables the identification of optimal models of care, improving outcomes for this population. Objective: This study aimed to perform a CVD risk assessment (using three different assessment tools) on PLWH attending the HIV clinic at the Korle-bu Teaching Hospital (KBTH). Methods: A hospital-based cross-sectional study involving 311 PLWH was conducted at the HIV Clinic of the KBTH using a questionnaire adopted from the WHO STEP wise approach to chronic disease risk factor surveillance. Blood pressure, anthropometric measurements and fasting blood samples were taken for metabolic/biochemical parameters. A retrospective chart review of clinical folders for HIV and ART-related data was done. To determine the level of risk for cardiovascular disease (CVD), three estimation methods were used: the 10-year Framingham risk score(FRS), the 10-year WHO/International Society of Hypertension (ISH)risk prediction chart, and the 5-year Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:D) cardiovascular risk score. Results: The estimated 10-year moderate to high risk of CVD was 20.6% using the FRS, 13.2% using the WHO/ISH risk score, and 52.4% using the D:A:D score. The majority of study participants were classified as having a low risk of cardiovascular disease (CVD) according to the FRS and WHO/ISH scoring systems. However, the D:A:D cardiovascular scoring system identified that over 50% of the participants were at a moderate to high risk of developing CVD. Conclusion: This study indicates that when using the D:A:D risk assessment system, over 50% of the individuals who participated were found to have moderate-to-high risks of CVD. This underscores the importance of conducting a cardiovascular risk assessment before initiation of antiretroviral therapy as well as regular assessments to promptly identify and manage these risk factors, thereby aiding in preventing the occurrence of cardiovascular events. Additionally, the findings highlight the need for CVD management to be included in the HIV clinic

Prevalence and Determinants of Selected Cardiovascular Disease Risk Factors: A cross-sectional study among Adults in Sabaragamuwa Province, Sri Lanka

Introduction: Cardiovascular Disease (CVD) is the leading cause of death and disability worldwide. The objective of this study was to assess the prevalence of selected risk factors of CVDs and their associations with socio-demographics and anthropometrics factors among adults in the Sabaragamuwa Province of Sri Lanka. Methods: A descriptive cross-sectional study was conducted among adults aged between 30-60 years. Participants were selected using a three staged random sampling method. The WHO STEPS wise approach was used to collect data. Results: There were 366 participants with a male to female ratio of 1:2.1. The mean age was 45.2 years (SD=8.8). Approximately two-thirds (63.4%) of the participants were physically inactive. Prevalence of high blood pressure, high blood glucose level, high total cholesterol level, high low-density lipoprotein (LDL) cholesterol level, low high-density lipoprotein (HDL) cholesterol level and high triglycerides were 27.0%, 22.1%, 39.9%, 37.7%, 29.0%, and 37.7% respectively. The mean values of systolic blood pressure (SBP), diastolic blood pressure (DBP) and triglyceride level were significantly higher among men, whereas mean values of HDL, LDL, waist circumference and BMI were higher in women. Mean SBP, DBP and prevalence of blood pressure increased with age. Mean waist circumference, BMI, total cholesterol, and triglyceride level increased with the years of education. Conclusion: The prevalence of CVD risk factors was considerably high in this population. Therefore, it is essential to plan public health interventions considering the population characteristics associated with CVD risk factors.&#x0D; &#x0D; Keywords: Adults, Cardiovascular disease, Risk factors, Sri Lanka, WHO STEP wise approach

Determination of level of self-reported adherence of antihypertensive drug(s) and its associated factors among patient with hypertension at a tertiary care center.

