Background The new European Kidney Function Consortium (EKFC) eGFR equation utilizes rescaled serum creatinine to an age- and sex-specific normal median value, making it applicable across the entire age spectrum. We evaluated the performance of the recalibrated EKFCcrea equation using Indian-specific Q (median serum creatinine) and K (normal GFR) in a large Indian cohort and the ability to correctly classify CKD. Methods Indian adults (healthy and patients with CKD) were recruited. Plasma iohexol clearance was used to measure glomerular filtration rate (mGFR). Indian-specific Q values were derived from healthy individuals, and K from those under the age of 40 years. We evaluated EKFCcrea, CKD-EPI2021, and recalibrated the EKFCcrea equations, incorporating the Indian Q (ISQ), Indian constant (ISK), and both (ISQ + ISK). We evaluated bias and accuracy (P30) for all equations. Results A total of 1,174 participants (615 healthy, 559 CKD), mean age 48 years, with equal gender distribution, were recruited. The EKFCcrea equation showed a mean bias of 9.9 (95% CI: 8.7, 11.1) mL/min/1.73 m2 with P30; 58.1%. EKFCISQ reduced bias to 4.9 (95% CI: 3.7, 6.0) mL/min/1.73 m2 and improved P30 to 64%. EKFCISK achieved a bias of -1.2 (95% CI: -0.1, -2.2) mL/min/1.73 m2 and P30 of 69%. 30%, 48%, and 67% of CKD patients were categorized into lower categories using the EKFCISQ, EKFCISK, and EKFCISQ+ISK equations, respectively, against the CKD-EPI 2021. Conclusion Recalibrating EKFCcrea with Indian-specific Q and K reduced bias and improved accuracy, with EKFCISK emerging as the best model. Adopting this recalibrated equation in clinical practice and public health initiatives after validation in diverse cohorts could lead to more accurate CKD diagnosis and staging in India.

Introduction: The new European Kidney Function Consortium (EKFC) eGFR equation uses rescaled serum creatinine (SCr) to an age-and sex-specific normal median value, making it applicable across the entire age spectrum. We evaluated the performance of the recalibrated EKFCcrea equation using Indian-specific Q (for median SCr) and K (for normal glomerular filtration rate [GFR]) in a large Indian cohort and the ability to correctly classify chronic kidney disease (CKD). Methods: Indian adults (healthy and patients with CKD) were recruited. Plasma iohexol clearance was used to assess measured GFR (mGFR). Indian-specific Q values were derived from healthy individuals, and K from those under the age of 40 years. We evaluated EKFCcrea, CKD-Epidemiology Collaboration (EPI)2021, and recalibrated the EKFCcrea equations, incorporating the Indian Q (ISQ), Indian constant (ISK), and both (ISQ + ISK). We evaluated bias and accuracy (P 30 ) for all equations. Results: A total of 1174 participants (615 healthy, 559 CKD), mean age 48 years, with equal sex distribution were recruited. The EKFCcrea equation showed a mean bias of 9.9 (95% CI: 8.7-11.1) ml/min per 1.73 m 2 with P 30 ; 58.1%. EKFCISQ reduced bias to 4.9 (95% CI: 3.7 6.0) ml/min per 1.73 m 2 and improved P 30 to 64%. EKFCISK achieved a bias of-1.2 (95% CI:-0.1 to-2.2) ml/min per 1.73 m 2 and P 30 of 69%. 30%, 48%, and 67% of CKD patients were categorized into lower categories using the EKFCISQ, EKFCISK, and EKFCISQ+ISK equations, respectively, against the CKD-EPI 2021 . Conclusion: Recalibrating EKFCcrea with Indian-specific Q and K reduced bias and improved accuracy, with EKFCISK emerging as the best model. Adopting this recalibrated equation in clinical practice and public health initiatives after validation in diverse cohorts could lead to more accurate CKD diagnosis and staging in India.

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.

Funding: This work is supported by the Social Sciences & Humanities Research Council [#895-2022-1015] and the Wellcome Trust [222422/Z/21/Z]. This work was also supported, in part, by a Novo Nordisk Foundation Grant for a scientifically independent International-Collaborative Bioscience Innovation & Law Programme (Inter-CeBIL) programme (#NNF23SA0087056 & #NNF17SA0027784).

