Neglected Non-Communicable Diseases-Looking beyond the BIG FOUR

In the era of Sustainable Development Goal, we have gone to the next level for achieving SDGs by monitoring and evaluation of  SDG indexes,(1) still we conceptualize that public health will face newer challenges in healthcare (SDG-3) in the form of Neglected Non-Communicable Diseases (NNCD) in the near future.(2) Poor nations are already facing the heat of double burden of communicable and non-communicable illnesses (NCDs), often known as chronic illnesses, which are characterized by a protracted course and are multifactorial in causation.(3) Cardiovascular disorders, Cancers, Chronic Respiratory Diseases, and Diabetes are considered as the most common NCDs entitled as BIG FOUR. NCDs disproportionately impact persons in poor countries, where almost three-quarters (31.4 million) of all NCD-related fatalities occur. (2,4–6) The "BIG FOUR" NCDs (cardiovascular diseases, malignancies, chronic respiratory illnesses, and diabetes) are well-recognized as the leading causes of global health loss, in terms of morbidity and mortality. However, 55 percent of the worldwide burden of NCDs is caused by other NCDs, which are often overlooked in terms of increased premature mortality, increased Disability Adjusted Life Years (DALY) and reduced Quality-Adjusted Life Year (QALY). The share of disease burden caused by “Cancer, COPD, Cardiovascular disease, and Diabetes-the BIG FOUR” is the greatest among all NCDs. However, many additional non-communicable diseases cause a comparable fraction of disease burden but receive less attention than the "BIG FOUR."(2,6

Prevalence of the Non-Communicable disease triad in hilly state of Uttarakhand: Evidences from National Family Health Surveys

India is facing epidemiological transition towards non communicable diseases and morbidities due to NCD triad of obesity, hypertension and diabetes. The risk factors contributing to chronic disease and NCD triad are lifestyle changes, poor dietary habits, lack of physical activity, tobacco/alcohol consumption. These risk factors are however modifiable and preventable. This article reviews secondary data of NFHS-4 and NFHS-5 to analyse trends of obesity, hypertension and diabetes among urban and rural population of Uttarakhand from 2015 to 2021

Tackling the silent epidemic of Type-I Diabetes Mellitus (Type-1 DM) through National Health Programmes- A narrative review of available evidence

Type 1 diabetes mellitus (T1DM) is an autoimmune ?-cell destruction, usually leading to absolute insulin deficiency, insulin resistance, or by a combination of both. Both the incidence and prevalence of diabetes T1DM is suspected to be high in India, but in the absence of nation-wide registry, the possibility of exact numbers is unsure. Till date, studies done among the population have seen prevalence more than the incidence of the disease, which has led to late screening and diagnosis of the disease within the community settings. India is already suffering from the burden of type 2 DM, in the process of screening those, patients with T1DM are somewhat getting ignored. Furthermore, cost associated with the treatment expenditure and social status of the people suffering from the disease too have a role to consider which has been totally side-lined in national programmes like National Program for Control of Diabetes, Cardiovascular disease, and Stroke (NPCDCS). There is also scarcity of data on the incidence of T1DM which could aid in formulating better policy avenues for the patients suffering from the disease.  Reports on trends in T1DM are more commonly available from countries with better established public health surveillance systems and diabetes research infrastructure. From India, due to scarcity of data on T1DM, we had to rely on published literature of some major centers across the country. Results from the Indian Council of Medical Research (ICMR) first phase, till July 2011 which included 5546 patients found T1DM among 63.9% cases and predominately among children; at registration 11.1% had already developed chronic complication of T1DM. As India is already suffering from the burden of type 2 DM, during current management and treatment, the problem lies at various levels which needs to be addressed. We propose a setting based, life course approach for T1DM where every age group will have access to the health care system either directly or indirectly from intra-natal life till elderly age group through health approach based on scientific methods delivered through health system. In this regard a central registry having enumeration and provisioning of mandatory Insulin to all through a national policy being implemented by NPCDCS is what policy makers must take up at urgent bases if we want to bend the curve of rising T1DM and prevalence of overall diabetes in India

Challenges of Second-hand Smoke: Are We Asking the Right Questions?

