ABSTRACT Context: Hypertension affects nearly a quarter of adults in India. While there are issues related to diagnosis and treatment gaps, even among those who receive treatment, adherence is a problem resulting in poor control. Aims: To identify predictors of nonadherence to antihypertensive medications among hypertensive adults in Delhi. Settings and Design: A community-based cross-sectional study was conducted in the Palam area of Southwest Delhi, the field practice area of the Department of Community Medicine, Lady Hardinge Medical College. Materials and Methods: Systematic random sampling was done to enroll 322 study participants. A semi-structured, pretested questionnaire was used to collect data, and Morisky’s Medication Adherence Scale, consisting of eight items, was used to assess adherence to medication. Participants who scored <8 on an 8-item Morisky Medication Adherence Scale were considered nonadherent, and those with a score of 8 were considered adherent. Statistical Analysis Used: IBM Statistical Package for the Social Sciences, version 25 for cleaning and analysis. Quantitative data were expressed in terms of mean and standard deviation. Qualitative data were expressed as proportions, and the chi-square test was applied to calculate statistical significance. Univariate and multivariable analyses were conducted to identify the predictors of nonadherence. P- value < 0.05 was considered statistically significant. Results: Nonadherence to antihypertensive medications was 74.3% (95% confidence interval [CI]: 69.7%–79.3%). Symptomatic patients had significantly higher odds of nonadherence (adjusted odds ratio [AOR] = 2.63; 95% CI: 1.40–4.96; P = 0.003). Patients with comorbidities were found to have significantly lower odds of nonadherence (AOR = 0.22; 95% CI: 0.11–0.43; P < 0.001). Conclusions: Nonadherence to antihypertensive medication was found to be high. Being symptomatic was associated with more nonadherence. Having comorbidities was associated with less nonadherence. Targeted interventions are needed to improve adherence in these groups.
ABSTRACT Objective: To compare the clinical, electrocardiographic, and biochemical characteristics of ST-elevation myocardial infarction (STEMI) and non-ST-elevation acute coronary syndrome (NSTE-ACS) and to evaluate factors associated with cardiogenic shock (CS). Materials and Methods: In this prospective observational study, 105 consecutive patients aged 18-80 years with acute coronary syndrome, admitted to a tertiary care center (June 2024–May 2025) were classified as STEMI ( n = 42) or NSTE-ACS ( n = 63; non-ST-elevation myocardial infarction = 48, unstable angina = 15). Clinical, electrocardiogram, and laboratory data were recorded at admission. Results: The mean age was 58 ± 10.8 years, and 74% were male. STEMI was associated with a higher incidence of CS (29% vs. 3%, P < 0.01) and lower left ventricular ejection fraction (median: 42.5% vs. 47.5%, P = 0.04) compared with NSTE-ACS. STEMI patients had higher levels of D-dimer, procalcitonin, creatine kinase-myocardial band, and neutrophil counts (all P < 0.05), consistent with greater thrombotic and inflammatory activity. CS occured more frequently in patients with diabetes (79% vs. 35%, P < 0.01) and in females (50% vs. 22%, P = 0.05). Conclusions: STEMI is associated with greater inflammatory and thrombotic activation and a higher risk of CS than NSTE-ACS. Diabetes was associated with an increased occurrence of CS. These findings require confirmation in larger studies.
ABSTRACT The burden of noncommunicable diseases (NCDs), including cardiovascular disease (CVD), is rapidly increasing in Thailand; 74% of deaths are caused by NCDs. Healthcare systems are required to adapt to respond to this disease shift, particularly in primary care, where most NCDs are managed. The concept of learning health systems (LHS) is one approach to driving quality improvement (QI) in NCD management and control. Championed by the World Health Organization, the LHS approach supports dynamic learning being embedded into routine clinical care. One example of an LHS study aims to trial and evaluate the LHS approach for the management of hypertension, diabetes mellitus, and chronic kidney disease in primary care in Chiang Mai and Lamphun provinces (Reg No: NCT06873243). Electronic health record (EHR) data will be used in digital software to help primary care staff prioritise patients for CVD management. Staff will receive support and training from facilitators, staff experienced in the use of EHRs to drive QI. Eventually, peer learning networks will be developed for continued learning across primary care units. There are challenges and opportunities associated with this approach. Although it can offer solutions developed from existing resources, existing challenges in providing care may be exacerbated if the LHS is not supported properly. The future of using the LHS approach for the control of CVD in primary care will require transparent knowledge exchange, an open approach to sharing challenges, and continued feedback cycles to embed iterative learning in routine care.
