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BRIEF RESEARCH ARTICLE
Year : 2014  |  Volume : 58  |  Issue : 3  |  Page : 195-198  

Prevalence of behavioral risk factors, overweight and hypertension in the urban slums of North 24 Parganas District, West Bengal, India, 2010


1 Deputy Chief Medical Officer of Health, Department of Health and Family Welfare, Government of West Bengal, West Bengal, India
2 Scientist F, National Institute of Epidemiology, Indian Council of Medical Research, Chennai, Tamil Nadu, India

Date of Web Publication13-Aug-2014

Correspondence Address:
Dr. Prabhdeep Kaur
Scientist C, National Institute of Epidemiology, Indian Council of Medical Research, No. R-127, 3rd Avenue, Tamil Nadu Housing Board, Ayapakkam, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.138632

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   Abstract 

Globally, 1 billion people live in slums. There are few reports of high prevalence of noncommunicable disease (NCD) risk factors among the urban poor. The prevalence of NCD risk factors in the slums in North 24 Parganas, West Bengal, India was estimated. Cross-sectional survey in 24 slums selected using cluster sampling method was conducted. Questionnaire for behavioral risk factors was used and anthropometric and blood pressure measurements were done. The study population included 1052 participants aged 25-64 years, 528 (50%) were males. Among males, 206 (39%) were current smokers and 154 (29%) were current alcohol users. Central obesity was prevalent among 32.8% males and 56.1% females and 115 (10.9%) had body mass index ≥27.5 kg/m 2 . Hypertension was prevalent among 35% males and 33% females. We observed high prevalence of NCD risk factors among urban slum dwellers that need to be addressed with health promotion programs and strengthening of primary health care system.

Keywords: Hypertension, India, Obesity, Overweight, Tobacco, Urban slum, West Bengal


How to cite this article:
Acharyya T, Kaur P, Murhekar MV. Prevalence of behavioral risk factors, overweight and hypertension in the urban slums of North 24 Parganas District, West Bengal, India, 2010. Indian J Public Health 2014;58:195-8

How to cite this URL:
Acharyya T, Kaur P, Murhekar MV. Prevalence of behavioral risk factors, overweight and hypertension in the urban slums of North 24 Parganas District, West Bengal, India, 2010. Indian J Public Health [serial online] 2014 [cited 2017 Dec 11];58:195-8. Available from: http://www.ijph.in/text.asp?2014/58/3/195/138632

Globally, 1 billion people out of the 6 billion live in slums. Slums are characterized by poor infrastructure and overcrowding. [1] Although, the research in the urban slums has been primarily focused on reproductive and child health and communicable diseases, there are few reports of high prevalence of noncommunicable disease (NCD) risk factors among the urban poor due to changing life styles in the urban environment. [2],[3],[4] West Bengal is one of the Eastern states in India. North 24 Parganas is the second highest urbanized district next to Kolkata in West Bengal with 54% of the population living in urban areas. Overall, 20% of the populations live in slums but the proportion of slum population is as high as 78% in one of the municipalities in the district. [5] The study was conducted to estimate prevalence of NCD risk factors in the slums in North 24 Parganas in West Bengal.

North 24 Parganas district is situated in the lower Eastern side of the West Bengal state with population of 9.7 million. [5] We defined slums listed as per census 2001 in our study. Study population was the registered slums of the municipalities of South Dum Dum, Titagarh and Panihati of North 24 Parganas with the slum population of 104,534, 102,363 and 97,706 respectively. Our study included all the adults in the age group of 25-64 years, core age group recommended for surveillance for NCD risk factors. [6] Cluster sampling was done. We listed all the slums in the three municipalities. We selected slums, based on the probability proportion to size. In each slum, randomly selected household as per the family register was the starting point. We surveyed contiguous households and all the individuals in the eligible age-group until the target number was reached. We calculated sample size assuming 15% prevalence of the risk factor, 5% absolute precision, 95% confidence coefficient and design effect of 1.2. Sample size was 264 for each stratum in 24 clusters with cluster size of 11. We had four strata; namely males 25-44 and 45-64 years age group and females of 25-44 and 45-64 years age group. Therefore, total sample size was 1056.

