|Year : 2018 | Volume
| Issue : 2 | Page : 60-64
A cross-sectional study to evaluate awareness about noncommunicable diseases among rural adolescents in North West India
Rajiv Kumar Gupta1, Rashmi Kumari1, Shahid Hussain1, Sunil Kumar Raina2, Bhavna Langer1, Zahida Parveen1
1 Department of Community Medicine, Government Medical College, Jammu, Jammu and Kashmir, India
2 Department of Community Medicine, Dr. RP Government Medical College, Jammu, Jammu and Kashmir, India
|Date of Web Publication||1-Nov-2018|
Dr. Sunil Kumar Raina
Department of Community Medicine, Dr. RP Government Medical College, Jammu, Jammu and Kashmir
Source of Support: None, Conflict of Interest: None
Background: Noncommunicable diseases (NCDs) have emerged as serious public health problem worldwide affecting all the populations across the globe in general but low- and middle-income populations in particular. The current study was planned with the aim to assess the awareness among rural adolescents about NCDs and their risk factors. Materials and Methods: A cross-sectional study was conducted in Miran Sahib Zone of RS Pura Block. Students from intermediate classes from ten intermediate level schools, five government, and five private setup were selected for inclusion in the study. A predesigned, pretested, and self-admissible questionnaire was developed by three public health experts for use as a tool to collect the data. Results: Male respondents had better awareness about NCDs (P < 0.0001). A higher percentage of male students thought that lifestyle changes could prevent NCDs (P < 0.005). Conclusion: There is a need to reinforce the knowledge among adolescents in those areas about NCDs where they are lacking some knowledge.
Keywords: Diabetes, hypertension, obesity, risk factors
|How to cite this article:|
Gupta RK, Kumari R, Hussain S, Raina SK, Langer B, Parveen Z. A cross-sectional study to evaluate awareness about noncommunicable diseases among rural adolescents in North West India. J Dent Allied Sci 2018;7:60-4
|How to cite this URL:|
Gupta RK, Kumari R, Hussain S, Raina SK, Langer B, Parveen Z. A cross-sectional study to evaluate awareness about noncommunicable diseases among rural adolescents in North West India. J Dent Allied Sci [serial online] 2018 [cited 2019 Jan 16];7:60-4. Available from: http://www.jdas.in/text.asp?2018/7/2/60/244761
| Introduction|| |
The trend of urbanization is increasing all over the world leading to an economic transition. Among the consequences of this economic transition has been a shift in the diseases spectrum from communicable diseases to noncommunicable diseases (NCDs). Cardiovascular diseases, diabetes mellitus, and stroke have emerged as major NCDs of public health importance in India, with morbidity and mortality in the most economically productive years of life posing a challenge to society as well as the economy of the nation. Currently, more than 35 million people die from NCDs each year worldwide representing nearly two-third of world's deaths and most of these deaths (>80%) are in low- and middle-income countries and occur before the age of 60. NCDs have common risk factors such as tobacco use, unhealthy diet, physical inactivity, high alcohol consumption, raised blood pressure (BP), and excess adiposity. The policies and programs focusing on reducing the burden of these common risk factors are likely to make a substantial impact on mitigating the mortality and morbidity due to NCDs.
The major and potentially preventable risk factors of NCDs are associated with lifestyle and behavior pattern which are largely due to practices adopted in younger age. Intermediate school children (adolescents) are known for experimentation and are vulnerable to adopt certain lifestyles which may predispose them to NCDs. The awareness and knowledge of adolescents about NCDs and their risk factors are an important part of population-based prevention strategy. Assessing and appropriately disseminating knowledge of the modifiable risk factors at an early age are an essential preventive educational approach. The awareness levels in them could be used as a baseline on which health promotional strategies can be developed. It was in this context that the current cross-sectional study was designed with the aim to know the awareness level of intermediate school students in a rural area of Jammu.
| Materials and Methods|| |
This cross-sectional study was conducted in Miran Sahib Health Zone of RS Pura block of Jammu district of J and K state, India, after approval by the Institutional Ethics Committee. The Miran Sahib Health Zone caters to a population of 24,811 spread over 24 villages. With an expected adolescent population of 5000, required sample size calculated was 318 at 99.9% confidence interval, design effect of 1, and allowable error of 5% using Epi Info Software (Stat-Cal-sample size and power).
The study was conducted using a two-stage design. In the first step of Stage 1, Miran Sahib Health Zone of RS Pura block (comprising 8 health zones) was chosen randomly using lottery method for the conduct of the study. The detailed are as under.
Each zone of the RS Pura Block was assigned a unique number. The numbers were then thoroughly mixed by putting them in a jar. Then, without looking, one of the numbers was selected. The zone thus selected was identified as the study area for carrying out this cross-sectional survey. Therefore, Miran Sahib Health Zone was identified for the conduct of this study.