Second-hand tobacco smoke as defined by WHO is the smoke emitted by a smoker or released from a burnt cigarette or any tobacco product. It is highly prevalent all over the globe but its serious health implications are often neglected by the public and the scientific community alike. Second-hand smoke has everlasting impact on all the body’s major organs, especially among the vulnerable population of children, pregnant ladies, people with chronic diseases and senior citizens. Although India started its war against this menace earlier than other counties, all its efforts remain bootless as its approach and implementation have a wide range of lacunae. This review aims to give a big picture of second-hand smoke, highlighting its pathophysiological changes in the body, socioeconomic impact, various strategies, and the gap that prevents these strategies from finding a favorable result in India. It becomes all the more important to reduce its impact owing to the increase in prevalence among youth reducing their vitality, derailing the society and the nation. It is recommended that the health authorities approach this health problem with utmost seriousness as a laid-back approach could welcome this silent killer’s known and unknown repercussions

Non-communicable disease surveillance in India using Geographical Information System-An experience from Punjab

"Geographic information system (GIS) collects various kinds of data based on the geographic relationship across space." Data in GIS is stored to visualize, analyze, and interpret geographic data to learn about an area, an ongoing project, site planning, business, health economics and health-related surveys and information. GIS has evolved from ancient disease maps to 3D digital maps and continues to grow even today. The visual-spatial mapping of the data has given us an insight into different diseases ranging from diarrhea, pneumonia to non-communicable diseases like diabetes mellitus, hypertension, cardiovascular diseases, or risk factors like obesity, being overweight, etc. All in a while, this information has highlighted health-related issues and knowledge about these in a contemporary manner worldwide. Researchers, scientists, and administrators use GIS for research project planning, execution, and disease management. Cases of diseases in a specific area or region, the number of hospitals, roads, waterways, and health catchment areas are examples of spatially referenced data that can be captured and easily presented using GIS. Currently, we are facing an epidemic of non-communicable diseases, and a powerful tool like GIS can be used efficiently in such a situation. GIS can provide a powerful and robust framework for effectively monitoring and identifying the leading cause behind such diseases.  GIS, which provides a spatial viewpoint regarding the disease spectrum, pattern, and distribution, is of particular importance in this area and helps better understand disease transmission dynamics and spatial determinants. The use of GIS in public health will be a practical approach for surveillance, monitoring, planning, optimization, and service delivery of health resources to the people at large. The GIS platform can link environmental and spatial information with the disease itself, which makes it an asset in disease control progression all over the globe

Risk of secondhand smoke exposure and severity of COVID-19 infection: multicenter case–control study

IntroductionExposure to secondhand smoke (SHS) is an established causal risk factor for cardiovascular disease (CVD) and chronic lung disease. Numerous studies have evaluated the role of tobacco in COVID-19 infection, severity, and mortality but missed the opportunity to assess the role of SHS. Therefore, this study was conducted to determine whether SHS is an independent risk factor for COVID-19 infection, severity, mortality, and other co-morbidities.MethodologyMulticentric case–control study was conducted across six states in India. Severe COVID-19 patients were chosen as our study cases, and mild and moderate COVID-19 as control were evaluated for exposure to SHS. The sample size was calculated using Epi-info version 7. A neighborhood-matching technique was utilized to address ecological variability and enhance comparability between cases and controls, considering age and sex as additional matching criteria. The binary logistic regression model was used to measure the association, and the results were presented using an adjusted odds ratio. The data were analyzed using SPSS version 24 (SPSS Inc., Chicago, IL, USA).ResultsA total of 672 cases of severe COVID-19 and 681 controls of mild and moderate COVID-19 were recruited in this study. The adjusted odds ratio (AOR) for SHS exposure at home was 3.03 (CI 95%: 2.29–4.02) compared to mild/moderate COVID-19, while SHS exposure at the workplace had odds of 2.19 (CI 95%: 1.43–3.35). Other factors significantly related to the severity of COVID-19 were a history of COVID-19 vaccination before illness, body mass index (BMI), and attached kitchen at home.DiscussionThe results of this study suggest that cumulative exposure to secondhand cigarette smoke is an independent risk factor for severe COVID-19 illness. More studies with the use of biomarkers and quantification of SHS exposure in the future are needed

Food literacy & food labeling laws—a legal analysis of India's food policy

Aggressively marketed, cheaper and more easily available pre-packaged foods, often considered as foods high in fat, salt, and sugar (HFSS) is finding a growing preference amongst consumers in India. These HFSS foods are the major causes of heart and other non-communicable diseases worldwide. To prevent or control further widespread of NCDs, Food Safety and Standard Authority of India (FSSAI) has issued numerous food and packaging laws and acts to control their manufacture, storage, distribution, sale, and import so that a safe and wholesome food is available to the consumers. The Front-of-pack labeling (FOPL), proposed by FSSAI in 2019, is a key strategy to alert and educate consumers in making an informed choice. This article aims to enlist and describe various food and labeling laws and acts enacted in India since the last two decades and identify that what type of label would be best suited to India