Antimicrobial resistance (AMR) represents one of the biggest threats to health globally. The rise of AMR has been largely attributed to the misuse and abuse of antimicrobials in veterinary, human, and agricultural medicine. This study aimed to assess human, livestock, and agricultural health profiles, and practices of One Health and antibiotic use through a situational analysis of an Indigenous village Gurah, in a rural area of Mohali district in Punjab state using a demographic and facility survey. A survey questionnaire was used to collect information on the village's socio-demographic, human, livestock, and agricultural profiles. The study included 77 households from the village Gurah, with the majority i.e., 71.4 % engaged in agricultural activity and 68.8 % with livestock. Survey results showed that self-reported adherence to any medicine prescribed by doctors was high (92.3 %) and self-medication reported by the respondents was 11 %. Forty-two percent of antibiotic consumption was verified from prescription. The major crops grown in the village were exposed to pesticides, and most dairy and non-dairy products were sold in markets, with consumers unaware of any pesticide or antibiotic exposure. Additionally, villagers were unaware of disease diagnosis and the medicines their livestock consumed. Findings from veterinarians revealed that around 50 % of the livestock was given antibiotics for treatment for mastitis. In our study, 67.9 % of the green fodder for animals was homegrown and pesticide use was reported. The study reported that 81.1 % of the animal feed additives were purchased from the market and farmers might be unaware whether commercially-purchased feed contains antibiotics. The results provide a picture of the current situation and guide further research for the containment of AMR under the One Health approach. Inadequate multi-sectoral and cross-disciplinary efforts to combating AMR in current practice call for prompt coordinated action integral to a "One Health approach."

Introduction:Type 2 diabetes mellitus (T2DM) presents significant public health challenges in India, where unique genetic and phenotypic characteristics elevate susceptibility. Recent research highlights the interaction of genetic polymorphisms and dietary factors in T2DM management, forming the basis of personalised nutrition interventions. This study outlines the protocol for NUDGE clinical trial to evaluate the efficacy of gene-based dietary strategies compared to standard recommendations in T2DM management. Methods:The NUDGE trial is an exploratory, open-label, parallel-group, randomised controlled clinical trial conducted across healthcare settings in Chandigarh, India. A total of 300 participants diagnosed with T2DM will be randomised into intervention and control groups. The intervention group will receive personalised diet plans based on genetic polymorphisms (TCF7L2 and PPARG), anthropometric, and lifestyle data, while the control group follows standard dietary advice. Baseline and endline assessments will measure fasting blood glucose, HbA1c, anthropometric parameters, and adherence. Discussion:Primary outcomes focus on changes in FBG, while secondary outcomes include weight and blood pressure. Statistical analyses will evaluate gene-diet interactions and adherence to dietary plans. The trial aims to establish evidence for precision nutrition in T2DM by leveraging gene-diet interactions to tailor interventions. Findings will provide insights into the role of personalised nutrition in improving glycemic control. Conclusion:The NUDGE trial seeks to advance precision nutrition in T2DM management, paving the way for individualised dietary recommendations to mitigate disease progression and complications. Ctri reg no:CTRI/2021/09/036121 Clinical Trial Registry of India.

Background and objectives To enable an accurate assessment of vaccine hesitancy among adults, a validated Hindi vaccine hesitancy questionnaire, encompassing multiple sub-domains of vaccine hesitancy, is a pre-requisite. The following study was conducted to translate and determine the reliability, content, construct, and concurrent validity of the Hindi Adult Vaccine Hesitancy scale (5C) among adults in Northern India. Methods Translation-back translation of the 5C tool (which comprises five domains of vaccine hesitancy: confidence, calculation, complacency, constraint, and collective responsibility) to Hindi, followed by cognitive interviews among the target population, was done. Item-wise (I-CVI) and full-scale Content Validity Index (S-CVI) were determined through a panel of experts. The robust econometric approach of Confirmatory Factor Analysis (CFA) was employed and construct validity were tested among 150 participants. Discriminant and Convergent validity were examined using the Average Variance Extracted (AVE). The reliability of the domains was assessed through Composite Reliability (CR). Results The I-CVI and Kappa statistics of all tool items ranged from 0.8 to 1.0. The S-CVI/AVE was calculated to be 0.97. The composite reliability (CR ≥ 0.70) and convergent validity (AVE ≥ 0.50) coefficients were found to be adequate. AVE of the latent variables was greater than the squared values of the latent variable correlations, indicating adequate discriminant validity. 5C tool in the Indian setting demonstrated a ‘good fit’ established through confirmatory factor analysis. Interpretation and conclusions Hindi version of the 5C scale is a valid tool to assess vaccine hesitancy among the Hindi-speaking population North Indian Population. Willingness to take the recommended vaccines was positively correlated with ‘confidence,’ ‘calculation,’ and ‘collective responsibility’ and negatively correlated with ‘complacency’ and ‘constraint’ domains.