In the second step of Stage 1, a list of all intermediate schools in the Miran Sahib Health Zone was procured from Chief Education Officer of Jammu district which formed the sampling frame for the current study. There are 31 intermediate schools (12 government and 19 private) in Miran Sahib Zone. The total contribution of government and private school in terms of number of adolescents was arrived. The total number of adolescents enrolled in these schools is 512. To complete the required sample of 318 adolescents, it was planned than 159 adolescents will be contributed by the government and another 159 by private schools. Therefore, 159 adolescents were chosen from government schools using a probability proportional to size from 5 government schools. Using a similar technique, an effort was made to recruit 159 students from 5 private schools as well to complete the required sample of 318. However, while recruiting from private schools, more students expressed interest in being included in the study. Hence, a total of 194 students got recruited instead of a required sample of 159. In the selected schools, all the students of 11th and 12th classes (intermediate classes) who were present in the school at the time of the time of the study were included. A prior permission from the school administration was sought, and the purpose of the study was explained to the principals of the respective schools. Informed verbal consent was obtained from all the study participants. The study was conducted from October 1, 2015, to December 31, 2015.
In the next step, to assess the awareness of risk factors among adolescent students, a questionnaire was developed by faculty members of Community Medicine, Government Medical College, Jammu. The questionnaire was pilot tested on 25 adolescent students from one of the schools in RS Pura area, and this school did not form the part of the study. From the feedback obtained from the pilot study, necessary amendments were incorporated before the questionnaire was finally administered. To “measure”’ the trustworthiness of the questionnaire developed, a team of experts reviewed the questions themselves - for reducing ambiguity, leading questions, emotive questions, stressful questions, etc., The predesigned and pretested questionnaire was distributed among the students with the help of their class teachers and collected from the students after half an hour. While collecting back, the researchers checked and ensured the completeness of the questionnaire.
The questionnaire was explained to the students beforehand, and it consisted of questions pertaining to awareness of common NCDs such as diabetes mellitus, hypertension, and obesity and their risk factors. The data so obtained were entered into an excel sheet and analyzed using SPSS version 16 (IBM, Armonk, North Castle, New York, United States). Chi-square test was used as test of significance (P < 0.05)
| Results|| |
During the course of current study, a total of 346 students were interviewed, and majority of them 134/346 (53.17%) were female. All the respondents were in the age group of 15–19 years, out of which 234/346 (67.63%) were in 15–17 years age group.
The results revealed that 88.88% of the male respondents had heard of NCDs in comparison to their female counterparts (77.82%), and it was found to be highly significant statistically [P < 0.0001, [Table 1]. Awareness about individual NCDs was excellent about hypertension and diabetes mellitus in both the groups. Awareness about obesity and blindness was excellent in the male respondents, and it was highly statistically significant (P < 0.000). A high percentage (83.95%; 136/162) male respondent thought that NCDs were becoming a leading public health problem. Knowledge about risk factors of NCDs was found to be fairly good in both the groups except for passive smoking in both groups. More than (two-third) of the respondents were aware about complications of NCDs and they being preventable. Knowledge regarding preventive measure about NCDs was found to be fairly good in both the sexes. Electronic and print media was the main source of knowledge for the respondents, and it was statistically significant [P < 0.0001, [Table 1].
A significant higher percentage (P < 0.05) of males thought that the intake of green leafy vegetables, daily fruit intake and physical activity, screening as well as regular medication was helpful in preventing NCDs. An equal percentage of both sexes responded positively to avoiding excess salt intake for NCDs prevention. More of male respondents thought that changes in lifestyle could prevent NCDs which was statistically significant (P < 0.0056). 81.48% male students opined that allopathic system was better in comparison to 66.30% female students, and it was significant statistically [P < 0.001%, [Table 2].
| Discussion|| |
Adolescence is a transition phase which has been recognized as vulnerable as far as risk behavior for NCDs is concerned.
Hence, awareness and knowledge of NCDs in this particular age group are of immense public health value. Health education remains a long-term measure of NCDs prevention (in all the populations irrespective of caste, creed, and religion). The current study intended to assess the awareness levels regarding NCDs and their risk factors among rural intermediate school children.
Awareness levels of respondents about NCDs, in general, were excellent though males had better heard of them as compared to their female counterparts (P < 0.0001). Further awareness about individual NCDs such as hypertension and diabetes mellitus was excellent among both the sexes. Goel and Singh reported 65.3% and 58.3% knowledge about hypertension and diabetes mellitus among senior secondary school students of Chandigarh, whereas Ade et al. reported that 50% of the students had heard of cardiovascular diseases, diabetes mellitus, and cancer. However, Shivalli et al. reported 30.5% and 27.3% rates of awareness among intermediate school students from Varanasi.
