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“A DISCUSSION ON MAIN CAUSES AND

PREVENTIVE MEASURES OF
NON COMMUNICABLE DISEASES IN
RAJASTHAN”

PREPARED BY:

 MOHAMMED IRFAN KHAN (189226165)

 VISHVENDRA SHARMA (189226180)


 VIKRAM CHOUDHARY (189226197)
 BABULAL CHARAN (189226172)
 ANIL VERMA (189226205)
 SUNIL KUMAR JAIN (189226212)

GOVERNMENT COLLEGE OF NURSING,


PSC 23151, KOTA (RAJASTHAN)

BPCCHN BATCH JULY-DEC. 2018


CHAPTER-I

INTRODUCTION & NEED FOR THE STUDY

“Trust is more important than Drugs

If there is no Trust, there is no Treatment at all”

Non-communicable disease (NCD) is a medical condition or disease that is not


caused by infectious agents (non-infectious or non-transmissible). NCDs can refer to chronic
diseases which last for long periods of time and progress slowly.

Sometimes, NCDs result in rapid deaths seen in certain diseases such


as autoimmune diseases, heart diseases, stroke, cancers, diabetes, chronic kidney
disease, osteoarthritis, osteoporosis, Alzheimer's disease, cataracts, and others. While
sometimes referred to as synonymous with "chronic diseases", NCDs are distinguished only
by their non-infectious cause, not necessarily by their duration, though some chronic diseases
of long duration may be caused by infections. Chronic diseases require chronic care
management, as do all diseases that are slow to develop and of long duration.

NCDs are the leading cause of death globally. In 2012, they caused 68% of all deaths
(38 million) up from 60% in 2000.[1] About half were under age 70 and half were
women.[2] Risk factors such as a person's background, lifestyle and environment increase the
likelihood of certain NCDs. Every year, at least 5 million people die because of tobacco use
and about 2.8 million die from being overweight. High cholesterol accounts for roughly 2.6
million deaths and 7.5 million die because of high blood pressure.
MOST COMMON NON COMMUNICABLE DISEASES

It includes-

1. Cardiovascular diseases

2. Cancer

3. Chronic respiratory diseases

4. Diabetes

5. Hypertension

6. Osteoporosis

7. Alzheimer disease

Here we are discussing about diabetes mellitus.

DIABETES

The medical term 'Diabetes Mellitus' is derived from the Greek words 'syphon' and 'sugar',
describing symptoms of uncontrolled diabetes, passing huge amounts of urine containing
sugar-glucose.

Diabetes is a condition characterized by high blood sugar (glucose) levels due to a lack or
insufficient production of a hormone called insulin in the body. Insulin is responsible for
decreasing the blood sugar levels and aids in producing energy for the cells. Without enough
insulin, glucose obtained from the food builds up in the blood stream leading to a hike in blood
sugar levels above than the normal limits. This causes many health complications.

It is a lifelong condition that can be managed with careful diet control and proper medication
(either oral medication or insulin) under your physician's and dietitian's supervision.
TYPES OF DIABETES

Type-1: It is definitely the far more serious and complicated, the simple reason being in this
that the pancreatic beta cells are totally dead or defective, and hence no production of insulin.
Therefore, regular, lifelong, insulin injections are required to maintain normal blood sugar.
Children, young men, women and those whose sugar levels can't be controlled by tablets come
under this category. It can happen to older persons, too, but very rarely. It is also termed as
Juvenile Diabetes, Insulin-Dependent Diabetes Mellitus or IDDM. This illness develops fast.

Type-II: Nearly 90 per cent of diabetics come under this category. Their bodies produce little
or defective insulin. Most of them develop this type of diabetes when they are around 40 to 50
years of age, and if they follow proper diet and exercise, can live on tablets without ever having
to take insulin. But usually they don't take it seriously and they end up with insulin sometime
in their lives.

Gestational diabetes: Some women have high blood sugar during pregnancy. This is termed
gestational diabetes. 95 per cent of the gestational diabetes disappears after childbirth. If
women are below 25 years, it's very rare. Generally, gestational diabetes symptoms are mild.