OBJECTIVE:To assess the impact of the COVID-19 pandemic associated governmental restrictions on physical activity and sedentary behavior of school-going adolescents in India and its effect on nutrition and health status. METHODS:This was a before-after natural experiment study that recorded paired data of 449 (206 boys) school-going adolescents. COVID-19 related governmental measures (March 24, 2020 till February 2021) were taken as the natural experiment. The change in proportion of adolescents who met the recommended amount of physical activity guidelines and change in sedentary and dietary behaviors and body mass index (BMI) were compared. RESULTS:The proportion of adolescents performing adequate physical activity decreased from 33.9% to 30.7% (OR 1.2,95% CI 0.9,1.6) during the pandemic. Fruit intake increased by 8.1% during the pandemic while junk food intake decreased by 17% during the pandemic. Mean (SD) BMI z-scores increased from -0.7 )1.4) to -0.5 )1.3) (P < 0.001). CONCLUSION:While there was a small decrease in the proportion of physically active adolescents during the pandemic, a shift towards healthier dietary habits was seen.

Context: The Chandigarh Noncommunicable Disease (NCD) Registry was set up in 2018 to assess the burden of major NCDs and inform the planning of public health and clinical interventions. Aim: The aim of the present study was to assess the burden of NCDs in Chandigarh. Settings and Design: The cross-sectional study design includes data from government and private facilities, pathology laboratories, birth, and death registrar offices catering to urban and rural Chandigarh. Subjects and Methods: It collects data of young diabetes, stroke, acute cardiac events, aplastic anemia, and cancer patients using a structured questionnaire. Statistical Analysis Used: The study reports a descriptive analysis of case distribution, done using SPSS version 23. MS Excel 2016 was used to produce graphical illustrations and calculate age-adjusted rates using the world standard population. Results: During July 2018–December 2019, 3721 (incident and death) cases were recorded for cancer (n = 2414, 64.9%), acute cardiac events (n = 1034, 27.8%), stroke (n = 231, 6.2%), young diabetes (n = 28, 0.8%), and aplastic anemia (n = 14, 0.4%). The age-adjusted incidence and mortality rates (per 100,000 population) were calculated for cancer (males: 102.6 and 62.0; females: 100.8 and 52.9), acute cardiac events (males: 47.1; females: 21.7 and 28.8), and stroke (males: 7.5 and 8.5; females: 13.1 and 21.8). Study participants were exposed to tobacco and alcohol consumption. Positive family history was reported by 40% of the registered patients. Conclusions: An integrated model of the NCD registry is feasible and can yield evidence in low-resource settings for secondary prevention to achieve global targets for reducing risk factors and premature mortality due to NCDs.

Background The nationwide lockdown imposed due to the COVID-19 pandemic disrupted daily routines, especially for children. Being at home and attending virtual classes unintentionally precipitated an increase in both academic and nonacademic screen time and probably led to decreased physical activity in children. However, there is lack of evidence related to the physical activity and screen time of school-age children during the COVID-19 pandemic. So this study aimed to investigate the effect of the COVID-19 pandemic and lockdown on physical activity and screen time of children. Methods An online survey was used to recruit parents of school-age children through convenience sampling. Parents were asked to compare their child’s physical activity and screen time in the previous week with those in the pre-lockdown and lockdown periods. The global physical activity questionnaire was used to assess physical activity, and a screen time questionnaire was developed and validated. Data collection was done from September 2020 to December 2020. Results Data of 104 children were collected from parents’ reports. The average age of parents was 39.1 + 4.8 years for mothers and 40.8 + 6.9 years for fathers. Results revealed a decrease in physical activity from 564.95 min/week before the lockdown to 146.05 min/week during the lockdown, with the absolute decrease of 448.9 min/week. Total screen time increased from 2.42 h/day before the lockdown to 7.41 h/day during the lockdown. Conclusion Necessary steps to mitigate the effect of COVID-19 pandemic unintentionally affected children in terms of decreased physical activity and increased screen time.