ABSTRACT Background: Leptin and ghrelin regulate appetite and inflammation, but their role in inflammatory bowel disease (IBD) is unclear. This study examined the associations between serum leptin and ghrelin levels and IBD activity, nutritional indicators, and inflammatory markers. Materials and Methods: A case–control study included 55 IBD patients (31 ulcerative colitis and 24 Crohn’s disease [CD]) and 55 healthy controls. Disease activity was assessed using the Mayo score, CD activity index, and fecal calprotectin (FC). Serum leptin and ghrelin were measured via enzyme-linked immunosorbent assay. Body mass index (BMI), total nutritional score, folic acid, and inflammatory markers were recorded. Group comparisons, Spearman’s correlations, and receiver operating characteristic (ROC) analyses were conducted. Results: A total of 110 individuals were analyzed (34 active IBD, 21 inactive IBD, and 55 controls). Demographics were similar across groups. Hormone levels differed significantly by disease activity ( P < 0.001). Leptin level was highest in controls and lowest in active IBD; ghrelin level was highest in controls, intermediate in active IBD, and lowest in inactive IBD. Ghrelin showed negative correlations with BMI, nutritional score, and alkaline phosphatase and a positive correlation with folic acid. Leptin correlated positively with BMI, erythrocyte sedimentation rate, and FC and negatively correlated with nutritional score. ROC curves demonstrated predictive value for nutritional decline for both leptin (area under the curve [AUC] 0.744– P < 0.001) and ghrelin (AUC = 0.64, P = 0.008). Conclusion: Leptin and ghrelin in IBD were associated with inflammatory markers and nutritional status, showing stronger links with inflammation. Their combined measurement may aid understanding of metabolic changes in active disease, though longitudinal studies are needed.
Background: Physical inactivity (PI) is a major global risk factor for noncommunicable diseases (NCDs), causing around 5 million deaths annually. PI is defined by the World Health Organization as insufficient physical activity to meet current health recommendations, namely <150 min of moderate-intensity or 75 min of vigorous-intensity physical activity per week among adults. In Africa, rapid urbanization and lifestyle transitions have fueled increasing inactivity, particularly in urban settings. This study examined the prevalence and determinants of PI among adults in Africa. Methods: This cross-sectional study analyzed World Health Organization STEPwise approach to surveillance (STEPS) survey data collected between 2014 and 2019 from twelve African countries, focusing on adults aged 15–69 years. Weighted logistic regression was used to explore associations between PI and sociodemographic, behavioral, and biomedical factors while accounting for complex survey design to ensure national representativeness. Results: The study found an overall PI prevalence of 16.7% (95% confidence interval [CI]: 15.9–17.5), with higher rates among women (20.8%) than men (10.6%) and in urban (20.3%) versus rural residents (12.1%). A pronounced age gradient was observed, with inactivity increasing steadily from 9.1% among those aged 15–19 years to 31.0% among adults aged ≥65 years. This age-related increase was evident in both sexes; however, females consistently exhibited higher levels of PI than males across all age groups. Overall, PI was nearly twice as prevalent among females (20.8%) compared with males (10.6%; 95% CI: 9.8–12.0), indicating a clear gender-based disparity superimposed on the age trend. Higher education, self-employment, and chronic conditions such as hypertension (25.9%) and diabetes (20.7%) were associated with PI. Predicted probabilities confirmed a sharper rise among older women, highlighting key high-risk groups. Conclusion: PI affects one in six African adults, rising with age and disproportionately higher among women, urban residents, and those with higher education. It is strongly associated with hypertension, diabetes, and poor dietary habits, highlighting its contribution to the growing burden of NCDs. Targeted, context-specific interventions are needed, including gender-sensitive programs, life-course approaches, urban planning for active living, and integration with NCDs prevention. Such strategies can reduce sedentary behavior and support healthier, more active populations across Africa.