CAUSES OF TYPE 1 DIABETES

Type 1 diabetes occurs when the immune system attacks and destroys the insulin-producing
cells in the pancreas (the beta cells). As a result, the body is left without enough insulin to
function normally (i.e. it becomes insulin deficient). This is called an autoimmune reaction,
because the body attacks itself and produces antibodies to its own insulin-producing cells,
thereby destroying them.

Researchers don’t exactly know why this process is activated in some people.

CAUSES OF TYPE 2 DIABETES

The causes of type 2 diabetes are multifactorial and complex. But even though there is no
single cause, there are some well-known predisposing factors – the most overwhelming being
obesity and a family history of type 2 diabetes.
Type 2 diabetes is the result of both insulin resistance (when the cells don’t respond well to
insulin and can’t easily take up glucose from the blood) and progressive beta-cell damage,
resulting in too little insulin being secreted by the pancreas.

COMMON CAUSES OF DIABETES

 Genetics (heredity)
 Obesity
 Irregular and unhealthy eating habits
 Stress
 Other Reasons

BACK-GROUND OF THE STUDY

Diabetes is an “Iceberg” disease. Previously it was a disease of the middle aged and elderly.
Recently type 2 diabetes mellitus escalated in all age group and now being seen in younger age
group including adolescent especially in high risk population.

The Indian council of medical research studies reported respectively the prevalence of
diabetes among the rural population from 0.4%in Himachal Pradesh, 1.3% Kerala, 1.5%Delhi
and 3.9% in Gujarat. National survey shown that 54.1% of diabetes developed it in the most
productive of their lives that is before the age of 50 years and they also had higher risk of
developing diabetic complications

NIDDM usually comes to light in the middle years of life and thereafter begins to rise in
frequency. Were Obesity in child hood and are at high risk of developing type 2 diabetes at an
elderly age. Sedentary life style appears to be important risk factors for development of
NIDDM. And also women who have had a baby weighing more than 4.5 kg women who show
excess weight gain during pregnancy, and patient with premature atherosclerosis.

According to the World Health Organization (WHO) report, India today heads the world with

over 32 million diabetic patients and this number is projected to increase to 79.4 million by the

year 2030. Recent surveys indicate that diabetes now affects a staggering 10-16% of urban
population and (5-8%) of rural population in India. There is very little data on the level of

awareness and prevalence about diabetes in developing countries like India. Such data is

important to plan the public health programme. Analysis of secular trends reveals an increase

in diabetes prevalence among rural population at a rate of 2.02 per 1000 population per year.

The rate of increase was high in males (3.33 per 1000 per year) as compared to females (0.88

per 1000 per year).

Diabetes was estimated to be responsible for 109 thousand deaths, 1157 thousand

years of life lost and for 2263 thousand disability adjusted life year in India during 2004.

However, health systems have not matured to manage diabetes effectively. Awareness about

and understanding of the disease is less than satisfactory among patients, leading to delayed

recognition of complications. The cost of treatment, need for lifelong medication, coupled with

limited availability of anti-diabetic medications in the public sector and cost in the private

sector are important issues for treatment compliance.

In order to meet learning need of the patients, structured teaching programmes have to

be developed for the promotion of health, prevention of diseases or complications, early

diagnosis and treatment and rehabilitation. It aims at the modification of inadequate behavior

and life style for preventing a health crisis. A variety of teaching strategies can be utilized to

teach patients. The need to test alternative strategy is an area that requires attention.

NEEED OF THE STUDY

R.M. ANJANA et.al. (2011) conducted cross sectional study. A total of 363
primary sampling units (188 urban, 175 rural), in three states (Tamilnadu, Maharashtra and
Jharkhand) and one union territory (Chandigarh) of India were sampled using a stratified
multistage sampling design to survey individuals aged ≥20 years. The prevalence rates of
diabetes and prediabetes were assessed by measurement of fasting and 2 h post glucose load
capillary blood glucose.