Abstract Background: Health systems in the limited-resource setting currently face a rapidly increasing burden from noncommunicable diseases (NCDs). The registries generate high quality data of diseases surveillance for estimating the disease burden and trends in population for different geographical regions. The reporting format or the registry tools are different for different registries as per the funding agency requirements. Despite of the fact that these NCD shares common risk factors, no integrated tool for data collection on NCD data is available. In the present study a practical and systematized Integrated NCD registry tool based on the international and national literature available has been developed and validated. Methods: We carried out a methodological study to examine the content validity of the patient-centered communication instrument through a two-step process (development and judgment). The Integrated NCD Registry tool for four NCDs includes the major 2 parts i.e., Part 1 includes general characteristic i.e. General data on reporting facility details, patient information, patient history including the behavioural risk factors for NCDs, Part 2 includes 4 disease modules i.e., young diabetes, Stroke, Cancer and Acute Cardiac events and follow up. For validation, at the first step, domain determination, sampling (item generation) and instrument formation and at the second step, content validity ratio, content validity index and modified kappa statistic was performed by a panel of experts. Suggestions of expert panel and item impact scores are used to examine the instrument face validity. Result: The overall S-CVI for the 126 items scale was 0.91 which indicated high content validity of the items. Items which had a 0.67 I-CVI indicated the need for revising them. Kappa statistic ranged from 0.81 to 1 for most of the items. Nine items with negative kappa coefficient reflected a disagreement among raters regarding their inclusion in the integrated registry tool. In the he final version, it was observed that out of 125 items, 92% of the items were validated. For face validity, the impact scores of all the items were above 1.5 which is acceptable. The final version of the tool includes four NCDs includes the major 2 parts i.e. Part 1 includes general characteristic i.e. General data on reporting facility details, patient information, patient history including the behavioural risk factors for NCDs, Part 2 includes 4 disease modules i.e. Young diabetes, Stroke, Cancer and Acute Cardiac events and follow up.Conclusion: The quantification of content validity on the basis of CVI (I-CVI & S-CVI), Kappa coefficient, and CVR indicated high content validity for the items. Thus, a Registry tool was constructed and validated professionals to collect the NCD patient’s data in a timely, effective and quality manner. Integrated NCD registry will offer a sustainable noncommunicable disease surveillance module for limited resource settings.

Background Existing creatinine-based equations to estimate glomerular filtration rate (GFR), developed primarily in populations of European and African American ancestry, do not accurately reflect the GFR in the Indian population due to differences in body composition, diet, and other factors. This manuscript describes the rationale and methodology for developing a creatinine-based equation for more accurate GFR estimation in Indian subjects. Materials and Methods This cross-sectional study will be conducted in India’s two geographically and demographically diverse locations: Chandigarh (north) and Puducherry (south). Participants will include a representative sample from the general population and subjects with chronic kidney disease (CKD), with the latter being recruited from outpatient clinics. A total of 1558 subjects will be enrolled in the discovery and cross-validation cohort and 620 subjects in the external validation cohort. The reference standard for measured GFR (mGFR) will be the plasma clearance of iohexol. Stepwise multiple regression on log-transformed data will determine a set of variables that jointly predict mGFR and identify factors influencing mGFR and estimated (eGFR) in the study population. This study will also explore the performance of mGFR by iohexol measurement from dried blood spots against mGFR from plasma clearance of iohexol. Conclusion Developing a more reliable and accurate creatinine-based GFR estimating equation will improve CKD diagnosis, classification, and management. The findings will have substantial implications for CKD research in India and other regions with similar populations.

