Risk Factor (CDRF) Study Preet Dhillon, Dilip Jha Dewan Alam, Amit - - PowerPoint PPT Presentation

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Oct 18, 2022 146 likes •316 views

Multi-centre Household Chronic Disease Risk Factor (CDRF) Study Preet Dhillon, Dilip Jha Dewan Alam, Amit Dias, Joseph Williams Shah Ebrahim Project period: Jan. 2011-Jan. 2013 Funded by the Wellcome Trust, UK 1 Objectives Prevalence of

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Multi-centre Household Chronic Disease Risk Factor (CDRF) Study

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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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 clustering of NCD’s in households, effects of NCD’s on expenditures, HH members & health care decision-making

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Methods

◊ 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

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Data collection

◊ Household-level data

Cooking fuel exposure
Salt, sugar, oil
Household expenditures, insurance

◊ Individual-level data Questionnaires:

Tobacco, alcohol, physical activity, diet, medicine
Disabilities, pain, falls, urinary
Mental health, neighbourhood, networks

Physical Measurements:

Anthropometrics, body fat
Lung function, visual acuity, grip strength
Blood pressure, fasting glucose, 24-hr urine

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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

Results

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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

Results

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Matlab (n=1143) Carambolim (n=1212) Sirudhavur (n=940)

Men Women Men Women Men Women

High fasting glucose (Glucose > 126 mg/dl)

10.0

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

Results

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Exposure to biomass fuel

◊ 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

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Lung function data

◊ Spirometry –5 blows (FEV1, FVC, Predicted) ◊ Exclusion criteria:

Surgeries in past 3 months (eg, eye, heart)
Heart attack in past 3 mos, suffers from heart ailment
Pulse > 120 beats/min
Blood pressure greater than 180 (SBP)/ 100 (DBP)
Epilepsy, Pregnant, breast feeding

◊ Re-schedule if:

Respiratory infection, bronchodilators, smoking

◊ Comments – position, unable to complete, unable to understand, refused to cooperate, etc.

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Spirometry

“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:

Gold standard (other clinical-based measures)
Variations in technical abilities, interpretations
Used to distinguish asthma vs. COPD
Management of respiratory disease
Epilepsy, Pregnant, breast feeding

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Airway obstruction

◊ Spirometry data: – FVC : Forced Vital Capacity – total volume of air patient can forcibly exhale in one breath (litres)

FEV1: Forced Expiratory Volume in 1 second- volume
f air patient can exhale in the 1st second of exhalation (litres)
FEV1/FVC: Ratio expressed as a fraction

◊ Interpreting the data:

Normal FEV1/FVC: 0.7-0.8
Airway obstruction < 0.7 (COPD post-bronchodilator)
Caution with 70+ years (overdx; 0.65 threshold OK)
Flow-volume measurement: traces flow rate against

rate of air exhaled to produce a flow-volume curve

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Spirometry curve

* GOLD: 3 blows that are consistent and within 5% of each other is ideal

Normal: Volume-time curve rises rapidly & smoothly & plateaus within 3-4 seconds

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Flow-vol curves

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Concluding points

◊ Comparison with national/other data

Similarities: tobacco use, hypertension, depression
Differences: alcohol abuse
First time: physical activity, disability

◊ Gender differences

Health awareness
Tobacco & alcohol use
Depression

◊ Potential –Intra-/inter-household NCD pathways & effects ◊ Challenges – Recruitment to clinics, male migrants, blood donation, spirometry in women

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Thank you

Wellcome Trust, UK

International Centre for Diarrheal Disease Research, Bangladesh (ICDDR,B) Sangath, Goa Voluntary Health Services (VHS), Chennai HealthChakra, HandsRel

Ms. Bavani Priya
Dr. Rohit Ajgaonkar
Ms. Sherin Abraham
Dr. Shariful Islam

Dedicated field staff

Multi-centre Household Chronic Disease Risk Factor (CDRF) Study

Objectives

Methods

◊ 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

Data collection

Results

Results

Results

Exposure to biomass fuel

◊ Household-level questionnaire

Window

Lung function data

◊ Spirometry –5 blows (FEV1, FVC, Predicted) ◊ Exclusion criteria:

◊ Re-schedule if:

◊ Comments – position, unable to complete, unable to understand, refused to cooperate, etc.

Spirometry

“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:

Airway obstruction

◊ 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

Spirometry curve

Flow-vol curves

Concluding points

◊ 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

Thank you

Wellcome Trust, UK

Study participants in Matlab, Carambolim & Sirudhavur