Of the 16,607 individuals selected for the study, 14,277 (86%) participated, of whom 13,055
gave blood samples. The weighted prevalence of diabetes (both known and newly diagnosed)
was 10.4% in Tamilnadu, 8.4% in Maharashtra, 5.3% in Jharkhand, and 13.6% in
Chandigarh. The prevalences of prediabetes (impaired fasting glucose and/or impaired
glucose tolerance) were 8.3%, 12.8%, 8.1% and 14.6% respectively. Multiple logistic
regression analysis showed that age, male sex, family history of diabetes, urban residence,
abdominal obesity, generalised obesity, hypertension and income status were significantly
associated with diabetes. Significant risk factors for prediabetes were age, family history of
diabetes, abdominal obesity, hypertension and income status.

Barbara J Anderson and Wendy F Auslander (2012) conducted Research on


diabetes management and the family has been traditionally viewed within a linear model, in
which parental attitudes toward diabetes are seen as the principal influence on the child's
adjustment and metabolic control. Recently the focus of research has shifted to the broader
family milieu, with an emphasis on patterns of cooperation and conflict among all family
members in implementing the treatment regimen. As investigators have begun to study the
entire family, the linear model of parental influences has been overshadowed by a systems
model of family interaction, based on the concept of mutual influences among all individuals
in the family. Several methodological problems have characterized research in this area, such
as inadequate assessments of family functioning, unreliable indices of metabolic control, and
insensitivity to differences in age and disease variables. Future studies of diabetes management
will have much to gain from consideration of the role of the father and siblings in treatment,
attention to the diabetic child's impact on family functioning, and recognition of sources of
support and stress outside the family that affect adaptation to diabetes.
CHAPTER-II
REVIEW OF LITERATURE

The review of literature is a broad, comprehensive, in depth, systematic and critical


review of scholarly publication, unpublished scholarly print materials, audio-visual materials
and personal communications. A literature review is a written summary of the state of existing
knowledge on a research problem. The task of reviewing research literature involves the
identification, relation, critical analysis and written description of existing information on a
topic.

The investigator has discussed the literature review under the following sections:-
Section A -Review of Literature Related to Prevalence of Diabetes Mellitus

Section B - Review of Literature related to Knowledge of Diabetes Mellitus

Review of Literature Related to Prevalence of Diabetes Mellitus

Siddiqui FJ & et all (2015) : A Study Conducted in an Urban District of Karachi,


Pakistan. 10 Elements of the study aimed to explore the prevalence of, and factors associated
with, uncontrolled diabetes mellitus (UDM) in a community setting in Pakistan. A single-
center, cross-sectional study, conducted in a community-based specialized care center (SCC)
for diabetes in District Central Karachi, in 2003, registered 452 type 2 DM participants, tested
for HbA1c and interviewed face-to-face for other information. Logistic regression analysis was
conducted to identify factors associated with UDM. Prevalence of UDM among diabetes
patients was found to be 38.9% (95% CI: 34.4-43.4%). Multivariable logistic regression model
analysis indicated that age <50 years (OR: 1.9; 95% CI: 1.2-2.9), being diagnosed in a hospital
(vs. a clinic) (OR: 1.8; 95% CI: 1.1-2.8), diabetes information from a doctor or nurse only (vs.
multiple sources) (OR: 1.8; 95% CI: 1.2-2.9), higher monthly treatment cost (OR: 1.3; 95% CI:
1.1-1.6; for every extra 500 PKR), and higher consumption of tea (OR: 1.5; 95% CI: 1.0-2.2;
for every 2 extra cups) were independently associated with UDM. The prevalence of UDM was
approximately 39% among persons with type 2 diabetes visiting a community based SCC for
diabetes. Modifiable risk factors such as sources of diabetes information and black tea
consumption can be considered as potential targets of interventions in Karachi.