The study aimed to determine the level of self-reported adherence to antihypertensive drug(s) and its associated factors among patient with hypertension at a tertiary care center. The authors performed hospital based observational cross-sectional study using semi-structured questionnaires, WHO STEP tool and Hill and Bone high blood pressure compliance scale from December 1, 2021 to February 28, 2022. Descriptive statistics, Chi-square/Fisher's exact test and non-parametric tests were used for statistical analysis. Among 150 cases included in the study, majority (94, 62.67%) had good adherence based on Hill and Bone high blood pressure compliance scale with adherence level labelled as "good adherence" (score 3) and "not good adherence" (score<3). The adherence to drug therapy was significantly better in females compared to males (50 [71.43%] vs. 44 [55.00%], p=.038). Among the factors related to hypertension and anti-hypertensive therapy, people with higher body mass index (ρ=-.324, n=56, p=.015) and taking three or more pills (6, 1.71%, p=.017) had lower adherence to therapy. Likewise, forgetfulness (30, 53.57%), ineffective counseling (7, 12.50%), and missed follow-up (13, 23.21%) were the factors associated with lower adherence to anti-hypertensive therapy. This study finds good adherence among the patients taking anti-hypertensive medications. However, with the improved education, lesser number of pills and physical fitness help to adhere with the anti-hypertensive therapy.

Incidence And Their Associated Factors of Non-Communicable Diseases Among Khyber Pakhtunkhwa Population

World Health Organization proposes implementing the WHO STEP smart strategy for tracking, to continuously monitoring noncommunicable diseases (NCDs) and associated risk factors (STEPS). Objective: To analyze the prevalence and contributing factors of NCD risk factors in Pakistan, a country with a low income where NCDs are responsible for 66 percent (or two-thirds) of fatalities annually. Methods: Total 675 eligible participants, ages 15 to 60, were selected by a multistage sampling approach from February 2020 and May 2021 for STEPS survey (version of instrument 3.2). Assessment of behavioral and physiological risk variables was part of the data collection process. SPSS version 25 was used for data analysis. Results: Intake of lesser than five portions of vegetables and fruits every day may be the greatest common risk factor. Of all participants, 341 (50.51%) were smoking currently, 513 (76%) were not physically active. A total of 251 (37.18%) individuals have elevated blood pressure whilst 245 (36.29%) individuals are affected by sugar. The cholesterol level is high in 215 (31.85%) participants out of 675. Each individual had an average of two risk factors for NCDs (2.04, 95percent [Confidence interval]: 2.02-2.08). Conclusions: Numerous risk factors for NCDs are present in a significant section of the Pakistani community. With the help of a multi-sectoral national coordination system, this observed data must be employed to promote and track specific NCD management and prevention programs for cities across Pakistan.

Almost all working adults have at least one risk factor for non-communicable diseases: Survey of working adults in Eastern Ethiopia.

The disease burden and mortality related to Non-communicable Diseases (NCD) increased in the last couple of decades in Ethiopia. As a result, an estimated 300,000 deaths per annum were due to NCD. According to a World Health Organization report, 39% of the total deaths in Ethiopia were attributable to NCD. Rapid urbanization characterized by unhealthy lifestyles such as tobacco and/or alcohol use, physical inactivity, low fruits and vegetable consumption, and overweight drive the rising burden of NCD. However, studies on risk factors for NCD and associated variables are limited among working adults in Eastern Ethiopia. Therefore, this study aimed to examine the magnitude of the risk factors of NCD and associated factors among working adults in Eastern Ethiopia. A cross-sectional study was carried out among 1,200 working adults in Eastern Ethiopia that were selected using a simple random sampling technique from December 2018 to February 2019. Data were collected following the World Health Organization Stepwise Approach to NCD Risk Factor Surveillance (WHO STEP) instruments translated into the local language. A total of five risk factors were included in the study. The Negative Binomial Regression Model was used to determine the association between NCD risk factor scores and other independent variables. Adjusted incidence rate ratio (AIRR) with a 95% Confidence Interval (CI) was used to report the findings while the association was declared significant at a p-value of less than 0.05. STATA version 16.1 was used for data clearing, validating and statistical analysis. Totally, 1,164 (97% response rate) participants were employed for analysis. Overall, 95.8% (95% CI: 94.4-96.7%) of the participants had at least one of the five risk factors of NCD. Furthermore, the proportion of participants that had all NCD risk factors was 0.3%. Among the participants, 47.5% were alcohol drinkers, 5.1% were current smokers, 35.5% were overweight, 49.1% exercise low physical activity, and 95% had less than five portions of fruits and vegetables intake per day. Higher risk factor scores were associated with those of advanced age (AIRR = 1.24; 95% CI: 1.01-1.53 in 35-44 age group and AIRR = 1.28; 95% CI: 1.01-1.62 in 45-54 age group), and the ones who are higher educational level (AIRR = 1.23; 95% CI: 1.07-1.43 for those who have completed secondary school and AIRR = 1.29; 95% CI: 1.11-1.50 for those who have completed college education). The overwhelming majority (95.8%) of the participants had at least one risk factor for non-communicable diseases. The risk score of non-communicable diseases was higher among those with advanced age and who completed secondary and above levels of education. In a nutshell, the finding shows the need for lifestyle modification and comprehensive non-communicable diseases prevention programs for working adults in Eastern Ethiopia.

