IDSP NCD-Risk Factor Survey
 
  Objective
  Coverage
  Methodology
  Finding
 
  Objective Top
 

The Government of India through the Ministry of Health and Family Welfare (MOHFW) initiated a decentralized, state based Integrated Disease Surveillance Project (IDSP) in the country with the assistance of the World Bank in the year 2004. The component of non communicable disease surveillance planned periodic community based surveys of population aged 15-64 to provide data on the risk factors at state level enabling states to develop strategies and activities to prevent and control the non-communicable diseases.

The overall objective of the NCD-risk factors survey was to improve the information available to the Government health services and care providers on a set of high-priority risk factors, with a view to improve the on-the-ground responses to such risk factors. The specific objectives of the survey were to:

  • Assess the prevalence of NCD risk factors in different strata of population in the states.
  • Establish a baseline database of NCD risk factors needed to monitor trends in population health behavior and risk factors for chronic diseases over a period of time in the states; and
  • Provide evidence for evolving strategies and interventions for identified risk factors in the community to reduce the burden of Non-Communicable Diseases in the population

 
  Coverage Top
 

The phase of the survey covered seven states namely Andhra Pradesh, Kerala, Madhya Pradesh, Maharashtra, Mizoram, Tamil Nadu and Uttarakhand.

 
  Methodology Top
 

WHO STEPS methodology for NCD Risk Factor Surveillance has been adopted for the survey. It was designed to provide prevalence estimates of risk factors for each 10 years age group (15-24 through 55-64) by sex (male/female) and place of residence (urban/rural). The survey used a systematic, multi-stage stratified sampling design to select a representative sample, bilingual schedules (English and the regional language of the state concerned), field protocol for data collection and physical measurements to facilitate comparability across states and also to ensure high quality data. And appropriate sampling weights for households were used for urban and rural areas of the state. From each selected household one member aged 15-54 was selected using the KISH Method and all members aged 55-64 were selected. For each state, post stratification weights for individuals were constructed using the age distributions by sex.

 
  Finding Top
 

During the survey, the household coverage was 4905 households in Andhra Pradesh, 4430 in Kerala, 4998 in Madhya Pradesh, 4997 in Maharashtra, 4569 in Mizoram, 4799 in Tamil Nadu and 4932 in Uttarakhand. From these households, the number of individuals selected randomly and interviewed was 6218 in Andhra Pradesh, 4859 in Kerala, 5853 in Madhya Pradesh, 6091 in Maharashtra, 4495 in Mizoram, 5177 in Tamil Nadu and 5433 in Uttarakhand. The household non-response rates were less than 5% in Andhra Pradesh, Madhya Pradesh, Maharashtra, Tamil Nadu and Uttarakhand, and it was 9% in Mizoram and 11% in Kerala. The individual response rates was over 99% in Andhra Pradesh, Maharashtra, Mizoram and Uttarakhand, and it was between 96 to 98% in other states. The analysis of the survey data have been presented and discussed in the present report providing information about the proportion of population or subgroup of population under the risk of Non-communicable diseases.

Except Mizoram, majority of the households in every state are Hindu which varies from 92% in Madhya Pradesh to 56% in Kerala. In Mizoram, 92% of households are Christian and 26% households in Kerala are Muslim. The access to piped drinking water in urban households was more than 84% in all the states except Madhya Pradesh (69%) and Kerala (42%). However, it varied between 87% in rural Tamil Nadu to 10% in rural Madhya Pradesh. More than three-fourth of the urban households in all the states have flush toilet facility except Madhya Pradesh where less than half of all households have such facilities (48%). The flush toilet facility in rural households varied from a high 90% in Kerala to a low 2% in Madhya Pradesh. Overall, more than 90% households used electricity as main source of lighting in Andhra Pradesh, Maharashtra, Mizoram, Kerala and Tamil Nadu. However, it was 72% in Uttarakhand and 68% in Madhya Pradesh. The differences between rural and urban area in using electricity was also higher in some states. Amongst the rural households in each state, majority of the households were still using wood as a main source of cooking fuel, which varied from 87% in Madhya Pradesh to 66% in Mizoram and Kerala. However, LPG was commonly used in urban households. The rural households reside in kachha houses were high in Madhya Pradesh (64%) followed by Maharashtra (61%), Mizoram (42%) and Uttarakhand (32%).