Ashok Kumar & et all (2015) : This Study is conducted in SGPGIMS,


Lucknow in India. Diabetes Mellitus (DM) foot complications are a leading cause of morbidity
in developing countries and prevalence of diabetes is expected to increase in the next decades
in these countries. The aim of this study was to assess the knowledge about diabetic foot care
among diabetic patients (with and without foot ulcer i.e. DFU+VE and DFU-VE) attending
tertiary care hospitals (SGPGIMS, Lucknow) in India. This is a comparative study carried out
from July 2013 to June 2014 based on questionnaires. The knowledge and practice scores,
hypoglycaemia and diet score, and insulin administration and exercise score were classified as
good if score ≥70%, satisfactory if score was 50-69% and poor if score was < 50%. Among
DFU+VE patients (200), 47.7% had good knowledge of foot care versus 52.3% had poor
knowledge about foot care, 66.5% had good knowledge to treat hypoglycemia at home; 48.53%
had good knowledge of insulin administration. In DFU-VE patients (200), 52% had good
knowledge versus 48% had poor knowledge about foot care; 64.5% had good knowledge to
treat hypoglycemia at home; 36.93% had good knowledge of insulin administration. Illiteracy
and low socioeconomic status were significantly associated with poor knowledge and practice
of foot care, hypoglycaemia and diet, and insulin administration and exercise in DFU+VE
cases. This study has highlighted the deficiency of the knowledge of foot care among the
DFU+VE and DFU-VE patients, underscores the need for an educational programme to reduce
the diabetic foot complication.

Alsabbagh MW & et all (2015) : A retrospective short study aimed to describe


trends in the prevalence and incidence of diabetes mellitus and also report the overall use of
diabetes medications among patients newly admitted to a long-term care facility (LTCF). A
retrospective cohort study was done using health administrative databases in Saskatchewan.
Eligible patients were newly admitted to LTCF in Saskatchewan between 2003 and 2011 and
maintained LTCF residency for at least 6 months. Prevalence of diabetes was defined with
physician or hospital claims in the 2 years preceding admission. Antihyperglycemic medication
use was estimated from prescription claims data during the first 6 months after LTCF
admission. All data were descriptively analyzed. The validated case definition for diabetes (≥2
diagnostic claims) in the 2 years before or 6 months after admission was met by 16.9% of
patients (2471 of 14,624). An additional 965 patients (6.6%) had a single diabetes diagnostic
claim or antihyperglycemic prescriptions only. Among patients receiving antihyperglycemic
therapies, 64.9% (1518 of 2338) were exclusively managed with oral medications, and
metformin was the most commonly used medication. Glyburide was commonly withdrawn
after LTCF admission. Insulin use was observed in 23.9% of diabetes patients, with a mean
daily average consumption of 54.7 units per day. Use of diabetes medications appear to
generally align with Canadian practice recommendations as evidenced by declining use of
glyburide and frequent use of metformin. Future studies should examine clinical benefits and
safety of hypoglycemic agent use in LTCFs.

Review of Literature related to Knowledge of Diabetes Mellitus


Pena-Purcell NC & et all (2014) : A prospective, quasi-experimental study
conducted in the threefold purpose of this study is to assess diabetes knowledge among
Hispanic/Latinos attending a culturally sensitive, empowerment-based, diabetes self-
management education program; second, to examine the utility of the Spoken Knowledge in
Low Literacy in Diabetes (SKILLD) scale as an assessment tool for this population; and third,
to assess the relationship between hemoglobin A1C and knowledge improvement in the
intervention group. A prospective, quasi-experimental, repeated-measure design tested pre-
and post-A1C and diabetes knowledge using the SKILLD scale. The sample consisted of 71 in
the intervention group and 64 controls. Most participants were female, marginally acculturated,
and, on average, 60 years of age. Both groups were similar in baseline diabetes knowledge
score (median 6 out of 10), and higher literacy was significantly related to increased baseline
knowledge. The intervention group significantly improved at follow-up compared with the
controls: Participants in the intervention with low baseline knowledge scores had a mean
follow-up score of 5.6; those with a high baseline score had a mean score of 7.6. The
intervention cohort scored significantly better in knowing why to see an eye doctor, what are
normal fasting blood glucose and A1C, and understanding long-term diabetes complications.
Increased knowledge of a normal fasting blood glucose level had a significant effect on follow-
up A1C in the intervention group. The intervention favorably affects diabetes knowledge, and
the SKILLD scale has utility with low-literate Hispanic/Latinos. The significant impact on A1C
by diabetes knowledge gain shows that the empowerment-based diabetes self-management
education was successful for this ethnic population.

Yacoub MI & et all (2014) : A cross-sectional study is Conducted in Jordan.