ABSTRACT Context: Hepatitis B and C are blood-borne infections affecting the liver. Patients with diabetes mellitus (DM) are at increased risk of these infections through frequent percutaneous exposures while practicing regular blood glucose monitoring and insulin injections. Thus, the study was undertaken to evaluate the effectiveness of a nurse-led self-care package on the prevention and management of hepatitis B and C among type 1 and type 2 diabetes mellitus (T1DM and T2DM) patients. Materials and Methods: An experimental two-group pretest–posttest design was used, and the study was done in the Endocrinology Outpatient Department, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh. A total of 100 T1DM and T2DM patients were randomized into control ( n = 50) and experimental ( n = 50) groups. Primary outcomes included hepatitis B and C prevention practices and hepatitis B vaccination status. Data were collected from September to December 2023. Baseline assessments were done through interviews and observation checklists. The experimental group received a nurse-led self-care package followed by three telephonic follow-ups, i.e., at weeks 1, 2, and 4. Endline assessment for both groups was conducted at the eighth week. The study was ethically approved by the Institute Ethics Committee, PGIMER, and registered with the Clinical Trials Registry-India (CTRI/2023/08/057132). Results: The experimental group showed significant improvement in knowledge about hepatitis B and C prevention and management, with mean knowledge scores increasing from 18.56 ± 4.60 to 26.08 ± 1.60. Percutaneous exposure practices improved more in the experimental group, with a mean score change of 9.72 compared to 4.66 in the control group. The prevalence of hepatitis C among diabetic patients was 1%. Conclusion: The nurse-led self-care package effectively improved percutaneous practices and knowledge on hepatitis B and C prevention among T1DM and T2DM patients.
Abstract Background: Noncommunicable diseases (NCDs) are the leading cause of death globally and account for over one-third of mortality in the World Health Organization (WHO) African Region. Surveillance systems are essential for tracking progress toward the global NCD targets for 2025 and Sustainable Development Goal 3.4, yet capacity across countries in the region remains uneven. Materials and Methods: We conducted a descriptive study of NCD surveillance systems in the WHO African Region. Data sources included the 2023 WHO NCD Country Capacity Survey (CCS) and the WHO internal database of STEPwise risk-factor surveys (STEPS). CCS responses were triangulated with WHO taxation datasets, International Agency for Research on Cancer registry listings, and WHO-Global Database on the Implementation of Food and Nutrition Action. Analyses were descriptive, using frequency tables, composite policy indices, choropleth maps, and heat maps. Results: Of 47 countries, 46 responded to the CCS. Eighteen countries (38.3%) were on-cycle for STEPS, 25 (53.2%) were off-cycle, and 4 (8.5%) had never conducted a survey. Standardized patient-level data systems were reported by 71.7% of countries, with cancer registries present in 80.4%, but registries for stroke and myocardial infarction were almost absent. National NCD strategies existed in 51.1% of countries, whereas 78.7% had clinical guidelines. Adoption of upstream policies was low, particularly for healthy diet (8.5%) and physical activity (10.6%). Only two countries had functional Civil Registration and Vital Statistics (CRVS) systems for cause-specific mortality. Conclusion: The WHO African Region has made progress in STEPS and cancer registries, but critical gaps remain in CRVS and upstream policy adoption. Strengthening surveillance, expanding registries, and prioritizing CRVS are essential for achieving the 2025 and 2030 NCD targets.
ABSTRACT The rising burden of noncommunicable diseases (NCDs) in India requires a holistic approach to disease control efforts. This review synthesizes evidence from articles, government reports, policy briefs, and guidelines to describe lessons learnt, challenges in surveillance, and propose a comprehensive framework for surveillance. Nationwide surveys have been periodic, expensive, time-consuming exercises generating evidence on four main risk factors (unhealthy diet, inadequate physical activity, and alcohol and tobacco use) and on major NCDs (cancer, cardiovascular diseases, diabetes, and chronic respiratory diseases). Although the country has demonstrated capacity in conducting surveys, registries, and risk factor assessments, there has been no cohesive linking of such information to action and evaluation to complete the surveillance cycle. Many of the surveys do not reflect state or district-level patterns that can enable better health planning. India lacks a systematic ongoing NCD surveillance system, even though there is a huge demand for it in the context of the rising NCD burden. The challenge is that no single model of surveillance can assess the interconnected risk factors, their social, commercial, and health system drivers, and NCD morbidity and mortality. A well-defined policy for institutionalizing NCD surveillance with well-defined objectives, standard methods, definitions, risk factors, health conditions, and health system response is the need of the hour. An exposome framework of endogenous and exogenous lifetime exposures and health effects monitoring can be instituted through a combination of active and passive models, digital data, a whole-of-society and whole-of-government approach. These shall support NCD surveillance and guide NCD prevention and control efforts.
