Awareness of Risk Factors, Warning Signs, and Immediate ...

© 2018 Journal of Natural Science, Biology and Medicine | Published by Wolters Kluwer ‑ Medknow 227

Original Article

IntroductIon

Noncommunicablediseases(NCDs)inmiddle‑andlow‑incomecountries account for three‑fourths of the total deathsworldwide.[1]They account formore than one‑third of theoutpatientdepartment(OPD)visitsandinpatientadmissionsandmore thanhalf of the proportionalmortality rate fromallcausesofdeathinIndia.[2,3]Italsocontributesto44%ofdisability‑adjustedlifeyearslost.[3]

ThehighriskofsuchNCD‑relatedmorbidityandmortalityamongIndiansisduetoseveralreasons.Theseincludegeneticpredispositiontocentralobesityandmetabolicsyndromealongwithotherfactorssuchassmokingandfaultylifestylehabits.[4]

Theburdenofmodifiable risk factors ofNCDs in India isincreasingsignificantlyoverthepastfivedecades.[5]Therefore,thereasonbehindthisneedstobeascertained.Lowawareness

isstillattributedasareasonforhighprevalenceofhypertensioninbothurbanandruralpartsofIndia.[6‑8]Aminimalreductioninmean blood pressure levels has been reported to saveover100,000deathsduetostrokeandcoronaryheartdiseasesover here.[9]Awareness generation of people regarding thewarningsignsofvariousNCDsisequallyessentialtoenableearlydiagnosisandtreatment.

VeryfewstudiesinIndiahaveresearchedontheawarenessofpeopleaboutspecificNCDs.

Awareness of Risk Factors, Warning Signs, and Immediate Management Measures of Noncommunicable Diseases:

A Multihospital‑based StudyNitin Joseph, R. Srinath, Aditya Ramanathan, Ashutosh Kumar Gupta, P. Nandan, Rimsha Afnan

Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal University, Karnataka, India

Introduction: Noncommunicablediseases(NCDs)accountformorethanone‑thirdofoutpatientvisitsandinpatientadmissionsandmorethanhalfoftheproportionalmortalityratefromallcausesofdeathinIndia.TheburdenofmodifiableriskfactorsofNCDsinIndiaisincreasingsignificantlyoverthepastfivedecades.Therefore,thereasonbehindthisandthepreparednessofpeopletodealwithitneedtobeascertained.Objectives: Theobjectiveofthisstudywastoassesstheawarenessofpeopleregardingriskfactors,warningsigns,andimmediatemanagementpracticesinspecificNCDs.Materials and Methods:Thiscross‑sectionalstudywasconductedamongpeopleinagovernmentandprivatetertiarycarehospitalofMangalorecityinFebruary2016.Datawerecollectedbyinterviewingeachparticipantusingapretestedvalidatedstructuredinterviewschedule.Results:Allthe400enrolledparticipantshadheardaboutheartattack,hypertension,anddiabetesmellitus.However,only250(62.5%)hadheardaboutstroke.Goodawarenessaboutheartattackwaspresentamong62.5%,strokeamong57.6%,hypertensionamong59%,anddiabetesmellitusamong55.8%ofparticipants.Multivariateanalysisusingordinallogisticregressionanalysisfoundthatgoodeducationalstatusandbeingvegetarianweresignificantpredictorsofgoodawarenesslevelaboutheartattack.Similarly,thesefactorsalongwithurbanresidentialstatusweresignificantpredictorsofgoodawarenesslevelaboutstroke.Ageabove55yearswasasignificantpredictorofgoodawarenesslevelaboutdiabetesmellitus.Conclusion: ThevarioussociodemographicgroupsidentifiedtohavepoorknowledgeaboutNCDsinthisstudyrequiretargetedinterventionduringhealtheducationalcampaigns.

Keywords:Awareness,immediatemanagementpractices,noncommunicablediseases,riskfactors,warningsymptoms/signs

Address for correspondence: Dr. Nitin Joseph, Department of Community Medicine, Kasturba Medical College, Light

House Hill Road, Manipal University, Mangalore, Karnataka, India. E‑mail: [email protected]

Access this article online

Quick Response Code:Website:www.jnsbm.org

DOI:10.4103/jnsbm.JNSBM_187_17

Abstract

How to cite this article:JosephN,SrinathR,RamanathanA,GuptaAK,NandanP,AfnanR.Awarenessofriskfactors,warningsigns,andimmediatemanagementmeasuresofnoncommunicablediseases:Amultihospital‑basedstudy.JNatScBiolMed2018;9:227‑35.