Nurses play a vital role in caring for people with diabetes where knowledge constitutes the
cornerstone of this care. This study assessed the level of Jordanian nurses' perceived and actual
knowledge of diabetes and examined the relationship between nurses' actual knowledge of
diabetes and their different characteristics. A cross-sectional descriptive design was used to
report knowledge regarding diabetes. Registered nurses were asked to complete self-
administered questionnaires. The Diabetes Self-Report Tool and the Modified Diabetes Basic
Knowledge Test were used to assess nurses' perceived and actual knowledge of diabetes. A
total of 277 out of the 450 eligible registered nurses accepted to participate and returned
questionnaires from seven hospitals in Jordan. Nurses in this study mostly demonstrated a
knowledge deficit in clinical and theoretical-based topics, such as initial treatment of
hypoglycaemia, insulin storage and preparation; meal planning and duration of action with
hypoglycaemic agents. Nurses' actual knowledge of diabetes was positively correlated with
their perceived knowledge, perceived competence and level of education. Study participants
were selected using convenience sampling. The length of time needed for nurses exceeded
50 min to complete study questionnaires. This study examined current knowledge among
Jordanian registered nurses regarding diabetes. A knowledge deficit regarding diabetes was
demonstrated by the nurses who participated in this study. The role of continuing education is
essential to supporting nurses' knowledge of complex clinical conditions, such as diabetes.
Adequate implementation and dissemination of evidence-based guidelines on caring for people
with diabetes is a prerequisite to improve the nurses' knowledge. Promoting continuing
education in diabetes for nurses requires continuous effort and creativity. Healthcare system
administrators must acknowledge and prioritize the need for this education.
CHAPTER-III
METHODOLOGY

“Methodology of research organises all the components of the study in a way

that is most likely to lead valid answers to the sub-problems that have been posed.”

This chapter deals with the methodology that was selected by the investigator in order to find out main
causes and preventive measures of Non communicable diseases in Rajasthan”

The methodology of the study includes research approach, research design, variables, setting of the
study, population, sample and sampling technique, sampling criteria, data collection process and plan for
data analysis.

PROBLEM STATEMENT

““A discussion on main causes and preventive measures of Non communicable diseases in

Rajasthan”

OBJECTIVES OF THE STUDY

1. To find out main types of non-communicable diseases.


2. To identify main causes and preventive measures of non-communicable diseases.

RESEARCH APPROACH

In order to accomplish the main objectives of evaluating main causes and preventive measures of
Non communicable diseases in Rajasthan”, an evaluative research approach was adopted.

Evaluation research is the process of collecting and analysing information relating to

the functioning of a programme, policy or procedure in order to assist decision makers in

choosing a course of action. Its goal is to assess or evaluate the success of a programme. In the
present study the investigator aimed at evaluating the effectiveness of the research on find out

main causes and preventive measures of NCD.

RESEARCH DESIGN

Research design is the overall plan for addressing a research question, including

specification for enhancing the integrity of the study.

Descriptive research design was adopted for the study.

SETTING OF THE STUDY

Setting of the study include MBS hospital and J.K. Loan hospital, Kota (Raj)

POPULATION

Population means all possible elements that could be included in research. It represents the
entire group under study. In this study, the population consists persons who came at Diabetic
clinic at MBS hospital, Kota.
CRITERIA FOR SAMPLE SELECTION

Inclusive criteria:

1. Person who came at Diabetic clinic of MBS hospital, Kota (Raj.)

2. Person who willing to participate in study.

3. Person who are available at the time of data collection.

Exclusion criteria:
1. Person who did not came at Diabetic clinic of MBS hospital, Kota (Raj.)

2. Women who are not willing to participate in study.

3. Women who are not available at the time of data collection.

STUDY PERIOD-
27 Sep 2018 to 29 Sep 2018.