Prevalence of Impaired Fasting Glucose and Type 2 Diabetes in Kazakhstan: Findings From Large Study.

Type 2 diabetes mellitus (T2DM) is a serious public health problem. A large proportion of patients with T2DM are unaware of their condition. People with undiagnosed T2DM are at a greater risk of developing complications, whereas prediabetes has an elevated risk of becoming T2DM. The aim of this study is to estimate the prevalence of impaired fasting glucose (IFG), undiagnosed and prior-diagnosed T2DM in Kazakhstan. A cross-sectional study was conducted in four geographically remote regions using the WHO STEP survey instrument. The status of T2DM of 4,753 participants was determined using the WHO diagnostic criteria based on fasting plasma glucose (FPG) level. As a result, the survey-weighted prevalence of IFG was 1.9% (95% CI 1.1%; 3.5%) and of T2DM was 8.0% (95% CI 3.8; 15.9). A total of 54% of T2DM have been newly diagnosed with T2DM. Being 55–64 years old (OR = 2.71, 95% CI 1.12; 6.60) and having lowered HDL-C level (OR = 3.72, 95% CI 1.68; 8.23) were found to be independent predictors for IFG. Being older than 45 years, a female (OR = 0.57, 95% CI 0.39; 0.83), having high waist circumference, was associated with newly diagnosed T2DM. Whereas, the age older than 45 years, high waist circumference, and family history of diabetes (OR = 2.42, 95% CI 1.64; 3.54) were associated with preexisting T2DM. This study shows a high prevalence of IFG and a high proportion of newly diagnosed T2DM in Kazakhstan. A series of risk factors identified in the study may be used to strengthen appropriate identification of IFG or undiagnosed patients in healthcare settings to deliver either preventive or therapeutic interventions aimed to reduce the incidence of T2DM or the delay of their complications. Further longitudinal studies are needed to confirm these associations in our population.

Single-center, retrospective study on changes in pain-relieving therapy after bone metastasis detection by bone scintigraphy in prostate cancer patients

Whole-body bone scintigraphy (WB-BS) is used for detecting and monitoring metastatic spread of prostate cancer (PCa) and to investigate bone pain episodes. To investigate the impact of a positive WB-BS on pain-relieving medicine prescription in PCa patients, a single-center, retrospective cohort study with PCa patients classified as positive for bone metastases (BM) by WB-BS was conducted. Demographic, clinical, and ambulatory pain-relieving medicine prescription data were evaluated. Pain-relieving medicines were categorized according to the WHO ‘Analgesic Ladder’. Regimens adopted before and after WB-BS were compared. Differences were considered significant at p<0.05. A total of 180 PCa patients were diagnosed with BM, 64.4% of whom were ≥65 years of age. Thirty-three patients were prescribed analgesics only after WB-BS, mostly including NSAIDs and weak opioids. Pain-relieving prescription changed after WB-BS in patients with prescriptions before and after WB-BS, with a reduction in NSAIDs and adjuvants and an increase in weak and strong opioids. In addition, 40% of patients with WHO analgesic step 1 drugs and 21.7% of patients with WHO step 2 drugs before WB-BS changed to other WHO steps after WB-BS. Pain-relieving prescriptions changed after a positive WB-BS, providing evidence that it could contribute to clinical management of painful metastatic PCa patients.

