Impact of Migration on Non-Communicable Disease Risk Factors: Comparison of Gulf Migrants and their Non-Migrant Contemporaries in the District of Origin in Kerala, India

Introduction: We assessed the prevalence of non-communicable disease (NCD) risk factors between gulf migrant workers and non-migrant workers of Malappuram district, Kerala. Methods: Using a multistage cluster sampling technique, 191 migrants and 193 non-migrant men between 25-65 years of age were selected. Data on NCD risk factors were collected using World Health Organization (WHO) STEPS protocol. Multivariate analysis was used to find the relation between migration and NCD risk factors Results: Prevalence of current tobacco use was 21.4% among migrants and 16.6% among non-migrants, current alcohol use was 8.9% among migrants and 12.4% among non-migrants, physical inactivity was 26.7% among migrants and 23.8% among non-migrants, poor diet habit was 86.9% among migrants and 76.2% among non-migrants, history of chronic diseases was 37.5% among migrants and 21%among non-migrants, working 7 days /week was 35% among migrants and 1% among non-migrants, working >8hrs/day was 76.9% among migrants and 33.1% among non-migrants, sleeping less than 6hrs /day was 41.3% among migrants and 14% among non-migrants. Prevalence of hypertension was 59.7% among migrants and 29.8% among non-migrants (p=<0.001) (adjusted OR 2.5, 95% CI=1.38-4.46), abdominal obesity was 79.5% among migrants and 44.5% among non-migrants (p=<0.001) (adjusted OR 2.4, 95% CI=1.35-4.31). Among migrant hypertensive 43.5% were aware, 33.9% were on treatment and 12.2% achieved adequate control, the corresponding figures for non-migrants were 56.9%, 53.4%, and 48.3% respectively. Conclusion: Majority of the risk factors were significantly higher among gulf migrants than non-migrants, which calls for urgent intervention to reduce these risk factors in this population.

Risk factor profile for non-communicable diseases among Mishing tribes in Assam, India: Results from a WHO STEPs survey.

Background & objectives: A comprehensive risk factor profile of non-communicable diseases (NCDs) as suggested by the World Health Organization (WHO) has not been reported from tribal population in India. This survey was carried out to assess the prevalence of NCD risk factors among Mishing tribes in Assam using the WHO STEPs approach. Methods: A total of 332 individuals of the Mishing tribe (men 54%) aged 25-64 yr were selected from Tinsukia district by multistage cluster sampling. Using the WHO STEPs approach information was collected on demographics, STEP 1 variables (tobacco, alcohol, physical activity, diet) and measured STEP 2 variables (weight, height, waist circumference and blood pressure). Multivariate analysis was used to find the relation between STEP 1 and STEP 2 variables. Results: Overall, tobacco use was 84 per cent (men 94%; women 73%, p<0.001) and alcohol use was 67 per cent (men 82%; women 50%, p<0.05); 86 per cent reported vigorous physical activity, (men 91%, women 82%; p < 0.05). Sixty eight per cent reported to consume unhealthy diet (less than five servings of fruits and vegetables/day), 11 per cent had abdominal obesity, 16 per cent were overweight and 26 per cent had hypertension. Non users of tobacco and those who consumed more fruits and vegetables had higher prevalence of overweight (p<0.05). Among the hypertensives, 24 per cent were aware, 17 per cent treated and 2.4 per cent controlled their hypertension. Older individuals had higher hypertension prevalence (p<0.05) compared to younger individuals. Interpretation & conclusions: Tobacco use, alcohol use and unhealthy diet habits were high among men and women in this population and were major NCD risk factors. An integrated approach of culturally appropriate population level and high risk strategies are warranted to reduce these risk factors and to enhance adequate control of hypertension.

Assessing the readiness to integrate tobacco control in medical curriculum: Experiences from five medical colleges in southern India.

Background. Making tobacco cessation a normative part of all clinical practice is the only way to substantially reduce tobacco-related deaths and the burden of tobacco-related morbidity in the short term. This study was undertaken because information on receptivity to integrate tobacco control education in the medical curriculum is extremely limited in low- and middle-income countries. Methods. From five medical colleges (two government) in southern India, 713 (men 59%) faculty and 2585 (men 48%) students participated in our cross-sectional survey. Information on self-reported tobacco use and readiness to integrate tobacco control education in the medical curriculum was collected from both the faculty and students using a pretested structured questionnaire. Multiple logistic regression analysis was done to find the associated factors. Results. Current smoking was reported by 9.0% (95% CI 6.6–12.1) of men faculty and 13.7% (CI 11.8–15.9) by men students. Faculty who were teaching tobacco-related topics [odds ratio (OR) 2.29; 95% CI 1.65–3.20] compared to those who were not, faculty in government colleges (OR 1.69; CI 1.22–2.35) compared to those in private colleges and medical specialists (OR 1.79; CI 1.23–2.59) compared to surgical and non-clinical specialists were more likely to be ready to integrate tobacco control education in the medical curriculum. Non-smoking students (OR 2.58; CI 2.01–3.33) compared to smokers, and women students (OR 1.80; CI 1.50–2.17) compared to men were more likely to be ready to integrate a tobacco control education in the curriculum. Conclusion. Faculty and students are receptive to introduce tobacco control in the medical curriculum. Government faculty, medical specialists and faculty who already teach tobacco-related topics are likely to be early introducers of this new curriculum.

Risk factor profile for chronic non-communicable diseases: Results of a community-based study in Kerala, India.

Background & objectives: Kerala State is a harbinger of what will happen in future to the rest of India in chronic non-communicable diseases (NCD). We assessed: (i) the burden of NCD risk factors; (ii) estimated the relations of behavioural risk factors to socio-demographic correlates, anthropometric risk factors with behavioural risk factors; (iii) evaluated if socio-demographic, behavioural and anthropometric risk factors predicted biochemical risk factors; and (iv) estimated awareness, treatment and adequacy of control of hypertension and diabetes, in Kerala state. Methods: A total of 7449 individuals (51% women) stratified by age group, sex and place of residence were selected and information on behavioural risk factors; tobacco use, diet, physical activity, alcohol use, measured anthropometry, blood pressure was collected. Fasting blood samples were analysed for blood glucose, total cholesterol, high density lipoprotein cholesterol and triglycerides in a sample subset. Using multiple logistic regression models the associations between socio-demographic and anthropometric variables with biochemical risk factors were estimated. Results: The burden of NCD risk factors was high in our sample. Prevalence of behavioural and each of the biochemical risk factors increased with age, adjusting for other factors including sex and the place of residence. The odds ratios relating anthropometric variables to biochemical variables were modest, suggesting that anthropometric variables may not be useful surrogates for biochemical risk factors for population screening purposes. Interpretation & conclusions: In this large study of community-based sample in Kerala, high burden of NCD risk factors was observed, comparable to that in the United States. These data may serve to propel multisectoral efforts to lower the community burden of NCD risk factors in India in general, and in Kerala, in particular.