Field-testing of primary health-care indicators, India

Nambiar, Devaki; Sankar, Hari; Negi, Jyotsna; Nair, Arun; Sadanandan, Rajeev

doi:10.2471/blt.19.249565

Cited by 11 publications

(7 citation statements)

References 27 publications

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“…Filling this gap, we sought to examine inequalities in testing and self-reported prevalence of HBP and HBG by education, wealth, caste and tribes and religion separately for men and women in Kerala. We drew upon a health systems survey undertaken to monitor the performance of Kerala’s Aardram health reform initiatives as a part of a larger implementation research study assessing equity in Universal Health Coverage reforms in the state [ 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

Intersecting sex-related inequalities in self-reported testing for and prevalence of Non-Communicable Disease (NCD) risk factors in Kerala

Negi¹,

Sankar

Nair³

et al. 2022

BMC Public Health

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Background Non-Communicable Diseases (NCDs) are among India’s top burdens, particularly in states like Kerala, which is at an advanced stage of the epidemiological transition. Evidence in India points towards intersectional inequalities in risk factors of NCDs and testing, both of which are understudied in Kerala. We estimated the self-reported testing and prevalence of key NCD risk factors—blood pressure (BP) and blood glucose (BG) comparing Kerala men and women across educational, wealth, religion, as well as caste and tribal status subgroups. Method A multistage random sample survey of 3398 women and 2982 men aged 30 years and over was administered in 4 districts of Kerala from July to October 2019. Descriptive analysis for men and women was undertaken using survey weights. Slope index of Inequality and Relative Concentration Index for wealth and education related inequalities, and, Weighted Mean Difference from Mean and Index of Disparity for caste and tribal status, as well as religion related inequalities were calculated using World Health Organisation’s Health Equity Assessment Toolkit Plus and Stata 12. Results A significantly higher proportion of women reported BP and BG testing by medical personnel in the previous year than men (BP Testing among Women (BPTw): 90.3% vs BP Testing among Men (BPTM):80.8%, BG Testing among Women (BGTw): 86.2% vs BG Testing among Women (BGTM):78.3%). Among those tested, more women (11.2%) than men (7.9%) reported High Blood Pressure (HBP) but not High Blood Glucose (HBG). Testing for BP was concentrated among less-educated women while BG testing was concentrated among both less educated women and men. HBP and HBG were concentrated among less educated and wealthier groups. Although sex differences were insignificant across caste and tribal status and religion subgroups, magnitude of inequalities was high for HBP and HBG. Conclusion Distinct patterns of sex inequalities were present in self-reported testing and prevalence of NCD risk factors in Kerala. Education and wealth seem to be associated with testing while prevalence appeared to vary by religious groups. Given the low rates of illiteracy, it is encouraging but maybe a data artefact that a small population of less-educated persons was getting tested; however, exclusion of poor groups and inequalities by other dimensions raise concerns. Further exploration is needed to understand underlying mechanisms of these inequalities to ensure we leave no one behind.

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Section: Introductionmentioning

confidence: 99%

Intersecting sex-related inequalities in self-reported testing for and prevalence of Non-Communicable Disease (NCD) risk factors in Kerala

Negi¹,

Sankar

Nair³

et al. 2022

BMC Public Health

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“…The government of Kerala has significantly revamped the primary care in the public health system by introducing family health centres (FHCs) with electronic health records (eHealth) [8,9]. For people with diabetes, a comprehensive diabetes care plan was initiated about five years ago, and it includes screening for all complications of diabetes except DR [10]. Therefore, implementing a DR screening programme within the primary care not only provides a complete preventive medicine plan for people with diabetes but also contributes to achieving some of the Sustainable Development Goals (SDG) [11].…”

Section: Introductionmentioning

confidence: 99%

Burden of Diabetic Retinopathy amongst People with Diabetes Attending Primary Care in Kerala: Nayanamritham Project

Sivaprasad

Sahasranamam²,

George³

et al. 2021

JCM

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Background: The burden of diabetic retinopathy (DR) in people attending the public health sector in India is unclear. Thirty percent of the population in India is reliant on public healthcare. This study aimed to estimate the prevalence of DR and its risk factors in people with diabetes in the non-communicable disease registers who were attending the family health centres (FHCs) in the Thiruvananthapuram district in Kerala. Methods: This cross-sectional study was conducted over 12 months in 2019 within the framework of a pilot district-wide teleophthalmology DR screening programme. The age- and gender-adjusted prevalence of any DR and sight-threatening DR (STDR) in the whole sample, considering socio-demography, lifestyle and known clinical risk groups, are reported. Results: A total of 4527 out of 5307 (85.3%) screened in the FHCs had gradable retinal images in at least one eye. The age and gender standardised prevalence for any DR was 17.4% (95% CI 15.1, 19.7), and STDR was 3.3% (95% CI 2.1, 4.5). Ages 41–70 years, males, longer diabetes duration, hyperglycaemia and hypertension, insulin users and lower socio-economic status were associated with both DR outcomes. Conclusions: The burden of DR and its risk factors in this study highlights the need to implement DR screening programs within primary care to reduce health inequality.