Seroprevalence and risk factors for hepatitis B and hepatitis C in three large regions of Kazakhstan.

Kazakhstan has implemented comprehensive programs to reduce the incidence of Hepatitis B and Hepatitis C. This study aims to assess seroprevalence and risk factors for HBsAg and anti-HCV positivity in three large regions of Kazakhstan. A cross-sectional study was conducted in three regions geographically remote from each other. Participants were randomly selected using a two-stage stratified cluster sampling and were surveyed by a questionnaire based on the WHO STEP survey instrument. Blood samples were collected for HBsAg and anti-HCV testing. A total of 4,620 participants were enrolled. The seroprevalence was 5.5% (95%CI: 3.6%-8.4%) for HBsAg and 5.1% (95%CI: 3.5%-7.5%) for anti-HCV antibodies. Both were more prevalent in the western and northern regions than in the southern. A history of blood transfusion was significantly associated with anti-HCV presence, with odds ratios (ORs) of 2.10 (95%CI: 1.37-3.21) and was borderline associated with HBsAg 1.39 (95%CI: 0.92-2.10), respectively. Having a family member with viral hepatitis was also borderline associated (2.09 (95%CI: 0.97-4.50)) with anti-HCV positivity. This study found a high-intermediate level of endemicity for HBsAg and a high level of endemicity for anti-HCV antibodies in three large regions of Kazakhstan. We found that history of surgery was not associated with HbsAg neither with anti-HCV seropositivity rates. Blood transfusion was associated with anti-HCV seropositivity, however, to investigate effectiveness of the introduced comprehensive preventive measures in health care settings, there is a need to conduct further epidemiological studies.

Health messaging with Viber application on risk factors of non-communicable diseases among the rural population: community-based quasi-experimental study

Background: Mobile health and mobile phone technology have become increasingly noticed as favorable communication channels for the prevention of non-communicable diseases (NCDs) by reducing the unhealthy behaviors of NCDs. The study was carried out to assess the effect of the health messaging with the Viber application on modifiable risk factors of NCDs.Methods: A community-based quasi-experimental study was conducted among a total of 240 community members who were 30 to 60 years old selected from two villages in Twantay township with a one year intervention. Face-to-face interviews with all participants using the WHO STEP survey questionnaire and measurements of behavioral and metabolic risk factors of NCDs were carried out at baseline and after 12 months follow up. Changes in behavior and metabolic risk factors between the intervention and control group were analyzed using mixed-effects random-intercept linear regression modeling with propensity score adjustment. Because of the small sample in smoking, smokeless tobacco and alcohol users, the Wilcoxon rank-sum (Mann-Whitney) test was used to compare the changes between the two groups.Results: The amount of smoking and smokeless tobacco use among current users in the intervention group was reduced after the intervention (p&lt;0.05). Of metabolic risk factors, participants in the intervention group had a significant net reduction in fasting blood sugar with a mean change relative to controls of -18.7 mg/dl 95% CI (-32.83, -4.56, p=0.010). No significant mean reduction was seen in other behavioral or metabolic risk factors.Conclusions: The study results showed that intervention affected a reduction in some behavioral and metabolic risk factors of NCDs.

Lifestyle Risk Factor Assessment Through WHO STEP Approach in Tabriz, Iran.