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Joseph, et al.: Awareness of noncommunicable diseases

Journal of Natural Science, Biology and Medicine ¦ Volume 9 ¦ Issue 2 ¦ July-December 2018228

Hence, this studywas done to assess the awareness ofrisk factors and warning signs of heart attack, stroke,hypertension,anddiabetesmellitusamongpeoplevisitingvarious tertiary health‑care centers. It also assessed theirimmediatemanagement practices toward heart attack andstroke.

mAterIAls And methods

Study settings and study designThiscross‑sectionalstudywasconductedinagovernmentandprivatetertiarycarehospitalofMangalorecityofSouthIndiainthemonthofFebruary2016.

Ethics committee approvalInstitutionalEthicsCommitteeapprovalwasobtainedbeforethecommencementofthisstudy.Permissiontoconductthisstudy at these hospitalswas obtained from the respectivemedicalsuperintendents.

Sample size calculation and sampling methodSamplesizewascalculatedbasedontheformulaZα2pq/d2,where“p”wastakenas34%basedonthefindingsofapreviousstudy[10]whichreportedthat34%ofparticipantswereawareaboutthewarningsignsofstroke.At95%confidenceintervals,withanallowableerror(d)takenas15%of“p”andsubstituting“q”as100‑p,thesamplesizewascalculatedas332.Itwasroundedoff to400participants.Awarenessofpeopleaboutwarningsignsofstrokeinparticularwaschosenforsamplesizecalculationas it isusually the leastunderstoodamongvariousNCDs.Theparticipantswereenrolled in thisstudybyconveniencesamplingmethod.

Study populationInclusion and exclusion criteria• PatientsandtheirattendersvisitingOPDofthesehospitals

wereincludedinthisstudy• Participantsagedbelow18yearsandseriouslyillpatients

wereexcludedfromthisstudy.

Consent for participationTheparticipantswere explained the nature andpurposeofthestudyandwereassuredconfidentialityoftheinformationprovidedbythem.Writteninformedconsentwastakenfromallconsentingparticipants.

Data collection methodologyDatawere obtained by interviewing each participant in aprivateroomclosetotheOPDusingastructuredinterviewschedule.TheschedulewastranslatedintothelocallanguageKannadaandwaslanguageandcontentvalidatedbyexperts.Itwaspretestedinagroupoftenparticipantswhowerenotincludedinthisstudy.

Sociodemographicdetailssuchasage,gender,maritalstatus,education,occupation,educationandoccupationofheadofthehousehold,totalmonthlyfamilyincome,typeoffamily,andplaceofresidencewereinquiredofeachparticipantby

interviewing them.Theywere also inquired about the pasthistoryandfamilyhistoryofcomorbidities,substanceabuse,dietary habits, and awareness of anymedical emergencynumber. In relation to thestudyobjectives, theparticipantswereinquiredwhethertheyhadheardaboutspecificNCDssuch as heart attack, stroke, hypertension, and diabetesmellitus.Iftheyhadheard,theywerefurtherinquiredaboutriskfactorsandwarningsymptomsandsignsofeachofthefourNCDs.

However,theawarenessofparticipantsregardingimmediatemanagement measures was inquired only for medicalemergenciessuchasheartattackandstroke.Ifmorethanonecorrectanswerwasgivenforeachitembytheparticipant,atotaloftwopointswereawarded.Onlyonepointwasawardedforasinglecorrectanswerandzeropointwasawardedfornoresponseorforanincorrectanswer.

Cumulative score of 0–1was categorized as poor, 2–3 asmoderate,and4–6asgoodawarenesslevelregardingheartattack and stroke. For hypertension and diabetesmellitus,cumulative score of 0–1was categorized as poor, 2–3 asmoderate, and4asgoodawareness.Thecutoff scores2–3indicatingmoderateawarenesslevelwerebasedonasinglecorrect answer by participants to risk factors, warningsymptoms/signs, and immediatemanagementmeasures foreachNCD.

