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   Table of Contents - Current issue
Coverpage
April-June 2019
Volume 4 | Issue 2
Page Nos. 35-61

Online since Wednesday, July 10, 2019

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EDITORIAL  

Noncommunicable diseases need an urgent and systematic response p. 35
Mukesh Kapila
DOI:10.4103/jncd.jncd_13_19  
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ORIGINAL ARTICLES Top

Health workforce availability and competency to manage noncommunicable diseases at secondary care level hospitals of Delhi p. 38
Shalli Bavoria, Baridalyne Nongkynrih, Anand Krishnan
DOI:10.4103/jncd.jncd_10_19  
Context: Health system strengthening is a major component of the national strategy to address noncommunicable diseases (NCDs). Human resource (HR) is an important building block of health system, and its capacity to address NCDs needs to be assessed. Aims: We assessed the availability, training, and self-rated competencies of available staff in secondary-level health facilities under the Government of Delhi for NCD services. Settings and Design: This study was conducted in a secondary care hospital in Delhi; this was a cross-sectional study. Subjects and Methods: Fifteen hospitals listed by the Directorate of Health Services, Delhi, were assessed through personal visits. Medical superintendents provided information regarding the availability of workforce and their training. Self-rated competency was assessed among doctors, nurses, and laboratory workers using a self-administered questionnaire. Results: A total of 85 doctors, 66 nurses and 52 laboratory technicians were interviewed. Shortage of staff ranged from 7.2% for staff nurse to 42.5% for medicine specialist. None of the staff had undergone special training for providing NCD-related services. 96.5% of doctors and 83.3% of nurses reported being aware of standard treatment guidelines for diabetes and hypertension. Key reported deficiencies were seen in doctors and nurses in managing diabetes complications. Cancer was not being managed in any hospital. Proficiency in cardiovascular disease management was reported by 24.7% and COPD management by 83.5% of doctors. There was major gap in competencies related to stroke management. Conclusions: Availability of trained and competent workforce was a limiting step in delivering NCD care in secondary-level public health facilities of Delhi, indicating the need for strengthening the HR capacity.
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Markers of insulin resistance and their performance in adult Nigerians with metabolic syndrome p. 43
Ifeoma Christiana Udenze, Idowu A Taiwo, Joseph Babatunde Minari, Casmir E Amadi
DOI:10.4103/jncd.jncd_53_18  
Background: Insulin resistance (IR), which is a state of deficient response to normal insulin levels, is associated with metabolic abnormalities of dyslipidemia, glucose intolerance, obesity, and hypertension, parameters which define metabolic syndrome (MS). Markers of IR could be useful tools to predict MS. Aim: This study aims to evaluate the performance of surrogate markers of IR in predicting MS in nondiabetic adult Nigerians. Settings and Design: This cross-sectional, analytical study was conducted in Lagos, Nigeria. Subjects and Methods: One hundred and forty-one apparently healthy adult Nigerians aged between 40 and 80 years were consecutively recruited. MS was defined according to the harmonized MS criteria. Data were collected using a questionnaire, and fasting blood samples were collected for analysis. Statistical Analysis: The data were analyzed using the IBM SPSS statistical package. Statistical significance was set at P < 0.05. Results: The mean values of Homeostatic Model for Insulin Assessment-IR (HOMA-IR), HOMA-beta cell (HOMA-B), and Quantitative Insulin Sensitivity Check Index (QUICKI), but not fasting glucose-insulin ratio (FGIR), significantly distinguished individuals with and without MS components (P = 0.0001). HOMA-IR and QUICKI, but not HOMA-B and FGIR, had significant correlations with the components of MS (P = 0.041). QUICKI had the largest area under the receiver operating characteristic curve for predicting MS, with a sensitivity of 90% and a specificity of 40%, at a cutoff value of 0.324 (P < 0.05). Conclusion: QUICKI performed better than HOMA-IR, HOMA-B, and FGIR in predicting MS in apparently healthy adult Nigerians.
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RESEARCH PROTOCOL Top