BackgroundThe aim of this study was to assess the lifestyle behaviour and risk factors for lifestyle-related diseases in East Azerbaijan province, Iran.MethodsA household study using a two-stage cluster sampling method was performed. Tabriz city was randomly selected for data collection among five geographic regions in the East-Azerbaijan province. Short WHO-STEP and Ultra-short version of Socio-Economic Status assessment questionnaire were used. Six hundred households were asked to respond to the STEP questionnaire.ResultsA total of 1196 people have participated in the study. People with higher socioeconomic status consumed more fruits, vegetables and fish than the people with lower socioeconomic status. People with academic education less likely to be hypertensive compared to people with non-academic education. People with a medium socioeconomic status are less likely to be hypertensive than people with high socioeconomic status. The majority of participants had poor dietary habits. In this study, 17.22%, 7.53% and 4.35% of respondents had hypertension, diabetes and depression, respectively.ConclusionConsidering that lifestyle-related risk factors are common among people. Due to the direct link between lifestyle and the occurrence of many chronic diseases, campaigns for and training programs to implement healthy lifestyle habits are recommended.

MO111PATTERN OF CARDIAC AND RENAL RISK FACTORS PREVAILING IN HYPERTENSIVE SUBJECTS OF RURAL COMMUNITY: PRIMARY RESULTS FROM AN ONGOING SYSTEMATIC SURVEY IN BANGLADESH

Abstract Background and Aims Hypertension is the leading entity of non communicable diseases (NCD). Some 15-30% adult population is identified suffering from hypertension at any given time worldwide. Complications of hypertension cause severe functional deficit and a major decline in quality of life for the patient and family. This study was carried out to identify the presence and pattern of cardiac and renal risk factors influencing major morbidity and mortality in hypertensive subject by performing relevant clinical and laboratory evaluations. Method In this survey adult subjects were selected randomly from a defined rural area. Their demographic, anthropometric and clinical information was recorded by WHO STEP wise approach surveillance-Instrument v.3.1. Information on prevailing NCDs and related risk factor were collected on a short questionnaire by face-to-face interview. Blood Pressure (BP) was measured by digital blood pressure monitor (Omron) with standard sized cuff after 10-15 minutes of rest in sitting posture by taking mean of two readings. Systolic BP ≥140 and/or diastolic BP ≥90mmHg or subjects taking antihypertensive medications were considered for hypertension. Early morning urine and fasting blood sample was collected for glycemic profile, lipid profile, serum creatinine, eGFR (MDRD equation) and urine ACR estimations for identifying diabetes, dyslipidemia and nephropathy. Results from an early group are presented here. Results From surveyed population consequative 300 hypertensive subjects with 100 normotensive subjects were analyzed. Male/female distribution was 66% and 34%. Age in 75% was between 25-55 years and BMI overweight to obese in 45%. Etiology wise in 81% it was essential hypertension followed by diabetes 18% and nephropathies in rest. Mean systolic BP was 147±16 and diastolic BP 71±9 mmHg. Comparison of hypertensive vs. normotensives showed FBS 6.7±3 vs. 5.8±1.0 mmol/l, (p&amp;lt;0.001). Lipids as cardiac markers were TG 170±107 vs. 130±76 g/dl, (p&amp;lt;0.001); Cholesterol 195±50 vs. 180±49 g/dl, (p&amp;lt;0.001); LDL 170±107 vs. 130±76 g/dl, (p&amp;lt;0.04); and HDL 42±7 vs. 46±8 g/dl, (p&amp;lt;0.001). Renal parameters like eGFR was 88±22 vs. 98±26 ml/min, (p&amp;lt;0.001); and ACR 99±556 vs. 30±87 mg/g, (p&amp;lt;0.04). These comparisons showed fasting hyperglycemia with most of the lipids higher and HDL lower in hypertensives. Renal parameters like eGFR was lower and albuminuria was significantly higher with similar urinary Na and K excretion in hypertensives. Other cardio renal markers like Uric Acid and hCRP was similar in both groups. Pearson’s correlations showed a positive correlation of systolic and diastolic BP with major components of cardiac, renal and metabolic risk factors. Conclusion It is found that hypertension is essential in nature among 81% of rural subjects. Nearly half of the study subjects are overweight. Dyslipidemia, albuminuria and low GFR is more pronounced in hypertensives in comparison to the normotensive counterparts. So, hypertension is mostly associated with adverse cardio-renal risk markers.