An interviewer administered questionnaire (schedule) was used to collect data on demographic and behavioral risk factors. We collected data regarding sociodemographic characteristics, tobacco use, alcohol consumption and fruit/vegetable consumption. Weight was measured in the upright position to the nearest 0.1 kg using calibrated weighing scale. Height was measured without shoes to the nearest 0.1 cm using calibrated stadiometer (Seca). Waist circumference (WC) was measured to the nearest 0.1 cm at the narrowest point between lower end of the rib cage and iliac crest maintaining appropriate privacy. Measurements were done by female investigators inside the house during the door to door survey. Two readings of blood pressure were measured from the right arm after the participant had been sitting for at least 5 min using automatic blood pressure apparatus (Omron MX3).

A current smoker was defined as a person who continued to smoke at the time of survey daily or occasionally and ex-smoker was defined as a person who had quit smoking. [6] Current alcohol user was defined as a person who has consumed alcohol in the past 12 months. [6] Fruit and vegetable intake was estimated with one serving of fruit/vegetable being equivalent to 100 g. [6] Median intake of fruit and vegetable servings (combined) per day was computed by dividing total number of servings per week by 7 days. We categorized body mass index (BMI) as per Asian classification as increased risk (23.0-27.49 kg/m 2 ) and high risk (≥27.5 kg/m 2 ). [7] Central obesity was defined as either WC ≥90 cm for men and WC ≥80 cm for women. [8] Hypertension was defined as systolic blood pressure of ≥140 mmHg or diastolic blood pressure ≥90 mmHg as per WHO criteria or history of previously known disease or treatment with antihypertensives. [9] Overall prevalence of each risk factor with 95% confidence intervals was calculated. Epi info v.3.5 for data entry and analysis was used. We obtained approval from Institutional Ethics Committee. We obtained written informed consent from all the participants.

A total of 1052 participants in 24 slums (total population 45,150) in the age group of 25-64 years were surveyed. There were 528 (50.2%) males and 524 (49.8%) females. Most participants were either Hindus (651 [61.9%]) or Muslims (399 [38%]). Public flush toilet was used by 41.5% and 20% of the participants had their own flush toilet. Electricity was present in the house for 95% of the participants. There was a single room in the house for 676 (64%) and 862 (82%) had no separate kitchen. Nearly 90 (17%) males and 267 (51%) females were illiterate. Majority (366 [70%]) of the females were home makers. Among participants, 194 (18.4%) had previous history of hypertension and 47 (4.5%) had previous history of diabetes.

Overall, 393 (37.4%) were smokeless tobacco consumers. Smokeless tobacco use was also higher among males (262 [50%]) as compared to females (131 [25%]). Among males, 206 (39%) and among females, 21 (4%) were current smokers [Table 1]. Mean age at which smokeless tobacco use was started was 22.7 years (standard deviation [SD]: 8.7). The most common smokeless tobacco used was khaini 206 (20%), followed by chewing tobacco and tobacco with pan (betel). The most common form of smoking among males was bidi 165 (31%) followed by cigarettes 44 (8%). Mean number of bidis smoked per day among males were 10.4 (SD: 7.7) and cigarettes were 6.4 (SD: 3.5). Mean age at which the smoking was started was 20 years (SD: 5.76). Overall alcohol consumers were 158 (15%) and among them four were females. Among males, 137 (26%) had consumed alcohol in the previous 30 days. Nearly half of the consumers had alcohol at least once in a week. Overall 51 (9.7%) males and one female had all three risk factors namely current smoking, current smokeless tobacco use and current alcohol use.
Table 1: Overall and sex-wise prevalence of behavioral risk factors in urban slums, North 24 Parganas, West Bengal, India, 2010


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Overall 234 (22%) subjects did not consume any fruits in the previous week. Majority consumed vegetables daily. Only 38 (7%) males and 61 (12%) females consumed four or more fruit and vegetable servings [Table 1]. Among the studied population, 973 (92.5%) used mustard oil and 61 (5.8%) used palm oil for cooking.