PROCESS OF DATA COLLECTION

The data collection period for study was scheduled from 27 Sep 2018 to 29 Sep 2018. In this
study data is collected from all the persons who came at diabetic clinic of MBS Hospital, Kota
(Raj)

TYPES OF DIABETES

Type-1: It is definitely the far more serious and complicated, the simple reason being in this
that the pancreatic beta cells are totally dead or defective, and hence no production of insulin.
Therefore, regular, lifelong, insulin injections are required to maintain normal blood sugar.
Children, young men, women and those whose sugar levels can't be controlled by tablets come
under this category. It can happen to older persons, too, but very rarely. It is also termed as
Juvenile Diabetes, Insulin-Dependent Diabetes Mellitus or IDDM. This illness develops fast.
Type-II: Nearly 90 per cent of diabetics come under this category. Their bodies produce little
or defective insulin. Most of them develop this type of diabetes when they are around 40 to 50
years of age, and if they follow proper diet and exercise, can live on tablets without ever having
to take insulin. But usually they don't take it seriously and they end up with insulin sometime
in their lives.

Gestational diabetes: Some women have high blood sugar during pregnancy. This is termed
gestational diabetes. 95 per cent of the gestational diabetes disappears after childbirth. If
women are below 25 years, it's very rare. Generally, gestational diabetes symptoms are mild.

CAUSES OF TYPE 1 DIABETES

Type 1 diabetes occurs when the immune system attacks and destroys the insulin-producing
cells in the pancreas (the beta cells). As a result, the body is left without enough insulin to
function normally (i.e. it becomes insulin deficient). This is called an autoimmune reaction,
because the body attacks itself and produces antibodies to its own insulin-producing cells,
thereby destroying them.

Researchers don’t exactly know why this process is activated in some people.

CAUSES OF TYPE 2 DIABETES

The causes of type 2 diabetes are multifactorial and complex. But even though there is no
single cause, there are some well-known predisposing factors – the most overwhelming being
obesity and a family history of type 2 diabetes.

Type 2 diabetes is the result of both insulin resistance (when the cells don’t respond well to
insulin and can’t easily take up glucose from the blood) and progressive beta-cell damage,
resulting in too little insulin being secreted by the pancreas.

COMMON CAUSES OF DIABETES

 Genetics (heredity)
 Obesity
 Irregular and unhealthy eating habits
 Stress
 Other Reasons

SIGN AND SYMPTOMS OF DIABETES

The symptoms of diabetes can include:

 blurred vision

 fatigue

 increased hunger and thirst

 frequent urination

 numbness or tingling in the hands and feet

 sores that do not heal

 unexplained weight loss


CHAPTER-IV
ANALYSIS AND INTERPRETATION OF DATA

Reducing risks and preventing disease:


The global epidemic of NCDs can be reversed through modest investments in interventions.
Some effective approaches are so low in cost that country income levels need not be a major
barrier to successful prevention. What is needed are high levels of commitment, good
planning, community mobilization and intense focus on a small range of critical actions. With
these, quick gains will be achieved in reducing the major behavioural risk factors: tobacco
use, harmful use of alcohol, unhealthy diet and physical inactivity, together with key risk
factors for cancer, notably some chronic infections.

At a time when diabetes is fast gaining the status of a potential epidemic in India, Rajasthan
has the lowest number of people affected by the disease. This striking fact surfaced in the
National Family Health Survey-2015-16 report which union ministry of health tabled in a
reply to a question asked in Lok Sabha recently.

As per the report, 5.8 per cent women and 8.8 per cent men in the age group of 15-59 years
on an average out of the surveyed in

India were found suffering from diabetes measuring above 140 Mg/dl. The percentage of
people suffering from high blood pressure in Rajasthan is much lower than the national
average and at the bottom when compared to rest 35 states and union territories.

The survey finds that only 3.5 percent women and 5.7 percent men were found diabetic in
2015-16 in Rajasthan which is the lowest in the country. It also indicates that men are more
prone to diabetes than women. On the other hand, Kerala and Goa were top two in the
country with the highest share of population with 8.7 per cent (women)-13.1 percent (men)
and 8.9 percent (women) and 12.3 percent(men) ratio respectively.
These were followed by Andhra Pradesh at 8.2 percent population ratio in women and West
Bengal with 11.4 percent in men categories. Apart from Rajasthan, Haryana, Jharkhand and
Maharashtra have secured bottom position with fewer diabetic patients.

The survey indicates that Haryana with 4.8 percent patients in males is followed by
Jharkhand at 4.9 percent.In females, Maharashtra keeps second place from bottom with 5.9
percent which is followed by Haryana at 6.1. The findings of the survey as far as Rajasthan is
concerned is shocking and hard to be digested by endocrinologists.