Data analysisDataenteredandanalyzedusingStatisticalPackageforSocialSciencessoftwarepackage(SPSSInc.,Chicago,IL,USA)version16.0.UnivariateanalysisusingChi‑squaretestandmultivariateanalysisusingordinallogisticregressionanalysisweredonetoidentifythepredictorsofgoodawarenesslevelofparticipants. P <0.05wastakenasstatisticallysignificantassociation.

results

Themeanageofthetotal400participantswas36.9±13.0years.Among them, 211 (52.8%) were from the governmentand the rest 189 (47.2%)were from the private hospital.Majority of participantsweremales (270 [67.5%]),wereeducatedtillhighschoollevelorabove(253[63.2%]),wereunskilledworkers (110 [27.5%]),were fromupper lowersocioeconomic status (SES) (46.5%), andwere from ruralareas(246[61.5%])[Table1].

Allparticipantshadheardaboutheartattack,hypertension,anddiabetesmellitus.However,only250 (62.5%)of themhadheardaboutstroke.Themostcommonriskfactorofheartattackidentifiedbytheparticipantswasstress(108[27%]),of strokewas hypertension (30.8%), of hypertensionwasstress(141[35.3%]),andofdiabetesmellituswasexcessivesugarintake(164[41%])[Table2].

Themostcommonwarningsymptomofheartattackidentifiedby the participantswas chest pain (228 [57%]), of strokewasweakness of extremities (56%), of hypertensionwas


229Journal of Natural Science, Biology and Medicine ¦ Volume 9 ¦ Issue 2 ¦ July-December 2018 229

anger (133 [33.3%]), andof diabetesmellituswasdelayedwoundhealing(165[41.3%])[Table3].

Inthisstudy,241(60.3%),265(66.3%),andallparticipantswereawareofatleastonewarningsignorsymptomsaboutheartattack,diabetesmellitus,andhypertension,respectively.Withrespecttostroke,awarenessofatleastonesignorsymptomwaspresentamong179(71.6%)outof250participantswhohadheardaboutstroke[Table3].

Themostcommonimmediatemanagementpracticeforheartattackandstrokeasstatedbyover70%ofparticipantswasmedicalassistance[Table4].

Goodawarenesslevelaboutheartattack,stroke,hypertension,anddiabetesmellituswasseenamong62.5%,57.6%,59%,and55.8%participants,respectively[Table5].

Education,occupation,SES,placeofresidence,andtypeofdietwereassociatedwithawarenesslevelaboutheartattackamongparticipants.Educational status, place of residence,andtypeofdietwereassociatedwithawarenesslevelaboutstrokeamongparticipants.Educationalstatuswasassociated

Table 1: Sociodemographic distribution of the study participants

Characteristics Frequency (%)Agegroup(years)18‑25 85(21.2)26‑35 130(32.5)36‑45 86(21.5)46‑55 58(14.5)56‑65 33(8.3)>65 8(2.0)

GenderMale 270(67.5)Female 130(32.5)

MaritalstatusMarried 270(67.5)Unmarried 126(31.5)Widow 4(1.0)

EducationalstatusGraduate/postgraduate 69(17.2)Intermediate/posthighschooldiploma 92(23.0)Highschool 92(23.0)Middleschool 43(10.8)Primaryschool 59(14.8)Illiterate 45(11.2)

OccupationalstatusProfessional 3(0.8)Semi‑professional 36(9.0)Clerical/shopowner/farmer 56(14.0)Skilledworker 65(16.2)Semi‑skilled 42(10.5)Unskilled 110(27.5)Unemployed 88(22.0)

SES(n=387)Upper 2(0.5)Uppermiddle 81(20.9)Lowermiddle 100(25.9)Upperlower 180(46.5)Lower 24(6.2)

TypeoffamilyNuclear 245(61.3)Joint 93(23.2)Threegeneration 62(15.5)

PlaceofresidenceUrban 154(38.5)Rural 246(61.5)Total 400(100.0)

Table 2: Awareness of risk factors of various noncommunicable diseases among participants (n=400)

Risk factors n (%)HeartattackStress 108(27.0)Hypertension 97(24.3)Smoking 91(22.8)Dyslipidemia 62(15.5)Shockingnews 45(11.3)Obesity 40(10.0)Alcoholintake 24(6.0)Diabetesmellitus 22(5.5)Poorexercisinghabits 15(3.8)Misconceptions 23(5.8)Don’tknow 127(31.8)