Mean BMI was 22.8 kg/m 2 and 23.5 kg/m 2 for males and females respectively. Mean WC was 85.4 cm and 82.1 cm for males and females respectively. Overall, 380 (36%) had BMI 23.0-27.4 kg/m 2 and in 115 (10.9%) had BMI ≥27.5 kg/m 2 . The central obesity was present among 467 (44%) [Table 2]. Prevalence of central obesity was significantly higher among females when compared to males. There was no significant difference in the overweight, obesity, and central obesity in the two age groups both among males and females.
Table 2: Prevalence of overweight, central obesity and hypertension in various age-sex in urban slums of North 24 Parganas, West Bengal, India, 2010

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The overall prevalence of hypertension was 34.2%. Among patients with hypertension, 93 (50.2%) males and 73 (41.7%) females had newly detected hypertension. Hypertension was more prevalent in the 45-64 years age group as compared to 25-44 years age group.

We observed high prevalence of NCD risk factors in the slums in North 24 Parganas district. Our results were consistent with high prevalence of NCD risk factors previously reported in slums in Northern India. [2],[3] This suggests the effect of urbanization and changing life styles among urban poor. We observed high prevalence of tobacco and alcohol use among males similar to national level survey in eight major Indian cities that showed at least one of the two poor males used tobacco. [4] We observed low intake of fruits and vegetables similar to other studies from slum populations. [3] This could due to high cost of fruits and vegetables and lack of inclusion of fruits/vegetables in the locally prepared staple food that primarily consists of rice, pulses and fish. High prevalence of overweight and obesity, more so among females was consistent with findings from national survey where it ranged from 14% to 35% in eight Indian cities. [4]

High prevalence of hypertension requires screening and management programs at the primary care level. Poor primary care infrastructure, lack of sensitization among health providers and poor utilization of existing facilities limit the access to primary care in general among urban poor in slums in India. [10] NCDs such as hypertension require strengthening of existing health facilities with focus on the training the health providers and ensuring availability of adequate diagnostics and drugs. The limitation of our study was we could not include few risk factors such as salt intake and physical inactivity and we did not present data for pre hypertension. We did not analyze the factors associated with various outcomes as the sample size was mainly calculated for prevalence of risk factors. This can be done in future larger studies.

There is need for health promotion programs with specific focus on need to quit smoking, smokeless tobacco and alcohol and encourage high intake of locally available fruits and vegetables. Strengthening and reorientation of primary health care system is needed to improve availability and accessibility to hypertension screening and treatment.

 
   References Top

1.UN-Habitat GUO. Guide to Monitoring Target 11: Improving the Lives of 100 Million Slum Dwellers. Nairobi: UN-Habitat; 2003.  Back to cited text no. 1
    
2.Misra A, Pandey RM, Devi JR, Sharma R, Vikram NK, Khanna N. High prevalence of diabetes, obesity and dyslipidaemia in urban slum population in northern India. Int J Obes Relat Metab Disord 2001;25:1722-9.  Back to cited text no. 2
    
3.Anand K, Shah B, Yadav K, Singh R, Mathur P, Paul E, et al. Are the urban poor vulnerable to non-communicable diseases? A survey of risk factors for non-communicable diseases in urban slums of Faridabad. Natl Med J India 2007;20:115-20.  Back to cited text no. 3
    
4.Gupta K, Arnold F, Lhungdim H. Health and Living Conditions in Eight Indian Cities. National Family Health Survey (NFHS-3), India, 2005-06. Mumbai, Calverton, Maryland, USA: International Institute for Population Sciences; 2009.  Back to cited text no. 4
    
5.HDRCC GoWB. District Human Development Report North 24 Parganas. In: Development and Planning Department, editor. Kolkata: Development and Planning Department, Government of West Bengal; 2010.  Back to cited text no. 5
    
6.WHO. STEPS Manual; 2008. Available from: http://www.who.int/chp/steps/manual/en/index.html. [Last accessed on 2008 Dec 25].  Back to cited text no. 6
    
7.WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-63.  Back to cited text no. 7
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8.Inoue S, Zimmet P, Caterson I, Chunming C, Ikeda Y, Khalid A, et al. The Asia-Pacific Perspective: Redefining Obesity and its Treatment. Sydney: Health Communications, Sydney, Australia; 2000.  Back to cited text no. 8
    
9.Whitworth JA, World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003;21:1983-92.  Back to cited text no. 9
    
10.Agarwal S, Sangar K. Need for dedicated focus on urban health within National Rural Health Mission. Indian J Public Health 2005;49:141-51.  Back to cited text no. 10
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