Gall bladder cancer (GBC) is common among the socioeconomically deprived populations of certain geographical regions. Aflatoxin is a genotoxic hepatocarcinogen, which is recognized to have a role in the pathogenesis of hepatocellular carcinoma. However, the role of aflatoxin in the pathogenesis of GBC is largely unknown. We determined serum AFB1-Lys albumin adduct (AAA) levels as a marker of aflatoxin exposure in the patients with GBC and compared to those without GBC. The relationship of AAA levels to cytogenetic (TP53mutation&HER2/neu amplification) and radiological characteristics of the tumor was assessed. We included GBC cases (n = 51) and non-GBC controls (n = 100). Mean serum AAA levels were higher in the GBC group (n = 51) than those without GBC (n = 100) (26.1 ± 12.2 vs. 13.1 ± 11.9 ng/mL; p < .001). HER2/neu expression was associated with higher AAA levels compared to those with equivocal or negative expression (43.9 ± 3 vs. 28.6 ± 10 vs. 19.3 ± 7 ng/mL; p < .001). Older age (age >50 years) (odds ratio [OR] = 3.2 [CI: 1.3-8.2]; p = .013), positive Helicobacter pylori serology (OR = 5.1 [CI: 1.4-17.8]; p = .012), presence of GS (OR = 5 [CI: 1.5-16.9]; p = .009) and detectable AAA levels (OR = 6.8 [CI: 1.3-35.7]; p = .024) were independent risk factors for the presence of the GBC among all study subjects. Among patients harboring GS, older age (age >50 years) (OR = 4.5 [CI: 1.3-14.9]; p = .015), female gender (OR = 3.8 [CI: 1.2-12.5]; p = .027), presence of multiple GS (OR = 21.9 [CI: 4.8-100.4]; p < .001) and high serum AAA levels (OR = 5.3 [CI: 1.6-17.3]; p = .006) were independent risk factors for the presence of the GBC. Elderly age >50 years (OR = 2.6 [CI: 1.3-5.2]; p = .010) and frequent peanut consumption (OR = 2.3 [CI: 1.1-4.9]; p = .030) were independent risk factors for high serum AAA levels. The current study has implications for the prevention of GBC through the reduction of dietary aflatoxin exposure.

Background: Low- and middle-income countries (LMICs) face numerous challenges in the implementation of noncommunicable diseases (NCDs) prevention programs due to a shortage of health workforce. Task shifting to nurses is a viable and effective solution to address the healthcare human resource crisis. We, therefore, intend to assess the existing evidence on the effectiveness of interventions by nurses for the management of chronic NCDs in LMICs. Methods: We did a systematic review and meta-analysis of the trials that utilized nurses for the management of NCDs in LMICs. We searched PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and clinical registries of different LMICs to search for relevant literature. Meta-analysis using an inverse-variance weighted random effect model was used to summarize the findings. The study protocol was registered in the PROSPERO database (CRD42019118430). Results: We found 2097 studies from the literature search, out of which 39 studies with 15,672 participants were eligible for narrative synthesis. Result of the meta-analysis showed that nurse-led interventions were effective in the reduction of systolic blood pressure (SBP) (average pooled mean difference was −4.32 [95% (confidence interval) CI − 7.07–−1.57]), diastolic blood pressure (DBP) (−3.11 mmHg; 95% CI −4.96–−1.26), glycated hemoglobin (HbA1c) (−0.73; 95% CI − 1.08–−0.38), fasting blood sugar (FBS) (−0.8; 95% CI −13.42–−2.58), total cholesterol (TC) (−1.18; 95% CI −20.06–−3.57), and triglycerides (TG) (−12.20; 95% CI − 23.52–−0.87). However, there was no major significant difference in low-density lipoprotein (LDL) and high-density lipoprotein (HDL). The overall quality of evidence based on the Grading of Recommendations Assessment, Development, and Evaluations was moderate for FBS, low for SBP, DBP, HbA1c, HDL, TC, and TG, and very low for LDL. Interpretation: Nurse-led interventions as compared to usual care are effective for the management of diabetes and hypertension and can be effectively used for national NCD programs in LMICs.

A prospective study was conducted to assess the effectiveness of learning from an online public health course (6th International Course on Public Health Approaches to Noncommunicable Diseases) among participants from India. The knowledge significantly improved after attending the online public health practice course (P < 0.05) and remained without any significant change over the period of time till 6 months after the online course (P = 0.988). Majority of the respondents were applying the learnings from the course in their program management (64.7%–89.3%). Online delivery of public health courses in India has shown to improve knowledge and maintain the acquired knowledge.