Promoting healthier diets in India through “Front of Package Food Labeling”

The rising NCDs are attributed to an epidemiological health transition resulting from rapid urbanization, sedentary lifestyle, and transforming nutritional preferences. The behavioral risk factors like the adoption of a sedentary lifestyle and changing dietary pattern have resulted in the consumption of an unhealthy diet, building up and less burning of calories. It has been observed that nutrition labeling has played a crucial role in shaping consumer level food behavior. Many labeling systems have been proposed and designed as per country specific needs. Consumers face many challenges while accessing the food packets, small fonts, labeling on the back side, not understanding its language, and unable to evaluate the nutritional information which is described on the packets. Our aim should be to improve the information available within the food package, increase food information accessible to the people, and more importantly, the use of this information must be brought into service by the consumers as to make healthy food choices. Chile's approach to warning labels is currently considered the gold standard in the FOPL system, which have significantly reduced the consumption of unhealthy foods by people. There is a need to introduce the replica of the same Chile’s FOPL system in India. It's time to make the right move and make India a global leader in FOPL food systems by the introduction of strong and stringent FOPL laws that may help consumers with informed food choices and FSSAI may play a leadership role in this

Determinants of substance use among young people attending primary health centers in India

Abstract Background Substance use is a complex condition with multidimensional determinants. The present study aims to find the prevalence and determinants of substance use among young people attending primary healthcare centers in India. Methods A multicentric cross-sectional study was conducted across 15 states in India on 1,630 young people (10–24 years) attending primary health centers. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to capture data on substance use. The degree of substance involvement was assessed and multivariate regression analysis was conducted to determine the risk factors of substance use. Results The prevalence of substance use was 32.8%, with a median substance initiation age of 18 years. Among the substance users, 75.5% began before completing adolescence. Tobacco (26.4%), alcohol (26.1%) and cannabis (9.5%) were commonly consumed. Sociodemographic determinants included higher age, male gender, urban residence, positive family history, northeastern state residence and lower socioeconomic class. Over 80% of users had moderate or high involvement. Conclusions High substance use prevalence among young people in Indian healthcare centers underscores the urgency of targeted intervention. Insights on determinants guide effective prevention strategies for this complex public health issue

Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

Background: There is limited evidence on whether active case finding (ACF) among marginalised and vulnerable populations mitigates the financial burden during tuberculosis (TB) diagnosis. Objectives: To determine the effect of ACF among marginalised and vulnerable populations on prevalence and inequity of catastrophic costs due to TB diagnosis among TB-affected households when compared with passive case finding (PCF). Methods: In 18 randomly sampled ACF districts in India, during March 2016 to February 2017, we enrolled all new sputum-smear-positive TB patients detected through ACF and an equal number of randomly selected patients detected through PCF. Direct (medical and non-medical) and indirect costs due to TB diagnosis were collected through patient interviews at their residence. We defined costs due to TB diagnosis as ‘catastrophic’ if the total costs (direct and indirect) due to TB diagnosis exceeded 20% of annual pre-TB household income. We used concentration curves and indices to assess the extent of inequity. Results: When compared with patients detected through PCF (n = 231), ACF patients (n = 234) incurred lower median total costs (US$ 4.6 and 20.4, p < 0.001). The prevalence of catastrophic costs in ACF and PCF was 10.3 and 11.5% respectively. Adjusted analysis showed that patients detected through ACF had a 32% lower prevalence of catastrophic costs relative to PCF [adjusted prevalence ratio (95% CI): 0.68 (0.69, 0.97)]. The concentration indices (95% CI) for total costs in both ACF [−0.15 (−0.32, 0.11)] and PCF [−0.06 (−0.20, 0.08)] were not significantly different from the line of equality and each other. The concentration indices (95% CI) for catastrophic costs in both ACF [−0.60 (−0.81, –0.39)] and PCF [−0.58 (−0.78, –0.38)] were not significantly different from each other: however, both the curves had a significant distribution among the poorest quintiles. Conclusion: ACF among marginalised and vulnerable populations reduced total costs and prevalence of catastrophic costs due to TB diagnosis, but could not address inequity