ABSTRACT Noncommunicable diseases (NCDs) remain the leading cause of death globally, with the World Health Organization (WHO) South-East Asia Region (SEAR) facing a disproportionately high burden and risk of missing Sustainable Development Goal target 3.4.1. This article presents a comprehensive review of NCD surveillance and monitoring systems across the regional countries, aligned with the WHO Global Monitoring Framework. The analysis draws on WHO reports and surveys to assess three core areas of NCD surveillance and monitoring: national civil registration and vital statistics systems (CRVS) for mortality surveillance, conduct of population-based surveys for surveillance of NCD risk factors, and the capacity of the patient information systems to monitor programmatic and patient-level NCD outcomes. Findings reveal significant gaps in mortality surveillance, with only Thailand achieving full functionality in generating reliable cause-specific mortality data. Risk factor surveillance shows moderate progress, with Bhutan, Nepal, and Sri Lanka fully achieving the indicator for adult surveys, whereas adolescent-focused surveillance remains limited. Cancer registries are unevenly distributed, with only Bhutan meeting the gold standard of national population-based registries. Patient-level data systems are present in most countries but vary in coverage, digitization, and interoperability. Thailand is the only country with fully electronic systems across all care levels. The SEAHEARTS initiative has catalyzed digital tracking of hypertension and diabetes, yet operationalization remains inconsistent. Strengthening CRVS systems, institutionalizing periodic surveys, expanding cancer registries, and investing in interoperable digital health systems are recommended to enhance NCD surveillance and monitoring in the WHO SE Asia region. These efforts are critical to inform policy, improve service delivery, and accelerate progress toward global NCD targets.
ABSTRACT Background: Adolescent obesity represents an escalating public health challenge in India, with limited evidence on its multifactorial determinants. This study was undertaken to assess the prevalence and determinants of overweight and obesity among school-going adolescents in South India. This study employed the waist-to-hip ratio and body mass index to assess central obesity. Materials and Methods: Four schools were selected using stratified random sampling. Preexisting validated questionnaires were adapted. Dietary intake patterns were assessed using the World Health Organization Oral Health Assessment Proforma and the NOVA food classification system. Physical activity (PA) was assessed using the Physical Activity Questionnaire for Adolescents. Anthropometric measurements were recorded using regularly calibrated standardized equipment. Results: Among the 372 sampled adolescents, the prevalence of overweight or obesity was 17.2% while 14% of participants had central obesity based on waist-to-hip ratio. Female participants (adjusted odds ratio [AOR]: 3.68; 95% confidence interval [CI]: 1.78–7.62), participants from upper (AOR: 4.85; 95% CI: 1.00–23.46) or middle (AOR: 6.07; 95% CI: 1.63–22.57) socioeconomic class, and those of older age (AOR: 2.00; 95% CI: 1.24–3.21) showed significantly higher odds of being overweight or obese. Consumption of three or more meals per day (AOR: 7.16; 95% CI: 1.43–35.61), moderate consumption of ultra-processed foods (UPFs; AOR: 2.94; 95% CI: 1.23–7.01), and higher consumption of culinary ingredients (AOR: 3.75; 95% CI: 1.08–12.98) were significantly associated with increased odds of central obesity. Conclusion: Higher UPF intake was significantly associated with central obesity, and adequate sleep and PA were associated with lower odds of overweight or obesity. There is a need for multilevel intervention, implementing school-based regulations to restrict the availability of UPFs and incorporating health education into school curricula.