Stroke(n=250)Hypertension 77(30.8)Stress 42(16.8)Smoking 31(12.4)Poorphysicalactivity 13(5.2)Dyslipidemia 11(4.4)Obesity 9(3.6)Hereditary 5(2.0)Misconceptions 47(18.8)

HypertensionStress 141(35.3)Increasedsaltintake 52(13.0)Hereditary 36(9.0)Poorphysicalactivity 20(5.0)Obesity 18(4.5)Excessivespiceintake 16(4.0)Dyslipidemia 9(2.3)Misconceptions 18(4.5)Don’tknow 205(51.3)

DiabetesmellitusExcessivesugarintake 164(41.0)Hereditary 82(20.5)Obesity 36(9.0)Stress 29(7.3)Poorphysicalactivity 21(5.3)Junkfoods 19(4.8)Dyslipidemia 12(3.0)Misconceptions 19(4.8)



withawarenesslevelabouthypertensionamongparticipants.Age, SES, and family history of diabetesmellituswereassociatedwithawarenesslevelaboutdiabetesmellitusamongparticipants[Table6].Thisinfersthatagreaternumberofriskfactorswereassociatedwithawarenesslevelaboutheartattackamongparticipants.

Ofthetotalparticipants,322(80.5%)hadheardofemergencynumberwhichneedstobedialedduringmedicalemergencies.However, only 165 (51.2%) of them knew this numbercorrectly.

Multivariate analysis identified several predictors of goodawareness level among participants regarding individualtypesofNCDs.Educationalstatusofhighschoollevelandaboveandbeingavegetarianweresignificantpredictorsofgoodawarenesslevelaboutheartattack,takingilliterateandnonvegetarians as the reference population, respectively.Educationalstatusof intermediate levelandabove,beingavegetarian,andfromanurbanareaweresignificantpredictorsof good awareness level about stroke, taking illiterate,nonvegetarians,andruralresidentsasthereferencepopulation,respectively.Ageabove55yearswasasignificantpredictorof good awareness level about diabetesmellitus, taking18–25yearsasthereferencepopulation[Table7].

dIscussIon

Goodawarenesslevelwasseenamongagreaterproportionofparticipants(62.5%),regardingheartattackcomparedtootherNCDs.Amongthetotalnumberofvariousriskfactorsassociatedwith the awareness level of differentNCDs inthisstudy,majoritywasagainforheartattack.Thisindicatesthat awareness aboutheart attack is quite commonamongpeople.Inapopulation‑basedstudydoneinKuwait,[11]40%ofparticipantswerenotawareofanyheartattacksymptomssimilar to 39.8%observed in this study. In addition, only50.4%wereawarethatchestpainisawarningsymptomforheartattackintheformerstudy[11]comparedto57%reportedhere.

InastudydoneinNellore,India,[10]only35%ofparticipantswereawareaboutstrokeandonly30%ofparticipantsknewlimbweakness as awarning signof stroke.Thesefindingswereagainlesserthanthatreportedinthepresentstudywhere250(62.5%)hadheardaboutstrokeandofthem,56%knewthatitcanmanifestwithweaknessofextremities.

In amultivariate analysis in the former study[10] and in asystematicreview,[12]higheducationalstatuswasfoundtobeassociatedwithgoodawarenesslevelofstrokeasalsoobservedinthisstudyalongwithotherriskfactorsobservedheresuchasbeingvegetariansandfromurbanareas.

There has been a tremendous increase in stroke‑associatedmorbidityandmortalityinIndiaovertheyearstoanextentthat it has exceeded the statistics of industrializedWesterncountries.[13]Therefore,itisamatterofconcernthat37.5%ofparticipantsinthisstudyhadnotheardaboutstrokeandamongthosewhohadheard,28.4%werenotawareofitswarningsymptoms/signs.

Inotherstudies,itwasreportedthat20%–50%[10,12,14]werenotawareofanyriskfactorsand23%–80%[12,14]oftheparticipantswerenotawareofevenasinglewarningsignforstroke.Thetimewithin60minutesofonsetofsymptomsofstrokeiscalledthegoldenhourforstrokemanagement.[15]Hence,awarenessofthisconditionandearlyrecognitionofitswarningsignsandsymptomsneedfurtherimprovementfortimelyinitiationoftreatmentwithinthistimewindow.