Literacy rate was high in Mizoram (91%) and Kerala (90%) but it varied from a high 75% in Maharashtra to a low 55% in Andhra Pradesh. However, there existed sex and rural-urban differentials in educational attainment in most of the states.

Tobacco is one of the major risk factors of non-communicable diseases. The current daily smokers among males were high in Mizoram (64%) followed by Madhya Pradesh (38%) and Uttarakhand (35%). Low prevalence of smoking among males was recorded in Maharashtra (15%). The prevalence of smoking among females was low in all the states except Mizoram (17%). However, daily smokeless tobacco users among males were high in Madhya Pradesh (52%) followed by Mizoram (44%) and Maharashtra (41%). In other states, it varied from a high 21% in Uttarakhand to a low 5% in Kerala. The prevalence of smokeless tobacco users among females were high in Mizoram (53%) followed by Maharashtra (23%) and Madhya Pradesh (22%). However, the prevalence among females was low in other states. Overall, prevalence tobacco use in any form (i.e. smoking or smokeless) was high in Mizoram (68%) followed by Madhya Pradesh (47%), Maharashtra (37%) and Uttarakhand (27%).

The mean age of initiation of smoking tobacco among young age (15-34 years) people was recorded 19 and 20 years in all the states except Mizoram (17 Years). However, the mean age of initiation of smokeless tobacco use among young age (15-34 years) people was recorded 20 years in all the states except Mizoram (18 Years)

The alcohol consumption is known risk factors of many non-communicable diseases. The alcohol consumption at least once in last one year among males varied from a high 37% in Andhra Pradesh to a low 21% in Mizoram. The alcohol consumption among females was low in all the states. Those who consumed alcohol in last seven days, binge drinkers were high in Uttarakhand (52%) followed by Andhra Pradesh (23%), Madhya Pradesh (13%) and Kerala (11%). The mean age of initiation of alcohol consumption by young age (15-34 years) people was recorded 20 years in Andhra Pradesh and Madhya Pradesh, 21 years in Maharashtra, Mizoram, Tamil Nadu and Uttarakhand, and 22 years in Kerala.

Nutritional inadequacy is the major risk factors of many non-communicable diseases. Overall, the population of states consuming less than five servings of fruits and vegetables per day were 99% in Tamil Nadu, 89% in Uttarakhand, 88% in Andhra Pradesh, 87% in Kerala, 85% in Mizoram, 83% in Madhya Pradesh and 76% in Maharashtra which was inadequate as per WHO recommended standards. On an average the people were consuming fruits only two days in a week in Andhra Pradesh, Madhya Pradesh, Maharashtra, Mizoram and Tamil Nadu; and three days in a week in Kerala and Uttarakhand. The consumption of vegetables in a week varied between 4 days in Maharashtra to 7 days in Mizoram. It showed that the consumption of vegetables was comparatively higher against fruits in all the states.

Physical inactivity is the leading cause of diabetes, hypertension and coronary heart disease. Overall, the population of states in low category of physical activity were 90% in Madhya Pradesh, 89% in Tamil Nadu, 86% in Uttarakhand, 80% in Andhra Pradesh, 73% in Maharashtra, 67% in Mizoram and 63% in Kerala. The population of state detected with pre hypertension stage varied from a low 43% in Andhra Pradesh and Tamil Nadu to a high 58% in Mizoram. However, the stage I and stage II hypertension among the people was recorded between 19% in Mizoram to 24% in Madhya Pradesh and Maharashtra. According to BMI, the population in the category of over weight was high in Kerala (27%) followed by Tamil Nadu (23%) and Uttarakhand (15%). In rest of the four states, it varied from a high 13% in Andhra Pradesh to a low 8% in Madhya Pradesh. However, the population recorded as under weight were 39% in Madhya Pradesh, 28% in Uttarakhand, 25% in Tamil Nadu, 23% in Andhra Pradesh and Maharashtra, 16% in Kerala and 14% in Mizoram. However, the population in the category of central obesity was 43% in Kerala, 25% in Tamil Nadu, 18% in Uttarakhand, 14% in Andhra Pradesh and Maharashtra, 12% in Mizoram and 11% in Madhya Pradesh. These were the major health issues related to Non-communicable diseases of people in Phase-I states.