ABSTRACT Background: Diet is a key determinant of health across the life course. Balanced and healthy diets reduce risks of malnutrition and noncommunicable diseases (NCDs), whereas unhealthy diets high in refined carbohydrates, fats, sugars, and salt increase risks of obesity, diabetes, cardiovascular diseases, and cancers. Southeast Asia faces a nutrition transition marked by rising consumption of processed foods, contributing to a double burden of undernutrition and NCDs. Strengthened nutrition surveillance is essential to inform policy and public health action. Methodology: A systematic search and narrative review were conducted across 10 WHO Southeast Asia Region countries. Reports and national surveys from governments, WHO, and peer-reviewed publications were examined. Data on surveillance coverage, frequency, indicators (dietary diversity, micronutrient intake, anthropometry, and biomarkers), and prevalence of NCD risk factors were synthesized. Results: NCDs account for 53%–85% of mortality across the region. Hypertension and diabetes are most prevalent in Timor-Leste and India, while overweight and obesity are highest in Nepal and Thailand. Physical inactivity is widespread in the Maldives and India, but lower in Nepal and Myanmar. Daily per capita calorie intake ranges from 1485 kcal in Thailand to 2571 kcal in Myanmar. Existing surveillance systems – such as India’s National Nutrition Monitoring Bureau and the Comprehensive National Nutrition Survey, WHO STEPS, and national health surveys – vary considerably in scope, frequency, and integration of dietary and metabolic indicators. Conclusion: Nutrition surveillance in Southeast Asia remains fragmented, limiting timely responses to the double burden of malnutrition and NCDs. Inferences: The substantial heterogeneity and fragmentation of nutrition surveillance systems across Southeast Asia highlight an urgent need for harmonized, integrated, and periodic monitoring frameworks that combine dietary, anthropometric, and metabolic indicators. Strengthening regional surveillance capacity is critical to guide evidence-based policies addressing both undernutrition and the escalating burden of NCDs.
ABSTRACT Objective: This study aimed to evaluate the psychometric properties of the Turkish version of the Type 2 Diabetes Distress Assessment System (T2-DDAS-TR) and to examine its validity and reliability among patients with type 2 diabetes mellitus (T2DM). Materials and Methods: This methodological study was conducted with 153 patients with T2DM attending an internal medicine outpatient clinic between December 2022 and April 2023. Construct validity was assessed using Confirmatory Factor Analysis (CFA) performed with IBM SPSS Statistics 24.0 and LISREL 8.80. Data were collected through a demographic information form and the T2-DDAS-TR. Reliability was evaluated using Cronbach’s alpha coefficients. Results: Language equivalence and content validity were ensured through expert review and pretesting. CFA confirmed the 29-item, eight-factor structure of the T2-DDAS-TR, comprising eight items for core distress and 21 items across seven distress source domains. Fit indices indicated acceptable model fit ( χ 2 /df = 1.951, comparative fit index = 0.96, incremental fit index = 0.96, root mean square error of approximation = 0.074, standardized root mean square residual = 0.071). Item factor loadings ranged from 0.35 to 0.78. Cronbach’s alpha values ranged from 0.55 to 0.89 across subscales, demonstrating satisfactory internal consistency. Conclusion: The T2-DDAS-TR exhibited strong content validity, construct validity, and reliability, supporting its use as a culturally appropriate instrument for assessing both the intensity and sources of diabetes-related distress in Turkish patients with T2DM. Further studies on larger and more diverse samples are recommended to confirm its robustness across the clinical settings.
ABSTRACT Diabetes is a growing global public health concern that places a substantial burden on health care systems, particularly in low- and middle-income countries (LMICs). Rapid lifestyle and nutritional transitions, combined with limited resources, contribute to the rising prevalence and poor management of this disease in these settings. Globally, an estimated 589 million adults aged 20–79 years are living with diabetes, with LMICs carrying most of this burden. In India, the progression from impaired glucose tolerance or impaired fasting glucose to diabetes occurs more rapidly than in many other populations, highlighting the need for timely detection and effective surveillance. Diabetes surveillance is essential to guide prevention, early diagnosis, and management. Approaches include passive, active, and sentinel surveillance. Passive surveillance relies on routinely collected data to track disease patterns. However, it often underestimates the actual burden. Active surveillance involves systematically seeking cases in the community and generating more accurate estimates but requires greater resources. Sentinel surveillance, using selected health care facilities or defined populations, offers a practical middle ground by monitoring trends, assessing risk factors, and evaluating interventions in a representative manner. This strategy is particularly valuable in LMICs with fragmented health care systems and limited resources. Despite the importance of surveillance, LMICs face barriers such as limited public awareness, stigma, workforce shortages, and inadequate laboratory and treatment facilities. Strengthening surveillance through improved health information systems, integration of sentinel sites, and use of digital health care tools can provide reliable data to inform public health action and reduce the growing burden of diabetes.