Knowledge of risk factors about NCDs was excellent in both the sexes except for passive smoking in both sexes as a risk factor for NCDs among males. Our results are in line of agreement with those reported by Shivalli et al. and Shaikh et al. In contrast to the results of the current study, baseline knowledge of students regarding risk factors of HTN, hypertension one of the important NCDs, was unsatisfactory as reported by Chaudhari et al. Similarly, only one-third of the students revealed knowledge about risk factors of hypertension in a study by Lorga et al. (Thailand).
Ade et al. also reported low awareness of risk factors of NCDs in the majority (76.2%) of the respondents as was reported by Batlish et al. and Divakaran et al. Regarding knowledge about preventive measures, it was found to be equally good among the both sexes. In contrast, Chaudhari et al. and Ade et al. reported low levels of awareness about the prevention of NCDs in their respective studies.
Attitude and physical activity being preventive for NCDs were significantly (P < 0.000) more in boys. Taha et al. reported that <50% of the students knew about beneficial effects of physical activity in the prevention of NCDs. Aubert et al. also reported that 79% of the respondents were aware of the benefits of physical exercise on BP in a study conducted in Seychelles.
A fairly high to excellent awareness and knowledge about most of NCDs as well as risk factors in the study population could be explained on the following grounds. The maternal literacy among more than half of the respondents was 10th which may be an influencing factor. In addition, socioeconomic status of only one-third of the study participants was below poverty line which too may have some bearing on the outcome. More number of private school participants may also be a reason for these results. The good knowledge may have been acquired by the respondents from academic curriculum as well as print/electronic media. Besides, this area is in close proximity to Jammu city and thus may not be true representative of a typical rural area.
The study was limited to adolescents from the rural area of block only. A study also involving urban adolescents will have given us a better idea on the awareness about NCDs.
| Conclusion|| |
Awareness among rural intermediate students was fairly good to excellent regarding NCDs and their risk factors. Although a positive sign, it should not make the concerned authorities lax. India being a vast country, the results may not be the true representative of all rural and difficult to reach areas. As it has been well established that risk factors for NCDs are of multiplicative nature, the need is to promote community-based behavioral and lifestyle-related interventions.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mohan V, Deepa M, Farooq S, Prabhakaran D, Reddy KS. Surveillance for risk factors of cardiovascular disease among an industrial population in Southern India. Natl Med J India 2008;21:8-13.
Reddy KS. Prevention and Control of Non-communicable Diseases: Status and Strategies. Working paper no. 104. New Delhi: Indian Council for Research on International Economic Relations; 2003. p. 30.
Epping-Jordan JE, Galea G, Tukuitonga C, Beaglehole R. Preventing chronic diseases: Taking stepwise action. Lancet 2005;366:1667-71.
Goel S, Singh A. Health awareness of high school students. Indian J Community Med 2007;32:192-4. [Full text]
Ade A, Chethana KV, Mane A, Hiremath SG. Non-communicable diseases: Awareness of risk factors and lifestyle among rural adolescents. Int J Biol Med Res 2014;5:3769-71.
Shivalli S, Gupta MK, Mohapra A, Srivastava RK. Awareness of non communicable diseases and their risk factors among rural school children. Indian J Community Health 2012;24:4.
Shaikh RB, Mathew E, Sreedharan J, Muttappallymyalil J, Sharbatti SA, Basha SA. Knowledge regarding risk factors of hypertension among entry year students of a medical university. J Family Community Med 2011;18:124-9.
Chaudhari AI, Rami K, Thakor N. Awareness regarding NCDs among adolescents. Int J Med Sci Public Health 2016;5:1.
Lorga T, Aung MN, Naunboonruang P, Junlapeeya P, Payaprom A. Knowledge of communicable and noncommunicable diseases among Karen ethnic high school students in rural Tha Song Yang, the far Northwest of Thailand. Int J Gen Med 2013;6:519-26.
Batlish R, Jadhav SL, Banerjee A. Coronary heart disease: Awareness of risk factors and lifestyle among school-going adolescents. Indian J Med Sci 2007;61:474-6.
] [Full text]
Divakaran B, Muttapillymyalil J, Sreedharan J, Shalini K. Lifestyle riskfactors of noncommunicable diseases: Awareness among school children. Indian J Cancer 2010;47 Suppl 1:9-13.
Taha AZ. Self-reported knowledge and pattern of physical activity among male school students and their teachers in Al Khobar, Saudi Arabia. J Fam Community Med 2005;12:19-25.
] [Full text]
Aubert L, Bovet P, Gervasoni JP, Rwebogora A, Waeber B, Paccaud F. Knowledge, attitudes, and practices on hypertension in a country in epidemiological transition. Hypertension 1998;31:1136-45.
[Table 1], [Table 2]