Objectives Prevalence of household & individual non-communicable - - PowerPoint PPT Presentation
Objectives Prevalence of household & individual non-communicable disease (NCD) risk factors and outcomes in rural populations Feasibility of community-based interviews, point-of-care diagnostics and electronic data capture Evaluate
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Prevalence of household & individual non-communicable disease (NCD) risk factors and outcomes in rural populations Feasibility of community-based interviews, point-of-care diagnostics and electronic data capture Evaluate clustering of NCD’s in households, effects of NCD’s on expenditures, HH members & health care decision-making
Matlab (n=1143) Carambolim (n=1212) Sirudhavur (n=940)
Men Women Men Women Men Women
Age, yrs (SD)
30.5 (22.0) 30.0 (19.2) 29.0 (18.4) 33.6 (19.0) 28.2 (17.1) 30.5 (18.1)
Education Illiterate 48 47 17 34 20 35 Primary school 23 18 38 35 18 18 Secondary school 30 35 34 28 15 41 Occupation At home, unemployed, student
46.4 96.9 50.4 71.5 41.4 61.0
Unskilled manual, farming
16.7 1.2 28.2 21 39.3 32.8
Skilled manual
16.7 0.3 8.5 1.3 6.3 2.3
Semi-/Professional
19.6 1.4 12.2 5.6 6.7 2.3
Cigarettes/Beedi 46 15 6 33 0.3 Tobacco 13 31 14 11 28 28 Alcohol n/a n/a 30 0.2 75 1.4
Matlab (n=1143) Carambolim (n=1212) Sirudhavur (n=940)
Men Women Men Women Men Women
Age, yrs (SD)
30.5 (22.0) 30.0 (19.2) 29.0 (18.4) 33.6 (19.0) 28.2 (17.1) 30.5 (18.1)
Education Illiterate 48 47 17 34 20 35 Primary school 23 18 38 35 18 18 Secondary school 30 35 34 28 15 41 Occupation At home, unemployed, student
46.4 96.9 50.4 71.5 41.4 61.0
Unskilled manual, farming
16.7 1.2 28.2 21 39.3 32.8
Skilled manual
16.7 0.3 8.5 1.3 6.3 2.3
Semi-/Professional
19.6 1.4 12.2 5.6 6.7 2.3
Cigarettes/Beedi 46 15 6 33 0.3 Tobacco 13 31 14 11 28 28 Alcohol n/a n/a 30 0.2 75 1.4
Matlab (n=1143) Carambolim (n=1212) Sirudhavur (n=940)
Men Women Men Women Men Women
High fasting glucose (Glucose > 126 mg/dl)
8.0 7.0 4.9
Hypertension (SBP>140 or DBP>90 mmHg or BP meds)
9.5 10.4 23.6 18.3 15.2 8.8
Body Mass Index 23+ kg/m2 21 33 27 40 27 32 25+ kg/m2 10 18 15 25 16 21 Depression Any (PHQ>5) 11 20 9 22 37 61 Disability (WHO-DAS II> 5) 9 29 6 19 35 64 Airflow obstruction (Obs. Vs.pred < 0.7) 6.4 2.7 5.1 3.7 10.1 12.3
◊ Spirometry –5 blows (FEV1, FVC, Predicted) ◊ Exclusion criteria:
◊ Re-schedule if:
◊ Comments – position, unable to complete, unable to understand, refused to cooperate, etc.
“A method for assessing lung function by measuring the volume of air a patient can expel from the lungs after a maximal inspiration” It is then compared with predicted normal values based on age, height, ethnicity, gender to gauge airway obstruction ◊ Uses of Spirometry:
◊ Spirometry data: – FVC : Forced Vital Capacity – total volume of air patient can forcibly exhale in one breath (litres)
◊ Interpreting the data:
rate of air exhaled to produce a flow-volume curve
* GOLD: 3 blows that are consistent and within 5% of each other is ideal
◊ Comparison with national/other data
◊ Gender differences
◊ Potential –Intra-/inter-household NCD pathways & effects ◊ Challenges – Recruitment to clinics, male migrants, blood donation, spirometry in women
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Preet Dhillon, Dilip Jha Dewan Alam, Amit Dias, Joseph Williams Shah Ebrahim
Project period: Jan. 2011-Jan. 2013 Funded by the Wellcome Trust, UK
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◊ Design: Cross-sectional, community-based ◊ Sample size: 250 households x 3 partner sites 3000 total ◊ Study population: Adults Children 2+ years ◊ Locations: Matlab, Bangladesh Carambolim, Goa Sirudhavur, Chennai
◊ Household-level data
◊ Individual-level data Questionnaires:
Physical Measurements:
◊ Household-level questionnaire
2.1
Does the house have electricity?