Introduction:Dyslipidemia and mental illnesses are significant contributors to the global noncommunicable disease burden and studies suggest an association between them. Aim:Using data from a noncommunicable disease risk factor survey conducted in Haryana, India, we undertook a secondary data analysis to examine the association between lipids and depressive symptoms. Methods:The survey involved 5,078 participants and followed the World Health Organisation STEPwise approach to NCD risk factor surveillance approach. Biochemical assessments were undertaken in a subset of participants. Lipid markers were measured using wet chemistry methods. Depressive symptoms were assessed using the Patient Health Questionnaire-9. Descriptive statistics were presented for all variables; logistic regression was used for association analyses. Results:The mean age of the study population was 38 years and 55% of them were females. A majority of the participants belonged to a rural background. The mean total cholesterol was 176 mg/dL and approximately 5% of the participants were found to have moderate to severe depression. The association of total cholesterol (odds ratio [OR] 0.99, P = 0.84), LDL-cholesterol (OR = 1.00, P = 0.19), HDL-cholesterol (OR = 0.99, P = .76), and triglycerides (OR 1.00, P = .12) with depressive symptoms was not significant. Conclusion:This study did not find any association between lipids and depressive symptoms. However, further investigations using prospective designs are warranted to understand this relationship and complex interactions with other mediating factors better.

Background: Healthcare workers (HCWs) are at the front line of the Coronavirus disease (COVID-19) outbreak response. They have faced great risks to both physical and mental health. We aimed to assess the psychological effect of COVID-19 among ancillary hospital staff. Methods: A cross-sectional study was conducted among 267 on-duty ancillary hospital staff using a semi-structured questionnaire to assess their psychological status and risk perception. In addition, their knowledge, attitude, and practices (KAP) and risk perception were also assessed. The General Health Questionnaire (GHQ-12) was used to screen for psychological distress. Results: Among 267 participants, the mean (±SD) age was 33.5 (7.6) years. The majority knew about the symptoms of COVID-19 (88.4%), droplet spread (99.3%), and the importance of isolation (99.3%). About 35.2% were worried about infecting family members, while 26.2% were worried about colleagues at the frontline. Only 38.9% of them had a good knowledge score. Participants with high school and above education level had significantly good knowledge about COVID-19 (OR = 1.99; 95% CI = 1.17- 3.39) than those with primary school or below. Being female (OR 1.99; 95% CI 1.17-3.39) and working with COVID-19 patients (OR 3.88, 95% CI 1.77-8.47, P = 0.001) was associated with psychological distress. Conclusion: The ancillary hospital staff had insufficient knowledge regarding the risk factors of COVID-19 but possessed positive attitudes and practices. Continued health education and appropriate psychological interventions may improve understanding and reduce psychological distress.

Background Recent studies have documented high variation in epidemiologic transition levels among Indian states with noncommunicable disease epidemic rising swiftly. However, the estimates suffer from non-availability of reliable data for NCDs from sub populations. In order to fill the knowledge gap, the distribution and determinants of NCD risk factors were studied along with awareness, treatment and control of NCDs among the adult population in Haryana, India. Methods NCD risk factors survey was conducted among 5078 residents, aged 18-69 years during 2016-17. Behavioural risk factors were assessed using STEPS instrument, administered through an android software (mSTEPS). This was followed by physical measurements using standard protocols. Finally, biological risk factors were determined through the analysis of serum and urine samples. Results Males were found to be consuming tobacco and alcohol at higher rates of 38.9% (95% CI: 35.342.4) and 18.8% (95% CI: 15.821.8). Onetenth (11%) (95% CI: 8.6-13.4) of the respondents did not meet the specified WHO recommendations for physical activity for health. Around 35.2% (95%CI: 32.6-37.7) were overweight or obese. Hypertension and diabetes were prevalent at 26.2% (95% CI: 24.6-27.8) and 15.5% (95% CI: 11.0-20.0). 91.3% (95% CI: 89.393.3) of the population had higher salt intake than recommended 5gms per day. also made available for use under a CC0 license. not certified by peer review) is the author/funder. This article is a US Government work. It is not subject to copyright under 17 USC 105 and is The copyright holder for this preprint (which was this version posted November 28, 2018. ; https://doi.org/10.1101/482117 doi: bioRxiv preprint