Table 3: Awareness of warning symptoms/signs of various noncommunicable diseases among participants (n=400)

Signs and symptoms n (%)HeartattackChestpain 228(57.0)Breathlessness 71(17.8)Painintheupperlimbs 51(12.8)Fatigue 49(12.3)Sweating 46(11.5)Dizziness 21(5.3)Vomiting 7(1.8)Abdominaldiscomfort 3(0.8)Misconceptions 5(1.3)Don’tknow 159(39.8)

Stroke(n=250)Weaknessofextremities 140(56.0)Numbness 97(38.8)Difficultywithspeech 54(21.6)Difficultywithwalking 52(20.8)Imbalance 29(11.6)Dizziness 21(8.4)Misconceptions 27(10.8)Don’tknow 71(28.4)

HypertensionAnger 133(33.3)Dizziness 54(13.5)Headache 41(10.3)Blurringofvision 15(3.8)Sweating 11(2.8)Breathlessness 9(2.3)Sleeplessness 6(1.5)Misconceptions 8(2.0)

DiabetesmellitusDelayedwoundhealing 165(41.3)Fatigue 135(33.8)Polyuria 49(12.3)Dizziness 32(8.0)Polyphagia 30(7.5)Weightloss 28(7.0)Polydipsia 21(5.3)Visualdisturbances 11(2.8)Infections 7(1.8)Misconceptions 23(5.8)Don’tknow 135(33.8)



Table 4: Awareness of immediate management practices in various noncommunicable diseases among participants

Immediate management practices n (%)Heartattack(n=400)Callformedicalhelp 280(70.0)Cardiopulmonaryresuscitation 97(24.3)Rest 48(12)Ventilation 14(3.5)Medication 10(2.5)Loosenclothes 11(2.8)Rubthechest 4(1.0)Misconceptions 6(1.5)Don’tknow 76(19.0)

Stroke(n=250)Callformedicalhelp 178(71.2)Makethemlieononeside 42(16.8)Misconceptions 54(21.6)Don’tknow 65(26.0)

Table 5: Awareness level of participants with respect to different types of noncommunicable diseases

Type of NCD Level of knowledge Total

Poor Moderate GoodHeartattack 134(33.5) 16(4.0) 250(62.5) 400Stroke 27(10.8) 79(31.6) 144(57.6) 250Hypertension 4(1) 160(40) 236(59) 400Diabetesmellitus 4(1) 173(43.2) 223(55.8) 400NCD:Noncommunicabledisease

Table 6: Association between sociodemographic variables and other risk factors with awareness level of participants about various noncommunicable diseases

Risk factors Awareness level about heart attack

Total

Poor/moderate GoodAgegroup(years)18‑25 27(31.8) 58(68.2) 8526‑35 54(41.5) 76(58.5) 13036‑45 28(32.6) 58(67.4) 8646‑55 22(37.9) 36(62.1) 58>55 19(46.3) 22(53.7) 41χ2,P 4.37,0.359

GenderMale 101(37.4) 169(62.6) 270Female 49(37.7) 81(62.3) 130χ2,P 0.003,0.956

MaritalstatusMarried 105(38.9) 165(61.1) 270Unmarried/widow 45(34.6) 85(65.4) 130χ2,P 0.684,0.408

EducationalstatusGraduate/postgraduate 11(15.9) 58(84.1) 69

Table 6: Contd...Intermediate/posthighschooldiploma

24(26.1) 68(73.9) 92

Highschool 34(37) 58(63) 92Middleschool 19(44.2) 24(55.8) 43Primaryschool 31(52.5) 28(47.5) 59Illiterate 31(68.9) 14(31.1) 45χ2,P 44.24,<0.001

OccupationProfessional/semi‑professional

6(15.4) 33(84.6) 39

Clerical/shopowner/farmer

15(26.8) 41(73.2) 56

Skilledworker 18(27.7) 47(72.3) 65Semi‑skilledworker 14(33.3) 28(66.7) 42Unskilledworker 61(55.5) 49(44.5) 110Unemployment 36(40.9) 52(59.1) 88χ2,P 29.4,<0.001

Socioeconomicstatus(n=387)Upper/uppermiddle 17(20.5) 66(79.5) 83Lowermiddle 31(31.0) 69(69.0) 100Upperlower 86(47.8) 94(52.2) 180Lower 8(33.3) 16(66.7) 24χ2,P 20.4,<0.001

TypeoffamilyNuclear 88(35.9) 157(64.1) 245Joint 32(34.4) 61(65.6) 93Threegeneration 30 32 62χ2,P 3.78,0.151