1=No, 2=Yes
2.2
Fuel for cooking
1=Kerosene 5=Wood 9=Animal Dung/cake 2=Charcoal 6=Agriculture/crop 10=Shrub/Grass 3=Coal 7=Gobar Gas/bio gas 11=Other 4=Gas 8=Electricity 12=None
Primary Fuel Secondary Fuel
2.3 Where is the cooking for the household done?
1=Inside the house 2=Inside the house in a separate kitchen 3=Outside the house 4=Both inside and outside
2.4 Does the inside cooking area have the following?
1=No 2=Yes, 3=Not Applicable
Window
Chimney Exhaust
2.5 On average, how many months per year do you cook inside?
(0-12 months, 99=unknown) Primary Fuel Secondary Fuel
2.6 On average, how many months per year do you cook outside?
(0-12 months, 99=unknown) Primary Fuel Secondary Fuel
questionnaire ?
and Kapil)
health outcomes using a regression model (Lindsay and Howard)
fuel for indoor cooking on health outcomes (Francesca)
Almost 20% households do not have access to electricity
Hemangi (graphical representation of the exposure distribution)
Type of cooking fuel
Wood is used by more than 50% households for primary and nearly 20% households for secondary cooking.
More than 80% households do their cooking inside the house either totally or partially.
Kitchen Facilities
More than 20% households do not have any ventilation facility. Less than 10% households have sophisticated facilities like Chimney and Exhaust fan.
Inside cooking
More than 35% households do their primary cooking and more than 15% households do their secondary cooking inside the house through out the year.
factors relative to Adult Female
cooking(A)} + {# months py secondary unclean cooking(B)}*] *(#years cooking)
for the corresponding activity.
Up to five measures
FVC (Liters) FEV1/FVC ( %) Mean (SD) Range Mean (SD) Range Children (n=301) 2.0 (0.9) 0.6 - 7.2 88.83 ( 9.4) 48.5- 125.4 Adult –men (n=554) 3.6 (1.3) 0.8-8.9 84.5 (10.6) 38.2 - 149.3 Adult- women (n= 604) 2.3 (0.8) 0.7-8.1 85.6 (9.8) 39.0 – 108.8
.1 .2 .3 10 20 30 40 50 phqsumm
Primary Fuel Score x2 Secondary Fuel Score
– Could not calculate proportion of time spent cooking inside for those participants that cook inside
– Assumptions required to assign exposure to individuals (women, men, and children)
Sco re Fuel Source Location of Cooking Ventilation: window, chimney, or exhaust Total Count Clean N/A N/A 1413 1 Unclean Outside N/A 706 2 Unclean Sometimes outside or inside but in separate room 2 or 3 25 3 Unclean Sometimes outside or inside but in separate room 1 590 4 Unclean Sometimes outside or inside but in separate room None 345 5 Unclean Inside 2 or 3 33 6 Unclean Inside 1 515 7 Unclean Inside None 69 NA 24
Secondary Total
locations in rural areas of India (slides with her description of the data sets are attached)
level (and categorical), but the individual level outcomes and risk factors more than 100) are at the individual level
regarding the exposure to biomass. From this slide we need to define the “intervention variable” as “clean" versus "non clean" cooking.
and electricity" as a primary and non secondary
intervention of “clean" cooking on several outcomes, some are continuous (pulmonary functions) and some are categorial (depression score). We could do a matched analyses, propensity scores, or anything else you like!
Saanvi 1.She is 49 2.She lives in Sangath 3.She is cooking indoor 4.High intake of sugar 5.Her husband smoke 6.No physical activity 7.3 children 8.She has hypertension (outcome) 9.She does only indoor cooking with woods (exposure) Question: what would have been Saanvi’s health outcome, if she had a gas stove? (counterfactual)
can estimate the counterfactual by taking the outcome for the women that are as similar as possible to Saanvi in terms of all the measured confounders but that they use ONLY clean sources of indoor cooking (indoor and gas)