PREVENTIVE MEASURES

1. National policies to ensure that walking, cycling, sports and other recreational
activities are accessible and safe are required to promote physical activity.

2. The physical environment plays an important role in physical activity, ensuring that
walking, cycling and other forms of activity are accessible and safe for all. The
physical environment can also promote active and safe methods of travelling to and
from schools and workplaces; provide adequate sports, recreation and leisure
facilities; and ensure adequate safe spaces for active play, especially for children.

3. Workplaces: Multi-component programmes promoting physical activity in the


workplace are shown to be effective when they:

• Provide space for fitness and signs to encourage the use of stairs;

• Involve workers in programme planning and implementation;


• Involve families through self-learning programmes, newsletters, festivals,
etc.;

• Provide individual behaviour change strategies and self-monitoring.

Community level: The most effective physical activity interventions at the


community level include: community development campaigns with multisectoral
cooperation that focus on a common goal, such as reduction in CVD risk, as well
as group-based physical activity programmes or classes for homogenous groups.

4. Following a healthy eating plan.

5. Do not smoke.

6. Get regular exercises.


CHAPTER-V
CONCLUSION AND RECOMMENDATIONS
The socio-demographic and economic transition has a big role in the current rise of non-
communicable diseases in developing countries. Increased urbanization in developing
countries means that people are more at risk because the urban environment exposes to more
risky behaviour

These diseases mainly result from life-style related factors such as unhealthy diet, lack of
physical activity, tobacco and alcohol use etc. Changes in life style, behavioral pat-terns, and
demographic profile, socio-cultural are leading to sharp increase in the prevalence of non-
communicable diseases like diabetes, cardiovascular diseases, stroke, cancer etc.

These diseases can be prevented by making simple changes in the way of we live their out
or simple by changing over life-style. The lifestyle intervention programmes can improve the
overall health profile of the communities. Dietary programmes and Physical activity
programmes that encourage better control of existing diseases such as obesity, hypertension,
diabetes and dyslipidemia, can also promote the community health status.

Poor life-style includes, poor diet, lack of exercise, smoking, excess alcohol, poor sleep,
stress due to heavy workload. Several factors are resulting in the increasing burden of lifestyle
disease which includes longer average life span, rising income, increasing tobacco
consumption, decreasing physical activity and increased consumption of unhealthy food. In
Rajasthan, rapid urbanization and globalization mainly contribute towards increased number
of people suffering from life-style disorders
The main risk factors for NCDs namely smoking, alcohol intake, unhealthy diet and low
physical activity are prevalent in both rural and urban communities. There are initiatives to
control the burden of non-communicable diseases in the country.

However, there is need to focus more on primary prevention at population level targeting
interventions to reduce exposure to tobacco, reduce alcohol intake, reduce salt intake, promote
healthy diets and physical activity.

The observed differences in risk factors and prevalence of non-communicable diseases in urban
areas could also be explained by the fact that in urban areas people have more access to refined
processed foods which are energy dense and or high fat diets than the traditional foods
characterized by high roughage content. This could either be due to poverty or lack of
information and misconceptions also lack of access to healthy food which means that many are
forced to eat what is cheaply available especially during business hours when outside their
homes hence at increased risk of NCDs.

Further community mobilization is needed to implement prevention strategies and reduce and
prevent exposure to the non-communicable diseases risk factors and subsequently reduce the
burden of the diseases.
REFERENCES

1. World Health Organization. “Obesity: Preventing and managing the global epidemic.

Report of World Health Organization Consulta-tion on Obesity”. Geneva (2000).

2. https://www.health24.com/Medical/Diabetes/Overview/Causes-of-diabetes-20140714

3. https://www.healthline.com/nutrition/prevent-diabetes

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5320852/

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282458/

6. https://www.cdc.gov/diabetes/prevention/index.html

7. https://www.dnaindia.com/jaipur/report-rajasthan-ranks-lowest-in-diabetes-prevalence-

survey-2520204

8. http://care.diabetesjournals.org/content/3/6/696.short