ABSTRACT Surveillance underpinned by the global monitoring framework provide internationally comparable data on noncommunicable diseases (NCDs) and their risk factors over time and benchmarks the situation in individual countries against others. Over the last decade, data on 25 indicators of the global monitoring framework have provided the foundation for advocacy, policy development, political commitment, and accountability for NCD prevention and control. This paper discusses how surveillance and monitoring have helped to prioritize NCDs in the global health agenda, reinforce political commitment, galvanize international support, and promote accountability for prevention and control of NCDs at global, regional and national levels. It outlines why surveillance and monitoring are absolutely essential for governance of NCD prevention and control including the development and implementation of NCD plans, policies, coordination mechanisms, financing strategies and a health system response. In addition, it underscores the seminal role of the World Health Organization (WHO) in surveillance and monitoring of the NCD burden at global, regional, and national levels.
Background:Stomach cancer is a global health challenge, with diet playing a key role in its multifactorial causes. The distinct dietary habits of the Kashmiri population, influenced by prolonged winters, may heighten their risk, emphasizing the need for targeted prevention strategies.Aim of the Study:The study aimed to assess the risk factors for stomach cancer among the ethnic Kashmiri population.Materials and Methods:It was a case-control study conducted at the Super Specialty Hospital, Shireen Bagh, Kashmir, from April 2019 to September 2020, evaluating 116 confirmed cases of stomach cancer to identify potential risk factors. Controls were age (+/- 5 years) and gender matched with the cases and selected from three categories. Category A included 83 patients who underwent upper gastrointestinal endoscopy in the same laboratory but had findings other than stomach cancer. Category B comprised 17 apparently healthy family members of the cases, while Category C included 16 patients from nononcological wards without any history of malignancy. Each control was matched in a 1:1 ratio with a case, resulting in a total of 116 controls after fulfilling the inclusion and exclusion criteria.Results:The mean age (standard deviation) of participants was 60.22 +/- (11.90) years. Majority of the participants (69.8%) were males. Cases were predominantly from the rural area (58%). Our results found that those residing in rural areas have 2.64 times more chances of getting the disease than those residing in urban areas (95% confidence interval = 1.51-4.62; P = 0.001). Helicobacter pylori treatment (odds ratio: 0.2) and the consumption of refrigerated food, green chili peppers, fruits, and sweet tea were identified as protective factors. In contrast, high salt intake, red meat, pickles, hot tea, and salted tea significantly increased the risk.Conclusion:Given the high mortality and morbidity associated with stomach cancer, raising awareness about modifiable risk factors, particularly diet and smoking, is essential. Dietary modifications could serve as a practical strategy to reduce the incidence of stomach cancer in Kashmir.
Introduction: Unique challenges are faced while conducting surveys, facility, and community-based activities for the control of noncommunicable diseases (NCDs) among the urban underprivileged. Objectives: The objective of this study was to describe the challenges faced by field staff in carrying out NCD-related activities in an urban underprivileged area. Materials and Methods: A qualitative study was conducted among the field staff working for an NCD project in an underprivileged area near a medical college in Bengaluru. A group discussion followed by the construction of a loose bubble plot was done to identify the challenges faced by the staff in conducting community-based NCD activities and survey. The principles of the loose bubble plot were used to reflect the frequency, magnitude, and modifiability of the issues faced. Solutions for identified problems were discussed. Results: The challenges faced were categorized as survey-related, personal, and training related. Challenges perceived to be of great magnitude and occurring at high frequency were, unavailability of the working population during the day, participants not consenting, poor hygiene of participants, unclean surroundings, female staff maintaining menstrual hygiene, and accessing toilet facility on the field. The challenges of lesser magnitude and occurring less frequently were problems faced while using the app and calculating portion size during dietary recall. The main training-related challenge was scheduling a day convenient for the Urban Primary Health Center staff. Community resources were identified for overcoming the challenges. Conclusion: We identified unique and various sets of challenges faced by field staff while conducting community-based NCD activities. Prior planning, good communication, problem-solving skills, and engagement with local community leaders would help address such challenges in the field.