Development and cost estimates of an integrated noncommunicable disease registry in North India: A study protocol p. 49
Ronika Paika, JS Thakur, Dheeraj Khurana, Sanjay Kumar Bhadada, Rajesh Vijayvergiya, Rakesh Kapoor, Shankar Prinja
DOI:10.4103/jncd.jncd_18_19  
Background: Out of the total deaths globally, noncommunicable diseases (NCDs) account for 72%. In India, as per the Global Burden of Disease Estimates 2016, NCDs contributed to 62% of the deaths and 55% of the disability-adjusted life years (DALYs), thereby posing a huge burden. In low- and middle-income countries, NCD burden estimates are either not available or that are available are insufficient. Hence, the tools to be used in developing countries similar to that in India are disease registries which work as a powerful method to record the data for NCDs. Methods: The integrated registry will be developed in Chandigarh (UT), North India. The situational analysis of operationalization of the existing individual NCD registries of Chandigarh will be done with baseline assessment for core and advanced activities. From a review of the existing tools of varied registries, the integrated tool will be developed and validated. The integrated registry will also be developed as m-registry, i.e., the questionnaire in the form of mobile-based application will be linked to a web-based server so as to make the real-time data entry. Economic evaluation of the isolated NCD registries will be done so as to find the cost of per case registered, on the basis of which the cost of operationalizing an integrated NCD registry will be developed. Discussion: The integrated registry would mean integration in terms of uniform reporting system for different NCDs such as cancer, diabetes at a younger age, acute cardiac events, and stroke, with a separate portion for each disease and pooling of human resources which will ultimately help in developing integrated evidence-based public health interventions for prevention and control. The Barbados' multi-NCD registry has developed a disease surveillance model to record NCD with the phased introduction of one registry component per year with the pooling of human resource and data at one place. A similar model of integrated registry has been developed in the Philippines.
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PERSPECTIVE Top

Himachal Pradesh – a hilly state of India on path of – Universal health coverage p. 53
Gopal Ashish Sharma, Sumala Kapila
DOI:10.4103/jncd.jncd_14_19  
Himachal Pradesh (HP) is one of the states of India with a population of 6,864,602 and density of 123/km2. In the first healthy states, progressive India report on the ranks of states and union territories, HP scores overall 5th rank in health index based on reference year 2015-2016. Similarly, in first of its kind, “Health of nation states” report published recently revealed disease burden status of respective states and HP falls under highest epidemiological transition levels with epidemiological ratio of <0.31 in 2016 which was 1.14 in 1990. Particularly, the leading causes of disability-adjusted life years were reported as ischemic heart disease and chronic obstructive pulmonary disease for HP. These above-stated factual indicators reflect on high expenditure being incurred by an average resident of state suffering from any form of noncommunicable diseases while assessing health-care services. Sustainable development goal 3 and 3.8 of financial risk protection is being addressed through various government-sponsored schemes envisaging National Health Policy-2017 goals. Government of HP had taken major strides for Universal Health Coverage (UHC) and extended the similar benefits of Ayushman Bharat scheme to all sections of society with notification of Himachal Health Care scheme on December 29, 2018. Being a hilly state, HP is having its own challenges of inaccessibility and disparities, but its journey and direction on path of UHC is well directed and aptly supported by government policies.
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CONSENSUS STATEMENT Top

Gaborone call to action on noncommunicable diseases to achieve Sustainable Development Goals #3 p. 56
Davison Munodawafa
DOI:10.4103/jncd.jncd_22_19  
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CONFERENCE PROCEEDINGS Top

Proceedings of meeting of the World NCD Federation, Africa Region: Framing the noncommunicable diseases response and realizing sustainable development goals for the African region; December 12–14, 2018 p. 58
Davison Munodawafa
DOI:10.4103/jncd.jncd_21_19  
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