PlaceofresidenceUrbanarea 47(30.5) 107(69.5) 154Ruralarea 103(41.9) 143(58.1) 246χ2,P 5.206,0.023

TypeofdietVegetarian 13(21.7) 47(78.3) 60Nonvegetarian 137(40.3) 203(59.7) 340χ2,P 7.55,0.006

PresenceofNCDsYes 27(38.6) 43(61.4) 70No 123(37.3) 207(62.7) 330χ2,P 0.042,0.838

FamilyhistoryofNCDPresent 62(33.5) 123(66.5) 185Absent 88(40.9) 127(59.1) 215χ2,P 2.33,0.127

HistoryofsubstanceabusePresent 47(37.3) 79(62.7) 126Absent 103(37.6) 171(62.4) 274χ2,P 0.003,0.956

Total 150 250 400

Risk factors Awareness level about stroke Total

Poor/moderate GoodAgegroup(years)18‑25 22(46.8) 25(53.2) 47

Contd... Contd...



Table 6: Contd...26‑35 33(45.8) 39(54.2) 7236‑45 25(40.3) 37(59.7) 6246‑55 14(36.8) 24(63.2) 38>55 12(38.7) 19(61.3) 31χ2,P 1.48,0.829



EducationalstatusGraduate/postgraduate 15(28.8) 37(71.2) 52Intermediate/posthighschooldiploma

24(34.3) 46(65.7) 70

Highschool 29(50) 29(50) 58Middleschool 9(47.4) 10(52.6) 19Primaryschool 15(51.7) 14(48.3) 29Illiterate 14(63.6) 8(36.4) 22χ2,P 12.457,0.029


9(32.1) 19(67.9) 28


11(26.2) 31(73.8) 42

Skilledworker 18(43.9) 23(56.1) 41Semi‑skilledworker 9(42.9) 12(57.1) 21Unskilledworker 32(51.6) 30(48.4) 62Unemployment 27(48.2) 29(51.8) 56χ2,P 8.69,0.122

Socioeconomicstatus(n=242)Upper/uppermiddle 22(33.3) 44(66.7) 66Lowermiddle 22(34.9) 41(65.1) 63Upperlower 47(48.5) 50(51.5) 97Lower 9(56.2) 7(43.8) 16χ2,P 6.31,0.098

TypeoffamilyNuclear 65(40.9) 94(59.1) 159Joint 22(42.3) 30(57.7) 52Threegeneration 19(48.7) 20(51.3) 39χ2,P 0.788,0.674

PlaceofresidenceUrban 36(32.7) 74(67.3) 110Rural 70(50) 70(50) 140χ2,P 7.525,0.006



Table 6: Contd...FamilyhistoryofNCDsYes 45(38.1) 73(61.9) 118No 61(46.2) 71(53.8) 132χ2,P 1.66,0.197

HistoryofsubstanceabusePresent 36(47.4) 40(52.6) 76Absent 70(40.2) 104(59.8) 174χ2,P 1.1,0.293Total 106 144 250

Risk factors Awareness level about hypertension

Total

Poor/moderate GoodAgegroup(years)18‑25 37(43.5) 48(56.5) 8526‑35 57(43.8) 73(56.2) 13036‑45 38(44.2) 48(55.8) 8646‑55 20(34.5) 38(65.5) 58>55 12(29.3) 29(70.7) 41χ2,P 4.37,0.358



EducationalstatusGraduate/postgraduate 34(49.3) 35(50.7) 69Intermediate/posthighschooldiploma

44(47.8) 48(52.2) 92

Highschool 43(46.7) 49(53.3) 92Middleschool 14(32.6) 29(67.4) 43Primaryschool 17(28.8) 42(71.2) 59Illiterate 12(26.7) 33(73.3) 45χ2,P 13.689,0.018


16(41) 23(59) 39


28(50) 28(50) 56

Skilledworker 26(40) 39(60) 65Semi‑skilledworker 19(45.2) 23(54.8) 42Unskilledworker 37(33.6) 73(66.4) 110Unemployment 38(43.2) 50(56.8) 88χ2,P 4.85,0.434

Socioeconomicstatus(n=387)Upper/uppermiddle 41(49.4) 42(50.6) 83Lowermiddle 46(46) 54(54) 100Upperlower 63(35) 117(65) 180Lower 10(41.7) 14(58.3) 24χ2,P 6.1,0.107

TypeoffamilyNuclear 100(40.8) 145(59.2) 245

Contd... Contd...