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“…More than reflecting testing, this perhaps pertains to the relationship between these other variables and socioeconomic status in general (i.e., the recursively and strength of relationship between wealth (inequality) and caste as well as wealth (inequality) and education may be greater than that between wealth (inequality) and sex or religion per se). Research in northern India has found that males were being excluded from population-based screening efforts, hypothesized to be attributed to the emphasis of health systems on maternal and child care in those regions [38]. Given that NCD control programs have been longer running in India's southern states like Kerala, the lack of sex and religion-based exclusion warrants further study and may offer insights for programming in other parts of the country.…”

Section: Discussionmentioning

confidence: 99%

“…Th inclusion criteria was decided as household which had at least one member above 30 years. The detailed sampling design, survey method, data collection, sample size calculation and data processing are reported elsewhere [32,38].…”

Section: Study Design and Settingmentioning

confidence: 99%

Decomposing socioeconomic inequality in blood pressure and blood glucose testing: evidence from four districts in Kerala, India

Sharma

Nambiar

Sankar

et al. 2022

Int J Equity Health

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Background Non-Communicable Diseases (NCDs) constitute a significant danger to the nation’s public health system, both in terms of morbidity and mortality, as well as the financial burden they inflict. Kerala is undergoing an epidemiologic transition, which has significantly impacted the state’s morbidity and mortality figures. For decades, the state has been putting in place myriad programs to reduce the burden of NCDs across population groups. Socioeconomic inequalities in NCD testing have been documented in India, although they are understudied in Kerala. The study aimed to estimate and characterize districtwise socioeconomic inequality in Blood Pressure (BP) and Blood Glucose (BG) testing. Methods A cross-sectional household survey was conducted between July–October 2019 in Kasaragod, Alappuzha, Kollam and Thiruvananthapuram districts of Kerala, India. A total of 6383 participants aged 30 years and above were interviewed using multistage random sampling. Descriptive statistics were derived district-wise. We computed ratios, differences, equiplots, and Erreygers concentration indices for each district to measure socioeconomic inequality in BP and BG testing. Erreygers decomposition techniques were used to estimate the relative contribution of covariates to socioeconomic inequality. Results There was a significant concentration of BP and BG testing favouring wealthier quintiles in Alappuzha, Kollam, and Thiruvananthapuram districts. The inequality in BP and BG testing was highest in Thiruvananthapuram (0.087 and 0.110), followed by Kollam (0.077 and 0.090), Alappuzha (0.083 and 0.073) and Kasaragod (0.026 and 0.056). Decomposition analysis revealed that wealth quintile and education contributed substantially to socioeconomic inequality in BP and BG testing in all four districts. It was also found that family history of NCDs significantly contributed to observed socioeconomic inequality in BP testing (29, 11, 16, and 27% in Kasaragod, Alappuzha, Kollam, and Thiruvananthapuram, respectively). Similarly, in BG testing, family history of NCDs substantially contributed to observed socioeconomic inequality, explaining 16–17% in Kasaragod, Alappuzha, Kollam, and Thiruvananthapuram respectively of the total inequality. Conclusion While the magnitude of socioeconomic inequality in NCD risk factor testing did not appear to be very high in four Kerala districts, although levels were statistically significant in three of them. Greater exploration is needed on how education and caste contribute to these inequalities and their relationship to NCD risk factors such as family history. From such analyses, we may be able to identify entry points to mitigate inequalities in testing access, as well as burden.

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Field-testing of primary health-care indicators, India

Cited by 11 publications

References 27 publications

Intersecting sex-related inequalities in self-reported testing for and prevalence of Non-Communicable Disease (NCD) risk factors in Kerala

Intersecting sex-related inequalities in self-reported testing for and prevalence of Non-Communicable Disease (NCD) risk factors in Kerala

Burden of Diabetic Retinopathy amongst People with Diabetes Attending Primary Care in Kerala: Nayanamritham Project

Decomposing socioeconomic inequality in blood pressure and blood glucose testing: evidence from four districts in Kerala, India

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