Abstract P362: Surveillance Of Non-Communicable Diseases By Non-Physician Health Workers In Kerala: the Epidemiology of Non-communicable Diseases in Rural Areas (ENDIRA) study
Introduction: India carries the greatest burden of global non-communicable diseases(NCDs). There are few contemporary, community-based studies of prevalence, particularly in rural settings despite known regional variations. Given the shortage of physicians in rural India, there is an urgent need for large-scale, region-specific studies of NCDs using non-physician health workers.
Methods: In central Kerala, India, a population of 113,462 was defined by five panchyats(village councils), consisting of 75 wards in Ernakulam district. The "Epidemiology of Non-communicable Diseases in Rural Areas" (ENDIRA) study was conducted via ASHAs (Accredited Social Health Activists), who are non-physician health workers employed by State Government of Kerala to each cover one ward. Standardised questionnaires were used in household interviews of individuals ≥18 years during 2012 to gather sociodemographic, lifestyle and medical data.
Results: ASHAs recruited 84456 adults who were included in the analyses (25.4% below the poverty line). NCDs were relatively common: prevalence of myocardial infarction(MI) 1.4%, stroke 0.3%, respiratory diseases 5.0%, and cancer 1.1%. 84.1% of the population was vegetarian, 15.9% ate meat/fish ≥ 1 day per week, 4.2% had ≥1 alcoholic drink per week and 8.1% smoked regularly.
Compared with males, females were older, had lower BMI (p<0.0001), more likely to be hypertensive (p<0.0001), less likely to smoke or drink alcohol, have diabetes or dyslipidaemia (p<0.0001). NCDs were more common in males than females: MI (1.9% vs 0.9%), stroke (0.5% vs 0.3%), cancer (1.2% vs 0.9%) and respiratory diseases (5.9% vs 4.0%); p<0.0001.
Age≥65 years, hypertension, diabetes, dyslipidaemia, smoking and male gender were strongly associated with MI and stroke (Table 1).
Conclusions: Non-physician health workers (ASHAs) were able to effectively conduct a large-scale prevalence study of NCDs in Kerala, including risk factors. In rural Kerala, traditional risk factors were strongly associated with MI and stroke.
Author Disclosures: A. Banerjee: None. J. Joseph: None. A. Thachil: None. T.V. Attacheril: None. J. Menon: None.
- © 2014 by American Heart Association, Inc.