2003-12-31-世界卫生组织-2004_STEPS_Country_Report_India_71页_9mb

Summary of the ICMR-WHO Multi-Centric Study on Risk Factors for Non-Communicable Diseases in India (April 2003 to March 2005)

Core Content

This document outlines the ICMR-WHO Multi-Centric Study on Risk Factors for Non-Communicable Diseases (NCDs) in India, conducted between April 2003 and March 2005. The study aimed to develop a sustainable system for NCD surveillance by establishing six Regional Sentinel Health Monitoring Centres across different geographic regions of the country. The study followed the WHO Global STEPwise approach for risk factor surveillance, adapting it to the Indian context.

The project was coordinated by Dr. Bela Shah, a Senior Deputy Director General at the Indian Council of Medical Research (ICMR), and involved a Project Advisory Group of leading experts in public health and medicine. The study was funded by the World Health Organization (WHO) and included data collection from urban, rural, and slum populations to understand the distribution of risk factors and their impact on NCDs.

Main Objectives

• To develop modules for the surveillance of major NCD risk factors within the country.
• To collect data on selected risk factors for NCDs.
• To formulate and implement a methodology for NCD risk factor surveillance that can be integrated into national health information systems.
• To use the findings as a tool for advocacy and policy-making.

Key Risk Factors Studied

The study focused on the following major risk factors:

• Tobacco use: Including current, never, and age of initiation; distinction between smoking and non-smoking forms.
• Alcohol use: Regular, occasional, and never; identification of problem drinkers.
• Physical activity and dietary behavior.
• Blood pressure, pulse rate, and obesity (measured through waist circumference).
• Demographics, occupation, and literacy.

These factors were selected based on their impact on NCD mortality and morbidity, potential for modification through primary prevention, and validity of measurement.

Methodology

• The WHO STEPwise approach was adapted for use in India.
• Each center was responsible for data collection in urban, rural, and slum areas, with the exception of the Institute of Human Behavior and Allied Sciences (IHBAS), which focused only on urban and slum populations.
• Sample size was calculated based on age and sex categories, with 250 individuals per category.
• Total sample size across all six centers: 42,500 individuals.
• Data entry and analysis were conducted using Epi-Info 6.0 and SPSS 12.0, with 10-15% of data double-entered for validation.
• Data collation and cleaning were performed at the ICMR coordinating unit.

Data Collection

• Conducted through active surveillance.
• Urban areas used wards as the primary sampling unit.
• Rural areas used Primary Health Centers (PHCs) as the primary sampling unit.
• Slum areas were included as a distinct population.
• Adolescents were included in the study, expanding the age range to 15-64 years due to lifestyle changes.
• Questionnaires were pilot-tested and translated into local languages to ensure cultural relevance and data accuracy.

Key Findings (Population Distribution)

1.1 Participation of Men and Women

1.4 Years Spent in School (Men)

1.6.1 Highest Level of Education (Women)

Key Stakeholders and Support

• Principal Investigators:

  • Ballabgarh: Dr. K Anand, Dr. SK Kapoor
  • Chennai: Dr. V Mohan, Dr. CS Shanthi Rani
  • Delhi: Dr. NG Desai, Dr. U.K. Sinha
  • Dibrugarh: Dr. J Mahanta, Dr. NC Hazarika, Dr. Medhi
  • Nagpur: Dr. Prashant P Joshi, Dr. Sanjay Zodpey, Dr. Poonam Lavhe
  • Trivandrum: Dr. KR Thankappan, Ms. GK Mini

• WHO Support:

  • Dr. Ruth Bonita (Geneva)
  • Dr. Kathy Douglas (Geneva)
  • Dr. J Leowski (South East Asia Office)
  • Dr. Cherian Varghese (India Office)

• ICMR Team:

  • Dr. Bela Shah (Principal Investigator)
  • Dr. Prashant Mathur (Program Officer)
  • Dr. DK Shukla (Statistical Coordination and Analysis)
  • Dr. Geetha Menon (Deputy Director General)

• Administrative Team:

  • Mr. PK Chawla (Section Officer)
  • Mrs. Madhu Gambhir (Assistant)
  • Mr. Tarun Kant (Stenotypist)

Ethical and Technical Considerations

• Ethical clearance was obtained from the Institutional Review Board (IRB) of each center.
• Training was provided to field staff and medical students.
• Data validation was ensured through double entry of 10-15% of the data.
• Standardized data collection methods were used to ensure consistency and reliability.

Conclusion

The study provided baseline data on the prevalence and trends of NCD risk factors across urban, rural, and slum populations in six different regions of India. It emphasized the importance of surveillance in policy development and public health planning, and laid the groundwork for integrating risk factor data into national health information systems. The results are critical for advocacy, intervention planning, and understanding the burden of NCDs in the context of changing lifestyles and increasing life expectancy.