Assessment of the Management of Post-Tonsillectomy Pain at the ENT-CFS Department of Ignace Deen National Hospital

Introduction: Tonsillectomy is described as one of the oldest surgical procedures according to the authors of the surgical treatise (Aulus Amida and Paul of Aegina in the 6th and 7th centuries) found in the Vatican library. The contraindication of codeine in children has changed the management of post tonsillectomy pain. The aim of this study was to assess the management of post tonsillectomy pain in our developing country context. Methods: This was a prospective, analytical study lasting 6 months (September 2019-February 2020), carried out in the ENT/CFS department of the Ignace Deen National Hospital. We included in this study all patients who underwent a tonsillectomy in the department during the study period and who agreed to participate in the survey. Results: 34 patients were included in our study, i.e. a frequency of 25% of surgical interventions. The mean age of our patients was 18.06 ± 12 years with extremes of 03 years and 45 years. Recurrent hypertrophic tonsillitis with sleep disturbances was the most frequent indication for surgery in our study, at 47.06% (n = 16). We performed an isolated tonsillectomy in 52.9% (n = 18) of cases. Analgesia was multimodal using the WHO Step I and II analgesics in 44.1% (n = 15) and 55.9% (n = 19), respectively. Pain control was satisfactory in all patients. Conclusion: The evaluation of post tonsillectomy pain is essential for optimal management. In this indication, multimodal analgesia, involving several levels I and II analgesics, provided satisfactory pain control.

Epidemiology of hypertension in selected towns of Wollega zones, Western Ethiopia, 2019: A community-based cross-sectional study.

Introduction:Hypertension remains an emerging public health problem globally, particularly in developing countries. Age, income level, obesity, alcohol consumption, smoking, vegetables and fruit consumption, physical activity and chat chewing were some risk factors of hypertension. However, there are limited data on the epidemiology of hypertension in Ethiopia. This study aimed to assess Epidemiology of Hypertension among the community of selected towns of Wollega zones.Methods:A community-based cross-sectional study was conducted from 1 to 30 June 2019 in selected towns of Wollega zones. A multistage sampling technique was used to select 840 study participants. Data were collected using the WHO STEP wise approach. The data were coded and entered into EpiData 3, and exported to SPSS version 20.0 for analysis. Bivariate and multivariable logistic regression analyses were conducted. Statistical significance was declared at p-value < 0.05.Results:The study included a total of 838 respondents with a response rate of 99.7%. The prevalence of hypertension was found to be 189 (22.6%) (95% confidence interval = 19.9%–25.2%). Of this, 108 (12.9%) and 81 (9.7%) of female and male were hypertensive, respectively. Age groups of 30–44 years (adjusted odds ratio = 2.65 (1.43, 4.89)), 45–59 years (adjusted odds ratio = 3.55 (1.79, 7.04)), above 60 years (adjusted odds ratio = 2.97 (1.43, 6.18)), having history of alcohol consumption (adjusted odds ratio = 4.29 (2.4, 7.66)), involving in vigorous physical activity (adjusted odds ratio = 0.096 (0.028, 0.33)), not walking to and from the work (adjusted odds ratio = 13.12 (8.34, 20.67)), being overweight (adjusted odds ratio = 1.98 (1.21, 3.25)), inadequate fruits serving per day (adjusted odds ratio = 2.93 (1.75, 4.88)) were significantly associated with hypertension.Conclusion:The prevalence of hypertension was found to be high in the study area. Older age, alcohol consumption, not engaging in vigorous activity, physical inactivity, being overweight and inadequate intake of fruits were found to be risk factors for hypertension. Therefore, health care providers should provide extensive health education and promotion on recommended lifestyle modification to tackle the burden of hypertension.