Background and Aims: Familial hypercholesterolemia (FH) is a common genetic disorder. The prevalence of FH in premature coronary artery disease (CAD) in Sri Lanka was unknown before this study. Materials and Methods: A cross-sectional study was conducted in 602 individuals aged 18-60 years with CAD. FH was diagnosed using the Dutch Lipid Clinic Network (DLCN) score. Results: The prevalence of definite FH was 0.67% (95% confidence interval [CI]: 0.18-1.7), with probable FH of 4.1% (95% CI: 2.7-6.1) and possible FH of 18.4% (95% CI: 15.4-21.7). The mean age at onset of early-onset CAD was 48.3 years (standard deviation [SD] = 6.9). The mean low-density lipoprotein cholesterol (LDL-C) levels were highest in the probable and definite FH groups: 260.5 mg/dL (SD = 39.2) and 420.7 mg/dL (SD = 129.3), respectively. The prevalence of diabetes and obesity was similar in patients with and without FH. Among those not on statins (n = 352), the mean LDL-C was 118.6 mg/dL (SD = 23.9 mg/dL). Among the 250 patients on statins, the target LDL-C level of <55 mg/dL was achieved by 34 (13.6%), whereas among the total population, it was 5.6%. The mean LDL-C level of patients receiving statins was 76.7 mg/dL. Among the correlations for the probability of having FH, a first-degree relative with premature coronary and vascular diseases had a strong correlation (Cram & eacute;r's V = 0.7). In the multivariate logistic regression analysis, higher LDL-C levels were significantly associated with probable/definite FH, with each 1 mg/dL increase in LDL-C corresponding to 8% higher odds of FH (odds ratio = 1.08 [95% CI: 1.05-1.11]; P = 0.001). Conclusions: FH is relatively common in patients with premature CAD. These results highlight the need to promote FH identification in patients with premature CAD.
Cardiovascular disease (CVD) remains the leading cause of death globally, with approximately 18 million deaths annually, over 80% occurring in low- and middle-income countries (LMICs). This narrative review synthesizes evidence on community-based CVD prevention strategies in LMICs, including community health worker programs, peer-led interventions, faith-based partnerships, school-based initiatives, and policy-level interventions. A systematic literature search across PubMed, MEDLINE, and the World Health Organization Institutional Repository for Information Sharing database was conducted to identify relevant studies published between 2000 and 2024. Included studies demonstrate that well-designed community-based programs can achieve 12%–25% reductions in blood pressure, 15%–25% improvements in medication adherence, and 10%–25% improvements in healthy dietary choices, with incremental cost-effectiveness ratios ranging from US$10 to US$150 per disability-adjusted life year averted – well within established cost-effectiveness thresholds for LMICs. Successful programs share common characteristics, including strong community engagement, multicomponent design, cultural adaptation, health system integration, and sustained implementation. Recommendations are stratified into three implementation tiers: essential interventions for all LMICs, context-dependent strategies, and aspirational long-term goals, each linked to evidence strength and feasibility. This review provides evidence-based guidance for policymakers and program implementers designing community-based CVD prevention adapted to local contexts and resource constraints.
Background:The asymptomatic nature of prediabetes makes it a critical yet often unnoticed condition, emphasizing the urgent need for timely screening to prevent the progression to type 2 diabetes. This study aims to investigate the prevalence of prediabetes among adults in southern rural Karnataka and elucidate the contributing factors.Methods and Analysis:This study is part of a cluster randomized controlled trial (CTRI/2023/03/050421). While the parent trial focuses on nutritional interventions, the data presented here are derived from a comprehensive community-wide screening program. A census-based recruitment strategy was employed within six randomly selected villages, and 1604 individuals aged 20-50 years were screened. Data on sociodemographic factors, lifestyle habits, and anthropometric and biochemical measures were collected through interviews and blood tests. Prediabetes was defined as fasting plasma glucose levels between 100 and 125 mg/dL. Chi-square tests and multivariable logistic regression were used to identify potential determinants of prediabetes.Results:The prevalence of prediabetes was 32.7%. Significant factors associated with prediabetes included increasing age (adjusted odds ratio [AOR]: 1.03, 95% confidence interval [CI]: 1.01-1.04), illiteracy (AOR: 1.75, 95% CI: 1.24-2.72), lack of physical activity (AOR: 1.58, 95% CI: 1.17-2.25), central obesity based on waist-to-height ratio (AOR: 1.83, 95% CI: 1.18-2.82), and uncontrolled blood pressure (AOR: 1.62, 95% CI: 1.26-2.06).Conclusions:This study showed 32.7% prevalence of prediabetes in rural Karnataka. Key risk factors identified include age, education level, central obesity, and physical inactivity. The elevated prevalence observed in this study suggests that rural communities may be particularly vulnerable, necessitating targeted public health interventions to address these risk factors in rural communities.