Table 6: Contd...Joint 39(41.9) 54(58.1) 93Threegeneration 25(40.3) 37(59.7) 62χ2,P 0.049,0.976



PresenceofNCDsYes 28(40) 42(60) 70No 136(41.2) 194(58.8) 330χ2,P 0.035,0.851

PresenceofhypertensionYes 14(33.3) 28(66.7) 42No 150(41.9) 208(58.1) 358χ2,P 1.14,0.286

FamilyhistoryofNCDsYes 71(38.4) 114(61.6) 185No 93(43.3) 122(56.7) 215χ2,P 0.978,0.323

FamilyhistoryofhypertensionYes 41(34.5) 78(65.5) 119No 123(43.8) 158(56.2) 281χ2,P 3.0,0.083

HistoryofsubstanceabusePresent 50(39.7) 76(60.3) 126Absent 114(41.6) 160(58.4) 274χ2,P 0.132,0.716

Total 164 236 400

Risk factors Awareness level about diabetes mellitus

Total

Poor/moderate GoodAgegroup(years)18‑25 45(52.9) 40(47.1) 8526‑35 64(49.2) 66(50.8) 13036‑45 36(41.9) 50(58.1) 8646‑55 27(46.6) 31(53.4) 58>55 5(12.2) 36(87.8) 41χ2,P 21.3,<0.001


MaritalstatusMarried 115(42.6) 155(57.4) 270Unmarried/widow 62 68 130χ2,P 0.925,0.336

EducationalstatusGraduate/postgraduate 26(37.7) 43(62.3) 69

Table 6: Contd...Intermediate/posthighschooldiploma

45(48.9) 47(51.1) 92

Highschool 44(47.8) 48(52.2) 92Middleschool 20(46.5) 23(53.5) 43Primaryschool 28(47.5) 31(52.5) 59Illiterate 14(31.1) 31(68.9) 45χ2,P 5.98,0.308


16(41) 23(59) 39


21(37.5) 35(62.5) 56

Skilledworker 36(55.4) 29(44.6) 65Semi‑skilledworker 20(47.6) 22(52.4) 42Unskilledworker 40(36.4) 70(63.6) 110Unemployment 44(50) 44(50) 88χ2,P 8.61,0.126

Socioeconomicstatus(n=387)Upper/uppermiddle 25(30.1) 58(69.9) 83Lowermiddle 54(54.0) 46(46.0) 100Upperlower 83(46.1) 97(53.9) 180Lower 11(45.8) 13(54.2) 24χ2,P 10.8,0.013

TypeoffamilyNuclear 109(44.5) 136(55.5) 245Joint 47(50.5) 46(49.5) 93Threegeneration 21(33.9) 41(66.1) 62χ2,P 4.2,0.122




PresenceofdiabetesmellitusYes 12(30) 28(70) 40No 165(45.8) 195(54.2) 360χ2,P 3.66,0.056

FamilyhistoryofNCDYes 77 108 185No 100(46.5) 115(53.5) 215χ2,P 0.964,0.326

FamilyhistoryofdiabetesmellitusPresent 33(31.4) 72(68.6) 105Absent 144(48.8) 151(51.2) 295χ2,P 9.49,0.002

Historyofsubstanceabuse

Contd... Contd...



Table 6: Contd...Present 50(39.7) 76(60.3) 126Absent 127(46.4) 147(53.6) 274χ2,P 1.56,0.212

Total 177 223 400NCDs:Noncommunicablediseases

Table 7: Ordinal logistic regression analysis of predictors of awareness level of various noncommunicable diseases among the participants (n=400)

Independent predictors of good awareness level

Adjusted OR

95% CIs of adjusted OR

P

Lower limit

Upper limit

OfheartattackEducationalstatusGraduate/postgraduate

0.14 0.05 0.45 0.001

Intermediate/posthighschooldiploma

0.25 0.1 0.61 0.003

Highschool 0.4 0.17 0.95 0.037Middleschool 0.48 0.19 1.22 0.123Primaryschool 0.56 0.24 1.34 0.192Illiterate 0

