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Preventive approach: Key to tackling NCDs

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Non communicable diseases have unquestionably become a healthcare priority in India. The pattern of NCDs in rural India looks largely similar to that in urban India

The disease pattern in India, particularly rural India, has undergone a significant shift over the last 15 years. Whilst previous health efforts focussed primarily on addressing communicable diseases, according to the Global Status Report on NCDs (2014) 62 per cent of deaths in India were due to non communicable diseases.

Non communicable diseases (NCDs) have unquestionably become a healthcare priority in India. The pattern of NCDs in rural India looks largely similar to that in urban India. High blood pressure, the biggest metabolic risk factor for death worldwide, now affects one in five adults in rural India, while diabetes affects about one in 20 adults.

With this significant shift in the health profile of rural India, there is a need, now more than ever, to focus on taking a preventive approach to tackling non-communicable diseases (NCDs). In fact, a study conducted by Ambuja Cement Foundation (ACF) across 101 villages and 1440 respondents (Control and interventions villages), highlighted the fact that 90 per cent of respondents had poor knowledge of risk factors of NCDs – which contributed to poor lifestyle choices and resulted in high prevalence of disease.

Additionally, the study showed that one in five of those diagnosed with NCD, had not sought care which led to inadequate treatment and poor outcomes. By identifying high risk groups and conducting focussed education and awareness interventions, we can help rural communities make the necessary lifestyle changes to curb the onset of NCDs in the future.

A multi-pronged approach
With a variety of inroads into rural communities, ACF has been educating groups of engaged community members, who currently work closely with ACF on various other programme interventions, on the risk factors of NCDs and the necessary lifestyle changes to curb them.

By leveraging the already strong relationships they have with these groups, they have been able to influence behaviour change in a stronger way. Education and awareness activities target a variety of community groups, including women, farmers, adolescents and the broader community. They cover topics like awareness building and finding the root cause of NCD to lifestyle changes being implemented and addiction control.

Self Help Groups – Self Help Groups are an association of community women. Providing health interventions to women in SHGs provides an easy connect with the community. By focussing on nutritional practices and right food for the family, ACF has been able to influence women who primarily cook food for their family. With high fat, salt and sugar intake being key lifestyle contributors to these diseases, ACF’s brigade of Sakhi’s (community health workers) have been conducting nutrition awareness by facilitating cooking demonstrations, reduced intake of deep fried foods, and reduction of processed foods which are widely advertised in rural communities. Additionally they are actively promoting an increase in physical activity and advocating a reduction in alcohol and tobacco consumption. In Chandrapur, most women in villages have started taking morning walks in groups, Bhatapara has kick-started yoga classes, and in Bathinda, an open gym has been established all through community efforts.

Farmer Groups – ACF works extensively in agricultural livelihoods and provides inputs to different farmer groups to help them increase their profitability. ACF health team also creates awareness to these farmers about NCD awareness, with a primary focus on diabetes and hypertension.

Adolescents in schools – Adolescents are showing high incidences of overweight and obesity which is a major risk factor for NCD. Age standardised prevalence of obesity has increased in India by 22 per cent in recent years. Adolescents also have shown an obsession with fast and junk food available nearby school and colleges which presents a major risk. Every ACF location has an Adolescent Health Education Programme being run in schools, called as APEKSHA (an adolescent peer educator module) which primarily focusses on sexual and reproductive health. By tapping into this existing programme, ACF has been able to educate and reach adolescents with preventive health messages.

Reaching Household – ACF reaches households through Sakhis and evaluate adult population over 30 years of age with a questionnaire based risk assessment on NCD. These are probable high risk which can be prevented with lifestyle modifications. Risk assessment questionnaire assesses on risk factors and also helps to create awareness.

Community in general – The broader community is targeted through various mass events, rallies, poster exhibitions, and wall paintings, screen camps with various health messages towards preventive and promotive health. In fact, across many locations, ACF team members tied up with local health systems to create a community drive for early identification of NCD and lifestyle modification.

Scaling interventions
Current NCD interventions by ACF are conducted across seven locations and include 125 villages, 34055 households, and a total of 1,57,857 (of which 61,243 are adults above 30 years) in which 13 per cent diabetes and 24 per cent hypertension prevalence was observed. To date, 15,586 people (28 per cent of population) have already been identified as high risk and screening continues regularly.

There are further plans to scale in the future. By working in collaboration with Harvard TN Chan School of Public Health, ACF has formed a tripartite agreement between ACF, Harvard (HSPH) and the District Health Department of Bathinda to conduct an action research study on NCD in 12 villages of Bathinda district in Punjab. The study is being done in a stepped wedge manner,
targeting over the age of 30 population for a duration of two years. The purpose of the study is to collect accurate data and document evidence based practice to identify the difference made on NCDs pre and post interventions, using interventions and control groups within the 12 selected villages at different intervals. The collected data will range from their demographics characteristics, medical diagnostics and medical history to addiction patterns and treatment taken. Field observations will be conducted on a regular basis to reinforce and ensure the importance of measurement precision and standardised data collection methodology. Additionally, by tying up with mDiabetes, ACF will generate and circulate information to community members on mobile phones with pre-recorded messages on diabetes prevention, nutrition, lifestyle modifications.

A partnership with Cipla Foundation and Chest Research Foundation as technical support, will see ACF expand its NCD interventions into chronic obstructive pulmonary disease (COPD) and asthma. For the next two years, it will expand the scope of its work to include respiratory conditions. ACF will perform various tests in clinics set up by ACF that are now owned by the community servicing over 7,000 households of 48 villages of the district. The drive will be led by the Sakhis, who will also initiate community mobilisation, thereby creating awareness about risk factors, like indoor pollution and nutrition.

The economic impact of NCDs
NCDs pose a significant economic threat to rural India. NCDs not only affect health, but also productivity and economic growth. The probability of dying during the most productive years (ages 30-70) from NCDs is a staggering 26 per cent. As such, India stands to lose $4.58 trillion before 2030 due to NCDs. There is a need for more stakeholders to collaborate and work together to encourage lifestyle and behaviour changes among rural communities, to curb the frightening trend towards NCD growth among these vulnerable populations. ACF will continue to make efforts to attempt to create pilots around important health issues with cost effective models to address for rural India.

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