TypeofdietVegetarian 0.43 0.21 0.9 0.022Nonvegetarian 0

Ofstroke(n=250)EducationalstatusGraduate/postgraduate

0.23 0.093 0.58 0.002

Intermediate/posthighschooldiploma

0.24 0.098 0.57 0.001

Highschool 0.48 0.198 1.18 0.111Middleschool 0.64 0.223 1.84 0.409Primaryschool 0.69 0.257 1.84 0.455Illiterate 0

PlaceofresidenceUrban 0.55 0.351 0.86 0.01Rural 0

TypeofdietVegetarian 0.47 0.259 0.84 0.011Nonvegetarian 0

OfdiabetesmellitusAgegroup(years)≥56 0.13 0.045 0.365 <0.00146‑55 0.8 0.4 1.59 0.52036‑45 0.62 0.33 1.16 0.13826‑35 0.87 0.493 1.52 0.61618‑25 0

CIs:Confidenceintervals,OR:Oddsratio

Awareness level regarding strokewas significantly betteramongurbanresidentsinthepresentstudy.Similarly,inastudydone inMysore, India, awareness about diabetesmellitus,hypertension, dyslipidemia, and strokewas significantlyhigher among participants from urban area.[16] Better

awareness among themmight be due to easy accessibilitytomedicalcareandhealthclubs,moreofmassmediaandinternetfacilities,andbetterliteracyrateinurbancomparedtoruralareas.

Inthisstudy,awarenessofhypertensionwasseensignificantlybetteramongthosewhowereilliterateorthoseeducateduptoprimaryschoollevelcomparedtoothers.Themoderate‑to‑goodawareness levelabouthypertension in this studywas99%,whichwasalsomuchhigher than that reported inpreviousstudieswhereitrangedfrom36.9%to60%.[7,8,17,18]Thismightbebecauseofopportunisticscreeningofbloodpressure(forthoseagedabove30years)byhealth‑careproviders,whichisdoneroutinelynowadays,undertheNationalProgrammeforPreventionandControlofCancer,Diabetes,CardiovascularDiseasesandStroke.ThisstrategyunderNPCDCSwhichwasimplementedthroughoutIndiain2015mighthavegeneratedawarenessabouthypertensionevenamongthelesseducatedgroups. Previous studies[17,19] reported awareness abouthypertensiontobesignificantlybetteramongwomen,whichwasdifferentfromourobservationswherenoassociationwithgenderwasobserved.

In another study[17] done indifferent parts ofKerala, India,moderate‑to‑goodawarenesslevelaboutdiabetesmellituswasfoundtobe72.2%comparedto99%reportedinthepresentstudy.However,knowledgeofparticularriskfactorssuchasphysicalinactivityandobesityresultingindiabetesmellituswasreportedin11.9%ofparticipantsinaChennai,India[20]basedstudywhichwasmorethanourobservationswhereonly5.3%and9%ofparticipants,respectively,knewit.Thisindicatestheurgentrequirementofneed‑baseddiabeteseducationprogramsinbothurbanandruralIndia.Itshouldtargetthosewhowerefoundparticularlytobelessawareaboutdiabetesmellitusinthepresentstudysuchasyoungerpopulationgroups.

conclusIon

Good awareness level about variousNCDs ranged from55.8% to 62.5%amongparticipants in this study.There isthusaneedforfurtherimprovementofawarenessofpeopleregardingvariousNCDs.Theseawarenessprogramsshouldbe so designed to improve awareness regarding those riskfactorsofNCDswhicharenotwidelyknownamongpeoplesuchasthoseidentifiedinthisstudy.Thiswillhelptheminthe implementationofsuitablepreventivemeasuresagainsttheseriskfactors.Awarenessonwarningsymptomsandsignsandimmediatemanagementmeasureswilladditionallyensureearlydiagnosisandtreatment.Thevarioussociodemographicgroupsidentifiedtohavepoorknowledgeinthepresentstudyneedtobeprovidedtargetedinterventionduringthesehealtheducationalcampaigns.ThesemeasureswillhelpincontainingthecurrentincreasingburdenofNCDsinIndia.

LimitationApopulation‑basedstudywouldhavegivenabetterestimateoftheawarenesslevelofvariousNCDsincomparisontoanyhospital‑basedstudy.



AcknowledgmentsTheauthorsthankthemedicalsuperintendentsofthehospitalsfortheircooperationintheconductofthisstudy.

Financial support and sponsorshipNil.

Conflicts of interestTherearenoconflictsofinterest.

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